Thursday, 16 July 2015

Most Dialysis Patients Aren't Receiving The Best Treatment

According to a recent article at GPB, most dialysis patients are not getting the recommended treatment. For twenty years or more, it's been recommended that arteriovenous fistulas should be used, which requires a simple operation, which in turn shortens the time for each dialysis session by increasing the blood flow. But a report in JAMA Surgery says only 20% of patients are going down this route. Despite the fact that using arteriovenous fistulas improves the survival rate.

The results should that it also depended on where you life, with some areas having 11% of hemodialysis patients using arteriovenous fistulas and other regions having up to 22%. This was from a study of almost 500,000 patients. Which suggests almost 400,000 are not getting the best option available.

"Doctors are usually really good about following standards of care and recommendations, but in this area, we are failing miserably," said Dr. Mahmoud Malas, a surgeon at Johns Hopkins University School of Medicine who led the study. "We have had recommendations for [the best possible care for] 20 years now, but after all this time, only about 20 percent of those starting dialysis are getting it done right."

Fistulas are also safer. "Chances of you dying are 30 to 40 percent less if you use a fistula," Malas says. That's a pretty important statistic as well.

If the recommended treatment was used, life would be better and longer for a very large proportion of those on dialysis. Do the right thing and save thousands of lives each year recommends the study.

Tuesday, 14 July 2015

Obesity and kidney failure

On a recent UK hospital reality show, they introduced a patient weighing in at 270kg - and you thought 270lbs was bad! He had various problems and was being considered for a gastric band operation, because, among other problems, the doctors were detecting kidney problems due to his obesity. Except he wasn't fit enough to have the operation to reduce his obesity - not fit enough due to his obesity!

I always wonder how people can get so seriously obese. "Well after I got married I started to put on weight" he said. Really? Call me naive and taking a somewhat simple view of things, but to get to 270lbs you have to eat a lot of food every day and not take any exercise. So how much do you need to eat regularly to get up to 270kg??? It doesn't happen overnight you know, and eating less while taking more exercise will help. So someone chose to eat vast amounts of food and chose not to do any exercise, and kept doing this for a very long time. Should we have sympathy for someone doing that?

In the UK, the health service is paid for by tax payers, enabling anyone to get medical help that they need without the burden of expensive insurance policies. There's no need to worry about visiting a doctor as you don't need to be able to afford any treatment or drugs prescribed in the vast, vast majority of cases. That's a very good thing in my opinion. But should we be paying for the care of someone as obese as 270kg, or even a "mere" 270lbs? There's a certain self-induced factor in cases like this, and I loose my normal sympathy for those in an unfortunate situation.

Obesity is well known to cause kidney problems, leading to transplants or dialysis. Surely at some point someone should have mentioned that this sort of level of obesity is life threatening. Even at the 270lb mark it's life threatening, and I'm sure some doctor must have mentioned this to the patient.

I really can't understand how someone can get themselves into such a situation, or even get to 270lbs far less 270kg. And why did their family keep giving in and feeding them the huge amounts of food that it takes to get them up to this size. I might be making myself unpopular saying this, but hey, it's my opinion.