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A synthetic membrane used in dialysis treatments may be more effective than the standard cuprophane membrane in improving kidney function. A study of 72 patients with acute kidney failure undergoing hemodialysis to cleanse their blood found the synthetic polymethyl methacrylate membrane to be associated with a higher survival rate than the cuprophane membrane (80% versus 40%). The synthetic membrane may be more compatible with the body than the cuprophane membrane. This may enable patients with acute kidney failure to recover kidney function, and enable long-term dialysis patients to retain some kidney function for a longer period of time. The synthetic membrane may not activate the body's white blood cells as does the cuprophane membrane. This could may make a difference in the success of dialysis for patients with oliguria (reduced urine output). The synthetic membrane may cost more than the cuprophane membrane, but the improved treatment rate may more than pay for the difference.

Background: The prevalence of depressive affect is not well defined in the incident hemodialysis (HD) population. We investigated the prevalence of and associated risk factors and hospitalization rates for depressive affect in incident HD patients. Methods: We performed a prospective investigation using the Patient Health Questionnaire 2 (PHQ2) depressive affect assessment. From January to July of 2013 at 108 in-center clinics randomly selected across tertiles of baseline quality measures, we contacted 577 and 543 patients by telephone for depressive affect screening. PHQ2 test scores range from 0 to 6 (scores ≥3 suggest the presence of depressive affect). The prevalence of depressive affect was measured at 1-30 and 121-150 days after initiating HD; depressive affect risk factors and hospitalization rates by depressive affect status at 1-30 days after starting HD were computed. Results: Of 1120 contacted patients, 340 completed the PHQ2. In patients screened at 1-30 or 121-150 days after starting HD, depressive affect prevalence was 20.2% and 18.5%, respectively (unpaired t-test, P=0.7). In 35 patients screened at both time points, there were trends for lower prevalence of depressive affect at the end of incident HD, with 20.0% and 5.7% of patients positive for depressive affect at 1-30 and 121-150 days, respectively (paired t-test, P=0.1). Hospitalization rates were higher in patients with depressive affect during the first 30 days, exhibiting 1.5 more admissions (P<0.001) and 10.5 additional hospital days (P=0.008) per patient-year. Females were at higher risk for depressive affect at 1-30 days (P=0.01). Conclusions: The prevalence of depressive affect in HD patients is high throughout the incident period. Rates of hospital admissions and hospital days are increased in incident HD patients with depressive affect. [ABSTRACT FROM AUTHOR]

The rate of rehospitalization is at a critical level. Twenty percent of all Medicare patients are rehospitalized within 30 days of discharge, and this rate is even higher (36%) for end-stage renal disease patients. Dialysis-dependent patients are commonly discharged from the hospital with a decline in various health measures (such as hemoglobin, albumin, and estimated dry weight) when compared to pre-hospital values, making the common response to resume previous orders" in the outpatient setting inadequate. Both quality of care and financial penalties by the Centers for Medicare & Medicaid Services have set the stage for partnerships between dialysis providers and hospitals to develop strategies to reduce readmissions for ESRD patients, and provide for the "RightReturn" to the outpatient setting with resumption of their daily lives at home in optimal health.