A Home Dialysis Primer for Internists

Since PD and home HD are increasing in use due to their clinical and practical advantages, clinicians need to understand these treatments. A new primer in the Annual Review of Medicine will help them do just that.

Read the abstract » | (added 2023-12-15)

Tags: Home Dialysis, HD, PD, Home Dialysis Primer

Lessons from Almost 15,000 PD Catheter Placements

Of the various PD catheter placement techniques, laparoscopy had higher 6-month mechanical complications, exit site infections, revision, and removal rates, while fluoroscopy had higher rates of sepsis and death. Open surgery had higher rates of catheter displacement.

Read the abstract » | (added 2023-12-15)

Tags: PD Catheter Placement Technique, Laparoscopy, Mechanical Complications, Exit Site Infections, Revision, Removal Rates, Fluoroscopy, Sepsis, Death

The PD Surprise Question Predicts Transfer to HD

An observational study of 1,275 PD patients in 35 programs asking the RN and treating nephrologist, “Would you be surprised if this patient transferred to HD in the next 6 months?” identified 15% as high risk. After 6 months, the transfer to HD rate was nearly four times higher in the high risk group than the low risk group.

Read the abstract » | (added 2023-12-15)

Tags: PD, Home Dialysis, Peritoneal Dialysis, Surprise Question

Dietary Protein Intake and Survival on PD

Among 668 stable PD patients followed for up to 13 years, quarterly 3-day dietary records were collected for 2 ½ years. Dietary protein intake greater than 0.8 g/Kg/day improved long-term survival.

Read the abstract » | (added 2023-12-15)

Tags: Dietary Protein, Survival, PD

Perhaps Prophylactic Omentectomy Should be Standard in Pediatric PD Patients

A meta-analysis of nine studies and 775 patients found significant reductions in catheter obstruction in children who had an omentectomy at the time of PD catheter placement. There was a trend toward reduced rates of PD catheter removal or reinsertion as well.

Read the abstract » | (added 2023-12-15)

Tags: Prophylactic Omentectomy, Pediatric PD, Catheter Obstruction

High Ultrafiltration Volumes May Contribute to Pruritus

Could changes in skin perfusion and inflammation play a role in dialysis itching? An observational study of 392 patients looked at self-reports of pruritus severity and UF volumes. BMI and UF volume independently predicted pruritis severity.

Read the abstract » | (added 2023-12-15)

Tags: Ultrafiltration Volume, UF Volume, BMI, Pruritus, Skin Perfusion, Inflammation

Should We Drop PD “Adequacy” as a Measure?

New ISPD guidelines suggest that patient well-being should be the goal of the PD prescription, not target urea or creatinine clearances. Identification of solutes that cause uremic symptoms could help devise ways to limit their accumulation.

Read the abstract » | (added 2023-12-15)

Tags: ISPD Guidelines, Patient Well being, PD Prescription, Uremic Symptoms

How Sugar Harms the Peritoneum and Causes Fibrosis

HOW does sugar harm the peritoneum? An RNA sequencing study looked at peritoneal endothelial cell (EC) function in mice and human ESRD cells in the presence or absence of glucose. In mice, glucose increased EC proliferation, permeability, and inflammation. Blocking glucose caused a therapeutic benefit. Human cells reacted in a similar way.

Read the abstract » | (added 2023-12-15)

Tags: Sugar, Glucose, Peritoneum, RNA Sequencing, Endothelial Cell Function

Surprising Impact of First Dialysis Modality on Survival in Patients with Diabetes

A retrospective cohort study of 739 patients from 2010 to 2018 (inclusive) used propensity score matching to compare mortality between standard HD and PD in China, matching 125 PD patients with HD patients. No significant differences were found—except in those with diabetes, who had significantly better survival with PD.

Read the abstract » | (added 2023-11-15)

Tags: Modality, Survival, Diabetes, Propensity Score Matching

Rate of Residual Kidney Function Decline and Mortality in PD

When 497 PD patients were divided into two groups based on RRF decline value, those in the fast-decline group had significantly higher rates of all-cause and cardiovascular mortality. In fact, each 0.1mL/min/1.73m2 per month drop in RRF in the first year of PD predicted a 19% higher risk of all-cause mortality and a 20% higher risk of cardiovascular mortality.

Read the abstract » | (added 2023-11-15)

Tags: Rate Of Residual Kidney Function Decline, All cause Mortality, Cardiovascular Mortality