Journal Watch
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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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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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Even one bout of peritonitis can permanently change the membrane
An analysis of 541 people on PD compared the membranes of those who did and did not have a bout of peritonitis. In those who did, small solute transport was faster, they absorbed more glucose from the PD fluid, and the ultrafiltration rate was lower than in people who did not have peritonitis.
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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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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Online educational modules for professionals boost home therapies
A 3-module package of web-based e-learning about home dialysis was developed and tested on 88 undergraduate health professionals in Australia. Matching pre- and post-educational attitudes revealed clear knowledge deficits at the start, and significant improvement (p<0.001) afterward.
Read the abstract » | (added 2014-04-09)
Tags: Chronic kidney disease
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High-sensitivity CRP levels predict technique and patient survival on PD
High C-reactive protein (CRP) levels suggest inflammation. Among 402 PD patients followed for 2 years, those with the lowest CRP levels were more likely to still be on PD and had better survival. Each 1 mg/L increase in CRP predicted a 1.4% higher risk of mortality.
Read the abstract » | (added 2014-04-09)
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An HbA1c mean glucose formula for PD
Glucose in PD solution changes HbA1c levels. Chinese researchers compared blood sugar and HBA1c levels of 305 people on CAPD, of whom 13 had type 1 diabetes and 161 had type 2. Using linear regression, the authors identified a formula to correct HBA1c levels for PD users.
Read the abstract » | (added 2014-04-09)
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US dialysis education in this study was a FAIL—especially for seniors
In a study of 99 US dialysis consumers, education about options was poor regardless of age—but was far worse in those over age 65. Significantly fewer older people said the doctor explained the cause of their kidney failure, the impact dialysis would have on their daily lives, or the life-long need for dialysis, and most felt that the choice of treatment was made by the doctor.
Read the abstract » | (added 2014-03-07)
Tags: Chronic kidney disease