Journal Watch
An Integrated Home Approach: PD to Home HD
Even in Canada, it is rare (2-6%) that patients who stop PD transfer to home HD. A new review article shares data and describes an integrated home dialysis model that covers patient identification, timely transition planning, and challenges.
Read the abstract » | (added 2024-11-21)
Tags: PD Transfer To Home HD, Transition, Integrated Home Dialysis Model
Stepwise PD Starts vs. Conventional PD Starts—Which is Better?
Stepwise Initiation of PD (SIPD) is an approach that uses a gradual introduction to PD (perhaps like incremental PD in the U.S.?). In a retrospective look at 39 SIPD patients vs. 78 conventional PD (CPD) starts during a 13-year period matched for age and sex, early complications and PD catheter survival were similar between groups. But, late complications were significantly lower in the SIPD group. The authors believe SIPD may aid tissue healing and reduce biofilms, which may reduce infections. As always, more studies are needed…
Read the abstract » | (added 2024-11-21)
Tags: Stepwise Initiation Of PD, Incremental PD, Late Complications, Infection, Tissue Healing, Biofilms
Unphysiology is Back and Affects the Heart in Standard HD
It’s been quite a while since “unphysiology” appeared in a journal article title. The authors note that the intermittent nature of in-center HD causes significant upward and downward fluctuations that affect fluid status, add to hemodynamic instability, and increase cardiovascular risk. More frequent HD modalities, on the other hand, can reduce left ventricular hypertrophy, improve BP control, and possibly boost survival, and PD is more continuous and gentle.
Read the abstract » | (added 2024-11-21)
Tags: Unphysiology, In center HD, Fluid Status, Hemodynamic Instability, Cardiovascular Risk, HD, PD
Updated ISPD Adequacy and Prescription Clinical Guidelines
PD adequacy is transitioning from solute clearance and ultrafiltration to quality of life. With sections on adequacy, residual kidney function, and prescription of CAPD and APD, the new guidelines specify the level of evidence and strength of the recommendations
Read the abstract » | (added 2024-10-15)
Tags: PD Adequacy, Solute Clearance, Ultrafiltration, Quality Of Life
More Nephrologist Time Linked with Lower PD Peritonitis and Catheter Infection Rates
A PDOPPS study in Korea divided 276 incident PD patients into two groups based on whether they got <15 minutes (n=184;66.7%) vs. >15 (n=92; 33.3%) minutes of nephrologist time during each visit. Average age between groups did not differ, but the group that had more nephrologist time had significantly fewer 3- and 12-month PD-related infections.
Read the abstract » | (added 2024-10-15)
Cloudy-only Peritonitis May Point to Vancomycin First
A study that looked at clinical characteristics of PD-associated peritonitis (PDAP) was able to correlate the signs and symptoms with the pathogen, allowing the team to choose antibiotics in a more informed way. The researchers divided the records of 162 patients with culture-positive PDAP into those who had cloudy effluent only vs. those who also had pain and/or fever, and compared the culture and sensitivity results. All 30 of the cloudy-only group had gram-positive infections; significantly more than the multi group (P<0.001), and 29 of those infections were susceptible to vancomycin, for specificity of 98.48%. This insight may help guide a first choice of antibiotic.
Read the abstract » | (added 2024-10-15)
Tags: PD associated Peritonitis, Cloudy Effluent, Vancomycin
Preferences for ESKD Treatment Options among Seniors
A choice experiment of 327 UK seniors (median age 77) with stage 4 CKD examined the survival benefit patients needed 2 years after starting treatment to accept dialysis. Overall, they needed 8-59% absolute survival benefit, and preferred less frequent treatment and home treatment. Seniors who had partners had significantly higher preferences for survival. Most wanted their capacity preserved and an acceptable frequency of care.
Read the abstract » | (added 2024-10-15)
Utility of the 5-day Cell Count in Refractory Peritonitis
A retrospective study in Turkey analyzed 11 years of data on 135 patients with 236 episodes of refractory peritonitis. While age, gender, diabetes, prior hemodialysis, and PD duration did not reveal any significant differences, a day 5 dialysate white blood cell count higher than 1000/mm3 and hospitalization were linked width catheter loss.
Read the abstract » | (added 2024-10-15)
Tags: Refractory Peritonitis, Arteriovenous Fistula, Ark Implant, Cannulation
CAPD vs. APD: Meta-analysis Sheds No New Light
A Cochrane Kidney and Transplant Register of Studies update identified two new randomized controlled trials (n=131) to include, one with 6-month follow-up and one with 24-month follow-up. Both studies had mostly low risk of bias. Conclusions about differences in CAPD and APD outcomes for death, hospitalizations, peritonitis, modality change, residual kidney function, health-related quality of life, overhydration, blood pressure, and a host of other outcomes were all based on low to very low certainty evidence.
Read the abstract » | (added 2024-10-15)
Tags: CAPD, APD, Modality Outcomes
Value of Remote Monitoring of PD
A cluster-randomized trial assigned 21 hospitals with automated PD (APD) programs to either do remote monitored (RM-APD; 10 hospitals) or conventional APD (11 hospitals) for 398 adult patients initiating PD. In the conventional APD group, all-cause mortality, cardiovascular deaths, and hospitalizations were significantly higher, as were PD dropouts and adverse events and hospitalizations related to cardiovascular disease, fluid overload, or poor PD adequacy.
Read the abstract » | (added 2024-09-12)
Tags: Automated PD, APD, All cause Mortality, Cardiovascular Deaths, Hospitalizations, Cardiovascular Disease, Fluid Overload, PD Adequacy