Do you remember the first time you did it?

Dr Ray Ulan does, it was 21st December 1962, in Edmonton, Canada. He carried out the first hemodialysis treatment in Canada - what did you think I was discussing? ;)

The patient was Diane Sutton, 17 years old and expected to die, because that's what happened back then when your kidneys failed. And she nearly did, as part of the new equipment was missing.

Years later, Ulan would eventually lead Edmonton’s burgeoning nephrology specialty, watching dialysis improve and more patients receive successful transplants until his retirement a few years ago. Dialysis currently helps over 1,100 patients at 22 sites in northern Alberta.

You can read about it in the Edmonton Journal

Don't take some things as just routine, sometimes it was anything but routine.

New implant trial in UK hospitals

St George’s Hospital in London and Central Manchester University Hospital are trialling a new implant for hemodialysis patients, in an attempt to reduce scar tissue formation associated with traditional methods of attaching patients to machines.

The system they are testing is called Optiflow, made by BioConnect Systems. Eric Chemla, Consultant Renal Transplant and Vascular Surgeon at St George’s, who was the first surgeon in Europe to fit the tube, says: ‘There has been a huge rise in the demand for dialysis in recent years because of lifestyle-related illnesses such as diabetes. ‘This device has the potential to improve and save the lives of so many and, depending on long-term results, should be rolled out nationally by 2013.’

The strange thing is a search on google suggests that this is a system mentioned in 2010 as having European certification, and other instants have dates of 2006. So has the UK been sitting around ignoring new developments, or is this a new model? Or is it just the Daily Mail (link below)being slow to report on things? ;)

Read Daily Mail article, December 2012:

The Optiflow system was the subject of a research paper by some of the same team (plus others from outside the UK), published back in April 2012, which you can read here., while an earlier article from January 2011 mentions the device and describes the first UK implant as having taken place. This article has some nice graphics of the system as well.

AWAK Develop Hemodialysis System

AWAK Technologies attracted a fair bit of interest with their portable peritoneal dialysis unit, and our post on their device has been among one of the most popular. Now they have turned their attention to hemodialysis.

The special feature of their portable unit is the way it recycles the dialysate, thus reducing the volume of liquid required. They say it can be recycled indefinitely. Something which would help keep the cost of treatment down. Conventional hemodialysis uses about 120 litres of ultra-pure water to make the dialysate used in a single treatment, and the used dialysate is discarded. Just a bit wasteful.

The AWAK sorbent unit requires less than 6 litres of tap water and regenerates and reconstitutes spent dialysate into fresh dialysate. This unique feature eliminates the needs for expensive purification water system, thus, enabling dialysis to be performed in areas where such supplies are lacking. Less water equates to significantly less energy for heating the dialysate. AWAK say that their sorbent technology can be adapted to suit different dialysis modes and machines, and is smaller than current sorbent systems, which enables development of more portable devices. In earthquake victims, where Rhabdomyolysis can reduce the survival rates without proper treatment, portable units could help those who didn't get the proper treatment they initially needed and are at risk of ending up with damaged kidneys.

The sorbent system used was co-invented by Dr. David B. N. Lee and Dr. Martin Roberts (both of the Veterans Affairs Greater Los Angeles Healthcare System and the David Geffen School of Medicine at UCLA), and their technology has been exclusively licensed by the University of California at Los Angeles and the Department of Veteran Affairs to AWAK Technologies

Read more here.

Hurricane Sandy affects dialysis patients

Hurricane Sandy caused dreadful problems, some of which are still around, when it hit America. Dialysis patients had some extra problems.

Clinics needed to use generators when their patients turned up, but those on home dialysis had problems with the power outage as well, as explained in this video report from EverydayHealth.

With winter approaching we strongly recommend you read this article on preparing yourself for problems in bad weather. It has some good advice which should help disaster proof the lives of those on dialysis.

Talking improves your dialysis!

I had to read the article twice to be sure I wasn't missing something. But talking with your doctor during dialysis seems to improve the end result!

An article in eAJKD reports on a presentation at the National Kidney Foundation in May 2012. Here is the video interview with the lead researcher.

There's an abstract from the presentation available as well

Medical staff having a general conversation with patients for anywhere from 5 - 30 mins (but the actual time doesn't seem to matter much, 5 - 10 mins is perfectly okay) was found to be beneficial. "We found that just 'talking' about non-treatment issues was positive," said lead researcher Judith Beto from Loyola University in Illinois, USA.

Chronic hemodialysis education may result in boredom and disinterest, meaning patients may struggle with noncompliance secondary to depression, explain Beto and team.

The health educators just talked about living with hemodialysis in general, without trying to set an educate the patient goal of any sort.

The research showed that 84% of dialysis patients who received what was called “talking control support therapy” had at least one health improvement activity. The talking between the patients and the techs in the study was more like talking between friends rather than the kind that often occurs in dialysis clinics, with the tech just lecturing the patient for bad lab values. Both the worker and the patient shared information about themselves on a more personal level. The talking also covered issues such as life with dialysis.

"Talking control" is a cognitive behaviour, similar to befriending, which has been studied in depressed older populations in the primary care setting, say the researchers, who believe their findings are the first to use the technique in a dialysis population.

So, next time you're in for dialysis, or monitoring a patient of dialysis, have a chat!

Home Dialysis Option

I've just read an article, dated 4th October 2012, that says home dialysis is now an option for some dialysis patients. Pardon? It's been an option for a while, hasn't it!

A recent article in Clinical Journal of the American Society of Nephrology highlights the lack of acceptance of home hemodialysis, despite frequent claims that this is a cost effective solution. Newer home hemodialysis systems are easier for patients to use, but it suggests that many patients and physicians have little experience with home dialysis and so don't ask or prescribe it. The article hopes to overcome any barriers to using home dialysis

At the present moment, less than 2% of US dialysis patients are using home dialysis, partly because of the time to train the patient in its use, and a doctor and dialysis center willing to use the method.

But everyone involved in the chain of events from diagnosis to implementation is used to the standard idea of visiting a dialysis clinic at regular intervals. However the home option is cheaper and evidence is beginning to suggest that patients who can stick to the regime are healthier, the researchers said. One wonders why the insurers who are paying for treatment haven't spotted this option.

Many studies have shown that peritoneal dialysis is within the ability of many patients, and home hemodialysis units can also make life easier of the user. Including making holidays more practical.

But home dialysis does require a fair bit of commitment by the patient, and may not suit everyone. A little bit of effort to stick to the hygiene standards, a dedication to not taking short cuts or skipping a session. Not difficult, really.

But less than 2% of users out of almost 500,000 US dialysis patients says something is wrong. Are doctors hesitant to recommend it? Unfamiliar with the concept? Or just going through the same old routine of recommending a dialysis clinic with which they might have a financial arrangement?

Back in September 2011 we reported on a Scottish dialysis patient who undertook a long distance canoe trip, along with his portable dialysis unit, to raise awareness and money to fund more such machines (at the time there only 2 such machines in Scotland and about 70 in England).

Kidney Stones and Kidney Failure

A recent article in the British Medical Journal says that kidney stones can double the risk of a person requiring dialysis or transplants. The study looked at over 3 million patients in Alberta, Canada over a 12 year period. They reported that those with a history of kidney stones were twice as likely to have serious kidney problems later in life when compared to people who had never suffered from kidney stones. Age was also an important factor (perhaps giving time for more damage to occur?) as those under 50 had more problems than those over 50; women seemed more susceptible too - women under the age of 50 years who had a history of kidney stones were four times as likely to later develop kidney failure.

It should be noted that the actual number of those who ended up requiring dialysis was low, but the risk was greater than in the normal population. When you are passing a stone through a kidney, there is definitely the potential for permanent damage.

People could try to decrease the likelihood of the development of kidney stones by decreasing their sodium intake, drinking more water and, if needed, taking certain medication, the researchers suggest. It has been previously observed that those who develop kidney stones have kidneys that don’t function at optimal levels, which is a factor in the whole issue.

Chronic Obstructive Pulmonary Disease Raises Dialysis Patient Death Risk

Chronic Obstructive Pulmonary Disease (COPD)is the occurrence of chronic bronchitis or emphysema, a pair of commonly co-existing diseases of the lungs in which the airways become narrowed. This leads to breathing problems. Smoking is one of the commonest causes of COPD. But if a patient starts dialysis, it increases the risk of death and decreases the chance that the patient will receive a transplant, according to recent research.

The research covered 769,984 US dialysis patients over a nine year period - with a large pool like this, the results are very much more reliable. It found that those suffering from COPd had a 20% increased risk of death compared with those who did not have COPD. If the patient also smoked, the risk increased by 28%. Smokers also had a lower chance of getting a transplant compared to non-smokers.

GranuFlo and NaturaLyte Withdrawal

Granuflo and NaturaLyte are products made by Fresenius, as buffer solutions in the final dialysis solution. Buffers control the pH of the solution and blood. There is concern that incorrectly mixed dialysate could lead to problems for dialysis patients.

Both products are an acetic acid / sodium acetate mixture. Buffers are a mixture of a weak acid and its sodium salt, and the choice of acid and salt determine the pH range over which the buffer will operate.

The first problem is that the body can metabolize acetate ions to carbonate and hydrogencarbonate (bicarbonate) ions, thus raising the level of bicarbonate in the blood. And bicarbonate ions are are part of one of the body's own buffer control systems. Altering the bicarbonate levels can lead to a pH imbalance and metabolic alkalosis - the blood is too alkaline during and after dialysis.

And metabolic alkalosis is an independent risk factor for low blood pressure, low blood oxygen, high blood carbon dioxide, heart rhythm problems, and sudden cardiac death.

Now the second problem.

A leaked memo from Fresenius was made available to the FDA. In it, Fresenius warned doctors at its company-owned clinics of the risk of GranuFlo side effects when using these concentrates. It advised its doctors to check bicarbonate levels in patients before dialysis, and to adjust prescriptions as necessary. The company failed, however, to warn outside clinics of the risks associated with GranuFlo and NaturaLyte.

Eventually the FDA issued a class 1 recall on these two products.

One interesting result I found was this article, dated 2009, claiming that acetate buffers are an old-fashioned type of buffer and, on my reading of it, had been replaced. So why were Fresenius still producing these products at all? Well, neither product is dangerous in it's own right, it is the risk of errors when making up the final solutions to administer to patients that is the problem.

Other acid concentrates are primarily just acetic acid. As a PhD chemist I have to point out that the acetic acid in these concentrates will interact with any sodium in the blood to result in sodium acetate being present in solution. Thus the acetate ions are present once again and metabolism to bicarbonate will still occur. Presumably the amount of acetate ions will be so much lower in these cases that the conversion will be much less of a problem.

Problems when patients start dialysis too soon.

The glomerular filtration rate (GFR) quantifies the rate at which filtered fluids are processed by the kidneys. By medical consensus, a GFR of 10 is deemed “early” for dialysis. But recently, the number of elderly people (those 75 and over) who started dialysis when their GFR was lower than 10 increased from 1 in 4 (in 1996) to more than 6 in 10 (in 2009), according to an article at The Journal of the American Medical Association.

It is suggested that with medics receiving a referral fee from dialysis centres, patients were being referred sooner than necessary. Whether or not this is a factor, the article says that early introduction to dialysis is not justified. Elderly patients with age related decreases in muscle mass may have higher GFR due to this problem instead. And being subjected to dialysis can lead to a higher risk of death, while a controlled trial found no benefit from starting dialysis early. Indeed the article stated that for those over 80, they were more likely to die from other causes before starting dialysis.

The article ends with the following statement:
"The public perception that pursuit of dialysis is always in patients' best interest should be replaced by a more realistic view of the “sad truth” about early dialysis initiation in elderly patients."

Dialysis demand increases after elective surgery

Elective surgery - surgery which can be scheduled in advance as it does not involve a medical emergency.

The number of patients needing dialysis after major elective surgery has tripled since 1995, a Canadian study reported here suggests.

Researchers reviewed data on 552,672 patients in Ontario who had elective major surgery in the province between 1995 to 2009. Out of this group, 2,231 received acute dialysis within 14 days after surgery. This represents an increase from 0.2 percent in 1995 to 0.6 percent in 2009. An extra 0.4 percent might not seem much, but it's 1487 more people!

According to kidney specialist Dr. Amit Garg of London Health Sciences Centre, when someone develops the complication and is sick enough after surgery to need dialysis, 40 per cent will unfortunately have died at 90 days. So it's a very high risk of death in patients who develop this complication. And in those who survive 90 days, one fourth are now left with permanent kidney failure needing ongoing maintenance dialysis and those outcomes haven't changed in the last 15 years.

Older, sicker patients may be higher risk of acute kidney injury, the researchers said, with people who already had weak kidneys, or high blood pressure or diabetes before the surgery at highest risk.

Kidney Donor Refused Insurance

One of the first things that is checked after a matching donor is found is that they are in good health. Very good health. So when Radburn Royer donated a kidney to his daughter, Erika, he was glad to be told he was in great shape.

But when he tried to get medical insurance and life insurance, he was told he had chronic kidney disease as he only had one kidney. The refusal has stunned him. As a donor he had to be in great shape to be accepted, but two insurance companies are saying otherwise.

There is little data on how often kidney donors have trouble obtaining insurance, but advocates say the fear of being uninsurable may be a powerful deterrent to donation. A 2006 study done by an advocacy organization for transplant professionals found that 39 percent of transplant centers reported that they had had eligible donors who declined to donate because they feared having future insurance problems. Being treated like this could potentially affect thousands of people (especially those with family of their own who would like to think they would be looked after if anything went wrong).

This article mentions several others who faced similar treatment when seaking various types of insurance. Other donors faced problems at work if they needed more time to recover than expected. This sort of thing will not encourage potential donors

Hope for Kidney Regeneration

Indiana University School of Medicine scientists have successfully transplanted primary kidney cells intravenously to treat renal failure in rats, pointing the way to a possible future alternative to kidney transplants and expensive dialysis treatments in humans.

The researchers (above), Katherine J. Kelly, M.D., associate professor of medicine, and Jesus Dominguez, M.D., professor of medicine, genetically modified the cells in the laboratory to produce a protein – called SAA – that plays an important role in renal cell growth, embryonic kidney development and kidney regeneration after an injury. Modified cells found their way to the appropriate locations of the damaged kidneys, resulting in regeneration of tissue and improved function in the kidney.

"Ultimately, you can imagine taking a part of someone's kidney, expanding those cells with appropriate growth factors in a tissue culture dish, and then giving the cells back," said Dr. Kelly.

The researchers cautioned, however, that much work remains to be done before tests could begin in humans.

Their work will be published in an article in American Journal of Physiology – Renal Physiology, read the abstract

83 year old kidney donor!

Yes, you read that right!

It was featured on the UK tv news on many channels, and several newspapers, such as The Guardian for 17th May

Nicholas Crace is officially the oldest living kidney donor in the UK (not sure about the world, but Google didn't seem to turn up anyone older, which wasn't a surprise). Nicholas thought about helping others some time after his wife died last year, as he had no dependents to worry about. He felt that with over 7000 people in the UK waiting for a donor, he could do some good as an altruistic donor (not donating to a relative, just to help someone)

After several months of tests and hospital visits, which assessed his kidneys as being in great shape), he underwent a three hour operation to remove a kidney. He is one of a rare breed in the UK - just over 100 other people have made a similar donation. The surgeon who carried out the operation, Sam Dutta, said that using a living donor works better, more quickly and lasts longer than a kidney from an accident victim who has joined the donor scheme.

Altruistic donors were "very special people", said Annabel Ferriman, chair of the charity Give a Kidney – One's Enough.
She is just so right!

Renal Denervation Might Protect the Kidneys

A simple procedure lowers blood pressure in kidney disease patients

Disrupting certain nerves in the kidneys can safely and effectively lower blood pressure in patients with chronic kidney disease (CKD) and hypertension, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings indicate that the procedure might improve CKD patients’ heart health.

Overactivity of neurons in the sympathetic—or fight or flight—nervous system is very common in patients with CKD. It not only contributes to high blood pressure and heart problems in these patients, but also to worsening of their kidney disease.

Using radio frequency waves in a minimally invasive approach can disrupt the overactive sympathetic nerves of the arteries in the kidneys and lower blood pressure in patients with hypertension and normal kidney function.

According to Dr Markus Schlaich of the Baker IDI Heart & Diabetes Institute, in Melbourne, Australia, where the research was carried out, “These initial findings now open up an entirely new approach to better control blood pressure in CKD and potentially slow down progression of CKD and reduce cardiovascular risk in these patients."

A Better Method for Diagnosing Kidney Disease

The standard way to check for kidney problems is to have a blood test and the test centre assesses your kidney function by calculating your glomerular filtration rate using various factors including the serum creatine level measured. There is a standard equation into which is fed your age, sex, race and creatine level to calculate the filtration rate. The equation was proposed in 1999 and is known as the MDRD equation.

Recently researchers at the Johns Hopkins Hospital compared results from this equation with a new method, the CKD-EPI equation, looking at patients who were known to have kidney problems. The study looked at data from over one million patients! The results from using the new calculation method were found to be better at predicting whether patients had kidney problems, often putting patients into a higher category of risk than the older method.

The study involved over 200 collaborators and data from 40 countries. The original research was published in May 2009, and slowly labs are beginning to swap to using this newer way to calculate patient risk, a methodology that took almost ten years of research to come up with.

You can read about the article here, or view the original article here.

Routine Kidney Disease Screening Not Worthwhile, Experts Say

It's been reported (Health News article, 30th April) that one in ten Americans have chronic kidney disease, but most don't know it and for most it is not a problem, experts say. According to those experts interviewed in the report, in most cases the disease is mild and doesn't affect them.

But when it comes to screening people for kidney problems there appears to be insufficient data to say whether or not this is actually effective. For example, the article says there has been no analysis of how effective blood or urine tests for creatine are at detecting chronic kidney disease.

The U.S. Preventive Services Task Force is calling for studies on identifying and treating chronic kidney disease. They also say it isn't known what the effect would be of treating otherwise healthy people whose disease is not currently a problem.

In the case of those at higher risk of CKD, such as those with diabetes or high blood pressure or African Ammericans, screening is still recommended, as there is evidence this is effective.

It was also pointed out that as most people's kidneys decrease in function with age, mass screening of healthy older people would worry those otherwise healthy individuals whose reduced function was detected.

FDA fast-tracks three new technology products

FDA announces plans to pilot end-stage kidney disease technology in new program

Innovation Pathway aims to reduce time and cost of bringing safe and effective, breakthrough technologies to patients.

Three products for patients with end stage renal disease (ESRD) have been chosen to participate in the FDA’s Innovation Pathway, an evolving system designed to help medical devices reach patients in a safe, timely and collaborative manner.

The FDA selected three from 32 product applications ranging from an artificial kidney to devices that assist kidney function that were submitted in response to a January 2012 request from FDA’s device center.

The three products are:

• An implantable Renal Assist Device (iRAD) being developed by the University of California, San Francisco.
• A Wearable Artificial Kidney (WAK) in development by Blood Purification Technologies Inc. of Beverly Hills, Calif.
• A Hemoaccess Valve System (HVS) that has been designed by Greenville, S.C.-based CreatiVasc Medical.

The majority of the 32 applications came from small, start-up business or academic institutions.

The ESRD products will be the focus of the second version of the Innovation Pathway, first announced in 2011, to shorten the time and cost it takes for the development, assessment and review of medical devices, in particular breakthrough medical devices.

ESRD is the progressive loss in kidney function over a period of months or years. The kidneys play an essential role, filtering and removing waste from the body and producing hormones that are responsible for calcium absorption and red blood cell production.

The FDA chose ESRD because more than half a million Americans suffer from the disease. Management of the disease is largely dependent upon medical device technology, such as hemodialysis (process for removing waste products) equipment.

This info is from a recent press release by the FDA

Transplant Waiting Lists In Australia

In Australia the percentage of dialysis patients over 65 who are on a waiting list for a transplant is surprisingly low compared to many other countries. In the UK it is 48%, in France it's 49% and in the US its 33%. But in Australia it's just 18%. The numbers are slowly falling as well, despite an increase in the numbers having dialysis. Yet patients receiving a transplant have a longer survival rate than those on dialysis. An article on the Australian site 9News reports on this problem.

The reasons for this low rate aren't totally clear - are local doctors making a decision based on limited information? Under the current law a person must have an 80 per cent chance of surviving at least five years after a transplant to be considered. Is the survival chance being estimated wrongly and suitable patients ignored?

In the Northern Territory, the rate is unusually low - reported as being just 1% (!) by ABC.net.au just yesterday. And they say that one renal health worker in the Northern Territory says the situation amounts to institutionalised racism. Note that Indigenous Australians make up 32.5% of the population of the area (according to Wikipedia), and have reportedly had poor health treatment in many news reports over the years. So perhaps this is what the ABC.net news item is referring to. But whatever the cause, 1% being on a transplant waiting list is an extremely low figured compared to other countries!

Oil Services company decides to support Scottish dialysis charity

Aker Solutions is an international oil services company with a base in Aberdeen, Scotland. They have just announced that they will support two charities during 2012, one of which is the Kidney Dialysis Unit Stonehaven. The charity was brought to their attention when one of their IT support staff was diagnosed as suffering from chronic kidney disease. Since then the staff member, Julie Robertson, has been involved in several fund raising events, and is overwhelmed by the support her employer has given, culminating in this charity sponsorship.

Does your company have a charity policy? Do they they choose a different charity each year? Why not drop the hint about chronic kidney disease and dialysis units? Many of the bigger companies are quite happy to support charities in their local area (and not for the publicity it brings them either). Most will look at several and then, like Aker Solutions, make a decision on a couple to support for a year, then review things the next year, to spread their contributions around a bit, while providing a great deal of help to the chosen ones during their year or so of support. Staff members in situations like Ms Robertson often create a stir with their own work and trigger the company into action. Go on, try it yourself.

Dialysis in China

China has four times as many patients with chronic kidney disease as the US, according to a recent report at Bloomberg, and is spending vast amounts on health care - twice as much last year as in 2008. But increasing rates of kidney disease as pushing up the costs for individual families. A staggering 13% of families send at least 40% of their income on health care products; the average family spends 13% of it's income on health care. In an attempt to reduce the burden, the government is promoting the use of peritoneal dialysis as opposed to the more expensive hemodialysis (although lower salaries for doctors and nurses means it is only 10% more costly than peritoneal dialysis, unlike in the West).

Rising rates of diabetes in Asia, and especially in China are increasing the strain on dialysis centres. Many patients in China die within five years even with dialysis. Fresenius Medical is building its first dialysis clinic in the region, a center in the eastern province of Jiangsu that will care for about 40 patients when it opens midyear, it said. It has agreements to provide dialysis machines and disposable products to 52 clinics, and plans to drive growth in China primarily through partnerships with local clinics and management contracts, Fresenius Medical said.

Kidney donor was her husband's MISTRESS !

I thought I was seeing things when this one caught me eye, but that's what it says here!

A Turkish woman, Meliha Avci,, has been on dialysis for 12 years has had a transplant. The donor was a woman her husband met 5 years ago, while he visited the hospital when she was having dialysis, and she became his mistress.

But it isn't just a kidney she has received - earlier she received a blood donation from the mistress as well!
Meliha Avci is quoted as saying "We have shared blood, we have shared my husband, and now we are sharing kidneys"

Meliha Avci only found out about the affair recently. It's one thing to treat an affair in a sensible, non-violent manner, but you don't expect the other woman to give you a kidney as well!

Prepare yourself of problems, especially in winter.

We thought that, given the bad weather at this time of year, a bit of emergency planning advice would be helpful. Having a plan to cope with a local flood, dangerous storms or strong winds, or heavy snow falls can be vital of dialysis patients. Last year my car was snowed in and unusable for three weeks, for example. Could you handle that?

Missed dialysis treatments can obviously cause you problems (recent research showed that those on three times a week dialysis were more likely to have a problem during the three-day gap, compared to the other two two-day gaps). Missing a dialysis session due to extreme weather will lead to excess fluid build-up, which could lead to heart failure, breathing problems and other complications.

One obvious plan is to have a decent reserve of renal friendly food in stock, in case deliveries to your local store gets disrupted or you can't get there for supplies for a few more days than normal. Restricting your fluid intake becomes even more important if there is a chance you will miss your next session - it's no use realising this on the day you can't leave your home and face a bigger gap than normal between sessions. So think and plan ahead.

Create an emergency box, with copies of the important local phone numbers, first aid kit and several days supply of any drugs you will need. In the case of drugs, don't pack a box and leave it sitting there for two years, the drugs may be out of date. A sensible idea would be to remove and use any drugs in your emergency box once a month, and replace them with some of your latest supplies, thus keeping them all within date. This is quite important for diabetics with kidney problems.

Monitor your diet a bit more closely when bad weather is threatened. You don't want to get close to a sensible limit, then have to survive snow bound for three days and go over the limit on, say, potassium intake or fluid intake.

If you are on home dialysis, how would you handle a power cut? Does your machine have a standby battery? Is it actually fully charged? In more remote areas, where a power cut can leave people very isolated, some have a standby power generator. Does it have fuel handy as well? Is your cell phone fully charged? Some people who use their mobile phone a lot have an add-on booster battery pack that will keep it charged for several days of heavy use. As you may be in greater need of reliable communications than the average yuppie, getting such a booster battery pack could be vital. The cost is trivial compared to the benefits it brings.

These sort of plans are all very obvious when you read them. But have you implemented any of these ideas? Why not start now.

Dialysis companies grilled over rising costs

The Oregon Medical Insurance Pool (OMIP) decided that, when its dialysis costs rose from $7 million to $20 million, in a mere three years, it was time to have a word with the two biggest dialysis companies and the American Kidney Fund. After all this represents inflation of around 100% per year! Not quite what the rest of the world is seeing as an inflation rate.

According to an article in Oregon Live, OMIP board members cited figures showing dialysis companies charge OMIP dialysis patients as much as 15 times what they charge Medicare. Dialysis companies said that's because they lose money on Medicare rates, which are set by federal law. But the high rates also means the program's patients can hit their $2 million OMIP coverage limit in a few years, leaving them without health insurance.

Naturally OMIP are concerned about this state of affairs, and are trying to persuade the big two, Fresenius and DaVita, to lower their rates to something comparable with the rates paid by Medicare.

KDN's Greatest Hits

As it's January, and due to the way the blog moves posts out of sight (but not site), I thought a review of our most popular posts would be in order. It will also enable you to easily look back at posts you may have missed. (Or why not deliberately look at some of the older posts from the selection in the Blog Archive list on the left?)

By far and away the most popular post is
Cost comparison of peritoneal dialysis vs hemodialysis from December 2010, with twice the number of views of the next most popular post. Clearly something people are very interested in.
Are patients getting treatment dictated by the profit margin or its suitability?

In second place we have
Vitamin E helps fight muscle cramps during dialysis, a post from November 2009. You'd expect some older posts to have generated a fair number of views, but nothing compares to the younger post above.

In third place it's
Implantable Artificial Kidney - coming soon from September 2010. An article like this can be expected to be popular of course, but we have seen similar claims dating back several years as most people would know.

The fourth most popular post is
News Release on Wearable Kidney Belt, from February 2010. The more astute readers might be noticing a trend at this point, and wondering what's coming next.

And the trend spotters would be right, because in fifth place it's
Portable Dialysis Machine, from December 2009.

Finally, as these are more established posts and you'd expect them to have generated more hits over time, what was the most popular post from 2011? You might be able to predict it...
AWAK testing a portable dialysis unit, from August 2011. and this was the ninth most popular post overall. Not bad for such a recent post.
That trend in popularity just continues, doesn't it...

The next most popular post from 2011 wasn't even in the top ten
Diet that reversed kidney failure in diabetic mice, from June 2011. Unfortunately the researchers involved admitted that it was questionable whether the diet model used would be sustainable in humans, even in the short term.

So, an annual list of seven - bet you've read so many top ten lists by now that something different is appreciated. Who will be the winners next year? At this rate the current No. 1 and 2 are likely to stay there, as for the rest - that's up to you.

Happy New Year