Older patients found to do better with long dialysis sesions

At first glance most people would say they would prefer short dialysis treatment sessions. But a recent research paper says that for older people, a longer session increases how long they will survive with the disease.

This was a retrospective cohort study of people who first commenced thrice-weekly haemodialysis aged ≥65 years, reported to the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry from 2005 to 2015, included from 90 days after dialysis start. The primary outcome was all-cause mortality. Cox regression analysis was performed with haemodialysis session duration the exposure of interest.

They found that longer dialysis hours per session was associated with a decreased risk of death - and for people over the age of 65, that is a good result.

You can read the abstract online here https://pubmed.ncbi.nlm.nih.gov/36401820/   There are some mathematical statements about how the study was assessed, but the important thing is the work says longer individual sessions are better for older patients.

NICE Recommends three treatments for Covid-19

A direct quote from the source article

People at highest risk of developing severe disease include those who are immunosuppressed (for example, as a result of chemotherapy or having had an organ transplant), or who have other conditions such as heart disease, respiratory disease, diabetes, or neurological conditions.

The draft guidance means  they will have access to treatments taken either at home or in hospital. It recommends 3 medicines as options for treating COVID-19 in adults:

Paxlovid (also called nirmatrelvir plus ritonavir and made by Pfizer);

Xevudy (also called sotrovimab and made by GlaxoSmithKline); and

RoActemra (also called tocilizumab and made by Roche).

As people with kidney problems looking for a transplant may have a reduced immunity and are therefore more likely to catch COVID-19, it's nice to know that NICE is looking into safer treatments.

Covid-19 and Kidney Damage

 In a worrying report, research shows that Covid-19 can lead to kidney damage. 

Covid-19 has been studied a great deal during the pandemic and researchers are finding evidence that it cause a whole host of problems, including acute renal failure. Research reported here gives you the technical details - for those with the deep medical knowledge, angiotensin-converting enzyme 2 (ACE2) has been implicated in the pathogenesis of chronic kidney disease (CKD) and is a membrane receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease (COVID-19).

As with al things Covid-19, the more research done and the longer the period over which it is investigated, the more knowledge will be available. This article summarises some of the things found so far.

Some worrying things to consider are that it looks like 81% of patients in intensive care with Covid-19 developed Acute Kideny Injury, with the virus more likely to target the kidneys than other parts of the body. And age seems to be a factor as well, with those over 60 being twice as likely to have problems as those under 60. In fact many of the factors that affect the severity of Covid-19 are similar in those who get Acute Kidney Injury.

Get on Your Bike!

A recent news report (April 2021) claims that cycling during dialysis could dramatically improve the heart health of patients with kindey failure, and lead to significant savings for the UK's NHS.

Yes, cycling DURING dialysis. Okay, on a specially adapted bicycle during regular dialysis sessions. Not going out on the road with a dialysis machine strapped to your back!

The research was carried out by the University of Leicester, supported by the charity Kideny Research UK and the Natioanl institute for Health Research Leicester.

The heart suffers long-term effects when you are on dialysis, and the hope was that regular exercise would reduce the problem. And after six months of using the bicycle for 30 minutes during their dialysis sessions, investigations revealed  several improvments in the patients. This sounds like a cheap way to improve a patient's health and thus reduce the need for treatment for heart problems assiciated with dialysis. It's based on the well-known fact that regular exercise will improve your health, so why not do some excerise while hooked up to your dialysis machine.? After all the time spent travelling to a centre, sitting around doing nothing but reading a book while connected to your machine, then travelling home means you have spent a very inactive day. cycling like this makes you healthier, reduces problems and saves money. What more could you want?

You can read the whole article here.

AI powered tool hailed as major diagnostic advance

The analysis tool, called KidneyIntelX has been developed by RenalytixAI and is expected to be launched in the middle of this year. It is described as a major break-through in this news article. It should help decide what treatment is best for a patient and whether they need medicine, dialysis or a transplant.

So how does this sort of tool work?

It's basically similar to those telephone systems where you get asked a series of questions on what help you want when calling a support helpline, with the answer you give defining what the next group of questions should be. This is how a doctor decides what is wrong with you, or how a research chemist analyses an unknown chemical by starting with a few standard tests, then choosing the next tests to use based on the results of the first texts. Eventually, the doctor or chemist reaches a conclusion, assuming they remember what the next step is after each preliminary test.

But it includes a few extra twists after that.

Initially, doctors give the software the important questions to ask and say what the answers mean, and what questions to ask next. The creators of the tool then fed into the system the medical records and answers given to questions for literally 3 million patient health records. Then the AI system kicks in and looks for common features that might not spring to mind as being related to the problem being studied. The more real cases the AI code (called a neural network) examines, the more likely the system is to spot the important trends such as do your symptoms match those of patients diagnosed as in need of dialysis by their doctor. Or the bit that humans struggle with, is there some common factor in your earlier medical history that hints about the likely outcome? Your medical history and the outcome of the treatment will be added to the system over time. as well.

This is described as the AI system learning how to diagnose and predict the best outcome. It's not got a mind of its own, it is looking for common factors between patients and what the result of certain treatments was, based on, as mentioned earlier, millions of medical records. It does also need a lot of records where the patient didn't have a kidney problem, to avoid false positives. And contrary to popular views on these systems, it does not decide what will happen to you, it advises the doctor on what to do, and the doctor makes the final decision.

It could take a doctor quite some time to read through your medical record, and to spot changes over time. But humans can miss these odd clues occasionally. This sort of software can do this very quickly and is usually very good at spotting the smaller important clues in amongst your entire medical history. So the doctor is presented with the most important data very quickly and can come to a more accurate conclusion. Freeing up more time, leading to more patients getting the treatment they need.

It's not some power-mad living machine trying to rule your life. The cyborgs from Terminator are not making the decisions. ;)