Journal Watch
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Benefits of switching from 3x/week in-center HD to 6x/week home HD
Among 11 people who switched treatments, blood pressure dropped, hemoglobin levels rose (with lower ESA doses), the calcium-phosphorus product dropped (with no change in binder doses), and BMI and serum albumin levels went up. We are so not surprised!
Read the abstract » | (added 2011-03-30)
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Simpler pill regimen needed by those using nocturnal home HD
Among 35 people who switched from standard in-center HD to nocturnal home HD, the number of pills per day did not drop—but the regimen was much simplified—and health-related quality of life was significantly improved.
Read the abstract » | (added 2011-03-30)
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Better fluid removal with icodextrin PD fluid - Meta-analysis
A new study of 9 randomized controlled trials has found that people using icodextrin removed much more water than those using glucose based fluid—with no change in residual kidney function or increase in peritonitis or death. Rash was more common in those using icodextrin.
Read the abstract » | (added 2011-03-30)
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Daily HD survival compares to transplant
A study by Kjellstrand et. al. pooling data from 1006 short daily HD patient years (415 patients, both at home and in-center) found 2–3 times better survival than on standard in-center HD. In fact, survival with daily HD was similar to that of deceased donor transplant. (Interesting that no-one disputes that survival is better with transplant than standard HD—though patients are selected for it (just as for home HD) and no randomized controlled trial has been done.)
Read the abstract » | (added 2011-02-24)
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New study: Survival benefit for nocturnal HD
Researchers from the U.S. and Canada matched each of 94 people on nocturnal HD and 43 on short daily HD to 10 controls on standard HD. Even using the "proportional hazards model", they found a significantly lower risk of hospitalization and death on nocturnal, and a lower (but not significant) risk for daily, too.
Read the abstract » | (added 2011-02-24)
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Secondary arteriovenous fistulas: Converting prosthetic AV grafts to autogenous dialysis access
Dialysis fistulas tend to have fewer clots, infections, and hospital stays than grafts. Switching from a graft to a fistula was highly (90%+) successful after 2 years in a new study.
Read the abstract » | (added 2011-02-24)
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Consistent aspirin use associated with improved AVF survival among incident HD patients in the DOPPS
A new paper from the Dialysis Outcomes & Practice Patterns Study (DOPPS) reports that people who took aspirin had significantly less fistula failure than those who didn't. (Talk to your doctor about whether a baby aspirin or an adult aspirin might benefit you.)
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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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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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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