Journal watch

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.

Basing dialysis dose on REAL toxins

Dialysis "adequacy" is based on removing urea—a waste that is not all that toxic. A new article points out that finding and choosing wastes that truly are toxic could change the way we measure dialysis for the better.

Home HD and mortality risk in Australia and New Zealand

Researchers analyzed data from 26,016 patients in the ANZDATA registry (856,007 patient-months) to see if home HD helped people live longer. Compared to standard in-center HD, those on standard (3x/week), more-frequent, or nocturnal home HD were about twice as likely to survive.

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.)

Ratios of Omega-6 to Omega-3 fats may impact health in kidney disease

Western diets tend to have too much omega 6 and not enough omega 3 fatty acids. In 145 people on standard in-center HD, having too much omega 6 was linked with significantly higher inflammation.

Read more | (added Jul 26, 2011)

Dialysis removes Vitamin B6; supplements can help

A meta-analysis has found 24-56% Vitamin B6 deficiencies, a problem made worse by ESAs, some phosphate binders, and modern dialyzer membranes. B6 supplementation recommendations may need to be updated.

Review: What do we know now about more-frequent HD?

Studies have shown since the 1960s that more-frequent dialysis improves outcomes. The recent Frequent Hemodialysis Network trials confirmed these findings. This article reviews the data.

Read more | (added Jul 26, 2011)

Nocturnal HD helps people grow cells that lead to healthy new blood vessels

Growth of new blood vessels is impaired with standard in-center HD. The cells that grow blood vessels don't work as well as they should, because waste levels in the blood are still too high, even with treatment. But, nocturnal HD is another story. With the blood much cleaner, there was significantly better cell function.

Read more | (added Jul 26, 2011)

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.

Read more | (added Jul 26, 2011)

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