Journal Watch
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)
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
PD vs. HD for Quality of Life
Eleven studies from 2000 to 2019 (N=3,711) comparing PD with in-center HD (ICHD), PD vs. home HD, ICHD vs. self-care ICHD, ICHD vs. home HD, and various home HD modalities with each other were analyzed to determine the impact of modality on quality of life. PD was favored in some domains, while ICHD was favored in others. Home HD was rated significantly higher than ICHD for some domains.
Read the abstract » | (added 2020-11-12)
Tags: Dialysis, Dialysis Choice, PD, HD
Quanta SC+ Efficacy and Safety
A human factors test of the Quanta SC+ of 60 patients in the UK (1,333 treatments) using conventional, thrice weekly schedules had no serious adverse events. Ultrafiltration was within acceptable limits.The threshold standardized Kt/V was exceeded in 94% of treatments, and in 97.6% of patients who did not have significantly residual kidney function.
Read the abstract » | (added 2020-11-12)
Warming PD Fluid to Body Temperature Does Not Improve Clearance
There may not be a clear benefit to warming PD fluid to body temperature, suggests a small (N=18) single blind randomized controlled trial. Participants were assigned to have a peritoneal equilibrium test with fluid at 37°C or warmed with conventional methods. The two groups had similar outcomes for peritoneal clearance, abdominal discomfort, body temperature, blood pressure, and other parameters.
Read the abstract » | (added 2020-11-12)
Complications in Planned vs. Unplanned Peritoneal Dialysis Starts
A metaanalysis of 14 papers totalling 2,401 PD patients looked at the outcomes and safety of unplanned PD starts within 7 days of catheter placement vs. 7-14 days. Early-start PD was linked with more leaks, omental wrap, and—for CAPD—catheter malposition. There were no significant differences in infectious complications, but the risk of transition to HD and mortality were higher. More studies are needed.
Read the abstract » | (added 2020-11-12)
Which Form of PD Has a Higher Risk of Peritonitis?
If you guessed CAPD because there are more exchanges to perform, you are correct, finds a study that matched 106 APD to 106 CAPD patients and followed them for 3 years. During the study period, there were 64 cases of peritonitis, and the risk was 30% higher among those who did CAPD.
Read the abstract » | (added 2020-11-12)
Tags: PD, Peritoneal Dialysis, CAPD
Pilot: Chlorhexidine-impregnated Sponge Dressings to Prevent Exit Site Infections
In a single-center study, 50 incident PD patients were taught to use a weekly chlorhexidine dressing on their exit sites, and followed for a year. While 12% developed contact dermatitis, 73% found the dressings acceptable. Episodes per patient year of exit-site/tunnel infections and peritonitis were 0.09 and 0.07, respectively, while 1-year technique and patient survival rates were 86% and 96%, respectively.
Read the abstract » | (added 2020-10-12)
Tags: Chlorhexidine Dressing, Exit site Infection, Peritoneal Dialysis
24-hour Dietary Recall Less Accurate for Protein Intake Assessment in PD
Among 50 PD patients, use of protein nitrogen appearance (PNA) revealed levels of protein that ranged from 48.27-67.74 grams per day; median 55.75—while 24-hour dietary estimated the levels at 45.28-87.40; median 61.43 g/day. The authors suggest that proportionality bias may have influenced the results.
Read the abstract » | (added 2020-10-12)
Tags: Dialysis Initiation, Dialysate, Peritoneal Dialysis, PD
Physical Activity May Reduce Bone Density in PD
In a paradoxical finding, 13 women and 21 men on PD who were sedentary had higher BMD than those who were moderately or vigorously physically active. Other aspects of body composition and biochemistry, such as creatinine clearance and triglyceride levels were linked with higher levels of physical activity.
Read the abstract » | (added 2020-10-12)