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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Randomized controlled trial: group education aids options choice

Among 80 people with ESRD, receiving a group education class with their support person led to significantly higher knowledge of treatment options—and more positive attitudes toward hemodialysis and living donation—than usual care. At 2 year follow up, 49 had begun renal replacement therapy, and 34 had had a transplant, of which 22 were preemptive.

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

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Peritoneal cavity model will help the study of fibrosis

Researchers have devised a model peritoneum that allows them to study the impact of PD on the cells. The model has a mesothelial layer, an endothelial layer, and a collagen membrane chamber. When used for simulated PD, various solutions had different effects on the cells—but reduced nitric oxide production seems to be a mechanism for fibrosis. This new tool may lead to new ways to prevent and treat peritoneal fibrosis.

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

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Medihoney <i>Does</i> Equal Mupirocin for PD Infection Control

While Medihoney did not reduce overall PD infections, a substudy of the “Honeypot” trial did find positive results. Among 371 PD patients randomized to daily exit site antibacterial honey or nasal mupirocin (for staph carriers), rates of both exit site infections and peritonitis were equivalent. NOTE: Honey does not create antibiotic resistant bacteria, which is a plus.

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

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Low Molecular Weight Heparins for Nocturnal HD

A small Netherlands study of in-center nocturnal HD suggests that two divided doses may work best for low molecular weight heparins dalteparin and nadroparin. Careful dosing is needed to obtain the right level of anticoagulation and avoid overcorrection. Dalteparin required higher doses than nadroparin.

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

Tags: Home dialysis

Where Are We With Wearable Artificial Kidneys?

Sorbent and enzyme technologies are helping forward movement in the WAK world, but the long-time Achilles heel of hemodialysis—vascular access—along with anticoagulation and regulations are still challenges.

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

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Assisted PD Not a Large Burden for Care Partners

Not everyone can do PD without assistance, so what is the cost of this help for a care partner? Not too much, finds a study of 231 PD patients (89 assisted), 72 care partners, and 39 family members of self-care patients. Family members who helped with PD had more task-oriented duties, but did not perceive any greater of a burden than those whose loved one did not need help.

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

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Brazil APD Survival Significantly Better than CAPD

A prospective study matched each of the incident APD patients in Brazil with a CAPD patient, using 15 matching factors, and looked at mortality, technique failure, and time to first peritonitis. With 1,445 patients each in the APD and CAPD groups, the researchers found 44% higher mortality among CAPD patients, but no differences in technique failure or time to peritonitis.

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

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High Phosphorus Levels on PD Risk Heart Vessel Calcification

Among 157 people on PD who had three or more scans for coronary artery calcification, high serum phosphorus levels were an independent risk factor for faster progression of the problem, along with age.

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

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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