Journal Watch
Intraperitoneal Pressure and Hernias
While it has long been believed that high intraperitoneal pressure (IPP) is a factor in hernia development, this notion had not been proven. A prospective observational study of 124 incident PD patients over a 10-year period suggests that the common wisdom was correct. Higher IPP at PD onset, older age, higher BMI, prior hernia, laparoscopic PD catheter placement, and technique failure were related to hernia formation.
Read the abstract » | (added 2023-09-13)
Tags: Intraperitoneal Pressure, IPP, Hernia, Incident PD, Hernia Formation Factors
Factors Linked with Time to First Peritonitis on PD
In a 5-year, 57 clinic, prospective randomized controlled trial in Europe, 33% of 671 participants had a bout of peritonitis. The factors independently linked with time to first peritonitis included older age, higher number of PD bags, low serum albumin, and higher body weight.
Read the abstract » | (added 2023-04-19)
Tags: Peritonitis, Age, PD Bags, Serum Albumin, Body Weight
The Predictive Value of Early, Non-infectious PD Complications
A prospective, multicenter cohort study of 1,596 people starting PD in New Zealand from 2014 to 2018 (inclusive) looked at survival and time on PD of those who had catheter-related exit site dialysate leaks or other leaks within 30 days of PD start. Peritonitis-free survival, first PD catheter survival, and tunnel infection free survival were secondary outcomes. Among the 102 with an early complication, overall mortality, the rate of stopping PD, and first catheter failure were all higher.
Read the abstract » | (added 2022-11-16)
Tags: PD, Survival, Peritonitis free Survival, First PD Catheter Survival, Tunnel Infection Free Survival, Early Catheter related Complication
Impact of Telemedicine on PD Technique Survival
Can telemedicine (TM) help people stay on PD longer? A prospective study conducted in 27 hospitals in China since 2016 enrolled 7,539 patients. Compared to matched patients in the non-TM group (60.9%), those in the TM group (39.1%) had significantly lower risks of severe fluid overload, inadequate solute clearance, non-infectious catheter complications, transfer to HD, and death.
Read the abstract » | (added 2022-09-13)
Tags: Telemedicine, PD, Technique Survival, Fluid Overload, Inadequate Solute Clearance, Non infectious Catheter Complications
Prospective Cohort Study of Urgent-start APD
Can automated PD be used for urgent-start dialysis? A study from China enrolled 68 people who needed to start treatment urgently and did either APD (52.9%) or HD. After following for an average of 20.1 months, the APD group had “significantly fewer short-term dialysis-related complications,” and lower hospital costs. Both groups had similar technique survival, infection rates, and patient survival.
Read the abstract » | (added 2022-07-13)
Tags: Automated Peritoneal Dialysis, Cost effectiveness, End stage Renal Disease, Esrd, Urgent start
In-center Nocturnal HD Improves Quality of Life vs. Standard In-center HD
A small prospective cohort study of standard in-center HD patients (n=36) who switched to in-center nocturnal HD compared baseline health-related quality of life to levels 12 months later. Among the 24 who completed the study and permitted follow up, the mental component score increased by 7.1 points, and improvements were seen in several domains.
Read the abstract » | (added 2021-06-15)
Tags: In center Nocturnal Hemodialysis, Health related Quality Of Life, End stage Renal Disease, KDQOL 36
Advantages of PD in Primary Glomerulonephritis (PGN)
A prospective observational study followed all incident PD patients (n=2,243) who had PGN in the Levante registry from 1995 to 2014. Compared to other diagnoses, those with PGN had a significantly lower rate of peritonitis and better mean survival. The authors conclude that “PD has several advantages as a first dialytic treatment, and our results suggest that it is an excellent technique to manage patients with PGN while they await a kidney transplant.”
Read the abstract » | (added 2020-09-11)
Tags: Patient Survival, Peritoneal Dialysis, Primary Glomerulonephritis
Glucose and Peritonitis
A prospective, longitudinal cohort study followed 105 PD patients for up to 5 years (mean of 23 months). Higher glucose exposure significantly predicted peritonitis, and patients with more residual kidney function also had a significantly longer time to first bout of peritonitis. Read the abstract. The authors suggest using the lowest concentration of glucose possible.
Read the abstract » | (added 2020-03-16)
PD—Controlling Volume to Reach Normal Hydration Protects the Heart
Reanalysis of data from a multicenter, prospective, randomized controlled trial looked at fluid control in PD in 151 patients followed for a year. While most (120) reached normal hydration levels as measured by bioimpedance analysis, those who did not had significantly higher left atrial diameter—and a lower left ventricular ejection fraction at the end of the study.
Read the abstract » | (added 2019-12-10)
Tags: Fluid Management, Cardiovascular Risk, PD, Peritoneal Dialysis, Bioimpedance Spectroscopy
PD Outcomes under the Medicare Expanded Dialysis Prospective Payment System
A Medicare change in 2011 may have increased the likelihood that clinics would expand PD to a broader population. Did this affect outcomes? A prospective cohort study compared 10,585 patients who started PD before payment reform, 7,832 interim patients, and 18,742 during the reform period. With similar demographics, more patients were treated in clinics with less PD experience—and these clinics had higher PD discontinuation rates. But, PD discontinuation fell overall, and mortality risk was stable.
Read the abstract » | (added 2019-10-14)
Tags: Expanded Dialysis Prospective Payment System, PD, Medicare