Journal Watch
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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)
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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)
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Survival Benefit of More HD Hours is Not Sustained After a Switch Back to Standard
In the ACTIVE Dialysis trial, 200 standard HD patients were randomized to receive usual care (median of 12 hours of HD/week) or extended hours (median of 24 hours of HD/week) for 12 months, with follow up through 60 months. After the 12 months, intervention group participants were switched back to usual care. At 5 years, there was no difference between the groups in all-cause mortality.
Read the abstract » | (added 2020-10-12)
Tags: Dialysis, End stage Kidney Disease
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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
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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
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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)
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International Use of HD—Including Home HD
A new survey of stakeholders in 182 countries (with respondents from 160 countries) found a use rate for HD of 298.4 per million. Among incident dialysis patients, the HD rate was 98.0. Standard in-center HD was available among 27% of low-income countries (and these patients paid more of the costs); home HD was available in 36% of high-income countries. Monitoring of patient-reported outcomes was done in 61% of countries, while 60% monitored bone minerals and patient survival, and 51% monitored technique survival. Just 5% of countries initiated patients on HD with arteriovenous access.
Read the abstract » | (added 2020-09-11)
Tags: Hemodialysis, Homedialysis, HD
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Converting In-center HD Patients to Home: the Importance of Belief
A small, cross-sectional study (n=44) interviewed patients who were and were not considering home HD. Only 68% of patients said they’d heard about the benefits of home HD. The cohort who were willing to consider it were significantly more likely to believe that self-care and home HD would improve their quality of life, particularly travel, better health outcomes, and the comfort of being at home.
Read the abstract » | (added 2020-09-11)
Tags: Home Hemodialysis, Hemodialysis, Homedialysis, HD
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International Use of PD
Worldwide PD use is approximately 11%, which varies across the globe, finds a new survey of stakeholders in 182 countries (with 313 respondents from 160 countries). Median PD use was 38.1 per million. Thirty countries, mainly low-income, did not offer PD, while in 69% of countries, PD was the first modality for <10% of incident patients. The range of PD costs passed on to patients was 1-25%, with higher co-pays in South Asia and low-income countries. Patient-reported PD outcomes were rarely measured.
Read the abstract » | (added 2020-09-11)
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Aspergillus Peritonitis Review
Compared to other fungal peritonitis, colonization with aspergillus is more dangerous, and identification is still a challenge. Among 55 cases reported in the literature between 1968 and 2019, the mortality rate was 38.3%, 85.5% had to have their PD catheter removed, and 81.8% of patients had to switch to HD.
Read the abstract » | (added 2020-09-11)
Tags: Aspergillus, Mortality, Peritoneal Dialysis, Peritonitis