Tuesday, 5 June 2018

Vitamin K antagonist use and renal function in pre-dialysis patients

A research article, available at Dove Press, discusses whether vitamin K or oral anticoagulants is the best option for patients with only mildly reduced kidney function. Here we quote directly from the article. (Data was collected from 984 patients.)

A post hoc analysis of a recent trial on direct oral anticoagulants versus vitamin K antagonists showed that amongst patients with mildly decreased kidney function, use of vitamin K antagonists was associated with a greater decline in renal function than use of direct oral anticoagulants. Whether these vitamin K antagonist effects are the same in pre-dialysis patients is unknown. Therefore, the aim of this study was to investigate the association between vitamin K antagonist use and the rate of renal function decline and time until start of dialysis in incident pre-dialysis patients.

Conclusion: In incident pre-dialysis patients, the use of vitamin K antagonists was not associated with an accelerated kidney function decline or an earlier start of dialysis compared to non-use. The lack of knowledge on the indication for vitamin K antagonist use could lead to confounding by indication.

Sunday, 15 April 2018

New Microsensor Enables Kidney Dialysis to be Customized to the Patient's Needs

It's nice to have the personal touch when having dialysis. Having your doctor or nurse set things up to better match your needs. But new research goes a step further than that.

Researchers from TU Eindhoven have developed a microsensor that makes it possible to directly monitor and adjust the composition of kidney dialysis fluid. This is a crucial step towards patient-specific dialysis, which will remove a significant proportion of the serious side effects of the use of standard dialysis fluid. And on 29 March 2018, Manoj Kumar Sharma will be awarded a PhD for his research on this sensor.

The number of patients worldwide on dialysis is quite astonishing - 2 million people are being treated just now.

Salts and impurities in the blood are removed via the dialysate fluid, passing through a membrane into the fluid. The rate of flow is dependant on the concentration difference between the blood and the dialysate. And the concentration in the blood varies from patient to patient. It doesn't help that the dialysate is supplied at a standard concentration, not tailored to each patient (and the patient's needs would be different at each session. There are side effects if the mismatch in concentrations is too high or too low.

It would be better to continuously adjust the concentrations of salts in the dialysate so that they are optimal for the patient. This, however, requires that the concentrations of salts in the dialysate can be monitored live, but there has not been a reliable technique to do this so far.

But now things are changing for the better.

PH D student Manoj Kumar Sharma has devised an ingenious solution for this. He developed a micro-system with a centrally positioned microchannel through which dialysate flows. He covered the walls of the microchannel with sensor molecules, which are only fluorescent in the presence of a salt, such as sodium. The more sodium there is in the dialysate, the stronger the fluorescence. To reinforce this effect, he introduced micropillars into the microchannel, resulting in even more surface covered with sensor molecules.

A laser light shines on the microchannel and activates the fluorescence of the sensor molecules. Sharma captures this fluorescence using glass fibres that he connected to the channel in the micro-system. The light passes through the fibres to a spectrometer for analysis. The laser light, which is of a different wavelength, is first filtered out. Then, based on the measured intensity of the fluorescence, the sodium concentrations can be read out.

If the sensors and monitoring system can be mass produced and used on a large scale, built into dialysis machines, one day each patient will receive during their dialysis session a customised dialysate to match their needs, the concentration changing to suit the current state of their blood.

Visit the University website to read the full article on this exciting development.

Thursday, 12 April 2018

Second Transplant with a Difference

Some patients receive a kidney transplant and get along okay after that. Some are unlucky and need a second kidney transplant years later - a worrying situation when they may have struggled for years to find a suitable doner the first time.

But some kidneys are special.

And the one that Vertis Boyce received was very special indeed. The kidney was first transplanted two years ago from a 17-year-old girl into a man in his early 20s, who had just unexpectedly died in a car accident. Boyce would be its second recipient.

Boyce had by then been on dialysis for nine-and-a-half years and on the transplant list for nearly as long. Waiting for the right organ to become available. And at 69, wondering if she would ever get her chance.

For her surgeon, Jeffrey Veale, it was special too, it was only the second time he had re-used a transplanted kidney - since then he has carried out a third such transplant. THREE very special kidneys.

You can read about these special organs here.

Just how often could a kidney be transplanted? Scar tissue from several operations may cause problems, as happened in this case. But could a kidney be re-used three times? Four times? Live on for many, many decades each time?

Well, you might want to read this news item that we reported on back in August 2016 - the 100-year-old kidney!

Saturday, 24 March 2018

Everything You Need To Know About Being A Live Kidney Donor

It's not normal for a blog like this to post a link to a womans/fashion magazine, but today, that's exactly what I am doing. Yes, seriously.

The article in this week's Elle looks into how singer Selena Gomez received a kidney from best friend Francia Raisa. It takes a clear plain language approach to discussing a variety of things about kidney failure and what's involved in being a live donor.

I feel we should thank them for opening up the topic such wide audience of people.

So have a read of Elle's article (I'm linking to the UK edition, it might also be in the editions for other countries, I'm not fully up to date on my  fashion magazines...)

To quote from the article:
"There is a common misconception, among people who have not had a lot of experience with kidney disease, that cadaver donation is the only pathway back to health.

Living donation isn't widely discussed in the mainstream enough for people to truly understand the ins and outs of giving someone a kidney while you're still living and breathing.

But, in fact, live kidney donation is a lot more common than you likely know, with about a third of all kidney transplants carried out in the UK coming from living donors. And you don't have to be a family member to offer someone an organ - plenty of kidney donations come from friends or non-directed altruistic kidney donations (anonymously)."

Wednesday, 21 March 2018

Kidneys Infected with Hepatitis C Safe for Dialysis Patients

Researchers at Johns Hopkins report their use of a drug that cures the infection, leaving the kidneys suitable for use by dialysis patients desperate for a transplant.

They carried out a small study (only ten very sick patients were involved), where patients were given a transplant with an infected kidney, then treated with a drug prevents hepatitis C from replicating in the body. In each test, the patient had been waiting for quite some time for a donor but no suitable living donor was available. This was a very risky experiment for these patients. But it was worth it - all 10 patients were found to be clear of the virus after their 12-week course of medication using Zepatier, donated by Merck which funded the study, was complete.

Normally kidneys infected with hepatitis would be rejected as an option for transplants. Will this research doesn't mean there will be a flood of new potential donors, it will increase the pool of available organs, and should enable more transplants to take place.

You can read more about this in the research article here from the Johns Hopkins researchers, and also in an earlier report here, and on NBC NEWS, which includes an interview with one of the team.

There are several other articles on this type of treatment if you just google on  "hepatitis c kidneys used in transplants".