Nocturnal HD may reduce risk factors for sudden heart death

Sudden cardiac death is the leading cause of death on dialysis. A chart review study with ECGs has found that a year of nocturnal HD significantly improved heart function vs. standard in-center HD, even before changes to the left ventricle could be seen. More frequent nocturnal HD decreased Tpeak to Tend and QRS amplitude variation.

Read the abstract » | (added 2014-01-08)

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Extended HD improves sleep quality in China, too

Studies find that extended HD helps people sleep better—and, per a new study, this is just as true in China as elsewhere. Forty standard HD patients were switched to in-center nocturnal HD thrice weekly for 6 months. After the switch, Kt/V rose significantly, as did BUN clearance, hemoglobin (with fewer ESAs), and albumin. Phosphorus levels dropped significantly, as did blood pressure. Sleep quality and quality of life were significantly better as well, though sleep quality started to decline again after 2 months.

Read the abstract » | (added 2014-01-08)

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How does PD change muscle protein use?

PD is the only form of dialysis that removes protein-bound solutes. But, PD also "induces a new state in muscle protein dynamics," finds a new study, decreasing protein turnover rates and reducing their efficiency. Treatments like use of amino or ketoacids, vitamin D, exercise, and myostatin antagonism for malnourished patients may help.

Read the abstract » | (added 2014-01-08)

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PD catheter fixation is helpful

In a series of 53 patients, placing PD catheters laparoscopically and fixing the catheter in place reduced catheter migration and other complications, was faster and less invasive than open placement, and led to shorter recover times.

Read the abstract » | (added 2014-01-08)

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Treatment of encapsulating peritoneal sclerosis

Science has not yet shed light on how to prevent EPS. But, this review covers treatments for the rare and devastating condition. These include steroids, tamoxifen, and the immunosuppressants sirolimus or everolimus (at transplant blood levels). Surgery may also be needed.

Read the abstract » | (added 2014-01-08)

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Fluid overload predicts LVH in people on PD

In a cross-sectional echocardiogram study of 31 people on PD, those with LVH had lower serum albumin levels, higher blood pressure, and more overhydration than those who did not have LVH. Overhydration (p=0.007) was the strongest predictors of LVH in multivariate analysis.

Read the abstract » | (added 2014-01-08)

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Urgent-start PD: A how-to guide

Many nephrologists would choose PD for themselves. But few patients start on it, in part because ESRD may be found so late that dialysis is imminent. If only PD starts could be as done as easily as HD catheter placements... As it turns out, PD can be started on an urgent basis, and this approach is starting to pick up speed. This article reviews the literature, ways to overcome challenges, and the possible impact of changing the paradigm away from a default of standard in-center HD.

Read the abstract » | (added 2013-12-10)

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Home HD: A good start's the key

A look at 95 home HD patients found that those who started treatment in the hospital or with a catheter had far higher rates of hospital stays, changing to another treatment, or death than those who had better starts. For both new patients and those coming to dialysis from a failed transplant, a planned home HD start with a permanent access led to better outcomes.

Read the abstract » | (added 2013-12-10)

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Ultrathin silicon membranes for wearable dialysis.

A wearable artificial kidney will need a membrane efficient enough to remove a lot of toxins in a small device. This article explains the technical details of porous nanocrystalline silicon made into chips. Pore size can be controlled to keep albumin in but let middle molecules out, like a healthy kidney. Special coatings that repel water keep proteins from adhering to the membrane.

Read the abstract » | (added 2013-12-10)

Tags: Chronic kidney disease

PD fluid: Does less sugar lead to better outcomes?

A recent randomized, controlled trial with 251 patients combined two studies of standard vs. low-glucose PD fluids. The study looked at hemoglobin A1c levels. In the low-glucose fluid group, A1c and triglyceride levels dropped and lipid profiles improved. But...there were more serious events and deaths in this group due to fluid overload. So, the low-glucose fluid was better for blood sugar and lipids, but with a higher risk of fluid problems. The authors suggest that if low-glucose fluids (like icodextrin) are used, it is vital to watch fluid levels closely.

Read the abstract » | (added 2013-12-10)

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