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Science & medical journals: peritoneal dialysis

Depressed and on PD? Sertraline (Zoloft) may help

Of 32 people on PD who had clinical depression, 25 agreed to try Zoloft. Twelve weeks later, the Zoloft group was less depressed and had better physical and mental function, with no adverse drug effects. Read the abstract.

Soy reduces heart disease risk on PD

Adding 1/2 oz. of soy protein per day for 8 weeks reduced the levels of Lp(a)—a marker of risk for heart disease—in people on PD. In the study, 20 people were randomly assigned to get the soy protein, while 20 did not. Read the abstract.

PD and home HD don't compete with each other

A new study finds that different people are attracted to PD vs. home HD. Those who chose PD tended to be older, female, and have diabetes and/or high blood pressure. Those who chose home HD were younger, more likely to be male, and had heart or blood vessel disease. Both treatment options are growing worldwide (perhaps because they're better?!). Read the abstract.

PD: Better survival than standard HD for up to 5 years

In a study of 9,277 people, DaVita researchers have found a 40% improvement in 5-year survival vs. standard HD in people aged 60 and under, and 35% in those older than 60. Read the story. It's becoming clear that ANY treatment option is better for survival and quality of life than standard HD!

Older patients had better quality of life, fewer burdens, on PD

Among 140 people aged 65 or older, those using PD had fewer symptoms and felt that PD intruded less into their lives than those on HD. People on PD had better quality of life, too. Read the abstract.

Give me a D!

No, it's not your grade in math. A new study has found that deficiency of vitamin D (the sunshine vitamin) is present in 79% of people on dialysis—especially if they start treatment in the winter. Too-low levels have been linked to bone and heart disease. Ask your doctor if your levels are where they should be. Read the abstract.

Not even a little bit pregnant

How much does waist size really grow on PD? Not much at all. A new study measured 44 PD'ers around the belly at hip and belly button height—full and empty. The average difference? About 3 cm or less—just about an inch and a quarter. Read the abstract.

Survival on PD beats standard in-center HD hands down

Studies done with data from the early 1990s found better survival on standard in-center HD than PD. But a new study pairing 6,337 PD patients who started treatment in 2003 with standard HD patients found just the opposite. Survival was significantly better with PD—especially for those under 65, and those who did not have heart disease or diabetes. Read the abstract.

Extended catheters make PD possible for more people

For those who can't have an abdominal PD catheter, an "extended" (i.e., presternal) catheter that can exit in the chest can make PD work. A new study found 1, 2, and 3-year catheter success rates that were slightly lower than standard PD catheters. Read the abstract.

Surgical adhesions? PD may still be possible

Conventional wisdom says that PD is not a good choice for people who've had complex abdominal surgery or have adhesions. But a study of two groups of people—with and one without adhesions—found no significant differences in catheter success, infections, or the need for more surgery. Read the abstract.

On PD, higher uric acid levels predict faster loss of kidney function

Keeping as much of your kidney function as you can is a plus on PD or HD. A new study from Korea has found that people on PD whose levels of uric acid were higher had a faster decline in their kidney function. Those with higher blood pressure tended to have higher uric acid levels. Read the abstract.

Which is safer for placing a PD catheter: General or local anesthesia?

Trick question. Turns out, they're both safe! In more than 300 people followed between 1999 and 2008, there were no major complications in either group. PD catheter failure rates were similar (5% for general, 7% for local). Read the abstract.

Icodextrin PD fluid causes less weight gain

We're not surprised to learn that PD fluid that doesn't contain dextrose (sugar) is less likely to cause weight gain! A study of 183 PD patients found weight gains after 3 years (88% of it fat) among those using standard fluid, and significantly less weight gain in an icodextrin group. Read the abstract.

PD catheter placement: Surgeon or nephrologist?

Does who places a PD catheter make a difference in complications or catheter survival? Not really, finds a new Greek study that looked at 152 patients who received 170 catheters. Only early leakage (easily treated) was more likely with nephrologist placement. Read the abstract.

Mupirocin (Bactroban®) reduces staph exit site infection and peritonitis in PD

A metaanalysis of 14 studies looking at 1233 patients and 1217 controls has concluded that using an ointment with mupiricin can help prevent PD problems. Exit site infections and peritonitis—both due to staph aureus and to some other germs—were reduced by as much as 72%. Read the abstract.

Rat study: Celexicob reduces peritoneal fibrosis

COX-2 is involved in fibrosis and the growth of new blood vessels. Is there a way to protect the peritoneal membrane using a COX-2 inhibitor so it lasts longer for PD? Perhaps one day there will be. A new study found that rats given a substance that causes fibrosis had fewer new blood vessels and milky spots, and far less fibrosis than controls. Read the abstract.

Diabetes + PD? Icodextrin-aided fluid removal and metabolic control

A randomized controlled trial of glucose PD fluid vs. icodextrin (ICO) found significant benefits. Among 59 people with diabetes on CAPD, those in the group using ICO for the long exchange were far less likely to need higher concentration fluid (9% vs. 66%). And, the ICO group needed less insulin, had lower triglycerides, and had lower A1cs. Read the abstract.

Better stats help prove the value of more dialysis

It's clear to us that more dialysis is more like having healthy kidneys. But the statistic used to measure the risk of death ("proportional hazards model")...didn't quite succeed. A new statistical model based on when the kidneys fail and toxins start to build up DOES find a strong relationship. In fact, each 0.1 unit increase in Kt/V improved survival by 3.5%! Read the abstract.

A honey of an idea

Some clinics help prevent peritonitis in people with PD by using an antibiotic ointment. But bacteria may become resistant. In Australia, a new randomized study of Medihoney, a honey-based wound dressing (which is FDA-approved in the US) will see whether exit site or tunnel infections or peritonitis can be reduced. Read the abstract.

Wearable artificial kidney...for PD?

Dr. Claudio Ronco reports in a new article that many of the challenges of making a wearable artificial kidney could be solved if it was used for PD instead of HD. Read the abstract.

Home FIRST—a new paradigm

Why is the least effective—and most costly—form of treatment the default choice in the U.S.? A new article asks this question, and suggests that we present treatment options in terms of home vs. in-center, rather than HD vs. PD. Read the abstract.

In-center HD pill burden lowers quality of life

Taking (and paying for) an average of 19 pills each day (with a strict fluid limit!) reduces health-related quality of life in people using standard in-center HD, a new study finds. Of course, every form of home treatment requires fewer pills! Read the abstract.

Removing adhesions improves PD catheter survival

In a series of 436 PD catheter placements using a laparoscope, Drs. Crabtree and Burchette from Kaiser Permanente reduced catheter loss from blocked flow to just 0.7% by removing adhesions—even in people with prior abdominal surgeries. Read the abstract.

Hope predicts a better adjustment to dialysis

How important is hope? A new study finds that hopeful people on dialysis were less anxious and depressed and had fewer symptoms. (We'd bet that home dialyzors are more hopeful.) Read the abstract.

Icodextrin improved nutrition & inflammation in PD

Replacing glucose-based PD fluid with icodextrin led to 66% better fluid removal, significantly higher protein levels, and significantly lower levels of the inflammation marker CRP. Read the abstract.

New resource for intraperitoneal drug delivery

On PD, it's not hard to inject a drug into the PD bag so it goes into the peritoneum. Which drugs are safest and most effective this way? A new article tells you the scoop. Read the abstract.

Pain meds may one day protect the peritoneum

COX-2 inhibitors fight pain and inflammation. A new study in mice has found that COX-2 drugs were able to reduce fibrosis and damage to the peritoneum caused by PD fluid. This finding may one day help people to do PD longer. Read the abstract.

Hope for peritoneal fibrosis?

Over time, the peritoneum can become fibrous and thickened, and less able to filter the blood during PD. A new study in rats suggests that erythropoietin (EPO) may help. Rats treated with EPO had less fibrosis. Down the road, perhaps this finding will help people. Read the abstract.

Female sexual function better on PD than standard in-center HD

If you're a woman, a new study finds that a transplant is the best way to restore your sexual function to normal levels. But PD did a much better job than standard HD—and the study didn't look at daily or nocturnal HD. Read the abstract.

Need a bone density test on PD? Be sure you're empty

A new study has found that having fluid in your belly when you have a bone density test (called DXA) can change the results. Read the abstract.

PKD is not a barrier to successful PD

In a study that compared 56 people with polycystic kidney disease on PD to 56 non-diabetic people with small kidneys on PD, there were no differences between the two groups after 37 months. Read the abstract.

Why Canadians choose self-care dialysis

A new study randomized 70 new ESRD patients into standard options classes or to have the benefits of self-care taught with a booklet, video, and small group brainstorms. Compared to the group getting standard education, benefits group patients who valued lifestyle were 7 times more likely to choose self-care; those who valued freedom were 9.1 times more likely. Read the abstract.

Longer survival on PD with ACE-inhibitors or ARBs

Even if blood pressure is normal, taking blood pressure pills in the ACE-inhibitor or ARB class was linked with much better survival in a new study. Researchers studied 306 new PD users from 2001 to 2005. Even adjusting for age, blood pressure, and other illnesses, those who took the BP pills had a 62% lower risk of death. Read the abstract.

Matching home dialysis to lifestyle

A "continuum home program concept" described in a new article would help people with kidney failure continue their lifestyles with dialysis—rather than disrupt them with treatment. The aim is for a continuous flow of services from education to treatment choice, dialysis access, and option changes when needed. Read the abstract.

PD: Less cancer risk than standard HD

DNA damage that can lead to cancer can occur in kidney failure, as the buildup of toxins stresses the body. A new study looked at genetic damage in 20 people on standard in-center HD, 20 on PD matched for gender and age, and 40 controls. Cheek swabs were used to look for DNA damage. Creatinine levels, smoking, alcohol use, age, income, and length of time on dialysis were also examined. The only factor that mattered was length of time on standard HD. Read the abstract.

Does icodextrin (extraneal) cause more peritonitis?

Doesn't look like it. A study observed icodextrin and regular, sugar-based PD fluid use in 722 people. No differences were found in the rate of peritonitis infection orĘso-called "sterile peritonitis" where no bacteria are found. Read the abstract.

PD fluid with amino acids may help prevent malnutrition—and improve heart health

Basing PD fluid on amino acids (AA) instead of glucose may improve nutrition on PD in the future. A new study switched 13 non-diabetic PD patients from glucose to AA-based fluid. Uptake of amino acids by the skeletal muscles was significantly better with the AA fluid. Read the abstract. Another study of AA-based PD fluid found it less likely than glucose-based fluid to cause release of hormones (leptin and adipnectin) linked with heart problems. Read the abstract.

MYTHBUSTERS: microwaving PD fluid does NOT create glucose degradation products (GDPs)

While the belief persists that microwaving PD bags creates harmful GDPs when sugars are caramelized, the literature does not bear this out:

GDPs are a concern with PD fluid, but these are created when the fluid is manufactured, not when it is heated by the user. Of course, "hot spots" are still a concern. Anyone using a microwave to heat PD fluid should flip the bag from side to side to mix the contents well and use a thermometer strip to reduce the risk of burns.

Biocompatible PD fluid helps adequacy

"Glucose degradation products" (GDPs) occur when sugars are caramelized as PD fluid is made. GDPs can reduce PD adequacy, and in time, harm the peritoneum. A new study of 104 PD patients who randomly received standard fluid or a pH neutral fluid with fewer GDPs found that the new fluid led to better adequacy. Read the abstract.

Once-a-month IV Aranesp keeps up Hgb levels on PD

It would sure be convenient to only need anemia drugs once a month—and a new study suggests that this can work for people using PD. In a study of 72 folks on PD, hemoglobins were kept in the target range with once-monthly dosing. Read the abstract.

Predicting blood vessel calcification in PD

In a study of 231 PD patients, those whose C-reactive protein (CRP) and interleukin-6 levels were higher had a higher risk of blood vessel calcification and heart problems than those with lower levels. Read the abstract.

How long should PD catheters be embedded before use?

A study of 5,624 patient months found that PD catheters embedded under the skin are most likely to work if used from 48-133 days after placement—and least likely to have peritonitis if used even later: after 134 days. Using PD catheters before 47 days was linked to higher failures and more peritonitis. Read the abstract.

How to start late-referred ESRD patients on PD urgently

When as many as half of Americans with ESRD have less than 3 months notice before needing dialysis, it's great to know that PD can safely be done as a first treatment. This avoids HD catheters, keeps working folks employed, and buys time for a fistula or transplant. This article describes patients who did very well. Read the abstract.

Need a PD catheter? Laparoscopic placement is better

Some surgeons place PD catheters "blind" (without imaging), while others use a laparoscope to let them see inside of the peritoneum before they insert the catheter. A new study finds—not surprisingly—that it's best to see what you're doing. Laparoscopic placement had a almost an 18% better success rate and fewer revisions or replacments. Read the abstract.

Lipid-lowering drugs save lives on PD

A new look at data from 1,053 people on PD from the USRDS has found that statins and other drugs that lower blood lipid (fat) levels seem to have a big impact on survival. Death rates from all causes or heart disease dropped by 26% and 33%, respectively. Read the abstract.

Larger patients can safely do PD

A brand new Canadian study of 4,054 people on PD from 1994 to 2003 has found that a high body mass index (BMI > 30) was not linked with worse survival in people on PD—though a BMI of less than 18.5 was. The researchers concluded that "High BMI patients should not be discouraged from PD just because of their size." Read the abstract.

November 2006 Kidney International supplement focuses on PD

Is survival better on PD or HD? What factors predict PD success? What are best practices in PD catheter placement? Does use of biocompatible PD solution reduce peritonitis? Learn the answers to these and many other key PD questions in the November 2006 supplement of KI. (For kidney professionals who don't subscribe to Kidney International, we've compiled the links to all of the abstracts from the special supplement on PD (November, 2006). You can find them below.

Note to dialyzors: Kidney International is a medical journal for professionals. Feel free to read the abstracts—and please write and let us know if there is information you think we should focus on for a future "Topic of the Month" article. We'd love to hear from you!

Protect the peritoneal membrane to do PD longer

A new review article suggests replacing some glucose-based dialysate exchanges with icodextrin, resting the peritoneum, using bicarbonate or pyruvate as a buffer, and treating infections immediately as ways to help protect the peritoneal membrane. Read the abstract.

C-reactive protein may help identify those at greater risk of post-peritonitis problems

People with higher CRP levels during and after peritonitis were at higher risk for relapse, a switch to HD, or death than those with lower levels, found a study in the Feb. 14 issue of Kidney International. CRP levels may be a useful screening tool. Read the abstract.

Author suggests PD for disaster preparedness

A new article in this month's Advances in Chronic Kidney Disease suggests that PD is a good option for people whose dialysis lives are disrupted by hurricanes or other natural disasters. Home dialysis with PD, portable HD, or HD machines that do their own water treatment can help make dialyzors more self-sufficient in any emergency—from a storm to a flu epidemic. It's something to think about... Read the abstract.

CAPD and CCPD come out even in meta-analysis

A Cochrane database review looked at studies comparing CAPD and CCPD for peritonitis, hernias, switching to HD, fluid leaks, hospital stays, and death—and found no significant differences between them. CCPD may have some pluses in terms of schedule for younger, working patients. Read the abstract.

Low serum albumin is a risk factor for peritonitis in PD patients

On PD? Be sure to eat enough protein. A new study looked at whether conventional PD solutions were linked to more or less peritonitis than Nutrineal or Extraneal. There were no significant differences between them—but patients with serum albumin levels less than 3g/dL were at significantly higher risk. Read the abstract.

Make your own PD fluid?

Okay, it's a long way off. But what if you could make pure water at home for PD, instead of having to ship bags of PD fluid across the country? Think of the space you'd save. Researchers in Italy used a dialyzer to purify used PD fluid and create pure water. Read the abstract.

Peritoneal cell transplants—a future option for PD?

Over time, glucose-based PD fluid can cause fibrosis and blood vessel changes to the peritoneal membrane, making PD impossible. But what if you could transplant the cells lining the peritoneum and grow a new layer from your own tissue? Could PD continue? Researchers are looking into this intriguing possibility. Read the abstract.

Inflammation helps explain EPO resistance on PD

Sometimes high doses of EPO are needed to reach a target hemoglobin. Why? A new study found that on PD, inflammation (measured by c-reactive protein), too-low levels of serum albumin, and abnormal levels of PTH were some of the factors. Read the abstract.

On PD and need a colonoscopy? Ask for antibiotics first

A new study of 77 people on PD who had 97 colonoscopies found that peritonitis is much less likely when antibiotics are taken before it was done. Even in those who did get peritonitis, antibiotic treatment worked. Read the abstract.

Pipeline PD technology: Vincenza wearable artificial kidney minicycler

What if instead of exchanging bags of fluid for CAPD, you put in one fresh bag each morning, then wore a small pump to filter and regenerate it over and over? You'd save time—and use a lot less fluid. This system, invented by Dr. Claudio Ronco and associates in Italy, is being tested right now. Read the abstract.

Tidal PD preserves residual kidney function longer

In tidal PD, instead of draining ALL of the fluid out after an exchange, some fluid is always left in the peritoneum. A new, small study suggests that this technique may allow longer use of PD by helping to preserve residual kidney function. After 3 years, 10 dialyzors using tidal PD had significantly higher renal creatinine clearance and urine output than 19 automated PD users. Read the abstract.

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