Journal Watch
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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
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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
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Updated ISPD Adequacy and Prescription Clinical Guidelines
PD adequacy is transitioning from solute clearance and ultrafiltration to quality of life. With sections on adequacy, residual kidney function, and prescription of CAPD and APD, the new guidelines specify the level of evidence and strength of the recommendations
Read the abstract » | (added 2024-10-15)
Tags: PD Adequacy, Solute Clearance, Ultrafiltration, Quality Of Life
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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
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Preferences for ESKD Treatment Options among Seniors
A choice experiment of 327 UK seniors (median age 77) with stage 4 CKD examined the survival benefit patients needed 2 years after starting treatment to accept dialysis. Overall, they needed 8-59% absolute survival benefit, and preferred less frequent treatment and home treatment. Seniors who had partners had significantly higher preferences for survival. Most wanted their capacity preserved and an acceptable frequency of care.
Read the abstract » | (added 2024-10-15)
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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
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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
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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)
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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)
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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