Is peritoneal dialysis a good option for black patients?

Blacks are less likely than whites to use peritoneal dialysis (PD) as the initial renal replacement therapy. The reason for the underusage of PD by blacks is unknown. In a cross-sectional multicenter trial, we studied peritoneal transport character, small-molecular-weight solute clearances, and nutritional status in 475 patients undergoing PD (168 whites, 192 blacks, and 115 Asians). The mean age of blacks undergoing PD was significantly younger than that of whites (47.6 +/- 14.7 v 58.2 +/- 16.7 years; P < 0.0001). Target Kt/V and weekly creatinine clearance (WCC) as defined by the Dialysis Outcome Quality Initiative Work Group was achieved by 62.5% of whites, 67.2% of blacks, and 54.8% of Asians (P = 0.05). Total protein (7.25 +/- 0.88 v 6.55 +/- 0.73 g/dL), albumin (3.72 +/- 0.57 v 3.55 +/- 0.53 g/dL), and lean body mass (LBM; 41.7 +/- 15.6 v 33.0 +/- 11.8 kg) were lower in whites compared with blacks (P < 0.001). Although the normalized protein catabolic rate (nPCR) was greater (0.82 +/- 0.24 v 0.90 +/- 0.32 g/kg/d; P = 0.04), total protein (6.24 +/- 0.85 g/dL) and serum albumin levels (3.36 +/- 0.52 g/dL) and LBM (30.1 +/- 8.0 kg) were significantly lower in Asians than blacks (P < 0.0001). The favorable anabolic response in blacks may partially be explained by a higher calorie intake in this group of patients (29.6 +/- 10.7 Cal/kg/d) compared with whites (22.4 +/- 6.8 Cal/kg/d) and Asians (23.9 +/- 9.8 Cal/kg/d; P = 0.03). Multiple regression analysis identified that black race and weight were positively associated, whereas dialysate/plasma creatinine ratio (D/P(Creat)) and age had a negative effect on serum albumin level. Follow-up data indicated that the Kt/V (2.09 +/- 0.50 v 2.39 +/- 0.56; P = 0.02) and WCC (60.8 +/- 4.3 v 70.2 +/- 7.3 L/1.73 m2; P = 0.02) increased significantly from baseline only in blacks. We conclude that PD is an ideal renal replacement therapy in at least a subset of blacks with end-stage renal disease.

Quenching the thirst in dialysis patients.

In a double-blind cross-over trial, 22 stable end-stage renal failure patients on maintenance haemodialysis were subjected to conventional dialysis with dialysate containing 137 mEq/l sodium and constant ultrafiltration (UF) and to a different dialysis therapy, in which, by linear sodium modelling, the dialysate sodium was reduced from 137 to 128 mEq/l. A computerized UF program was used to gradually reduce the UF to a minimum towards the end of the session. Severity of thirst, interdialytic weight gain and intradialytic complications were less with low sodium dialysate. It allowed adequate UF with absolute hemodynamic stability. The reduced incidence of complication with low sodium dialysate therapy was probably because they required less UF.