Journal Watch
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Time Matters: HD Kt Dose , Hospitalization, and Death
Does adding more HD benefit patients? Yes, finds a Fresenius study of 6,129 patients in Spain. There as a progressive increase in the risk of death for patients who were below the target Kt, and as Kt rose to reach and exceed the target, the risk declined, as did the risk of hospitalization. “Thus, prescribing an additional 3 L or more above the minimum Kt dose could potentially reduce mortality risk, and 9 L or more reduce hospitalization risk,” noted the authors.
Read the abstract » | (added 2016-11-10)
Tags: Hemodialysis
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Systematic Review of Pregnancy on HD
A new review summarizes 101 full papers and 25 abstracts and addresses the promise of successful pregnancy if enough HD is given.
Read the abstract » | (added 2016-11-10)
Tags: Hemodialysis
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Patient Peritonitis Perspectives
Australian researchers conducted interviews with 29 current or past PD patients to gain insights into the prevention of peritonitis. The four themes identified were the constant need for vigilance, invading harm from infection, incapacitating lifestyle interference, and exasperation with hospitalizations. The authors concluded that education about peritonitis and lifestyle impacts of PD may be helpful.
Read the abstract » | (added 2016-10-13)
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In the Netherlands, High-Dose HD Holds Up to Cost Scrutiny
Is high-dose HD cost-effective? A new Dutch study finds that while conventional home HD (three treatments per week) may be the most cost-effective, since high-dose HD is twice as much treatment, "from a payer’s perspective, high dose HD should be offered as a home therapy to obtain its clinical benefits in a cost-effective manner."
Read the abstract » | (added 2016-10-13)
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US Home Dialysis Use by Racial and Ethnic Minorities
Are African Americans about 50% less likely to do home therapies across the entire US—or are certain states less well-represented than others? An analysis of 369,164 Medicare fee-for-service dialysis patients was analyzed by state. African American patients were the least likely to use PD in every US region except Massachusetts. Across the US, all minorities were less likely to use home HD than Caucasians, but Asians were more likely to use home HD in the Midwest.
Read the abstract » | (added 2016-10-13)
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Case Study Offers Hope for Successful EPS Treatment
Working on the hypothesis that encapsulating peritonitis has TWO causes (a deteriorating peritoneum and inflammation), researchers tried a new treatment approach—and it worked. Combining sirolimus, a low-dose corticosteroid, and intradialytic parenteral nutrition helped a patient.
Read the abstract » | (added 2016-10-13)
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PD Dose Needs Adjustment for Activity Level
Is one PD Kt/Vurea level the same in a sedentary older person as it is in an active younger one? NO, finds a new study that looked at energy expenditure in 148 PD patients. Adjusting Kt for resting energy use showed that women received less PD than men, younger people received less PD than older ones, and working people received less PD than unemployed ones—among other significant differences.
Read the abstract » | (added 2016-10-13)
Tags: Hemodialysis
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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
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10-year Experience with Incremental PD
People who start dialysis with residual function may not need full-on, four- exchanges-per-day PD. This center reports excellent clinical experiences using incremental PD, 1-2 dwells per day, until residual function dropped (a mean of 17 months), finding no differences between an incremental and a standard PD start—and better maintenance of residual function.
Read the abstract » | (added 2016-09-14)
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Which Tidal PD Setting is Most Efficient?
A study of 5 different tidal prescriptions for automated PD (APD) were used with six low-average and six high-average transporters. There were significant differences in urea and creatinine clearance between the prescriptions.
Read the abstract » | (added 2016-09-14)
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