Journal Watch
More Nephrologist Time Linked with Lower PD Peritonitis and Catheter Infection Rates
A PDOPPS study in Korea divided 276 incident PD patients into two groups based on whether they got <15 minutes (n=184;66.7%) vs. >15 (n=92; 33.3%) minutes of nephrologist time during each visit. Average age between groups did not differ, but the group that had more nephrologist time had significantly fewer 3- and 12-month PD-related infections.
Read the abstract » | (added 2024-10-15)
Utility of the 5-day Cell Count in Refractory Peritonitis
A retrospective study in Turkey analyzed 11 years of data on 135 patients with 236 episodes of refractory peritonitis. While age, gender, diabetes, prior hemodialysis, and PD duration did not reveal any significant differences, a day 5 dialysate white blood cell count higher than 1000/mm3 and hospitalization were linked width catheter loss.
Read the abstract » | (added 2024-10-15)
Tags: Refractory Peritonitis, Arteriovenous Fistula, Ark Implant, Cannulation
Cloudy-only Peritonitis May Point to Vancomycin First
A study that looked at clinical characteristics of PD-associated peritonitis (PDAP) was able to correlate the signs and symptoms with the pathogen, allowing the team to choose antibiotics in a more informed way. The researchers divided the records of 162 patients with culture-positive PDAP into those who had cloudy effluent only vs. those who also had pain and/or fever, and compared the culture and sensitivity results. All 30 of the cloudy-only group had gram-positive infections; significantly more than the multi group (P<0.001), and 29 of those infections were susceptible to vancomycin, for specificity of 98.48%. This insight may help guide a first choice of antibiotic.
Read the abstract » | (added 2024-10-15)
Tags: PD associated Peritonitis, Cloudy Effluent, Vancomycin
CAPD vs. APD: Meta-analysis Sheds No New Light
A Cochrane Kidney and Transplant Register of Studies update identified two new randomized controlled trials (n=131) to include, one with 6-month follow-up and one with 24-month follow-up. Both studies had mostly low risk of bias. Conclusions about differences in CAPD and APD outcomes for death, hospitalizations, peritonitis, modality change, residual kidney function, health-related quality of life, overhydration, blood pressure, and a host of other outcomes were all based on low to very low certainty evidence.
Read the abstract » | (added 2024-10-15)
Tags: CAPD, APD, Modality Outcomes
Value of Remote Monitoring of PD
A cluster-randomized trial assigned 21 hospitals with automated PD (APD) programs to either do remote monitored (RM-APD; 10 hospitals) or conventional APD (11 hospitals) for 398 adult patients initiating PD. In the conventional APD group, all-cause mortality, cardiovascular deaths, and hospitalizations were significantly higher, as were PD dropouts and adverse events and hospitalizations related to cardiovascular disease, fluid overload, or poor PD adequacy.
Read the abstract » | (added 2024-09-12)
Tags: Automated PD, APD, All cause Mortality, Cardiovascular Deaths, Hospitalizations, Cardiovascular Disease, Fluid Overload, PD Adequacy
PD vs. HD for Women’s Sexual Function (But, Would Intensive HD be Better?)
Women (n=200) with non-dialysis CKD, HD, CAPD, and controls who completed the Female Sexual Function Index (FSFI) were analyzed by treatment group. The control group had the highest FSFI mean scores. The point means between PD and standard HD were nearly identical, except for sexual satisfaction, which favored CAPD (p<0.05). NOTE: Intensive HD was not compared in this study—but may prove to be helpful.
Read the abstract » | (added 2024-09-12)
Tags: PD, HD, Female Sexual Function Index, FSFI
Potential Benefits for Tidal (TPD) vs. Intermittent PD (IPD)
A study randomized 85 patients to TPD (n=43) or IPD (n=42) and followed them for up to 2 years. Of the total, 19 patients died and 25 stopped PD. There were no differences in overall survival or technique survival among the remaining patients, but those who did TPD had significantly higher urine volume (p=0.001) as well as lower BUN (p=0.002) and phosphorus (p=0.004) and fewer cycler alarms (p<0.001). The TPD group had a higher chance of reporting abdominal fullness (p=0.001).
Read the abstract » | (added 2024-09-12)
Tags: Tidal PD, TPD, Intermittent PD, IPD
Frailty and Transfers from PD to HD
In an 11-year, single-center, retrospective study, incident PD patients (n=182) were assessed with the clinical frailty scale from 1 (very fit) to 7 (severely frail). In 379 patient years at risk, there were 42 deaths and 69 transfers from PD to HD. The rates of death and transfer to HD were twice as high among patients whose frailty score was >4.
Read the abstract » | (added 2024-09-12)
Fat Mass May Protect Bones and Muscles on PD
Among 359 PD patients, 25% had osteoporosis, 32% had sarcopenia, 15% had osteosarcopenia, with considerable overlap between these conditions. Using body composition monitoring, fat tissue index (FTI) and lean tissue index (LTI) were measured. Low FTI—but not normal or high FTI—was linked with all three conditions, even after adjusting for age and BMI.
Read the abstract » | (added 2024-09-12)
Tags: PD, Osteoporosis, Sarcopenia, Osteosarcopenia, Fat Mass, Fat Tissue Index, FTI, Lean Tissue Index, LTI
Systematic Review: Depression May Not Affect PD Adherence
Metaanalysis of data from eleven eligible studies did not find depression to be a significant predictor of technique survival or death on PD, even after including qualitatitive analysis. Peritonitis data were conflicting, and more data are needed.
Read the abstract » | (added 2024-09-12)