Journal watch: PD

Antioxidant improves residual kidney function in PD

Four weeks of twice-daily oral N-acetylcysteine, an antioxidant, significantly increased residual kidney function of people on PD in a small study (n=10).

Mucomyst does not prevent nephrogenic systemic sclerosis

A new study randomized 2,308 people at risk for kidney injury from contrast dye into two groups. One group was given acetylcysteine (Mucomyst®) by mouth, a strong antioxidant. The other group was given a placebo. Both groups had the same rate of kidney injury and need for dialysis.

Using L-carnitine instead of sugar for PD fluid

Over time, sugar can harm the peritoneal membrane so it can't be used for PD. L-carnitine is a substance the body needs for energy. In a new rat study, PD fluid with L-carnitine removed as much—or more—water and wastes as sugar-based fluid. The new fluid was well tolerated and did not damage the peritoneum.

Standard PD fluids work just as well as biocompatible ones

A randomized controlled trial compared standard PD fluid to biocompatible PD fluid in 267 patients (for 7000+ dialysis months). There were no differences in PD technique survival or peritonitis between the groups.

Tweaking the PD cycler prescription can have big payoffs

Changing dwell time make a difference in how well PD works, finds a new, randomized crossover study of 19 patients. All received the same number of hours of PD using the same PD fluid prescription. But instead of doing several exchanges each with the same dwell time and volume, the researchers first used a short dwell time with a small fill volume to remove water, then a longer dwell time and larger volume to remove wastes. The change significantly improved urea, creatinine, phosphorus, water removal, and mean blood pressure. (To learn more about how to adjust a PD prescription, read our Life@Home article on the topic by Joanne Bargman: Tailoring automated PD to your life.)

Blood glucose meters may overestimate blood sugar levels when Icodextrin PD fluid is used

If you use a blood sugar monitor, you need to be able to trust the results. But, they may not be accurate if you use Icodextrin PD fluid. A case report of four people with insulin-dependent diabetes found that their blood sugar monitor readings were normal—at the same time that their hospital drawn blood sugars were dangerously low.

Choosing PD may mean fewer access procedures for you

In a study of 369 Canadians with ESRD, 224 (61%!) chose PD, and just 145 (39%) chose HD. After an average of 1.3 years, those who chose PD had significantly fewer access procedures. PD catheters were less likely to fail than HD access.

PD is safe and efficient for urgent dialysis starts

Researchers in Germany followed 123 people who started dialysis without a prior plan (66 did PD, 54 did standard in-center HD). Those on HD had much higher infection rates and somewhat (but not significantly) lower survival.

Fresenius options education program boosts PD & venous access use

The 3,165 people who attended a treatment options program (TOPs) were more than 8 times more likely to choose PD than those who didn't attend—and twice as likely to get a fistula or graft if they chose HD. TOPs attendees were also more likely to survive the first 90 days of treatment.

Better survival on home HD than PD in England and Wales

A study from the UK compared 225 people on home HD from 1997 to 2005 with age and sex matched people on PD and standard HD. Those on home HD lived significantly longer than those on PD—even when the researchers adjusted for those who received transplants or were on the wait list.

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