Journal Watch

  • Challenges in Assessing Survival of In-center vs. Home HD

    It’s treatment time that matters, not location—of course—suggests a new thorough review of the survival data. And, while it is challenging to prove a survival benefit when all home HD is so often conflated (short daily vs. nocturnal, for example), quality of life is demonstrably better—and matters more to patients.

    Read the abstract » | (added 2019-08-14)

  • In-center HD patients tend to overestimate how long they are likely to live

    Statistics do not apply to individuals. However, a survey of 996 standard in-center HD patients from 31 clinics found that most could not correctly guess how long other “people your age with similar health conditions” usually live (<5 years, 5-10 years, >10 years, not sure). Just 11.2% chose <5 years, when the USRDS results would suggest 60.3%. Those who believed they would live longer were less likely to have advance directives.

    Read the abstract » | (added 2019-07-15)

  • How longer HD treatments affect bone minerals

    The ACTIVE study randomized 200 people to do 24+ hours of HD per week vs. standard (<18 hours per week) HD. Long HD treatments reduced serum phosphate levels, but did not change PTH or serum calcium. In a second analysis of the data, those who did longer HD needed fewer phosphate binders as well.

    Read the abstract » | (added 2019-07-15)

  • Impact of daily low-flow HD on potassium and lactate levels

    In the NxStage FREEDOM study, 345 patients switched from standard in-center HD to daily, low-flow HD. Blood levels of potassium and lactate were analyzed during the last 3 months of standard HD and the first 3 months of daily HD. On daily HD, predialysis serum potassium decreased significantly at a dialysate potassium level of 1 mEq/L, with no change at 2 mEq/L. Predialysis serum bicarbonate level decreased significantly with dialysate lactate concentration of 40 mEq/L—but increased significanty at 45 mEq/L. Choosing the correct dialysate for the patient is important.

    Read the abstract » | (added 2019-07-15)

  • Incremental PD may preserve residual kidney function longer

    A single-center observational study in Korea followed 347 patients; half started full-dose PD and half started incremental PD. While patient, technique, and peritonitis-free survival were similar between groups, the incremental PD group had a significantly lower risk of losing all of their kidney function (anuria).

    Read the abstract » | (added 2019-07-15)

  • Half of PD patients may develop a new glucose disorder

    A metaanalysis of nine studies with a total of 13,879 PD patients found that 8% had new-onset diabetes, 15% developed impaired glucose tolerance, and 32% had newly abnormal fasting blood sugar levels. No differences were found by ethnicity. The authors concluded that PD patients should receive glucose tolerance tests.

    Read the abstract » | (added 2019-07-15)

  • 10-year retrospective study of urgent-start PD

    Among urgent-start 2,059 PD patients followed for a decade, older patients were less likely to have PD catheter failure than younger ones, while men and people with diabetes had higher catheter failure rates. Lower hemoglobin levels predicted more abdominal wall complications. Overall, urgent-start PD was safe and effective, and a well-trained team and comprehensive follow up were recommended.

    Read the abstract » | (added 2019-07-15)

  • Moving the PD Exit Site to Combat Infection

    A 5-year retrospective cohort analysis looked at the impact of treating PD exit site and tunnel infections in 27 patients by removing the cuff and relocating the catheter under local anesthetic. After follow up ranging from 10.8 to 79.4 months, no leaks occurred, and the infections resolved in 74% of the patients. The rest had to have their catheters removed.

    Read the abstract » | (added 2019-06-13)

  • Higher Serum Albumin May Protect Residual Kidney Function in PD

    In a prospective study of 104 new PD patients, having low serum albumin levels was independently associated with complete RKF loss (<100 mL/day of urine).

    Read the abstract » | (added 2019-06-13)

  • Low vs. Very Low Site PD Catheter Placement to Prevent Migration

    A retrospective 5-year series of 76 patients whose PD catheter tips migrated had received either a traditional low-site insertion (N=39) or a very-low-site insertion (N=37). After 2 years of follow up, the very-low-site group had significantly better catheter and patient survival, with fewer catheter complications—and no tip migration.

    Read the abstract » | (added 2019-06-13)