Patients to be offered choice over setting and type of dialysis treatment

This UK news item is interesting.

People being treated with dialysis after kidney failure are to be offered a choice over where and what type of treatment they have.

New recommendations say patients, in discussion with their clinician, can choose which type of dialysis is right for them and where they can have their treatment.

There are three types of dialysis which are offered on the NHS depending on local arrangements and which is right for the patient:

Peritoneal dialysis (PD) takes places at home. It involves pumping dialysis fluid into the space inside your abdomen to draw out waste products from the blood passing through vessels lining the inside of the abdomen.
Haemodialysis (HD) and haemodiafiltration (HDF) can take place at home or in hospital. Both involve diverting blood into an external machine, where it's filtered before being returned to the body.
Previously peritoneal dialysis (PD) was the first choice of dialysis treatment for people with residual renal function and adults without another significant disease or disorder. Children under the age of two will continue to be offered peritoneal dialysis (PD) in the first instance.

After deciding which type of dialysis is right for them, the patient in consultation with their clinician, will decide whether their treatment takes place at home or in hospital. This will also depend on local arrangements.



For our overseas readers, health care for residents in the UK is free, and has been since 1948, and treatment is not decided by your insurance company..

Research aims to prevent kidney failure caused by type 2 diabetes

A grant of $1.75 million spread over four years has been made to study how to prevent kidney damage and, ultimately, failure, caused by type 2 diabetes.

The chief researcher in this project is Dr Krisztian Stadler, who has published 56 research articles which are often quoted in other scientists' work.

"Kidney disease is a major complication of obesity and type 2 diabetes," Dr. Krisztian Stadler said. "Our projects focus on discovering the mechanisms that lead to the death of proximal tubular epithelial cells."

Tubular epithelial cells play a crucial role in kidney function, and the cells require high amounts of a specific type of energy source to work correctly - lipids and fatty acids, Dr. Stadler said. Unfortunately, people with type 2 diabetes have lipid metabolism derailments. Their kidney tubular cells can't properly burn fat or make enough of the molecule adenosine 5'-triphosphate (ATP) to meet the cells' energy needs. Without enough ATP, tubular epithelial cells wither and die.

"Our hope is that by understanding these mechanisms, future interventions can be designed not only to treat but to prevent tubular cell injury and kidney failure," Dr. Stadler said.

You can read the press release here

Peritoneal Dialysis Still Not Used Enough

The two main types of dialysis are Hemodialysis, the original version, where a patient visits a clinic regularly and spends a long time hooked up to a machine and Peritoneal Dialysis which occurs overnight in the patients home, via a catheter inserted into the patient's abdomen. Peritoneal Dialysis is much more convenient for the patient, as it happens while they are asleep and doesn't require regular appointments at a clinic three times a week. So life becomes a bit less restricted for the patient. It's also cheaper.

But a report here points out that only a small percentage of patients use Peritoneal Dialysis! About 9 - 10% of patients in the US. In other countries that emphasize this option, the numbers are a lot higher - as many as 80% of kidney failure patients in Hong Kong are on Peritoneal Dialysis! In the UK the figures vary from region to region, as reported here and can be as high as 30% in adults and 56% in children.

So why so few in the US? It's been suggested that patients are not being advised to take this route and that clinicians claim there is not enough staff available who can train the patient to carry out the procedure at home. Of course, if care is geared towards expensive to set up dialysis clinics, would you expect these centres to recommend a cheaper alternative? Why are more patients not doing a bit of research before committing to Hemodialysis, which requires a lot of reorganising of their life and work? If you have just been diagnosed as needing dialysis or know someone who has, make an effort to check out the various methods available and make your own decision.

Even Medicare is trying to promote home dialysis, as reported here.

Study shows Vitamin D Lowers Infection Risk

Infections are common and can be fatal in patients undergoing long-term dialysis. Recent studies have shown conflicting evidence associating infection with vitamin D status or use of vitamin D and have not been systematically reviewed in this population.

So a group of medical scientists took a detailed look at existing studies and carefully analysed the results.

If a patient has high or normal serum levels of vitamin d and uses vitamin D supplements, there is a lower risk osf infection for patients on long-term dialysis.
A review by  two groups, one at Karolinska Institutet in Stockholm, Sweden and the other at Guangdong Provincial Hospital of Chinese Medicine, of 17 studies came to this conclusion. Also, those with vitamin D deficiency who took supplements reduced their chances of infection by 41%.

You can have a read of the summary here

Kidney Donor Found via Facebook

We all know that some people act as anonymous altruistic kidney donors, and how amazing they are. This news item refers to how one young lady found a donor.

Louise Sach was told she was in kidney failure aged 8 and wouldn't make it through adulthood without a transplant.

Louise Sach, 28, had reached a stalemate in her search for a donor after being told her kidney function was starting to seriously deteriorate last year.

In a last bid to find a match, Louise set up a Facebook page to see if she could attract a donor.

She hoped an old friend or colleague might come forward.

The last thing she expected was a complete stranger to give her the kidney she so badly needed.

Incredibly, that's exactly what happened.

Kayleigh Wakeling, 33, from Hertfordshire stepped forward and now the two are best friends.



You can read the full news item on the Mirror's website.

Kidneys and the Brain

Kidney disease doesn't just affect a patient's body, it's hard on their brain too—but no one really knows to what extent. Scientists at Queens University, Canada, are conducting studies into the kidney-brain connection.

Patients on dialysis are being assessed by the KINARM, a state-of-the-art robotic system developed at Queen’s University, to measure the brain effects of kidney disease. The KINARM precisely measures what’s happening in an individual’s brain or nervous system by testing their ability to perform ordinary movements and tasks.

Leading the research is Dr. Boyd, a critical care doctor and neurologist at Kingston Health Sciences Centre who looks at the links between oxygen levels and brain injury in intensive care patients. He says the project was sparked by a casual conversation with Dr. Rachel Holden, a kidney disease specialist at KHSC whose patients are often in intensive care. “We were talking about sensors for tissue oxygenation in the brain, she suggested that we should use them on her patients,” says Dr. Boyd.

Early indications have been startling, he says. “We’ve been told by the KINARM team that our cohort of patients are some of the most cognitively impaired they’ve ever seen.”  

While there is some evidence showing that kidney disease, especially in its later stages, can affect some brain functions such as attention and memory, the conventional pen-and-paper tests used to track these effects produce variable and subjective results – and they can’t diagnose the motor effects of brain injury, says Dr. Boyd.

The researchers will compare patients’ test scores and oxygenation data to study which procedure – hemodialysis or home dialysis -- has the better effect on patients’ cognitive function.

You can read the full report on the University's website.  

Vitamin K antagonist use and renal function in pre-dialysis patients

A research article, available at Dove Press, discusses whether vitamin K or oral anticoagulants is the best option for patients with only mildly reduced kidney function. Here we quote directly from the article. (Data was collected from 984 patients.)

A post hoc analysis of a recent trial on direct oral anticoagulants versus vitamin K antagonists showed that amongst patients with mildly decreased kidney function, use of vitamin K antagonists was associated with a greater decline in renal function than use of direct oral anticoagulants. Whether these vitamin K antagonist effects are the same in pre-dialysis patients is unknown. Therefore, the aim of this study was to investigate the association between vitamin K antagonist use and the rate of renal function decline and time until start of dialysis in incident pre-dialysis patients.

Conclusion: In incident pre-dialysis patients, the use of vitamin K antagonists was not associated with an accelerated kidney function decline or an earlier start of dialysis compared to non-use. The lack of knowledge on the indication for vitamin K antagonist use could lead to confounding by indication.

New Microsensor Enables Kidney Dialysis to be Customized to the Patient's Needs

It's nice to have the personal touch when having dialysis. Having your doctor or nurse set things up to better match your needs. But new research goes a step further than that.

Researchers from TU Eindhoven have developed a microsensor that makes it possible to directly monitor and adjust the composition of kidney dialysis fluid. This is a crucial step towards patient-specific dialysis, which will remove a significant proportion of the serious side effects of the use of standard dialysis fluid. And on 29 March 2018, Manoj Kumar Sharma will be awarded a PhD for his research on this sensor.

The number of patients worldwide on dialysis is quite astonishing - 2 million people are being treated just now.

Salts and impurities in the blood are removed via the dialysate fluid, passing through a membrane into the fluid. The rate of flow is dependant on the concentration difference between the blood and the dialysate. And the concentration in the blood varies from patient to patient. It doesn't help that the dialysate is supplied at a standard concentration, not tailored to each patient (and the patient's needs would be different at each session. There are side effects if the mismatch in concentrations is too high or too low.

It would be better to continuously adjust the concentrations of salts in the dialysate so that they are optimal for the patient. This, however, requires that the concentrations of salts in the dialysate can be monitored live, but there has not been a reliable technique to do this so far.

But now things are changing for the better.

PH D student Manoj Kumar Sharma has devised an ingenious solution for this. He developed a micro-system with a centrally positioned microchannel through which dialysate flows. He covered the walls of the microchannel with sensor molecules, which are only fluorescent in the presence of a salt, such as sodium. The more sodium there is in the dialysate, the stronger the fluorescence. To reinforce this effect, he introduced micropillars into the microchannel, resulting in even more surface covered with sensor molecules.

A laser light shines on the microchannel and activates the fluorescence of the sensor molecules. Sharma captures this fluorescence using glass fibres that he connected to the channel in the micro-system. The light passes through the fibres to a spectrometer for analysis. The laser light, which is of a different wavelength, is first filtered out. Then, based on the measured intensity of the fluorescence, the sodium concentrations can be read out.

If the sensors and monitoring system can be mass produced and used on a large scale, built into dialysis machines, one day each patient will receive during their dialysis session a customised dialysate to match their needs, the concentration changing to suit the current state of their blood.


Visit the University website to read the full article on this exciting development.

Second Transplant with a Difference

Some patients receive a kidney transplant and get along okay after that. Some are unlucky and need a second kidney transplant years later - a worrying situation when they may have struggled for years to find a suitable doner the first time.

But some kidneys are special.

And the one that Vertis Boyce received was very special indeed. The kidney was first transplanted two years ago from a 17-year-old girl into a man in his early 20s, who had just unexpectedly died in a car accident. Boyce would be its second recipient.

Boyce had by then been on dialysis for nine-and-a-half years and on the transplant list for nearly as long. Waiting for the right organ to become available. And at 69, wondering if she would ever get her chance.

For her surgeon, Jeffrey Veale, it was special too, it was only the second time he had re-used a transplanted kidney - since then he has carried out a third such transplant. THREE very special kidneys.

You can read about these special organs here.

Just how often could a kidney be transplanted? Scar tissue from several operations may cause problems, as happened in this case. But could a kidney be re-used three times? Four times? Live on for many, many decades each time?

Well, you might want to read this news item that we reported on back in August 2016 - the 100-year-old kidney!

Everything You Need To Know About Being A Live Kidney Donor

It's not normal for a blog like this to post a link to a womans/fashion magazine, but today, that's exactly what I am doing. Yes, seriously.

The article in this week's Elle looks into how singer Selena Gomez received a kidney from best friend Francia Raisa. It takes a clear plain language approach to discussing a variety of things about kidney failure and what's involved in being a live donor.

I feel we should thank them for opening up the topic such wide audience of people.

So have a read of Elle's article (I'm linking to the UK edition, it might also be in the editions for other countries, I'm not fully up to date on my  fashion magazines...)

To quote from the article:
"There is a common misconception, among people who have not had a lot of experience with kidney disease, that cadaver donation is the only pathway back to health.

Living donation isn't widely discussed in the mainstream enough for people to truly understand the ins and outs of giving someone a kidney while you're still living and breathing.

But, in fact, live kidney donation is a lot more common than you likely know, with about a third of all kidney transplants carried out in the UK coming from living donors. And you don't have to be a family member to offer someone an organ - plenty of kidney donations come from friends or non-directed altruistic kidney donations (anonymously)."

Kidneys Infected with Hepatitis C Safe for Dialysis Patients

Researchers at Johns Hopkins report their use of a drug that cures the infection, leaving the kidneys suitable for use by dialysis patients desperate for a transplant.

They carried out a small study (only ten very sick patients were involved), where patients were given a transplant with an infected kidney, then treated with a drug prevents hepatitis C from replicating in the body. In each test, the patient had been waiting for quite some time for a donor but no suitable living donor was available. This was a very risky experiment for these patients. But it was worth it - all 10 patients were found to be clear of the virus after their 12-week course of medication using Zepatier, donated by Merck which funded the study, was complete.

Normally kidneys infected with hepatitis would be rejected as an option for transplants. Will this research doesn't mean there will be a flood of new potential donors, it will increase the pool of available organs, and should enable more transplants to take place.

You can read more about this in the research article here from the Johns Hopkins researchers, and also in an earlier report here, and on NBC NEWS, which includes an interview with one of the team.

There are several other articles on this type of treatment if you just google on  "hepatitis c kidneys used in transplants".

Patient Voices - Hear Real People's Experiences

Ever wondered what it's like for people on dialysis or with impending renal failure? Well, the New York Times wondered as well, and produced this article to let you hear how it's been for real people, how it's affected their lives.

Patient Voices: Kidney Disease.

Usually all we read are the words of medicals and experts, researchers and drug companies. But this set of comentaries is from the patients themselves. There's some text, and an audio track with each individual patient's story. With nearly 30 million people in the United States alone affected by chronic kidney disease, this is of importance to a very large number of people.

It's an article from several years ago, but it's as relevant today as when it was first put on line.

Air Pollution Linked to Kidney Disease

Air pollution is well known to be a health hazard, hence the drive in many countries to switch to lead free petrol and improve the way deisel engines work to reduce dangerous exhaust fumes. And of course fuel efficient cars giving higher miles per gallon means less fuel being burnt, which automatically reduces your car's contribution to pollution. So don't drive around in large engined gas guzzlers!

And, unfortunately, now we can add kidney disease to the problems caused by pollution.

A recent article published in the Journal of the American Society of Neprology followed 2,482,737 veterans for an average of 8 and a half years (so quite a big long-term study, which increases the accuracy of the results).

Combining data from NASA and the Environmental Protection Agency, their detailed analyses showed a linear relationship between PM2.5 (a class of partical size) concentrations and risk of kidney outcomes. Exposure estimates derived from National Aeronautics and Space Administration satellite data yielded consistent results. Our findings demonstrate a significant association between exposure to PM2.5 and risk of incident CKD, eGFR decline, and ESRD.

Experimental laboratory evidence suggests that exposure to deep exhaust particles leads to disturbances in renal hemodynamics, promotes oxidative stress, inflammation, and DNA damage in renal tissue, exacerbates AKI, and further promulgates chronic renal injury in murine models. And now they've shown the risk to humans is just as real. They calculated that pollution was resulting in an annual increase of 44,793 cases of CKD, with 2,438 cases requring dialysis.

It's great to see the work of NASA and the Environmental Protection Agency being put to such good use, to increase public awareness of the health risks of airborne pollution.