Journal Watch
PD catheter tunnel and exit site infections more likely with poor glycemic control—but not peritonitis
Diabetes is known to raise the risk of infection. A study that looked back at blood sugar levels of 183 people new to PD, those with poor glycemic control had almost twice as many catheter tunnel and exit site infections, and had a first infection much sooner (p = 0.004). But, there was no increase in the risk of peritonitis.
Read the abstract » | (added 2014-10-07)
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Nocturnal home HD boosts hemoglobin level and reduces ESA use
Every other night nocturnal home HD (NHHD) was compared to standard in-center HD in a small study. Among the 23 people using NHHD, Hemoglobin increased by about 2 g/dL after 2 years (P<0.001), while ESA dose dropped by just over 50% (P<0.001), and 26% were able to stop ESAs. Among the 25 people doing standard HD, hemoglobin levels dropped by almost 2 g/dL (P = 0.007), and ESA dosage increased (P<0.001).
Read the abstract » | (added 2014-10-07)
Home therapies: Better outcomes
A review article suggests that outcomes for PD and home HD are as good—or better—than those for standard in-center HD. PD use in the US has grown after the Medicare bundle created an incentive for its use. Home therapies are effective and patient-centered treatments.
Read the abstract » | (added 2014-10-07)
Tags: Home dialysis
Biocompatible PD fluid may preserve long-term residual kidney function
A metaanalysis of 11 studies (n=1,034) found that biocompatible PD fluid did not boost residual kidney function (RKF) in the short term. But, at 12 months or more, there was a long-term preservation of RKF.
Read the abstract » | (added 2014-10-07)
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Self-locating catheters (SLC) vs. straight Tenckhoff catheters for PD
Which is better to reduce complications: an SLC designed to avoid trapping the tip against the abdomen wall? Or, a single cuff, straight Tenckhoff catheter? In a series of 78 people new to PD, 40 were given SLCs and 38 were given Tenckhoffs. Prior to the start of PD, there were no differences between the groups. But, once PD began, there were fewer problems in the SLC group (p=0.021). Plus, it was easier to solve problems with SLCs using laxatives, and no surgeries were needed.
Read the abstract » | (added 2014-10-07)
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Men on PD fare worse with high serum uric acid levels
In a study of 985 people using PD in China followed for more than 2 years, men in the highest tertile for serum uric acid were at the highest risk of death. The results were adjusted for age; BMI; comorbidities; residual kidney function; total Kt/V; use of allopurinol, ACE-inhibitors and ARBs; Hgb, serum albumin, creatinine, calcium and phosphorus, triglycerides, LDL cholesterol, and high-sensitivity C-reactive protein.
Read the abstract » | (added 2014-09-05)
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Home HD in people over age 65
As MEI has noted in our MATCH-D tool, age alone should not be a contraindication for home PD or HD—and a new study shows this. In an international, multi-center study of 79 people over age 65 at dialysis initiation, event-free survival on home HD was 85% at 1 year, 77% at 2 years, and 24% at 5 years, with technique survival of 92%, 83%, and 56%, respectively. Just over half (54%) needed a helper for home HD.
Read the abstract » | (added 2014-09-05)
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Home HD access survey
A survey of consumers and clinicians on vascular access practices for home HD found that nurses were not following their own training procedures or using generally accepted procedures (GAP) to cannulate—and consumers were reluctant to report some signs and symptoms of access infection. Not one nurse or consumer had followed all of the GAP steps. (Editor’s note: This may help explain the high—and preventable—infection rate reported with the Buttonhole technique...)
Read the abstract » | (added 2014-09-05)
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VOLUME FIRST to improve outcomes in people on HD
We try to include only HOME dialysis abstracts—but when the Chief Medical Officers of most of the US dialysis clinics agree on key messages to improve care, we need to summarize their four key points. These are: (1) Normalizing extracellular fluid volume should be a primary goal of dialysis. (2) Fluid removal should be gradual and treatments should not routinely be less than 4 hours. (3) Keep dialysate sodium in the range of 134-138 mEq/L and avoid routine sodium modeling and hypertonic saline. (4) Counsel consumers to avoid salt in their diets.
Read the abstract » | (added 2014-09-05)
Tags: Home dialysis
Tolvaptan may boost urine output for people on PD
A drug called tolvaptan nearly doubled the average urine volume and reduced the need for PD fluid volume by about 5000 mL weekly in a small trial of 11 people. The medication did not affect Kt/V, serum sodium, or serum albumin.
Read the abstract » | (added 2014-09-05)
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