Journal Watch
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PD Outcomes under the Medicare Expanded Dialysis Prospective Payment System
A Medicare change in 2011 may have increased the likelihood that clinics would expand PD to a broader population. Did this affect outcomes? A prospective cohort study compared 10,585 patients who started PD before payment reform, 7,832 interim patients, and 18,742 during the reform period. With similar demographics, more patients were treated in clinics with less PD experience—and these clinics had higher PD discontinuation rates. But, PD discontinuation fell overall, and mortality risk was stable.
Read the abstract » | (added 2019-10-14)
Tags: Expanded Dialysis Prospective Payment System, PD, Medicare
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The Role of Frailty in Home Dialysis
Evaluation of frailty among 109 home dialysis patients revealed a greater than 2-fold increase in risk of a composite outcome that included technique failure and all-cause death. Weakness and weight loss were both linked with higher risk. “Assessing frailty as part of the clinical evaluation for home dialysis therapies may be useful for prognostication and clinical management,” report the authors.
Read the abstract » | (added 2019-10-14)
Tags: Frailty, Home Dialysis, All cause Death
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Home Dialysis: Better Outcomes at Lower Costs
Five years after starting dialysis, the population of Ontario, Canada over age 18 had mean 30-day PD costs 50% lower than in-center HD—and home HD costs 64% lower than in-center. After adjusting for covariates, home HD cost the least and had the highest survival (80%) vs. 52% on PD and 42% on in-center HD.
Read the abstract » | (added 2019-10-14)
Tags: Home Dialysis, PD Cost, HD Cost, HD Survival
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BMI Alters Sodium Balance in PD
In a review of 439 PD patients, those with more urine volume, protein nitrogen appearance rate, fewer comorbidities, and higher BMI had greater sodium losses.
Read the abstract » | (added 2019-09-11)
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A Patient on Home HD for 45 Years
A 62-year old Mississippi woman, one of the first home HD patients of Dr. John D. Bower, is reported to have been on home HD for 45 years now, a record.
Read the abstract » | (added 2019-09-11)
Tags: Home Hemodialysis, Quality Of Life, Long term Survival
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RCT: Which Works Best, Straight or Coiled PD Catheters?
A metaanalysis recently found that straight catheters were better, and an RCT of 308 CAPD patients randomly assigned to receive a straight (n=153) or coiled (n=155) catheter corroborates that finding. After a mean follow-up of 21 months, straight PD catheters caused almost 9 times less dysfunction or drainage failure (0.7% vs. 5.8%) with less pain than coiled catheters. Both catheters had a similar risk of peritonitis.
Read the abstract » | (added 2019-09-11)
Tags: Catheter, Randomized Controlled Trial (RCT), PD, CAPD
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Glycated Albumin vs. HbA1c Predicts Mortality in PD Patients with Diabetes
In patients on hemodialysis, glycated albumin (GA) reflects glycemic control and predicts all-cause mortality. A new retrospective, longitudinal observational study looked at GA in PD. Among 44 PD patients with diabetes matched to 88 HD patients with diabetes followed for 3 years, GA was a more precise way to measure glycemic control than hemoglobin A1c.
Read the abstract » | (added 2019-09-11)
Tags: Peritoneal Dialysis, All cause Mortality, Glycaemic Control, Glycated Albumin, Glycated Haemoglobin
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Fluid Management Risks of Incremental HD
Incremental HD critics worry that less-frequent treatments will lead to fluid overload—and they may be right. A sample of 23 patients had interdialytic weight gains (IDWG) analyzed in the first and last 3 months of twice-weekly (2x) HD and first 3 months of thrice-weekly (3x) HD. IDWG exceeded 5.7% of dry weight 0% in the first 3 months of 2x HD—12% in the last 3 months—and 4% after a switch to 3x. The authors said, “fluid management in incident-ESKD patients receiving bi-weekly HD deteriorates prior to conversion to thrice-weekly HD.”
Read the abstract » | (added 2019-08-14)
Tags: Incremental HD, Fluid Management Risks, Volume Management
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High Fiber Diet May Save Lives on PD
A study of 881 PD patients followed for up to 12 years found that participants who ate more fiber tended to be younger, male, and have more residual kidney function. In those who did not have diabetes, each 1 gram increase in daily fiber intake independently predicted improved survival by 13%.
Read the abstract » | (added 2019-08-14)
Tags: Chronic Kidney Disease, Dietary Fiber, Mortality, Peritoneal Dialysis
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PD: Better Quality of Life than In-Center HD for 2 Years
Among 989 patients starting PD or in-center HD, health-related quality of life (HRQOL) was measured at 3, 12, and 24 months after dialysis start. PD patients scored higher all along on several key dimensions than HD patients—and this effect lasted up to 2 years. Both PD and HD patients had about the same amount of decline in HRQOL over 2 years.
Read the abstract » | (added 2019-08-14)
Tags: HRQOL, PD, In center HD, Quality Of Life