Journal Watch

  • PD vs. Standard In-center HD for Quality of Life

    A 24-month observational study compared 45 standard HD and 30 PD patients, and assessed their quality of life, cognitive function, and depression at study start and every 12 months. Over the 24 months, PD patients had significant improvement in physical and social well-being—while HD patients stayed the same. Cognitive function held steady in PD patients—but declined in HD patients. Depression increased among those on standard HD—but not those on PD.

    Read the abstract » | (added 2019-11-16)

  • Proton Pump Inhibitors Increase Peritonitis Risk in PD

    In a single-center, 36-month retrospective look at 230 Japanese PD patients, those who took PPIs were 72% more likely to develop peritonitis than those who did not.

    Read the abstract » | (added 2019-11-16)

  • A Post-op Surgical Girdle for Pain and Catheter Tunnel Infections in Urgent Start PD

    Urgent start PD can be associated with pain and tunnel infections. In a study of 85 consecutive PD catheter placements, a surgical girdle was used from days 1-3 while patients were supine. Among the 23 patients who completed pain surveys, the girdle helped significantly. Tunnel infections were reduced as well.

    Read the abstract » | (added 2019-11-16)

  • Is PD Unwise for Patients with Lupus Nephritis?

    A small study found 92.4% (1 year), 84.7% (3 year) and 67.6% (5 year) patient survival among 28 non-diabetic lupus patients doing PD—compared to 100% (1 year), 93.5% (3 year), and 82.9% (5 year) among 56 controls. While the lupus was not directly associated with mortality, it was a risk factor for PD technique failure, infection, and hospitalizations.

    Read the abstract » | (added 2019-11-16)

  • Antibiotics Before Colonoscopy May Reduce Peritonitis Risk in PD Patients

    In a retrospective study of 236 CAPD patients who had colonoscopies, 9 developed peritonitis within a week of the procedure. No patient who received prophylactic antibiotics developed peritonitis. Randomized controlled trials are recommended.

    Read the abstract » | (added 2019-11-16)

  • PD Outcomes under the Medicare Expanded Dialysis Prospective Payment System

    A Medicare change in 2011 may have increased the likelihood that clinics would expand PD to a broader population. Did this affect outcomes? A prospective cohort study compared 10,585 patients who started PD before payment reform, 7,832 interim patients, and 18,742 during the reform period. With similar demographics, more patients were treated in clinics with less PD experience—and these clinics had higher PD discontinuation rates. But, PD discontinuation fell overall, and mortality risk was stable.

    Read the abstract » | (added 2019-10-14)

  • Sudden Cardiac Death (SCD) in PD vs. HD

    A Korean registry analysis of 132,083 dialysis patients between 1985 and 2017 found that SCD caused 19.6% of the 34,632 deaths. Even after adjusting for age and significant comorbidities, HD was independently associated with SCD, as was diabetes.

    Read the abstract » | (added 2019-10-14)

  • PD and Swimming

    Australian nurses in 39 PD clinics conducted phone surveys. While only 77% of the clinics advocated swimming, nearly all had patients who did swim, mainly in sea water or a private pool. Covering the exit site and catheter with a waterproof dressing or ostomy bag was recommended, along with routine exit-site care. Several infections were linked with swimming.

    Read the abstract » | (added 2019-10-14)

  • Home Dialysis: Better Outcomes at Lower Costs

    Five years after starting dialysis, the population of Ontario, Canada over age 18 had mean 30-day PD costs 50% lower than in-center HD—and home HD costs 64% lower than in-center. After adjusting for covariates, home HD cost the least and had the highest survival (80%) vs. 52% on PD and 42% on in-center HD.

    Read the abstract » | (added 2019-10-14)

  • The Role of Frailty in Home Dialysis

    Evaluation of frailty among 109 home dialysis patients revealed a greater than 2-fold increase in risk of a composite outcome that included technique failure and all-cause death. Weakness and weight loss were both linked with higher risk. “Assessing frailty as part of the clinical evaluation for home dialysis therapies may be useful for prognostication and clinical management,” report the authors.

    Read the abstract » | (added 2019-10-14)