Journal Watch
US dialysis education in this study was a FAIL—especially for seniors
In a study of 99 US dialysis consumers, education about options was poor regardless of age—but was far worse in those over age 65. Significantly fewer older people said the doctor explained the cause of their kidney failure, the impact dialysis would have on their daily lives, or the life-long need for dialysis, and most felt that the choice of treatment was made by the doctor.
Read the abstract » | (added 2014-03-07)
Tags: Chronic kidney disease
Japanese strategy to prevent encapsulating peritoneal sclerosis (EPS)
EPS is a rare and severe complication of PD. Japanese clinicians offer a multidisciplinary approach to avoid EPS and improve outcomes for those who have it. Icodextrin and combination PD/HD treatment is used, and high-risk patients have planned PD stoppage. Between 2008 and 2012, the incidence of EPS was 0.3% for PD < 3 years, 0.6% for PD = 5 years, 2.3% for PD = 8 years, and 1.2% for PD > 8 years. Prednisone (n=11) and surgery (n=2) were used to treat EPS; remission occurred in 12 of the patients (85.7%), while 3 died (21.4%).
Read the abstract » | (added 2014-03-07)
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Standard HD vs. PD for risk of hip fracture
Among the 64,124 incident ESRD patients in a Taiwan registry between 1998 and 2008, 2,587 had a hip fracture. The risk of fracture was linked with sex, age, heart disease, diabetes, epilepsy drugs, diuretics, steroids, and vitamin D use. Those on standard in-center HD had a 52% higher risk of hip fracture than those on PD (p = 0.02).
Read the abstract » | (added 2014-03-07)
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Older patients on PD and health-related quality of life
In a cross-sectional study of 201 people using APD or CAPD, those over age 65 had significantly better quality of life than those under 65—though rates of anxiety and depression in both groups were similar. Age is not a reason to preclude PD.
Read the abstract » | (added 2014-03-07)
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Does polyhexanide solution reduce PD exit site infections?
In a 12-month trial of 46 people on PD, 20% of those in Group A (randomized to standard exit site care with saline and povidone iodine) had an exit site infection. Just 6.7% of Group B (randomized to polyhexanide solution) did (p=0.037), and there were no side effects or allergies. The authors suggest use of polyhexanide for the care of healthy PD exit sites.
Read the abstract » | (added 2014-03-07)
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Why it may be best to start with PD first
Those who transfer from HD to PD have higher rates of PD technique failure and death than those who started out on PD. These results come from a new study of more than 13,000 people from Canada. In the first year, the risk of poor outcome was 50% higher among the switchers than in those who started PD in the first place.
Read the abstract » | (added 2014-02-06)
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Diabetes does not worsen PD technique survival
In a registry-based study of 432 patients, the 23% who had diabetes were able to stay on PD just as long as those who did not have the disease. And, more recent PD users had even higher success rates with the treatment than those in past years. However, PD dropout due to loss of autonomy (stroke in particular) and death were higher in the diabetes group.
Read the abstract » | (added 2014-02-06)
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HeRO grafts work as well as regular grafts
The HeRO graft is a last chance for patients who can't have any other type of dialysis access. A new randomized, controlled trial of 72 people (52 with HeRO grafts and 20 with standard arteriovenous grafts) has found similar patency, dialysis adequacy, and infection rates in both types of access.
Read the abstract » | (added 2014-02-06)
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Nephrologist perspectives on dialysis: An international study
Among 324 practicing nephrologists, 90% had patients using standard in-center HD, 8% had patients on PD, and 2% had some on home HD. Most believed that quality of life was superior on home HD, and that doing more treatments than 3 per week and making them longer would lead to "significantly better clinical outcomes" than than standard treatments.
Read the abstract » | (added 2014-02-06)
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Colonic dialysis—a 2-year case report
A 20-year old woman has been kept alive for 2 years after refusing dialysis. Instead, she used PD fluid to wash out her bowels (she had bowel surgery that required her to irrigate her bowels so she could move them). Her creatinine has risen from 1.7 mg/dL to 2.8 mg/dL over the 2 years.
Read the abstract » | (added 2014-02-06)
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