Apples and Pears - the Difference Really Matters

People's body shape can be classified as being an apple or a pear. Apple people, apart from buying expensive phones, carry excess weight around their abdomen, making them round, like an apple. Pear shaped people carry any excess weight a bit lower, around their hips. And why does this matter?

Because carrying excess weight around the abdomen is linked to an increased risk of kidney disease, a recent study suggests.

It was already known that being apple-shaped, as opposed to pear-shaped, added to the risk of developing cardiovascular problems. The new research, in the Journal of the American Society of Nephrology, found signs of kidney problems in even otherwise healthy apple-shaped people.

The study, by a team at the University Medical Center Groningen, in the Netherlands, examined 315 healthy individuals with an average BMI of 24.9 kg/m2 (normal weight range BMI 18.5–24.9 kg/m2) and found people with apple-shaped bodies tended to have lower kidney function, lower kidney blood flow, and higher blood pressure within the kidneys than people with pear-shaped bodies –even after adjusting for sex, age, mean arterial pressure, and BMI. They looked at the waist to hip measurement ratio as a way of quantifying a person's body shape.

High blood pressure in the kidneys of people with apple-shaped bodies may be responsible for their increased risk of developing kidney disease later in life.

So, what shape are you in? Would a bit of exercise and diet be a good idea?

Racial differences in survival on dialysis

A recent article suggests that your genetic background dictates how long you might survive on dialysis. The work suggests that Hispanics tend to live longer than blacks and whites.

It's known that your ethnic background can affect how likely you are to need dialysis - diabetes is more common among some races for example, as mentioned here, so should it be surprizing that your survival time is also dependent on your race?

A number of theories exist as to why Hispanic and black dialysis patients tend to live longer than whites. It may be that Hispanic and black patients are more likely to die before they develop kidney failure, and those who survive are generally healthier and thus more likely to live longer than white patients, the researchers suggested.

The researchers examined data from the United States Renal Data System involving 1,282,201 adults on dialysis between 1995 and 2009.

Source: Clinical Journal of the American Society of Nephrology, news release, March 28, 2013
Abstract

Four kidneys and three pancreases

When we saw this headline, our initial thought was that someone had gone through a series of unsuccessful transplants, involving removal of a failed organ and replacement with a donor organ. We were wrong.

The article in the UK paper The Sun is about Carl Jones, aged 32. He has undergone several transplant operations, with a small difference. They left his original organs in place. So now he is living with four kidneys and three pancreases in his body. Carl had diabetes and spent a lot of time on a dialysis machine. He had his first kidney and pancreas transplant in 2004. Then in 2008 he had a second set implanted.

His diabetes has been cured, and he no longer goes through the regular dialysis treatment he endured for many years.

New risk factor for heart disease.

Kidney failure affects 25 million individuals in the U.S. and many, many more throughout the world. Loss of kidney function means the majority of these patients must undergo dialysis treatments to remove excess fluids and waste products. Although dialysis therapy coupled with medication has improved the life expectancy for people with kidney failure, for unknown reasons, patients' risk of sudden heart failure and death remains 10 to 20 times greater than average.

A new study helps explain why this may be the case. Appearing on-line in Science Translational Medicine, the new findings show that a process known as protein carbamylation contributes to heart disease risk among patients with kidney failure undergoing dialysis, and demonstrates that a blood test to measure carbamylated albumin protein can help clinicians better gauge the effectiveness of dialysis and identify patients at risk of cardiac complications. The findings additionally suggest the need for further investigation to determine if therapy with supplemental amino acids could help to prevent the carbamylation process.

The problem arises due to accumulation of urea in patients blood. Although urea is generally non-toxic, in some cases it can degrade into cyanate, a toxic chemical that binds to and permanently modifies proteins through a process known as carbamylation.

In two independent clinical experiments, the investigators demonstrated that increased carbamylated albumin is strongly associated with an elevated risk of premature death in patients on dialysis. They additionally found that increased carbamylated albumin in dialysis patients was linked with low blood concentrations of amino acids, the building blocks of proteins.

Reported in a Eureka press release

Forget dialysis, get a transplant

According to a report in the Jamaican paper The Gleaner, doctors are suggesting that transplants are cheaper than dialysis, and thus the logical answer to keep health service costs down is to give the patient a transplant. The dialysis patient may require treatment for 20 - 30 or more years, and Professor Everard N. Barton, director of the Caribbean Institute of Nephrology based at the University of the West Indies, Mona, says transplants are far cheaper.

The suggestion is that transplants start to become cheaper overall after two and a half years compared to dialysis, and thus would reduce the strain on the health system. And reduce the long waiting list to get dialysis.

The public should be encouraged to take part in organ donation schemes, thus increasing the number of patients who could be considered for a transplant.

You can read the article in The Gleaner