Journal Watch

  1. Low Molecular Weight Heparin as Anticoagulation for Nocturnal HD

    How can the dialysis circuit be kept free of clots during slow, HD treatments done during sleep? In a small study, 12 patients who did alternate night, 8-hour treatments were randomized to nadroparin (a low molecular weight heparin) or unfractionated heparin. The dosing regimens were adapted to make them more practical for overnight use. Both were effective, but with different monitoring requirements.

    Read the abstract » | (added 04/12/2018)

    Tags: Anticoagulation, Home Haemodialysis, Low Molecular Weight Heparin, Nadroparin, Unfractionated Heparin

  2. LVH Regression in the FHN Trials

    Among the 243 randomized patients with biomarker data in the daily HD trial, 121 had no change, 77 got better, and 45 got worse over the course of the study. Changes in levels of collagen turnover and klotho enzyme levels seemed to predict which patients would improve; a finding that will need to be verified in another study.

    Read the abstract » | (added 04/12/2018)

    Tags: Copeptin, Brain Natriuretic Peptide, Cardiac Biomarkers, Frequent Hemodialysis, Klotho, Left Ventricular Hypertrophy, Markers Of Collagen Turnover

  3. Emergent Start PD Yet Again

    Learn about the rationale and feasibility of using PD as a first dialysis option for emergent start patients instead of inserting a central venous catheter and starting HD. .

    Read the abstract » | (added 04/12/2018)

    Tags: End Stage Renal Disease, Haemodialysis, Peritoneal Dialysis, Unplanned Start, Urgent Start

  4. Experiences of Self-cannulation in Men

    Self-cannulation can be a barrier to home HD, and a new qualitative study examined why that is and how patient attitudes toward it changed over time. Eight male patients were interviewed, and the course of becoming a self-cannulator was described as a “process” of gaining control, building confidence, and finding a new norm. The article suggests practical techniques that can be used by clinic staff. Read the abstract

    Read the abstract » | (added 03/16/2018)

    Tags: Self Cannulation, Techniques

  5. Improving Incident ESRD Care with Transitional Care Units

    Patients who transition onto dialysis are at high risk for morbidity and mortality—along with high costs. Transitional care units use the first 30 days of treatment for systematic onboarding that includes education and informed options choice—and may be especially helpful to those who start treatment emergently. Read the abstract.

    Read the abstract » | (added 03/16/2018)

    Tags: Dialysis Transition, Transitional Care Unit

  6. Homocysteine as a Marker for Spontaneous Bacterial Peritonitis

    A non-invasive marker for SBP could save both time and money, and in a series of 323 PD patients with ascites, the ascitic fluid was tested for homocysteine levels. Both serum and ascitic levels were elevated in the SBP group—and both levels dropped after treatment. A cutoff level was suggested. Read the abstract.

    Read the abstract » | (added 03/16/2018)

    Tags: Ascites, Homocysteine Levels

  7. Standard Kt/V urea Targets Less Useful for Home HD

    When patients do home HD more often than three times a week, do the Kt/V urea targets still predict outcomes? Not all that well, suggests a new study. Multivariate regression analysis of 109,273 standard in-center HD patients compared to 2,373 home HD patients found that while a lower Kt/V urea (<2.1) did predict higher blood pressure in both groups, it did not predict metabolic control in either group. For those on home HD, a low Kt/V did not predict hospitalization, mortality, or technique failure, though it did for in-center patients. The authors concluded that the current Kt/V urea targets “have limited utility” for home HD.

    Read the abstract » | (added 02/15/2018)

    Tags: Home Hd, Kt/V Urea Targets, Metabolic Control

  8. Nephrology Fellows Need Home HD Training & Experience

    Home HD offers research and quality improvement topics for fellows, but lack of training is a barrier to patient use of this option. Fellows should attend lectures and receive at least 6-12 months of outpatient clinical exposure that includes transitioning three or more patients to home, argues a new op ed. Having a passionate home HD expert and advocate is essential, as is exposure to home HD nurses.

    Read the abstract » | (added 02/15/2018)

    Tags: Home Hd, Outpatient Clinical Exposure

  9. LVAD Users – A New Group Who Can Benefit from Home HD

    Patients who need a left ventricular assist device prior to heart transplant surgery may develop acute kidney injury as well. Instead of standard in-center HD, a first patient has been trained for and is successfully doing home HD while waiting.

    Read the abstract » | (added 02/15/2018)

    Tags: Left Ventricular Assist Device, Heart Transplant Surgery, Acute Kidney Injury

  10. Avoiding Short-term HD with Lower PD Abdominal Pressure

    When PD patients have hernias, leaks, surgeries, etc., they are often told that they must switch to HD temporarily—using a central venous catheter. Another approach, reducing intraabdominal pressure, may reduce the need for HD, decrease morbidity, and minimize cost.

    Read the abstract » | (added 02/15/2018)

    Tags: Hernias, Leaks, Surgeries, Intraabdominal Pressure