Long-term effects of daily HD on vascular access

Does more frequent use of a vascular access create problems for those who do short daily HD? A new 4-year prospective, randomized study of 77 people says NO. Patients did six 3-hour HD sessions per week (n=26) or three 4-hour sessions (n=51). There were fewer access procedures in the daily group (543.2 per 1000 patient years, vs. 400.8), though this difference was not significant. There was also no difference in time to first access revision or access failure.

Read the abstract » | (added 2012-10-25)

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Mathematical modeling shows long, slow HD is better

Dropping the blood flow rate from 350 mL/min to 175 mL/min and dialyzing for 8 hours instead of 4 removes significantly more wastes—especially beta2 microglobulin, which causes amyloidosis.

Read the abstract » | (added 2012-10-25)

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Bone density better in PD than in standard HD

A study compared bone density X-rays in 56 people on standard HD and 23 on PD to 79 healthy people matched for age, gender, BMI, and menopausal status. The healthy people had higher bone density than those on dialysis. But, those on standard HD had significantly lower bone density than those on PD.

Read the abstract » | (added 2012-10-25)

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Are infections requiring hospitalization more common with PD or standard HD?

A study in Canada paired 910 people on PD with people on HD, matched by age, race, smoking, BMI, comorbid conditions, and lab data. After 2 years, researchers found that those on PD were more likely to be in the hospital for peritonitis—but less likely to have sepsis or pneumonia than those on standard HD.

Read the abstract » | (added 2012-09-25)

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Longer or more-frequent HD normalizes mortality patterns

It has long been known that those on PD have an equal chance of dying on any day of the week—while standard in-center HD are much more likely to die on a Monday (or Tuesday with Tue-Thu-Sat treatments). A new study looking at 14,636 Australian registry deaths found that those who got more than 3 standard in-center treatments per week or did home HD were no more likely to die on a Monday (or Tuesday) than any other day.

Read the abstract » | (added 2012-09-25)

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A "self-locating" PD catheter

The Di Paolo self-locating PD catheter was tested in 20 patients in Italy. The researchers found no infections, and only 0.8% dislocated catheters—vs. 12% for Tenkhoff PD catheters.

Read the abstract » | (added 2012-09-25)

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Reasons why patients prefer more HD

An in-depth, interview study of 10 short daily or nocturnal HD patients in Canada found four main reasons why they liked their choice. 1) They felt better physically and mentally. 2) They felt more in control of their time. 3) They didn't feel "sick" and were more able to work. 4) They had the support they needed to succeed.

Read the abstract » | (added 2012-09-25)

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PD in older patients

This study from Ireland looked at 148 people over age 50 who started PD between 1998 and 2008. The mean age was 63; most were over 70. The researchers found no difference in survival or technique survival by age, though older people did need a longer hospital stay to get started on PD.

Read the abstract » | (added 2012-08-16)

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Short daily HD reduces left ventricular mass

The Frequent Hemodialysis Network trials found significant reductions in left ventricular mass (LVM)—with greater benefit for patients whose left ventricular mass was higher than normal at the start of the study.

Read the abstract » | (added 2012-08-16)

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Thrice-weekly nocturnal HD reduces arterial stiffness

A Turkish study compared 60 people on standard in-center HD to 60 on nocturnal in-center HD. After a year, those who did nocturnal HD needed fewer blood pressure meds, had lower serum calcium and calcium-phosphorus product, reduced left ventricular mass, and their arteries were less stiff.

Read the abstract » | (added 2012-08-16)

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