Tuesday, 7 January 2020

Do hemodialysis patients need a blood test every month?

Recent research suggests not necessarily.

 Routine monthly blood testing for prevalent patients on hemodialysis (HD) is not associated with a lower risk of death, hyperkalemia, cardiovascular (CV) events, or hospitalization compared with blood testing every 6 weeks, according to a new study.

Among incident patients on HD, monthly testing was associated with an increased risk of hyperkalemia, CV events, and hospitalization compared with testing every 6 weeks.

However, the optimum time interval between tests couldn't really be determined from the research, published  in the article by Thomas A, Silver SA, Perl J, et al. The frequency of routine blood sampling and patient outcomes among maintenance hemodialysis patients [published online November 12, 2019]. Am J Kidney Dis. doi: 10.1053/j.ajkd.2019.08.016, available here 

Wednesday, 25 September 2019

Are patients at for-profit dialysis centers getting less transplants

I have just read a somewhat worrying (and slightly predictable) article.

A report this month says that in the US, patients attending for-profit dialysis centers are less likely to get a transplant than those at nonprofit centers! This is based on a study examining nearly 1,500,000 dialysis patients over a 17 year period. So it's got a fair bit of data behind it. The link at the start of the paragraph is to the abstract (summary) of the research, but there is a bit more detail in the Reuters news report.

A transplant in the long run is cheaper than receiving dialysis for life, but according to one of the authors, Rachel Patzer from Emory University School of Medicine, “The current system has no financial incentive for dialysis providers to educate, to spend time with and to refer patients for transplant.”

Patients at for-profit facilities were 64% less likely to get on a transplant waiting list, 56% less likely to get a transplant from a deceased donor and 48% less likely to receive a kidney transplant from a living donor.

So if you are on dialysis at a for-profit treatment center, ASK about transplant options, don't just sit there assuming that dialysis is your only option.

Saturday, 11 May 2019

Wearable Dialysis Devices

We have reported on this several times in the past, and now some such devices have been validated by a contest award. But when will we see them in production and in regular use?

The contest had 16 concepts submitted. The winners are invited to develop their ideas into prototypes and to compete in the second phase of the competition, in which up to three winners will be awarded $500,000 each next year.

Let's wait and see what happens after the winners get the funding boost.

Sunday, 5 May 2019

Plans for Mobile Kidney Dialysis Unit in Scottish Highlands

The population in the Scottish Highlands is spread over a large area of the country. Giving every local hospital a dialysis unit could be an expensive solution to treat a small number of people each week. So crisis-hit NHS Highland is planning to introduce a mobile kidney dialysis unit across the region to save patients from having to travel hundreds of miles a week to Inverness for treatment. This could help with its cash flow problems and a big financial black hole.

This will only help a small number of patients, but reduce costs and the inconvenience these patients face due to the long distances they have to travel and easy family life problems.

You can read about this news here.

Tuesday, 30 April 2019

Diabetes Drug May Prevent or Slow Kidney Disease

Recent research reports that a drug normally used to control blood sugar levels in diabetics helps to prevent or slow down kidney disease.

The new study tested Invokana, a daily pill sold now to help control blood sugar, to see if it also could help prevent kidney disease when added to standard treatments.

For the study, about 13,000 people with Type 2 diabetes and chronic kidney disease from around the world were to be given Invokana or dummy pills. Independent monitors stopped the study early, after 4,400 people had been treated for about 2.5 years on average, when it was clear the drug was helping.

Those on the drug had a 30% lower risk of one of these problems — kidney failure, need for dialysis, need for a kidney transplant, death from kidney- or heart-related causes, or other signs that kidneys were failing.

For every 1,000 people taking the drug for 2.5 years, there would be 47 fewer cases of one of these problems, researchers estimate.

This seems a pretty important result and could help a large number of people.

You can read the story here, from April 2019. And the report from the manufacturers is also available.

However, we came across other reports that paint a worrying problem.

The Food and Drug Administration issued safety warnings about Invokana, which may increase the risk of severe urinary tract infection and diabetic ketoacidosis leading to kidney failure. There's a report on that here

Patients can also have problems with increased risk of bone fractures which could lead to foot or leg amputations in a small number of cases.

These are not reported as regular events from taking the drug, they affect a small number of patients, so while a bit disturbing, it doesn't mean those taking the drug should stop - drug companies have to mention almost every report of a problem encountered.