Home dialysis (peritoneal dialysis (PD) and home haemodialysis (HHD)) are ideal options for kidney replacement therapy (KRT). Occasionally, because of technique failure, patients are required to transition out of home dialysis, and the most common option tends to be to in-centre HD. There are few published studies on home-to-home transition (PD to HHD or HHD to PD) and dynamics during the transition period. We present a retrospective review of 28 patients who transitioned from a home-to-home dialysis modality at our centre over a 24-year period. We observed a total of 911 home dialysis patients with technique failure (826 PD patients and 85 HHD patients) with only 28 patients (3% of the total with technique failure) having successful home-to-home transition. During the transition period, 11 patients (39%) were hospitalized and 13 patients (46%) required variable periods of in-centre HD. After a median follow-up of 48 months following dialysis modality transition, four patients switched to in-centre HD permanently (home dialysis technique survival of 86% censored for death and kidney transplantation) and four patients died resulting in a patient survival of 86% (censored for switch to in-centre HD and transplantation). In our centre, home-to-home transition is a feasible strategy with comparable patient and technique survival. A significant proportion of patients switching from a home-to-home dialysis modality required variable intervals of hospitalization and in-centre HD during transitions. Future efforts should be directed towards assessment and home dialysis education during the entire process of dialysis transition.

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Background: Functional peritoneal dialysis (PD) access is critical to the success of PD therapy. The aim of this review is to describe the spectrum of definitions and methods employed in the measurement of unique outcomes across PD access trials particularly focusing on the outcomes of PD access flow restriction and operative-related outcomes. Methods: Using Cochrane CENTRAL registry, MEDLINE, and EMBASE, we searched for studies restricted to randomized controlled trials (RCTs) involving interventions related to PD access without restrictions on age, language, or publication year. Studies were screened and data abstracted by two independent reviewers. Definitions, outcome measures, and time points of measurements were captured and documented separately. Unique combinations of these variables resulted in reporting the different ways of measurements. Results: Of the 1768 screened studies, 47 RCTs were included among which 817 PD access outcomes were grouped into 7 broad categories. Interventions evaluated in the RCTs were catheter type/configuration ( n = 17), insertion technique ( n = 15), multiple interventions ( n = 3), and other (6 interventions, n = 12). PD access flow restriction (a subcategory of mechanical outcomes) and operative-related outcomes were reported in 91% and 58% of the included trials, respectively. Tip migration was the most frequently reported flow restriction outcome (59% of RCTs) followed by catheter dysfunction (23% of RCTs). Of the components utilized in definition of flow restriction, description of the impaired flow was reported in 37% of RCTs, need for intervention in 42% of RCTs, and presumed etiology of flow restriction in 60% of RCTs. Conclusion: Variability exists in the definitions, reporting methods, choice of outcomes, and analysis of the PD access outcomes across RCTs. Operative-related outcomes remain underreported across RCTs. Outcomes relating to PD access flow restriction were the most common complications reported in the included RCTs but were reported heterogeneously with variability in reporting of the three key components of its definition including description and severity of the flow restriction, the need for intervention and etiology of flow restriction. In the future, defining PD access flow restriction should include all of these components to better evaluate the comparative effect of various PD access interventions.

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BackgroundCombined treatment with vasoactive drugs, prophylactic antibiotics and endoscopic techniques is the recommended standard of care for patients with acute variceal bleeding. However, treatment failure occurs in about 10-15% of patients. With the development and validation of the Model for End-stage Liver Disease (MELD) scoring system as an index of the severity of liver disease, it is now possible to use it as predictor of survival and variceal rebleeding. ObjectivesThe aim of this study was to investigate the value of the MELD score in predicting early variceal rebleeding after endoscopic intervention in cirrhotic patients. Materials and methodsThis study included 100 randomly selected patients admitted with acute variceal hemorrhage. All patients were subjected to mult-operator endoscopic intervention (band ligation or sclerotherapy) to control bleeding. Patients were followed for 1 week to detect variceal rebleeding. The MELD score and the Child Pugh score were calculated for all patients. ResultsRebleeding occurred in 22% of the patients and the mean time for rebleeding was 2.591 ± 1.552 days. Patients with rebleeding had a younger age, used the Sengestaken tube more frequently, required packed RBCs transfusion and had a larger size of varices, higher serum creatinine, higher INR, higher serum total bilirubin and a higher MELD score than nonrebleeders. Patients with rebleeding also had a higher Child class and their varices were mainly esophageal. At a cutoff value of more than 20, the MELD score had a sensitivity of 90.91%, a specificity of 75.64%, a positive predictive value of 51.3% and a negative predictive value of 96.7% in predicting early rebleeding with the area under the ROC curve being 0.892. ConclusionAddition of the MELD score as a predictor of early variceal rebleeding will improve the ability to identify patients who are at a substantially increased risk of rebleeding over a short term. Patients with MELD more than 20 have a high risk of rebleeding.