Journal Watch
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A New Approach for Treating Peritonitis in Patients Over Age 50
Researchers tried a new, 3-step “Mero-PerRest” protocol when patients over age 50 developed peritonitis due to enteric (gut) microorganisms. 1). Temporary “peritoneal rest” with the catheter in place. 2). IV meropenem. 3). Meropenum as a catheter lock. Compared to 203 bouts of peritonitis treated with usual care, 217 bouts treated with the new protocol had a higher primary cure rate (90% vs. 65.3%), better PD survival (90% vs. 64.9%), and similar patient survival.
Read the abstract » | (added 2017-02-08)
Tags: Peritoneal dialysis
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Does Frequent HD Boost Quality of Life? NO
A new Canadian study randomized 200 patients to standard in-center HD (12-15 hours/wk; maximum of 18 hours) or extended HD (>24 hours/wk) for a year. Extended HD reduced phosphate and potassium levels and boosted Hgb, and patients took fewer BP meds and phosphate binders. However, health-related quality of life scores did not differ significantly between the groups.
Read the abstract » | (added 2017-02-08)
Tags: Hemodialysis
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Gender, PD Dose, and Anemia
Do gender and PD adequacy matter in anemia treatment, wondered researchers? Yes, as it turned out. A two-part study first included 2,180 prevalent PD patients, then followed 88 new PD patients for 3 years, recording data once a year. Regardless of adequacy, women had lower hemoglobin levels than men at every point—even with higher ESA doses.
Read the abstract » | (added 2017-01-09)
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Peritonitis Predicts Long-term Cardiac Outcomes on PD
A large study (n=5,707) of PD patients from Brazil has found that just one bout of peritonitis boosts the risk of late cardiovascular death by 22%. Two bouts of peritonitis raised the risk by 78%, three by 181%, and four by 284%.
Read the abstract » | (added 2017-01-09)
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Early and Late Outcomes in Urgent-start PD
A single-center, matched-case control study compared 26 urgent start PD patients to 78 who started PD in the standard fashion. Urgent-start PD was linked with more catheter leaks and catheter migration. But, the rates of infection were similar, and urgent-start PD was safe.
Read the abstract » | (added 2017-01-09)
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Low Molecular Weight Heparin Use in Nocturnal HD
Since people sleep during nocturnal HD, a form of heparin with a longer half-life is needed to keep blood from clotting. Enter low molecular weight heparin (LMWH). A study in Hong Kong* randomized 12 nocturnal HD patients to receive nadroparin or unfractioned heparin for a week—and then switch. The researchers concluded that LMWH was safe and effective, though if treatments are done each night, it is important to monitor for build up of the heparin in the blood.
Read the abstract » | (added 2017-01-09)
Tags: Hemodialysis
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Using PET Results to Screen for Encapsulating Peritoneal Sclerosis (EPS)
Identifying EPS early is vital to effectively treat this rare but devastating problem. Researchers studied whether the amount of sodium removed from the dialysate (sodium sieving) could predict EPS, in a 20-year study of 161 people. Age at PD start, duration of PD, and sodium sieving were all important predictors.
Read the abstract » | (added 2017-01-09)
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PD Patient Education in Australia
Clinical PD outcomes in Australia were as much as 10-fold different from one site to another. An effort to standardize PD teaching has begun to improve PD outcomes. Of the 54 PD clinics, 70% completed an online survey about their PD teaching practices—which varied widely in the number of hours and presence of competency assessments.
Read the abstract » | (added 2017-01-09)
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PD Catheter Fixation Works
Can we keep PD catheters in place? This study compared 152 people who were randomly divided into three groups. Group 1 had their PD catheters placed with traditional open surgery. Group 2 had a modified open surgery placement. Group 3 had open surgery with the PD catheter fixated to the lower abdominal wall, and a vertical tunnel. After 6 months, all of the PD catheters worked in the fixated group—a much higher rate than for Group 1. There were no significant differences in infection, bleeding, leakage, pain, hernia, or wound healing.
Read the abstract » | (added 2016-12-09)
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NxStage Outcomes in France and Belgium
Among 62 patients from 31 centers in France and Belgium, albumin and bicarbonate levels improved significantly, and technique survival was 75% at one year (most who stopped received transplants). Despite the low volume of dialysate, the rsearchers concluded that dialysis adequacy was acceptable.
Read the abstract » | (added 2016-12-09)
Tags: Hemodialysis