Metaanalysis of Patient Education and Choice of PD

An analysis of 15 studies (including one randomized controlled trial and 9 observational studies) found that patient-targeted education tripled the odds that patients would intend to use PD as a first treatment option.

Read the abstract » | (added 2016-05-12)

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Starting PD with Three Exchanges

Are four PD exchanges magical? Or could new patients thrive with three exchanges per day, at least for a while? In a new study, 46 incident PD patients began treatment with three exchanges. During the 2 years of the study, 25% received a kidney transplant. Most were able to use three exchanges for a mean of 24 months before needing a fourth, and there was less loss of residual kidney function than in the predialysis period prior.

Read the abstract » | (added 2016-05-12)

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Preliminary Data for the VasQ™ Fistula Construction Tool

A new Israeli device (available in three sizes) has been tested in 20 patients as a way to improve fistula flow and reduce hyperplasia at the anastomosis to reduce primary fistula failure. Primary patency was assessed at 1, 3, and 6 months, and there were no device-related adverse events. At the end of the study 14 of the 15 patients who required dialysis had a working fistula.

Read the abstract » | (added 2016-05-12)

Tags: Hemodialysis

Kt/V Urea Should NOT Be Used as an Adequacy Measure for PD

Since the National Cooperative Dialysis Study, PD adequacy attention has focused on urea clearance, rather than on the more important benefit of middle molecule clearance. In this opinion piece, Dr. Joanne Bargman asserts that the PD community “made a mistake” adopting urea kinetics to the peritoneal dialysis process,” an error that continues to this day despite the lack of evidence linking Kt/V to outcomes in PD patients.

Read the abstract » | (added 2016-05-12)

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Survival on PD is Better with Normal Magnesium Levels

A retrospective study of 253 incident PD patients followed for up to 10 years found that deaths due to cardiovascular causes (58.3%) were linked with low serum magnesium levels. Low serum albumin, and levels of triglycerides, potassium, calcium, and phosphate were also important. Those in the group with the lowest magnesium had significantly higher all-cause mortality (p<0.001).

Read the abstract » | (added 2016-04-12)

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Urea Alone is Not a Good Index of Dialysis Dose

All-cause mortality in the HEMO study was not significantly related to removal of small solutes in short, intermittent, standard HD. “Failure to achieve greater reductions in solute levels may explain the failure of high Kt/V urea treatment to improve outcomes,” the authors note. (Yet another reanalysis of the HEMO study data has confirmed the obvious…)

Read the abstract » | (added 2016-04-12)

Tags: Hemodialysis

Survival on PD vs. Daily Home HD

A USRDS study matched 3,142 people starting daily home HD with 2,688 starting PD and compared survival. Those who were doing short daily HD had 12.7 deaths per 100 patient years, vs. 16.7 in the PD group.

Read the abstract » | (added 2016-04-12)

Tags: Hemodialysis

If One PD Exit Site Antibiotic is Good, Are Two Better?

In a single center study, 146 people on PD were randomized to use gentamycin cream on their exit sites (n=71) or to switch between gentamycin in odd months and mupirocin in even months (n=75). After 174 (gentamycin) or 181 patient years (alternating), the group switching between two antibiotics had significantly more peritonitis, especially gram-negative and fungal.

Read the abstract » | (added 2016-04-12)

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Loss of Kidney Function Slowed After Starting PD

In 77 new PD patients, the rate of decline of kidney function was significantly slower after they started PD than it was when they were predialysis (p<0.01).

Read the abstract » | (added 2016-04-12)

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Milk Thistle Extract Improved Hemoglobin and Albumin in PD

Silymarin is an antioxidant. Among 50 people on PD randomly assigned to take silymarin (n=28) or a control (n=22) for 2 months, those who took the supplement three times a day had significantly higher antioxidant levels. They also had significant increases in hemoglobin and albumin levels at the p<0.05 level. (NOTE: Always inform a nephrologist of any supplement use.)

Read the abstract » | (added 2016-04-12)

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