Journal Watch
Head to Head: 8-hour Hemodialysis vs. 4-hour Hemodiafiltration
A randomized trial assigned 12 nocturnal HD patients to either two weeks of 8-hour HD or 4-hour HDF, followed by a crossover to the other option. Participants were also randomized to one of two dialyzers: a Fresenius FX80 or a Nipro Elisio. The 8-hour HD treatments removed significantly more urea and creatinine. But, the HDF removed more FGF23—and several other toxin levels were the same. The FX80 dialyzer cleared somewhat more B2M.
Read the abstract » | (added 2018-05-11)
Tags: Nocturnal HD, Extended hours Haemodialysis, Haemodiafiltration
HD at Home—Review of Current Machines
A new review articles compares and contrasts home HD machine options.
Read the abstract » | (added 2018-05-11)
Is the Future Near? Portable Dialysis and Implantable Devices
Portable and wearable PD and HD devices are in development that have the potential to improve patient mobility and autonomy, and perhaps increase technique survival. Bioartificial kidneys that may partly replace some of the endocrine functions of kidneys are on a longer development horizon, followed by miniaturized, implantable devices. Multiple challenges must be overcome for any of these options to become available.
Read the abstract » | (added 2018-05-11)
Tags: Bioartificial Kidney, Implantable Artificial Kidney, Renal Replacement Therapy, Wearable Artificial Kidney
LVH Regression in the FHN Trials
Among the 243 randomized patients with biomarker data in the daily HD trial, 121 had no change, 77 got better, and 45 got worse over the course of the study. Changes in levels of collagen turnover and klotho enzyme levels seemed to predict which patients would improve; a finding that will need to be verified in another study.
Read the abstract » | (added 2018-04-12)
Tags: Copeptin, Brain Natriuretic Peptide, Cardiac Biomarkers, Frequent Hemodialysis, Klotho, Left Ventricular Hypertrophy, Markers Of Collagen Turnover
Low Molecular Weight Heparin as Anticoagulation for Nocturnal HD
How can the dialysis circuit be kept free of clots during slow, HD treatments done during sleep? In a small study, 12 patients who did alternate night, 8-hour treatments were randomized to nadroparin (a low molecular weight heparin) or unfractionated heparin. The dosing regimens were adapted to make them more practical for overnight use. Both were effective, but with different monitoring requirements.
Read the abstract » | (added 2018-04-12)
Tags: Anticoagulation, Home Haemodialysis, Low molecular Weight Heparin, Nadroparin, Unfractionated Heparin
Emergent Start PD Yet Again
Learn about the rationale and feasibility of using PD as a first dialysis option for emergent start patients instead of inserting a central venous catheter and starting HD. .
Read the abstract » | (added 2018-04-12)
Tags: End stage Renal Disease, Haemodialysis, Peritoneal Dialysis, Unplanned Start, Urgent Start
Homocysteine as a Marker for Spontaneous Bacterial Peritonitis
A non-invasive marker for SBP could save both time and money, and in a series of 323 PD patients with ascites, the ascitic fluid was tested for homocysteine levels. Both serum and ascitic levels were elevated in the SBP group—and both levels dropped after treatment. A cutoff level was suggested. Read the abstract.
Read the abstract » | (added 2018-03-16)
Tags: Ascites, Homocysteine Levels
Improving Incident ESRD Care with Transitional Care Units
Patients who transition onto dialysis are at high risk for morbidity and mortality—along with high costs. Transitional care units use the first 30 days of treatment for systematic onboarding that includes education and informed options choice—and may be especially helpful to those who start treatment emergently. Read the abstract.
Read the abstract » | (added 2018-03-16)
Experiences of Self-cannulation in Men
Self-cannulation can be a barrier to home HD, and a new qualitative study examined why that is and how patient attitudes toward it changed over time. Eight male patients were interviewed, and the course of becoming a self-cannulator was described as a “process” of gaining control, building confidence, and finding a new norm. The article suggests practical techniques that can be used by clinic staff. Read the abstract
Read the abstract » | (added 2018-03-16)
Tags: Self cannulation, Techniques
Nephrology Fellows Need Home HD Training & Experience
Home HD offers research and quality improvement topics for fellows, but lack of training is a barrier to patient use of this option. Fellows should attend lectures and receive at least 6-12 months of outpatient clinical exposure that includes transitioning three or more patients to home, argues a new op ed. Having a passionate home HD expert and advocate is essential, as is exposure to home HD nurses.
Read the abstract » | (added 2018-02-15)