Journal Watch

  1. 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

  2. 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: Outpatient Clinical Exposure, Home Hd

  3. 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

  4. 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

  5. Starting PD with One Daily Exchange of Icodextrin

    Incremental PD can be less restrictive for patients initiating therapy. Is one daily exchange with icodextrin enough? A physiological study used a 3-pore kinetic model to assess fluid and solute removal among patients with residual function that ranged from 0 to 15 mL/min/1.73m2. All but very large patients (total body water >60L) were predicted to achieve adequate dialysis with this approach.

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

    Tags: Incremental Pd, Icodextrin, Fluid And Solute Removal

  6. Year 1 Cognitive Function Better with PD than Standard In-center HD

    PD came out the winner over standard in-center HD in a study of cognitive function among 96 HD and 101 PD patients who took cognitive tests at the start and end of their first year of treatment, though both groups saw some improvement.

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

    Tags: Pd, Hd, Cognitive Function

  7. A New, Early Marker for Encapsulating Peritoneal Sclerosis?

    Can a drop in dialysate sodium sieving during a PET forecast EPS in advance? A 20-year, controlled longitudinal cohort study found a correlation. Of 161 incident PD patients, 13 went on to develop EPS—and sodium was the best predictor.

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

    Tags: Dialysate Sodium Sieving, Pet, Eps

  8. PD and Inflammation

    The moment a PD catheter is inserted or fluid is instilled in the peritoneum, a cascade of cytokines occurs. This reaction is reduced somewhat when a neutral-pH, low-GDP fluid is used, vs. a conventional one, finds a new observational study.

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

    Tags: Pd Catheter, Cytokines, Low Gdp Fluid

  9. Connecting Home HD Patients to Care Teams Reduces Dropout

    Nx2me is a telehealth platform that allows patients who use NxStage machines for home HD to send data to and communicate with their care teams. Compared to matched controls, 606 Nx2me users were more likely to successfully complete training and less likely to drop out of home HD.

    Read the abstract » | (added 01/11/2018)

    Tags: Telehealth, Nx Stage Machines, Nx2me, Home Hd

  10. Peritoneal Membrane Transport and Survival on PD

    Among 470 PD patients followed for up to 10 years, high transporters were stable for the first few years, and after 5 years or so, PD adequacy began to slowly fall. The rate of PD transport did not affect patient survival.

    Read the abstract » | (added 01/11/2018)

    Tags: High Transporters, Pd Adequacy, Pd Transport, Patient Survival