Journal watch

87 people on nocturnal home HD for 12 years had just 30% the mortality of standard HD

How does survival of people on nightly home HD compare to those in the USRDS? A single-center study of 87 people who got 40±6 hours a week of HD found that 79% lived 5 years, and 64% lived for 10 years—a mortality rate just 30% of the USRDS average. Higher levels of education and more hours of dialysis were the only factors independently linked with survival.

Read more | (added Apr 25, 2011)

More working-age dialyzors who chose PD kept their jobs, found a study of 102,104 people

Each year, half of all new dialyzors are working-age (<65), but most stop work after starting treatment. An analysis of USRDS data from 1992–2003 of people who were working 6 months before dialysis found that those most likely to work were: 1) white men ages 30–49; 2) those with glomerular, cystic, or urologic causes of ESRD; 3) those who chose PD first; 4) those with employer group health plans; 5) those who received ESAs.

Switching from 3x4 hours HD to 6x3 hours reduced blood pressure, and improved hgb, albumin, & BMI

Healthy kidneys work 168 hours a week, but most people only get about 12 hours of dialysis. In this study, 11 people were switched to more frequent HD. After 12 months, they had significantly better blood pressure with fewer meds, higher hgb levels with lower ESA doses, higher albumin levels, lower dry weight, and better BMIs. Calcium-phosphorus products dropped significantly with no changes in binder doses.

Read more | (added Apr 25, 2011)

Chemical ablation to correct recurrent secondary hyperparathyroidism post parathyroidectomy

Reoperation after a parathyroidectmy can be risky. In a study of 49 people, injecting ethanol (alcohol) into the gland, guided by ultrasound, helped to lower PTH levels without more surgery.

Read more | (added Apr 25, 2011)

CAPD maintains residual kidney function better than APD

A new study followed 505 people on CAPD and 78 on APD for 3 years. The two groups had no major differences in residual kidney function (RKF) at baseline, but those on APD had a much higher risk of RKF loss in the first year. The highest risk of losing all RKF was found in those who had the highest GFRs at the study start.

Read more | (added Apr 25, 2011)

Better PD technique survival in people with diabetes who use icodextrin

In the first randomized control trial using icodextrin in lieu of glucose for PD solution, 41 people with diabetic nephropathy were assigned one or the other. After 2 years, 71.4% of the icodextrin group was still doing PD, while only 45% who used glucose-based solution still did PD.

Simpler pill regimen needed by those using nocturnal home HD

Among 35 people who switched from standard in-center HD to nocturnal home HD, the number of pills per day did not drop—but the regimen was much simplified—and health-related quality of life was significantly improved.

Benefits of switching from 3x/week in-center HD to 6x/week home HD

Among 11 people who switched treatments, blood pressure dropped, hemoglobin levels rose (with lower ESA doses), the calcium-phosphorus product dropped (with no change in binder doses), and BMI and serum albumin levels went up. We are so not surprised!

AAKP’s study of patient satisfaction with kidney education and dialysis (hint: not so good)

977 patients completed a 46-item survey asking about satisfaction with current treatment for kidney failure and education on a scale of 1–10 (with 1 low). Standard in-center HD rated 4.5. PD rated 5.2, home HD was 5.5, and transplant was 6.1. About 31% of participants felt the treatment options were not equally and fairly presented, and 32% had not been educated about home HD.

Better fluid removal with icodextrin PD fluid - Meta-analysis

A new study of 9 randomized controlled trials has found that people using icodextrin removed much more water than those using glucose based fluid—with no change in residual kidney function or increase in peritonitis or death. Rash was more common in those using icodextrin.

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