Journal Watch
Get drier: Live longer
A 3.5 year long study of 269 people on HD has found that folks who had more water removed from the blood (tested with a body composition monitor) lived significantly longer than those who stayed water-logged. (Drier is better, and doing longer and/or more frequent HD makes that possible.)
Read the abstract » | (added 2011-02-24)
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Mind the gap
In the UK, "mind the gap" means watch your step as you get off the train. For in-center HD, the gap is the 2-day dialysis weekend. It turns out that switching randomly chosen patients from 3x/week to every other day HD for 12 months reduced blood pressure, left ventricular mass, EPO dose, urea rebound, and symptoms. Of course; it's more physiological!
Read the abstract » | (added 2011-02-24)
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Nocturnal HD improves melatonin rhythm for better sleep
Is sleep better or worse on nocturnal HD, since it is done at night? A new study of 13 people who switched from standard HD to nocturnal found that standard HD disrupts the normal rhythm of melatonin (the hormone that helps you sort out day from night). After 6 months of night-time treatments, this rhythm was partly restored—and sleep was much better.
Read the abstract » | (added 2011-02-24)
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November 2006 Kidney International supplement focuses on PD
Is survival better on PD or HD? What factors predict PD success? What are best practices in PD catheter placement? Does use of biocompatible PD solution reduce peritonitis? Learn the answers to these and many other key PD questions in the November 2006 supplement of KI. (For kidney professionals who don't subscribe to Kidney International, we've compiled the links to all of the abstracts from the special supplement on PD (November 2006). You can find them below.
- Mortality studies comparing PD and HD: What do they tell us?
- French PD registry (RDPLF): Outline and main results
- PD in the US: Evaluation of outcomes in contemporary cohorts
- Selected best demonstrated practices in PD access
- Use of the embedded PD catheter: Experience and results from a North American Center
- Prevention of infectious complications in PD: Best demonstrated practices
- Microbiology and outcomes of peritonitis in North America
- Impact of new dialysis solutions on peritonitis rates
- Place of PD in the management of treatment-resistant congestive heart failure
- The role of PD in the management of treatment-resistant congestive heart failure: A European perspective
- Mitigating peritoneal membrane characteristics in modern PD therapy
- Profiles of automated PD prescriptions in the US 1997-2003
- Tidal PD: Its role in the current practice of PD
- The role of tidal PD in modern practice: A European perspective
- Glucose sparing in PD: Implications and metrics
- New insight of amino-acid based dialysis solutions
- Management of hyperlipidemia in patients on PD: Current approaches
- Structural requirements for a successful PD program
- Nosogogy: When the learner is a patient with chronic renal failure
- Patient retraining in PD: Why and when it is needed
- Patient and technique survival on peritoneal dialysis in patients with failed renal allograft: A case-control study
- Place of genotyping and phenotyping in understanding and potentially modifying outcomes in PD patients
Read the abstract » | (added 2011-02-24)
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If you can't beat 'em, zap 'em!
Fibrils of amyloid can build up in the joints and soft tissues when too-little beta-2 microglobulin (B2m) is removed from the blood during dialysis. Longer and more frequent treatments remove more B2m. But what if we could remove fibrils that have already occurred? A new study suggests that laser treatments can destroy existing fibrils and slow the rate of new ones.
Read the abstract » | (added 2011-02-24)
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Children on dialysis have good survival prospects
Some of the longest survivors of ESRD were children or teens when their kidneys failed. A new study finds that 5-year survival of this group after they reach age 18 was 95.1%, with an average life expectancy of age 63 with a transplant—or age 38 with standard dialysis. Of course, two recent studies have found that survival with longer and/or more frequent HD rivals that of transplant.
Read the abstract » | (added 2011-02-24)
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Lower B2m levels predict better survival
More frequent—and especially longer—HD remove much more beta-2 microglobulin, a toxin that causes dialysis-related amyloidosis (DRA), with waxy protein deposits in bones, joints, and sometimes soft tissues. Since a new study has found that lower levels of B2m on dialysis predict survival, getting more dialysis is a plus!
Read the abstract » | (added 2011-02-24)
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Treatment length matters (we knew that!)
Even when the same number of blood liters are processed, long, slow dialysis does a better job of removing toxins. In a study where patients on HD were dialyzed for 4, 6, or 8 hours, the longer treatments removed significantly more urea, creatinine, phosphorus, and beta-2 microglobulin. The authors conclude that Kt/V should not be the only measure of dialysis adequacy.
Read the abstract » | (added 2011-02-24)
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Finally, data! Buttonhole Technique causes fewer fistula problems than site rotation
A new study compares 75 HD patients using the Buttonhole technique for fistula needles with 70 patients using the "standard" technique of "rope ladder" needle site rotation. Buttonhole users had fewer missed cannulations, bruises, and aneurysms, and needed less angioplasty. Infection precautions are vital: there was a higher infection rate.
Read the abstract » | (added 2011-02-24)
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Poor sleep on standard in-center HD
Good sleep on dialysis improves survival. A new study compared sleep quality on standard in-center HD and a control group matched for age, sex, body mass index, and race. The in-center HD patients had significantly worse sleep.
Read the abstract » | (added 2011-02-24)
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