Wanted: A Paradigm Shift from Urea to Sodium Removal

When nephrology icon Zyblut Twardowski talks, we listen! When dialyzors in Seattle in the 1960s got 30 hours a week of dialysis, the mortality rate was 10%. Since then, short treatments—justified by the flawed NCDS study—were driven by the equally flawed notion of Kt/V urea.

Read the abstract » | (added 2018-12-14)

Tags: Kt/V Urea, Mortality Rate, Sodium Removal, Dialysis Quality, NCDS, RCT

Longer-term Benefits of Early Start PD

Do people who start PD emergently differ from those with a planned PD start? No, suggests a new study of 154 patients followed for a median of just over a year. Early vs. planned-start patients had similar ages, BMIs, genders, and rates PD drop-out due to peritonitis, catheter dysfunction, and burnout. Only diabetes and BMI >25 were independently associated with PD technique failure—but no differences were found between early and planned starts.

Read the abstract » | (added 2018-12-14)

Tags: Emergent PD, Planned PD, Early Start PD

Metaanalysis of PD for Kidney Failure due to PKD

Polycystic kidneys may displace room for PD fluid, so can PD be a viable treatment option? A metaanalysis of 12 studies and more than 17,000 patients found…maybe. PD outcomes were about the same for those with PKD as with other primary kidney diseases, and some can do PD. More research is needed to determine who is suitable. Read the abstract.

Read the abstract » | (added 2018-10-12)

Tags: Dialysis Adequacy, PD associated Complications, Peritoneal Dialysis, Polycystic Kidney Disease

Peritonitis Symptoms in Older vs. Younger People

A single center study compared the time to first episode of peritonitis treated successfully with antibiotics in PD patients >65 (n=79)compared to those who were younger (n=168). Of 377 peritonitis episodes, 126 were in the older group and 251 in the younger group. Older patients were less likely to have fever or cloudy dialysate as symptoms than younger patients, but rates of transfer to hemodialysis, relapse, hospitalization, and mortality were similar. Read the abstract.

Read the abstract » | (added 2018-10-12)

Tags: Peritonitis, Outcomes Of Peritonitis, Elderly PD, Patient PD

PD and Dialysis Patient Employment

In a Swedish study, 4,734 working-age (20-60 years old) patients who survived at least one year on in-center HD or PD were compared. Patients using PD had a 4% increased probability of employment over in-center HD—as well as a 6% lower disability pension and higher work income. Read the abstract

Read the abstract » | (added 2018-10-12)

Tags: PD, HD, Employment, Disability Pension, Work Income

Urgent Start PD + Diabetes

A retrospective study compared the first 30-day outcomes and survival trends of 80 urgent start dialysis patients, 50 of whom (62.5%) did PD. Compared to those who started standard in-center HD, the dialysis-related complications were significantly lower for those on PD, and PD survival was higher as well. Read the abstract.

Read the abstract » | (added 2018-10-12)

Tags: Diabetes, Survival Trends, Urgent Start Dialysis, PD, In center HD, Dialysis related Complications

MXene Sorbents: A Step Toward a WAK

A sorbent tested for use in a wearable artificial kidney was able to adsorb urea with 99% efficiency in testing—twice the level removed with standard dialysate. The hemocompatible sorbent did not damage cells or reduce cell viability at the concentrations tested. A successful sorbent product will facilitate the design of a WAK. Read the abstract.

Read the abstract » | (added 2018-10-12)

Tags: Wearable Artificial Kidney, 2D Materials, Urea, MXene, Adsorption, Dialysate

What Makes Home HD Patients Reach for On-Call Support?

A 4-month prospective observational study analyzed the reasons why 58 home HD patients called the on-call nurse or technician. Most calls to nurses were made for clinical issues or machine set-up or alarm questions, some of which required a technician. Most of the technician calls were for machine malfunction, set-up and alarms, or water treatment. Read the abstract.

Read the abstract » | (added 2018-10-12)

Tags: Home Hemodialysis, Independent Hemodialysis, Nocturnal Hemodialysis, Short Daily Hemodialysis

Nocturnal HD vs. Transplant: Health-related Quality of Life Compared

In a small study, transplant candidates using nocturnal HD (n=41) and transplant patients (n=31) took the KDQOL-short-form survey of health-related quality of life (HRQOL). Those with transplants had significantly higher “effects” of kidney disease scores than those on nocturnal HD. The other domains were not significant. Read the abstract.

Read the abstract » | (added 2018-10-12)

Tags: Transplant, Nocturnal HD, Kdqol, HRQOL, Effects Of Kidney Disease

Metaanalysis of Nocturnal HD and Sleep Quality

Nine studies of 286 patients found significantly less sleep apnea and better O2 saturation—but less total sleep time—after switching from conventional to nocturnal HD. Prospective pre-post studies found improved sleep quality, but randomized trials did not. Read the abstract.

Read the abstract » | (added 2018-10-12)

Tags: Sleep Apnea, CHD, NHD, O2 Saturation, Nocturnal HD, Conventional HD, Sleep Quality