Journal Watch
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A Swan Song for Kt/V (It’s About Time!)
A new review of the flaws of Kt/V—including a lack of proof of concept—“leaves little room for any conclusion other than that Kt/V, as an indicator of dialysis adequacy, is obsolete.” [Editor’s Note: Now, if the authors would take on the concept of “adequate” vs. optimal therapy…]
Read the abstract » | (added 05/15/2019)
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To Reinsert a PD Catheter or Not to Reinsert: That is the Question
Among 470 PD patients in Singapore, 92 required PD catheter removal. Of these, 39% had a second PD catheter placed, while the rest switched to HD. Patients who could not continue PD were excluded from the analysis. Survival was about the same in both groups. Surprisingly, those who required catheter removal due to infection were more likely to be able to continue PD than those who required it due to catheter malfunction.
Read the abstract » | (added 05/15/2019)
Tags: Pd Catheter, Hd, Catheter Remova
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PD Fluid Overload Linked with Peritonitis from Gut Pathogens
PD patients with extra fluid in their bodies are at a significantly higher risk for peritonitis due to gut bacteria, finds a study of 138 patients. Patients in the highest third for intra-and extracellular water were at the highest risk.
Read the abstract » | (added 05/15/2019)
Tags: Body Composition, Overhydration, Peritoneal Dialysis, Peritonitis
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Shared Decision-making (SDM) Boosts Uptake of PD and Living Kidney Transplants
Researchers in Taiwan found that levels of PD choice and living kidney transplantation were higher in the 71% of 310 patients (n=220) who received an SDM intervention were significantly more likely to choose PD or to obtain a living donor kidney transplant than those who did not.
Read the abstract » | (added 05/15/2019)
Tags: Pd Choice, Living Kidney Transplantation, Sdm Intervention
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Operationalizing Telehealth for Home Dialysis
In January, 2019, Medicare rules for telehealth changed to permit the home as an originating site for home dialysis patients. ESCOs can take advantage of waivers to obtain payment for a monthly comprehensive telehealth visit with a home patient after the first 3 months of therapy—with no geographic restrictions. Technical, regulatory, and operational challenges are discussed in this article.
Read the abstract » | (added 04/11/2019)
Tags: Maintenance Dialysis Therapy, Telehealth Services, Legislation, Regulatory Requirements, Remote Monitoring
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Perspectives on Payment for More Frequent Home HD
This article explains the role of the Medicare regional contractors in implementing—or thwarting—payment for more than three home HD payments per week, and offers options for changing Medicare’s payment system to ensure that this option is supported.
Read the abstract » | (added 04/11/2019)
Tags: Medicare Regional Contractors, Medicare Payment System, Hd Payments
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Three Diuretics are Better than One on PD
A small study (n=51) randomly assigned adult CAPD patients to receive three diuretics or just one plus placebo for 6 months. Among the 43 patients who completed the trial, those who took three diuretics had significantly better hydration status and more change in urine output—with no adverse events reported.
Read the abstract » | (added 04/11/2019)
Tags: Peritoneal Dialysis, Furosemide, Hydration Status, Hydrochlorothiazide, Spironolactone
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Cognitive Impairment Predicts PD Peritonitis
A prospective cohort study assigned 458 PD patients to a cognitively impaired (CI) or non-CI group based on results of mental state testing. The groups were not otherwise significantly different. Over 31.4 (median) months, 94 patients had first-time peritonitis, and short-term memory losses were independently linked with a higher risk.
Read the abstract » | (added 04/11/2019)
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Clues to Home HD Retention
Why do people drop out of home HD? A new interview study of 15 current and 10 former patients sheds some light. The study identified five themes, each with a positive and a negative aspect: degree of independence, support, technical aspects, home environment, and attitudes and expectations.
Read the abstract » | (added 03/12/2019)
Tags: Hhd, Modality, Discontinuation
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Home HD - Significantly Better Survival and Transplant Rate
A Swedish matched cohort study compared the long-term survival of 152 home HD patients with those doing PD (n=456) or standard in-center HD (n=608). Median survival for home HD was significantly better (18.5 years) than PD (15.0) and in-center HD (11.9). Home HD patients were also significantly more likely to have received a transplant.
Read the abstract » | (added 03/12/2019)
Tags: Survival, Home Hemodialysis, Institutional Hemodialysis, Peritoneal Dialysis