Home HD Core Curriculum 2021

AJKD has released a new edition of this manual, which covers benefits, pitfalls and challenges of starting and growing a home HD program, home HD equipment, prescriptions, and medical management.

Read the abstract » | (added 2021-12-16)

Tags: Home Hemodialysis, HHD, Home HD Program, Patient Choice

Standard vs. Incremental PD Start: 12-year Retrospective Study

When people start PD with some residual function, is it beneficial not to begin with a full PD prescription? A study looked back at 12 years of people who started PD, 232 standard and 71 intermittent (iPD; 2-3 manual exchanges per day). Those who did iPD had higher residual kidney function than those on standard PD. For people with diabetes, iPD was linked with a survival advantage as well.

Read the abstract » | (added 2021-12-16)

Tags: PD, Residual Function, Intermittent PD, IPD, Diabetes

Oral Hygiene and Nutritional Status on PD

Clean teeth mattered for nutritional status and hand grip strength in a small study (n=41) of people on PD. Inflamed gums can cause tooth loss and limit what people can eat. Those with dirty to very dirty teeth had poorer nutrition than those with clean or slightly dirty teeth, and their hand grips were weaker. Those with dirty teeth also had more GI symptoms and a higher risk of malnutrition.

Read the abstract » | (added 2021-12-16)

Tags: PD, Tooth Loss, Malnutrition, Gingivitis, Periodontitis

Clinically-focused Shared Decision-making Does NOT Improve Home Dialysis Uptake

A qualitative interview study with 95 people in Wales found that generic, clinically-focused shared decision-making was not able to overcome denial, lack of symptoms, and health systems issues to increase use of home dialysis. Unmet and unrecognized family needs and untranslated medical knowledge were additional challenges. The “simplest” option seemed to be standard hemodialysis.

Read the abstract » | (added 2021-12-16)

Tags: Clinically focused Shared Decision making, Home Dialysis Uptake, Pre dialysis

Minority of UK Dialyzors Would Choose Standard HD Schedule

Given the choice of 12 different scheduling options, just 38% of 183 people doing standard in-center HD would always choose to keep doing what they were doing. Of the remainder, after being informed of the survival and quality of life benefits of more dialysis, 27.1% would choose longer treatments thrice weekly, and 34.4% would choose four 4-hour treatments per week.

Read the abstract » | (added 2021-11-12)

Tags: In center HD, More Frequent Hemodialysis, Longer Treatments

Italians Improve on Daily Home HD

As in the U.S., the Italian Ministry of Health has home dialysis as a primary objective. In a 2-year study of seven people switched to six times per week daily home HD, significant improvements began to appear almost immediately. After 3-6 months, bone mineral balance and blood pressure were better, PTH levels and use of phosphate binders dropped, and the participants needed less rhEPO.

Read the abstract » | (added 2021-11-12)

Tags: Home Dialysis, Daily Home HD, RhEPO, Mineral Balance, Blood Pressure, PTH Levels

New Clinical Practice Guidelines for Exercise on PD

The International Society for Peritoneal Dialysis and the Global Renal Exercise Network have teamed up to grade and review the literature and clinical experience to help people on PD stay physically active safely. With sparse quality evidence available, the new guidelines are largely opinion based, and cover timing of exercise relative to PD (i.e., empty or full); impact of exercise on mental health, weight, frailty, etc.; exercise nutrition, and potential adverse PD outcomes.

Read the abstract » | (added 2021-11-12)

Tags: Peritoneal Dialysis, Exercise, Physical Activity, PD Outcomes

Local Anesthetic for PD Catheter Placement

A study of 27 people tested the feasibility of using mepivacaine 1% (which lasts longer than lidocaine) plus sedation with Remifentanil for PD catheter placement. None of the 27 needed to convert to general anesthesia, and all of the catheters worked with no leakage.

Read the abstract » | (added 2021-11-12)

Tags: PD Catheter, Mepivacaine, Remifentanil

Health-related Quality of Life Better on PD than Standard HD in Morocco City

Compared to 71 people using standard HD, 20 doing PD had significantly better physical and mental component scores and staff encouragement, and significantly lower burden of kidney disease scores.

Read the abstract » | (added 2021-11-12)

Tags: Standard HD, PD, Component Scores, Burden Of Kidney Disease Scores

Some Antihypertensive Meds Reduce GI Bleeds in PD

GI bleeding is more likely in people with CKD. A study of 734 people on PD were followed to see if use of an ACE-inhitor or angiotensin receptor blocker (ARB) would reduce the incidence. After an 8-year follow-up, those who were taking these meds had a significantly lower rate of GI bleeding.

Read the abstract » | (added 2021-11-12)

Tags: GI Bleeding, CKD, PD, ACE inhitor, Angiotensin Receptor Blocker