Journal Watch
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)
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)
Barriers to Intensive HD in Pediatrics
Why don’t more people choose intensive hemodialysis? Responses to a survey by 134 of the 221 pediatric dialysis centers in the International Pediatric Dialysis Network found that more than 2/3 were aware of evidence supporting the benefits of intensive HD and half believed it produced the best outcomes (just 2% favored conventional HD). Key barriers included lack of funding and staff, with lack of expertise and motivation as minor factors. Read the abstract.
Read the abstract » | (added 2017-11-13)
Tags: Children, Financial Barriers, Home Dialysis, Intensified Hemodialysis, Nocturnal Hemodialysis
Views of Patients vs. MDs Re: Important Dialysis Outcomes
An international 3-round Delphi survey that started with 202 patients and care partners and 979 renal professionals aimed to generate a consensus-based prioritized list of core outcomes for HD trials. Not surprisingly, patient/care partner priorities differed dramatically from those of professionals: patients largely valued quality of life outcomes, while professionals focused on clinical ones.
Read the abstract » | (added 2017-10-13)
Tags: What Is The Best Dialysis Option For Me, Making Dialysis Better
Canadian Home Dialysis by Race: Access vs. Outcomes
Unlike the US, Canada’s universal healthcare system does not limit access to home dialysis by racial minorities. However, compared to whites, Asians, blacks, and some others had better survival on PD, while Aboriginals had poorer survival. No survival differences were found among home HD patients based on race—but event numbers were lower.
Read the abstract » | (added 2017-09-15)
Tags: Choosing The Right Path Through ‘The System’ Education Issues: For Patients And Professionals
Pregnancy Outcomes with Short Daily HD
A case report from France observed two pregnant women who chose to continue doing short daily HD. The resulting babies were moderately premature but had no other complications.
Read the abstract » | (added 2017-08-17)
PD for People with PKD—It’s Possible
Many believe that large, polycystic kidneys make PD impossible. A review has concluded that PD is well-tolerated in those with autosomal dominant PKD, with outcomes that are equivalent—or better—than in other patient groups.
Read the abstract » | (added 2017-07-14)
Why and how to change the dialysis default to PD
PD is comparable to standard HD in outcomes, but costs less, is more convenient, does a better job of preserving residual kidney function, and delivers better quality of life, argues a new editorial.
Read the abstract » | (added 2017-05-09)
Tags: Peritoneal dialysis
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