Journal Watch
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Outcomes with PD to HHD Compared to Direct HHD
Analysis of data from all patients who started PD or HHD in the first 90 days of kidney replacement therapy in Canada matched PD+HHD patients (n=163) 1:1 to incident HHD patients (n=711). Interestingly, while hospitalization risk was similar, clinical outcomes were better in the PD+HHD group.
Read the abstract » | (added 2023-09-13)
Tags: PD, HHD, Kidney Replacement Therapy, Clinical Outcomes
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Early Survival Advantage for Incremental PD
From 2008 to 2017, 1,315 patients from one hospital who started PD were enrolled in a study that propensity matched them 1 (incremental; n=285):2 (full dose; n=502) for age, sex, residual kidney function and urine volume, hemoglobin, serum albumin, and other variables. For the first 6 years, intermittent PD had significantly better survival than full dose PD, with a 39% lower risk of all-cause mortality and 41% less cardiovascular mortality. This advantage disappeared with longer time on PD.
Read the abstract » | (added 2023-09-13)
Tags: Intermittent PD, Full Dose PD, Mortality
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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
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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
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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
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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
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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
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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
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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
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Value of an Integrated Home Dialysis Model in the United Kingdom: A Cost-Effectiveness Analysis
This study aimed to determine the lifetime cost-effectiveness of increasing home hemodialysis as a treatment option for patients experiencing peritoneal dialysis technique failure compared with the current standard of care.
Read the abstract » | (added 2023-07-17)
Tags: Cost effective, Home Hemodialysis, Treatment Option, Peritoneal Dialysis Technique Failure