Journal Watch

  1. Operationalizing Telehealth for Home Dialysis

    In January, 2019, Medicare rules for telehealth changed to permit the home as an originating site for home dialysis patients. ESCOs can take advantage of waivers to obtain payment for a monthly comprehensive telehealth visit with a home patient after the first 3 months of therapy—with no geographic restrictions. Technical, regulatory, and operational challenges are discussed in this article.

    Read the abstract » | (added 04/11/2019)

    Tags: Maintenance Dialysis Therapy, Telehealth Services, Legislation, Regulatory Requirements, Remote Monitoring

  2. Perspectives on Payment for More Frequent Home HD

    This article explains the role of the Medicare regional contractors in implementing—or thwarting—payment for more than three home HD payments per week, and offers options for changing Medicare’s payment system to ensure that this option is supported.

    Read the abstract » | (added 04/11/2019)

    Tags: Medicare Regional Contractors, Medicare Payment System, Hd Payments

  3. Three Diuretics are Better than One on PD

    A small study (n=51) randomly assigned adult CAPD patients to receive three diuretics or just one plus placebo for 6 months. Among the 43 patients who completed the trial, those who took three diuretics had significantly better hydration status and more change in urine output—with no adverse events reported.

    Read the abstract » | (added 04/11/2019)

    Tags: Peritoneal Dialysis, Furosemide, Hydration Status, Hydrochlorothiazide, Spironolactone

  4. Cognitive Impairment Predicts PD Peritonitis

    A prospective cohort study assigned 458 PD patients to a cognitively impaired (CI) or non-CI group based on results of mental state testing. The groups were not otherwise significantly different. Over 31.4 (median) months, 94 patients had first-time peritonitis, and short-term memory losses were independently linked with a higher risk.

    Read the abstract » | (added 04/11/2019)

    Tags: Cognitive Impairment, Mental State, Peritonitis

  5. Clues to Home HD Retention

    Why do people drop out of home HD? A new interview study of 15 current and 10 former patients sheds some light. The study identified five themes, each with a positive and a negative aspect: degree of independence, support, technical aspects, home environment, and attitudes and expectations.

    Read the abstract » | (added 03/12/2019)

    Tags: Hhd, Modality, Discontinuation

  6. Home HD - Significantly Better Survival and Transplant Rate

    A Swedish matched cohort study compared the long-term survival of 152 home HD patients with those doing PD (n=456) or standard in-center HD (n=608). Median survival for home HD was significantly better (18.5 years) than PD (15.0) and in-center HD (11.9). Home HD patients were also significantly more likely to have received a transplant.

    Read the abstract » | (added 03/12/2019)

    Tags: Survival, Home Hemodialysis, Institutional Hemodialysis, Peritoneal Dialysis

  7. HOW do AGE’s Cause Peritoneal Fibrosis?

    For years, researchers have known that the advanced glycation endpoints (AGEs) that form when sugar-based PD fluid is made harm the membrane. But, we didn’t know why. Human cell modeling finds that AGEs cause outer layer peritoneal cells (epithelial) to become connective tissue cells (mesenchymal).

    Read the abstract » | (added 03/12/2019)

    Tags: Ag Es, Mesothelial, Epithelial, Stat3

  8. Longer HD Treatments Do Not Make Up for the 2-day “Killer Gap”

    For 20 years, the kidney community has known that death on HD is significantly higher on the day after the 2-day “killer gap.” An analysis of 250+ minutes vs. <200 minutes HD treatments found that even 4.5 hour long treatments thrice weekly did not make the gap less lethal.

    Read the abstract » | (added 03/12/2019)

    Tags: Treatment Time, Interdialytic Interval, Hospitalization, Mortality

  9. Most Cost Effective Dialysis Options: Metaanalysis

    An analysis of 16 economic studies from both high- and low-income countries determined that home dialysis options are less costly and offer comparable—or better—health outcomes than in-center HD. Quality of life concerns were rarely investigated, however.

    Read the abstract » | (added 02/14/2019)

    Tags: Economic Studies, Hd, Cost, Dialysis Options, Health Outcomes

  10. Longitudinal Experience with Remote PD Monitoring

    Patients whose PD was monitored remotely had almost twice the number of APD prescription changes--and significantly fewer nighttime alarms and less need for in-person visits than control subjects, saving both time and money.

    Read the abstract » | (added 02/14/2019)

    Tags: Pd, Remote Monitoring, Apd, Nighttime Alarm, In Person Visit