Journal Watch
Double Purse String Suture for Urgent Start PD Catheters
An Italian article reports that use of a double purse-string technique allowed immediate CAPD starts within 24 hours of catheter placement, with no difference in complications (mechanical or infectious) or catheter survival between surgical or trocar placement.
Read the abstract » | (added 2020-03-16)
Tags: Double Purse string, CAPD Starts, Catheter Placement, Catheter Survival
Glucose Degradation Product (GDP) Disrupts Peritoneal Membrane Function
Growth of new, immature blood vessels on the peritoneal membrane is linked with ultrafiltration failure. Exposure to the GDP methylgyoxal (MGO) up-regulated both vascular endothelial growth factor (VEGF) and suppressed platelet-derived growth factor (PDGF) in vitro, potentially disrupting the balance of angiogenesis.
Read the abstract » | (added 2020-03-16)
Tags: Peritoneal Membrane, Ultrafiltration Failure, Methylgyoxal, Angiogenesis
Glucose and Peritonitis
A prospective, longitudinal cohort study followed 105 PD patients for up to 5 years (mean of 23 months). Higher glucose exposure significantly predicted peritonitis, and patients with more residual kidney function also had a significantly longer time to first bout of peritonitis. Read the abstract. The authors suggest using the lowest concentration of glucose possible.
Read the abstract » | (added 2020-03-16)
Physician Reimbursement Increases Did Not Drive PD in Canada
Among a cohort of 4,262 patients in Alberta, Canada followed between 2001 and 2014, an increase in PD physician pay from $0 to $135 (over a 9-year period) revealed no statistical evidence of a difference in PD use or trends—and the role of the physician in modality selection was unclear.
Read the abstract » | (added 2020-03-16)
Tags: PD Physician Pay, PD Use Trend
Green Nephrology: Reducing the Environmental Impact of Dialysis
Climate change and extreme weather events both increase the incidence of kidney disease and destabilize care. But, healthcare in general—and dialysis in particular—contribute substantially to greenhouse gases. Monitoring resources and reducing waste in HD can be done through reuse of RO reject water, renewable energy sources, better waste management, and slower dialysate flow rates. For PD, point-of-care dialysate will reduce the environmental impact.
Read the abstract » | (added 2020-02-19)
Tags: Environmental Change, Kidney Disease Factors, Environmental Impact Of Dialysis
PD Glucose Absorption and Lipid Profiles
Lipid status was assessed at baseline and 12 month in 143 CAPD patients, 2/3 of whom used a daytime icodextrin exchange. No associations were found between glucose absorption, lipid profiles, or changes in serum lipids.
Read the abstract » | (added 2020-02-19)
Tags: Peritoneal Dialysis, Cholesterol, Glucose, Triglycerides
Exercise in PD Patients and Residual Renal Function
After a 12-week home-based exercise program was completed, researchers analyzed residual renal function among 13 patients who received usual care and 16 who had been in the exercise intervention group. Urinary liver-type fatty acid-binding protein and microalbumin-to-creatinine ratios were significantly lower in the exercise group, suggesting a possible benefit.
Read the abstract » | (added 2020-02-19)
Tags: Exercise, Renal Outcome, Residual Renal Function, Peritoneal Dialysis
Comorbidities—but not Peritonitis—drove Mortality on PD
Among 242 Turkish PD patients followed for up to 9 years, age over 65, diabetes, cancer, and heart failure were independent risk factors for death, but surprisingly peritonitis was not.
Read the abstract » | (added 2020-02-19)
Tags: Peritoneal Dialysis, Mortality, Patient Survival, Peritonitis, Technique Survival
The Q-Cohort Study: More Dialysis, Less Risk of Cancer
Uremic toxins increase cancer risk. In a study of 3,450 HD patients followed for 4 years, patients were divided into quartiles based on their baseline Kt/V. Four-year survival dropped linearly along with Kt/V. Every 0.1 increase in Kt/V reduced the risk of cancer death by 8%.
Read the abstract » | (added 2020-02-19)
Tags: Dialysis Dose, Cancer Death, Hemodialysis, Uremic Toxins, Kt/V
Survival with PD vs. Home HD and When to Go Home
Using a national cohort of 1,993 patients transitioning to home HD and 16,514 to PD between 2007 to 2011, 1,195 home HD were matched to 1,195 using propensity scores and adjusting for demographics, comorbidities, dialysis duration, and BMI. Those on home HD had significantly better survival (9.6 vs. 12.9 deaths per 100 patient-years; p<0.001). However, when patients switched to PD within the first 12 months of starting dialysis, survival was comparable between PD and home HD: patients who transitioned after 12 months had an 83% higher risk of death.
Read the abstract » | (added 2020-02-19)
Tags: Home HD, PD, Comorbidities, Dialysis Duration, BMI, Survival