Monday, 23 January 2017

UK National Chronic Kidney Disease Audit Results

The first ever National CKD audit produced worrying results for the UK. With 1 in 20 adults having CKD and often no symptoms until it is too late, those at higher risk eg patients with diabetes and high blood pressure, regular blood and and urine tests should be done, and at least annually if not more often. But the recently released National CKD audit found that on average only 54% of people with diabetes have the relevant urine tests, compared to 86% that have blood tests. In some other groups, including those with high blood pressure, it’s less than 30%.

This makes the chance of identifying patients with problems a bit variable to put it mildly. Further findings showed that whilst over 80% of those who have CKD had had a blood test in the previous year, only 31% had a repeat urine test. For people without diabetes, urine testing rates dropped to less than 15%. This is despite recommendations that effort should be focused on regular review. The report authors also urged GPs to review how they record the fact a patient has CKD on their systems as almost a third of confirmed CKD cases were not given the right coding and 1 in 10 people who were coded as having CKD did not have it.

You can read the full report at the Healthcare Quality Improvement Partnership.

For our American readers, GP is short for General Practitioner, the free medical providers available to all UK residents. The vast majority of UK medical care is provided free by the state's National Health Service.

Saturday, 21 January 2017

Kidney dialysis treatment negatively impacts heart function says MRI study

The world’s first MRI study of the effect of kidney disease on heart function shows that the necessary dialysis treatments for those with kidney failure can cause heart damage.

Recent research conducted by the University of Nottingham used magnetic resonance imaging to study the stress placed on patients’ hearts while they underwent kidney dialysis. The study compared the effects of two different types of dialysis on the heart—hemodialysis and hemodiafiltration.

They noted the amount of blood pumped per minute by the left ventricle, as well as how efficiently the muscle could contract, as well as blood flow into the coronary artery, and found that cardiac function suffered while the patient underwent both forms of dialysis, with some recovery after the treatment.

Professor of Nephrology at the University of Nottingham, Maarten Taal, summarized their findings, noting that “All patients showed some degree of left ventricular dysfunction and blood flow to the small capillaries in the heart muscle decreased significantly during both types of treatment.” While the sample size tested was small, 100% of patients’ cardiac function was negatively impacted by the dialysis treatments, raising concern.

But for many patients, dialysis is not something they can casually say no thanks to. That causes even greater problems. More research is required so that doctors can treat chronic kidney disease by dialysis without causing heart problems.

A summary of this report can be read here

Wednesday, 21 December 2016

Kidney transplanted in place of spleen

A child who has been on dialysis since birth due to a rare kidney problem and malformed blood vessels has had her spleen removed and a kidney transplanted in the space created. This is reported as a new and innovative technique in the an Italian newspaper, Tonino (let google translate it for you), UK's Daily Mail and many others world wide.

The operation is described as an immediate success as the six year old Italian girl's new kidney started functioning immediately

Tuesday, 20 December 2016

Dialysis patients can walk their way to better health.

Everyone should know by now that exercise can improve your health and lead to a better and longer life. But doctors are also recommending the same thing for dialysis patients as well.

A team of Italian scientists have come to the conclusion that a few minutes a day of walking benefits dialysis patients. Although to my mind more than "a few minutes" would be a lot better. Earlier research on this topic shows that exercise has a positive effect on dialysis patients health, and now it's being suggested that exercise should be part of all dialysis patients health regime

In the new study, researchers led by Dr. Carmine Zoccali wanted to see if that was true for even simple activities, such as walking. Zoccali is from the Institute of Clinical Physiology, National Research Center in Reggio Calabria, Italy. Their research included 296 dialysis patients who were randomly assigned to either a low-intensity exercise program, or a comparison group who underwent no formal exercise program.

The "low-intensity" regimen included 20 minutes of walking at low-to-moderate speeds every second day, with the intensity gradually increasing over six months. The average distance covered during a six-minute walking test in the exercise group gradually improved -- from about 1,100 feet at the start of the study to 1,200 feet six months later. In comparison, the group without the exercise program showed no increase in walking distance, the researchers said.

People who did the walking program also improved in what's known as the "sit-to-stand" test -- a standard test designed to assess lower-body strength in older adults.

Mental function also improved significantly in the exercise group compared to the control group, the researchers reported.

So, don't just sit there, do something!

The study was published Dec. 1 in the Journal of the American Society of Nephrology. You can read this article in full online

Tuesday, 8 November 2016

New Implant Reduces Damage Veins of Dialysis Patients

Vascular access is a problem - continual needle insertion can lead to damage to the vein. A Singapore based company has presented their solution to this problem - A tiny titanium implant under the skin, which helps nurses insert a needle the same way every time without damaging the vein.

Continual insertion of needles over time can lead to damage to the veins because dialysis can last for the rest of a patient's life. For anyone operating a home dialysis unit, and self inserting a needle, things can be a bit more tricky than for a trained nurse.

Dr Akira Wu, a renal specialist at Mount Elizabeth Hospital, said the device - which is called the av-Guardian - could be especially useful for fat people or those with smaller veins.

"It can be a real challenge to find the fistula, especially for women, whose veins are a bit smaller," Dr Wu said. "Sometimes, you just have to use your judgment and push the needle in."

Advent Access - a spin-off from the Agency for Science, Technology and Research - is working with National University Hospital, Singapore General Hospital and National Kidney Foundation on a pilot trial.

The press report can be read here.