Testing Begins on Wearable Kidney Machine

One of the commonest themes that pops up in news reports is work on portable / wearable dialysis machines. And now the University of Washington has the go-ahead for the first human safety trial of a portable, wearable kidney dialysis machine. (Known as Wearable Artificial Kidney, WAK.)

The device, in development for more than 10 years, cannot be marketed until it is evaluated for safety and fully tested, said the UW.

The device being tested is a prototype and developers expect that updated versions will be streamlined and lighter. It can be worn like a tool-belt. It runs continuously on batteries.

Dr. Victor Gura, a physician specializing in internal medicine and kidney disease, created the initial prototypes for the WAK in his clinic in Beverly Hills, Calif. He completed the prototypes in a lab at Cedars-Sinai Hospital in Los Angeles. His original team included the late Austrian physicist and equipment safety standards developer Hans Dietrich Polachegg, as well as bioengineer Masoud Beizai, and physician and medical device researcher Carlos Ezon, both of whom live in Los Angeles. Gura is clinical associate professor at the David Geffen School of Medicine at UCLA.

Read more at the University's own news site

Miniature Dialysis Machine for Babies and Young Children

A study in the British medical journey Lancet says that to alleviate problems caused when equipment designed for use by adults is used on young children and babies, an Italian group has produced a miniaturised dialysis machine which has been tested on a newly born baby with serious organ failure problems, After 30 days the child's kidney function was restored.

Dialysis on such young children is very challenging they say.

The Italian group set out to design a continuous renal replacement therapy (CRRT) suitable for such young babies under 15kg in weight - specifically in the 2kg to 10kg weight range. Peritoneal dialysis is the treatment of choice for such young tiny children but is not always feasible. Machines designed for adults can withdraw too much fluid from a young child, or even too little.

Dialysis on such young children is very challenging they say. In the UK about a dozen children like this are treated, and hopefully this new machine with much smaller catheters will improve matters in a challenging but not impossible medical problem. However like all new treatments, this will require further testing.

Kidney charity backs call for organ donor reforms

Some news from Scotland on the problems of waiting for a transplant.

So just how hard is it to get treatment do you think, once diagnosed as in need of a transplant? A PATIENT on dialysis could travel to Mars and back - twice - in the time it takes to get a new kidney. The average waiting time for a transplant is 1000 days, about the time it would take to make two trips to Earth's second closest planet, which is around 140 million miles away. So says an article in a Glasgow news paper.

With a reported 700+ dialysis patients in Glasgow alone, with one dying every week, Scotland is in need of a lot more transplant operations. The charity Kidney Research UK is urging people to sign up to the transplant donor register. Have you signed an organ donor card? Do you carry it with you at all times? Does your family or friends know this? DO SOMETHING! Now!

Longest Kidney Transplant Chain

We've spoken before about transplant chains. For those unfamiliar with the process, a friend or relative of patient A whose kidney is not a match for patient A offers their kidney to anyone else who has a friend or relative who is willing to donate to patient A, or someone else, until a chain is formed where patient A gets a kidney that is suitable.

Friend of A---> Patient B Friend of B---> Patient C Friend of C---> Patient D Friend of D---> Patient A

You get the picture? An altruistic transplant chain, not just one generous person giving to one person.

We've mentioned a long chain of about 8 patients once before and thought that was pretty cool (and pretty life saving too). But we've got news of something a bit bigger than that. A lot bigger than that!

A report here and several other news sites reports a chain of 21 transplants - yes, that's 21, not a typo! The University of Alabama Birmingham Hospital is celebrating America's longest kidney transplant chain. (Is it the longest in the world? I might check up on that, if I can work out how to.) All thanks to the transplant program at UAB and a team of more than 80 medical professionals.

Update!

Well, You will not believe it but there is a longer transplant chain that will just make you gasp - are you ready for this one? 30 - that's right, 30 transplants in a chain! Read it here!

Chain 124, as it was labeled by the nonprofit National Kidney Registry, required lock-step coordination over four months among 17 hospitals in 11 states. It was born of innovations in computer matching, surgical technique and organ shipping, as well as the determination of a Long Island businessman named Garet Hil, who was inspired by his own daughter’s illness to supercharge the notion of “paying it forward.”

Walking can help reduce likelihood of dialysis

As we should all know, walking and regular exercise helps prolong your health in many ways. A recent article in the Daily Mail points out that there are benefits for those with kidney disease. And the figures are quite astonishing.

The study, reported in the Clinical Journal of the American Society of Nephrology, examined the activity patterns of a large number of patients with an average age of 70 and found that those who walked were 33% less likely to die and 21 per cent less likely to need dialysis or a kidney transplant. Even greater benefits were found the more they walked.

People who walked seven times a week or more were 59% less likely to die according to the study, and 44% less likely to need dialysis or a transplant that those who rarely took such exercise. These improvements in life expectancy and reduced susceptibility to requiring further treatment are so huge, we really hope anyone reading this just gets up and goes for a walk! Once a day for 30 minutes and your health improves.
Hit the road. NOW!

DaVita Launches Hemodiafiltration Treatment in US

DaVita is starting a six-month trial of hemodiafiltration to selected patients in Colorado Springs, in the US. Reported here and on many other news sites too.

Hemodiafiltration differs from hemodialysis – the country's most common dialysis method – in that hemodiafiltration incorporates the standard hemodialysis process but adds an extra step designed to remove even larger toxin particles, thereby further cleansing a patient's blood. Hemodiafiltration is commonly practiced in Europe but until recently there was no FDA approved device for use in the U.S.

A very quick online search reveals references to Hemodiafiltration stretching back to 1998. One wonders why the US is only just getting its first ever trial of the technique.

UK Sees Huge Increase in Altruistic Donations

Several UK news stations and papers are reporting today a huge increase in the number of "stranger" donations of kidneys for transplants over the last seven years.

Altruistic donation first became possible the UK in 2007. In that first year, only three kidneys were donated but last year (2013) a total of 107 donations took place. However, there are still over 5500 people in the UK on the transplant waiting list.

Okay, when comparing a first year with only three donations, any increase will seem huge, but this is an increase of almost 40 times more! And it's hoped that by raising awareness, even more generous individuals will step forward and become a living donor. There were 76 such donations in 2012. After all, if this man can do it, so can others.

High Altitude Dialysis

A recent report suggests that if you are unlucky enough to need dialysis, it helps if you happened to live at high altitude, say 6000' amsl

University of California Irvine Medical Center studied a national cohort of 144,892 dialysis patients with a follow-up of 801 days to examine the connection between residential altitude and all-cause mortality in these patients. The researchers found that high residential altitude, defined as 6000 feet or greater, was associated with a significant 8% reduction in all-cause mortality risk in dialysis patients compared with living at less than 250 feet.

Other studies have found similar observations, but with a larger effect being reported.

However, there are a few points to be born in mind - Patients living in higher altitudes were more likely to be white, married, on peritoneal dialysis, and receiving catheter dialysis access, compared to those on lower altitudes (less than 250 feet). They also displayed higher hemoglobin and creatinine levels, but lower parathyroid hormone levels.

Perhaps the background to these high altitude patients is just as important. It has been suggested that survival of dialysis patients at high altitude is due to the regulatory effects of hypoxia-induced factors on enzymes associated with cardiovascular risk, while increased UV light at higher altitudes, leading to higher vitamin D levels, might also be a factor.

Jab solution for overactive parathyroid

This news comes from Singapore.

One side effect of kidney dialysis is overactive parathyroid glands, which are found in the neck. This could lead to a loss of calcium, resulting in bones becoming soft and deformed. - See more here

Usually, dialysis patients with overactive parathyroid glands have them removed. A tiny portion is then surgically implanted into an arm muscle to restore some of the gland's function.

Surgeons at Singapore General Hospital (SGH), however, mince the tissue finely and inject it into the fat just under the skin instead. This not just shortens the time for the surgery but also improves the patient's recovery process. And reduces scarring as well.

Such treatments do seem a bit strange, don't they. But if they work, and prevent the bones getting damaged, that's all that matters.

Dialysis for Pregnant Women with Kidney Failure

A study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN) concludes that intensive dialysis for pregnant women with failing kidneys results in a greater proportion of live births when compared with standard dialysis.

Pregnancy is considered dangerous if the mother-to-be has advanced kidney disease. Dangerous to both the mother and child. The study compared the live birth rate for a group who had received intensive dialysis treatment with the more general cases who had received standard dialysis treatment. With intensive hemodialysis the live birth rate was 86.4% (22 patients) while in the standard treatment group of 70 patients, the live birth rate was 61.4%. This was considered a significant improvement.

Among the findings of this Canadian study were the following:

In patients with established kidney failure at conception, the live birth rate in the group from Toronto was 83%, compared with only 53% in the American group.

The median duration of pregnancy in the more intensively dialyzed group of women from Toronto was 36 weeks compared with 27 weeks in American women.

A dose response between dialysis intensity and pregnancy outcomes occurred. For women dialyzed for more than 36 hours per week, the live birth rate was 85%, while it was only 48% in women dialyzed for 20 hours or less per week. Infants were a healthier weight at birth when women were dialyzed for more than 20 hours per week than when women were dialyzed for 20 hours or less per week.

Complications were few and manageable in women who received intensive dialysis.


“More intensive dialysis has improved pregnancy rates and dramatically improved pregnancy outcomes,” said Dr. Hladunewich, lead scientist in the study. “This study provides hope to young women on dialysis who might want to consider having a family.”

Read more at http://www.redorbit.com/news/health/1113071914/intensive-dialysis-in-pregnant-women-with-kidney-failure-benefits-mother-and-baby/#uelVRcEB8iXSsWmL.99

The Journal's online abstract can be found at http://jasn.asnjournals.org/content/early/2014/02/12/ASN.2013080825.abstract?sid=30c84217-5b94-4be3-a355-56ea952bbcc4

Canadian Society of Nephrology Changes Guidelines

A recent change to guidelines has appeared in the Canadian Medical Association Journal.

The articles talks about the timing of starting dialysis for sufferers of chronic kidney disease and how there is a need to identify a threshold before which starting dialysis offers no benefit to the patient but beyond which there may be some measurable risk.

Basically they suggest that a patient should not commence their dialysis treatment until their glomerular filtration rate drops to 6mL/minute per 1.73m² or less, or clinical indications become evident. Close monitoring of the patient should begin when levels reach 15mL per minutes per 1.73m². 

"Delaying dialysis in people without symptoms appears to be safe, as long as they are closely followed by their kidney specialist," lead author Gihad Nesrallah, MD, associate scientist at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, London, Ontario, Canada, said in a journal news release. "This approach is sure to be preferred by patients, who generally enjoy a better quality of life off dialysis than on it." 

THe spokesman also said that there did not seem to be any downside to delaying the start , assuming that it can be started promptly when required.

Apparently the report authors didn't consider any cost savings in making their guidelines, but did note that there would probably be a substantial saving made.

Previous guidelines placed more emphasis on laboratory tests than on patients' symptoms and recommended starting dialysis at higher eGFR rates for people with diabetes or a decline in nutritional status.

These recommendations were made after analysing 23 studies on  dialysis.

Want to Sell Your Kidney?

We read stories about selling kidneys with a lot of distaste.  Usually some person from a very poor country receives a small amount of money (which might seem like a lot to them), them a middle-man receives a much much larger amount, passing it on to a surgeon (or rather passing on the poor person for surgery) and the surgeon makes an even larger amount for carrying out the operation.

We found several such reports back in 2011, although the links to the news items don't seem to work. but the article is still worth reading.

A recent article in the Wall Street Journal looks at the number of people in the US who are on the waiting list for a new kidney and the number who get one, and asks the question is there a case of a market for organs.

The article is by Gary S. Becker and Julio J. Elias.
Mr. Becker is a Nobel Prize-winning professor of economics at the University of Chicago and a senior fellow at the Hoover Institution.
Mr. Elias is an economics professor at the Universidad del CEMA in Argentina

The article says
"Finding a way to increase the supply of organs would reduce wait times and deaths, and it would greatly ease the suffering that many sick individuals now endure while they hope for a transplant. The most effective change, we believe, would be to provide compensation to people who give their organs—that is, we recommend establishing a market for organs."

Then points out that
"For example, people age 45 to 49 live, on average, eight additional years if they remain on dialysis, but they live an additional 23 years if they get a kidney transplant. That is why in 2012, almost 4,500 persons died while waiting for kidney transplants."

It goes on to compare the cost of dialysis over the average waiting time for a transplant (they say it's $350,000) with the cost of a transplant operation (they say it's $150,000).  Clearly it would be cost effective to pay someone, say $100,000 for a kidney and after adding in the cost of the transplant operation, taking the total up to $250,000, compared to the total for the dialysis and the operation - $500,000.  And of course significantly lengthen the life of the recipient, rather than risk them dying before they ever receive a new kidney.

The paper estimates that you could probably find people willing to sell a kidney for around $15,000 although they think the price could be between $5,000 to $25,000. (For $100,000 you could have mine tomorrow, but not for $25,000. Especially if the cost of dialysis over four or five years is $350,000.)

You can legally sell your kidney in some countries, and the article says that in Iran the price is a mere $4,000 and this has eliminated waiting times. Given the incomes in Iran (one quarter of that in the US), this roughly matches their estimate of what it would cost in the US. They suggest that such a scheme could totally eliminate the kidney shortage, as many people would be willing to sell at that sort of price.

They also suggest payments to people who say their organs can be used when they die (any organ). The payment would then go to their relatives (damn I was just about to check what I could go with that money if only it was paid in advance...)

The article points out that the rich can simply go to another country and deal in the underground illegal kidney market, leaving more kidneys for those who would have to wait their turn.

The article finishes by suggesting that this will happen one day, and then people will wonder why it took so long to become acceptable.

Thought proving, isn't it.  Immoral? To be honest, when a donor is paid a fair amount, rather than exploited, it's not that bad.  It's those from poor backgrounds getting a few $100 that is the immoral bit, especially if the surgeon is counting his/her pay in the tens of thousands.  Would altruistic donors continue to just give? Perhaps.  They can still be generous to help those from a poor background, the ones who currently suffer the most.

And finally, have you tried putting kidney for sale in to Google? !