Journal Watch
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When choosing a treatment option, lifestyle is what matters to patients
A metaanalysis found 16 studies of how people with late-stage CKD choose what type of dialysis to do. Common elements included the life-or-death nature of ESRD; minimal intrusion of treatment into quality of life, autonomy, values, and sense of self; and making informed choices.
Read the abstract » | (added 2013-01-25)
Tags: Chronic kidney disease
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Can more fluid removal mean needing less toxin removal?
Makers of a wearable ultrafiltration (UF; water removal) device wanted to know if daily UF could be a way to cut back on the need for dialysis toxin removal. For 4 weeks, 13 in-center patients had 4 days a week of UF plus 2 days a week of HD. Then they did 4 weeks of standard, 3x week HD. Daily UF lowered blood pressure and weight gain between treatments significantly—while Kt/V rose.
Read the abstract » | (added 2013-01-25)
Tags: Chronic kidney disease
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PD: Better survival than standard in-center HD
DaVita followed 23,718 patients new to dialysis for 2 years. Those who chose PD (1,358) were nine times more likely to switch treatment options and three times more likely to get a transplant than those who chose standard in-center HD. The PD patients also had 48% better survival than those who did standard in-center HD.
Read the abstract » | (added 2013-01-25)
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Review: survival on intensive HD vs. transplant
Canadian researcher Robert Pauly reviews the literature on survival with short daily and nocturnal HD, and compares it to kidney transplant survival.
Read the abstract » | (added 2013-01-25)
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PD + C + E = reduced oxidative stress
We need oxygen to live. But, too much of a good thing can cause heart and blood vessel damage, and, if you do PD, damage your peritoneum. What can help? Among 20 people doing PD, supplements of the antioxidants vitamins C and E improved measures of oxidative stress, compared to 10 healthy volunteers who did not take the vitamins. (Ask your nephrologist if this is wise for you.)
Read the abstract » | (added 2013-01-25)
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If at first you don't succeed with PD...it still costs less than in-center HD
A 4-year Canadian study has found that over a 3-year period, the cost of starting on PD and then switching to HD ($114,503) is still much less than doing standard in-center HD ($175,996). But starting and continuing PD is the lowest cost dialysis option ($58,724).
Read the abstract » | (added 2013-01-25)
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Neutral pH PD fluid protects peritoneal membranes
Standard PD fluid may have an acidic pH and contain high levels of glucose degradation products (GDPs). Japanese researchers followed 12 patients using standard fluid and 12 using a neutral pH fluid with low GDPs. The low GDP group had less membrane fibrosis, blood vessel sclerosis, and build up of AGEs, and had higher ultrafiltration volume than the high GDP group.
Read the abstract » | (added 2012-12-19)
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Improve PD uptake by addressing misconceptions
In Singapore, interviews with predialysis patients and their families, people on dialysis, and health care professionals were done to explore how a treatment option choice is made. Fear of PD, daily commitment to PD, and misperceptions of PD were barriers that kept people from choosing the option. Patients were strongly influenced by other patients and wanted to hear what day-to-day life would be like before making a choice.
Read the abstract » | (added 2012-12-19)
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Phosphate is a blood vessel toxin
High levels of phosphorus in the blood is linked with blood vessel calcification, thickened blood vessel walls, arterial stiffness, and heart damage—and may even cause premature aging.
Read the abstract » | (added 2012-12-19)
Tags: Chronic kidney disease
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Modality choice is a factor in AV fistula creation
Canadian researchers compared the predialysis modality preferences of 508 people to their actual modality, and looked at their vascular accesses. The chance of having a fistula was much less in those who chose PD but started HD (39%), or who made no choice (50%), than in those who preferred HD and started on HD (79%).
Read the abstract » | (added 2012-12-19)
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