Nurses may be a barrier to extended in-center HD treatments

In a UK study to assess the feasibility of recruiting patients for a trial of 6-hour HD vs. 4-hour, 56 nurses were polled about their attitudes. While 95% of national non-nurse healthcare providers felt that the longer treatments were clinically helpful, just 42% of nurses agreed. And, while 75% of the non-nurses felt that longer HD treatments were well-tolerated, only 45% of nurses thought so—while 83% of nurses were concerned about the impact of the longer treatments on scheduling shifts.

Read the abstract » | (added 2015-04-10)

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Maximum ultrafiltration rate as a measure of optimal HD

Dialysis removes both wastes and water. Yet, while we have measures for waste removal, we have no marker for water—even though, in the short run, it is more important for patient health and well-being. Dr. Agar proposes a maximum ultrafiltration rate.

Read the abstract » | (added 2015-04-10)

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Daily HD – fewer hospital days and less dropout than PD

Compared to PD patients in the USRDS, 1,116 people who did daily home HD had significantly fewer hospital days (5.2 vs. 9.2) and were significantly less likely to switch back to standard in-center treatment (15% vs. 44%). Hospital rates for daily home HD were about the same as those for standard in-center HD in this study.

Read the abstract » | (added 2015-04-10)

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ACTIVE trial of extended dialysis described

A Clinical Trial of IntensiVE (ACTIVE) Dialysis is a randomized trial of extended (24+ hours) or standard (12-18 hours) of weekly HD for 12 months, looking at quality of life, left ventricular mass, and safety. The study has 200 participants from Australia, China, Canada, and New Zealand, meeting the planned recruitment target. The trial is registered at clinicaltrials.gov (NCT00649298).

Read the abstract » | (added 2015-04-10)

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Glucose-sparing PD fluids improve glycemic control

Hemoglobin A1c levels can be inaccurate in people on dialysis. In the IMPENDIA trial using serum fructosamine levels corrected for serum albumin, patients who used PD were randomized to a glucose-sparing (n=89) or standard PD fluid (n=91). In the glucose-sparing group, fructosamine levels dropped significantly, while in the standard group, the levels increased slightly.

Read the abstract » | (added 2015-04-10)

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Metanalysis of low-glucose PD fluid and residual kidney function

An analysis of six randomized controlled trials of neutral pH, low-glucose PD fluids has found that patients who used these fluids had a much slower rate of residual kidney function loss and much higher weekly Kt/Vs than those using standard PD fluids. There were no significant differences between groups in ultrafiltration, blood pressure, or all-cause mortality.

Read the abstract » | (added 2015-04-10)

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Biocompatible PD fluids are cost-effective (in capitated systems…)

In Australia, where the cost of hospitalization is of concern to the National Healthcare System, one group of PD patients was given biocompatible PD fluid, while a control group received standard PD fluid. After 2 years, the more costly biocompatible fluid created significant cost savings due to reduced peritonitis and hospital stays.

Read the abstract » | (added 2015-04-10)

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Icodextrin reduces PD failure and boosts survival

In a prospective trial of 306 incident PD patients between 2007 and 2011, those who used icodextrin were significantly more likely to continue with PD and more likely to live longer than those who used standard PD fluid.

Read the abstract » | (added 2015-04-10)

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Biocompatible PD fluid reduces cell death due to inflammation

In time, the peritoneum (just one cell layer thick) can wear out when used for PD. A new study finds that peritoneal cells in petri dishes bathed in standard PD fluid were more likely to die due to inflammation caused by glucose. But, cells bathed in biocompatible fluids were protected from the damage. In humans, this means that the peritoneum may last longer.

Read the abstract » | (added 2015-04-10)

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More reasons to use PD fluid with less sugar

Using a novel index created by dividing the glucose content of PD solution by body weight, this study looked at the impact of PD fluid sugar on hemoglobin A1c, fluid overload, and inflammation (measured by interleukin (IL) 6) in 43 people on PD. Higher sugar levels were linked with worse diabetes control, more fluid overload, and higher IL-6 levels.

Read the abstract » | (added 2015-03-11)

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