Trial of a Virtual Home HD Ward

Transitions from hospital stays back to home can lead to gaps in care. In Toronto, a virtual ward (VW) has been tested to see if care can be made more seamless. Following hospital discharge, a procedure, an antibiotic prescription, and/or completion of home dialysis training, patients were followed in the VW for 14 days. A nurse looked for the need for an HD prescription change, coordination of follow-up care, and medication changes. Care gaps were found in 67% of the 52 VW admissions for a total of 85 gaps. The researchers concluded that using a VW is practical, feasible, and identifies gaps that can be addressed.

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

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Pelvic Drainage + Catheter Removal May Aid Refractory Peritonitis

Complications of peritonitis can go on even after PD catheter removal. A retrospective review of 46 patients with refractory peritonitis over 12-years found that the 12 who’d had pelvic drainage with closed active suction devices had an 8% future complication rate, vs. 44% in those who did not. None of the active drainage group needed further drainage or open laparotomy, while 35% of the non-drainage group did.

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

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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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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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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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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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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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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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Kinetic modeling helps predict best PD prescription

Researchers found 12 subgroups among 1,005 people on PD, based on their membrane transport and amount of body water. Using PD Adequest 2.0, patients each had a PD prescription tailored to reach a minimum adequacy target for urea and water, using glucose and icodextrin fluids. A cut-off of more or less than 2mL/min of residual kidney function was identified. Use of icodextrin simplified the regimen and reduced glucose exposure and PD fluid volumes.

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

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