Journal Watch

  • HD frequency vs. length: Which matters most?

    For toxin removal, are you better off with more frequent HD, or longer treatments? Turns out that longer HD removes significantly more creatinine and methylguanidine than standard or more frequent treatments—but the combination of BOTH was best. (You knew we'd say that!)

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

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  • Get drier: Live longer

    A 3.5 year long study of 269 people on HD has found that folks who had more water removed from the blood (tested with a body composition monitor) lived significantly longer than those who stayed water-logged. (Drier is better, and doing longer and/or more frequent HD makes that possible.)

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

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  • Mind the gap

    In the UK, "mind the gap" means watch your step as you get off the train. For in-center HD, the gap is the 2-day dialysis weekend. It turns out that switching randomly chosen patients from 3x/week to every other day HD for 12 months reduced blood pressure, left ventricular mass, EPO dose, urea rebound, and symptoms. Of course; it's more physiological!

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

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  • Nocturnal HD improves melatonin rhythm for better sleep

    Is sleep better or worse on nocturnal HD, since it is done at night? A new study of 13 people who switched from standard HD to nocturnal found that standard HD disrupts the normal rhythm of melatonin (the hormone that helps you sort out day from night). After 6 months of night-time treatments, this rhythm was partly restored—and sleep was much better.

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

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  • If you can't beat 'em, zap 'em!

    Fibrils of amyloid can build up in the joints and soft tissues when too-little beta-2 microglobulin (B2m) is removed from the blood during dialysis. Longer and more frequent treatments remove more B2m. But what if we could remove fibrils that have already occurred? A new study suggests that laser treatments can destroy existing fibrils and slow the rate of new ones.

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

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  • Children on dialysis have good survival prospects

    Some of the longest survivors of ESRD were children or teens when their kidneys failed. A new study finds that 5-year survival of this group after they reach age 18 was 95.1%, with an average life expectancy of age 63 with a transplant—or age 38 with standard dialysis. Of course, two recent studies have found that survival with longer and/or more frequent HD rivals that of transplant.

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

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  • Lower B2m levels predict better survival

    More frequent—and especially longer—HD remove much more beta-2 microglobulin, a toxin that causes dialysis-related amyloidosis (DRA), with waxy protein deposits in bones, joints, and sometimes soft tissues. Since a new study has found that lower levels of B2m on dialysis predict survival, getting more dialysis is a plus!

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

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  • Treatment length matters (we knew that!)

    Even when the same number of blood liters are processed, long, slow dialysis does a better job of removing toxins. In a study where patients on HD were dialyzed for 4, 6, or 8 hours, the longer treatments removed significantly more urea, creatinine, phosphorus, and beta-2 microglobulin. The authors conclude that Kt/V should not be the only measure of dialysis adequacy.

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

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  • Finally, data! Buttonhole Technique causes fewer fistula problems than site rotation

    A new study compares 75 HD patients using the Buttonhole technique for fistula needles with 70 patients using the "standard" technique of "rope ladder" needle site rotation. Buttonhole users had fewer missed cannulations, bruises, and aneurysms, and needed less angioplasty. Infection precautions are vital: there was a higher infection rate.

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

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  • Poor sleep on standard in-center HD

    Good sleep on dialysis improves survival. A new study compared sleep quality on standard in-center HD and a control group matched for age, sex, body mass index, and race. The in-center HD patients had significantly worse sleep.

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

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