Journal Watch
Yet Another Study Demonstrates the Superiority of Home HD over In-Center
A cohort registry study matched 181 home HD patients with 413 in-center HD patients in Australia and New Zealand by age, gender, and cause of ESKD. After adjusting for BMI, smoking, race, and comorbidities, home HD had almost half the death risk of in-center HD, as well as significantly lower phosphate levels. Both groups had similar rates of transplant and graft survival 6 months after a transplant.
Read the abstract » | (added 2021-01-12)
Will Silicone Be the Future of HD Membranes?
Silicone nanoporous membranes (SNMs) have an average pore size of 8 nanometers. Tested with urea and creatinine, the new material was able to clear about 81% of high concentration uremic toxins in 45 minutes. This material could make more compact and portable dialysis systems possible.
Read the abstract » | (added 2021-01-12)
Tags: Silanization, Silicon Nanoporous
New Xylitol-based PD Fluid with L-Carnitine May be More Biocompatible
It is ironic that the glucose-based fluid that made PD possible can also harm the membrane so it stops working. A new PD fluid uses xylitol and l-carnitine to remove water instead of glucose. When tested on human cells, the new fluid kept more cells alive and reduced inflammation.
Read the abstract » | (added 2021-01-12)
Remote Monitoring May Reduce PD Technique Failure
In a study looking back at 558 adult APD patients, 148 who had used remote monitoring were matched to 148 patients from the 410 who had not. The researchers found a significantly lower rate of PD technique failure in the remote-monitored group. More studies are needed.
Read the abstract » | (added 2021-01-12)
Tags: Technique Failure, Telemedicine.
Mobile Health Readiness of Home vs. In-Center Dialysis Patients
Smartphones and other mobile devices can be used to deliver health messages. In a survey of 949 patients from 14 home and 21 in-center dialysis clinics, 81% had mobile devices to get online, and 72% used the Internet, some (18%) despite concerns about data privacy and security. Younger, non-Hispanic, and more educated patients were more likely to use mobile health, and working patients had the highest rates of proficiency. After adjustment, in-center and home patients were equally proficient with mobile health.
Read the abstract » | (added 2021-01-12)
Tags: Kidney Disease, Hemodialysis, Telehealth, Telemedicine
Benefits of Remote PD Monitoring
Compared to 38 standard care PD patients, 35 who received remote monitoring (RM) for 6 months had better outcomes despite higher Charlson Comorbidity scores. The RM group lived further from the clinic or had mobility issues, but were more satisfied with their care, and they had fewer emergency room visits and nephrology-related hospitalizations.
Read the abstract » | (added 2020-12-10)
Tags: Quality Of Life, Remote Monitoring
Exercise May Improve Residual Kidney Function in PD
A post-hoc study of a 12-week randomized controlled trial of home exercise for PD patients eliminated those with anuria (n=18) and analyzed 13 patients in the usual care group and 16 in the exercise group. Two RKF markers, liver-type fatty acid-binding protein (L-FABP) and the microalbumin-to-creatinine ratio, were significantly lower in the exercise group.
Read the abstract » | (added 2020-12-10)
Are In-center Hemodialysis Patients Interested in Self-Care?
In-center self-care can be a bridge to home hemodialysis. A survey of 91 patients and 31 nurses revealed higher interest among the patients than the nurses (2.43+0.93 vs. 2.19+0.77). Patients also considered themselves to be capable of performing self-care tasks. Greater interest and perceived capability were linked with years of education, patient activation, disease severity, and age.
Read the abstract » | (added 2020-12-10)
Tags: Renal Dialysis, Self‐care, Self‐management
Use of CMS-reimbursed CKD Education Doubles the Likelihood of Home Dialysis
While Medicare has paid for stage 4 CKD kidney disease education (KDE) since 2010, only a tiny fraction have used it—but KDE matters, finds an analysis of 369,968 patients who started dialysis between 2010 and 2014. Just 3,469 (0.9%) had received at least one KDE session, but compared to controls matched for age, gender, ESRD Network and year of dialysis start, they were twice as likely to have started a home dialysis treatment. Concerningly, African American and Hispanic patients were significantly less likely to have received KDE services.
Read the abstract » | (added 2020-12-10)
Tags: Home Dialysis, Kidney Disease Education, Peritoneal Dialysis
Nephrology Fellows Not Ready for Home Dialysis
Even nephrology fellows attending home dialysis conferences did not feel prepared to care for PD or home HD patients, finds a small study. Of 110 attendees, 76 (66%) completed a survey about their confidence with regard to management of home dialysis. Most were “moderately” confident about PD principles—though just 11% had seen a PD catheter insertion, and only 3% had initiated a patient on urgent start PD. Most had “low” confidence in their ability to manage home hemodialysis.
Read the abstract » | (added 2020-12-10)