Journal Watch
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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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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Is low blood sodium as harmful in PD as it is in HD?
Hyponatremia (low blood sodium levels) raise the risk of death in people who do standard in-center HD. A prospective observational study of 441 incident PD patients found a higher mortality risk among those who did PD, too. In fact, after 3 years, the 1/3 of study participants whose sodium was lowest had a 79% higher risk of death than those whose levels were higher.
Read the abstract » | (added 2014-12-09)
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On PD, motivation matters
With the changes in the bundle, more people are being started on PD. In a study of 104 people on PD followed for 14 months, nurse ratings of home cleanliness or patients’ exchange techniques did not predict outcomes. Instead, unmotivated or depressed people were significantly more likely to have peritonitis.
Read the abstract » | (added 2014-12-09)
Tags: Peritonitis
mTOR inhibitors may treat encapsulating peritoneal sclerosis
In a case study report, a class of drugs that includes Rapamycin (sirolimus) was used to successfully treat a 16 year old who developed EPS after a switch from PD to HD. mTOR inhibitors help keep new blood vessels from growing.
Read the abstract » | (added 2014-11-07)
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Older patients may make less informed options decisions
In a study of 99 people on dialysis in North Carolina, those who were over age 65 reported significantly less informed decision making. They were less likely to say that the doctor had explained their health problems, and more likely to feel that the doctor made a choice for them.
Read the abstract » | (added 2014-11-07)
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Are portable or wearable kidney devices on the horizon?
Nanotechnology may allow for a new generation of wearable and portable devices to treat kidney failure. Some are now in large animal and human trials. A new day may be coming.
Read the abstract » | (added 2014-11-07)
Tags: Chronic kidney disease
Short-term transfer from PD to HD was not harmful
Peritonitis may require a switch to HD for a while. Does this affect patient or technique survival? No, finds an Australian study that looked at 8 years of people new to PD and matched PD-to-HD-and-back switchers to those who stayed just on PD or HD.
Read the abstract » | (added 2014-11-07)
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Self-locating catheters (SLC) vs. straight Tenckhoff catheters for PD
Which is better to reduce complications: an SLC designed to avoid trapping the tip against the abdomen wall? Or, a single cuff, straight Tenckhoff catheter? In a series of 78 people new to PD, 40 were given SLCs and 38 were given Tenckhoffs. Prior to the start of PD, there were no differences between the groups. But, once PD began, there were fewer problems in the SLC group (p=0.021). Plus, it was easier to solve problems with SLCs using laxatives, and no surgeries were needed.
Read the abstract » | (added 2014-10-07)
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Nocturnal home HD boosts hemoglobin level and reduces ESA use
Every other night nocturnal home HD (NHHD) was compared to standard in-center HD in a small study. Among the 23 people using NHHD, Hemoglobin increased by about 2 g/dL after 2 years (P<0.001), while ESA dose dropped by just over 50% (P<0.001), and 26% were able to stop ESAs. Among the 25 people doing standard HD, hemoglobin levels dropped by almost 2 g/dL (P = 0.007), and ESA dosage increased (P<0.001).
Read the abstract » | (added 2014-10-07)