Journal Watch
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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
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Which came first: the peritoneal glucose load index, or LVH?
Glucose load in 43 stable PD patients was calculated with a peritoneal glucose load index (PGLI) based on glucose in grams/Kg/day in the daily PD prescription. A PGLI of > 3 g/Kg/day was positively correlated both with hemoglobin A1c levels and with left ventricular mass (p<0.001). The authors conclude that safe levels for PGLI need to be studied further. But, while this seems very plausible, correlations are not causal...
Read the abstract » | (added 2014-03-07)
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Pregnancy may be safe and feasible in women with ESRD receiving intensive hemodialysis
In a comparison of 22 Canadian pregnancies and 70 US pregnancies among women on dialysis, intensive HD helped the Canadian women by a wide margin. Live birth rate in Canada: 86.4%. In the US? 61.4%. Mean pregnancy length in Canada: 36 weeks. In the US? 27 weeks. Women who dialyzed < 20 hours per week had just a 48% live birth rate—while those who dialyzed > 36 hours per week had an 85% live birth rate with few complications.
Read the abstract » | (added 2014-03-07)
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Short daily HD may reduce phosphate burden vs. standard HD
In a small study of short daily HD users (n=24) vs. standard in-center HD users (n=54), serum calcium, serum phosphorus, and PTH levels were similar between the two groups. But, levels of fibroblast growth factor 23—which may be a marker of cumulative phosphate burden in the body—were significantly lower with short daily HD (P<0.01).
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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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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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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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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