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.

Thursday, 3 November 2016

Landmark in Altruistic Kidney Donation in UK

The charity Give a Kidney, in partnership with NHS Blood and Transplant, are officially announcing the 500th non-directed living kidney donation in the UK.

This means that more than 500 people have helped save the life of stranger by becoming a living kidney donor, and to mark this milestone NHS Blood and Transplant and partner charities like BKPA are now calling for more people to consider saving lives by donating to a stranger. Altruistic donors are especially valuable because they can generate transplant chains, where up to three kidney transplants are triggered thanks to the generosity of one stranger.

Fiona Loud, Policy Director at the British Kidney Patient Association, said: “The generosity of living donors is absolutely fantastic; we and the patients we support are very grateful for the gift of life which organ donation gives. The altruistic programme has transformed lives by giving more kidney patients the chance of a transplant and we are delighted that this important milestone has been reached. We hope it will continue to encourage more living donors and more kidney transplants.

This key moment was reached in September this year, but for various reasons I was unable to add it to the site. Better late than never.

Tuesday, 1 November 2016

Evidence Poor for Restricting High-Potassium Foods

The normal advice to dialysis patients is to reduce intake of high potassium foods, to reduce the risk of hyperkalemia, a problem which is already raised as renal failure is the most common cause of hyperkalemia. But new research is challenging this view.

An article in Journal of Renal Nutrition, which is reported on here suggests that there are several other reasons for high potassium levels. The summary says:
"Experimental studies of potassium kinetics show that serum potassium is affected by nervous and endocrine signals, chemical concentrations in and out of cells, circadian rhythms, and organ system functionality. For example, some evidence links acidosis to hyperkalemia in kidney disease patients. Intracellular and extracellular shifts in potassium occur in response to acid-base changes. Insulin also plays a role.

Furthermore, inadequate potassium excretion may contribute to hyperkalemia. When excess potassium is not removed by kidneys, it may be excreted through the bowel. Constipation, a common problem among patients, would hinder excretion."

It is suggested that there is no actual evidence to suggest that high potassium foods such as bananas, kiwis, baked potatoes, tomatoes, and oranges are likely to cause problems with potassium levels, and that more research is required to check whether other factors are more important such as prolonged fasting, hyperosmolality, metabolic acidosis, tissue breakdown, constipation, and medications. Dialysis modality and prescription are yet another influential variable.

"Ultimately, we conclude that this approach is not evidence-based and may actually present harm to patients,” Dr St. Jules and the other authors concluded. “However, given the uncertainty arising from the paucity of conclusive data, we agree that until the appropriate intervention studies are conducted, practitioners should continue to advise restriction of high-potassium foods.”

With this research going against the normal advice, clearly more research is required. So don't rush out to eat foods you have been recommended to avoid just yet. Changes like this have to be confirmed first, rather than immediately jumped upon as a new solution. Wait for conclusive proof from follo-up research which will surely take place.

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.