Why heart failure patients may benefit from PD

Like kidney failure, heart failure (HF) causes fluid to build up in the body. When diuretics don't work in people with HF, PD might help get rid of the excess, finds a new French study. The researchers found significantly better ejection fractions (amount of blood the heart can pump) with PD. And, those on PD had significantly fewer hospital days for HF.

Read the abstract » | (added 2013-10-02)

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Nocturnal in-center HD comes to Slovenia

Only a few handfuls of US clinics offer nocturnal in-center HD. Now, Slovenian researchers report their experience of switching 10 patients from "standard" (4-5 hours!) in-center treatments to thrice weekly 8-hour long nighttime ones. With almost twice as much dialysis per week, mean predialysis creatinine and urea dropped significantly, as did mean dry weight. Six of the ten were able to stop taking phosphate binders, and one more patient had a dose reduction—and phosphate was added to the dialysate for three patients. There were no major changes in predialysis blood pressure, calcium or potassium levels, mean ultrafiltration, hemoglobin, or EPO dose (Editor's note: perhaps because standard HD in Slovenia is longer, and because the nocturnal treatments were only three times per week).

Read the abstract » | (added 2013-10-02)

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What does frequent HD do to the heart?

In many people on dialysis, left ventricular hypertrophy or LVH (overgrowth of the heart's main pumping chamber) can lead to heart failure; a leading cause of death. In the Frequent Hemodialysis Network trial, 245 patients were randomized to receive standard in-center HD or frequent "daily" (six times per week) in-center HD. The nocturnal arm of the study randomized 87 patients to six nights per week of HD or three times per week standard home HD. In the daily trial, there were significant reductions in LVH—especially for those who still made some urine. There were no major differences in the nocturnal group (Editor's note: this arm of the study did not recruit enough people to draw statistical conclusions).

Read the abstract » | (added 2013-10-02)

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Very tiny numbers of serious adverse events during home HD

Ideally, no one on dialysis will ever run into a problem. But, when the blood needs be cleaned, sometimes things can go wrong. A new study from Canada looked at life-threatening events among 500 patient years among 190 people who were doing home HD. Researchers found one death and six other serious events (most involved blood loss). In five of the events, human error was involved. They calculated an adverse event rate of 0.06 per 1000 treatments. (Editor's note: unfortunately, we don't yet have a corresponding rate for adverse events for in-center HD, but it may be far higher.)

Read the abstract » | (added 2013-10-02)

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What are the challenges for successful home HD?

The UK has actually set a goal in 2002 for home HD of 10-15% of dialysis patients, but has not reached it yet. A new study (BASIC-HHD) is starting to look at the reasons for underuse of a treatment option that offers better results than standard in-center HD. A total of 500 patients will be followed, 200 pre-dialysis, 200 hospital HD, and 100 home HD from across the UK. The predialsyis patients will be followed for a year to better understand their journey to ESRD and renal replacement. They will be interviewed, take psychosocial assessments, and have blood tests. The researchers will also look at the attitudes and practices in dialysis clinics, the economics of home treatment, and care partner concerns.

Read the abstract » | (added 2013-10-02)

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Informed decision-making about dialysis options

Among 99 dialysis patients from 15 clinics in North Carolina, 67% said they felt like they had no choice about their modality, and about a third felt that the choice had already been made by their doctor.

Read the abstract » | (added 2013-08-22)

Tags: Chronic kidney disease

Overweight people (90 Kg) do well on PD

Forty-three patients who weighed more than 90 Kg had significantly fewer hernias and leaks than matched controls who weighed less than 90 Kg. They also had the same number of hospital days and stays and lived just as long.

Read the abstract » | (added 2013-08-22)

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Why nocturnal HD reduces sudden cardiac death

Prolonged QTc intervals between heartbeats increases the rate of sudden cardiac death in people whose kidneys work. In an ECG study, patients who did nocturnal HD had shorter QTc intervals—even if those intervals were long before dialysis and even before changes to the left ventricle.

Read the abstract » | (added 2013-08-22)

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Mineral balance in long HD

A metaanalysis from Canada of 21 studies concluded that keeping dialysate calcium ≥1.5 mmol/L for most patients on long/long-frequent HD prevents an increase in PTH levels and a decline in bone mineral density—without raising the risk of calcification. Adding phosphate to the dialysate for those with a low predialysis level or very low level makes sense.

Read the abstract » | (added 2013-08-22)

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New Vwing device helps start Buttonholes

A new, surgically implanted device used for 387 cannulations over 6 months in 9 patients was successful 94% of the time. But, standard cannulation for the other needle only worked 77% of the time. This device may help with difficult to cannulate fistulas.

Read the abstract » | (added 2013-08-22)

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