Journal Watch
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A Home First Policy Helps Drive Home Therapy Choice
In the multinational Peridialysis study, of 1,587 people starting dialysis, 32.5% were judged “unsuitable” for a home treatment due to contraindications—or a lack of assessment. Among the suitable 1,071, 65.4% chose PD and 3.6% chose home HD, and the remainder went in-center. Late referral, suboptimal dialysis initiation, acute illness—and no “home dialysis first” policy were factors linked to use of in-center HD.
Read the abstract » | (added 2021-09-14)
Tags: Lack Of Assessment, Glomerular Filtration Rate, Haemodialysis, Peritoneal Dialysis, Pre dialysis, Uraemia
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Outcomes of Incremental PD
A retrospective cohort study looked at 175 PD patients followed for about 2 years. Starting PD with a lower vs. higher dose was associated with better survival.
Read the abstract » | (added 2021-08-12)
Tags: Peritoneal Dialysis , PD, End stage Kidney Disease, Dialysate Volume, Survival
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Feel Low on PD? Could be Vitamin D
In a study of 50 people on PD, those with vitamin D deficiency (< 20ng/mL) did more poorly than those with adequate vitamin D levels on all subscales of the KDQOL-36 survey to measure health-related quality of life. High blood pressure was also a factor in higher kidney disease burden.
Read the abstract » | (added 2021-08-12)
Tags: Serum Vitamin D Levels, Health related Quality Of Life, Peritoneal Dialysis
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Encapsulating Peritoneal Sclerosis Linked to Vasculopathy
EPS is a rare but devastating complication of PD. Tissue samples from 223 people with EPS who had surgery to remove adhesions were analyzed under a microscope. In the 174 samples that could be evaluated, the individuals who had used conventional PD fluid had more severe vasculopathy and longer PD durations than those who used pH neutral PD fluid.
Read the abstract » | (added 2021-08-12)
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Poorer Survival for Those Who Switch from Home to In-center HD
Among 19,306 people who started HD in the ANZDATA registry from 2005 to 2015 and were treated for more than 90 days, those who started home HD and then went to in-center HD had significantly higher mortality than those who stayed at home. The reasons for this are not yet known.
Read the abstract » | (added 2021-08-12)
Tags: HD, Home HD, In center HD, Mortality, Home Hemodialysis Treatment Failure
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Healthcare System Change Increased PD and Home HD in Australia
A lean-thinking framework and commitment of top leadership to change the system of care were used in a “Home before Hospital” approach to increase use of home therapies. Multidisciplinary Pathway, Outreach, and Hybrid working groups were established, and goals were set. A target of >30% for PD and home HD was achieved in 2 years, 35% within 3 years—and was still being maintained at 8 years.
Read the abstract » | (added 2021-08-12)
Tags: Peritoneal Dialysis, PD, Home Haemodialysis
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Is Endoscopy Safe in PD?
Peritonitis can occur after endoscopy. A retrospective 10-year review divided 570 PD patients who had 1,316 endoscopies into three groups. Group 1 did not have prophylactic antibiotics. Group 2 did have them. Group 3 had prior antibiotics. An analysis of the peritonitis rates within 7 days of the procedures found a 3% rate that was not affected by whether or not antibiotics were given.
Read the abstract » | (added 2021-07-12)
Tags: Endoscopy, Peritoneal Dialysis, Peritonitis
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The Clinical Experience of In-center Nocturnal HD
An analysis of 4 years of INHD looked at 12 patients who chose to stop, 24 patients who continued, and interviews with patients and staff. A “starter pack” given to aid sleep in new INHD patients was well-received and sleep was not a reason to stop INHD. Staff were most concerned about emergency support, though staffing ratios were the same as during the day. Most of the clinical incidents for INHD centered around communication with patients and families, patient transfer delays, and equipment issues—not medical interventions, infection control, and transport, as during the day. Those who continued with INHD felt they had more social time and perceived health benefits.
Read the abstract » | (added 2021-07-12)
Tags: INHD
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PD Adequacy and Itching
Among 80 people on CAPD, blood levels of the pain marker “substance P” and total urea clearance both independently predicted itching. Inadequate PD seems to be a reason for people using PD to itch.
Read the abstract » | (added 2021-07-12)
Tags: Pruritus , Peritoneal Dialysis, CAPD, Substance P, Total Urea Clearance, Itching, PD
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Roxadustat for Anemia in PD
The anemia drug was tested in 129 people on PD randomized to roxadustat or other ESAs for 24 weeks. The roxadustat group had a 96% response rate (vs. 92%), lower hepcidin levels and higher TIBC. Total cholesterol and LDL dropped more with roxadustat, independently of C-reactive protein. Mean average hemoglobin on roxadustat were 11.5 g/dL (vs. 11.2). There were some common adverse events.
Read the abstract » | (added 2021-07-12)
Tags: Prolyl Hydroxylase Inhibitor, Erythropoiesis, Iron Metabolism, Anemia