Disparities in Access to PD

Per logistic regression of USRDS data from 2009 to 2019, the incident PD population more than doubled, with increases in PD use by seniors. There was a 5% increase in PD use by Hispanic people, but no difference in other races. Urban PD use also increased by 5%, and 7% for those in socioeconomically disadvantaged areas.

Read the abstract » | (added 2023-08-16)

Tags: Incident PD, PD Access, Disparity, PD Demographics

Skilled Nursing Facility “Home” Dialysis Improves Rehabilitation

Rehab therapies take time—and so does going off-site for in-center dialysis. Offering more frequent dialysis (MFD) at SNFs saves time. Does it improve PT participation? Yes, finds a new retrospective EMR review study. Compared to 562 in-center HD rehab patients, 92 people who received MFD in their SNF had higher PT participation rates (equivalent to almost 13,000 non-ESRD rehab patients), even though they had significantly more comorbidities.

Read the abstract » | (added 2023-08-16)

Tags: Rehabilitation Therapies, Skilled Nursing Facility, MFD, SNF, PT Participation, Comorbidities

Meta-analysis of Quality of Life by ESRD Treatment Modality

Analysis of 111 papers with more than 50,000 patients compared transplant, PD, home HD, and in-center HD for health-related quality of life outcomes. The rankings? Transplant, PD, home HD, in-center HD.

Read the abstract » | (added 2023-08-16)

Tags: Quality Of Life, ESRD, Treatment Modality

ISPD Proposes to Remove PD Toxin Clearance Targets

New ISPD Guidelines suggest that the focus of PD should be patient well-being—not lab values. This change would allow more people to do PD, and focusing on relieving uremic symptoms could help determine which solutes really do matter to quality of life.

Read the abstract » | (added 2023-08-16)

Tags: PD, Patient Well being, Lab Values, Uremic Symptoms, Quality Of Life

How Glucose Causes Peritoneal Fibrosis

Constant glucose exposure from PD dialysate often causes fibrosis that can make further PD impossible. High glucose causes chronic inflammation, interferes with lipid metabolism, and leads to angiogenesis and fibrosis. RAAS activation contributes to this process as well. There may be benefit to looking at the upstream pathways to see if there are ways to block fibrosis.

Read the abstract » | (added 2023-08-16)

Tags: High Glucose, PD Dialysate, Fibrosis

2023 AJKD Core Curriculum in Nephrology

Acute PD, more use of home treatments, and better peritoneal solute transfer models are part of the content of the new Core, which emphasizes the latest data for prevention and management of infectious and noninfectious complications of PD.

Read the abstract » | (added 2023-08-16)

Tags: Acute PD, Core Curriculum, Complications Of PD, Home Dialysis

Systematic Review of Culture-directed Antibiotics for Peritonitis

A review of 28 articles identified 18 antibiotics used for peritonitis, of which 9 (cefotaxime, ceftriaxone, daptomycin, ofloxacin, and teicoplanin in glucose-based solutions, tobramycin in Extraneal solution only and fosfomycin in Extraneal, Nutrineal, Physioneal 1.36% and 2.27% glucose solutions ) can be dosed interaperitoneally. Stability has not yet been demonstrated for all of these.

Read the abstract » | (added 2023-08-16)

Tags: Peritonitis, Antibiotics, Culture directed Antibiotics, Peritoneal Dialysis Solutions

Paradoxical Finding in PD Peritonitis

The common wisdom is that larger patients are at greater risk for PD-associated peritonitis (PDAP). But, a new single-center study of 483 peritonitis episodes in 285 patients suggests that the opposite may be true. A lower value of body surface area was an independent risk factor for peritonitis episodes. (p=0.015).

Read the abstract » | (added 2023-07-17)

Tags: Body Surface Area, PDAP, Metabolism, Nutrition, PD, Peritoneal Dialysis, Peritonitis

PD vs. Home HD for Severe Infections

In a Finnish study of 536 patients using home dialysis, the risk of a severe infection (C-reactive protein of 100mg/L or higher) in year 1 of CAPD was 35%, APD was 25% and home HD was 11%. Over a 5-year period, compared to home HD, the hazard ratio of severe infection for APD was 2.2 and for CAPD, 2.8. PD peritonitis accounted for the difference.

Read the abstract » | (added 2023-07-17)

Tags: Home Dialysis, Severe Infection, C reactive Protein, CAPD, APD, HD, Home HD, PD Peritonitis

GI Outcomes in PD Trials

A meta-analysis of 61 trials looking at patient-reported GI outcomes of PD mainly found nausea (43% of trials), diarrhea (43%), constipation (34%), abdominal pain (31%) and PD peritonitis (40%). But, only 19% of the available trials reported GI outcomes at all.

Read the abstract » | (added 2023-07-17)

Tags: GI Outcomes, PD, Nausea, Diarrhea, Constipation, Abdominal Pain, Peritonitis