The purpose of this blog is to provide pertinent information we received on Tuesday from our contact at Pentac concerning the deployment of their IPN product.
Tuesday, Lowe’s delivered the refrigerator to be used for keeping the IPN-infused bags cool. We received a Hisense 4.4 Cu Ft Model # HRC044AVE ($139.00) with an additional standalone thermostat. We are to keep the IPN bags between 36 and 46 F in the frig until up to 24 hours before use. After that, it must be disposed of and replacement(s) ordered.
Pentac’s Clinical Nutrition Pharmacy (800-223-4376, then 4, then option 2) will ship the product to us overnight via UPS or FedEx. We don’t have to be home to receive the product; it will be left on the porch. We opted to receive one shipment of seven bags on Tuesdays every week. Our first shipment of six will arrive on Thursday, my first treatment day.
If hospitalized, call the pharmacy to “hold” the shipment. For travel, notify Pharm so supplies can be shipped anywhere in the USA.
Inspect bags upon arrival. It should be cold, not frozen, and clear. Check white tags on bags. In a given shipment, all should have the same expiring date.
We are to receive 5 L bags, which for the IPN procedure should be placed on a peg as the second bag, with the normal, yellow bag for me, on the heater. Note this is contrary to direction elsewhere.
If you feel bad, notify the dialysis nurse. Adjustments will be made for too much or too little IPN. May experience an upset stomach and affect hydration, but this is unusual.
Call the Pharmacy if problems – physical problems with bags or shipment. Call Cynthia with Clinical questions (385-230-5388).
My wife, Linda, received a phone call from our IPN provider, Pentec Health. She was informed that we would receive a shipment of three of their protein-enhanced five-liter dialysis bags today/Tuesday, and four on Friday. Assuming Lowe’s delivers the refrigerator on Tuesday, we should be good. Also, we are to receive a phone call this afternoon at 1330 to bring us up to speed on the IPN gambit.
In doing research on IPN, a basic question arises. To wit, why do I need this? Why am I not getting enough protein via my diet, which lately has seen a large increase in protein-rich foods? What’s going on here?
I turned to Perplexity with the following Prompt and response:
Prompt: Is it possible that peritoneal dialysis reduces body protein to the extent that the patient is weak, gets winded after the slightest exertion, etc.
Peritoneal dialysis (PD) can contribute to significant protein loss, which may lead to muscle wasting, weakness, and fatigue. Here’s a detailed analysis:
Protein Loss in Peritoneal Dialysis
PD patients lose 5–7 grams of protein daily through dialysate, primarily albumin217.
This loss occurs because the peritoneum allows serum proteins to leak into the dialysis fluid during exchanges27.
Mechanisms Linking Protein Loss to Weakness
Muscle Wasting (Sarcopenia)
Chronic protein loss exacerbates protein-energy wasting, reducing muscle mass and strength37.
Uremia, inflammation, and hormonal imbalances further accelerate muscle breakdown34.
Fatigue and Exertional Limitations
Protein depletion impairs muscle repair and energy metabolism, causing fatigue and breathlessness during minimal exertion456.
Anemia (common in dialysis) reduces oxygen delivery, worsening fatigue6.
Inflammation and Metabolic Dysfunction
Chronic inflammation from PD increases catabolism (muscle breakdown)37.
Acidosis and insulin resistance further disrupt protein synthesis34.
Contributing Factors
Fluid Overload: Exacerbates protein loss and inflammation7.
Inadequate Nutrition: PD patients require 1.3g/kg/day of protein to offset losses1. Failure to meet this accelerates muscle loss.
Physical Inactivity: A vicious cycle where fatigue reduces activity, further diminishing muscle mass45.
Exercise: Resistance training preserves muscle mass and reduces fatigue56.
Volume Control: Optimizing fluid removal minimizes overhydration-related protein leakage7.
Conclusion
Yes, peritoneal dialysis can deplete body proteins sufficiently to cause weakness and exertional intolerance. This stems from direct protein loss, compounded by inflammation, metabolic dysregulation, and inadequate nutritional compensation. Addressing protein intake, volume status, and physical activity is crucial to mitigate these effects2137.
As I have been blogging about, I am in the throes of entry into the world of IPN. The refrigerator to cool the mixture is due to arrive tomorrow from Lowe’s. We expect to hear soon from Pentec to receive the training they provide for IPN usage. Soon to follow this should be the actual receipt of our weekly allotment of IPN-fused dialysis bags.
In preparation for our IPN gig, I quizzed Perplexity about the nuts and bolts of IPN actual use with the following Prompt and results. Doesn’t seem to be all that complicated after all.
Prompt:What are the nuts and bolts of actually using IPN from Pentec?
The nuts and bolts of actually using IPN (Intraperitoneal Nutrition) from Pentec Health involve several key steps and considerations to ensure safe and effective therapy for peritoneal dialysis patients who need additional protein supplementation:
What is IPN from Pentec?
IPN is a nutritional therapy that adds protein directly into the peritoneal dialysis fluid (dialysate) by replacing some of the usual dextrose with protein. This helps replenish protein losses that dialysis patients experience and supports nutritional status without requiring oral intake123.
How IPN is Prepared and Delivered
Pentec Health prepares customized IPN bags based on the patient’s specific dialysis regimen and nutritional needs. A Pentec nurse or pharmacist compounds the sterile bags by adding protein to the patient’s cycler or CAPD bag, removing some dextrose to maintain fluid balance14.
The IPN bags are shipped weekly to the patient’s home and must be refrigerated between 36-46°F. Pentec provides a refrigerator for storage. Patients are instructed to inspect bags for damage or discoloration immediately upon delivery and before use25.
Administration of IPN
IPN is typically administered daily at home as a replacement for one of the patient’s regular exchange bags, either manually or via cycler. Patients are trained on how to handle and infuse the bags safely25.
The IPN bag is usually the first bag on the cycler machine or hung to replace one exchange5.
Monitoring and Clinical Support
Pentec provides a clinical case manager and registered dietitians who work closely with the patient’s nephrologist and dialysis clinic. They:
Confirm patient eligibility and customize the IPN prescription.
Monitor nutritional status through labs (e.g., albumin levels) and clinical assessments.
Adjust therapy as needed based on patient response.
Help manage any side effects, such as dehydration, which can occur if IPN causes additional ultrafiltration14.
Fluid removal goals during dialysis are adjusted carefully. For example, for IDPN (similar therapy for hemodialysis), 75-80% of the total volume is suggested to be removed; similar judgment applies to IPN fluid management14.
Duration and Goals of Therapy
The length of IPN therapy varies per individual and depends on nutritional needs and response. Typically, improvements in appetite, strength, and energy are expected within a few months2.
Once protein levels normalize, clinicians may consider discontinuing or pausing therapy to see if nutrition can be maintained independently1.
Insurance and Financial Considerations
IPN therapy is covered by many commercial and Medicaid insurance plans. Pentec Health handles billing directly and offers flexible payment options and assistance programs if needed2.
Summary Table of Key Steps in Using Pentec IPN
Step
Description
Prescription
Nephrologist and dietitian determine need; PD nurse completes IPN prescription form with Pentec CCM
Preparation
Pentec compounds sterile, patient-specific IPN bags by adding protein and removing dextrose
Delivery & Storage
Weekly home shipment; refrigerate at 36-46°F; inspect bags for damage or discoloration
Administration
Replace one PD exchange bag daily with IPN bag; use cycler or manual exchange
Monitoring & Support
Regular lab tests (albumin), clinical assessments, therapy adjustments by Pentec clinical team
Side Effect Management
Watch for dehydration or other issues; clinical team intervenes as needed
Duration
Individualized; often several months until nutritional goals met
Insurance & Billing
Pentec handles insurance; offers payment plans and assistance
In essence, using Pentec’s IPN involves a coordinated clinical approach with personalized sterile nutrition bags integrated into the patient’s peritoneal dialysis routine, supported by ongoing clinical monitoring and patient education to optimize nutritional outcomes safely and effectively1245.
This blog follows along with my recent prescription to incorporate more protein in my diet to raise my albumin to acceptable levels. It is currently in the mid-threes, where it should be a minimum of five. I also have the lingering question of cause and effect of protein loss and my current tiredness and general lack of git up and go.
To look into this aspect of our dialysis burden, I turned to Perplexity with the following Prompt and result – spoiler – they go hand in glove:
Prompt: Is it possible that peritoneal dialysis reduces body protein to the extent that the patient is weak, gets winded after the slightest exertion, etc?
Peritoneal dialysis (PD) can contribute to significant protein loss, which may lead to muscle wasting, weakness, and fatigue. Here’s a detailed analysis:
Protein Loss in Peritoneal Dialysis
PD patients lose 5–7 grams of protein daily through dialysate, primarily albumin217.
This loss occurs because the peritoneum allows serum proteins to leak into the dialysis fluid during exchanges27.
Mechanisms Linking Protein Loss to Weakness
Muscle Wasting (Sarcopenia)
Chronic protein loss exacerbates protein-energy wasting, reducing muscle mass and strength37.
Uremia, inflammation, and hormonal imbalances further accelerate muscle breakdown34.
Fatigue and Exertional Limitations
Protein depletion impairs muscle repair and energy metabolism, causing fatigue and breathlessness during minimal exertion456.
Anemia (common in dialysis) reduces oxygen delivery, worsening fatigue6.
Inflammation and Metabolic Dysfunction
Chronic inflammation from PD increases catabolism (muscle breakdown)37.
Acidosis and insulin resistance further disrupt protein synthesis34.
Contributing Factors
Fluid Overload: Exacerbates protein loss and inflammation7.
Inadequate Nutrition: PD patients require 1.3g/kg/day of protein to offset losses1. Failure to meet this accelerates muscle loss.
Physical Inactivity: A vicious cycle where fatigue reduces activity, further diminishing muscle mass45.
Exercise: Resistance training preserves muscle mass and reduces fatigue56.
Volume Control: Optimizing fluid removal minimizes overhydration-related protein leakage7.
Conclusion
Yes, peritoneal dialysis can deplete body proteins sufficiently to cause weakness and exertional intolerance. This stems from direct protein loss, compounded by inflammation, metabolic dysregulation, and inadequate nutritional compensation. Addressing protein intake, volume status, and physical activity is crucial to mitigate these effects2137.
Been mullin’ over the comment in my last dialysis team meeting that I may have to start Hemo of some form in the near future because PD, at some point, wears out. I accept this statement as a fact, but it bears validation.
As per usual, I turned to Perplexity with the following Prompt and results. Spoiler again: not so soon, it seems.
Prompt:86-year-old male. went on PD Aug 28, 2022. What’s the probability i will need to go on HHD by the end of 2026?
Based on available data, the probability that an 86-year-old male who started peritoneal dialysis (PD) on August 28, 2022, will need to switch to hemodialysis (HD) by the end of 2026 is relatively low, but not negligible. The main reasons elderly patients on PD switch to HD are peritonitis, sepsis, or inadequate dialysis123.
Technique Survival Rates (Probability of Staying on PD)
These rates mean that, on average, about 70–80% of elderly patients who start PD are still on PD (not switched to HD) at 3–4 years after initiation. Your timeline (from August 2022 to end of 2026) is just over 4 years.
Risk Factors for Needing to Switch to HD
Peritonitis and/or sepsis are the most common causes for switching from PD to HD in elderly patients12.
Advanced age, comorbid diseases, low albumin, and low urine output at PD initiation increase risk of complications and mortality, but not necessarily technique failure134.
Technique survival (the probability of remaining on PD) is not significantly affected by age alone in most studies4.
Mortality vs. Technique Failure
Mortality rates are high in elderly PD patients; survival rates at 3 years are around 50%, and at 5 years drop to 17–36% for those over 751235.
Most elderly patients who leave PD do so because of death, not technique failure (i.e., not because they need to switch to HD)23.
Summary Table: Probability of Remaining on PD
Years on PD
Technique Survival Rate (Elderly)
Probability of Needing HD (Cumulative)
1
95–98%
2–5%
2
91%
9%
3
82–85%
15–18%
4
71%
29%
5
71–72%
28–29%
Estimates based on studies of elderly PD patients, most of whom are younger than 86, so your personal risk may be slightly higher due to advanced age123.
Conclusion
By the end of 2026 (a little over 4 years on PD), the probability that you will need to switch to HD is roughly 25–30%. The majority of elderly patients who leave PD do so because of death, not technique failure. Your individual risk may be higher if you have frequent peritonitis, low albumin, or significant comorbidities1234.
If you have been stable on PD so far, your chance of needing to switch to HD by the end of 2026 is less than one in three, but ongoing monitoring and good infection prevention are very important12.
My wife and I are in discussions about the new routine we’re about to embark upon, that of IPN. We debated how long it takes for it to take effect, so to speak. Is a day, a week, a month, or longer.
To obtain a definitive answer to this question, I turned to Perplexity with the following Prompt and response. Spoiler – it will take some time.
Prompt:How rapidly does IPN take effect? days, weeks, months?
Intraperitoneal Nutrition (IPN) typically takes several weeks to months to show measurable effects in patients on peritoneal dialysis. Here’s what the evidence and clinical experience indicate:
Improvements in nutritional markers such as serum albumin and prealbumin—key indicators of protein status and overall nutrition—are generally observed after several months of IPN therapy.
Positive changes in strength, physical health, and appetite are commonly reported by patients, but these also tend to develop over the course of months rather than days or a few weeks.
Clinical monitoring is usually performed at least quarterly (every three months), and the goal is often to see an albumin increase to around 4.0 g/dL. The time to reach this target varies, but most patients require ongoing therapy for a minimum of 3 months, with many continuing for longer depending on their response and nutritional needs.
Incremental improvements—such as a 0.2 g/dL increase in albumin—are considered clinically meaningful and can be seen during this period, with about 70% of patients in one cohort showing such improvements within several months.
If there is no significant improvement after 3 to 6 months, clinicians may consider discontinuing IPN and exploring alternative interventions.
In summary: Most patients will not see immediate effects within days; meaningful improvements typically require several weeks to months of consistent IPN therapy. The exact timeline can vary based on the individual’s baseline nutritional status, the degree of malnutrition, and how well they tolerate and absorb the therapy.
Since the hand started writing on the wall that Hemo is looming in my future, now is the time to start investigating it. Thus far I have ascertained that Fresenius, my company support provider, has two models that it uses, the NxStage Versi HD and the NX System One. Regardless of which one is provided, patients can essentially opt for either daytime or nighttime usage. Therefore, our decision tree involves selecting a model and then selecting a use.
To aid and abet in our decision process, I turned to Perplexity with the following Prompt and results. Note that I was informed by Fresenius that they assign Nxs based on their inventory at the time the request is submitted, making choice problematic. Spoiler – at this point, it looks like VersiHD and night is best for me.
Prompt: I am a 3-year peritoneal dialysis patient. informed by my dialysis team that soon I may have to switch to home hemo. Fresensis, my dialysis company, provides either NxStage Versi HD or System One, depending on what they have. Which is better for me, and should I go for night or day?
If you are transitioning from peritoneal dialysis (PD) to home hemodialysis (HHD) with Fresenius, your main options will be the NxStage VersiHD or System One. Both are designed for home use, but there are important differences and considerations for choosing between them, as well as deciding between daytime and nocturnal (overnight) dialysis.
NxStage VersiHD vs. System One
Feature
NxStage VersiHD
NxStage System One
Portability
Designed for easier learning, skill retention, and less risk of contamination
Compact, portable
Dialysate options
Pre-mixed bags, PureFlow SL
Pre-mixed bags, PureFlow SL
Ease of use
Enhanced touchscreen, GuideMe software
Simple interface, “Guide Me” steps
Data management
Nx2me app, automatic data transfer
Nx2me app, automatic data transfer
Training
Faster, more intuitive with GuideMe
Straightforward, but less advanced
FDA clearance
Approved for nocturnal and solo use
Approved for nocturnal and solo use
Maintenance
Disposable cartridge, minimal cleaning
Disposable cartridge, minimal cleaning
User experience
Designed for easier learning, skill retention, less risk of contamination
Well-established, widely used
VersiHD is the newer generation, featuring a more intuitive touchscreen interface, advanced GuideMe software for step-by-step instructions, and streamlined training. It’s designed to be easier for new users and care partners to learn and retain skills, with features that reduce the risk of contamination and simplify setup and cleaning123.
System One is the original NxStage portable HHD machine, also user-friendly and portable, but with a less advanced interface. It remains reliable and effective, especially for patients already familiar with NxStage systems456.
Both systems are FDA-cleared for day or night use, with similar clinical outcomes and safety profiles46. VersiHD’s newer software and interface may make it preferable if you are new to home hemo or want the easiest possible transition.
Daytime vs. Nocturnal (Night) Home Hemodialysis
Daytime HHD
Typically involves shorter (3–4 hour) sessions, 4–6 times per week.
Leaves nights free, but requires time during the day.
May be more familiar if you’re used to daytime PD exchanges.
Can be more flexible for people with variable sleep schedules or those who prefer to monitor their treatment closely78.
Nocturnal HHD
Performed overnight, usually 6–8 hours while you sleep, 4–6 nights per week.
Frees up your daytime for work, family, or activities.
Longer, slower treatments are gentler on your body, more closely mimic natural kidney function, and are associated with:
Better blood pressure and phosphorus control
Fewer dietary and fluid restrictions
Less post-dialysis fatigue and better energy
Improved sleep quality and overall well-being
Potentially longer survival compared to standard in-center HD9101112813.
Requires a stable sleep schedule and, in most cases, a care partner at night. Some people take time to adjust to sleeping with the machine, but alarms and safety features are built in1012.
Patient Experience
Many patients report feeling healthier and more energetic on nocturnal HHD, with the added benefit of having their days free for other activities. The gentler, longer treatments reduce the “washed out” feeling common after conventional dialysis and may allow for a more liberal diet11128.
Which Is Better for You?
VersiHD is likely the better choice if you want the latest technology, easier training, and enhanced support features. Its design is especially helpful for new home hemo patients and those who value simplicity and clear instructions123.
System One remains a solid option, especially if VersiHD is not available; both provide similar clinical outcomes46.
Nocturnal HHD is generally preferred for those who want the best health outcomes, more flexibility, and a lifestyle closer to normal kidney function—if you can accommodate overnight treatments and have a care partner9101112813.
Daytime HHD may be better if your sleep is disrupted, you don’t have a care partner at night, or you simply prefer to keep nights free for rest78.
Recommendations
Discuss your body weight, home environment, and lifestyle needs with your care team. For patients over 60 kg, achieving dialysis adequacy on NxStage may require longer or more frequent sessions, which is easier to accomplish with nocturnal treatments6.
If you value the most intuitive, modern system and easier training, ask for the VersiHD if available.
If you want to maximize your energy, minimize dietary restrictions, and have your days free, nocturnal HHD is likely the best fit—provided you can sleep with the machine and have a care partner9101112813.
If you have concerns about sleeping with the machine or lack a care partner, daytime HHD is still a strong option78.
In summary: Both NxStage VersiHD and System One are excellent, portable systems for home hemodialysis, with VersiHD offering a more user-friendly, modern experience. Nocturnal HHD provides the most health and lifestyle benefits for many patients, but your choice should ultimately reflect your personal needs, home situation, and preferences. Your care team can help guide you through training and setup for either option14923128.
As the title suggests, from time to time, I go off the topic of my dialysis journey. Today is no exception. I’m going to relate to you a little of the background from my formative years, the mid-fifties, when I was 15-17, and a sophomore-senior in high school.
Quite often during the time frame suggested, a small group of boys who were also into fast cars would meet in a friend’s garage (Paul Hinton to be exact) where we would discuss cars, girls, drink beer, play poker, and listen to radio station WLAC Nashville. Guys would drop in after dates, with some bringing their female friends with them. All through this, WLAC took front and center. So what’s with WLAC of yore? WLAC was, at the time, at the front of R&B. It brought R&B to the public’s attention and ours. In short, we listened to artists and music long before it reached the airwaves in Springfield, Ohio. WolfMan Jack hadn’t been invented, but WLAC had. Since WLAC played such a pivotal role in my early music listening, it is worth looking back to see where I am now. I quizzed Perplexity with the following Prompt and results. Following at bottom is a clip from Bo Diddley on how he got started. He was one of the artists on WLAC early on. I also inserted a Howlin’ Wolf rendition to give you a flavor of the tunes coming across from WLAC at the time.
WLAC and Its Pioneering R&B Broadcasts in the 1950s
WLAC was a Nashville, Tennessee, powerhouse AM radio station (1510 AM) that became legendary in the 1950s for broadcasting rhythm and blues (R&B) music across much of the United States, especially at night when its 50,000-watt clear-channel signal reached up to 28 states, parts of Canada, and the Caribbean. WLAC played a crucial role in introducing Black R&B music to both Black and white audiences during a time of deep segregation and limited access to such music on mainstream radio.
The WLAC R&B Format
Programming: Starting in the mid-1940s and peaking through the 1950s and 1960s, WLAC’s nighttime airwaves were dominated by a quartet of white DJs—Gene Nobles, John Richbourg (known as “John R.”), Bill “Hoss” Allen, and Herman Grizzard—who played records by Black artists such as Chuck Berry, Fats Domino, Little Richard, Muddy Waters, and Etta James.
Audience: The station’s management deliberately targeted Black listeners, knowing their signal reached 80% of Black homes in the country at night. However, the shows also attracted a large number of white teenagers, many of whom were hearing authentic R&B for the first time.
Cultural Impact: WLAC’s broadcasts helped lay the groundwork for the rock and roll explosion, influencing future musicians and helping to bridge racial divides in American popular music.
Sponsorship and “White Rose Petroleum Jelly”
Advertising Approach: The DJs’ shows were heavily sponsored by products marketed to Black consumers, many of which were sold via mail order and promoted with colorful, sometimes humorous, and often suggestive on-air pitches.
White Rose Petroleum Jelly: Among the most famous sponsors was “White Rose Petroleum Jelly,” a brand of white petroleum jelly. The DJs would read lively and sometimes double-entendre-filled commercials for this product, joking about its many supposed uses. The playful, sometimes risqué nature of these ads became part of the station’s mystique and appeal, especially among teenagers who felt they were part of a secret, subversive listening club.
Other Products: Alongside White Rose Petroleum Jelly, the station also advertised products like Royal Crown Hair Pomade and even live baby chicks, all targeting the station’s core late-night audience.
Business Model and Legacy
Mail-Order Economy: Much of the station’s revenue came from mail-order businesses, such as Randy’s Record Mart, which became the nation’s largest mail-order record seller thanks to WLAC’s reach and influence.
Social Change: While the DJs and station management profited from Black music and audiences, many Black musicians appreciated the exposure and career opportunities WLAC provided, even as the station’s aggressive product promotion sometimes took advantage of its listeners.
Enduring Influence: WLAC’s R&B shows were instrumental in breaking down racial barriers in American music, inspiring countless musicians (including Bob Dylan and members of The Band) and helping to usher in the rock and roll era.
“During the hours not sponsored by record shops, WLAC featured a whole slew of wonderful commercials for such things as… ‘live baby chicks,’ ‘Royal Crown Hair Dressing’ and ‘White Rose Petroleum Jelly.’ The disc jockeys used to have a lot of fun mentioning creative uses for that versatile substance, many with double entendre meanings.”
Summary Table: WLAC R&B Era Highlights
Feature
Details
Location
Nashville, Tennessee (not Memphis)
Era
1940s–1970s (peak R&B influence in 1950s–60s)
Signal Reach
50,000 watts; up to 28 states, Canada, Caribbean at night
Key DJs
Gene Nobles, John Richbourg (“John R.”), Bill “Hoss” Allen, Herman Grizzard
Audience
Primarily Black listeners, but also white teenagers across the eastern U.S.
Notable Sponsors
White Rose Petroleum Jelly, Royal Crown Hair Pomade, Randy’s Record Mart, live chicks
Legacy
Broke racial barriers, fueled R&B/rock crossover, influenced generations of musicians
WLAC’s nightly R&B programming, with its iconic product pitches for items like White Rose Petroleum Jelly, stands as a pivotal chapter in American radio and music history, shaping tastes and breaking down social barriers in the mid-20th century.
Since I am no longer taking the oral medication Januvia, my GP suggested I keep a close eye on my glucose to make certain it remains within limits. You may recall from several previous blogs you can search on herein, that in the past I have paid for wearable glucose monitors myself, then Medicare started to pay, and I used one for about two years. Then, somehow, the FDA got involved and stated that the devices had not been cleared for those of us on dialysis. Medicare pulled support for the devices, leaving me to go back to the old school of finger pricks. That’s where I am again. Forty years as a diabetic and nothing’s changed.
So it is of interest to me where this all now stands. I quizzed Perplexity with the following Prompt and results:
Prompt: FDA Approval Status of Wearable Glucose Monitors for Dialysis Patients
No wearable continuous glucose monitors (CGMs) are specifically FDA approved for use in patients on dialysis or those with end-stage renal disease (ESRD). This is a key distinction: while several CGMs are FDA approved for people with diabetes, their use in the dialysis population remains off-label.
Details from Recent Research and FDA Statements
According to diabetes technology experts and recent research, “these CGM devices… are not yet FDA approved for patients with ESRD on dialysis” due to the medical complexity of this population and their exclusion from most clinical trials111.
Studies have shown that factory-calibrated CGMs (such as the Dexcom G6-Pro) can provide reasonably accurate glucose readings in dialysis patients, but these studies are not large enough to support FDA approval for this specific use111.
The FDA has not cleared or approved any smartwatch or smart ring that measures glucose non-invasively (without skin piercing), for any population, including those on dialysis29.
Currently Approved CGMs
The Dexcom G7, Abbott FreeStyle Libre 14-Day, and Eversense E3 are all FDA approved for people with diabetes, but not specifically for those on dialysis5671012.
Over-the-counter CGMs such as Dexcom Stelo and Abbott Lingo have recently been cleared, but these are not indicated for people using insulin or those with problematic hypoglycemia, and there is no mention of approval for dialysis patients38913.
Off-Label Use in Dialysis
Despite the lack of specific FDA approval, many clinicians and patients use CGMs off-label in the dialysis population due to their potential benefits and reasonable accuracy as shown in pilot studies111.
If you are considering a CGM and are on dialysis, it is essential to discuss this with your healthcare provider, as they can help interpret the readings and manage any device limitations111.
Summary Table: FDA Status of Wearable Glucose Monitors for Dialysis
No wearable glucose monitor is FDA approved specifically for people on dialysis. However, off-label use of established CGMs is common, and emerging research supports their reasonable accuracy in this population, though further studies and regulatory review are needed before formal approval111. Always consult your healthcare provider before starting CGM use if you are on dialysis.
Prompt: How long, on average, does the peritoneal membrane operate for peritoneal patients?
The longevity of the peritoneal membrane is a key factor in how long patients can remain on peritoneal dialysis (PD). The average duration varies, but several studies provide insight into typical membrane survival and the factors that influence it.
Average Peritoneal Membrane Survival
Medium-term survival: For most patients, peritoneal dialysis is effective for the short to medium term, typically several years. Five-year technique survival rates (the ability to continue PD without switching to hemodialysis) are reported around 63%.
Long-term survival: Only about 11% of PD patients remain on therapy beyond 10 years, mainly due to loss of membrane function or complications such as peritonitis or ultrafiltration failure.
Factors Affecting Membrane Longevity
Peritonitis: Repeated infections are a major cause of membrane failure and technique dropout389.
Transport Status: Patients with higher peritoneal membrane transport rates have lower 2-year technique survival (as low as 68% for high transporters vs. 94% for low transporters).
Fibrosis and Aging: Fibrosis of the peritoneal membrane and molecular markers of aging can predict earlier failure, though not all patients with fibrosis experience membrane loss within five years.
Training and Care: Continuous patient training and infection prevention can improve survival and reduce complications8.
Survival Rates Table
Time on PD
Technique Survival Rate
Patient Survival Rate
Source
1 year
93%
91%
3
3 years
73%
72%
3
5 years
63%
53%
35
10 years
—
11%
2
Conclusion
On average, the peritoneal membrane supports effective dialysis for several years, with about two-thirds of patients maintaining function at five years and a small minority beyond ten years. Membrane longevity is influenced by infection rates, membrane characteristics, and quality of care. Regular monitoring and preventive strategies are essential to maximize membrane survival.
