Journal Watch

  • 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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  • 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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  • 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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  • 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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  • 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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  • 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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