Outcomes of Initiating Peritoneal Dialysis versus Hemodialysis in Severe, Symptomatic Kidney Failure.

Key Points: In severe and late-stage uremia, hemodialysis is often the preferred modality on the basis of the rationale that it can address complications within a few hours. Patients with symptomatic ESKD who urgently start peritoneal dialysis and hemodialysis were associated with similar mortality rates, correction of uremia, and technique survival.

Background: Urgent start peritoneal dialysis (PD) may be often avoided due to concerns of efficacy and unfavorable clinical outcomes among those with severe and symptomatic kidney failure.

Glucagon-Like Peptide 1 Receptor Agonists and the Risk of Emergency Department Visits and Hospitalization in Patients With Chronic Kidney Disease.

Objective: The aim of this study was to evaluate the effect of glucagon-like peptide 1 receptor agonist (GLP-1RA) versus dipeptidyl peptidase 4 inhibitor (DPP4i) initiation on emergency department (ED) visits and all-cause hospitalizations across the spectrum of kidney disease.

Research Design And Methods: This was a retrospective population-based observational cohort study in adults with an estimated glomerular filtration rate <90 mL/min/1.73 m2 using inverse probability of treatment weighting.

A Comparison of Hospitalization Outcomes Between Peritoneal Dialysis and Home Hemodialysis Patients by Sex and Race.

Introduction: As interest in home dialysis as an initial dialysis modality grows, it remains unclear how the different home dialysis modalities may impact hospitalization outcomes, or how this relationship may change depending on patient sex and race.

Methods: We compared all-cause hospitalization rates and days in hospital between incident peritoneal dialysis (PD, = 14,643) and home hemodialysis (HHD patients, = 875) between January 2005 and December 2018 (last follow-up was in July 2020) using a nationally representative cohort of incident dialysis patients.

Results: The overall hospitalization rate was 0.

SGLT2 Inhibitors and Risk for Hyperkalemia Among Individuals Receiving RAAS Inhibitors.

Importance: Hyperkalemia is a common complication of taking a renin-angiotensin-aldosterone system inhibitor (RAASi). Post hoc analyses of large randomized clinical trials suggested that the addition of sodium-glucose cotransporter 2 inhibitors (SGLT2i) may attenuate this risk. It is unknown if this observation extends to daily clinical practice.

Associations Between Serum Sodium, Peritoneal Dialysis-Associated Peritonitis, and Mortality in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).

Rationale & Objective: The clinical consequences of hyponatremia among patients receiving peritoneal dialysis (PD) are poorly understood. This study sought to evaluate the association of variations in serum sodium with peritoneal dialysis-associated peritonitis and death.

Study Design: Multicenter observational cohort study.

Effect of Dialysis Modality on Mortality and Complications in Cardiovascular Surgery: Insights from a National Retrospective Cohort Study.

Key Points: Maintaining peritoneal dialysis during the perioperative period may confer benefits over hemodialysis, including lower hospital charges and improved patient outcomes. Peritoneal dialysis is associated with lower in-hospital mortality compared with hemodialysis in patients undergoing cardiac surgery.

Background: Patients receiving maintenance dialysis face high mortality and complication rates after cardiovascular (CV) surgery.

PD-associated peritonitis: Something's fishy.

Peritoneal dialysis (PD)-associated peritonitis commonly arises from touch contamination events, however, it is important to be mindful of alternative etiologies and to take a detailed history and perform a root cause analysis for each episode. In fact, the PD effluent can be a window into intra-abdominal pathologies which may require surgical management. We present an unusual case of secondary enteric peritonitis due to foreign body bowel perforation from ingestion of a fish bone.

Peritoneal dialysis and kidney transplantation: Your questions answered.

Peritoneal dialysis (PD) and kidney transplantation are important therapeutic options in patients with advanced kidney disease. This article delineates the relationship between PD and kidney transplantation in several key domains, including: (1) Comparative merits and limitations of PD versus center-based hemodialysis prior to kidney transplantation, (2) Patient outcomes after kidney transplantation in individuals receiving PD prior to kidney transplantation, (3) Perioperative management strategies of patients receiving PD at the time of kidney transplantation, and (4) The relative advantages and clinical outcomes of PD use following kidney allograft failure compared to other modalities. This article aims to provide comprehensive guidance for optimizing care across the PD-kidney transplant transitions continuum.

Prevalence and Outcomes of Chronic Kidney Disease-Associated Pruritus: International Results from Peritoneal Dialysis Outcomes and Practice Patterns Study.

Key Points: CKD-associated pruritus is highly prevalent among peritoneal dialysis patients. Pruritus is associated with reduced health-related quality of life, and the composite of mortality and transfer to hemodialysis for peritoneal dialysis patients. Efforts to better identify and manage pruritus in this population are needed.

Effects of initial peritoneal dialysis prescription on clinical outcomes in Japanese peritoneal dialysis patients: a cohort study.

Effects of the initial peritoneal dialysis (PD) prescription on clinical outcomes are unknown in Japan. We conducted a cohort study using data from Peritoneal Dialysis Outcomes and Practice Patterns Study. The patients were divided into two groups by the volume of the initial PD prescription (≤ 4 L/day or > 4 L/day).

Infection prevention in home dialysis.

Purpose Of Review: Among patients with kidney failure, home dialysis modalities, including peritoneal dialysis (PD) and home hemodialysis (HHD) provide several individual and healthcare system benefits over in-center hemodialysis (HD). Infection remains a major source of morbidity and mortality in this population, and a core outcome of critical importance to patients, caregivers, and kidney health professionals. This narrative review provides evidence-based measures for infection prevention among individuals receiving home dialysis, with a particular emphasis on dialysis and access-related infections.

The impact of shortening patient-doctor contact duration on early peritoneal dialysis-related infections.

Early peritoneal dialysis (PD)-related infection is a severe complication. This study investigated the relationship between patient-doctor contact (PDC) duration and early PD-related infection. In the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) Korea, incident dialysis patients receiving PD were divided into two groups based on PDC duration (< 15 min versus ≥ 15 min), which was defined as the duration a nephrologist typically spends with a patient receiving PD during each visit according to the facility practice pattern.

Risk factors of peritoneal dialysis-related peritonitis in the Japan Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).

Background: Peritoneal dialysis (PD)-related peritonitis is a major complication of PD. Wide variations in peritonitis prevention, treatment strategies and consequences are seen between countries. These between-country differences may result from modifiable risk factors and clinical practices.

The effect of implementing a dialysis start unit on modality decision among patients with unplanned start kidney replacement therapy.

Introduction: Many individuals start dialysis in an acute setting with suboptimal pre-dialysis education. These individuals are often treated with central venous catheter insertion and initiation of in-center hemodialysis and only a minority will transfer to a home-based therapy. The dialysis start unit is a program performing in-center hemodialysis in a separate space while providing support and education on chronic kidney disease and treatment options in the initial weeks of kidney replacement therapy.

Pregnancies in Women With Kidney Failure on Home Dialysis in the United States.

Introduction: Women with kidney failure have impaired fertility and are at a higher risk of maternal and fetal morbidity and mortality. Little is known about pregnancies in women receiving maintenance home dialysis in the United States.

Methods: Using data from the United States Renal Data System (USRDS), a cohort of 26,387 women aged 15 to 49 years with kidney failure receiving maintenance home dialysis from 2005 to 2018 was examined.