Tuesday, 12 September 2017

Should we operate? Yale doctor seeks to limit surgeries for small kidney tumors.

This article, quoted below,presents a slightly contraversial view, that it is not always worth operating when a patient has a tumour on their kidney.

Not all kidney cancers are killers, and many small tumors can be left alone or watched over time because there is a low risk they will become dangerous, according to Dr. Brian Shuch at the Yale School of Medicine.

While doctors can detect more tumors because of increasingly sensitive tools, such as MRIs, surgery to remove the cancer is not called for in many cases, said Shuch, an assistant professor of urology and radiology.

“Many of these small tumors are very indolent or wimpy — low grade or low aggressiveness and low potential to spread or cause harm,” Shuch said. As many as 90 percent of tumors smaller than 4 centimeters fall into this category. Some actually turn out to be benign, he said.

Most surgeons will remove any cancerous tumor they find, out of concern for the risk of it growing, but also because they have a financial incentive to operate, as well as a fear of legal liability, Shuch said. This aggressive approach isn’t necessary and can lead to other issues later in life, such as dialysis, he said.

The full article can be found here and is worth reading. In countries where the surgeon gets paid for each operation based on the time taken and difficulty of the operation, many patients may be paying for treatment that they don't actual need. In other countries with a free health service, the views expressed in this article are the normal way to work, to spread the health service's limited resources to cases that really need them.

Wednesday, 31 May 2017

California Bill Addresses Safety Concerns At Dialysis Clinics

Saying they are concerned about safety in California’s dialysis clinics, a coalition of nurses, technicians, patients and union representatives is backing legislation that would require more staffing and oversight.

The bill, introduced by Sen. Ricardo Lara (D-Bell Gardens), would establish minimum staffing ratios, mandate a longer transition time between appointments and require annual inspections of the state’s 562 licensed dialysis clinics.

More than 63,000 Californians receive hemodialysis, which filters impurities from the blood of those with end-stage kidney disease. Demand for the procedure is growing statewide and nationwide as the population ages and more people suffer from chronic conditions that can lead to kidney failure, such as diabetes, hypertension and heart disease.

If the legislation passes, California would join several other states that have imposed minimum ratios for dialysis centers, including Utah, South Carolina and New Jersey.

You can read more about this story here and also here. Let's hope the bill succeeds in its purpose.

Monday, 29 May 2017

Hip hop artist Freeway tackles dialysis and raises awareness around kidney disease

Freeway is a hip hop rapper, a musician who loves to entertain his fans

Recently Freeway has taken on a new mission. Yes, he’s still making music, but he’s also an ambassador for the National Kidney Foundation and a constant advocate for kidney health awareness. Back in 2015, the 38-year-old rapper was diagnosed with kidney failure and is now on dialysis.

Freeway has been using his personal story to educate as many people as possible about the dangers of kidney failure, as he wasn’t aware of how crucial a healthy diet and getting regular physician check-ups could be. And beyond tweets and talks, Freeway is putting his money where his mouth is, leading marches and giving free performances to raise awareness of the issue, all while sticking to his own dialysis schedule.

You can read more about this story here and also here

Friday, 21 April 2017

Disappointment at proposed changes to chronic kidney disease quality standards

Here we quote a news item from the British Kidney Patients Association

We regularly work with the National Institute of Health and social Care Excellence (NICE) to add the perspective and views of kidney patients into their work. In 2011, the first ever CKD Quality Standards were produced, outlining markers of good quality for kidney care, including support for the patient’s mental as well as physical well-being, and recommending that a care planning discussion about treatment is held between the patient and doctor or nurse.

In 2017, NICE is reviewing the standards and have just put forward a proposal (external link). We're surprised to see that most of the standards have been removed and while we are all in favour of simplification we do not believe that removing the need for psycho-social support, or for a care planning discussion is the right thing to do for kidney patients.

We have made it clear that we want some of the previous standards to be retained and have worked closely with our colleagues in the Renal Association, British Renal Society, Renal Psychology Group and the renal services Clinical Reference group and they have also expressed these concerns in their responses to NICE.

We believe that people should be given information that’s appropriate for their kidney disease, and that the way in which they will be cared for should be documented and agreed with them. This standard should therefore remain. Furthermore we would like the standard recommending that “People with kidney failure have access to psychosocial support (which may include support with personal, family, financial, employment and/or social needs)” to be retained. Through our own work we fund much of this type of vital support for patients, yet NICE states that “the previous recommended quality standards are no longer considered national priorities for improvement but may still be useful at a local level”. This gives a disappointing and inaccurate message that these are not important for kidney patients. Something we know just simply isn’t true.

Tuesday, 18 April 2017

Antidepressants, Exercise, and Dialysis Patients

Having chronic kidney failure and being on dialysis is definitely depressing. But efforts to get these patients on antidepressants often fail, according to research published online in the Clinical Journal of the American Society of Nephrology.

Of 101 patients followed for ≤12 months, 39 met criteria for depression (Patient Health Questionnaire 9 score ≥10 on one or more assessments). These 39 patients had depression on 147 of 373 (39%) monthly assessments. At 103 of these 147 (70%) assessments, patients were receiving antidepressant therapy, and at 51 of 70 (70%) assessments, patients did not accept nurses’ recommendations to intensify treatment. At 44 assessments, patients with depression were not receiving antidepressant therapy, and in 40 (91%) instances, they did not accept recommendations to start treatment. The primary reason that patients refused the recommendations was attribution of their depression to an acute event, chronic illness, or dialysis (57%). In 11 of 18 (61%) instances in which patients accepted the recommendation, renal providers were unwilling to provide treatment.

Patients on chronic hemodialysis with depression are frequently not interested in modifying or initiating antidepressant treatment, commonly attributing their depression to a recent acute event, chronic illness, or dialysis. Renal providers are often unwilling to modify or initiate antidepressant therapy. Future efforts to improve depression management will need to address these patients- and provider-level obstacles to providing such care.

Interestingly, a second paper appeared in the very next issue of the journal, saying lower physical activity and depression are associated with hospitalization and shorter survival in CKD !

Physical activity or exercise training helps improve muscle strength and physical and mental function, including benefits on depressive symptoms, which affects at least 20%–30% of patients receiving maintenance hemodialysis (MD). Depression contributes to low quality of life and restricted living among patients with CKD. Thus, exercise can be an interesting intervention to reduce depression and hospitalization and improve quality of life in these patients. Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure.

Overall, is exercise beneficial to patients with CKD? The answer is yes. Both physical activity and exercise are associated with improved outcomes in these patients. Although a limited number of studies have been reported, all differing by protocol, they show that aerobic and resistance training can improve physical functioning, quality of life, depressive symptoms, survival, or hospitalization