VIPs in Dialysis Modality Choice

Whose opinion matters most to patients when it comes time to make a dialysis decision? In New Zealand, at least, it’s the nephrologist—even though respondents thought it would be predialysis nurses. In fact, a 1-point increase in nephrologist decisional power increased the rate of home therapies by 6.1%.

Read the abstract » | (added 2016-09-14)

Tags: Hemodialysis

Considering Alternative Markers for Dialysis Dose

A new review article looks at the impact of longer and/or more frequent, high-dose HD on dialysis adequacy—and inadequacy. Some uremic solutes come from nutrient intake and others don’t. For nutrient-based solutes, the authors suggest using inorganic phosphorus and protein-bound wastes as markers to develop new dose measures. For non-nutrient based middle molecules, they suggest beta-2-microglobulin measurement.

Read the abstract » | (added 2016-09-14)

Tags: Hemodialysis

Personal Support Workers for Home HD

Oh, Canada. The Canadians are out ahead of the US in virtually every dialysis parameter and they innovate constantly. Now, they have introduced a concept that CMS threw out with the bathwater in the 1980s—assisted home HD. A pilot project to dialyze six patients at home with personal support workers projected that costs would still be lower than for in-center HD. Phase 2 of the project includes 8 hospitals and 67 patients.

Read the abstract » | (added 2016-09-14)

Tags: Hemodialysis

Fallopian Tubes and PD Catheter Problems

In women, fallopian tubes can be an unrecognized cause of PD catheter malfunction. This case report study describes five episodes of catheter malfunction in four female patients.

Read the abstract » | (added 2016-08-09)

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Which is More Cost Effective, PD or Standard In-Center HD?

If you’ve been reading this site, you won’t be surprised to learn that yet another study has found PD to be more cost-effective than standard in-center HD. A cross-sectional analysis was done on matched pairs of incident PD and HD patients (N=4,285) in Taiwan who were followed for up to 14 years. While the quality-adjusted life expectancy was almost equal, HD costs were much higher.

Read the abstract » | (added 2016-08-09)

Tags: Hemodialysis

Encapsulating Peritoneal Sclerosis (EPS) Incidence and Outcomes

A new Scottish registry study found that 2.8% of PD patients between 2000 and 2007 (n=1,238) developed EPS. The rate rose from 1.1% by year 1 to 3.4% at year 3, 8.8% at year 4, 9.4% at year 5, and 22.2% by year 7. The authors note that “continuing PD beyond 3 years results in an exponential rise in the risk of developing EPS and deciding whether this risk is acceptable should be made on an individual patient basis.”

Read the abstract » | (added 2016-08-09)

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Weighing PD Catheter Techniques: Surgical vs. Percutaneous

Which is better for placement of a PD catheter—surgery, or use of a tiny incision and guidewire to push the tube through the skin (percutaneous). An analysis of 10 studies with 1,626 patients found no difference in 1-year catheter survival or the rate of peritonitis, tunnel/exit site infection, leaks, obstructions, bleeding, or hernias between the two techniques. But, there were fewer mechanical problems with the percutaneous approach.

Read the abstract » | (added 2016-08-09)

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Silk Filter for the PD WAK

A urease silk fibroin filter has been tested with a wearable artificial kidney (WAK) for PD. In lab analysis, the filter removed more than 50% of urea from a 50 mg/dL urea solution, and 90% after 24 hours.

Read the abstract » | (added 2016-08-09)

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French Patients on Daily HD

Daily HD is relatively new to France—yet this study was able to include 753 patients who started on the therapy between 2003 and 2012. Two-thirds had switched to daily HD from another option. Younger patients (<64) had better survival (72.6% vs. 31%) and were more likely to receive a kidney transplant than older patients (>64).

Read the abstract » | (added 2016-08-09)

Tags: Hemodialysis

Overhydration and Mortality Risk on PD

When PD does not remove enough water, the resulting overhydration is a major risk factor for death. A study of 54 PD patients between 2008 and 2015 measured with bioimpedance technology were divided into normohydrated and overhydrated groups. Older age, low diastolic blood pressure and overhydration predicted mortality.

Read the abstract » | (added 2016-08-09)

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