Journal watch: PD

PD + C + E = reduced oxidative stress

We need oxygen to live. But, too much of a good thing can cause heart and blood vessel damage, and, if you do PD, damage your peritoneum. What can help? Among 20 people doing PD, supplements of the antioxidants vitamins C and E improved measures of oxidative stress, compared to 10 healthy volunteers who did not take the vitamins. (Ask your nephrologist if this is wise for you.)

If at first you don’t succeed with PD…it still costs less than in-center HD

A 4-year Canadian study has found that over a 3-year period, the cost of starting on PD and then switching to HD ($114,503) is still much less than doing standard in-center HD ($175,996). But starting and continuing PD is the lowest cost dialysis option ($58,724).

What does glucose in PD fluid have to do with artery calcification?

Quite a bit, it appears. Among 50 people doing PD who did not have diabetes, about half had coronary artery calcification. Those who used more higher glucose PD fluids were more likely to have the problem, as were men with a history of heart disease, and those who did not get enough PD.

Modality choice is a factor in AV fistula creation

Canadian researchers compared the predialysis modality preferences of 508 people to their actual modality, and looked at their vascular accesses. The chance of having a fistula was much less in those who chose PD but started HD (39%), or who made no choice (50%), than in those who preferred HD and started on HD (79%).

Read more | (added Dec 19, 2012)

Improve PD uptake by addressing misconceptions

In Singapore, interviews with predialysis patients and their families, people on dialysis, and health care professionals were done to explore how a treatment option choice is made. Fear of PD, daily commitment to PD, and misperceptions of PD were barriers that kept people from choosing the option. Patients were strongly influenced by other patients and wanted to hear what day-to-day life would be like before making a choice.

Read more | (added Dec 19, 2012)

Neutral pH PD fluid protects peritoneal membranes

Standard PD fluid may have an acidic pH and contain high levels of glucose degradation products (GDPs). Japanese researchers followed 12 patients using standard fluid and 12 using a neutral pH fluid with low GDPs. The low GDP group had less membrane fibrosis, blood vessel sclerosis, and build up of AGEs, and had higher ultrafiltration volume than the high GDP group.

Read more | (added Dec 19, 2012)

HbA1c levels do not predict survival in PD patients with diabetes

Researchers seeking a hemoglobin A1c target for PD patients with diabetes were not able to find any change in survival among 91 patients whose A1c levels were <6.5%, 6.5–8%, or >8%.

Read more | (added Dec 19, 2012)

CAPD improved outcomes in hard to treat CHF

In a study in Spain, 28 people with advanced congestive heart failure were treated with PD, while 34 controls were not. Sixteen months later, those who did PD were 40% more likely to survive.

Biocompatible PD solution preserves residual kidney function

Researchers in Korea looked at the long-term impact of using Fresenius Balance® (FB) fluid vs. standard PD fluid. After 24 months, the GFR of patients using FB was twice that of those using standard fluid. Patients using FB also had better correction of metabolic acidosis, and higher levels of cancer fighting antigens.

Bone density better in PD than in standard HD

A study compared bone density X-rays in 56 people on standard HD and 23 on PD to 79 healthy people matched for age, gender, BMI, and menopausal status. The healthy people had higher bone density than those on dialysis. But, those on standard HD had significantly lower bone density than those on PD.

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