Journal Watch
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Ultrathin silicon membranes for wearable dialysis.
A wearable artificial kidney will need a membrane efficient enough to remove a lot of toxins in a small device. This article explains the technical details of porous nanocrystalline silicon made into chips. Pore size can be controlled to keep albumin in but let middle molecules out, like a healthy kidney. Special coatings that repel water keep proteins from adhering to the membrane.
Read the abstract » | (added 2013-12-10)
Tags: Chronic kidney disease
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Urgent-start PD: A how-to guide
Many nephrologists would choose PD for themselves. But few patients start on it, in part because ESRD may be found so late that dialysis is imminent. If only PD starts could be as done as easily as HD catheter placements... As it turns out, PD can be started on an urgent basis, and this approach is starting to pick up speed. This article reviews the literature, ways to overcome challenges, and the possible impact of changing the paradigm away from a default of standard in-center HD.
Read the abstract » | (added 2013-12-10)
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The Brits are doing something right in home HD
Among 166 home HD patients in Manchester, UK (chosen with "liberal selection criteria"), the drop-out rate was far smaller than we tend to see in the US. In 8 years, just 24 patients switched to a different option. Technique survival at home was 98.4% at 1 year, 95.4% at 2 years, and 88.9% at 5 years, excluding death and transplant. Patients older than 60, those with diabetes or heart failure, and those with more comorbidities were more likely to stop doing home HD. The technical error rate was just 0.7% per year.
Read the abstract » | (added 2013-11-06)
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Stacking up intensive HD against standard in-center HD
We know that the risk of death is far higher for patients after two days with no HD. Do longer and/or more frequent HD regimens successfully address this problem and save lives? This review compares the impact of different HD regimens on a number of factors, including access problems, burden of therapy, quality of life, residual kidney function, heart disease, bone disease, anemia, hospitalization, and survival.
Read the abstract » | (added 2013-11-06)
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Is there a new way to prevent PD infections? Sorry, honey
Honey has a long history of helping to heal wounds—with no risk of antibiotic resistance. But, a recent trial of the sweet stuff in PD exit site infections did not show a benefit. Researchers asked 186 patients from 26 clinics in Australia and New Zealand to put purified honey on their exit sites, while a control group (185 people) used standard care (or mupirocin if they carried S aureus). The time to first infection was about the same in both groups.
Read the abstract » | (added 2013-11-06)
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One type of PD catheter offers a significant survival advantage
Coiled? Swan neck? Straight? As it turns out, the catheter shape does matter. A new metaanalysis of 13 randomized controlled trials found that both catheters and people were twice as likely to survive when catheters were straight—not coiled.
Read the abstract » | (added 2013-11-06)
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PD First. It makes sense!
Why is the default US dialysis standard in-center HD, when it doesn't offer the best outcomes, costs more, and offers a poor quality of life? That's the question asked in a new review article that points out the benefits of a PD first strategy. Rather than allowing ease of HD initiation to drive treatment "choice," it makes sense to change the default initiation option to PD.
Read the abstract » | (added 2013-11-06)
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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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One way to reduce oxidative stress in PD patients
Oxygen is a great thing—in the right amounts. But, too much can wreak cellular havoc and even damage the heart. In people on PD, oxidative stress can hurt the peritoneum, too. Antioxidants to the rescue! A Greek study looked at the impact of vitamins C and E (alone and combined) in 20 people on PD vs. 10 healthy controls. Both of the vitamins reduced oxidative stress markers. (Talk to your doctor before taking any medication, vitamin, or supplement).
Read the abstract » | (added 2013-10-02)
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Risks of biocompatible PD solution
Sugar (dextrose) in PD solution helps remove water from the blood—at a cost. Advanced glycation endpoints (AGEs) formed when the solution is made can harm the peritoneum over time. It would seem to make sense more biocompatible (like the human body) solutions would be better and safer. Some studies have found this, but a new look in the ANZDATA registry of all PD patients from Australia/New Zealand from January 1, 2007 and December 31, 2010 did not. Use of biocompatible PD solution was linked with significantly more (49% more) peritonitis, and far less time to a first bout of the infection.
Read the abstract » | (added 2013-10-02)
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