Journal Watch
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Metaanalysis: Weighted PD Catheters are Better
Analysis of data from 20 RCTs and 18 observational studies found no differences between double-cuff vs. single-cuff, swan-neck vs. straight-neck, and coiled-tip vs. straight tip PD catheters. Weighted PD catheters, on the other hand, were linked with significantly lower rates of tunnel infection, migration, drainage failure, cuff extrusion, and complication-related removal.
Read the abstract » | (added 2021-04-16)
Tags: Self locating Catheter, Coiled Catheter, Tenckhoff Catheter
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Patients Who Want Autonomy More Likely to Choose PD
A national survey had 630 HD and PD patients respond to a survey about internal locus of control (ILOC) and an interest in treatment responsibility (ITR). The responding PD patients were younger and had significantly more desire both for control in general and interest in treatment responsibility in particular.
Read the abstract » | (added 2021-04-16)
Tags: Peritoneal Dialysis, Pd, Hemodialysis, Hd, Decision making
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Better Technique Survival with Assisted PD
A study of 384 PD patients in China compared the outcomes of 274 who did self-care PD with 110 who had assisted PD. Older age, diabetes, low residual kidney function and low serum albumin predicted higher mortality, as did assisted PD, since this group had more comorbidities. Technique failure was also significantly lower in the assisted PD group.
Read the abstract » | (added 2021-04-16)
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Missed Opportunities to Help Patients to Home Dialysis
Even strong home dialysis programs do not always successfully get everyone who is interested in a home therapy to go home. In British Columbia, of the 1,845 patients who started dialysis between 2015 and 2017, 34% started on their preferred home therapy—while 8.9% did not, and 8.4% had remained undecided and started in-center. A significant factor was that those who chose and started a home treatment had more home therapy-specific (vs. “general modality orientation”) education
Read the abstract » | (added 2021-03-09)
Tags: Home Hemodialysis, Peritoneal Dialysis, Pd
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Functional Iron Deficiency and Survival on PD
A 10-year retrospective look at survival examined records from 1,173 PD patients who had normal iron levels, absolute iron deficiency, functional iron deficiency (FID), or high iron levels. Among the group, 77.5% had iron deficiency, and FID, in particular, was linked with an increased risk of all-cause—but not cardiovascular—mortality.
Read the abstract » | (added 2021-03-09)
Tags: Mortality, Peritoneal Dialysis, PD
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Shared decision-making (SDM) About Modality: PD vs. HD Experiences
A cross-sectional survey of 300 dialysis patients (82 on PD and 218 on HD) revealed that those on PD were significantly more likely to report having received an SDM conversation than those on HD. The authors conclude that SDM should take place in the early stages of CKD.
Read the abstract » | (added 2021-03-09)
Tags: Hemodialysis, Peritoneal Dialysis, PD
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Outcomes and Costs of Assisted PD
As many as half of those who could use PD need assistance to do so, and many countries outside the U.S. offer this. A narrative review found no differences in quality of life, hospitalization, or mortality between PD and in-center HD patients after adjusting for age and frailty. Nurse assistance may result in better technique survival than family assistance. Assisted PD was still significantly less costly than in-center HD in Canada and Western Europe.
Read the abstract » | (added 2021-03-09)
Tags: Assisted Peritoneal Dialysis, Barriers, Cost, Hemodialysis, Peritoneal Dialysis, Pd
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Virtual Nephrologist Mentoring for Home Therapies
A “hub and spoke” model for virtual home mentorship may help overcome some of the physician barriers to home therapies, suggest some of the top Canadian home dialysis nephrologists, who also review the literature.
Read the abstract » | (added 2021-03-09)
Tags: Home Dialysis, Peritoneal Dialysis, Pd
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New PD Fluid Tested in Italy
Most PD fluid is glucose-based, unphysiologic, and can cause fibrosis and long-term damage to the peritoneum—but that may be changing. A new PD fluid replaces the glucose with L-carnitine and/or xylitol. After 4 weeks on the new fluid, 10 CAPD patients had good tolerance and no adverse safety events. More research will be needed, but this looks promising.
Read the abstract » | (added 2021-03-09)
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Choosing Home Dialysis Does Not Mean Getting It
A retrospective, single-center study that followed 167 patients referred for CKD education in 2019 through 2020 found that just 23% chose standard in-center HD—74% chose home, and the remaining 3% were undecided. But, with 90% of patients living in New York City with limited space, and a clinic requirement that a trained care partner be present for all treatments, 56% of the in-center HD patients had chosen a home treatment. (Hint: Stop requiring a care partner!)
Read the abstract » | (added 2021-02-09)
Tags: Home Dialysis, Home Hemodialysis, Peritoneal Dialysis, Pd