Urgent start PD: Better for Budgets than Urgent Start HD

A number of studies have found that urgent start PD is safe. But, does it save money, too, vs. placing a central venous catheter? Yes, finds a new study that surveyed practitioners: first 90 days costs for urgent start PD were estimated at $16,398, while for urgent start HD, the tab was $19,352.

Read the abstract » | (added 2015-01-08)

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Dealing with Home HD Technology: Patients and Families

An interview study was conducted with 19 home HD patients and carers who successfully used one of five different home HD machines. Respondents believed the machines were safe—but were still scared at first, and learned through mistakes. Machines that guide patients and carers (such as with step by step instructions) and help families communicate better with professionals (such as with remote monitoring) may be helpful.

Read the abstract » | (added 2015-01-08)

Tags: Home dialysis

Pilot Study: Flex Dialysis Facilitates Weight Loss

Patients who need to lose weight for better health or to obtain a transplant can be stymied by the strict diet limits of standard in-center HD. In a small series (four obese and two overweight patients), combining 2-6 sessions of flex, incremental HD with a coach-assisted weight loss program led to 5.7-20 kg weight loss over 12-30 months, better metabolic markers, and high patient satisfaction.

Read the abstract » | (added 2015-01-08)

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Should Home Dialysis Be Mandatory for Suitable Patients?

Considering improved survival, dramatically better quality of life, and reduced cost, should home dialysis be the default option?

Read the abstract » | (added 2015-01-08)

Tags: Home dialysis

Review of Bioartificial Kidney Development

This article looks at state-of-the art efforts to duplicate kidney functions, including cell-based therapies, cell sourcing, organ scaffolding, and immune response.

Read the abstract » | (added 2015-01-08)

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PD Catheter Placement with Nitrous Oxide

In a series of 87 patients, placement of PD catheters was done using nitrous oxide—including removal of the omentum and any adhesions. Just five patients required conversion to general anesthesia. After a year, 97.6% of the catheters were still working, and had not required any revisions.

Read the abstract » | (added 2015-01-08)

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Emergent-start PD works!

It flat-out makes more sense for people who need dialysis emergently to do PD, if possible, than to start HD with a catheter. A new review suggests that emergent-start PD may have a higher risk of catheter problems—but not infection. On the other hand, emergent-start HD risks both catheter problems and infection. The authors conclude that emergent-start PD is a “feasible, safe, and efficient alternative.”

Read the abstract » | (added 2014-12-09)

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New PD catheter technique uses Amplatz dilators

A laparoscope paired with Amplatz dilators to form the skin tunnel was used in 100 people who needed a PD catheter. The omentum was trimmed if it was long, and adhesions were lysed when present. There were no exit site or tunnel infections with this technique, and no catheter cuff extrusions. No catheters migrated or were displaced—and 97% of the catheters were working 6 months later.

Read the abstract » | (added 2014-12-09)

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Don’t trust glucometers on people using PD with icodextrin

Glucometer test strips can’t distinguish glucose from other sugars, like maltose. When icodextrin is used for PD in people with diabetes, standard glucometer use is risky. Blood glucose test results from glucometers can’t be trusted, and people may be given insulin they don’t need (which could cause coma or death). Three case reports show why this is the case—and the authors suggest using glucose-specific blood tests instead.

Read the abstract » | (added 2014-12-09)

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Nocturnal HD reduces blood endotoxin levels

Endotoxin drives inflammation throughout the body. Which type of HD is most effective at reducing endotoxin in the blood? This study compared standard in-center HD (n=56) to short daily HD (n=20) and nocturnal HD (N=10). Endotoxin levels were highest when ultrafiltration rates were highest (standard in-center HD) and lowest among those doing nocturnal HD.

Read the abstract » | (added 2014-12-09)

Tags: Nocturnal Hemodialysis