Journal Watch

  • KDIGO Controversies: Dialysis Start and Modality Choice

    A January 2018 Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference addressed significant variations between countries in dialysis start, patient preparation, and modality mix. Happily, attendees supported individualized care that incorporates patient goals and preferences (within quality and safety parameters), and the need to avoid a one-size-fits-all approach.

    Read the abstract » | (added 2019-05-15)

  • A Swan Song for Kt/V (It’s About Time!)

    A new review of the flaws of Kt/V—including a lack of proof of concept—“leaves little room for any conclusion other than that Kt/V, as an indicator of dialysis adequacy, is obsolete.” [Editor’s Note: Now, if the authors would take on the concept of “adequate” vs. optimal therapy…]

    Read the abstract » | (added 2019-05-15)

  • Operationalizing Telehealth for Home Dialysis

    In January, 2019, Medicare rules for telehealth changed to permit the home as an originating site for home dialysis patients. ESCOs can take advantage of waivers to obtain payment for a monthly comprehensive telehealth visit with a home patient after the first 3 months of therapy—with no geographic restrictions. Technical, regulatory, and operational challenges are discussed in this article.

    Read the abstract » | (added 2019-04-11)

  • Three Diuretics are Better than One on PD

    A small study (n=51) randomly assigned adult CAPD patients to receive three diuretics or just one plus placebo for 6 months. Among the 43 patients who completed the trial, those who took three diuretics had significantly better hydration status and more change in urine output—with no adverse events reported.

    Read the abstract » | (added 2019-04-11)

  • Perspectives on Payment for More Frequent Home HD

    This article explains the role of the Medicare regional contractors in implementing—or thwarting—payment for more than three home HD payments per week, and offers options for changing Medicare’s payment system to ensure that this option is supported.

    Read the abstract » | (added 2019-04-11)

  • Cognitive Impairment Predicts PD Peritonitis

    A prospective cohort study assigned 458 PD patients to a cognitively impaired (CI) or non-CI group based on results of mental state testing. The groups were not otherwise significantly different. Over 31.4 (median) months, 94 patients had first-time peritonitis, and short-term memory losses were independently linked with a higher risk.

    Read the abstract » | (added 2019-04-11)

  • Clues to Home HD Retention

    Why do people drop out of home HD? A new interview study of 15 current and 10 former patients sheds some light. The study identified five themes, each with a positive and a negative aspect: degree of independence, support, technical aspects, home environment, and attitudes and expectations.

    Read the abstract » | (added 2019-03-12)

  • Home HD - Significantly Better Survival and Transplant Rate

    A Swedish matched cohort study compared the long-term survival of 152 home HD patients with those doing PD (n=456) or standard in-center HD (n=608). Median survival for home HD was significantly better (18.5 years) than PD (15.0) and in-center HD (11.9). Home HD patients were also significantly more likely to have received a transplant.

    Read the abstract » | (added 2019-03-12)

  • HOW do AGE’s Cause Peritoneal Fibrosis?

    For years, researchers have known that the advanced glycation endpoints (AGEs) that form when sugar-based PD fluid is made harm the membrane. But, we didn’t know why. Human cell modeling finds that AGEs cause outer layer peritoneal cells (epithelial) to become connective tissue cells (mesenchymal).

    Read the abstract » | (added 2019-03-12)

  • Longer HD Treatments Do Not Make Up for the 2-day “Killer Gap”

    For 20 years, the kidney community has known that death on HD is significantly higher on the day after the 2-day “killer gap.” An analysis of 250+ minutes vs. <200 minutes HD treatments found that even 4.5 hour long treatments thrice weekly did not make the gap less lethal.

    Read the abstract » | (added 2019-03-12)