KIDNEY / NEPHROLOGY NEWS
Germs are microscopic bacteria, viruses, fungi, and protozoa that can cause disease and infection. Ta Duh, Ta Duh. They're everywhere. TA DUH TA DUH! For the most part, people whose immune system isn't compromised can live their lives without thinking too much about germs. But now that I've received a transplant and have to take immunosuppressants, I must be extra careful not to get an infection and risk rejection of the kidney.
Eating during hemodialysis could be a good idea for you. Dietitians are always reminding you to include enough calories and protein and not to skip meals. Since most hemodialysis shifts encompass a normal mealtime, you probably feel hungry when you're at the unit. Eating during dialysis would seem to make sense. Moreover, if you have diabetes, you shouldn't go for long periods without food, especially if you're taking diabetes medications. Low blood glucose could result.
How to Engage the Dialysis Team
In 2002, in an effort to promote patient safety, the Joint Commission along with CMS began a campaign called SPEAK UP (The Joint Commission, 2011). The aim is to encourage patients to become actively involved in their care by becoming informed consumers. I have adapted SPEAK UP for persons undergoing dialysis:
Lori's Lines "Building Your Confidence"
When the ups and downs of kidney failure get to me, it shakes my confidence, and I wonder whether I can ever do what I used to do or whether I have the courage to try something new. You see, I have this jury in my head: About half of the jurors think I should live freely and joyously, and the other half are ready to abandon me to my insecurities.
Understanding How Fluid Gains Affect Dialysis
Patients on hemodialysis have two basic fluid-related problems. First, gaining too much fluid between treatments damages the heart muscles by overstretching them. Second, when fluid is removed too quickly, there's an undetected but harmful effect on the heart muscles. This double-whammy is the norm for most patients who get conventional hemodialysis three times a week. Patients often exceed safe levels both in how much fluid they accumulate between treatments and in how fast that fluid is removed. Avoiding these problems can preserve heart health.
Fall Seven Times. Stand Up Eight
The rigors of treatment mean that it's hard for dialysis patients to sustain employment, although many continue to work. One such patient is 23-year-old Jessie. Her kidney failure resulted from a disease called Atypical Hemolytic Uremic Syndrome. She started dialysis at the tender age of 12 months. She did get a transplant once, but it lasted only 9 days. Despite all the challenges she has faced, she maintains a "normal" life.
Employment: Barriers and Solutions
Given the common knowledge that Social Security Disability Insurance is almost universally available to them, dialysis patients may wonder why they should bother to work. Besides increased income and possible employer insurance, there are tremendous psychosocial benefits. Work not only confers a sense of accomplishment and creates a sense of identity but it also fosters greater independence, creates increased opportunities for socialization, and ameliorates depression.
Honorable Mention - The Odd Ones - 2011 Essay Contest
Question: "What hobby helps improve your quality of life and helps you forget the many challenges kidney disease presents?" Answer: When I arrive at the DCI Clinic in Crowley, Louisiana, the staff always gives me a friendly greeting, but makes no move to start my treatment for the first several minutes. Why not? Because I'm one of "them."
Honorable Mention - My Life with Clorox - 2011 Essay Contest
Since I was born, Clorox Wipes have always been in my life. From the time I learned to walk and talk, if my mom was cleaning, I remember her using Clorox. I learned a lot from my mom, so later on, when I was older and able to use Clorox myself, I would do exactly what she did: wipe the counters, clean my bathroom and my bedroom, sanitize the dishes and anything else I could get my hands on. I'd found something that I enjoyed: cleaning.
Honorable Mention - For the Love of Cooking - 2011 Essay Contest
I knew my kidneys were failing. It was apparent several years before my doctor informed me that I would need dialysis or die. That was one of the worst days of my life. I was devastated. I thought to myself-go to the same place, three days a week, four hours a day, needles stuck in me, a machine acting as an artificial kidney, I might as well be dead! What quality of life could I have? After a few months of having "pity parties," I examined all aspects of my life, not just the kidney disease. I decided, "I have so much to live for!" I had three children and two granddaughters (now I have four granddaughters). While they're enough to live for, I began to ask myself, What do I love to do that would improve my quality of life and help me forget the many challenges kidney disease is about to present for me? I decided to put all my energy into what I enjoy doing most: cooking.
Devices Dominate Guidelines for Heart Failure (CME/CE)
(MedPage Today) -- BELGRADE, Serbia -- Lifestyle is out and devices are in for acute and chronic heart failure management, according to a major revision of European guidelines.
Lab Notes: Sugar Sours Memory, Fish Oil Trumps
(MedPage Today) -- Rats fed a sugary diet forgot how to run a maze they had previously mastered, but the effect was countered by omega-3 fatty acid supplements. Also this week: new hope for Fanconi anemia.
PodMed: A Medical News Roundup from Johns Hopkins (with audio)
(MedPage Today) -- This week's topics include stress testing after heart procedures, coffee and mortality, air pollution and markers of inflammation, and laxative-free colonoscopy.
Diabetic Nerve Damage Linked to Metabolic Factors (CME/CE)
(MedPage Today) -- Targeting the various aspects of the metabolic syndrome may provide a means for preventing the development of diabetic neuropathy, authors of a review suggested.
'Parachute' Promising for Heart Failure (CME/CE)
PARIS (MedPage Today) -- A percutaneous device that walls off part of the left ventricle to help failing hearts appears to have a big impact on outcomes, pilot study results showed.
Glitazones Take New Hit for Bladder Ca Risk
CHICAGO (MedPage Today) -- British patients followed after starting on glitazone drugs for type 2 diabetes were significantly more likely to develop bladder cancer than those taking sulfonylurea agents.
Nerve Ablation Safely Lowers BP in CKD (CME/CE)
(MedPage Today) -- Catheter-based renal nerve ablation helps lower resistant hypertension, but now researchers have found that it works as well in those with chronic kidney disease, a pilot study showed.
Bigger BP Drop Goal for Renal Denervation (CME/CE)
PARIS (MedPage Today) -- More dramatic blood pressure reductions may be on the horizon for patients with resistant hypertension given the phalanx of renal denervation systems under development.
Heart Is Focus for Hypertension Meeting
NEW YORK CITY (MedPage Today) -- Hypertension specialists will take a closer look at the connection between high blood pressure and the cardiovascular system at this year's meeting of the American Society of Hypertension here, according to the chair of the scientific program committee.
Off-Pump CABG Easier on Bad Kidneys (CME/CE)
(MedPage Today) -- For patients with impaired renal function, performing CABG off-pump rather than on-pump appears to improve outcomes, a retrospective study showed.
Lack of access to healthy food may contribute to health disparities in kidney disease
By EurekAlert Processed and fast foods enriched with phosphorus additives may play a role in health disparities in chronic kidney disease, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).
This Too Shall Pass: Avoid Kidney Stones Through Diet
There are surgical interventions to treat kidney stones, but when it comes to prevention, diet may be key. One new study finds that a diet rich in plant-based foods and low-fat dairy may help decrease the risk of developing kidney stones.
Anemia Drugs Could Pose Threat to Some Kidney Patients
WEDNESDAY, Sept. 15 (HealthDay News) -- When people with chronic kidney disease and type 2 diabetes take certain anemia drugs, the level of hemoglobin cells in their blood should go up.
Study finds clues to kidney disease in African-Americans
Associated Press PHILADELPHIA African-Americans are four times as likely to have kidney disease as Caucasians, and a recent study from Harvard University may explain why.
Odds of getting new kidney uneven
NEW YORK (Reuters Health) – People with kidney disease are more likely to be added to the waiting list for a kidney transplant if they've had a previous heart, lung or liver transplant, a new study suggests.
Father, son hike Kilimanjaro for juvenile diabetes
A father and son team are spending the next 14 days hiking Mt. Kilimanjaro in Arusha, Tanzania to raise money for juvenile diabetes. Matthew R. Weir, director of the division of nephrology at the University of Maryland School of Medicine, and his son, M.
New Warning Signs May Predict Kidney Transplant Failure
Kidney transplants that show a combination of fibrosis (scarring) and inflammation after one year are at higher risk of long-term transplant failure, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).
Antibiotic May Up Risk of Dangerous Potassium Levels in Seniors
A new study warns that seniors who take a common antibiotic combination for urinary tract infections are at increased risk of developing potentially life-threatening high potassium levels.
Hb Variability Doesn't Predict Mortality in Dialysis
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston. Variability in blood hemoglobin levels, associated with the use of erythropoiesis-stimulating agents (ESAs), does not predict mortality in dialysis patients, according to a large European population...
Pre-Dialysis Procedure Often Delayed in Poorer Communities
THURSDAY, Aug. 5 (HealthDay News) -- Kidney disease patients in poor communities are less likely than patients in wealthier areas to receive optimal care before they start dialysis, a U.
GENERAL MEDICAL NEWS
Looking away as you get stuck by a needle associated with less pain.
Health Day News: Averting your eyes when you're receiving a shot really may help reduce discomfort, new research suggests.
Possible risk of sudden death with certain alkalosis-inducing dialysate concentrates.
Renalweb: Evidence is now showing that a significant percentage of dialysis patients have unexpectedly high levels of bicarbonate in their blood and are actually suffering from alkalosis, the opposite of acidosis. The association between higher dialysate bicarbonate levels, pre-dialysis serum bicarbonate levels, and increased mortality was the topic of a presentation at the Annual Meeting of the American Society of Nephrology in November 2011. This problem appears to have been growing virtually unnoticed for many years, but apparently with the increased market share of Granuflo in the US and a lack of clinical knowledge about total buffer levels, more clinical problems have become evident.
Bedbugs and dialysis units in the news.
WSOC TV: “She usually takes a blanket. She was told not to bring her blanket because they had bedbugs,” Crank said. “I don’t know who has the bugs and who’s bringing them in,” said Chuck Garris, a patient at the facility.
Short-term azithromycin treatment associated with increased cardiovascular death risk.
EurekAlert: While the absolute number of deaths was quite low, relative to amoxicillin, there were about 47 more deaths per million courses of therapy in those taking the azithromycin. That risk increased to 245 additional cardiovascular deaths per million in patients already known to have a high risk for heart problems. The researchers emphasized that the decision to prescribe any antibiotic requires careful balancing of both potential benefits and risks. This calculation must consider the severity of the infection, the susceptibility of the organism, the availability of alternative antibiotics and adverse effects.
Study of HDL genetic variants casts doubt on the beneficial impact of higher HDL levels.
EurekAlert: What they found was surprising. Individuals who carried a particular variation in a gene called endothelial lipase had HDL levels that were elevated about 6mg/dl, or 10% — a change expected to decrease heart attack risk by about 13%. However, these individuals showed no difference in their risk of heart disease compared to people without the variant. Similarly, the researchers identified a panel comprised of not just one but 14 different HDL-raising variants. They devised a scoring system based on the total number of copies of the gene variants a person carries — ranging from 0 to 28 — and then asked whether that score relates to the risk of heart attack. Here also they uncovered no association.
Loyola Medicine: The technique is called "talking control support therapy.” As patients were undergoing dialysis, researchers stopped by for informal chats. A typical conversation began with small talk, before moving on to general conversation about healthy dialysis lifestyles. Unlike conventional dialysis education, no specific education goals were set. After 12 weeks, 82 percent of the study patients met or exceeded their target blood work goals for albumin and phosphorus, compared with 65 percent before the talking control therapy. And there was a 12 percent increase in patient-satisfaction scores. Results were presented at the National Kidney Foundation 2012 Spring Clinical Meetings.
Robot-assisted surgery now favored to treat some kidney cancers.
EurekAlert: Robot-assisted surgery has replaced another minimally invasive operation as the main procedure to treat kidney cancer while sparing part of the diseased organ, and with comparable results, according to a new research study by Henry Ford Hospital urologists.
EurekAlert: The biomarkers measured included those associated with systemic inflammation (fibrinogen, C-reactive protein [CRP], white blood cell [WBC] count) and thrombosis or endothelial dysfunction (platelet activation markers P-selectin [sCD62P] and soluble CD40 ligand [sCD40L] as well as the adhesive endothelial glycoprotein von Willebrand factor).
New MRI technique can follow changes in brain pH.
EurekAlert: According to Wemmie, the new imaging technique provides the best evidence so far that pH changes do occur with normal function in the intact human brain. The findings were published May 7 in the Proceedings of the National Academy of Sciences (PNAS) Early Edition. Specifically, the study showed the MRI-based method was able to detect global changes in brain pH in mice. Breathing carbon dioxide, which lowers pH (makes the brain more acidic), increased the signal, while bicarbonate injections, which increases brain pH, decreased the MRI signal. The relationship between the signal and the pH was linear over the range that was tested. Importantly, the method also seems able to detect localized brain activity. When human volunteers viewed a flashing checkerboard -- a classic experiment that activates a particular brain region involved in vision -- the MRI method detected a drop in pH in that region. The team also confirmed the pH drop using other methods. "Our study tells us, first, we have a technique that we believe can measure pH changes in the brain, and second, this MRI-based technique suggests that pH changes do occur with brain function," Magnotta says.
Mouse study suggests benefits of scheduled eating.
EurekAlert: To find out whether restricted feeding alone, without a change in calorie intake, could prevent metabolic disease, Panda's team fed mice either a standard or high-fat diet with one of two types of food access: ad lib feeding or restricted access. The time-restricted mice on a high-fat diet were protected from the adverse effects of a high-fat diet and showed improvements in their metabolic and physiological rhythms. They gained less weight and suffered less liver damage. The mice also had lower levels of inflammation, among other benefits.
Good news for nanomedicine: Quantum dots appear safe in pioneering study on primates
(University at Buffalo) A pioneering study to gauge the toxicity of quantum dots in primates has found the tiny crystals to be safe over a one-year period, a hopeful outcome for doctors and scientists seeking new ways to battle diseases like cancer through nanomedicine.
Experimental bariatric surgery controls blood sugar in rats with diabetes
(University Health Network) For the first time, scientists at the Toronto General Hospital Research Institute have shown that an experimental bariatric surgery can lower blood sugar levels in rats with type 1 diabetes.
Scientists discover distinct molecular subtype of prostate cancer
(New York- Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College) A collaborative expedition into the deep genetics of prostate cancer has uncovered a distinct subtype of the disease, one that appears to account for up to 15 percent of all cases, say researchers at Weill Cornell Medical College, the Broad Institute of MIT and Harvard and the Dana-Farber Cancer Institute.
Discovery of mechanisms predicting response to new treatments in colon cancer
(Vall d´Hebron Institute of Oncology) The Vall d'Hebron Institute of Oncology identifies biomarkers that predict resistance to treatment which will enable a better selection of patients who stand to benefit as well as avoid the administration of ineffective medicines. These findings identify experimental drugs to overcome resistance and open new therapeutic avenues in combinatorial treatment.
Scientists identify new target to battle rheumatoid arthritis
(Hospital for Special Surgery) A new study led by researchers at Hospital for Special Surgery identifies the mechanism by which a cell signaling pathway contributes to the development of rheumatoid arthritis (RA). In addition, the study provides evidence that drugs under development for diseases such as cancer could potentially be used to treat RA.
Songbirds' learning hub in brain offers insight into motor control
(University of California - San Francisco) To learn its signature melody, the male songbird uses a trial-and-error process to mimic the song of its father, singing the tune over and over again, hundreds of times a day, making subtle changes in the pitch of the notes. For the male Bengalese finch, this rigorous training process begins around the age of 40 days and is completed about day 90, just as he becomes sexually mature and ready to use his song to woo females.
Study evaluates use of inhaled saline for young children with cystic fibrosis
(JAMA and Archives Journals) Margaret Rosenfeld, M.D., M.P.H., of Seattle Children's Hospital, and colleagues conducted a study to examine if hypertonic saline would reduce the rate of pulmonary exacerbations in children younger than 6 years of age with cystic fibrosis (CF).
Low-dose CT screening may benefit individuals at increased risk for lung cancer
(JAMA and Archives Journals) Peter B. Bach, M.D., of the Memorial Sloan-Kettering Cancer Center, New York, and colleagues conducted a systematic review to examine the evidence regarding the benefits and harms of low-dose computerized tomography (LDCT) screening for lung cancer, which is the leading cause of cancer death.
Study examines treatments for relieving breathing difficulties among patients with lung effusions
(JAMA and Archives Journals) Helen E. Davies, M.D., of the University Hospital of Wales, Cardiff, and colleagues compared the effectiveness of treatments to relieve breathing difficulties among patients with malignant pleural effusion (presence of fluid in the pleural cavity [space between the outside of the lungs and the inside wall of the chest cavity], as a complication of malignant disease).
ASGE holds Crystal Awards Dinner as part of Digestive Disease Week
(American Society for Gastrointestinal Endoscopy) The American Society for Gastrointestinal Endoscopy (ASGE) will honor important contributions to the field of endoscopy during the eighth annual ASGE Crystal Awards on Sunday, May 20, 2012. Hosted by ASGE and the ASGE Foundation, this year's event will begin at 7:00 p.m. at San Diego's PETCO Park, home of the San Diego Padres.