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.

Study shows Vitamin D Lowers Infection Risk

Infections are common and can be fatal in patients undergoing long-term dialysis. Recent studies have shown conflicting evidence associating infection with vitamin D status or use of vitamin D and have not been systematically reviewed in this population.

So a group of medical scientists took a detailed look at existing studies and carefully analysed the results.

If a patient has high or normal serum levels of vitamin d and uses vitamin D supplements, there is a lower risk osf infection for patients on long-term dialysis.
A review by  two groups, one at Karolinska Institutet in Stockholm, Sweden and the other at Guangdong Provincial Hospital of Chinese Medicine, of 17 studies came to this conclusion. Also, those with vitamin D deficiency who took supplements reduced their chances of infection by 41%.

You can have a read of the summary here