Kidney Week 2025 Early Program - Home Dialysis: Expanding Access to Home Therapies in 2025 and Beyond-Home Dialysis in Special Populations, Including Patients with Liver Disease, Heart Failure, and Polycystic Kidney Disease: A Panel Discussion

Home Dialysis in Special Populations, Including Patients with Liver Disease, Heart Failure, and Polycystic Kidney Disease: A Panel Discussion

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Video Summary

The session introduced a panel on home dialysis in special populations—advanced liver disease, heart failure, and polycystic kidney disease (PKD)—using case-based discussion.<br /><br />For cirrhosis, Dr. Lauren Stern presented a 56-year-old man with alcohol-related cirrhosis and CKD5 awaiting combined liver-kidney transplant. She argued peritoneal dialysis (PD) is often preferable to hemodialysis (HD) due to less hemodynamic instability and bleeding risk. A large meta-analysis showed no significant mortality difference between PD and HD in cirrhosis; outcomes are driven mainly by liver disease severity. Peritonitis risk may be slightly higher but without survival impact. Practical perioperative management included pre-op large-volume paracentesis, bleeding mitigation (e.g., tranexamic acid), and an “urgent-start” low-volume, supine PD approach that can ultimately control ascites and reduce need for repeated paracentesis.<br /><br />Professor Edwina Brown discussed PD for refractory heart failure in a frail, blind 72-year-old with frequent admissions. PD offers gentler, continuous ultrafiltration with fewer BP swings, no anticoagulation, and better residual kidney function preservation. Assisted PD enabled symptom relief and fewer hospitalizations, emphasizing quality-of-life goals over Kt/V.<br /><br />Lisa presented a PKD case demonstrating PD feasibility despite concerns (hernia, leaks, adequacy). Evidence suggests higher hernia risk but not higher PD discontinuation; peritonitis and adequacy are generally comparable. The panel emphasized individualized, patient-centered modality choice.

Asset Subtitle

Edwina A. Brown, Lisa A. Koester Wiedemann, Matthew B. Rivara, Lauren D. Stern

Meta Tag

Module DIAL

Speaker FACULTY FACULTY

Keywords

home dialysis

peritoneal dialysis

hemodialysis

cirrhosis and advanced liver disease

refractory heart failure

polycystic kidney disease (PKD)

urgent-start low-volume supine PD

assisted peritoneal dialysis