Journal Watch
Encapsulating Peritoneal Sclerosis Linked to Vasculopathy
EPS is a rare but devastating complication of PD. Tissue samples from 223 people with EPS who had surgery to remove adhesions were analyzed under a microscope. In the 174 samples that could be evaluated, the individuals who had used conventional PD fluid had more severe vasculopathy and longer PD durations than those who used pH neutral PD fluid.
Read the abstract » | (added 2021-08-12)
Outcomes of Incremental PD
A retrospective cohort study looked at 175 PD patients followed for about 2 years. Starting PD with a lower vs. higher dose was associated with better survival.
Read the abstract » | (added 2021-08-12)
Tags: Peritoneal Dialysis , PD, End stage Kidney Disease, Dialysate Volume, Survival
Roxadustat for Anemia in PD
The anemia drug was tested in 129 people on PD randomized to roxadustat or other ESAs for 24 weeks. The roxadustat group had a 96% response rate (vs. 92%), lower hepcidin levels and higher TIBC. Total cholesterol and LDL dropped more with roxadustat, independently of C-reactive protein. Mean average hemoglobin on roxadustat were 11.5 g/dL (vs. 11.2). There were some common adverse events.
Read the abstract » | (added 2021-07-12)
Tags: Prolyl Hydroxylase Inhibitor, Erythropoiesis, Iron Metabolism, Anemia
Is Endoscopy Safe in PD?
Peritonitis can occur after endoscopy. A retrospective 10-year review divided 570 PD patients who had 1,316 endoscopies into three groups. Group 1 did not have prophylactic antibiotics. Group 2 did have them. Group 3 had prior antibiotics. An analysis of the peritonitis rates within 7 days of the procedures found a 3% rate that was not affected by whether or not antibiotics were given.
Read the abstract » | (added 2021-07-12)
Tags: Endoscopy, Peritoneal Dialysis, Peritonitis
The Clinical Experience of In-center Nocturnal HD
An analysis of 4 years of INHD looked at 12 patients who chose to stop, 24 patients who continued, and interviews with patients and staff. A “starter pack” given to aid sleep in new INHD patients was well-received and sleep was not a reason to stop INHD. Staff were most concerned about emergency support, though staffing ratios were the same as during the day. Most of the clinical incidents for INHD centered around communication with patients and families, patient transfer delays, and equipment issues—not medical interventions, infection control, and transport, as during the day. Those who continued with INHD felt they had more social time and perceived health benefits.
Read the abstract » | (added 2021-07-12)
Tags: INHD
Genes Help Predict Peritoneal Transport Rates
Among 2,850 people on PD who had complete genetic data, 5 single nucleotide variants at four loci had suggestive associations with the peritoneal solute transfer rate (PSTR), in particular rs28644184 at the KDM2B locus.
Read the abstract » | (added 2021-07-12)
Tags: Genetic Variants, Peritoneal Solute Transfer Rates, Kidney Failure, Peritoneal Dialysis
Higher HD Dose Linked with Better Survival
A national registry of 32,283 standard HD patients found that “a higher dose of dialysis was consistently associated with better survival.” Kt was most discriminating, with survival highest in the upper Kt quartile. Arteriovenous access, hemodiafiltration, scheduled dialysis initiation, and long weekly HD hours predicted higher Kt.
Read the abstract » | (added 2021-07-12)
Tags: Dialysis Frequency, Survival, Kt, Mortality
PD Adequacy and Itching
Among 80 people on CAPD, blood levels of the pain marker “substance P” and total urea clearance both independently predicted itching. Inadequate PD seems to be a reason for people using PD to itch.
Read the abstract » | (added 2021-07-12)
Tags: Pruritus , Peritoneal Dialysis, CAPD, Substance P, Total Urea Clearance, Itching, PD
PDOPPS Findings of Factors Important to Peritonitis Outcomes
The Peritoneal Dialysis Outcomes and Practice Patterns Study analyzed factors in the outcomes variations among 1,631 peritonitis episodes in 1,190 patients in seven countries. About 2/3 of the bouts were successfully cured, which was more likely with Gram-positive organisms, automated PD, and use of icodextrin (facility level), aminoglycosides, and ciprofloxacin vs. ceftazidime for Gram-negative organisms.
Read the abstract » | (added 2021-06-15)
Tags: Peritoneal Dialysis, Peritonitis, Peritoneal Dialysis And Outcomes Practice Patterns Study
Funding U.S. Dialysis Innovation: The Role of TPNIES
CMS is expanding reimbursement to encourage use of home treatments under the transitional add-on payment for new and innovative equipment and supplies (TPNIES). An up to 26% reimbursement to clinics requires machines to be eligible under the substantial clinical improvement (SCI) criteria—but these have not been adapted for home dialysis and may not be suitable.
Read the abstract » | (added 2021-06-15)
Tags: Home Dialysis, Transitional Add on Payment For New And Innovative Equipment And Supplies, TPNIES