Journal Watch
Why PD is (Still) Underused in the US
A new review article notes just 11% PD penetration in the US in 2019—vs. as high as 79% in other countries. Rural, minority, and low-income regions in the US have less PD than other areas. Our healthcare system has failures we are just starting to discuss.
Read the abstract » | (added 2022-03-16)
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Home HD Core Curriculum 2021
AJKD has released a new edition of this manual, which covers benefits, pitfalls and challenges of starting and growing a home HD program, home HD equipment, prescriptions, and medical management.
Read the abstract » | (added 2021-12-16)
Tags: Home Hemodialysis, HHD, Home HD Program, Patient Choice
A Home First Policy Helps Drive Home Therapy Choice
In the multinational Peridialysis study, of 1,587 people starting dialysis, 32.5% were judged “unsuitable” for a home treatment due to contraindications—or a lack of assessment. Among the suitable 1,071, 65.4% chose PD and 3.6% chose home HD, and the remainder went in-center. Late referral, suboptimal dialysis initiation, acute illness—and no “home dialysis first” policy were factors linked to use of in-center HD.
Read the abstract » | (added 2021-09-14)
Tags: Lack Of Assessment, Glomerular Filtration Rate, Haemodialysis, Peritoneal Dialysis, Pre dialysis, Uraemia
Outcomes of Incremental PD
A retrospective cohort study looked at 175 PD patients followed for about 2 years. Starting PD with a lower vs. higher dose was associated with better survival.
Read the abstract » | (added 2021-08-12)
Tags: Peritoneal Dialysis , PD, End stage Kidney Disease, Dialysate Volume, Survival
PD and Bone Mineral Disorders vs. HD
Body composition, nutritional status, DEXA, and bone mineral disease (BMD) biomarkers were assessed at baseline and one year in 242 ESRD patients starting either PD (n=138) or HD (n=104). Among HD patients, BMD decreased significantly—but not in PD patients. Preservation of BMD was associated with significantly lower all-cause mortality, with cortical bone preservation more predictive than trabecular bone preservation.
Read the abstract » | (added 2020-09-11)
Tags: End stage Renal Disease, Bone Mineral Density, Dialysis
Starting with PD Better than Switching to it from HD
A metaanalysis comparing patients who started with PD to those who began HD and then switched to PD after 3 months found significantly better overall and technique survival in the PD first group. There were no significant differences in the peritonitis rate.
Read the abstract » | (added 2020-07-10)
Tags: Hemodialysis, Peritoneal Dialysis, Renal Replacement Therapy
10-year PD Survival
In a group of 533 incident PD patients (mean starting age of 48 +16 years) followed from 2006 until 2018, survival at 1 year was 93%, at 3 years 81%, at 5 years 64%, and at 10 years 36%. Encapsulating peritoneal sclerosis (EPS) occurred in 1.3%.
Read the abstract » | (added 2020-06-10)
Survival with PD vs. Home HD and When to Go Home
Using a national cohort of 1,993 patients transitioning to home HD and 16,514 to PD between 2007 to 2011, 1,195 home HD were matched to 1,195 using propensity scores and adjusting for demographics, comorbidities, dialysis duration, and BMI. Those on home HD had significantly better survival (9.6 vs. 12.9 deaths per 100 patient-years; p<0.001). However, when patients switched to PD within the first 12 months of starting dialysis, survival was comparable between PD and home HD: patients who transitioned after 12 months had an 83% higher risk of death.
Read the abstract » | (added 2020-02-19)
Tags: Home HD, PD, Comorbidities, Dialysis Duration, BMI, Survival
Transplant Survival Better After PD Than Standard In-center HD
Is there an advantage to PD over standard in-center HD for transplant graft survival? YES, suggests a 15-year retrospective study of 2,277 transplant recipients. Those who did PD prior to transplant were 34.5% more likely to survive, and had less frequent rejection. Living donor kidneys did best among patients who received transplants before starting dialysis—or did PD.
Read the abstract » | (added 2019-11-16)
Tags: Kidney Transplant, Modality, PD, HD, Hemodialysis, Peritoneal Dialysis
Home Dialysis: Better Outcomes at Lower Costs
Five years after starting dialysis, the population of Ontario, Canada over age 18 had mean 30-day PD costs 50% lower than in-center HD—and home HD costs 64% lower than in-center. After adjusting for covariates, home HD cost the least and had the highest survival (80%) vs. 52% on PD and 42% on in-center HD.
Read the abstract » | (added 2019-10-14)
Tags: Home Dialysis, PD Cost, HD Cost, HD Survival