PD First. It makes sense!

Why is the default US dialysis standard in-center HD, when it doesn't offer the best outcomes, costs more, and offers a poor quality of life? That's the question asked in a new review article that points out the benefits of a PD first strategy. Rather than allowing ease of HD initiation to drive treatment "choice," it makes sense to change the default initiation option to PD.

Read the abstract » | (added 2013-11-06)

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Is there a new way to prevent PD infections? Sorry, honey

Honey has a long history of helping to heal wounds—with no risk of antibiotic resistance. But, a recent trial of the sweet stuff in PD exit site infections did not show a benefit. Researchers asked 186 patients from 26 clinics in Australia and New Zealand to put purified honey on their exit sites, while a control group (185 people) used standard care (or mupirocin if they carried S aureus). The time to first infection was about the same in both groups.

Read the abstract » | (added 2013-11-06)

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Risks of biocompatible PD solution

Sugar (dextrose) in PD solution helps remove water from the blood—at a cost. Advanced glycation endpoints (AGEs) formed when the solution is made can harm the peritoneum over time. It would seem to make sense more biocompatible (like the human body) solutions would be better and safer. Some studies have found this, but a new look in the ANZDATA registry of all PD patients from Australia/New Zealand from January 1, 2007 and December 31, 2010 did not. Use of biocompatible PD solution was linked with significantly more (49% more) peritonitis, and far less time to a first bout of the infection.

Read the abstract » | (added 2013-10-02)

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PD may one day help stroke victims

After an ischemic stroke that reduces blood flow, damage to brain cells can occur. High levels of the neurotransmitter glutamate in the blood—but not in brain cells—kills neurons. PD is known to remove glutamate from the blood. A new study in rats has found that using PD helped brain levels of glutamate to bounce back. In the rats, using PD shrunk the stroke damage area—and the rescued brain tissue still worked!

Read the abstract » | (added 2013-10-02)

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The future of dialysis: Mini dialyzers with nanopores

The smaller the dialzer, the more portable dialysis can become. Ultrathin silicon membranes have now been tried in mini dialyzers with nanopores. Coating the membrane with polyethylene glycol helps reduce activation of white blood cells without blocking the tiny pores.

Read the abstract » | (added 2013-10-02)

Tags: Chronic kidney disease

One way to reduce oxidative stress in PD patients

Oxygen is a great thing—in the right amounts. But, too much can wreak cellular havoc and even damage the heart. In people on PD, oxidative stress can hurt the peritoneum, too. Antioxidants to the rescue! A Greek study looked at the impact of vitamins C and E (alone and combined) in 20 people on PD vs. 10 healthy controls. Both of the vitamins reduced oxidative stress markers. (Talk to your doctor before taking any medication, vitamin, or supplement).

Read the abstract » | (added 2013-10-02)

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Why heart failure patients may benefit from PD

Like kidney failure, heart failure (HF) causes fluid to build up in the body. When diuretics don't work in people with HF, PD might help get rid of the excess, finds a new French study. The researchers found significantly better ejection fractions (amount of blood the heart can pump) with PD. And, those on PD had significantly fewer hospital days for HF.

Read the abstract » | (added 2013-10-02)

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Nocturnal in-center HD comes to Slovenia

Only a few handfuls of US clinics offer nocturnal in-center HD. Now, Slovenian researchers report their experience of switching 10 patients from "standard" (4-5 hours!) in-center treatments to thrice weekly 8-hour long nighttime ones. With almost twice as much dialysis per week, mean predialysis creatinine and urea dropped significantly, as did mean dry weight. Six of the ten were able to stop taking phosphate binders, and one more patient had a dose reduction—and phosphate was added to the dialysate for three patients. There were no major changes in predialysis blood pressure, calcium or potassium levels, mean ultrafiltration, hemoglobin, or EPO dose (Editor's note: perhaps because standard HD in Slovenia is longer, and because the nocturnal treatments were only three times per week).

Read the abstract » | (added 2013-10-02)

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What does frequent HD do to the heart?

In many people on dialysis, left ventricular hypertrophy or LVH (overgrowth of the heart's main pumping chamber) can lead to heart failure; a leading cause of death. In the Frequent Hemodialysis Network trial, 245 patients were randomized to receive standard in-center HD or frequent "daily" (six times per week) in-center HD. The nocturnal arm of the study randomized 87 patients to six nights per week of HD or three times per week standard home HD. In the daily trial, there were significant reductions in LVH—especially for those who still made some urine. There were no major differences in the nocturnal group (Editor's note: this arm of the study did not recruit enough people to draw statistical conclusions).

Read the abstract » | (added 2013-10-02)

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Very tiny numbers of serious adverse events during home HD

Ideally, no one on dialysis will ever run into a problem. But, when the blood needs be cleaned, sometimes things can go wrong. A new study from Canada looked at life-threatening events among 500 patient years among 190 people who were doing home HD. Researchers found one death and six other serious events (most involved blood loss). In five of the events, human error was involved. They calculated an adverse event rate of 0.06 per 1000 treatments. (Editor's note: unfortunately, we don't yet have a corresponding rate for adverse events for in-center HD, but it may be far higher.)

Read the abstract » | (added 2013-10-02)

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