Journal watch: HD

Green dialysis – reducing energy use and landfill space

Worldwide, dialysis uses an estimated 156 billion liters of water per year, 1.62 billion kilowatt hours of power, and generates 625,000 tons of plastic waste. Our own Dr. John Agar suggests ways to reduce the carbon footprint of dialysis through water conservation, solar power, and other ideas.

HD offers better survival than PD for congestive heart failure

A study of 933 people with CHF on PD and 3468 on HD in the French dialysis registry found that for people with congestive heart failure, HD is a safer choice. The risk of death with PD was 48% higher.

Protein intake improves after a switch from standard to nocturnal HD

After 8 months of nocturnal HD, 15 people who switched from standard in-center HD had significantly higher protein intake. Their phosphate intake rose as well—but their serum phosphate levels did not, even without binders.

Read more | (added Nov 28, 2011)

Adsorptive column removes B2m

Too-high levels of B2m cause amyloidosis in people on dialysis, with joint and bone pain. In Japan, people dialyzed using the Lixelle S-15 adsorptive column had significantly less B2m in their blood after a year of 3x/week treatments. They were also stronger and had less joint pain.

Read more | (added Nov 28, 2011)

Alternate-night HD improves bone minerals & blood pressure

Among 63 people in Australia who switched from standard HD to alternate-night HD, bone mineral balance and blood pressure improved after 18–24 months. Left ventricular mass did not improve, but remained stable.

Read more | (added Nov 28, 2011)

Working fistula rate doubled with procedures

Are repeated fistula procedures worth it? Yes, says a new study of 294 people who had 347 fistulas made, with 736 procedures between them. While only 36.8% of fistulas were working on their own after 2 years, 77.8% were working 2 years later after procedures to fix them. (One patient had 11 interventions.)

Read more | (added Nov 28, 2011)

Home dialysis boosts patient employment in Finland

A new study looked at employment results among 2,637 people ages 15 to 64 on dialysis or with kidney transplants in Finland. While just 19% of those on standard in-center HD were working, 39% of those on home HD, 40% of those with working transplants, and 44% on cycler PD were employed.

A new look at dialysis treatment length

There is increasing proof that dialysis treatments shorter than 4 hours are not long enough. A new paper reviews the literature knowing what we know now—and concludes that most people should get at least 4 hours per treatment.

Mucomyst does not prevent nephrogenic systemic sclerosis

A new study randomized 2,308 people at risk for kidney injury from contrast dye into two groups. One group was given acetylcysteine (Mucomyst®) by mouth, a strong antioxidant. The other group was given a placebo. Both groups had the same rate of kidney injury and need for dialysis.

Basing dialysis dose on REAL toxins

Dialysis "adequacy" is based on removing urea—a waste that is not all that toxic. A new article points out that finding and choosing wastes that truly are toxic could change the way we measure dialysis for the better.

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