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
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
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.
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.
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.
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.
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.
Sue Westhead needed a new kidney 43 years ago in 1973. With a transplant her only hope of survival, her mother, Ann Metcalfe, aged 57 at the time, decided to step in and offered one of her kidneys to save her daughter, who reportedly only had one tenth the normal renal function.
Sue is now 68, so the kidney is now 100 years old. And still going strong!
Sue thinks it's all down to good genes - her mother's good genes.
This shows just how long a patient can survive after a transplant. It's not just a few extra years
Wonder if the kidney is going to have a party, or get a telegram from the Queen...
Read about it Here
Well there's a surprize. Strange thing is, it has to be explained to some people.
Dialysis patients who smoke are much less likely to receive a life-saving kidney transplant and much more likely to die sooner according to researchers from the Health Research Institute (HRI) at the University of Limerick and UL’s Graduate Entry Medical School (GEMS).
The findings, which are published in a study appearing online in the journal BMC Nephrology, provide compelling evidence that smoking reduces overall life expectancy of dialysis patients as well as their overall chances of receiving a kidney transplant.
“Dialysis patients have extremely high premature death rates that are between 10- and 100-fold higher than in the general population, and smoking contributes substantially to lower patient survival,” said Professor Stack, senior author of the study, Consultant Nephrologist at University Hospital Limerick and Director of ULs Health Research Institute. “Smoking is a well-known risk factor for death and disability for patients in the general population. Our study, one of the largest ever conducted; found that smokers have alarmingly high rates of premature death. Quite strikingly, the risks of death were far greater in younger men and younger women than in older patients. Equally concerning, dialysis patients who smoked experienced lower rates of kidney transplantation and thus the opportunity to extend survival and quality of life. These risks were considerable in that smokers were between 26% and 50% less likely to receive a kidney transplant taking all other factors into consideration.
You can read more here
A wearable artificial kidney has been successfully tested in the USA in a clinical trial sponsored by the government (ClinicalTrials.gov NCT02280005), offering hope for more comfort and flexibility to kidney failure sufferers so far constrained to hospital-based haemodialysis.
The device, developed by Cedar-Sinai Medical Center researcher Victor Gura, was tested on seven patients in a trial authorised by the US Food and Drug Administration (FDA) and conducted by researchers from the University of Washington.
We've reported on this particular device (and several similar concepts) over the years, but this one is popping up on news sights a bit more. Which means it shows promise of becoming available. We noticed it being mentioned here and here in June this year. It's inventor is Dr. Victor Gura of the Cedars-Sinai Medical Center says the wearable artificial kidney could perform dialysis without patients having to spend hours at dialysis centers.
A detailed report is published here at JCI Insight
The report mentions that the trial was stopped early after some technical problems, but there were no serious complications, and the scientists and doctors involved hope to conduct a follow-trial in a few years time.
A project to develop technology that could improve outcomes for people with kidney disease received a boost, following a £1 million grant.
More than 2.5 million people worldwide have kidney conditions that require their blood to be routinely filtered by a dialysis machine. Most patients undergo a surgical procedure to prepare their veins for coping with the filtration process. This involves a surgeon creating a connection in the arm, called a fistula, between an artery and a vein, which is then connected to a dialysis machine. Although they are the gold standard in medical care, fistulas are unreliable, often blocking up and requiring repeated costly repair operations. In the US alone, $US 4.6 billion is spent annually to treat failing fistulas.
ePATH system is more intuitive and less invasive for patients
Now researchers from Imperial College London are developing the first minimally invasive procedure that uses a synthetic tube, called a stent graft, to form the fistula for dialysis. The team have also developed the prototype technology for inserting the stent graft between a patient’s artery and vein with precision and accuracy.
The device is called an Electronic Percutaneous Anastomosis Technology for Haemodialysis or ePATH. The researchers have received the £1 million funding from the NHS National Institute for Health Research to further develop the system and take it through patient trials.
The device enables a stent to be deployed inside the arm
To read more about this research, read the Imperial College article
Contradictory results have been published about a HPV vaccine, which does well for some patients but is less effective in others.
So what if someone said a vaccine would boost your immune system and help a great deal if you suffered from HVP and cervical cancer was a possibility? Great let me have it is the likeliest response. Unfortunately it's not as helpful if you have already had a transplant.
A recent scientific report says: -
Human papillomavirus (HPV) vaccination stimulates robust and sustained immune responses in girls and young women with chronic kidney disease (CKD) and those on dialysis, but less optimal responses to the vaccine were observed among those with a kidney transplant. The findings, which appear in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), suggest that HPV vaccination provides considerable benefits for kidney disease and dialysis patients but may not be as beneficial for kidney transplant recipients.
Cervical cancer is the second most common cancer in women worldwide and is almost entirely caused by HPV infections. Girls and young women with CKD, as well as those who have developed kidney failure that requires dialysis or a kidney transplant, have compromised immune systems, and as a result they have a significantly elevated risk of developing cervical cancer and genital warts if they become infected with HPV. Therefore, the potential health benefits of HPV vaccination may be substantial in this vulnerable population.
The scientists found that study participants with CKD and those on dialysis had antibody levels above the threshold that indicates protection from infection, but a significant proportion of patients with kidney transplants showed evidence of an inadequate antibody response.
Further work is planned to help the unfortunate patients who have had a transplant and are at risk of HVP
More details are available here