Journal Watch
Wanted: A Paradigm Shift from Urea to Sodium Removal
When nephrology icon Zyblut Twardowski talks, we listen! When dialyzors in Seattle in the 1960s got 30 hours a week of dialysis, the mortality rate was 10%. Since then, short treatments—justified by the flawed NCDS study—were driven by the equally flawed notion of Kt/V urea.
Read the abstract » | (added 2018-12-14)
Tags: Kt/V Urea, Mortality Rate, Sodium Removal, Dialysis Quality, NCDS, RCT
Protein Clearance Predicts Mortality on PD
Protein clearance on PD may be a marker of peritoneal inflammation. Among 711 PD patients followed for at least one year, each 10mL/day rise in protein clearance was linked with a 10.4% increase in the risk of all-cause mortality (p=0.008). Protein clearance was linked with serum albumin and C-reactive protein levels.
Read the abstract » | (added 2018-12-14)
Peritonitis Symptoms in Older vs. Younger People
A single center study compared the time to first episode of peritonitis treated successfully with antibiotics in PD patients >65 (n=79)compared to those who were younger (n=168). Of 377 peritonitis episodes, 126 were in the older group and 251 in the younger group. Older patients were less likely to have fever or cloudy dialysate as symptoms than younger patients, but rates of transfer to hemodialysis, relapse, hospitalization, and mortality were similar. Read the abstract.
Read the abstract » | (added 2018-10-12)
Tags: Peritonitis, Outcomes Of Peritonitis, Elderly PD, Patient PD
Home HD After PD Failure May Lead to More Transplants, Lower Mortality
Since PD failure can lead to hospitalization and death in those who switch to standard in-center HD (ICHD), would outcomes improve with home HD? A new analysis found 521 patients in the USRDS data who made the change. Compared to matched ICHD patients, the chance of transplant was nearly double (21% vs. 10.6%), while survival of home HD patients was 89.1% at 1 year and 80.5% at 2 years.
Read the abstract » | (added 2018-08-13)
Tags: PD Technique Failure, ICHD, Transplant, Home HD, Lower Mortality
High Peritoneal Transport and Long-term PD Outcomes
Among 470 patients who did PD for up to 10 years in Hong Kong, the peritoneal transport rate was able to differentiate survivors. After the first few years of PD, having high peritoneal transport became a significant risk factor for mortality.
Read the abstract » | (added 2018-05-11)
Improving Incident ESRD Care with Transitional Care Units
Patients who transition onto dialysis are at high risk for morbidity and mortality—along with high costs. Transitional care units use the first 30 days of treatment for systematic onboarding that includes education and informed options choice—and may be especially helpful to those who start treatment emergently. Read the abstract.
Read the abstract » | (added 2018-03-16)
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 2018-02-15)
Survival in Those Eligible for BOTH PD or Standard In-center HD
Yes, this is yet another survival comparison. A study of almost a decade of people (N=2,032) starting dialysis at seven Ontario clinics looked at mortality only among those who were judged to be suitable for either PD or standard in-center HD by a multidisciplinary team. Both options offered similar survival.
Read the abstract » | (added 2017-12-14)
PD in PKD?
There is yet more evidence that people with PDK can successfully do PD. Researchers in Peking analyzed survival data from people with PKD between1993 and 2015 on PD vs. HD. Additionally, they matched PD patients who did and did not have PKD. Neither PD nor PKD independently predicted mortality.
Read the abstract » | (added 2017-09-15)
PD vs. Standard HD for People with Cirrhosis
For cirrhotic people with kidney failure, data abstraction from the U.S. Nationwide Inpatient Study between 2005 and 2012 compared outcomes with PD and standard in-center HD. In-hospital mortality for those with ascites was significantly less with PD. In addition, PD hospital stays were shorter and costs were lower. Yet, just 1.7% of the sample was using PD.
Read the abstract » | (added 2017-04-12)
Tags: Peritoneal dialysis, Hemodialysis