Starting more people on PD does not cause harm

In Canada, a study looked at PD "attempt rates": how often each nephrologist would start new patients on PD. Between the highest and lowest attempt rates, there were no differences in PD success—or survival. The authors conclude that maximizing PD start rates can save money to help more people, with no harm to patients.

Read the abstract » | (added 2013-04-29)

Tags:

Icodextrin metaanalysis – no impact on patient survival

Australian researchers analyzed 11 studies of icodextrin vs. glucose PD fluid (1222 patients). Icodextrin did help reduce fluid overload without harming residual kidney function. But, it did not help reduce peritonitis, technique failure, or other adverse events. And, patients who used icodextrin did not live any longer.

Read the abstract » | (added 2013-04-29)

Tags:

Daily HD does not harm accesses – a prospective, controlled study

A 4-year study was done of 51 on standard HD (3x4 hours) vs 23 on daily HD (6x3 hours). The standard HD group had 543.2 access procedures/1000 patient years; the daily group had 400.8. Adjusting for age, gender, diabetes, phosphorus level, and anemia, there were no significant differences in number of procedures or time to first access revision.

Read the abstract » | (added 2013-04-29)

Tags:

Nocturnal home HD – no change in outcomes if a partner is needed

Do Canadian nocturnal home HD patients do worse if they need a partner to help them? No, says a study of 152 people, 47 who needed partners and 105 who could do their treatments unaided. Partner dependent patients were older, more likely to have diabetes, and had more comorbidities. But, there were no significant differences between groups in time to first hospitalization, technique failure, or survival.

Read the abstract » | (added 2013-04-29)

Tags:

Patients with diabetes & renters may need extra help for home HD

Among 177 Canadian patients who started home HD training, 24 did not finish and 8 had technique failure in the first year. The strongest predictors of failure were diabetes or rented housing. These patients may need extra support to succeed.

Read the abstract » | (added 2013-04-29)

Tags:

Home HD beliefs of patients and care partners in Italy

Home HD is underused in Italy. Interviews found three positive themes: flexibility/freedom, comfort in familiar surroundings, and altruistic motivation to be an example for others. Four negative themes were also found: disrupted sense of normality, family burden, housing constraints, and healthcare by "professionals", not "amateurs".

Read the abstract » | (added 2013-02-27)

Tags:

Wearable and implantable kidney devices

The current standard in-center paradigm needs to change, say the authors of this review. Radically new approaches are needed to improve patient outcomes and quality of life. Two such approaches on the horizon are wearable and implantable devices.

Read the abstract » | (added 2013-02-27)

Tags: Chronic kidney disease

PD corrects metabolic acidosis better than standard in-center HD

Too-low bicarbonate levels are a risk factor for death. Among 110,951 standard in-center HD patients and 10,400 PD patients, bicarb levels were much lower in those on PD. Survival data suggest that it is safest to keep bicarb levels higher than 22mEq/L for all ESRD patients—on any modality.

Read the abstract » | (added 2013-02-27)

Tags:

Multidisciplinary training to reduce peritonitis in PD

Researchers in Uruguay developed a tool to assess practical PD skills. They found that one on one lessons, retraining, and group meetings for PD patients cut the peritonitis rate nearly in half.

Read the abstract » | (added 2013-02-27)

Tags:

Alert: Icodextrin PD fluid can mask hypoglycemia

A case report of an 80 year old man in the emergency room highlights the need for healthcare providers to be aware of the impact of icodextrin PD fluid on blood sugar. Handheld glucose meters can overestimate blood sugar. A lab test can verify blood sugar if symptoms of hypoglycema are present and the glucometer reading is normal.

Read the abstract » | (added 2013-02-27)

Tags: