Journal Watch

  • Peritonitis with Diarrhea Could be C-diff

    Cloudy PD dialysate can signal infectious peritonitis from a variety of causes—including C-diff. But, use of cephalosporins could worsen a C-diff infection. A new article presents two case histories of C-diff peritonitis and suggests reexamining the traditional empiric treatment of peritonitis when diarrhea is present.

    Read the abstract » | (added 2020-03-16)

  • Glucose Degradation Product (GDP) Disrupts Peritoneal Membrane Function

    Growth of new, immature blood vessels on the peritoneal membrane is linked with ultrafiltration failure. Exposure to the GDP methylgyoxal (MGO) up-regulated both vascular endothelial growth factor (VEGF) and suppressed platelet-derived growth factor (PDGF) in vitro, potentially disrupting the balance of angiogenesis.

    Read the abstract » | (added 2020-03-16)

  • Physician Reimbursement Increases Did Not Drive PD in Canada

    Among a cohort of 4,262 patients in Alberta, Canada followed between 2001 and 2014, an increase in PD physician pay from $0 to $135 (over a 9-year period) revealed no statistical evidence of a difference in PD use or trends—and the role of the physician in modality selection was unclear.

    Read the abstract » | (added 2020-03-16)

  • Nocturnal HD in Children

    There are very few studies of the impact of intensified hemodialysis regimens (days/hours) on children. This review addresses implementation challenges.

    Read the abstract » | (added 2020-03-16)

  • Why Early Survival on PD Matters

    If survival between PD and standard in-center HD “evens out in the end,” does it matter? Yes, argues Mark Marshall, MD, from New Zealand. The early survival benefit increases patient life years—and persists even when accounting for use of central venous HD catheters. To support shared decision-making, patients have the right to know about survival on PD vs. standard HD.

    Read the abstract » | (added 2020-03-16)

  • 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)

  • Double Purse String Suture for Urgent Start PD Catheters

    An Italian article reports that use of a double purse-string technique allowed immediate CAPD starts within 24 hours of catheter placement, with no difference in complications (mechanical or infectious) or catheter survival between surgical or trocar placement.

    Read the abstract » | (added 2020-03-16)

  • Comorbidities—but not Peritonitis—drove Mortality on PD

    Among 242 Turkish PD patients followed for up to 9 years, age over 65, diabetes, cancer, and heart failure were independent risk factors for death, but surprisingly peritonitis was not.

    Read the abstract » | (added 2020-02-19)

  • Green Nephrology: Reducing the Environmental Impact of Dialysis

    Climate change and extreme weather events both increase the incidence of kidney disease and destabilize care. But, healthcare in general—and dialysis in particular—contribute substantially to greenhouse gases. Monitoring resources and reducing waste in HD can be done through reuse of RO reject water, renewable energy sources, better waste management, and slower dialysate flow rates. For PD, point-of-care dialysate will reduce the environmental impact.

    Read the abstract » | (added 2020-02-19)

  • The Q-Cohort Study: More Dialysis, Less Risk of Cancer

    Uremic toxins increase cancer risk. In a study of 3,450 HD patients followed for 4 years, patients were divided into quartiles based on their baseline Kt/V. Four-year survival dropped linearly along with Kt/V. Every 0.1 increase in Kt/V reduced the risk of cancer death by 8%.

    Read the abstract » | (added 2020-02-19)