Journal Watch

  • Switching from standard to nocturnal HD has many benefits

    We bet you won't be surprised to learn that the 13 patients studied had much lower BP (with fewer drugs), higher hemoglobins (with fewer ESAs), better nutritional status, and lower calcium-phosphorus product. (PTH rose in some, though.)

    Read the abstract » | (added 2011-02-24)

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  • In-center nocturnal—another good option

    Canada found that folks switched from standard in-center HD to nocturnal in-center HD (3 nights/week) used less EPO and had better sleep, quality of life, appetite, and energy. They also had fewer cramps.

    Read the abstract » | (added 2011-02-24)

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  • First report from the Frequent Hemodialysis Network studies!

    There are two FHN studies. One compares 6-days-a-week in-center HD to 3-days-a-week. The other looks at 6-nights-a-week home nocturnal vs. 3 standard home HD treatments. So far, the study shows that more-frequent HD really is a LOT more dialysis—enough that the results should be able to prove whether more is truly better.

    Read the abstract » | (added 2011-02-24)

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  • The WAK is back...

    The wearable artificial kidney (WAK) is still in development. In this most recent article, the developers have learned that a pulsing, rather than steady, flow of dialysate improves clearance of wastes. Activated charcoal is used to absorb Beta-2 microglobulin (which can cause dialysis-related amyloidosis). A dialyzer with a larger surface area and higher dialysate pH are also being tested.

    Read the abstract » | (added 2011-02-24)

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  • Nocturnal HD normalizes smooth muscle cells

    Blood vessel calcification is an all-too-common problem among people on dialysis. On standard HD, fewer smooth muscle cells grow inside the blood vessels, and more of them die. Switching from standard to nocturnal restored normal cell growth—and also lowered blood pressure, and PTH and phosphate levels.

    Read the abstract » | (added 2011-02-24)

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  • To reduce inflammation: Get rid of your HD catheter

    Even with no infection, an HD catheter can still trigger inflammation. In a new study, people who got a fistula and had a catheter removed had an 82% lower c-reactive protein (CRP) level 6 months later. Those who kept the catheter had a 16% higher CRP.

    Read the abstract » | (added 2011-02-24)

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  • Female sexual function better on PD than standard in-center HD

    If you're a woman, a new study finds that a transplant is the best way to restore your sexual function to normal levels. But PD did a much better job than standard HD—and the study didn't look at daily or nocturnal HD.

    Read the abstract » | (added 2011-02-24)

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  • MYTHBUSTERS: microwaving PD fluid does NOT create glucose degradation products (GDPs)

    While the belief persists that microwaving PD bags creates harmful GDPs when sugars are caramelized, the literature does not bear this out:

    GDPs are a concern with PD fluid, but these are created when the fluid is manufactured, not when it is heated by the user. Of course, "hot spots" are still a concern. Anyone using a microwave to heat PD fluid should flip the bag from side to side to mix the contents well and use a thermometer strip to reduce the risk of burns.

    Read the abstract » | (added 2011-02-24)

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  • Does dialysis time matter? YES!

    Perhaps if in-center folks got more HD, they would see that they feel better—and think about home. Per Drs. Lacson and Lazarus from Fresenius, "Compelling rationale and recent outcome data support use of longer Td [dialysis time]...Until such time that results from prospective randomized trials are available, we believe that physicians should prescribe and exert all efforts to convince thrice-weekly hemodialysis patients to accept 4 h as minimum Td."

    Read the abstract » | (added 2011-02-24)

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  • PD doesn't zap your heart

    "Myocardial stunning" occurs in HD due to brief periods of not enough blood flow to the heart muscle. Over time, as this happens over and over, it can cause heart damage. In a small study (just 10 people') looking at heart muscles, PD exchanges did not reduce blood flow to the heart—so, no stunning occurred.

    Read the abstract » | (added 2011-02-24)

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