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.

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.

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.