Journal Watch
Home HD, Self-cannulation, and Survival
An observational study of all home HD patients at a single center from 2001 to 2020 examined treatment survival and mortality. Among 77 self-cannulating patients dialyzing for a median of 18 hours per week, there were 11 deaths, largely cardiovascular, and 19 technique failures after 100 months, largely due to vascular access issues.
Read the abstract » | (added 2024-06-14)
Tags: Home HD, Self Cannulation, Treatment Survival, Mortality, Cardiovascular, Technique Failure, Vascular Access
Nursing Home Frequent Dialysis May Get People Home Sooner
Retrospective observation of admissions to skilled nursing facility (SNF) with on-site more frequent dialysis (MFD) studied 195 nursing homes in 12 states, 3,451 conventional dialysis treatments, and 10,246 MFD treatments. While the MFD population was sicker at baseline (lower hemoglobin, higher mean age, higher comorbidity score, more cerebrovascular disease and congestive heart failure), their discharge to home was 25% greater than those in the conventional dialysis group.
Read the abstract » | (added 2024-06-14)
Tags: Nursing Home, Frequent Dialysis, Skilled Nursing Facility, Discharge To Home Dialysis
Personalized PD Prescriptions
Urea alone is not able to assess dialysis adequacy. Rather than a focus on removing a single toxin, a more holistic, person-centered approach is emerging to improve well-being and minimize treatment burden—based on clinical outcomes and patient experiences of care. This approach requires close collaboration between patients and care teams and eliciting patient goals, priorities, and preferences. This paper reviews the evidence for a patient-centered approach to PD.
Read the abstract » | (added 2024-06-14)
Tags: Urea, Dialysis Adequacy, Treatment Burden, Patient centered Care, PD
IM-HOME Study Examines Barriers to Home Dialysis
A small advisory board of patients, care partners, and providers devised lists of perceived barriers to inform an online survey. Respondents ranked their top three barriers and described barriers. Among 298 patients and care partners, the top three barriers were fear, lack of space, and a need for support. Provider- (n=224) perceived barriers were quite different: poor patient education; limited support for home staff, mental health, and education; and lack of experienced staff.
Read the abstract » | (added 2024-06-14)
Management of PD Anemia in Japan
Should people who use PD have the same hemoglobin (hb) targets as those who do HD? Researchers analyzed registry data of 4,875 patients 18 or older who were doing PD at the end of 2012 and compared their hb levels with mortality for the 1,586 who died. In a U-shaped curve, hb levels < 9.0 and > 13.0 were significantly associated with death. In those who had a history of cardiovascular disease, hb levels > 12.0 were significantly associated with death.
Read the abstract » | (added 2024-06-14)
An Integrated Care Model Supports Home Dialysis
A new paper describes a model of care that prioritizes safe and effective use of home therapies, patient-centered care, informed decision-making, and comprehensive support. The integrated care framework emphasizes continuous quality improvement and helps to identify and assess patients, educate them, facilitate transitions between modalities, and consider the logistics of urgent dialysis starts. The aim is to create a seamless transition to home.
Read the abstract » | (added 2024-06-14)
Tags: Model Of Care, Home Therapies, Patient centered Care, Informed Decision making, And Comprehensive Support, Integrated Care Framework, Modality
Fluid Compartment Shifts and Post-hemodialysis Recovery Time
GENTLE ultrafiltration matters! A bioimpedance study analyzed data from 124 patients who had long (>1 hour) or short (<1 hour) recovery times after dialysis. Patients who had sessions with prolonged recovery time also reported more symptoms, psychological distress—and greater compartmental fluid shifts, as seen in extracellular water to total body water ratios.
Read the abstract » | (added 2024-05-09)
Tags: Ultrafiltration, Bioimpedance, Post hemodialysis Recovery Time, Fluid Compartment Shifts, Extracellular Water, Peri‐dialytic Symptoms
Why Do Patients Switch from PD to HD?
In retrospective data from 5,224 DCI PD patients from 2010 to 2019 about 61% started with PD (PD-first), 18% switched from HD to PD in the first 90 days (PD-early), and 21% after 90 days (PD-late). Compared to PD-first patients, those who switched early or late had a higher risk of transfer to HD in the first 9 months. Additional risk factors included peritonitis, fewer home visits, lower serum albumin, lower residual kidney function, and lower PD clearance.
Read the abstract » | (added 2024-05-09)
Tags: PD first, PD early, PD late, Peritonitis, Serum Albumin, Residual Kidney Function, PD Clearance
Carbon Footprint of CAPD vs. CCPD/APD in Australia
In the U.S., CAPD has been losing ground to cycler PD for a decade or more. But, an Australian analysis finds that CAPD has about a one-third lower carbon footprint than use of a PD cycler. With Baxter equipment, the manufacture and disposal of PD fluids and consumables were estimated at 1,992 Kg CO2 equivalent emissions for cycler PD; and just 1,245 Kg CO2 equivalent emissions for manual PD.
Read the abstract » | (added 2024-05-09)
Does Social Deprivation Impact PD Outcomes?
A French registry (REIN) study examined data from 1,581 adult PD patients during the 18 months from January 1, 2017 to June 30, 2018, with observation completed in December, 2020. More than a quarter (418; 26.5%) were in Quintile 5 of the European Deprivation Index; the most deprived patients. Social deprivation was not associated with death or a composite event of death or transfer to HD.
Read the abstract » | (added 2024-05-09)
Tags: Social Deprivation, PD Outcomes, European Deprivation Index