Journal Watch
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How longer HD treatments affect bone minerals
The ACTIVE study randomized 200 people to do 24+ hours of HD per week vs. standard (<18 hours per week) HD. Long HD treatments reduced serum phosphate levels, but did not change PTH or serum calcium. In a second analysis of the data, those who did longer HD needed fewer phosphate binders as well.
Read the abstract » | (added 07/15/2019)
Tags: Hd Duration, Long Hd Treatment, Serum Phospate, Mineral Metabolism, Phosphate Binders
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In-center HD patients tend to overestimate how long they are likely to live
Statistics do not apply to individuals. However, a survey of 996 standard in-center HD patients from 31 clinics found that most could not correctly guess how long other “people your age with similar health conditions” usually live (<5 years, 5-10 years, >10 years, not sure). Just 11.2% chose <5 years, when the USRDS results would suggest 60.3%. Those who believed they would live longer were less likely to have advance directives.
Read the abstract » | (added 07/15/2019)
Tags: Life Expectancy, Patient Education
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Impact of daily low-flow HD on potassium and lactate levels
In the NxStage FREEDOM study, 345 patients switched from standard in-center HD to daily, low-flow HD. Blood levels of potassium and lactate were analyzed during the last 3 months of standard HD and the first 3 months of daily HD. On daily HD, predialysis serum potassium decreased significantly at a dialysate potassium level of 1 mEq/L, with no change at 2 mEq/L. Predialysis serum bicarbonate level decreased significantly with dialysate lactate concentration of 40 mEq/L—but increased significanty at 45 mEq/L. Choosing the correct dialysate for the patient is important.
Read the abstract » | (added 07/15/2019)
Tags: Daily Hd, Potassium, Bicarbonate, Dialysate
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Incremental PD may preserve residual kidney function longer
A single-center observational study in Korea followed 347 patients; half started full-dose PD and half started incremental PD. While patient, technique, and peritonitis-free survival were similar between groups, the incremental PD group had a significantly lower risk of losing all of their kidney function (anuria).
Read the abstract » | (added 07/15/2019)
Tags: Full Dose Pd, Incremental Pd, Residual Kidney Function
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10-year retrospective study of urgent-start PD
Among urgent-start 2,059 PD patients followed for a decade, older patients were less likely to have PD catheter failure than younger ones, while men and people with diabetes had higher catheter failure rates. Lower hemoglobin levels predicted more abdominal wall complications. Overall, urgent-start PD was safe and effective, and a well-trained team and comprehensive follow up were recommended.
Read the abstract » | (added 07/15/2019)
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Half of PD patients may develop a new glucose disorder
A metaanalysis of nine studies with a total of 13,879 PD patients found that 8% had new-onset diabetes, 15% developed impaired glucose tolerance, and 32% had newly abnormal fasting blood sugar levels. No differences were found by ethnicity. The authors concluded that PD patients should receive glucose tolerance tests.
Read the abstract » | (added 07/15/2019)
Tags: Pd, Diabetes, Glucose Tolerance, Blood Sugar Levels, Glucose Tolerance Test
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Bioimpedance Assessment of Conventional vs. Daily HD
In a small physiological study, 12 patients were switched from conventional (3x/week) to daily (6x/week) HD treatments. Baseline and monthly blood pressure, BMI, and bioimpedance measurements were gathered on participants. Among the 9 patients who completed the data collection, body composition was not altered--but fluid overload was reduced and fewer antihypertensive medications were needed.
Read the abstract » | (added 06/13/2019)
Tags: Conventional Hd, Daily Hd, Blood Pressure, Bmi, Bioimpedance, Fluid Overload, Antihypertensive Medications
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Frequency vs. Time in HD Survival
Which matters more for HD--the number of treatments per week, or the length of each treatment? A retrospective registry study from the ANZDATA database looked at survival among 16,944 non-indigenous adult patients in Australia and New Zealand from 2001 to 2015. After controlling for frequency, patients with 5+ hour long treatments had significantly better survival than those whose treatments <5 hours. However, controlling for duration, increasing frequency did not boost survival.
Read the abstract » | (added 06/13/2019)
Tags: Anzdata, Session Frequency, Session Duration, Survival, End Stage Kidney Disease
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Low vs. Very Low Site PD Catheter Placement to Prevent Migration
A retrospective 5-year series of 76 patients whose PD catheter tips migrated had received either a traditional low-site insertion (N=39) or a very-low-site insertion (N=37). After 2 years of follow up, the very-low-site group had significantly better catheter and patient survival, with fewer catheter complications—and no tip migration.
Read the abstract » | (added 06/13/2019)
Tags: Catheter Dysfunction, Catheter Migration, Pd Catheter, Peritoneal Dialysis Catheter, Patient Survival
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BMI and Survival on PD
A large study from Korea (N=80,674 PD patients) found that those in the highest group for BMI: just 25.71, had significantly higher all cause mortality.
Read the abstract » | (added 06/13/2019)
Tags: Body Mass Index, Survival, Diabetes Mellitus, Peritoneal Dialysis, Mortality