Case Study: The Weighty Issue of Treatment Options for Obese Dialysis Patients.

Obesity is a complex chronic disease and common comorbidity in kidney failure and is the leading causes of death and disability in this population. Guidelines do not specifically address the preferred weight management option(s) for obesity while on dialysis. Large body size is a limiting factor for consideration of a kidney transplantation.

On-line hemodiafiltration therapy for end-stage kidney disease patients: Promises for the future? What's next?

On-line hemodiafiltration (OL-HDF) is currently the most advanced form of blood purification modality leading convective-based therapies in end-stage kidney disease patients. By adding a high convective component to the diffusive clearance achieved with highly permeable dialyzers, OL-HDF reinforces removal of small MWt compounds and enlarges the spectrum of uremic compounds cleared up to middle and large MWt compounds. The biological and clinical benefits of convective-based therapy are currently also being explored in a revisited hybrid modality, combining an increased internal filtration process with a more open membrane.

Hemodiafiltration outcomes in special situations.

This Seminars in Dialysis Hemodiafiltration Symposium includes many references regarding the outcomes of this modality in general. The results in special populations are included in some of the studies, but have not been compared in a systematic manner. The purpose of this review is to compile those outcome results in select populations.

Prescribing Home Hemodialysis.

Home hemodialysis (HHD), performed more frequently than in-center hemodialysis, is underutilized in the United States but has had a recent resurgence driven predominantly by innovative dialysis equipment that is easy to use, less intrusive to the home, and requires less storage space. There are 3 different hemodialysis machines approved for use in the home but currently NxStage™ accounts for the overwhelming majority of HHD patients. Therefore, it is the focus of this article.

Nomenclature in nephrology: preserving 'renal' and 'nephro' in the glossary of kidney health and disease.

A recently published nomenclature by a "Kidney Disease Improving Global Outcomes" (KDIGO) Consensus Conference suggested that the word "kidney" should be used in medical writings instead of "renal" or "nephro" when referring to kidney disease and kidney health. Whereas the decade-old move to use "kidney" more frequently should be supported when communicating with the public-at-large, such as the World Kidney Day, or in English speaking countries in communications with patients, care-partners, and non-medical persons, our point of view is that "renal" or "nephro" should not be removed from scientific and technical writings. Instead, the terms can coexist and be used in their relevant contexts.

Quantifying the risk of insertion-related peritoneal dialysis catheter complications following laparoscopic placement: Results from the North American PD Catheter Registry.

Background: Peritoneal dialysis (PD) is a more cost-effective therapy to treat kidney failure than in-center hemodialysis, but successful therapy requires a functioning PD catheter that causes minimal complications. In 2015, the North American Chapter of the International Society for Peritoneal Dialysis established the North American PD Catheter Registry to improve practices and patient outcomes following PD catheter insertion.

Aims: The objective of this study is to propose a methodology for defining insertion-related complications that lead to significant adverse events and report the risk of these complications among patients undergoing laparoscopic PD catheter insertion.

Strategies to Prevent Peritonitis after Procedures: Our Opinions.

Peritoneal Dialysis (PD) patients are at increased risk of peritonitis following elective colonoscopy and other potentially invasive dental or gynecological procedures. The increased risk of iatrogenic peritonitis is attributed to procedure-related factors such as instrumentation, biopsies, tissue injury, and peri-procedural bacterial contamination. Also contributory are patient-related factors such as the effect of the immunocompromised status of end-stage renal disease and the presence of intraperitoneal dialysate on the disruption of natural host defense mechanisms.

Exploring Barriers and Potential Solutions in Home Dialysis: An NKF-KDOQI Conference Outcomes Report.

Home dialysis therapy, including home hemodialysis and peritoneal dialysis, is underused as a modality for the treatment of chronic kidney failure. The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative sponsored a home dialysis conference in late 2017 that was designed to identify the barriers to starting and maintaining patients on home dialysis therapy. Clinical, operational, policy, and societal barriers were identified that need to be overcome to ensure that dialysis patients have the freedom to choose their treatment modality.

Incremental dialysis: review of recent literature.

Purpose Of Review: There are clinical, physiological, financial, and practical reasons to perform incremental hemodialysis in selected patients, incident to end-stage renal disease. Recent papers inform us further, especially in the large database studies.

Recent Findings: Small studies suggested, then a larger study corroborated, that incremental hemodialysis was associated with preservation of residual kidney function whenever compared with conventional hemodialysis.

Reproducibility of serial creatinine excretion measurements in peritoneal dialysis.

Aim: To test whether muscle mass evaluated by creatinine excretion (EX) is maintained in patients with end-stage kidney disease (ESKD) treated by peritoneal dialysis (PD), we evaluated repeated measurements of EX in a PD population.

Methods: One hundred and sixty-six PD patients (94 male, 72 female) receiving the same PD dose for the duration of the study (up to approximately 2.5 years) had repeated determinations of total (in urine plus spent dialysate) 24-h EX (EX T) to assess the adequacy of PD by creatinine clearance.

Incremental Hemodialysis: How I Do It.

Incremental hemodialysis (incrHD) is not widely used nor is it well understood. In addition, and perhaps with more impact, governmental regulations in the United States and their consequential influences on dialysis provider organizations have made the practice of incrHD more difficult than traditional thrice weekly in-center HD. IncrHD is critically dependent on the amount of residual kidney function (RKF) as well as the individualized goals of end-stage renal disease (ESRD) management.

Is hemodiafiltration ready for broader use?

Hemodiafiltration is practiced throughout Europe and in a few additional countries but, because of regulatory restrictions, is not currently available in the United States. Hemodiafiltration removes uremic species more broadly than is achieved by diffusion dialysis, perhaps explaining its better outcome profile.

Catheter Insertion and Perioperative Practices Within the ISPD North American Research Consortium.

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Background: In general, efforts to standardize care based on group consensus practice guidelines have resulted in lower morbidity and mortality. Although there are published guidelines regarding insertion and perioperative management of peritoneal dialysis (PD) catheters, variation in practice patterns between centers may exist. The objective of this study is to understand variation in PD catheter insertion practices in preparation for conducting future studies.

Arteriovenous fistula creation may slow estimated glomerular filtration rate trajectory.

Background: We practice the timely placement of an arteriovenous fistula (AVF) in patients facing chronic hemodialysis. We have anecdotally observed after AVF creation that there appears to be a slowing of the decline in kidney function as measured by the estimated glomerular filtration rate (eGFR). There are physiologically plausible explanations as to how an AVF might alter kidney function, but this clinical observation has been attributed to improved compliance and/or other practices.

Automated cyclers used in peritoneal dialysis: technical aspects for the clinician.

Peritoneal dialysis (PD) is a widely accepted and increasingly popular form of dialysis. The invention and technological advancement of the PD cycler further makes PD a convenient option. Prescription-specific parameters are entered into the cycler, which then automatically carries out the steps involved in continuous cycling PD.

Financial implications to Medicare from changing the dialysis modality mix under the bundled prospective payment system.

Background: The economic burden of treating end-stage renal disease (ESRD) continues to grow. As one response, effective January 1, 2011, Medicare implemented a bundled prospective payment system (PPS, including injectable drugs) for dialysis patients. This study investigated the 5-year budget impact on Medicare under the new PPS of changes in the distribution of patients undergoing peritoneal dialysis (PD), in-center hemodialysis (ICHD), and home hemodialysis (HHD).