Home HD: Flexibility, control, and independence

In-depth interviews with 24 home HD patients in New Zealand found that dialysis was disruptive in terms of the body and the time it takes—but also a positive experience on many levels, especially the way people relate to others.

Read the abstract » | (added 2014-07-07)

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Following the PD treatment plan – a stepwise approach

How do people learn to follow a treatment plan? Not all at once, finds a new nursing interview study of 36 PD patients (half male, half female) from Hong Kong. The researchers found three stages of PD adherence. First, new patients tried to follow instructions, but could not do so strictly and persistently. After 2-6 months, they adhered selectively by experimenting, checking their progress, and adjusting. Finally, after 3-5 years, they fit their regimens into their day-to day-lives.

Read the abstract » | (added 2014-06-05)

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Inflammation in PD? Look to the gums!

Researchers looked at gum disease in 68 people who were doing CAPD, and rated it as healthy, slight to moderate, and severe. Patients whose C-reactive protein levels (a marker of inflammation) were higher had worse gum disease and had been on PD longer. Those with heart disease and diabetes also had worse gum disease. The authors suggest that all people who use PD should have their gums checked.

Read the abstract » | (added 2014-06-05)

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Transplant still beats home HD in Canada

A retrospective study looked at 173 patients using intensive HD (>16 hours/week) and a total of 1,517 who received a kidney transplant. Those on dialysis had fewer hospital stays in the first 3 months to a year. But, those with transplants had fewer treatment failures or deaths.

Read the abstract » | (added 2014-06-05)

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Home HD survival in New Zealand

Researchers analyzed 15 years worth of home HD data in NZ (6,419 patients and 20,042 patient-years of follow up). After adjusting for comorbidities, home HD had 52% better survival than in-center HD. PD had 20% better survival than in-center HD in the first 3 years—but a 33% higher mortality risk after that.

Read the abstract » | (added 2014-06-05)

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Can short daily HD treat hypertension on dialysis?

Ah, cherish the rare RCT in dialysis. In this study, a group of standard HD patients with high blood pressure were switched to short daily HD to see if it could reduce their BP (and if so, how). Bioimpedance was used to check extracellular fluid volume (ECFV). Inflammation and oxidative stress were also measured. After 3 months, BPs were similar between the two groups—but the short daily HD patients needed significantly fewer BP medications. The reason for the difference is still a mystery.

Read the abstract » | (added 2014-06-05)

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Web e-learning boosts home dialysis knowledge in Australia

A 3-module e-learning package was developed for a “Home First” project in Australia and tested on 88 undergraduate health professionals. The students knew little about home dialysis before using the modules, and improved significantly afterward.

Read the abstract » | (added 2014-06-05)

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Timing of PD—is an early start harmful?

Early start HD (when eGFR is >10.5 mL/min/1.73m2) is not helpful, and may even be harmful. Is the same true of PD? No, suggests an observational study of 8,047 incident PD patients in Canada. Overall mortality was not higher for early, middle, or late start PD. However, first-year mortality was 38% higher in the early start group than in the late start group.

Read the abstract » | (added 2014-05-06)

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Strict volume control on PD helps the arteries and heart

In a prospective observational study of 58 people on PD, there was no difference in echocardiogram findings between APD and CAPD. But, those who followed strict volume control had better blood pressure control, less arterial stiffness, and lower NT-pro-BNP levels (a marker of left ventricular function).

Read the abstract » | (added 2014-05-06)

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Cost of in-center vs. home HD

Home HD has better clinical and patient centered outcomes than standard in-center HD. Does it cost less, too? A systematic literature review from 2000-2014 found six relevant studies and concluded that home HD (including short daily and nocturnal) is more cost effective; higher start-up costs are recouped over the long term. In-center HD has higher staff costs and poorer outcomes.

Read the abstract » | (added 2014-05-06)

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