Journal Watch
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The Varied Uses of Assisted PD in Spain
In a retrospective look from 1997 through 2020, a Spanish clinic identified four groups who used assisted PD at some point. Group 1 was totally dependent at PD start, group 2 was self-care and then became totally dependent, group 3 needed short-term PD help, and group 4, the controls, remained on self-care. Of those who required assistance, 73% did so during follow up, not initially. Up to 44% of autonomous patients became dependent for various reasons over time, including loss of a care partner. Assisted PD—even when paying care partners—was less costly than switching to standard HD.
Read the abstract » | (added 2022-10-17)
Tags: Assisted PD, Dependency
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Savings from Incremental PD
In a stud of 147 people who did incremental PD from 2009 through 2021, 11.9% transitioned to full-dose PD. Peritoneal glucose exposure was reduced by multiple kilos per year, and costs, plastic waste, and water use were also lower, as was time to manage PD.
Read the abstract » | (added 2022-10-17)
Tags: Healthcare Cost, Cost Analysis, Incremental PD, Full dose PD, Peritoneal Glucose Exposure
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PD: Sweat it Out to Reduce Fluid Overload
In a small study, 4 people on PD used a portable sauna bath daily for 10 days, at 30 minutes a day and a temperature of 45°C. Most (51) of the 54 sauna sessions were well-tolerated; two people reported dizziness and one person with advanced diabetic neuropathy received a second degree skin burn. Body water loss and blood pressure improved significantly from the control period. Larger studies are needed.
Read the abstract » | (added 2022-10-17)
Tags: Diaphoresis, Fluid Overload, Sauna Bath, Sweat
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HD Dose and Patient Survival: More is Better
Even using spKt/V—a flawed measure that considers only urea—a study of 558 standard HD patients from 2015 to 2020, of whom 214 died, found that a higher dose of dialysis reduced the risk of all-cause mortality by 33%.
Read the abstract » | (added 2022-09-13)
Tags: HD Dose, Dialysis Dose, Patient Survival, All cause Mortality
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Impact of Telemedicine on PD Technique Survival
Can telemedicine (TM) help people stay on PD longer? A prospective study conducted in 27 hospitals in China since 2016 enrolled 7,539 patients. Compared to matched patients in the non-TM group (60.9%), those in the TM group (39.1%) had significantly lower risks of severe fluid overload, inadequate solute clearance, non-infectious catheter complications, transfer to HD, and death.
Read the abstract » | (added 2022-09-13)
Tags: Telemedicine, PD, Technique Survival, Fluid Overload, Inadequate Solute Clearance, Non infectious Catheter Complications
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Replacing Dextrose in PD Fluid—with Steviol Glycosides?
Using glucose to remove water will scar the peritoneum over time—making PD a short-term option for most. Icodextrin (Extraneal®) is a glucose-free alternative. Now, researchers are looking at another one: steviol glycosides (SG), the compounds that make stevia taste sweet. Using artificial membranes and mice, dialysate with 1.5%, 1%, and even 0.75% SG had similar results as glucose-based fluids—with better biocompatibility.
Read the abstract » | (added 2022-09-13)
Tags: Dextrose, PD Fluid, Steviol Glycosides, Icodextrin
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Safety of Exercise for Those Who Do PD
A review of 25 studies of exercise in PD found only minor adverse events, mainly short-term muscle or joint pain or fatigue. There were no serious adverse events or signs of harm.
Read the abstract » | (added 2022-09-13)
Tags: PD, Peritoneal Dialysis, Exercise, Benefits, Adverse Events
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Too-high OR Too-low LDL Cholesterol and Survival on PD
A retrospective study in China looked at data from 3,565 people starting PD from 2005 to 2020. Both higher and lower levels of LDL-C were linked with higher all-cause and cardiovascular mortality. Malnutrition and low LDL-C was especially risky.
Read the abstract » | (added 2022-08-11)
Tags: PD, LDL C, Cardiovascular Mortality, All cause Mortality, Malnutrition
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Late CKD Options Education Affects PD Selection
Analysis of data from 355 people at one center found that those who received CKD options education while their eGFRs were higher were more likely to choose PD. Other factors such as gender, poverty, or living alone were not associated with PD choice.
Read the abstract » | (added 2022-08-11)
Tags: CKD Options, RRT Education Timing, Patient Education PD, Peritoneal Dialysis, Dialysis Choice
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Healthcare System Factors in Home Modality Choice
A Midwest interview study was conducted with 40 people, half doing standard in-center HD. Access to and engagement in healthcare prior to nephrology care and after dialysis start had an impact on patients’ awareness of their CKD, its progression, and dialysis options—and most had been passive during decision-making. Level of fatigue, treatment schedule, and access problems affected satisfaction.
Read the abstract » | (added 2022-08-11)
Tags: Standard In center HD, CKD Progression, Dialysis Options, Shared Decision making