Journal Watch
Half of PD patients may develop a new glucose disorder
A metaanalysis of nine studies with a total of 13,879 PD patients found that 8% had new-onset diabetes, 15% developed impaired glucose tolerance, and 32% had newly abnormal fasting blood sugar levels. No differences were found by ethnicity. The authors concluded that PD patients should receive glucose tolerance tests.
Read the abstract » | (added 2019-07-15)
Tags: PD, Diabetes, Glucose Tolerance, Blood Sugar Levels, Glucose Tolerance Test
10-year retrospective study of urgent-start PD
Among urgent-start 2,059 PD patients followed for a decade, older patients were less likely to have PD catheter failure than younger ones, while men and people with diabetes had higher catheter failure rates. Lower hemoglobin levels predicted more abdominal wall complications. Overall, urgent-start PD was safe and effective, and a well-trained team and comprehensive follow up were recommended.
Read the abstract » | (added 2019-07-15)
Impact of daily low-flow HD on potassium and lactate levels
In the NxStage FREEDOM study, 345 patients switched from standard in-center HD to daily, low-flow HD. Blood levels of potassium and lactate were analyzed during the last 3 months of standard HD and the first 3 months of daily HD. On daily HD, predialysis serum potassium decreased significantly at a dialysate potassium level of 1 mEq/L, with no change at 2 mEq/L. Predialysis serum bicarbonate level decreased significantly with dialysate lactate concentration of 40 mEq/L—but increased significanty at 45 mEq/L. Choosing the correct dialysate for the patient is important.
Read the abstract » | (added 2019-07-15)
Tags: Daily HD, Potassium, Bicarbonate, Dialysate
Incremental PD may preserve residual kidney function longer
A single-center observational study in Korea followed 347 patients; half started full-dose PD and half started incremental PD. While patient, technique, and peritonitis-free survival were similar between groups, the incremental PD group had a significantly lower risk of losing all of their kidney function (anuria).
Read the abstract » | (added 2019-07-15)
Tags: Full Dose PD, Incremental PD, Residual Kidney Function
In-center HD patients tend to overestimate how long they are likely to live
Statistics do not apply to individuals. However, a survey of 996 standard in-center HD patients from 31 clinics found that most could not correctly guess how long other “people your age with similar health conditions” usually live (<5 years, 5-10 years, >10 years, not sure). Just 11.2% chose <5 years, when the USRDS results would suggest 60.3%. Those who believed they would live longer were less likely to have advance directives.
Read the abstract » | (added 2019-07-15)
Tags: Life Expectancy, Patient Education
Moving the PD Exit Site to Combat Infection
A 5-year retrospective cohort analysis looked at the impact of treating PD exit site and tunnel infections in 27 patients by removing the cuff and relocating the catheter under local anesthetic. After follow up ranging from 10.8 to 79.4 months, no leaks occurred, and the infections resolved in 74% of the patients. The rest had to have their catheters removed.
Read the abstract » | (added 2019-06-13)
Tags: Exit Site Relocation, Exit site Infection, Tunnel Infection, Peritoneal Dialysis Catheter, PD Catheter
Low vs. Very Low Site PD Catheter Placement to Prevent Migration
A retrospective 5-year series of 76 patients whose PD catheter tips migrated had received either a traditional low-site insertion (N=39) or a very-low-site insertion (N=37). After 2 years of follow up, the very-low-site group had significantly better catheter and patient survival, with fewer catheter complications—and no tip migration.
Read the abstract » | (added 2019-06-13)
Tags: Catheter Dysfunction, Catheter Migration, PD Catheter, Peritoneal Dialysis Catheter, Patient Survival
BMI and Survival on PD
A large study from Korea (N=80,674 PD patients) found that those in the highest group for BMI: just 25.71, had significantly higher all cause mortality.
Read the abstract » | (added 2019-06-13)
Tags: Body Mass Index, Survival, Diabetes Mellitus, Peritoneal Dialysis, Mortality
Will Zinc Supplements One Day Help Prevent Peritoneal Sclerosis?
Ironically, PD saves lives, but high-glucose PD fluid damages the peritoneum, leading to fibrosis that can make PD impossible. By activating a complex metabolic pathway, a study in rats found that supplementing with zinc helped prevent fibrosis.
Read the abstract » | (added 2019-06-13)
Tags: High glucose PD Fluid, Peritoneum, Fibrosis, Zinc
Frequency vs. Time in HD Survival
Which matters more for HD--the number of treatments per week, or the length of each treatment? A retrospective registry study from the ANZDATA database looked at survival among 16,944 non-indigenous adult patients in Australia and New Zealand from 2001 to 2015. After controlling for frequency, patients with 5+ hour long treatments had significantly better survival than those whose treatments <5 hours. However, controlling for duration, increasing frequency did not boost survival.
Read the abstract » | (added 2019-06-13)
Tags: ANZDATA, Session Frequency, Session Duration, Survival, End stage Kidney Disease