Wednesday, 17 November 2010

Deliberately Damage Kidneys to Improve Your Health!

Well, I bet just like me, your first thoughts were What!!!

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

Health Problems in Dialysis Clinics?

A research report produced by ProPublica, which has been discussed on many news sites, suggests that there are some serious health issues attached to dialysis - not that dialysis itself is bad for you, but the clinic you receive treatment at may be very bad for you.

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

Dialysis decrease in diabetics - good or bad?

We read of what at first seems like good news.

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.