Journal Watch - Mortality

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  1. Is low blood sodium as harmful in PD as it is in HD?

    Hyponatremia (low blood sodium levels) raise the risk of death in people who do standard in-center HD. A prospective observational study of 441 incident PD patients found a higher mortality risk among those who did PD, too. In fact, after 3 years, the 1/3 of study participants whose sodium was lowest had a 79% higher risk of death than those whose levels were higher.

    Read the abstract » | (added 12/09/2014)

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  2. First-year outcomes of incident US PD patients

    Among 1,677 incident PD patients from Fresenius, 367 switched to HD within the first 90 days. Of those who continued with PD, first-year mortality was 10 per 100 patient-years, with 42 episodes of peritonitis and 128 hospitalizations per 100 patient-years. About 2/3 of the hospitalizations occurred in the first 6 months of PD therapy. Of those who switched to HD, 81.4% began treatment with a central venous catheter—and 78.3% still had one 90 days later.

    Read the abstract » | (added 07/07/2014)

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  3. Home HD survival in New Zealand

    Researchers analyzed 15 years worth of home HD data in NZ (6,419 patients and 20,042 patient-years of follow up). After adjusting for comorbidities, home HD had 52% better survival than in-center HD. PD had 20% better survival than in-center HD in the first 3 years—but a 33% higher mortality risk after that.

    Read the abstract » | (added 06/05/2014)

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  4. Timing of PD—is an early start harmful?

    Early start HD (when eGFR is >10.5 mL/min/1.73m2) is not helpful, and may even be harmful. Is the same true of PD? No, suggests an observational study of 8,047 incident PD patients in Canada. Overall mortality was not higher for early, middle, or late start PD. However, first-year mortality was 38% higher in the early start group than in the late start group.

    Read the abstract » | (added 05/06/2014)

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  5. High-sensitivity CRP levels predict technique and patient survival on PD

    High C-reactive protein (CRP) levels suggest inflammation. Among 402 PD patients followed for 2 years, those with the lowest CRP levels were more likely to still be on PD and had better survival. Each 1 mg/L increase in CRP predicted a 1.4% higher risk of mortality.

    Read the abstract » | (added 04/09/2014)

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  6. Phosphate is a blood vessel toxin

    If blood phosphate levels are too high, the blood vessels can turn to stone—even in children. Heart damage from high phosphate levels can begin in pre-dialysis CKD. "Keeping serum P levels in the normal range reduces cardiovascular risk and mortality," say the authors. [Editor's note: nocturnal hemodialysis removes the most phosphate of any dialysis option.]

    Read the abstract » | (added 05/24/2013)

    Tags: Chronic Kidney Disease

  7. Mortality patterns in PD & home HD differ from standard in-center HD

    In the Australian dialysis database (ANZDATA), 4,298 deaths on PD and 10,338 on HD were analyzed for patterns. Patients who did PD, home HD, or in-center HD more than 3 days per week were equally likely to die on any day of the week. Not so for standard in-center HD patients: they were significantly more likely to die from heart-related reasons on Monday, after the 2-day no-treatment weekend.

    Read the abstract » | (added 02/27/2013)

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  8. Community house home hemodialysis in Australia and New Zealand

    Not everyone who wants to dialyze at home is able to. In Australia and New Zealand unstaffed, non-medical community homes fill a gap to make "home" treatments possible. This observational study compared mortality among 113 community home dialyzers to 5,591 people on PD, 1,532 on home HD, and 5,647 on in-center HD. Community house HD was safe and effective.

    Read the abstract » | (added 12/19/2012)

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  9. Longer or more-frequent HD normalizes mortality patterns

    It has long been known that those on PD have an equal chance of dying on any day of the week—while standard in-center HD are much more likely to die on a Monday (or Tuesday with Tue-Thu-Sat treatments). A new study looking at 14,636 Australian registry deaths found that those who got more than 3 standard in-center treatments per week or did home HD were no more likely to die on a Monday (or Tuesday) than any other day.

    Read the abstract » | (added 09/25/2012)

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  10. Metaanalysis: Later dialysis start is better for HD

    Starting dialysis at a lower GFR allows more time for access placement and options education. But the U.S. trend has been to start earlier. A new metaanalysis of 17 studies found that starting dialysis at a higher GFR was linked with a significantly higher risk of all-cause mortality—in HD, but not PD. The mortality risk was lower when GFR was calculated than when it was estimated.

    Read the abstract » | (added 08/16/2012)

    Tags: Chronic Kidney Disease