Why Early Survival on PD Matters

If survival between PD and standard in-center HD “evens out in the end,” does it matter? Yes, argues Mark Marshall, MD, from New Zealand. The early survival benefit increases patient life years—and persists even when accounting for use of central venous HD catheters. To support shared decision-making, patients have the right to know about survival on PD vs. standard HD.

Read the abstract » | (added 2020-03-16)

Tags: Survival, PD, In center HD, Early Survival, HD Catheter

Glucose Degradation Product (GDP) Disrupts Peritoneal Membrane Function

Growth of new, immature blood vessels on the peritoneal membrane is linked with ultrafiltration failure. Exposure to the GDP methylgyoxal (MGO) up-regulated both vascular endothelial growth factor (VEGF) and suppressed platelet-derived growth factor (PDGF) in vitro, potentially disrupting the balance of angiogenesis.

Read the abstract » | (added 2020-03-16)

Tags: Peritoneal Membrane, Ultrafiltration Failure, Methylgyoxal, Angiogenesis

Nocturnal HD in Children

There are very few studies of the impact of intensified hemodialysis regimens (days/hours) on children. This review addresses implementation challenges.

Read the abstract » | (added 2020-03-16)

Tags: Intensified Hemodialysis, Children, Implementation Challenges

Physician Reimbursement Increases Did Not Drive PD in Canada

Among a cohort of 4,262 patients in Alberta, Canada followed between 2001 and 2014, an increase in PD physician pay from $0 to $135 (over a 9-year period) revealed no statistical evidence of a difference in PD use or trends—and the role of the physician in modality selection was unclear.

Read the abstract » | (added 2020-03-16)

Tags: PD Physician Pay, PD Use Trend

Peritonitis with Diarrhea Could be C-diff

Cloudy PD dialysate can signal infectious peritonitis from a variety of causes—including C-diff. But, use of cephalosporins could worsen a C-diff infection. A new article presents two case histories of C-diff peritonitis and suggests reexamining the traditional empiric treatment of peritonitis when diarrhea is present.

Read the abstract » | (added 2020-03-16)

Tags: PD Dialysate, Infectious Peritonitis, C diff, Cephalosporins, Empiric Treatment, Diarrhea

Exercise in PD Patients and Residual Renal Function

After a 12-week home-based exercise program was completed, researchers analyzed residual renal function among 13 patients who received usual care and 16 who had been in the exercise intervention group. Urinary liver-type fatty acid-binding protein and microalbumin-to-creatinine ratios were significantly lower in the exercise group, suggesting a possible benefit.

Read the abstract » | (added 2020-02-19)

Tags: Exercise, Renal Outcome, Residual Renal Function, Peritoneal Dialysis

Survival with PD vs. Home HD and When to Go Home

Using a national cohort of 1,993 patients transitioning to home HD and 16,514 to PD between 2007 to 2011, 1,195 home HD were matched to 1,195 using propensity scores and adjusting for demographics, comorbidities, dialysis duration, and BMI. Those on home HD had significantly better survival (9.6 vs. 12.9 deaths per 100 patient-years; p<0.001). However, when patients switched to PD within the first 12 months of starting dialysis, survival was comparable between PD and home HD: patients who transitioned after 12 months had an 83% higher risk of death.

Read the abstract » | (added 2020-02-19)

Tags: Home HD, PD, Comorbidities, Dialysis Duration, BMI, Survival

Green Nephrology: Reducing the Environmental Impact of Dialysis

Climate change and extreme weather events both increase the incidence of kidney disease and destabilize care. But, healthcare in general—and dialysis in particular—contribute substantially to greenhouse gases. Monitoring resources and reducing waste in HD can be done through reuse of RO reject water, renewable energy sources, better waste management, and slower dialysate flow rates. For PD, point-of-care dialysate will reduce the environmental impact.

Read the abstract » | (added 2020-02-19)

Tags: Environmental Change, Kidney Disease Factors, Environmental Impact Of Dialysis

PD Glucose Absorption and Lipid Profiles

Lipid status was assessed at baseline and 12 month in 143 CAPD patients, 2/3 of whom used a daytime icodextrin exchange. No associations were found between glucose absorption, lipid profiles, or changes in serum lipids.

Read the abstract » | (added 2020-02-19)

Tags: Peritoneal Dialysis, Cholesterol, Glucose, Triglycerides

The Q-Cohort Study: More Dialysis, Less Risk of Cancer

Uremic toxins increase cancer risk. In a study of 3,450 HD patients followed for 4 years, patients were divided into quartiles based on their baseline Kt/V. Four-year survival dropped linearly along with Kt/V. Every 0.1 increase in Kt/V reduced the risk of cancer death by 8%.

Read the abstract » | (added 2020-02-19)

Tags: Dialysis Dose, Cancer Death, Hemodialysis, Uremic Toxins, Kt/V