Journal Watch
PD Fluid Overload Linked with Peritonitis from Gut Pathogens
PD patients with extra fluid in their bodies are at a significantly higher risk for peritonitis due to gut bacteria, finds a study of 138 patients. Patients in the highest third for intra-and extracellular water were at the highest risk.
Read the abstract » | (added 2019-05-15)
Tags: Body Composition, Overhydration, Peritoneal Dialysis, Peritonitis
Operationalizing Telehealth for Home Dialysis
In January, 2019, Medicare rules for telehealth changed to permit the home as an originating site for home dialysis patients. ESCOs can take advantage of waivers to obtain payment for a monthly comprehensive telehealth visit with a home patient after the first 3 months of therapy—with no geographic restrictions. Technical, regulatory, and operational challenges are discussed in this article.
Read the abstract » | (added 2019-04-11)
Tags: Maintenance Dialysis Therapy, Telehealth Services, Legislation, Regulatory Requirements, Remote Monitoring
Perspectives on Payment for More Frequent Home HD
This article explains the role of the Medicare regional contractors in implementing—or thwarting—payment for more than three home HD payments per week, and offers options for changing Medicare’s payment system to ensure that this option is supported.
Read the abstract » | (added 2019-04-11)
Tags: Medicare Regional Contractors, Medicare Payment System, HD Payments
Three Diuretics are Better than One on PD
A small study (n=51) randomly assigned adult CAPD patients to receive three diuretics or just one plus placebo for 6 months. Among the 43 patients who completed the trial, those who took three diuretics had significantly better hydration status and more change in urine output—with no adverse events reported.
Read the abstract » | (added 2019-04-11)
Tags: Peritoneal Dialysis, Furosemide, Hydration Status, Hydrochlorothiazide, Spironolactone
Cognitive Impairment Predicts PD Peritonitis
A prospective cohort study assigned 458 PD patients to a cognitively impaired (CI) or non-CI group based on results of mental state testing. The groups were not otherwise significantly different. Over 31.4 (median) months, 94 patients had first-time peritonitis, and short-term memory losses were independently linked with a higher risk.
Read the abstract » | (added 2019-04-11)
HOW do AGE’s Cause Peritoneal Fibrosis?
For years, researchers have known that the advanced glycation endpoints (AGEs) that form when sugar-based PD fluid is made harm the membrane. But, we didn’t know why. Human cell modeling finds that AGEs cause outer layer peritoneal cells (epithelial) to become connective tissue cells (mesenchymal).
Read the abstract » | (added 2019-03-12)
Tags: AGEs, Mesothelial, Epithelial, STAT3
Home HD - Significantly Better Survival and Transplant Rate
A Swedish matched cohort study compared the long-term survival of 152 home HD patients with those doing PD (n=456) or standard in-center HD (n=608). Median survival for home HD was significantly better (18.5 years) than PD (15.0) and in-center HD (11.9). Home HD patients were also significantly more likely to have received a transplant.
Read the abstract » | (added 2019-03-12)
Tags: Survival, Home Hemodialysis, Institutional Hemodialysis, Peritoneal Dialysis
Longer HD Treatments Do Not Make Up for the 2-day “Killer Gap”
For 20 years, the kidney community has known that death on HD is significantly higher on the day after the 2-day “killer gap.” An analysis of 250+ minutes vs. <200 minutes HD treatments found that even 4.5 hour long treatments thrice weekly did not make the gap less lethal.
Read the abstract » | (added 2019-03-12)
Tags: Treatment time, Interdialytic Interval, Hospitalization, Mortality
Clues to Home HD Retention
Why do people drop out of home HD? A new interview study of 15 current and 10 former patients sheds some light. The study identified five themes, each with a positive and a negative aspect: degree of independence, support, technical aspects, home environment, and attitudes and expectations.
Read the abstract » | (added 2019-03-12)
Tags: HHD, Modality, Discontinuation
Fewer Hip Fractures with PD than Standard In-Center HD: Metaanalysis
Analysis of five cohort studies totalling more than 1.2 million ESRD patients found that those doing HD had a 61% higher risk of hip fracture than those doing PD.
Read the abstract » | (added 2019-02-14)
Tags: Hip Fractures, PD, In center HD