Monday, 15 August 2016

Give a Kidney, Get a Kidney

Interesting "Voucher Scheme" spreading across America

The numbers are staggering. Because of a lack of donor kidneys, an average of 13 people die every day in the US while waiting for a transplant. There are more than 100,000 names on the kidney waiting list in the U.S. and another 30 million people with chronic kidney disease who are at risk of joining them. More than 85% of those on the waiting list in 2015 are still waiting.

The good news is that there were 17,878 kidney transplants in the U.S. last year, the most in a single year, according to the United Network for Organ Sharing. And the numbers may keep growing thanks to an innovative voucher program that started in 2014 at Ronald Reagan UCLA Medical Center and is spreading across the country.

Here’s how it works: If you donate a kidney now, you will receive a voucher that a loved one could use to secure a kidney in the future. The Advanced Donation program is coordinated through the National Kidney Registry, which uses a national database to quickly and efficiently match donors and recipients.

The idea was approved by the Ethics Committee of the American Society of Transplant Surgeons in June, and has been sent to that group’s executive committee for formal approval. Ten hospitals across the country have so far joined UCLA to honor the voucher program. Donors currently need to go to one of these hospitals to receive a voucher but many other centers are expected to join.

From a recent issue of The Wall Street Journal, which gives more details. Let's hope this idea catches on.

Friday, 12 August 2016

Study finds no major difference in effectiveness of two classes of drugs in peritoneal dialysis patients

From the Journal of Nephrology

Background

There is evidence that angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-II receptor blockers (ARB) may reduce cardiovascular (CV) risk in patients undergoing peritoneal dialysis (PD), but no studies have compared the effectiveness between these drug classes. In this observational cohort study, we compared the association of ARB vs. ACEI use on CV outcomes in patients initiating PD.

Methods

We identified from the US Renal Data System all adult patients who initiated PD from 2007 to 2011 and participated in Medicare Part D, a federal prescription drug benefits program, for the first 90 days of dialysis. Patients who filled a prescription for an ACEI or ARB in those 90 days were considered users. We excluded patients who used both ACEI and ARB. We applied Cox proportional hazards regression to an inverse probability of treatment-weighted cohort to estimate the hazard ratios (HR) for the combined outcome of all-cause death, ischemic stroke, or myocardial infarction; all-cause mortality; and CV death.

Results

Among 1892 patients using either drug class, 39 % were ARB users. We observed 624 events over 2,898 person-years of follow-up, for a composite event rate of 22 events per 100 person-years. We observed no differences between ARB vs. ACEI users: composite outcome HR 0.94, 95 % confidence interval (CI) 0.79–1.11; all-cause mortality HR 0.92, 95 % CI 0.76–1.10; CV death HR: 1.06, 95 % CI 0.80–1.41.

Conclusion

We identified no significant difference in the risks of CV events or death between users of ARBs vs. ACEIs in patients initiating PD, thus supporting their mostly interchangeable use in this population.

Wednesday, 10 August 2016

Transplanted kidney now 100 years old

Sue Westhead needed a new kidney 43 years ago in 1973. With a transplant her only hope of survival, her mother, Ann Metcalfe, aged 57 at the time, decided to step in and offered one of her kidneys to save her daughter, who reportedly only had one tenth the normal renal function.

Sue is now 68, so the kidney is now 100 years old. And still going strong!

Sue thinks it's all down to good genes - her mother's good genes.

This shows just how long a patient can survive after a transplant. It's not just a few extra years

Wonder if the kidney is going to have a party, or get a telegram from the Queen...

Read about it Here

Tuesday, 9 August 2016

Dialysis Patients who Smoke are less likely to get a Kidney Transplant and Die Earlier

Well there's a surprize. Strange thing is, it has to be explained to some people.

Dialysis patients who smoke are much less likely to receive a life-saving kidney transplant and much more likely to die sooner according to researchers from the Health Research Institute (HRI) at the University of Limerick and UL’s Graduate Entry Medical School (GEMS).

The findings, which are published in a study appearing online in the journal BMC Nephrology, provide compelling evidence that smoking reduces overall life expectancy of dialysis patients as well as their overall chances of receiving a kidney transplant.

“Dialysis patients have extremely high premature death rates that are between 10- and 100-fold higher than in the general population, and smoking contributes substantially to lower patient survival,” said Professor Stack, senior author of the study, Consultant Nephrologist at University Hospital Limerick and Director of ULs Health Research Institute. “Smoking is a well-known risk factor for death and disability for patients in the general population. Our study, one of the largest ever conducted; found that smokers have alarmingly high rates of premature death. Quite strikingly, the risks of death were far greater in younger men and younger women than in older patients. Equally concerning, dialysis patients who smoked experienced lower rates of kidney transplantation and thus the opportunity to extend survival and quality of life. These risks were considerable in that smokers were between 26% and 50% less likely to receive a kidney transplant taking all other factors into consideration.

You can read more here

Wednesday, 29 June 2016

Wearable artificial kidney passes initial test.

A wearable artificial kidney has been successfully tested in the USA in a clinical trial sponsored by the government (ClinicalTrials.gov NCT02280005), offering hope for more comfort and flexibility to kidney failure sufferers so far constrained to hospital-based haemodialysis.

The device, developed by Cedar-Sinai Medical Center researcher Victor Gura, was tested on seven patients in a trial authorised by the US Food and Drug Administration (FDA) and conducted by researchers from the University of Washington.

We've reported on this particular device (and several similar concepts) over the years, but this one is popping up on news sights a bit more. Which means it shows promise of becoming available. We noticed it being mentioned here and here in June this year. It's inventor is Dr. Victor Gura of the Cedars-Sinai Medical Center says the wearable artificial kidney could perform dialysis without patients having to spend hours at dialysis centers.

A detailed report is published here at JCI Insight

The report mentions that the trial was stopped early after some technical problems, but there were no serious complications, and the scientists and doctors involved hope to conduct a follow-trial in a few years time.