New Dialysis Unit in Leicester, UK

 If you live in roughly the middle of England, this news is for you!

A new unit has opened at Genisis Park , South Wigston, and it's called Leicester South Dialysis Unit. It's job is to replace the facility at Leicester General Hospital.

It opened on 26th August, 2024.And has all the features you'd expect for such a unit, including a section where patients can be trained in home dialysis. Bonus!

So you are probably thinking this is an expansion of a hospital or an existing small facility, but you'd be wrong. It was, of course, a warehouse! Planning permission was granted in November 2022, and it is now run by University Hospitals of Leicester (UHL). Currently, UHL manages eleven dialysis centres, caring for around 1000 people.

A few more details can be found in the links below.

Link 1: https://www.leicestermercury.co.uk/news/local-news/warehouse-south-wigston-converted-kidney-8743114

Link 2:  https://www.bbc.co.uk/news/articles/cy4y187lqd5o

 

Mother Receives New Kidney From Daughter

When her mother needed a new kidney, her daughter stepped in and and got tested for compatability.

Now when you give someone you love a new kidney, you'd like the date to be memorable, and easy to remember as well. So when Dishna Hirani was offered two dates for the operation to donate to her mother, it was easy to choose which date to use. Because one of them was her mother's birthday. So Prevanda Varshani received quite a wonderful present from her daughter!

Apart from a few complications, overall the operation was a success.

Living donors are apparently not too common in the Asian community, and her mother was initially a bit hesitant about it. Perhaps this successful operation will encourage more people to do the same. A donation like this is not against the family's religion (they are Hindus) but it seems many are not aware of this option. They hope that more people of Asian, and African, heritage will consider the option of living kidney donation. And also sign up to donate organs if they die in an accident.

Recipient of first pig kidney transplant dies

It has been a hope for a long time that transplants of organs from animals to humans would one day be possible and help solve the problem of finding a donor that matched the recipient.

And Massachusetts General Hospital in Boston announced the world's first successful transplantation of a genetically modified pig kidney into a 62 year old man with end stage kidney disease, in March 2024.

Richard Slayman was recovering well from the four hour operation and was expected to be discharged soon, reported the hospital after this new milestone in kidney transplants. This raises hopes that more work can be done to genetically modify kidneys and other organs from pigs for humans.

Richard left hospital in April. Hopes were high for a successful outcome of this major event in the world of transplanted organs.

However, on May 11th, it was sadly announced that Richard had died after two months with his new kidney. We should not take this as a major setback - Louis Washkansky, the first person to received a heart transplant, died after 18 days, due to pneumonia as his immune system was weakened by the drugs administered to avoid rejection.

Let's hope that further research will lead to this concept becoming successful and save lives regularly, just as has happened with heart transplants. Remember, the first successful kidney transplant was back in 1954 and look at how common they (and heart transplants) are now.

Wife donates Kidney to Husband!

 Well, this man certainly made the right choice when he proposed to his partner 25 years ago!

Donna Creed gave her kidney to her husband Darren who was suffering from polycystic kidney disease. When his medical problems got worse over the 12 years since being diagnosed, he was advised to look for a donor and started with family members. But amazingly, it was his wife who turned out to be a match. Doctors told them it was a one in 22 million chance that they were a match!!!

What an amazing gift she gave him. Love does help a bit when deciding should you be a living donor or hope for the more common donation from a generous person who has sadly died.

You can read more about this story on the BBC News website. The couple are planning a charity event in September to raise money for the PKD (Polycystic Kidney Disease) charity.

Footballer player's fund donates £250,000 to Kidney Charity

 While on holiday, famous England footballer Andy Cole was infected with a virus that attacked his kidneys. In 2015 this superb athlete suffered kidney failure and his life was at risk. In 2017 he received a transplant kidney from his nephew. This set of life-changing events inspired him to set up a fund and to donate £250,000 to charity to further research into kidney disease and associated problems, including mental health issues.

You can read about his story here at Kidney Research UK and also in the Manchester News .

The story highlights how even a super fit athlete can have major problems - similar to what happened to Jonah Lomu who's story is also featured in this blog and here as well. 

Older patients found to do better with long dialysis sesions

At first glance most people would say they would prefer short dialysis treatment sessions. But a recent research paper says that for older people, a longer session increases how long they will survive with the disease.

This was a retrospective cohort study of people who first commenced thrice-weekly haemodialysis aged ≥65 years, reported to the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry from 2005 to 2015, included from 90 days after dialysis start. The primary outcome was all-cause mortality. Cox regression analysis was performed with haemodialysis session duration the exposure of interest.

They found that longer dialysis hours per session was associated with a decreased risk of death - and for people over the age of 65, that is a good result.

You can read the abstract online here https://pubmed.ncbi.nlm.nih.gov/36401820/   There are some mathematical statements about how the study was assessed, but the important thing is the work says longer individual sessions are better for older patients.

NICE Recommends three treatments for Covid-19

A direct quote from the source article

People at highest risk of developing severe disease include those who are immunosuppressed (for example, as a result of chemotherapy or having had an organ transplant), or who have other conditions such as heart disease, respiratory disease, diabetes, or neurological conditions.

The draft guidance means  they will have access to treatments taken either at home or in hospital. It recommends 3 medicines as options for treating COVID-19 in adults:

Paxlovid (also called nirmatrelvir plus ritonavir and made by Pfizer);

Xevudy (also called sotrovimab and made by GlaxoSmithKline); and

RoActemra (also called tocilizumab and made by Roche).

As people with kidney problems looking for a transplant may have a reduced immunity and are therefore more likely to catch COVID-19, it's nice to know that NICE is looking into safer treatments.

Covid-19 and Kidney Damage

 In a worrying report, research shows that Covid-19 can lead to kidney damage. 

Covid-19 has been studied a great deal during the pandemic and researchers are finding evidence that it cause a whole host of problems, including acute renal failure. Research reported here gives you the technical details - for those with the deep medical knowledge, angiotensin-converting enzyme 2 (ACE2) has been implicated in the pathogenesis of chronic kidney disease (CKD) and is a membrane receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease (COVID-19).

As with al things Covid-19, the more research done and the longer the period over which it is investigated, the more knowledge will be available. This article summarises some of the things found so far.

Some worrying things to consider are that it looks like 81% of patients in intensive care with Covid-19 developed Acute Kideny Injury, with the virus more likely to target the kidneys than other parts of the body. And age seems to be a factor as well, with those over 60 being twice as likely to have problems as those under 60. In fact many of the factors that affect the severity of Covid-19 are similar in those who get Acute Kidney Injury.

Get on Your Bike!

A recent news report (April 2021) claims that cycling during dialysis could dramatically improve the heart health of patients with kindey failure, and lead to significant savings for the UK's NHS.

Yes, cycling DURING dialysis. Okay, on a specially adapted bicycle during regular dialysis sessions. Not going out on the road with a dialysis machine strapped to your back!

The research was carried out by the University of Leicester, supported by the charity Kideny Research UK and the Natioanl institute for Health Research Leicester.

The heart suffers long-term effects when you are on dialysis, and the hope was that regular exercise would reduce the problem. And after six months of using the bicycle for 30 minutes during their dialysis sessions, investigations revealed  several improvments in the patients. This sounds like a cheap way to improve a patient's health and thus reduce the need for treatment for heart problems assiciated with dialysis. It's based on the well-known fact that regular exercise will improve your health, so why not do some excerise while hooked up to your dialysis machine.? After all the time spent travelling to a centre, sitting around doing nothing but reading a book while connected to your machine, then travelling home means you have spent a very inactive day. cycling like this makes you healthier, reduces problems and saves money. What more could you want?

You can read the whole article here.

AI powered tool hailed as major diagnostic advance

The analysis tool, called KidneyIntelX has been developed by RenalytixAI and is expected to be launched in the middle of this year. It is described as a major break-through in this news article. It should help decide what treatment is best for a patient and whether they need medicine, dialysis or a transplant.

So how does this sort of tool work?

It's basically similar to those telephone systems where you get asked a series of questions on what help you want when calling a support helpline, with the answer you give defining what the next group of questions should be. This is how a doctor decides what is wrong with you, or how a research chemist analyses an unknown chemical by starting with a few standard tests, then choosing the next tests to use based on the results of the first texts. Eventually, the doctor or chemist reaches a conclusion, assuming they remember what the next step is after each preliminary test.

But it includes a few extra twists after that.

Initially, doctors give the software the important questions to ask and say what the answers mean, and what questions to ask next. The creators of the tool then fed into the system the medical records and answers given to questions for literally 3 million patient health records. Then the AI system kicks in and looks for common features that might not spring to mind as being related to the problem being studied. The more real cases the AI code (called a neural network) examines, the more likely the system is to spot the important trends such as do your symptoms match those of patients diagnosed as in need of dialysis by their doctor. Or the bit that humans struggle with, is there some common factor in your earlier medical history that hints about the likely outcome? Your medical history and the outcome of the treatment will be added to the system over time. as well.

This is described as the AI system learning how to diagnose and predict the best outcome. It's not got a mind of its own, it is looking for common factors between patients and what the result of certain treatments was, based on, as mentioned earlier, millions of medical records. It does also need a lot of records where the patient didn't have a kidney problem, to avoid false positives. And contrary to popular views on these systems, it does not decide what will happen to you, it advises the doctor on what to do, and the doctor makes the final decision.

It could take a doctor quite some time to read through your medical record, and to spot changes over time. But humans can miss these odd clues occasionally. This sort of software can do this very quickly and is usually very good at spotting the smaller important clues in amongst your entire medical history. So the doctor is presented with the most important data very quickly and can come to a more accurate conclusion. Freeing up more time, leading to more patients getting the treatment they need.

It's not some power-mad living machine trying to rule your life. The cyborgs from Terminator are not making the decisions. ;)

American Kidney Fund Helping People

There were a lot of people getting transplants in America in 2019. Over 24,000 in fact. And not everyone has insurance or funds to cover a transplant. But then there's the American Kidney Fund...

According to this article from Yahoo! the AKF gave grants to 1,400 people to receive kidney transplants and post-transplant care. More than 60% of the people receiving these grants were from racial and ethnic minority groups, who in general have fewer transplants than white Americans. Yet this group are more likely to need a transplant as more have kidney failure! So without these grants, many people would become financially broken and never receive a transplant.

AKF is also fully supporting the objective of finding living kidney donors.

You can find out more about the American Kidney Fund at their website.

Similar Survival Rates Found for Different Dialysis Modes

Is one form of dialysis better than another? Should you always opt for one particular type of dialysis?
This is something every patient wonders about when told they will have to have dialysis. The trouble is when you are first told you need dialysis, you probably have not considered the options until that very moment. And you wonder if you might make the wrong choice.

A recent bit of research looked at 17 other studies of the possible problem and by pooling all the results - 113,578 patients' results over a 21 year period - came to the conclusion that there is no significant difference in the mortality rate between peritoneal dialysis (PD) and in-centre hemodialysis (HD). This could affect the initial counselling of new patients in the run-up to getting dialysis. The research showed that life expectancy was virtually the same for both the therapies.

As PD is a more cost-effective option and helps preserve a normal lifestyle, they concluded that PD should be encouraged. Many people worry that "home treatment" via PD might be riskier than HD, but this appears not to be the case.

Do hemodialysis patients need a blood test every month?

Recent research suggests not necessarily.

 Routine monthly blood testing for prevalent patients on hemodialysis (HD) is not associated with a lower risk of death, hyperkalemia, cardiovascular (CV) events, or hospitalization compared with blood testing every 6 weeks, according to a new study.

Among incident patients on HD, monthly testing was associated with an increased risk of hyperkalemia, CV events, and hospitalization compared with testing every 6 weeks.

However, the optimum time interval between tests couldn't really be determined from the research, published  in the article by Thomas A, Silver SA, Perl J, et al. The frequency of routine blood sampling and patient outcomes among maintenance hemodialysis patients [published online November 12, 2019]. Am J Kidney Dis. doi: 10.1053/j.ajkd.2019.08.016, available here 

Are patients at for-profit dialysis centers getting less transplants

I have just read a somewhat worrying (and slightly predictable) article.

A report this month says that in the US, patients attending for-profit dialysis centers are less likely to get a transplant than those at nonprofit centers! This is based on a study examining nearly 1,500,000 dialysis patients over a 17 year period. So it's got a fair bit of data behind it. The link at the start of the paragraph is to the abstract (summary) of the research, but there is a bit more detail in the Reuters news report.

A transplant in the long run is cheaper than receiving dialysis for life, but according to one of the authors, Rachel Patzer from Emory University School of Medicine, “The current system has no financial incentive for dialysis providers to educate, to spend time with and to refer patients for transplant.”

Patients at for-profit facilities were 64% less likely to get on a transplant waiting list, 56% less likely to get a transplant from a deceased donor and 48% less likely to receive a kidney transplant from a living donor.

So if you are on dialysis at a for-profit treatment center, ASK about transplant options, don't just sit there assuming that dialysis is your only option.

Wearable Dialysis Devices

We have reported on this several times in the past, and now some such devices have been validated by a contest award. But when will we see them in production and in regular use?

The contest had 16 concepts submitted. The winners are invited to develop their ideas into prototypes and to compete in the second phase of the competition, in which up to three winners will be awarded $500,000 each next year.

Let's wait and see what happens after the winners get the funding boost.

Plans for Mobile Kidney Dialysis Unit in Scottish Highlands

The population in the Scottish Highlands is spread over a large area of the country. Giving every local hospital a dialysis unit could be an expensive solution to treat a small number of people each week. So crisis-hit NHS Highland is planning to introduce a mobile kidney dialysis unit across the region to save patients from having to travel hundreds of miles a week to Inverness for treatment. This could help with its cash flow problems and a big financial black hole.

This will only help a small number of patients, but reduce costs and the inconvenience these patients face due to the long distances they have to travel and easy family life problems.

You can read about this news here.

Diabetes Drug May Prevent or Slow Kidney Disease

Recent research reports that a drug normally used to control blood sugar levels in diabetics helps to prevent or slow down kidney disease.

The new study tested Invokana, a daily pill sold now to help control blood sugar, to see if it also could help prevent kidney disease when added to standard treatments.

For the study, about 13,000 people with Type 2 diabetes and chronic kidney disease from around the world were to be given Invokana or dummy pills. Independent monitors stopped the study early, after 4,400 people had been treated for about 2.5 years on average, when it was clear the drug was helping.

Those on the drug had a 30% lower risk of one of these problems — kidney failure, need for dialysis, need for a kidney transplant, death from kidney- or heart-related causes, or other signs that kidneys were failing.

For every 1,000 people taking the drug for 2.5 years, there would be 47 fewer cases of one of these problems, researchers estimate.

This seems a pretty important result and could help a large number of people.

You can read the story here, from April 2019. And the report from the manufacturers is also available.

However, we came across other reports that paint a worrying problem.

The Food and Drug Administration issued safety warnings about Invokana, which may increase the risk of severe urinary tract infection and diabetic ketoacidosis leading to kidney failure. There's a report on that here

Patients can also have problems with increased risk of bone fractures which could lead to foot or leg amputations in a small number of cases.

These are not reported as regular events from taking the drug, they affect a small number of patients, so while a bit disturbing, it doesn't mean those taking the drug should stop - drug companies have to mention almost every report of a problem encountered.

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.