PD Catheters: To Dress or Not to Dress?

Which is better for preventing exit site infections, a PD catheter dressing, or leaving a healed catheter open to the air? A prospective, randomized, controlled trial in Malaysia followed 108 patients for 2 years. All were instructed to wash the exit site daily with antibacterial soap. The dressing group (n=54) used povidone iodine, mupirocin ointment, sterile gauze, and tape. The non-dressing group did not. Of the 97 patients who completed the study, the results from both groups were similar.

Read the abstract » | (added 2015-10-15)

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HD Membranes and Bisphenol A (BPA) Blood Levels

BPA, an ingredient in many plastics and resins, can build up in the bodies of people with kidney failure. Studies suggest that BPA may be linked with kidney and heart damage. Compared to BPA-free polynephron dialyzers, patients dialyzed using conventional polysulfone dialyzers had higher blood levels of BPA, and higher markers of oxidative stress and inflammation.

Read the abstract » | (added 2015-10-15)

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Majority of Patients Open to Self-Care or Home HD if Trained Properly

A survey of 250 in-center HD patients and 51 nephrologists found that 69% of patients said they were “Likely” or “Very Likely” to consider self-care HD if they received proper training on a new machine designed for patient use. Nephrologists believed patients could do many dialysis tasks, but would not be willing to—responses that did not match what the patients said. Perhaps they should ASK?!

Read the abstract » | (added 2015-10-15)

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For Phosphorus Removal, Dialysis Time Matters

Dialysis guru John Daugirdas, coauthor of the Handbook of Dialysis, observes that “the most practical way to increase phosphorus removal is to extend dialysis, time” in this article, recommending 18-30 hours of HD per week to eliminate the need for binders. Other suggested interventions include use of more efficient dialyzers and possibly hemodiafiltration.

Read the abstract » | (added 2015-10-15)

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Simultaneous PD Catheter Removal and Replacement

A PD catheter can be replaced without interrupting PD, finds a new study in 55 patients with peritonitis, tunnel infection, or mechanical problems. Most used low-volume APD even on the day of surgery. Antibiotics were given for 2-4 weeks, and almost 90% of the procedures were done in an outpatient setting. Just one had a peritonitis recurrence, and no newly placed catheters were lost. Using the protocol allowed a median PD technique survival of 5.1 years and avoided the use of central venous catheters.

Read the abstract » | (added 2015-10-15)

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Excessive Weight Gain in Year 1 of PD Predicts Poor Outcomes

In a PLoS One study, 148 incident PD patients were observed for a median of almost 2 years. Those who gained more than 3% of their body weight lost residual kidney function 4.17 times faster (p<0.001), and had higher blood pressure, more inflammation, and an increased rate of diabetes.

Read the abstract » | (added 2015-10-15)

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Urgent Start PD: Safe and Effective

The first Canadian group to try urgent start PD followed 30 patients for a total of 3 years. They found no peritonitis or exit site infections in the first 4 weeks after catheter placements, three minor leaks that were managed conservatively, and four catheter migrations that were relocated without the need for surgery. The researchers concluded that urgent start PD is safe and effective for people who need to start dialysis and do not have an access.

Read the abstract » | (added 2015-10-15)

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Calculating the dialysis dose for a wearable artificial kidney

How do you set a dialysis dose for a 24/7 continuous HD therapy? Using kinetic modeling, researchers developed theoretical doses that would be needed to achieve certain creatinine concentration targets. Interestingly, fluid intake did not affect the predicted clearances.

Read the abstract » | (added 2015-09-11)

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Home HD has 20% lower all-cause mortality than PD

In a new study that matched 4,201 new home HD patients in the USRDS database to new PD patients, the risk of all-cause mortality was 20% lower with home HD. In addition, there was an 8% lower risk of hospitalization, and a 37% lower risk of technique failure.

Read the abstract » | (added 2015-09-11)

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CRP levels and abdominal CT scans can find EPS early

A look back at CT scans and c-reactive protein levels from 30 people diagnosed with encapsulating peritoneal sclerosis has provided clues for early diagnosis. Higher than normal levels of c-reactive protein plus abnormal CT scan results found the rare complication early 78% to 87% of the time—making effective treatment more possible.

Read the abstract » | (added 2015-09-11)

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