PD Preserves Patient Jobs Compared to Standard In-center HD

In Japan, at least (and these questions are rarely looked at in the US), a study of social functioning on PD vs. standard in-center HD found an advantage for PD. Among 179 patients (102 PD and 77 HD), the odds of becoming unemployed after treatment were 5.02 fold lower with PD.

Read the abstract » | (added 2015-08-08)

Tags: Home dialysis

Outcomes of “integrated home dialysis” (PD then home HD)

What happens to people after PD fails—and why not plan to get them home on HD? Researchers in Australia and New Zealand looked at this model using ANZDATA registry data. Those treated with PD only (n=168) had the highest risk of technique failure and death, while those who did only home HD or who transitioned from PD to home HD fared much better.

Read the abstract » | (added 2015-07-08)

Tags: Home dialysis

Are we finally nearing the end of Kt/V?

We have been vocal critics of Kt/V on Home Dialysis Central since the start—and now we are not alone. A new paper finds that Kt/V is not a good fit for short daily or long nocturnal treatments, to the point where, “urea kinetics are hardly if at all representative for those of other solutes with a deleterious effect on morbidity and mortality of uremic patients.”

Read the abstract » | (added 2015-07-08)

Tags: Nocturnal Hemodialysis

It’s (past) time to avoid 3-day interdialytic intervals

A new review paper considers the ill effects of the thrice weekly standard in-center HD schedule and finds it wanting, noting higher mortality on the day after the long gap than any other day of the week. The authors conclude that the data warrant “reexamining the issue of timing and frequency of prescribed dialysis regimens in order to improve patient outcomes.”

Read the abstract » | (added 2015-07-08)

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Implantable microdialysis without dialysate fluid – in rats

What if we could implant an artificial kidney that did not require dialysate fluid? Researchers have developed a microdialysis system using microfluidic channels and nanoporous membranes, and tested it in rats with kidney failure. Filtrate was successfully collected with no blood leaks in the system, and the levels of creatinine in their blood was significantly reduced.

Read the abstract » | (added 2015-07-08)

Tags: Dialysis

Metaanalysis: PD fluid with fewer GDPs improves outcomes

Glucose degradation products (GDPs) are known to damage the delicate peritoneum. PD fluids with neutral pH and low levels of GDPs were reviewed in a new study of 11 randomized controlled trials (n=643). While most of the studies were of poor quality, low-GDP PD fluid was better at preserving residual kidney function and urine volume for a year than standard PD fluid.

Read the abstract » | (added 2015-07-08)

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More glucose in PD fluid makes it harder to cure peritonitis

A look back at bacterial peritonitis among 187 people on CAPD compared those whose peritoneum was exposed to more than 140 grams per day of glucose—or less. Those who used less glucose had a higher cure rate, fewer relapses, and less need for catheter removal.

Read the abstract » | (added 2015-07-08)

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Icodextrin PD fluid reduces insulin resistance in non-diabetic patients

Even without diabetes, insulin resistance can add to cardiovascular disease risk in people with CKD. A new study randomized non-diabetic adults to APD with 2.5% glucose (n=27) for the long dwell or icodextrin 7.5% (n=33). At 90 days, the icodextrin group had lower levels of insulin resistance.

Read the abstract » | (added 2015-07-08)

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New self-cannulation aid: Tattoo dots

In a case report of a patient who had a hard-to-feel fistula, small dots were tattooed to guide cannulation. With the permanent dots in place, the individual was able to self-cannulate and do home hemodialysis successfully.

Read the abstract » | (added 2015-06-10)

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PKD liver and kidney size may limit PD

In Japan, oversized polycystic kidneys may be treated with transcatheter arterial embolization (TAE) to cut off their blood supply and shrink them. Among two small groups of people with PKD, even those with reduced kidney volume still tended to develop hernias.

Read the abstract » | (added 2015-06-10)

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