Journal Watch - Mortality
Glycated Albumin vs. HbA1c Predicts Mortality in PD Patients with Diabetes
In patients on hemodialysis, glycated albumin (GA) reflects glycemic control and predicts all-cause mortality. A new retrospective, longitudinal observational study looked at GA in PD. Among 44 PD patients with diabetes matched to 88 HD patients with diabetes followed for 3 years, GA was a more precise way to measure glycemic control than hemoglobin A1c.
Read the abstract » | (added 09/11/2019)
Payment Policy is Driving Increases in U.S. Home Dialysis
Follow the money. Analysis of 523,526 patients starting dialysis in the U.S. between 2005 and 2013 found increases in home dialysis use in all groups, and a decline in racial/ethnic differences in home dialysis. However, over time, white patients had an increase in mortality compared to minority patients, while transplant rates remained lower in minority patients.
Read the abstract » | (added 08/14/2019)
BMI and Survival on PD
A large study from Korea (N=80,674 PD patients) found that those in the highest group for BMI: just 25.71, had significantly higher all cause mortality.
Read the abstract » | (added 06/13/2019)
Wanted: A Paradigm Shift from Urea to Sodium Removal
When nephrology icon Zyblut Twardowski talks, we listen! When dialyzors in Seattle in the 1960s got 30 hours a week of dialysis, the mortality rate was 10%. Since then, short treatments—justified by the flawed NCDS study—were driven by the equally flawed notion of Kt/V urea.
Read the abstract » | (added 12/14/2018)
Protein Clearance Predicts Mortality on PD
Protein clearance on PD may be a marker of peritoneal inflammation. Among 711 PD patients followed for at least one year, each 10mL/day rise in protein clearance was linked with a 10.4% increase in the risk of all-cause mortality (p=0.008). Protein clearance was linked with serum albumin and C-reactive protein levels.
Read the abstract » | (added 12/14/2018)
Peritonitis Symptoms in Older vs. Younger People
A single center study compared the time to first episode of peritonitis treated successfully with antibiotics in PD patients >65 (n=79)compared to those who were younger (n=168). Of 377 peritonitis episodes, 126 were in the older group and 251 in the younger group. Older patients were less likely to have fever or cloudy dialysate as symptoms than younger patients, but rates of transfer to hemodialysis, relapse, hospitalization, and mortality were similar. Read the abstract.
Read the abstract » | (added 10/12/2018)
Home HD After PD Failure May Lead to More Transplants, Lower Mortality
Since PD failure can lead to hospitalization and death in those who switch to standard in-center HD (ICHD), would outcomes improve with home HD? A new analysis found 521 patients in the USRDS data who made the change. Compared to matched ICHD patients, the chance of transplant was nearly double (21% vs. 10.6%), while survival of home HD patients was 89.1% at 1 year and 80.5% at 2 years.
Read the abstract » | (added 08/13/2018)
High Peritoneal Transport and Long-term PD Outcomes
Among 470 patients who did PD for up to 10 years in Hong Kong, the peritoneal transport rate was able to differentiate survivors. After the first few years of PD, having high peritoneal transport became a significant risk factor for mortality.
Read the abstract » | (added 05/11/2018)
Improving Incident ESRD Care with Transitional Care Units
Patients who transition onto dialysis are at high risk for morbidity and mortality—along with high costs. Transitional care units use the first 30 days of treatment for systematic onboarding that includes education and informed options choice—and may be especially helpful to those who start treatment emergently. Read the abstract.
Read the abstract » | (added 03/16/2018)
Standard Kt/V urea Targets Less Useful for Home HD
When patients do home HD more often than three times a week, do the Kt/V urea targets still predict outcomes? Not all that well, suggests a new study. Multivariate regression analysis of 109,273 standard in-center HD patients compared to 2,373 home HD patients found that while a lower Kt/V urea (<2.1) did predict higher blood pressure in both groups, it did not predict metabolic control in either group. For those on home HD, a low Kt/V did not predict hospitalization, mortality, or technique failure, though it did for in-center patients. The authors concluded that the current Kt/V urea targets “have limited utility” for home HD.
Read the abstract » | (added 02/15/2018)