Saturday, 18 December 2010
A Reuters article reported the following news, on 17 December 2010.
Baxter has recalled the following products, due to the potential presence of endotoxins - Dianeal, Extraneal and Nutrineal. According to a spokesperson of the European Medicines Agency "Although the number of batches affected is likely to be low, the agency's Committee for Medicinal Products for Human Use has concluded that current stocks should be replaced, because it is not possible to identify which bags are affected."
There is a risk that patients who receive solutions containing endotoxins may develop aseptic peritonitis. The toxins are thought to have been caused by bateria settling on microscopic cracks in two tanks used in the production of these solutions, at their Irish factory in Castlebar.
Friday, 3 December 2010
The article covers a cost comparison study looking at patients who started on dialysis between January 1st 2004 and December 31st 2006. It examined 463 patients, and paired up those on peritoneal dialysis with those in equivalent health on hemodialysis - it's important is such studies to match equivalent patients, to remove other variables from any differences found.
Because in the United States most dialysis patients have their costs paid by the Medicare ESRD system, there was a lot of data available for analysis by the researchers, who examined the use and cost of healthcare services during a 12-month period.
On a per-patient basis, those initiating dialysis with HD averaged 20 more outpatient visits over 12 months compared with matched patients in the PD group. The HD patients also had nominally more ED visits (mean [95% CI], 3.3 [2.1-5.0] vs 2.3 [1.3-3.5] for PD; P = .28). Over the 12-month period of follow-up, more HD patients were hospitalized (80% vs 50% for PD, P <.01).
The median (IQR) total per-patient healthcare costs were $43,510 higher among HD patients than among PD patients over 12 months ($173,507 [$98,706-$335,719] vs $129,997 [$73,212-$207,578], P = .03). Many of the cost differences between hemodialysis patients and peritoneal dialysis patients were quite spectacular. Such as the median (IQR) per-patient inpatient costs were $39,851 ($6089-$140,125) for HD patients versus $651 ($0-$40,591) for PD patients (P <.01). Read that again. You didn't imagine it. Read it again!
So given these costs, you might wonder a bit about the following statistic:
PD was the initial dialysis modality for only about 12% of patients in the study. In prior research, 7% to 27% of patients with ESRD in the United States have been reported to initiate dialysis with PD.
And yet peritoneal dialysis is significantly less expensive! And PD patients are much less likely to be hospitalised.
It makes you wonder if someone is suggesting to doctors that hemodialysis is a better choice, perhaps encouraging them to send patients to an HD clinic.
Wednesday, 17 November 2010
Among other things, your kidneys help control blood pressure, and a new medical procedure aims to knock out this control system, to lower your blood pressure substantially.
I just saw this reported on the BBC News tonight, but you can also read about it in Lancet, the world famous medical journal.
The research, by Australian medical scientists, selectively severs nerves to the kidney that have an vital role in controlling blood pressure. This is done via a catheter inserted into the groin which feeds a thin wire up next to the nerves in question. The wire is given a short burst of radio waves and the energy knocks out some of the nerves in the arteries of the kidneys. So they no longer signal to raise blood pressure.
The technique is suggested as useful where patients have trouble remembering to take normal blood pressure controlling medication, or where the medication has little effect, and it proved to be very successful as six months after treatment, 84% of those treated had a lower blood pressure. Okay, not a back to normal blood pressure, but a better level than before treatment anyway, thus lowering their risk of future strokes and heart attacks.
Friday, 12 November 2010
To quote from the report
"Nearly 40 years after Congress created a unique entitlement for patients with kidney failure, U.S. death rates and per-patient costs are among the world's highest while the biggest for-profit providers flourish."
ProPublica examined thousands of clinic inspection reports and interviewed many patients and others involved in dialysis, and came to a shocking conclusion - at clinics all over America, it is quite common for patients to receive their live-giving treatment in unsanitary conditions, where lapses in the quality of care can endanger their life. In a health care clinic!
The report describes some pretty scary events that have occurred, including some which have lead to the patient's death, and claims that medical care supervision is minimal in some clinics. That care is often administered by young under-qualified technicians. That staff to patient ratios are not prescribed by the authorities. That some clinics (note that it says some, not most) are run like a factory systems, with technicians stretched to their limits by monitoring too many patients simultaneously.
According to the report, the clinic inspections that they examined revealed that almost half of those checked were described as filthy or unsafe, and many exposed patients to hepatitis, staph, tuberculosis and HIV. Prescription errors were common.
And remember, in America, Medicare funds these clinics, and running clinics is big business. According to the report, the government's payment policies for dialysis have created financial incentives that, in some ways, have worked against better patient care, while enabling for-profit corporations to dominate the business.
But if you come from a poor background in the US and have kidney failure, where can you go for treatment? To a Medicare funded clinic. It's highly unlikely that the less well-off will get private care for their dialysis.
Italy has one of the lowest mortality rates for dialysis care -- about one in nine patients dies each year, compared with one in five in the US! And yet Italy spends about one third less on patients than the Medicare system, according to the report.
Italy has doctors and nurses present at all stages of treatment, not technicians whose general medical knowledge will, by definition, be more limited. Fistulas are used in preference to catheters - catheters can be used immediately they are inserted, but are more prone to infection and clotting than fistulas, which must be allowed to "settle in" before being used.
Overall the report paints a pretty poor picture of health care at some clinics, and advocates reform in the way dialysis patients are treated. The obvious answers include (but are not limited to) having better staffing ratios, with doctors and nurses present to check patients, not just technicians.
It's not as if there's much of a choice in having dialysis or saying no thanks, not today.
You just don't expect to be at risk by saying yes to treatment!
Friday, 5 November 2010
The number of people with diabetes going on to treatment for end stage renal disease in the US has dropped, according to a study reported on MedPageToday. It has fallen by a massive 35% between 1996 and 2007. But before you get excited, the question is why has it fallen?
Well, apparently the number of people with diabetes is increasing in the US, increasing a great deal in fact. So overall the actual number of diabetics who are on ESRD treatment has increased.
It is not really clear why the rate at which diabetics are moving on to dialysis has dropped - diabetes is still the single biggest cause of ESRD.
Does it mean more people have had undiagnosed diabetes and as medical techniques improve, many more cases have been reported, pushing up the apparent number of diabetics, while the number who need dialysis has only increased a little bit (presumably they'd be the worst cases, unlikely to go unrecognised)?
Further research is needed to settle this.
Wednesday, 20 October 2010
It seems that while the FDA acknowledges the possibility of risks being associated with the drug, they feel it can be used in kidney patients who are not yet on dialysis, and that more work needs to be done on the possible problem. The panel which recommended this is now looking into what the recommended dose should be.
With anemia a common side effect in kidney disease sufferers, some drugs such as Aranesp are used to boost production of hemoglobin.
Tuesday, 12 October 2010
If you regularly browse medical news sites, you may have seen this reported in the last few days.
The full warning notice can be viewed at the FDA website. It lists five points that they want corrected within 15 working days.
This is not the first warning that the FDA has issued to Fresenius - there were complaints about their Phoslo gelcaps product three times in the last 18 months.
Thursday, 23 September 2010
PKD is a common fatal inherited disease, and at the present moment there is no treatment available for it. Eventually it leads to loss of kidney function, and eventually dialysis or a transplant becomes necessary.
By inhibiting a receptor called c-Met, the drug lead to less cyst formation. It was tested by giving the compound to pregnant mice and examining their embryos.
The next stage to continue the research, trying adult mice, other animal models and eventually, check the drug's usefulness in humans. With all drug research, this will be a long and careful process to avoid any side effects.
The research article can be read at The Journal of Clinical Investigation. It's a very technical article, as you'd expect for a research paper.
Thursday, 9 September 2010
A filtering membrane will be produced using the same silicon fabrication technology as used in the computer industry to create the fine details of computer chips, allowing very small holes to be created for the filtration process.
Specially engineered compartments, called a BioCartridge, will be created to hold the patient's own kidney cells. This 'bioreactor' part of the device will be grown on the matrix that acts as the filter.
Mr Bole said: 'Those cells will perform the other functions of the original kidney cells, such as regulating vitamin D levels, water levels and metabolic function. So patients would NOT need immunosuppressant drugs because the device will use each patient’s own cells.'
We hear of wearable dialysis machines at regular intervals (our February 2010 post on this topic), but this device could be one step beyond that, and reduce the problems of finding suitable donors for transplants (although we have also posted on methods which allow transplants where the donor is not a close match for the recipient).
Friday, 20 August 2010
Recent research on a large number of dialysis patients shows that most have not taken any measures to safeguard themselves if some sort of disaster occurs (or even thought about it for that matter).
How would you handle an emergency evacuation? In August 2005 Hurricane Katrina threated and then wrecked havoc on a huge number of people. Including more than 5,800 Gulf Coast kidney dialysis patients. Dialysis centres were forced to close. Within a month 148 of these patients had died.
Okay, so you don't live in an area threatened by hurricanes, or tornadoes or earthquakes. What about floods? Even a "small" flood can be a disaster and cut off small villages or towns from the rest of the area. Just this week there was an intense rain storm where I was staying, and the downpour stretched the sewer system to its limits, with some drains overflowing due to the mass of water from nearby areas. It wasn't a disaster by any standards. But if it had been a bit bigger and more wide spread, roads could have become impassible. So how would you get to your dialysis clinic if the roads were flooded? There's a road in the valley I live in that is regularly flooded in bad storms. But I know another couple of roads that are not.
What about fire? Could that make some roads unusable? Of course it could, and it doesn't take a forest fire to do this either! A factory fire could prevent many people using their usual routes around town, and result in other roads being jammed with cars. A train crash could do the same thing.
On an even simpler level - what if your car breaks down - do you have a back-up vehicle available? Perhaps you have arranged with a friend to cover this eventuality, but can they come to you at short notice?
From the above research report:-
"End stage kidney disease patients are dependent on medical treatment at regular intervals for their ongoing health, and, as such, are particularly vulnerable to the effects of a disaster. We found that patients on dialysis are largely unprepared for such an event, whether they are forced to stay in their homes or evacuate," said Mark Foster, lead author of the study.Foster, a UNC medical student, presented the results June 3 at the annual meeting of the Society for Academic Emergency Medicine in Phoenix.
So, plan ahead. Have alternative routes to hand, alternative transport readily available. If you are on home dialysis and the local area has some disaster strike, have a plan to get you and your equipment out? Have something in place in case there is an electricity cut. Yes, something as simple and common as that has to be considered as well.
If you live where a natural disaster such as floods can occur, have you enough supplies to keep you going? I don't have all the answers, but it's certainly something you must think about.
Because according to the research done 5 years after Katrina struck, most dialysis patients in that same area are still not prepared for trouble.
I teach people to fly gliders. Before every single take-off we calmly consider everything that might lead to a bad launch and work out what our options are, to reduce the stress. Now it's your turn to do the same.
Tuesday, 27 July 2010
It looks like the usual, infamous, postcode lottery effect once again. Treatment doesn't depend on your health but your address.
Thursday, 15 July 2010
The type and intensity of treatment older Americans receive for kidney failure depends on the region where they receive care rather than on evidence-based practice guidelines and patient preferences, according to a study to be published in the July 14 Journal of the American Medical Association.
There are pronounced regional differences in treatment practices for older adults with kidney failure, including decisions about starting or stopping dialysis, that don't seem to be explained by differences in patient characteristics, said Manjula Kurella Tamura, MD, senior author of the study and assistant professor of nephrology at the Stanford University School of Medicine.
The report says that many important decisions are more likely to be influenced by where you live rather than the patient's actual needs.
In the UK they call this sort of thing "postcode lottery", and it affects all sorts of health care problems. People have been known to move house, just to get treatment.
The researchers found another, rather unexpected, result. Some areas spend much more on health care and have a higher density of nephrologists — physicians specializing in kidney disease. But despite this, patients with kidney failure in these areas were less likely to have seen a nephrologist before starting dialysis! And more amazingly, patients in the higher spending areas didn't actually fair any better than those in the other areas.
You might want to read the news alert as it does seem a strange set of results.
In my opinion, it's almost as if the specialists move to the areas that spend most, but don't necessarily give value for money treatment.
Tuesday, 15 June 2010
She has a page on Facebook, just like 300 million others do (including me ;) ) asking anyone with blood type O to go have a test and help her. It's called, unsurprizingly, Find a Kidney for Melissa Foster. She's tried lots of different ways to attract attention to her dilemma, including a bike ride that got some newspaper publicity and a blog - http://www.kidney4mel.com/
The Facebook page was created in mid May, and is proving popular, with many people linking to it as a friend. If someone links to the site as a friend using their Facebook page, then soon literally millions of people will know about her problem and perhaps a donor will come forward. At the present moment there are 808 people saying they like the page. If each one has 100 friends who each view it and one in ten then mentions it on their page, and each of these have 100 friends, well when you multiply the numbers together, you get a staggering number of people involved.
Melissa began having problems with her kidneys when she was 16 after a urinary tract infection backed up to her kidneys, causing them to fail. She started dialysis treatments at 16 and received her transplant when she was 25.
Now obviously this way of attracting attention might not work for everyone, and of course if hundreds of patients tried this, soon the web would be flooded with "find me a donor" pages, and perhaps others would just switch off to responding. It happens with major disasters, people become so saturated with seeing an appeal for help their brain filters it out. But it might just work - her blog includes a video by another renal failure patient who found a kidney donor via Twitter and Facebook.
So I tried entering "kidney donor found twitter" into Google, and then replaced twitter with facebook. Try it yourself - you'll be amazed with the results. Go on, read some wonderful stories about realy generous people coming forward.
Wednesday, 2 June 2010
When I broke my back while at university, the Uni generously allowed me more time for each exam, to help with the pain from sitting in one position for several hours, so it is always worth enquiring is help is available.
Wednesday, 12 May 2010
Yes, I was somewhat surprised when I saw this reported as well!
Research published in the American Journal of Kidney Diseases reports that the spouses (partners) of patients on dialysis are likely to suffer from chronic kidney disease themselves, and are advised to be tested.
The research looked at 196 first- and second-degree relatives and 95 spouses of 178 hemodialysis (HD) patients, and found that a significantly higher prevalence of CKD was found in relatives (the genetic link mentioned in the previous post), but an even higher prevalence was found in spouses / partners, who were more likely to suffer from CKD than the general population. Overall four out of ten spouses suffered from CKD, compared to less than one in ten of the general population.
The Taiwanese research scientists suggest that health habits, often similar for husbands and wives, were probably an important factor. Are both smokers? Are both inactive? Are both obese? Couples often adopt each other's lifestyle to some extent and if their lifestyle includes a factor that may lead to kidney problems, then they can both be at risk.
So, if you or your partner have CKD, then it's time for both of you to make a visit to the doctor.
Wednesday, 14 April 2010
An international team, including scientists from Edinburgh University (the place I got my Ph.D from), have found 13 new genes that influence renal function, and another seven that affect the production and secretion of creatinine.
Creatinine has been found to be a fairly reliable indicator of kidney function. If the kidney function is impaired, the creatinine level in the blood rises due to poor removal from the body by the kidneys. An abnormal high level is a warning of the possible impending failure of the kidneys.
Although chronic kidney disease is linked to age, and other conditions such as diabetes and high blood pressure, it has been known that there is a genetic component as well.
Two research articles were published on different aspects of the work. The first study involved 67,093 individuals of European ancestry, and collaborative work by 95 scientists all over the world. The second study involved another a further 23,000 individuals.
Dr Jim Wilson, a geneticist at the University of Edinburgh who worked on the study, said, "This work could revolutionize the treatment of kidney disease in the future – but this will take some time."
Obviously we shouldn't expect to hear of new treatments in the immediate future, but fundamental research such as this can't fail to lead to a better understanding of how the kidneys function and how they begin to fail.
See the BBC News Service for a longer report.
Or read the first article abstract at Nature and a second article's abstract, also at Nature
Monday, 15 March 2010
It sounds like one of those strange "human interest" stories you read in those real-life story magazines.
Andy Lamb was dying of kidney failure, he'd had a transplant before. He now has dialysis three times a week. His wife Samantha could save him by donating one of her kidneys. But she was overweight and had to loose 22kg (almost 50lbs) before the doctors would consider operating on her. She gave herself four months to loose the weight - 2kg a week. For the ladies, that's from a UK size 24 to a size 16.
As well as following her trying to shed so much weight, it includes part of Andy's treatment being filmed.
We also get treated to watching her kidney being removed, and then part of the transplant. Andy now has FOUR kidneys - his original two, still in the usual place, plus the first one transplanted and then his wife's, both in the front of his pelvic region. Most interesting part I found was just how quickly the new kidney sprung into action - as the surgeon completed the last stitches to join the blood supply to the new kidney, he said watch this, squeezed it and some blood-stained urine was expelled before he moved on to connecting it to the bladder.
If you have access to the BBC iPlayer and missed this, do have a look. (Yes, the transplant was a success.)
PS Samantha didn't use any magic diet pills, or special herbs, or special tea, or secret formula drink, she reduced her food intake and increased the amount of exercise she took.
Friday, 5 March 2010
Obviously it is important that users of these machines check immediately the status of their machine, so we are reproducing the machine details here.
Affected model numbers are:
Home Choice - 5C4471, 5C4471R, 5C4474, 5C4474R, T5C4441, T5C4441R, 5C4474D, 5C4474DR
Home Choice Pro - 5C8310, 5C8310R, R5C8320, R5C8320R, T5C8300, T5C8300R
All systems with these model numbers are affected.
This is because of reports of serious injuries and at least one death associated with Increased Intraperitoneal Volume (IIPV), also known as overfill of the abdominal cavity. IIPV can cause serious breathing and heart problems that can result in serious injury or death.
Children and non-verbal patients may be at increased risk because of their smaller size or inability to communicate. Increased monitoring of these patients is recommended.
Other vulnerable populations include critically ill patients and patients with pulmonary and hemodynamic instability.
Public Contact: If you need assistance with your HomeChoice or HomeChoice PRO, call the Baxter Customer Service line, available 24 hours and day, 7 days a week at 1-800-553-6898.
We suggest you have a read of both the web pages linked to above, in case we have missed out anything vital in our summary of the press release.
Thursday, 25 February 2010
We came across this news release on a wearable kidney belt for portable use. We seem to come across these sort of news items regularly.
Here's an extract from the news at Kidney Org. Australia
Australasian Home Haemodialysis Workshop Brisbane 11-12 February 2010
Dr Carmel Hawley, Clinical Director of Haemodialysis, Princess Alexandra Hospital and Chairman of a major conference in Brisbane on home dialysis said the wearable kidney would be discussed at the conference. The filtration device is worn on a belt around the waist and weighs approximately five kilograms. There are four micro-pumps which are driven by standard batteries.
The belt is manufactured by Xcorporeal Inc (United States), and a presentation by them is available online. You can visit the Xcorporeal website as well. They list several papers they have presented on this topic from 2006 - 2008, but I didn't notice anything more recent.
Tuesday, 23 February 2010
“During National Kidney Month, we are pleased to honor these 31 patients who demonstrate that people with CKD can lead well-rounded, fulfilling lives,” says Rice Powell, CEO of Fresenius Medical Care North America. “Many successful long-term dialysis patients are self-reliant people who have embraced their treatment program, and want to live as normal a life as possible.”
They plan to publish details about each patient on their web site, but at the present moment the champions pages are not on-line, not even a holding page. So no link to them yet. I might summarise a few of these patient reports here (but with 31 to choose from, it might take a while to decide who to talk about). Usually such stories describe personal achievements in overcoming problems, or how they continue with their work or hobbies just as before starting dialysis, and they can help those new to dialysis realise what they can do. Fresenius has a newsletter that often gives details about one or two CKD sufferers (who, just by coincidence, use their products), and I'd guess these champion stories will be in a similar format.
Friday, 5 February 2010
When you read about a transplant, you normally think "weren't they lucky to find a compatible donor". A post in January mentioned network transplants, showing the ingenuity sometimes required to get a compatible organ.
So it was a bit of a surprize to read in the Times Online today that a woman has had a transplant of an incompatible kidney. The operation was triggered when Maxine Bath developed serious blood pressure problems. The kidney, from her sister, was not compatible and she had been waiting for 15 years, hoping to get a transplant.
The technique used involved chilling samples of her blood, turning the proteins and anti-bodies into a gel, then filtering it to remove the antibodies (which would prevent a successful transplant by attacking the "foreign body"). Then the plasma is thawed out and can be returned to the body. Other antibody removal techniques would have lowered Ms Bath's blood pressure to dangerous levels. Five sessions of cryofiltration were required before the operation at University Hospital, Coventry, could be started.
Although tests had earlier shown no good match within her family circle, her sister Michelle was the closest match, and agreed to donate a kidney, as doctors thought Maxine only had months left to live.
This was said to be the first time this technique had been used for a kidney transplant. Apparently it will only slightly increase the number of renal failure patients who can have a transplant. But any increase is a bonus.
Sunday, 17 January 2010
It's about six minutes long, but it does show what's involved. There's no comentary, so just read the screen captions - she's concentrating on what she's doing (or perhaps she gets embarrassed hearing her own voice on playback ;) )
So now you know what's involved.
Friday, 8 January 2010
Meanwhile, 30 miles away, another recipient / donor pair have just been told that the donor is not a match, and they too have the transplant delayed. But it just so happens that you are a perfect match for this patient. And the donor in the second pair is a perfect match for someone 50 miles away in a similar situation. What if the potential donor for this third patient was a great match for your family member of friend? A three way swap would enable all three patients to get a new kidney. Not from their original generous friend or family member, but threw their willingness to help.
This is a network transplant, and it doesn't just apply to kidney patients either.
But how do these three patients and donors meet up? By chance? Highly unlikely, isn't it. So transplant networks exist, where patients and donors register and help each other. If you are willing to donate to save a friend or family member, ask your doctor about this concept. Don't just say, oh, I can't help him / her as I'm a poor match, so we'll give up now.
If you live in the US , check out this page at the National Kidney Foundation website.
UK Law was changed in 2004 to make such network transplants legal, as discussed in this article from the BMJ.
Live somewhere else? Just ASK about this.