Journal Watch
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Low Molecular Weight Heparins for Nocturnal HD
A small Netherlands study of in-center nocturnal HD suggests that two divided doses may work best for low molecular weight heparins dalteparin and nadroparin. Careful dosing is needed to obtain the right level of anticoagulation and avoid overcorrection. Dalteparin required higher doses than nadroparin.
Read the abstract » | (added 2015-08-08)
Tags: Home dialysis
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Medihoney <i>Does</i> Equal Mupirocin for PD Infection Control
While Medihoney did not reduce overall PD infections, a substudy of the “Honeypot” trial did find positive results. Among 371 PD patients randomized to daily exit site antibacterial honey or nasal mupirocin (for staph carriers), rates of both exit site infections and peritonitis were equivalent. NOTE: Honey does not create antibiotic resistant bacteria, which is a plus.
Read the abstract » | (added 2015-08-08)
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PD Preserves Patient Jobs Compared to Standard In-center HD
In Japan, at least (and these questions are rarely looked at in the US), a study of social functioning on PD vs. standard in-center HD found an advantage for PD. Among 179 patients (102 PD and 77 HD), the odds of becoming unemployed after treatment were 5.02 fold lower with PD.
Read the abstract » | (added 2015-08-08)
Tags: Home dialysis
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High Phosphorus Levels on PD Risk Heart Vessel Calcification
Among 157 people on PD who had three or more scans for coronary artery calcification, high serum phosphorus levels were an independent risk factor for faster progression of the problem, along with age.
Read the abstract » | (added 2015-08-08)
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Brazil APD Survival Significantly Better than CAPD
A prospective study matched each of the incident APD patients in Brazil with a CAPD patient, using 15 matching factors, and looked at mortality, technique failure, and time to first peritonitis. With 1,445 patients each in the APD and CAPD groups, the researchers found 44% higher mortality among CAPD patients, but no differences in technique failure or time to peritonitis.
Read the abstract » | (added 2015-08-08)
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Assisted PD Not a Large Burden for Care Partners
Not everyone can do PD without assistance, so what is the cost of this help for a care partner? Not too much, finds a study of 231 PD patients (89 assisted), 72 care partners, and 39 family members of self-care patients. Family members who helped with PD had more task-oriented duties, but did not perceive any greater of a burden than those whose loved one did not need help.
Read the abstract » | (added 2015-08-08)
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Implantable microdialysis without dialysate fluid – in rats
What if we could implant an artificial kidney that did not require dialysate fluid? Researchers have developed a microdialysis system using microfluidic channels and nanoporous membranes, and tested it in rats with kidney failure. Filtrate was successfully collected with no blood leaks in the system, and the levels of creatinine in their blood was significantly reduced.
Read the abstract » | (added 2015-07-08)
Tags: Dialysis
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It’s (past) time to avoid 3-day interdialytic intervals
A new review paper considers the ill effects of the thrice weekly standard in-center HD schedule and finds it wanting, noting higher mortality on the day after the long gap than any other day of the week. The authors conclude that the data warrant “reexamining the issue of timing and frequency of prescribed dialysis regimens in order to improve patient outcomes.”
Read the abstract » | (added 2015-07-08)
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Are we finally nearing the end of Kt/V?
We have been vocal critics of Kt/V on Home Dialysis Central since the start—and now we are not alone. A new paper finds that Kt/V is not a good fit for short daily or long nocturnal treatments, to the point where, “urea kinetics are hardly if at all representative for those of other solutes with a deleterious effect on morbidity and mortality of uremic patients.”
Read the abstract » | (added 2015-07-08)
Tags: Nocturnal Hemodialysis
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Outcomes of “integrated home dialysis” (PD then home HD)
What happens to people after PD fails—and why not plan to get them home on HD? Researchers in Australia and New Zealand looked at this model using ANZDATA registry data. Those treated with PD only (n=168) had the highest risk of technique failure and death, while those who did only home HD or who transitioned from PD to home HD fared much better.
Read the abstract » | (added 2015-07-08)
Tags: Home dialysis