Impact of PD Exchange Volume/Day on Outcomes

A DOPPS cohort study in Japan divided patients into two groups by daily PD dialysate volume (<4L/day; n=98 or >4L/day; n=244). Despite demographic differences between the groups, there were no significant differences in transfers to HD, mortality, hospitalization, peritonitis, or patient-reported outcomes based on volume—thus less volume may be more cost effective.

Read the abstract » | (added 2024-12-11)

Tags: Dialysate Volume, Peritoneal Dialysis Outcomes, Mortality, Patient reported Outcomes

Do Ketoanalogue (KA) Supplements Preserve Residual Kidney Function in PD?

A 1-year, six center, randomized, double-blind trial investigated the impact of KA supplements on RKF in 153 CAPD patients vs. placebo. For patients with early PD initiation, the KA group had a significantly lower decline in RKF. No differences were found in RKF decline in those with late PD starts or in PD adequacy, peritoneal function, nutritional status, or quality of life scores between groups.

Read the abstract » | (added 2024-12-11)

Tags: KA Supplements, Residual Kidney Function, CAPD, Ketoanalogues

Early Icodextrin (ICO) Use Reduced PD-associated Peritonitis Risk

A group of 82 patients who did PD between 2011 and 2020 were divided into a group (n=21) who received ICO at PD initiation and a group (n=61) who received it later or not at all. Patients were followed until they stopped PD, died, or 3 years passed. PD-associated peritonitis and tunnel infection-free survival rates were significantly better with early ICO use.

Read the abstract » | (added 2024-12-11)

Tags: PD, ICO, Early Icodextrin, Peritonitis, Tunnel Infection free Survival Rates

Pet Cats and Peritonitis—a Non-starter for PD?

The answer might surprise you. In a retrospective registry study in France, 52 PD patients who developed cat-related peritonitis were matched with 208 controls whose PD peritonitis was due to other causes. After analysis, pet-related peritonitis had lower risks of death or transfer to HD and a higher rate of transplant than other-cause peritonitis. The authors concluded that, while cats may cause peritonitis, having pets at home should not be considered a reason to refuse patients PD.

Read the abstract » | (added 2024-11-21)

Tags: Pets, Cats, Peritonitis, Pet related Peritonitis, PD, Technique Survival

Staying Infection-free with PD and Home HD

While home treatments tend to be better treatments, infection is still a risk—and prevention a necessity. Education and inclusion of infection-prevention in training are important, as are managing modifiable risk factors, such as constipation, gastric acid blockers, and hypokalemia in PD. For home HD, reducing CVC use and duration and using the rope ladder technique for cannulation can reduce risk.

Read the abstract » | (added 2024-11-21)

Tags: Infection prevention, Modifiable Risk Factors, PD, HHD, Central Venous Catheters, CVC

Unphysiology is Back and Affects the Heart in Standard HD

It’s been quite a while since “unphysiology” appeared in a journal article title. The authors note that the intermittent nature of in-center HD causes significant upward and downward fluctuations that affect fluid status, add to hemodynamic instability, and increase cardiovascular risk. More frequent HD modalities, on the other hand, can reduce left ventricular hypertrophy, improve BP control, and possibly boost survival, and PD is more continuous and gentle.

Read the abstract » | (added 2024-11-21)

Tags: Unphysiology, In center HD, Fluid Status, Hemodynamic Instability, Cardiovascular Risk, HD, PD

An Integrated Home Approach: PD to Home HD

Even in Canada, it is rare (2-6%) that patients who stop PD transfer to home HD. A new review article shares data and describes an integrated home dialysis model that covers patient identification, timely transition planning, and challenges.

Read the abstract » | (added 2024-11-21)

Tags: PD Transfer To Home HD, Transition, Integrated Home Dialysis Model

Stepwise PD Starts vs. Conventional PD Starts—Which is Better?

Stepwise Initiation of PD (SIPD) is an approach that uses a gradual introduction to PD (perhaps like incremental PD in the U.S.?). In a retrospective look at 39 SIPD patients vs. 78 conventional PD (CPD) starts during a 13-year period matched for age and sex, early complications and PD catheter survival were similar between groups. But, late complications were significantly lower in the SIPD group. The authors believe SIPD may aid tissue healing and reduce biofilms, which may reduce infections. As always, more studies are needed…

Read the abstract » | (added 2024-11-21)

Tags: Stepwise Initiation Of PD, Incremental PD, Late Complications, Infection, Tissue Healing, Biofilms

Utility of the 5-day Cell Count in Refractory Peritonitis

A retrospective study in Turkey analyzed 11 years of data on 135 patients with 236 episodes of refractory peritonitis. While age, gender, diabetes, prior hemodialysis, and PD duration did not reveal any significant differences, a day 5 dialysate white blood cell count higher than 1000/mm3 and hospitalization were linked width catheter loss.

Read the abstract » | (added 2024-10-15)

Tags: Refractory Peritonitis, Arteriovenous Fistula, Ark Implant, Cannulation

CAPD vs. APD: Meta-analysis Sheds No New Light

A Cochrane Kidney and Transplant Register of Studies update identified two new randomized controlled trials (n=131) to include, one with 6-month follow-up and one with 24-month follow-up. Both studies had mostly low risk of bias. Conclusions about differences in CAPD and APD outcomes for death, hospitalizations, peritonitis, modality change, residual kidney function, health-related quality of life, overhydration, blood pressure, and a host of other outcomes were all based on low to very low certainty evidence.

Read the abstract » | (added 2024-10-15)

Tags: CAPD, APD, Modality Outcomes