Journal Watch - Mortality

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  1. Urea Alone is Not a Good Index of Dialysis Dose

    All-cause mortality in the HEMO study was not significantly related to removal of small solutes in short, intermittent, standard HD. “Failure to achieve greater reductions in solute levels may explain the failure of high Kt/V urea treatment to improve outcomes,” the authors note. (Yet another reanalysis of the HEMO study data has confirmed the obvious…)

    Read the abstract » | (added 04/12/2016)

    Tags: Hemodialysis

  2. Survival on PD is Better with Normal Magnesium Levels

    A retrospective study of 253 incident PD patients followed for up to 10 years found that deaths due to cardiovascular causes (58.3%) were linked with low serum magnesium levels. Low serum albumin, and levels of triglycerides, potassium, calcium, and phosphate were also important. Those in the group with the lowest magnesium had significantly higher all-cause mortality (p<0.001).

    Read the abstract » | (added 04/12/2016)


  3. Why Do People Stop Doing Home HD?

    Among 2,840 people who started home HD between 2007 and 2009, nearly one in four stopped within a year, while 1-year mortality was 7.6%. The risks of stopping home HD were higher among those with diabetes, and substance use (alcohol, tobacco, drugs). Those who were listed for transplant or lived in rural areas were less likely to stop home HD.

    Read the abstract » | (added 01/10/2016)

    Tags: Hemodialysis

  4. Encapsulating Peritoneal Sclerosis Increases with Time on PD

    EPS is a devastating PD complication that can be lethal. An Italian clinic looked back at 30 years worth of data and found EPS prevalence rates of 2.8% overall among 920 patients: 0.4% for <2 years of PD, 3% at 2-4 years, 4% at 4-6 years, 6% at 6-8 years, 8% at 8-10 years, 75% by 12-14 years, and 67% for those with 14+ years of PD. Steroid treatment helped reduce mortality.

    Read the abstract » | (added 11/11/2015)


  5. Home HD has 20% lower all-cause mortality than PD

    In a new study that matched 4,201 new home HD patients in the USRDS database to new PD patients, the risk of all-cause mortality was 20% lower with home HD. In addition, there was an 8% lower risk of hospitalization, and a 37% lower risk of technique failure.

    Read the abstract » | (added 09/11/2015)

    Tags: Home Dialysis

  6. Brazil APD Survival Significantly Better than CAPD

    A prospective study matched each of the incident APD patients in Brazil with a CAPD patient, using 15 matching factors, and looked at mortality, technique failure, and time to first peritonitis. With 1,445 patients each in the APD and CAPD groups, the researchers found 44% higher mortality among CAPD patients, but no differences in technique failure or time to peritonitis.

    Read the abstract » | (added 08/08/2015)


  7. It’s (past) time to avoid 3-day interdialytic intervals

    A new review paper considers the ill effects of the thrice weekly standard in-center HD schedule and finds it wanting, noting higher mortality on the day after the long gap than any other day of the week. The authors conclude that the data warrant “reexamining the issue of timing and frequency of prescribed dialysis regimens in order to improve patient outcomes.”

    Read the abstract » | (added 07/08/2015)


  8. Are we finally nearing the end of Kt/V?

    We have been vocal critics of Kt/V on Home Dialysis Central since the start—and now we are not alone. A new paper finds that Kt/V is not a good fit for short daily or long nocturnal treatments, to the point where, “urea kinetics are hardly if at all representative for those of other solutes with a deleterious effect on morbidity and mortality of uremic patients.”

    Read the abstract » | (added 07/08/2015)

    Tags: Nocturnal Hemodialysis

  9. Metanalysis of low-glucose PD fluid and residual kidney function

    An analysis of six randomized controlled trials of neutral pH, low-glucose PD fluids has found that patients who used these fluids had a much slower rate of residual kidney function loss and much higher weekly Kt/Vs than those using standard PD fluids. There were no significant differences between groups in ultrafiltration, blood pressure, or all-cause mortality.

    Read the abstract » | (added 04/10/2015)


  10. On PD, less inflammation linked with longer survival

    Among 87 people on PD, ages 30-85, who were followed for 30 months, the inflammation marker serum amyloid-A (SAA) was a significant independent predictor of mortality. When four markers of inflammation were analyzed together, SAA, age, and the presence of cerebrovascular insults were the strongest predictors.

    Read the abstract » | (added 03/11/2015)