What are your thoughts on this article regarding PD Dialysis

[inga]

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Landmark Study Provides Key to Improved Survival in Peritoneal Dialysis Patients


Sep. 23, 2013 — Clinicians and scientists from Keele and Cardiff universities have published data from a landmark study that explains why survival in patients on peritoneal dialysis is low. The paper, entitled ‘Independent Effects of Systemic and Peritoneal Inflammation on Peritoneal Dialysis Survival" is published today in the Journal of the American Society of Nephrology.


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Peritoneal dialysis (PD) is a treatment for over 250,000 patients with chronic kidney disease worldwide, using the patient's peritoneum in the abdomen. Currently, only one in ten PD patients survives beyond 10 years on dialysis. For each one-year increase in the patient's age, the risk of death increases by 4% and patients with diabetes have a 30% increased risk of death.
 
Scientists have now discovered that inflammation in the body and in the peritoneal cavity (where dialysis is performed) are a separate process, which has implications for both the ability to perform dialysis and patient survival. In effect, systemic (whole body) inflammation controls the outcome (survival) whilst peritoneal inflammation controls membrane survival.
 
Professor Nicholas Topley from Cardiff University and Professor Simon Davies from Keele University designed the study that has taken 12 years to complete:
 
"Improving survival and doing better dialysis to improve quality of life is the key goal of our research," said Professor Topley from Cardiff University's School of Medicine. "This study was a hard one to bring home because of its length of follow up and the logistics of collecting patient samples worldwide. The importance of the results is self-evident -- this is a big leap forward for PD."
 
Professor Simon Davies, lead investigator from Keele University, said: "We will now be able to target inflammation to improve survival and recovery. Of course there is more to be done but this will form the basis of understanding that to holistically treat the patient one needs to define the clinical problem."
 
The 12-year international study, with 10 centres in the UK, Korea and Canada, is the longest and largest of its kind. Researchers recruited more than 1500 patients to the study over a 10-year period and then performed a detailed clinical and immunological analysis of samples obtained from PD patients. This for the first time characterised inflammation in these patients and linked it directly to patient outcomes.
 
The data will enable clinicians who treat PD patients to be able to target treatment where it is needed, thereby improving and extending the therapy, quality of life and reducing treatment failure.
 
Dialysis treatment is a daily reality for patients with kidney failure which can last for many years and incurs a huge annual cost for the NHS. A UK estimate suggests that renal disease costs the NHS in England £1.45 billion and £800million in Wales, annually.
 
More than 250,000 patients worldwide use peritoneal dialysis as their primary form of renal replacement therapy.

 
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Story Source:


The above story is based on materials provided by Keele University.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.


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Journal Reference:
 1.M. Lambie, J. Chess, K. L. Donovan, Y. L. Kim, J. Y. Do, H. B. Lee, H. Noh, P. F. Williams, A. J. Williams, S. Davison, M. Dorval, A. Summers, J. D. Williams, J. Bankart, S. J. Davies, N. Topley. Independent Effects of Systemic and Peritoneal Inflammation on Peritoneal Dialysis Survival. Journal of the American Society of Nephrology, 2013; DOI: 10.1681/ASN.2013030314

[inga]

My research has been that PD dialysis is generally better for the body; because it's more gentle. Not sure what to think of this article.

[MooseMom]

Systemic inflammation is a bugbear for anyone with a chronic disease.  There are inflammatory processes going on in anyone who is on dialysis or is at any stage of CKD.

I'm not sure that this one study should be the sole determinant for anyone deciding upon a modality.  There are many more things to consider.  But nothing in this study tells us anything we don't already know.  Dialysis is an unnatural process in and of itself, so I am not sure how inflammation of any sort can be eradicated, but as the authors say, that is their ultimate goal.

[KarenInWA]

PD should not be used for long-term therapy. There is a rare and fatal condition called EPS that can result from long-term PD. Not too many dr's know about it. It stands for Encapsulating Peritoneal Sclerosis. I can post some info about it later.

KarenInWA

[amanda100wilson]

PD is not a gentle treatment.  Mortality rates for PD are alongside thrice-weekly hemo dialysis.  It is only gentle in tht you don't get the Post-dialysis symptoms associated with the latter which are due to too fast fluid removal over a short-period of time.

[MaryD]

There is a rare and fatal condition called EPS that can result from long-term PD.
KarenInWA

It is thought that EPS is caused by the PD fluid having a PH level which is not compatible with the peritoneum.  I have been using Physioneal since early this year.   It is a double bag system.  The frangible between the two bags has to be broken to allow the two solutions to mix while draining out the old PD fluid.  The resulting mix has a PH level which is the same as my peritoneum, and is therefore supposedly not going to irritate my innards.  Before I started using Physioneal I would occasionally get a mild pain while I was draining in - I thought it was a couple of times a month.  After it was decided that I was to change from Dianeal to Physioneal I actually recorded the times I had 'drain in' pain.  It was two or three times a week.  It was not severe enough to complain about and it didn't hang about for long - nowhere near as severe a drain pain.  I haven't had my 'drain in' pain since using Physioneal.  I understand that it is not used in USA.  It is more expensive than Dianeal.  When I enquired about it before I started there were a few users in the UK.

PD is not a gentle treatment.

PD is more gentle than HD three times a week.  It is constantly removing toxins and fluids rather than reducing them three times a week.  I'm told that it supports whatever remaining kidney function you have, too.

[amanda100wilson]

MaryD, define what is more gentle.  Mortality rates are up there with in-unit dialysis.

[MaryD]

MaryD, define what is more gentle.  Mortality rates are up there with in-unit dialysis.

'Gentle' has nothing to do with mortality rates.  'Gentle' is the way toxins and fluids are in a state of being removed constantly rather than three times a week.  In-centre HD (especially after the two day break) means that a patient is 'cleansed' three times a week.  Without extreme care with fluid intake and diet they can be in a state of fluid overload and feeling 'poisoned' for three or four days a week.  As well as feeling this way, there is possibly underlying damage happening to organs, bones and their mental state.

I agree with your point about mortality rates.  Any form of dialysis is less than ideal.