Journal Watch
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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
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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
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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
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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)
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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
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Standard Kt/V urea Targets Less Useful for Home HD
When patients do home HD more often than three times a week, do the Kt/V urea targets still predict outcomes? Not all that well, suggests a new study. Multivariate regression analysis of 109,273 standard in-center HD patients compared to 2,373 home HD patients found that while a lower Kt/V urea (<2.1) did predict higher blood pressure in both groups, it did not predict metabolic control in either group. For those on home HD, a low Kt/V did not predict hospitalization, mortality, or technique failure, though it did for in-center patients. The authors concluded that the current Kt/V urea targets “have limited utility” for home HD.
Read the abstract » | (added 2018-02-15)
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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)
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Avoiding Short-term HD with Lower PD Abdominal Pressure
When PD patients have hernias, leaks, surgeries, etc., they are often told that they must switch to HD temporarily—using a central venous catheter. Another approach, reducing intraabdominal pressure, may reduce the need for HD, decrease morbidity, and minimize cost.
Read the abstract » | (added 2018-02-15)
Tags: Hernias, Leaks, Surgeries, Intraabdominal Pressure
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LVAD Users – A New Group Who Can Benefit from Home HD
Patients who need a left ventricular assist device prior to heart transplant surgery may develop acute kidney injury as well. Instead of standard in-center HD, a first patient has been trained for and is successfully doing home HD while waiting.
Read the abstract » | (added 2018-02-15)
Tags: Left Ventricular Assist Device, Heart Transplant Surgery, Acute Kidney Injury
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PD and Inflammation
The moment a PD catheter is inserted or fluid is instilled in the peritoneum, a cascade of cytokines occurs. This reaction is reduced somewhat when a neutral-pH, low-GDP fluid is used, vs. a conventional one, finds a new observational study.
Read the abstract » | (added 2018-02-15)
Tags: PD Catheter, Cytokines, Low GDP Fluid