To All Brothers & Sisters
"A Blessed & Happy New Year "
"May we have a good year ahead"
Best Wishes & Warmest Regards
from
MalaysianKidneySPA
Thursday, December 30, 2010
Saturday, December 25, 2010
Reader's comment....
We have received with thanks a comment from our reader:
"Heparin is a wonderful drug of course, however problems with Heparin Induced Thrombocytopenia, overanticoagulation with bleeding and clotting due to underanticoagulation exist. The main issue is that one size or dose in this case does not fit all and dosing of heparin ought to be guided by aCT monitoring. But this is expensive and beyond the reach of most stand alone centres. Another alternative is to use low molecular weight heparins, but only the porcine versions have predictable dose responses. Other alternatives exist but are not readily available in the country.....Yudi"
Yes Yudi we agree with you that low molecular weight heparin is a much better alternative, unless and until someone introduce the bovine version and at a affordable price, we have no choice but to do with what we have.....MalaysianKidneySPA
"Heparin is a wonderful drug of course, however problems with Heparin Induced Thrombocytopenia, overanticoagulation with bleeding and clotting due to underanticoagulation exist. The main issue is that one size or dose in this case does not fit all and dosing of heparin ought to be guided by aCT monitoring. But this is expensive and beyond the reach of most stand alone centres. Another alternative is to use low molecular weight heparins, but only the porcine versions have predictable dose responses. Other alternatives exist but are not readily available in the country.....Yudi"
Yes Yudi we agree with you that low molecular weight heparin is a much better alternative, unless and until someone introduce the bovine version and at a affordable price, we have no choice but to do with what we have.....MalaysianKidneySPA
Thursday, December 23, 2010
Friday, December 17, 2010
What is....
CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT)
Dr. Manish Chaturvedi Nephrologist, Dr. S. N. Medical College, Jodhpur
The Indian Anaesthetists’ Forum – (www.theiaforum.org) Online ISSN 0973-0311 October 2004
It is a mode of renal replacement therapy for hemodynamically unstable, fluid overloaded, catabolic septic patients and finds its application in management of acute renal failure especially in the critical care /intensive care unit setting. The popularity of ‘slow continuous therapies’ for the treatment of critically ill patients with renal failure is increasing. The techniques most commonly used are slow continuous hemodialysis and hemodiafiltration. Slow continuous hemofiltration and slow continuous ultrafiltration also are commonly used.
ARF in the ICU setting is frequent especially secondary to multiple organ dysfunction syndrome; post surgical setting i.e after abdominal surgery; post interventional studies eg. PTCA, PTRA studies in already susceptible individuals. These patients having various co-morbid conditions are on mechanical ventilation and various life supporting modalities which do not merit the dialysis procedure to be carried out in the routine dialysis set up.
Being catabolic, they require continuous clearance of waste produced due to ongoing illnesses and an adequate potential for infusion of nutritional and inotropic agents for sustenance of vital parameters which is continuously desired in the management. CRRT has tried to meet these challenges in the ICU settings since its inception and has saved many lives across the globe including critically ill paediatric or geriatric population with renal failure as a co-existent co-morbid illness.
The outcome of therapy depends on clearance of waste products achieved with restoration of blood biochemistry; maintenance of fluid, electrolyte and acid base balance; ability to maintain hemodynamic stability during the procedure with minimum side effects during the procedure.
Tuesday, December 14, 2010
Sunday, December 12, 2010
Reader's comment:
Article: Artificial Kidney made by Indian American
"very much thanks to malaysiankidneyspa.blogspot.com for providing such a useful information.
Dear Dr.Shuvo Roy more than half of the world is praying for your success. Hope very soon your artificial kidney will be available for human being also. very best of luck Dr. Shuvo Roy. Best blessing for you and your family."
by Aman
"very much thanks to malaysiankidneyspa.blogspot.com for providing such a useful information.
Dear Dr.Shuvo Roy more than half of the world is praying for your success. Hope very soon your artificial kidney will be available for human being also. very best of luck Dr. Shuvo Roy. Best blessing for you and your family."
by Aman
Wednesday, December 8, 2010
Artificial kidney made by Indian American
Artificial kidney made by Indian American awaits human trials | ||
Sifynews 2010-12-03 14:13:2 Submitted by Mr CS Soong | ||
|
Tuesday, December 7, 2010
Latest invention...
World's 1st artificial kidney device by an Indian
Posted on Dec 05, 2010 at 09:00 | Updated Dec 06, 2010 at 11:52
The world's first artificial kidney that can mimic almost all vital kindey functions has been created. Indian origin researcher who is making the headlines - Shuvo Roy and his team at the University of California in the US have made what could be the first bio-implantable device, to replace dialysis and even kidney transplantation.
The new kidney device protoype is made up two parts. First is made up of silicon chips that can filter toxins out of the bloodstream. The filtered material is pumped into the second half of the system which is also made up of silicon chips but coated with human kidney cells. These human kidney cells help reabsorb some of the useful substances like sugars and salts back into the body. It also produces vitamin D and helps regulate blood pressure.
"Better over dialysis, even transplants as well. Patients may not require anti-rejection drugs - as is required after transplants because there would be no exposed natural tissues for the immune system to attack," said Dr Alka Bhasin, Nephrologist, Max.
Animal trails have shown good results so far, while human trials are awaited over the next five years.
For the sake of more than a lakh new kidney disease patients every year in India alone and a far larger number on lifelong dialysis - both patients and the medical fraternity the world over, are no doubt, hoping that Dr Roy's invention is successful and to be made available.
Friday, December 3, 2010
Drug recall....
Johnson & Johnson recalls millions of antacid
Malaysian Mirror
03 December 2010 11:02
LOS ANGELES - Johnson & Johnson (J&J) said on Thursday that it is pulling millions of bottles of antacids from shelves because they don
't list the alcohol content of flavoring agents, reports China's Xinhua news agency.
The recall involved 12 million bottles of Mylanta and 85,000 bottles of Alternagel, the company said on its website.
There are no safety concerns related to the recall and consumers can still use the products as directed, said the company.
A spokesperson for the company said the alcohol content is less than one percent and is unlikely to cause adverse effects in alcohol-sensitive individuals.
The recalled products were connected to the company's plant in Fort Washington, Pennsylvania.
"Certain flavoring agents contribute small (less than 1 percent) amounts of alcohol. It is unlikely that use of these products will cause either absorption or alcohol sensitivity related adverse events."
J&J has been plagued by recalls all year. It has announced more than half a dozen recalls that included products such as Children' s Tylenol, Benadryl, and Motrin.
The company is already under criminal and congressional investigation due to quality control issues, according to ABC News. -Bernama
Malaysian Mirror
03 December 2010 11:02
LOS ANGELES - Johnson & Johnson (J&J) said on Thursday that it is pulling millions of bottles of antacids from shelves because they don
't list the alcohol content of flavoring agents, reports China's Xinhua news agency.The recall involved 12 million bottles of Mylanta and 85,000 bottles of Alternagel, the company said on its website.
There are no safety concerns related to the recall and consumers can still use the products as directed, said the company.
A spokesperson for the company said the alcohol content is less than one percent and is unlikely to cause adverse effects in alcohol-sensitive individuals.
The recalled products were connected to the company's plant in Fort Washington, Pennsylvania.
"Certain flavoring agents contribute small (less than 1 percent) amounts of alcohol. It is unlikely that use of these products will cause either absorption or alcohol sensitivity related adverse events."
J&J has been plagued by recalls all year. It has announced more than half a dozen recalls that included products such as Children' s Tylenol, Benadryl, and Motrin.
The company is already under criminal and congressional investigation due to quality control issues, according to ABC News. -Bernama
Sunday, November 28, 2010
What is Hyperkalemia?
Hyperkalemia
eMedicine from WenMD: Mar 19, 2010
Introduction
Background
Potassium homeostasis
Hyperkalemia is defined as a condition in which serum potassium greater than 5.3 mEq/L.
Potassium, the most abundant intracellular cation, is essential for the life of the organism. Potassium is obtained through the diet. Common potassium-rich foods include meats, beans, fruits, and potatoes. Gastrointestinal absorption is complete, resulting in daily excess intake of about 1 mEq/kg/d (60-100 mEq). This excess is excreted through the kidneys (90%) and the gut (10%). Potassium homeostasis is maintained predominantly through the regulation of renal excretion. The most important site of regulation is the distal nephron, including the distal convoluted tubule, the connecting tubule, and the cortical collecting tubule, where aldosterone receptors are present.
The regulation of potassium excretion at the cortical collecting tubule has been extensively studied. Sodium reabsorption through epithelial sodium channels (ENaC) located on the apical membrane of cortical collecting tubule cells, is driven by aldosterone and generates a tubular lumen negative electrical potential, driving the secretion of potassium at this site through specific potassium channels called the renal outer medullary K channels (ROMK). Studies have demonstrated, however that aldosterone also regulates sodium transport in the thick ascending limb of the loop of Henle, the distal convoluted tubule, and the connecting tubule.
Hyperkalemia is defined as a condition in which serum potassium greater than 5.3 mEq/L.
Potassium, the most abundant intracellular cation, is essential for the life of the organism. Potassium is obtained through the diet. Common potassium-rich foods include meats, beans, fruits, and potatoes. Gastrointestinal absorption is complete, resulting in daily excess intake of about 1 mEq/kg/d (60-100 mEq). This excess is excreted through the kidneys (90%) and the gut (10%). Potassium homeostasis is maintained predominantly through the regulation of renal excretion. The most important site of regulation is the distal nephron, including the distal convoluted tubule, the connecting tubule, and the cortical collecting tubule, where aldosterone receptors are present.
The regulation of potassium excretion at the cortical collecting tubule has been extensively studied. Sodium reabsorption through epithelial sodium channels (ENaC) located on the apical membrane of cortical collecting tubule cells, is driven by aldosterone and generates a tubular lumen negative electrical potential, driving the secretion of potassium at this site through specific potassium channels called the renal outer medullary K channels (ROMK). Studies have demonstrated, however that aldosterone also regulates sodium transport in the thick ascending limb of the loop of Henle, the distal convoluted tubule, and the connecting tubule.
Tuesday, November 23, 2010
What is CRRT?
CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT)
Dr. Manish Chaturvedi Nephrologist, Dr. S. N. Medical College, Jodhpur
The Indian Anaesthetists’ Forum – (www.theiaforum.org) Online ISSN 0973-0311 October 2004
It is a mode of renal replacement therapy for hemodynamically unstable, fluid overloaded, catabolic septic patients and finds its application in management of acute renal failure especially in the critical care /intensive care unit setting. The popularity of ‘slow continuous therapies’ for the treatment of critically ill patients with renal failure is increasing. The techniques most commonly used are slow continuous hemodialysis and hemodiafiltration. Slow continuous hemofiltration and slow continuous ultrafiltration also are commonly used.
ARF in the ICU setting is frequent especially secondary to multiple organ dysfunction syndrome; post surgical setting i.e after abdominal surgery; post interventional studies eg. PTCA, PTRA studies in already susceptible individuals. These patients having various co-morbid conditions are on mechanical ventilation and various life supporting modalities which do not merit the dialysis procedure to be carried out in the routine dialysis set up.
Being catabolic, they require continuous clearance of waste produced due to ongoing illnesses and an adequate potential for infusion of nutritional and inotropic agents for sustenance of vital parameters which is continuously desired in the management. CRRT has tried to meet these challenges in the ICU settings since its inception and has saved many lives across the globe including critically ill paediatric or geriatric population with renal failure as a co-existent co-morbid illness.
The outcome of therapy depends on clearance of waste products achieved with restoration of blood biochemistry; maintenance of fluid, electrolyte and acid base balance; ability to maintain hemodynamic stability during the procedure with minimum side effects during the procedure.
GOALS OF CRRT THERAPY
The aggressive management in initial hours to counter the derangements in critically ill patients is the cornerstone in the therapy. CRRT initiated for ARF in critically ill patients should serve as a renal ‘replacement’ therapy mimicking as artificial kidney support. It should enhance recovery of the native kidneys with prevention of hyperkalemia, hyper/hyponatremia, acidosis/alkalosis and rapid correction of pulmonary/peripheral edema by gradual and consistent removal of surplus fluid retained in the body. It should also diffuse the various ongoing smoldering proinflammatory mediators especially in multiple organ dysfunction syndromes.
Saturday, November 20, 2010
Vascular Access for Haemodialysis
Final Draft Version (26 October 2010) Posted on www.renal.org
Authors of this guideline were:
Dr Richard Fluck at Derby Hospitals NHS Foundation Trust and Dr Mick Kumwenda at Betsi Cadwaladr University Health
Vascular access remains a key component of haemodialysis. The ideal vascular access should provide safe and effective therapy by enabling the removal and return of blood via an extracorporeal circuit. Vascular access should be easy to use, reliable and have minimal risk to the individual receiving haemodialysis. However, the provision of good quality access, whilst it is a fundamental aspect of the treatment of haemodialysis patients, remains difficult to achieve.
Native access, in particular arteriovenous fistulae, requires prior planning yet has a high primary failure rate. Arteriovenous grafts utilizing replacement of synthetic or biological material in conjunction with native vessels again require planning and surgical expertise yet have a high demand to maintain them and a high rate of complications. Venous catheters (both tunnelled and non-tunnelled) are in common usage both as temporary access and in a smaller number of patients as the only form of access that is available, yet offer inferior therapy. Vascular access via central venous catheters provides poorer solute clearance related to the limited achieved blood flow and also a higher rate of complications.
This guideline updates the section on vascular access in the haemodialysis module of the 4th edition of the RA guidelines published on-line at www.renal.org in 2007. These guideline recommendations are based on a literature review from relevant publications in journals cited on MEDLINE, PubMed and UpToDate up to 1st May 2010. The modified GRADE system has been adopted by the Renal Association Clinical Practice Guidelines Committee and has been used to grade the recommendations in all of the modules in the 5th edition of the Renal Association guidelines. It explicitly describes both the strength of the recommendations and the quality of the underlying evidence, with the aim of maximising applicability to standard clinical practice (1-4). The modified GRADE system grades level of expert recommendation as “strong” (Grade 1) or “weak” (Grade 2) according to balance of benefits, risk, burden and cost. The quality or level of evidence is assessed as “high” (Grade A), “moderate” (Grade B), “low” (Grade C) or “very low” (D) depending on factors such as study design, directness of evidence and consistency of results (1-4).
Monday, November 15, 2010
Friday, November 12, 2010
Portable and wearable dialysis
Portable and wearable dialysis: where are we now?
Andrew DAVENPORT1, Claudio RONCO2, Victor GURA3
Hemodialysis International, 14: S22–S26. doi: 10.1111/j.1542-4758.2010.00486.x
Abstract
Although dialysis is a life-saving treatment for patients with acute and chronic kidney disease, mortality remains high, with the survival of patients treated by regular hemodialysis similar to that of some solid organ tumors. Recent reports have suggested that a major increase in the dose of dialysis, delivered by frequent nocturnal dialysis, may improve survival. Unfortunately, only a minority of centers can offer this type of therapy, and only to a minority of their patients. Thus, to improve access to dialysis as well as increase the delivered dose of dialysis, a major change in the current paradigm of dialysis delivery is required. For many years, the “holy grail” of dialysis has been to develop a wearable or portable system, allowing patients to be treated while performing their normal activities of daily living. It is only recently with the advances in technology that such dialysis devices have been possible. Prototype devices for both hemodialysis and peritoneal dialysis have been studied with favorable results. Typically, these have been short-term studies, and longer term trials are eagerly awaited, to determine whether the current generation of wearable continuous dialysis devices cannot only remove waste products of metabolism and control volume but also maintain acid-base and electrolyte homeostasis and actually improve outcomes. In addition, a novel generation of dialysis devices based on nanotechnologies are being developed. Hopefully, these wearable continuous devices will be available as an option for routine clinical practice in the not-too-distant future.
Monday, November 8, 2010
The influence of maintenance....
The influence of maintenance quality of hemodialysis machines on hemodialysis efficiency
Ahmad Taher Azar
Department of Biomedical Engineering, Misr University for Science and Technology, 6th of October 2009, City, Egypt
Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2010 Nov 8];20:49-56
Abstract
Several studies suggest that there is a correlation between dose of dialysis and machine maintenance. However, in spite of the current practice, there are conflicting reports regarding the relationship between dose of dialysis or patient outcome, and machine maintenance.
In order to evaluate the impact of hemodialysis machine maintenance on dialysis adequacy Kt/V and session performance, data were processed on 134 patients on 3-times-per-week dialysis regimens by dividing the patients into four groups and also dividing the hemodialysis machines into four groups according to their year of installation. The equilibrated dialysis dose eq Kt/V, urea reduction ratio (URR) and the overall equipment effectiveness (OEE) were calculated in each group to show the effect hemodialysis machine efficiency on the overall session performance. The average working time per machine per month was 270 hours.
The cumulative number of hours according to the year of installation was: 26,122 hours for machines installed in 1998; 21,596 hours for machines installed in 1999, 8362 hours for those installed in 2003 and 2486 hours for those installed in 2005. The mean time between failures (MTBF) was 1.8, 2.1, 4.2 and 6 months between failures for machines installed in 1999, 1998, 2003 and 2005, respectively. Statistical analysis demonstrated that the dialysis dose eq Kt/V and URR were increased as the overall equipment effectiveness (OEE) increases with regular maintenance procedures. Maintenance has become one of the most expedient approaches to guarantee high machine dependability. The efficiency of dialysis machine is relevant in assuring a proper dialysis adequacy.
Read full text here
Wednesday, November 3, 2010
The Buttonhole Technique.....
The Buttonhole Technique: Strategies To Reduce Infections
Lynda K. Ball
Nephrology Nursing Journal, 37(5), 473-478
Submitted By Mr Jeff Chong
The buttonhole technique has been utilized in the United States for over 10 years, and it has been very effective in reducing pain associated with cannulation, empowering patients to learn to self-cannulate, and decreasing complications related to site rotation cannulation. Unfortunately, there is one aspect of this technique that may impact its use – high infection rates.
Over the course of the last 20 years, there has been very limited published literature identifying concerns or complications associated with the buttonhole technique. It has only been within the last four years that research has been published citing infection as a potential problem requiring the renal community’s attention (Doss, Schiller, & Moran, 2008; Marticorena et al., 2006, 2009; van Loon, Goovaerts, Kessels, van der Sande, &Tordoir, 2009; Verhallen, Kooistra, & Van Jaarsveld, 2007). This article discusses specific issues associated with the buttonhole technique and identifies strategies to reduce the incidence of infection.
Read more here
Lynda K. Ball
Nephrology Nursing Journal, 37(5), 473-478
Submitted By Mr Jeff Chong
The buttonhole technique has been utilized in the United States for over 10 years, and it has been very effective in reducing pain associated with cannulation, empowering patients to learn to self-cannulate, and decreasing complications related to site rotation cannulation. Unfortunately, there is one aspect of this technique that may impact its use – high infection rates.
Over the course of the last 20 years, there has been very limited published literature identifying concerns or complications associated with the buttonhole technique. It has only been within the last four years that research has been published citing infection as a potential problem requiring the renal community’s attention (Doss, Schiller, & Moran, 2008; Marticorena et al., 2006, 2009; van Loon, Goovaerts, Kessels, van der Sande, &Tordoir, 2009; Verhallen, Kooistra, & Van Jaarsveld, 2007). This article discusses specific issues associated with the buttonhole technique and identifies strategies to reduce the incidence of infection.
Read more here
Friday, October 29, 2010
Letter by The President, Medico-Legal Society of Malaysia
Treat all patients equally
Letter to the Editor
Darryl S. C. Goon
President, Medico-Legal Society of Malaysia
The Sun ePaper
http://www.sun2surf.com/article.cfm?id=53426
The Medico-Legal Society of Malaysia views with grave concern the report by the auditor-general of shoddy repairs and upgrading work in government clinics. Some of the shortcomings render the facilities unsafe for patients. There are others that are potential health hazards.
It is time for the government to extend the provisions of the Private Healthcare Facilities & Services Act 1998 (ACT 586) to government clinics and hospitals. This legislation sets out what are essentially the minimum acceptable standards to be expected from private healthcare facilities. The provisions are comprehensive.
Why are these minimum standards not required of government hospitals and medical clinics? One cannot countenance double standards in healthcare. It is urged that the government acknowledges that all patients, including those in government hospitals and medical and dental clinics, should be entitled to the benefits of the minimum standards imposed under the Act. While there may be practical problems these should not be allowed to impede an acceptance of the fact that minimum standards for medical and dental care must apply to all patients, whether in government hospitals or private hospitals, without discrimination.
The minimum standards may be brought into effect progressively. The first step is for the government to recognise that all patients are to be treated equally.
Letter to the Editor
Darryl S. C. Goon
President, Medico-Legal Society of Malaysia
The Sun ePaper
http://www.sun2surf.com/article.cfm?id=53426
The Medico-Legal Society of Malaysia views with grave concern the report by the auditor-general of shoddy repairs and upgrading work in government clinics. Some of the shortcomings render the facilities unsafe for patients. There are others that are potential health hazards.
It is time for the government to extend the provisions of the Private Healthcare Facilities & Services Act 1998 (ACT 586) to government clinics and hospitals. This legislation sets out what are essentially the minimum acceptable standards to be expected from private healthcare facilities. The provisions are comprehensive.
Why are these minimum standards not required of government hospitals and medical clinics? One cannot countenance double standards in healthcare. It is urged that the government acknowledges that all patients, including those in government hospitals and medical and dental clinics, should be entitled to the benefits of the minimum standards imposed under the Act. While there may be practical problems these should not be allowed to impede an acceptance of the fact that minimum standards for medical and dental care must apply to all patients, whether in government hospitals or private hospitals, without discrimination.
The minimum standards may be brought into effect progressively. The first step is for the government to recognise that all patients are to be treated equally.
Sleep Disorders........
Sleep disorders in hemodialysis patients
Alaa A Sabry1, Hamdy Abo-Zenah2, Ehab Wafa1, Khaled Mahmoud1, Khaled El-Dahshan1, Ahmed Hassan1, Tarek Medhat Abbas1, Abd El-Baset M Saleh3, Kamal Okasha4
1 Mansoura Urology and Nephrology Center, Mansoura University, Egypt
2 Menuifiya University Faculty of Medicine, Tanta University, Egypt
3 Thoracic Medicine Department (Sleep-Disordered Breathing Unit), Mansoura University, Egypt
4 Department of Internal medicine, Division of nephrology, Tanta University, Egypt
Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2010 Oct 28];21:300-5
Abstract
The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 ± 16.3 years) chronic hemodialysis (HD) patients at the Urology and Nephrology Center, Mansoura Uni¬versity, Egypt over 4-month period. The investigated sleep disorders included insomnia, restless leg syndrome (RLS), obstructive sleep apnea syndrome (OSAS), excessive daytime sleepiness (EDS), narcolepsy and sleep walking, and we used a questionnaire in accordance with those of the International Restless Legs Syndrome Study Group, the Berlin questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders, and the specific ques¬tions of Hatoum's sleep questionnaire. The prevalence of sleep disorders was 79.5% in our pa¬tients, and the most common sleep abnormality was insomnia (65.9%), followed by RLS (42%), OSAS (31.8%), snoring (27.3%), EDS (27.3%), narcolepsy (15.9%), and sleep walking (3.4%). Insomnia correlated with anemia (r=0.31, P= 0.003), anxiety (r=0.279, P= 0.042), depression (r=0.298, P= 0.24) and RLS (r=0.327, P= 0.002). Also, RLS correlated with hypoalbuminemia (r=0.41, P= < 0.0001), anemia (r=0.301 and P= 0.046), hyperphosphatemia (r=0.343 and P= 0.001). EDS correlated with OSAS (r=0.5, P= < 0.0001), snoring (r=0.341, P= 0.001), and social worry (r=0.27, P= 0.011). Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assessment of sleep quality, preferably with polysomno¬graphy, is necessary to confirm our results. Interventional studies for management of sleep disor¬ders in HD patients are warranted.
Read More Here
Alaa A Sabry1, Hamdy Abo-Zenah2, Ehab Wafa1, Khaled Mahmoud1, Khaled El-Dahshan1, Ahmed Hassan1, Tarek Medhat Abbas1, Abd El-Baset M Saleh3, Kamal Okasha4
1 Mansoura Urology and Nephrology Center, Mansoura University, Egypt
2 Menuifiya University Faculty of Medicine, Tanta University, Egypt
3 Thoracic Medicine Department (Sleep-Disordered Breathing Unit), Mansoura University, Egypt
4 Department of Internal medicine, Division of nephrology, Tanta University, Egypt
Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2010 Oct 28];21:300-5
Abstract
The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 ± 16.3 years) chronic hemodialysis (HD) patients at the Urology and Nephrology Center, Mansoura Uni¬versity, Egypt over 4-month period. The investigated sleep disorders included insomnia, restless leg syndrome (RLS), obstructive sleep apnea syndrome (OSAS), excessive daytime sleepiness (EDS), narcolepsy and sleep walking, and we used a questionnaire in accordance with those of the International Restless Legs Syndrome Study Group, the Berlin questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders, and the specific ques¬tions of Hatoum's sleep questionnaire. The prevalence of sleep disorders was 79.5% in our pa¬tients, and the most common sleep abnormality was insomnia (65.9%), followed by RLS (42%), OSAS (31.8%), snoring (27.3%), EDS (27.3%), narcolepsy (15.9%), and sleep walking (3.4%). Insomnia correlated with anemia (r=0.31, P= 0.003), anxiety (r=0.279, P= 0.042), depression (r=0.298, P= 0.24) and RLS (r=0.327, P= 0.002). Also, RLS correlated with hypoalbuminemia (r=0.41, P= < 0.0001), anemia (r=0.301 and P= 0.046), hyperphosphatemia (r=0.343 and P= 0.001). EDS correlated with OSAS (r=0.5, P= < 0.0001), snoring (r=0.341, P= 0.001), and social worry (r=0.27, P= 0.011). Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assessment of sleep quality, preferably with polysomno¬graphy, is necessary to confirm our results. Interventional studies for management of sleep disor¬ders in HD patients are warranted.
Read More Here
Tuesday, October 26, 2010
Kidney patients overcharged by RM140k .....
Free Malaysia Today
By Stephanie Sta Maria
KUALA LUMPUR: Kidney failure is a heavy load to carry in life. More so when the hospital where treatment is sought overcharges.
The Auditor-General's 2009 report, tabled in Parliament yesterday, found that 10,101 patients at five hospitals nationwide paid a total of RM143, 329 in excess fees between 2007-2009.
The five are Sultanah Bahiyah Hospital in Kedah, Kuala Lumpur Hospital, Malacca Hospital, Sultanah Nur Zahirah Hospital in Terengganu and the Sarawak General Hospital.
Read more here
By Stephanie Sta Maria
KUALA LUMPUR: Kidney failure is a heavy load to carry in life. More so when the hospital where treatment is sought overcharges.
The Auditor-General's 2009 report, tabled in Parliament yesterday, found that 10,101 patients at five hospitals nationwide paid a total of RM143, 329 in excess fees between 2007-2009.
The five are Sultanah Bahiyah Hospital in Kedah, Kuala Lumpur Hospital, Malacca Hospital, Sultanah Nur Zahirah Hospital in Terengganu and the Sarawak General Hospital.
Read more here
Friday, October 22, 2010
Proposed Standards for Hemodialysis Practices - What it means to you?
We are very concerned with the response or should we say "lack of response and participation" from the management of private and NGO dialysis centres and also organizations representing patients during the recently concluded 8th NKF Annual Dialysis Meeting 2010 at Berjaya Times Square Hotel, Kuala Lumpur.
The NKFM (National Kidney Foundation Malaysia) together with the Nephrology Department, HKL should be commended to have initiated works to propose a Standards for Hemodialysis Parctices in Malaysia. Work groups were formed by NKFM with invitations to all stakeholders such as local Medical Consultants, Government agencies, private & NGO Dialysis organizations and suppliers.
The work groups were entrusted to come up with different components of a draft of Standards for Hemodialysis Practices in Malaysia. This draft was presented during the recent NKFM meeting to those involved in the industry for their feedback and opinion. Although the draft presented was not a complete document nevertheless it is a very important document to start with and having very far fetching implications to patients and all concerned in the industry.
During the just concluded NKFM meeting, the representative from the local Medical Consultants were spot on with his views concerning their roles and responsibilities. However representative from the Private & NGO centres were very "silent" to the proposals presented at the meeting. It leads us to conclude that the "right people" from the Private & NGO organizations were missing from the meeting.
It is our hope that once the completed draft document is ready, a roadshow be held to informed all those concerned again of its contents and obtain feedback and opinion before the proposal is presented to the KKM for consideration and approval.
Once again kudos to NKFM and Nephrology Depratment, HKL for initiating the proposal. To the other various players....PLEASE SIT UP, TAKE NOTE AND PARTICIPATE!!!
The NKFM (National Kidney Foundation Malaysia) together with the Nephrology Department, HKL should be commended to have initiated works to propose a Standards for Hemodialysis Parctices in Malaysia. Work groups were formed by NKFM with invitations to all stakeholders such as local Medical Consultants, Government agencies, private & NGO Dialysis organizations and suppliers.
The work groups were entrusted to come up with different components of a draft of Standards for Hemodialysis Practices in Malaysia. This draft was presented during the recent NKFM meeting to those involved in the industry for their feedback and opinion. Although the draft presented was not a complete document nevertheless it is a very important document to start with and having very far fetching implications to patients and all concerned in the industry.
During the just concluded NKFM meeting, the representative from the local Medical Consultants were spot on with his views concerning their roles and responsibilities. However representative from the Private & NGO centres were very "silent" to the proposals presented at the meeting. It leads us to conclude that the "right people" from the Private & NGO organizations were missing from the meeting.
It is our hope that once the completed draft document is ready, a roadshow be held to informed all those concerned again of its contents and obtain feedback and opinion before the proposal is presented to the KKM for consideration and approval.
Once again kudos to NKFM and Nephrology Depratment, HKL for initiating the proposal. To the other various players....PLEASE SIT UP, TAKE NOTE AND PARTICIPATE!!!
Thursday, October 14, 2010
Determining Optimum Hemoglobin Sampling.....
Determining Optimum Hemoglobin Sampling for Anemia Management
from Every-Treatment Data Clinical Journal of the American Society of Nephrology - Published ahead of print on September 28, 2010
Adam E. Gaweda, Brian H. Nathanson, Alfred A. Jacobs, George R. Aronoff, Michael J. Germain, and Michael E. Brier
Department of Medicine, University of Louisville, Louisville, Kentucky; OptiStatim, LLC, Longmeadow, Massachusetts; Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts; and Robley Rex Medical Center, Department of Veterans Affairs, Louisville, Kentucky
Submitted by Mr CS Soong
Abstract
Background and objectives: Anemia Management Protocols in ESRD call for hemoglobin (Hb) monitoring every 2 to 4 weeks. Short-term Hb variability affects the reliability of Hb measurement and may lead to incorrect dosing of erythropoiesis stimulating agents. We prospectively analyzed short-term Hb variability and quantified the relationship between frequency of Hb monitoring and error in Hb estimation.
Design, setting, participants, & measurements: Using the Crit-Line III TQA device, we prospectively observed Hb during each dialysis treatment in 49 ESRD patients and quantified long- and short-term Hb variability. We estimated Hb from data sampled at regular intervals; 8x, 4x, 2x, or 1x per month to establish how well we account for short-term variability at different monitoring intervals. We calculated the Hb estimation error (Hberr) as a root mean-squared difference between the observed and estimated Hb and compared it with the measurement error.
Results: The most accurate Hb estimation is achieved whenmonitoring 8x per month (Hberr = 0.23 ¡¾ 0.05 g/dl), but it exceeds the accuracy of the measurement device. The estimation error increases to 0.34 ¡¾ 0.07 g/dl when monitoring 4x per month, 0.39 ¡¾ 0.08 g/dl when monitoring 2x a month, and 0.45 ¡¾ 0.09 g/dl when monitoring 1x per month. Estimation error comparable to instrument error information is as follows: 8x per month, 15 patients; 4x per month, 22 patients; 2x per month, 6patients; 1x per a month, 6 patients.
Conclusions: Four times a month is the clinically optimal Hb monitoring frequency for anemia management
Abstract read here
from Every-Treatment Data Clinical Journal of the American Society of Nephrology - Published ahead of print on September 28, 2010
Adam E. Gaweda, Brian H. Nathanson, Alfred A. Jacobs, George R. Aronoff, Michael J. Germain, and Michael E. Brier
Department of Medicine, University of Louisville, Louisville, Kentucky; OptiStatim, LLC, Longmeadow, Massachusetts; Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts; and Robley Rex Medical Center, Department of Veterans Affairs, Louisville, Kentucky
Submitted by Mr CS Soong
Abstract
Background and objectives: Anemia Management Protocols in ESRD call for hemoglobin (Hb) monitoring every 2 to 4 weeks. Short-term Hb variability affects the reliability of Hb measurement and may lead to incorrect dosing of erythropoiesis stimulating agents. We prospectively analyzed short-term Hb variability and quantified the relationship between frequency of Hb monitoring and error in Hb estimation.
Design, setting, participants, & measurements: Using the Crit-Line III TQA device, we prospectively observed Hb during each dialysis treatment in 49 ESRD patients and quantified long- and short-term Hb variability. We estimated Hb from data sampled at regular intervals; 8x, 4x, 2x, or 1x per month to establish how well we account for short-term variability at different monitoring intervals. We calculated the Hb estimation error (Hberr) as a root mean-squared difference between the observed and estimated Hb and compared it with the measurement error.
Results: The most accurate Hb estimation is achieved whenmonitoring 8x per month (Hberr = 0.23 ¡¾ 0.05 g/dl), but it exceeds the accuracy of the measurement device. The estimation error increases to 0.34 ¡¾ 0.07 g/dl when monitoring 4x per month, 0.39 ¡¾ 0.08 g/dl when monitoring 2x a month, and 0.45 ¡¾ 0.09 g/dl when monitoring 1x per month. Estimation error comparable to instrument error information is as follows: 8x per month, 15 patients; 4x per month, 22 patients; 2x per month, 6patients; 1x per a month, 6 patients.
Conclusions: Four times a month is the clinically optimal Hb monitoring frequency for anemia management
Abstract read here
Wednesday, October 13, 2010
Congratulations
Datuk Dr. Ghazali Bin Ahmad
Senior Consultant Nephrologist & Head of Nephrology Department,
Hospital Kuala Lumpur
on being confered the
PANGLIMA JASA NEGARA (P.J.N.)
By
Yang Di-Pertuan Agung Malaysia XIII
Seri Paduka Baginda Yang Di-Pertuan Agong
Al-Wathiqu Billah Tuanku Mizam Zainal Abidin Ibni Al-Marhum
Sultan Mahmud Al-Muktafi Billah Shah
on the occasion of His Royal Highness' Birthday
on 5th June 2010 / 22 Jamadilakhir 1431H
Best Wishes and Warmest Regards
MalaysianKidneySPA
Saturday, October 9, 2010
Reader's comments....
We have received with thanks a comment each from a reader, Mr Yudi on the following articles which appeared on this blog, kindly checkout his comments by clicking the articles below:
2. New Drug Clears Hemodialysis Catheter Clots September 17, 2010
Wednesday, October 6, 2010
Amgen Recalls Products......
Amgen Recalls Products for Glass Flakes
Sept. 30, 2010
By: Angie Drakulich
EPT--the Electronic Newsletter of Pharmaceutical Technology
Amgen (Thousand Oaks, CA) issued a voluntary recall last week of certain lots of Epogen and Procrit (epoetin alfa) vials. The injectable products, used to treat anemia related to HIV therapy, chronic renal failure, and chemotherapy, may contain “extremely thin glass flakes (lamellae) that are barely visible,” says the press release. The lamellae, says the release, resulted from the interaction of the formulation with glass vials over the shelf life of the product. Approximately 200 lots of Epogen are being recalled, and 155 of Procrit are being recalled. Potential financial implications have not been released.
The company, along with Centocor Ortho Biotech Products, the authorized distributor of Procrit in the United States, found that the glass flakes have low potential for affecting patients. Although there have been no adverse event reports or complaints [as of Sept. 24, 2010], “potential serious adverse events resulting from the use of a sterile injectable product with particulates by the intravenous route include embolic, thrombotic, and other vascular events (e.g., phlebitis), and by the subcutaneous route include foreign body granuloma, local injection site reactions, and increased immunogenicity,” according to the Amgen release.
The recall is being conducted in cooperation with the US Food and Drug Administration. Of note, Amgen is the manufacturer of both Epoetin alfa products, which are manufactured in Puerto Rico, but Johnson & Johnson licenses and markets the product under the Procrit brand.
Article read here
Sept. 30, 2010
By: Angie Drakulich
EPT--the Electronic Newsletter of Pharmaceutical Technology
Amgen (Thousand Oaks, CA) issued a voluntary recall last week of certain lots of Epogen and Procrit (epoetin alfa) vials. The injectable products, used to treat anemia related to HIV therapy, chronic renal failure, and chemotherapy, may contain “extremely thin glass flakes (lamellae) that are barely visible,” says the press release. The lamellae, says the release, resulted from the interaction of the formulation with glass vials over the shelf life of the product. Approximately 200 lots of Epogen are being recalled, and 155 of Procrit are being recalled. Potential financial implications have not been released.
The company, along with Centocor Ortho Biotech Products, the authorized distributor of Procrit in the United States, found that the glass flakes have low potential for affecting patients. Although there have been no adverse event reports or complaints [as of Sept. 24, 2010], “potential serious adverse events resulting from the use of a sterile injectable product with particulates by the intravenous route include embolic, thrombotic, and other vascular events (e.g., phlebitis), and by the subcutaneous route include foreign body granuloma, local injection site reactions, and increased immunogenicity,” according to the Amgen release.
The recall is being conducted in cooperation with the US Food and Drug Administration. Of note, Amgen is the manufacturer of both Epoetin alfa products, which are manufactured in Puerto Rico, but Johnson & Johnson licenses and markets the product under the Procrit brand.
Article read here
Monday, October 4, 2010
Treatment of secondary hyperparathyroidism in haemodialysis patients...
Treatment of secondary hyperparathyroidism in haemodialysis patients: a randomised clinical trial comparing paricalcitol and alfacalcidol
Ditte Hansen1* email, Lisbet Brandi1,2* email and Knud Rasmussen1,2* email
1 Medical Department, Roskilde Hospital, Koegevej 7-13, DK-4000 Roskilde, Denmark
2 Department of Surgery and Internal Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen, Denmark
BMC Nephrology 2009, 10:28doi:10.1186/1471-2369-10-28
Abstract
Background
Secondary hyperparathyroidism is a common feature in patients with chronic kidney disease. Its serious clinical consequences include renal osteodystrophy, calcific uremic arteriolopathy, and vascular calcifications that increase morbidity and mortality.
Reduced synthesis of active vitamin D contributes to secondary hyperparathyroidism. Therefore, this condition is managed with activated vitamin D. However, hypercalcemia and hyperphosphatemia limit the use of activated vitamin D.
In Denmark alfacalcidol is the primary choice of vitamin D analog.
A new vitamin D analog, paricalcitol, may be less prone to induce hypercalcemia and hyperphosphatemia.
However, a randomised controlled clinical study comparing alfacalcidol and paricalcitol has never been performed.
The primary objective of this study is to compare alfacalcidol and paricalcitol. We evaluate the suppression of the secondary hyperparathyroidism and the tendency towards hyperphosphatemia and hypercalcemia.
Methods/Design
This is an investigator-initiated cross-over study. Nine Danish haemodialysis units will recruit 117 patients with end stage renal failure on maintenance haemodialysis therapy.
Patients are randomised into two treatment arms. After a wash out period of 6 weeks they receive increasing doses of alfacalcidol or paricalcitol for a period of 16 weeks and after a further wash out period of 6 weeks they receive the contrary treatment (paricalcitol or alfacalcidol) for 16 weeks.
Discussion
Hyperparathyroidism, hypercalcemia and hyperphosphatemia are associated with increased cardiovascular mortality in patients with chronic kidney disease.
If there is any difference in the ability of these two vitamin D analogs to decrease the secondary hyperparathyroidism without causing hypercalcemia and hyperphosphatemia, there may also be a difference in the risk of cardiovascular mortality depending on which vitamin D analog that are used. This has potential major importance for this group of patients.
Read full text here
Ditte Hansen1* email, Lisbet Brandi1,2* email and Knud Rasmussen1,2* email
1 Medical Department, Roskilde Hospital, Koegevej 7-13, DK-4000 Roskilde, Denmark
2 Department of Surgery and Internal Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen, Denmark
BMC Nephrology 2009, 10:28doi:10.1186/1471-2369-10-28
Abstract
Background
Secondary hyperparathyroidism is a common feature in patients with chronic kidney disease. Its serious clinical consequences include renal osteodystrophy, calcific uremic arteriolopathy, and vascular calcifications that increase morbidity and mortality.
Reduced synthesis of active vitamin D contributes to secondary hyperparathyroidism. Therefore, this condition is managed with activated vitamin D. However, hypercalcemia and hyperphosphatemia limit the use of activated vitamin D.
In Denmark alfacalcidol is the primary choice of vitamin D analog.
A new vitamin D analog, paricalcitol, may be less prone to induce hypercalcemia and hyperphosphatemia.
However, a randomised controlled clinical study comparing alfacalcidol and paricalcitol has never been performed.
The primary objective of this study is to compare alfacalcidol and paricalcitol. We evaluate the suppression of the secondary hyperparathyroidism and the tendency towards hyperphosphatemia and hypercalcemia.
Methods/Design
This is an investigator-initiated cross-over study. Nine Danish haemodialysis units will recruit 117 patients with end stage renal failure on maintenance haemodialysis therapy.
Patients are randomised into two treatment arms. After a wash out period of 6 weeks they receive increasing doses of alfacalcidol or paricalcitol for a period of 16 weeks and after a further wash out period of 6 weeks they receive the contrary treatment (paricalcitol or alfacalcidol) for 16 weeks.
Discussion
Hyperparathyroidism, hypercalcemia and hyperphosphatemia are associated with increased cardiovascular mortality in patients with chronic kidney disease.
If there is any difference in the ability of these two vitamin D analogs to decrease the secondary hyperparathyroidism without causing hypercalcemia and hyperphosphatemia, there may also be a difference in the risk of cardiovascular mortality depending on which vitamin D analog that are used. This has potential major importance for this group of patients.
Read full text here
Friday, October 1, 2010
The ultrafiltration coefficient of a dialyser (KUF).....
The ultrafiltration coefficient of a dialyser (KUF) is not a fixed value, and it follows a parabolic function: the new concept of KUF max
Submitted by Mr CS Soong
Nephrol. Dial. Transplant. (2010) - First published online: September 8, 2010 - doi: 10.1093/ndt/gfq510
Alain Ficheux 1, Peter G. Kerr 2, Philippe Brunet 3 and Àngel Argilés1,4
1 RD—Néphrologie, 104, rue de la Galéra, Ecole Nationale Supérieure de Chimie, 34090 Montpellier, France
2 Department of Nephrology, Monash Medical Centre, Monash University, Melbourne, VIC, Australia
3 Service de Néphrologie, Hôpital de La Conception—Université Aix-Marseille, 13005 Marseille, France
4 Centre de dialyse de Sète, Néphrologie Dialyse St Guilhem, 3420 4Sète, France
Abstract
Background. Hydraulic permeability (KUF) is an intrinsic characteristic of dialysers, reported by the manufacturer as a single value, which drives and limits fluid removal. High-flux dialysers have been introduced with the appearance of convective techniques, aiming to increase fluid and solute removal. High convective volumes are being employed, although their advantages have not been fully demonstrated.
Methods. We assessed KUF over a pre-selected range of ultrafiltration rates (QUF) in post-dilutional haemodiafiltration and high-flux haemodialysis.
Results. KUF vs QUF was neither a fixed value nor a linear function but followed a parabolic function with a vertex der (y) = 0, which we have called KUF max. This also held true in high-flux routine dialysis.
Conclusions. These findings are completely new and have clear applications in clinics. The vertex point might be used to define the optimal QUF of a dialysis system, which would be that obtained at KUF max and corresponds to the best QUF/transmembrane pressure ratio, as opposed to the maximum QUF (which corresponds to the highest possible QUF), frequently associated with haemoconcentration, clotting, loss in dialyser surface area, and treatment problems. Determining KUF max in vivo could be of help in dialysis prescription and control with automatic systems.
Abstract found here
Submitted by Mr CS Soong
Nephrol. Dial. Transplant. (2010) - First published online: September 8, 2010 - doi: 10.1093/ndt/gfq510
Alain Ficheux 1, Peter G. Kerr 2, Philippe Brunet 3 and Àngel Argilés1,4
1 RD—Néphrologie, 104, rue de la Galéra, Ecole Nationale Supérieure de Chimie, 34090 Montpellier, France
2 Department of Nephrology, Monash Medical Centre, Monash University, Melbourne, VIC, Australia
3 Service de Néphrologie, Hôpital de La Conception—Université Aix-Marseille, 13005 Marseille, France
4 Centre de dialyse de Sète, Néphrologie Dialyse St Guilhem, 3420 4Sète, France
Abstract
Background. Hydraulic permeability (KUF) is an intrinsic characteristic of dialysers, reported by the manufacturer as a single value, which drives and limits fluid removal. High-flux dialysers have been introduced with the appearance of convective techniques, aiming to increase fluid and solute removal. High convective volumes are being employed, although their advantages have not been fully demonstrated.
Methods. We assessed KUF over a pre-selected range of ultrafiltration rates (QUF) in post-dilutional haemodiafiltration and high-flux haemodialysis.
Results. KUF vs QUF was neither a fixed value nor a linear function but followed a parabolic function with a vertex der (y) = 0, which we have called KUF max. This also held true in high-flux routine dialysis.
Conclusions. These findings are completely new and have clear applications in clinics. The vertex point might be used to define the optimal QUF of a dialysis system, which would be that obtained at KUF max and corresponds to the best QUF/transmembrane pressure ratio, as opposed to the maximum QUF (which corresponds to the highest possible QUF), frequently associated with haemoconcentration, clotting, loss in dialyser surface area, and treatment problems. Determining KUF max in vivo could be of help in dialysis prescription and control with automatic systems.
Abstract found here
Tuesday, September 28, 2010
Comparison and causes of transfer from one dialysis modality
Comparison and causes of transfer from one dialysis modality to other
Submitted by Mr CS Soong
International Urology and Nephrology –
Online First- DOI: 10.1007/s11255-010-9836-2
Aydin Unal, Ismail Kocyigit, Murat Hayri Sipahioglu, Bulent Tokgoz, Oktay Oymak and Cengiz Utas
Abstract
Aim To evaluate the patients transferred from one dialysis modality to another and to compare the patient characteristics on both renal replacement modalities.
Patients and method The data of dialysis patients, who were followed up between January 2000 and December 2009 in our nephrology department, was evaluated retrospectively. Fifty-seven patients were transferred from HD to PD (Group 1) and 94 patients were transferred from PD to HD (Group 2) were included in this study. We recorded patients demographic, clinical, and laboratory findings, and
the cause of transfer from HD to PD or from PD to HD.
Results The mean age of the patients was 52.1 ¡¾ 4.1 years. Eighty-four of the 151 patients were men and 67 were women. The etiology of end-stage renal failure was diabetes mellitus and hypertension in most of the patients. The causes of transfer from HD to PD were vascular access problems in 37 (64.9%), patient preference in 8 (14.0%), cardiovascular
problems in 7 (12.3%), inadequate dialysis in 4 (7.0%) patients, and unknown in 1 (1.8%) patient. On the other hand, the causes of transfer from PD to HD were refractory peritonitis in 61 (64.9%), catheter-related problems in 14 (14.9%), inadequate dialysis in 8 (8.5%), increased intraabdominal pressure-related problems in 7 (7.4%), patient
preference in 2 (2.1%), and ultrafiltration failure in 2 (2.1%) patients. Alkaline phosphatase and calcium ¡¿ phosphorus products were significantly higher in Group 1 compared to Group 2. The presence
of diabetes mellitus, Kt/Vurea, and 24-h residual urine volume were significantly higher in Group 2 than in Group 1. There was no significant difference in terms of other parameters.
Conclusion Vascular access problems were the most frequent cause of transfer from HD to PD. On the
other hand, the most frequent cause of transfer from PD to HD was refractory peritonitis. Preservation of residual urine volume was better in PD patients compared to HD patients.
Abstract read here
Submitted by Mr CS Soong
International Urology and Nephrology –
Online First- DOI: 10.1007/s11255-010-9836-2
Aydin Unal, Ismail Kocyigit, Murat Hayri Sipahioglu, Bulent Tokgoz, Oktay Oymak and Cengiz Utas
Abstract
Aim To evaluate the patients transferred from one dialysis modality to another and to compare the patient characteristics on both renal replacement modalities.
Patients and method The data of dialysis patients, who were followed up between January 2000 and December 2009 in our nephrology department, was evaluated retrospectively. Fifty-seven patients were transferred from HD to PD (Group 1) and 94 patients were transferred from PD to HD (Group 2) were included in this study. We recorded patients demographic, clinical, and laboratory findings, and
the cause of transfer from HD to PD or from PD to HD.
Results The mean age of the patients was 52.1 ¡¾ 4.1 years. Eighty-four of the 151 patients were men and 67 were women. The etiology of end-stage renal failure was diabetes mellitus and hypertension in most of the patients. The causes of transfer from HD to PD were vascular access problems in 37 (64.9%), patient preference in 8 (14.0%), cardiovascular
problems in 7 (12.3%), inadequate dialysis in 4 (7.0%) patients, and unknown in 1 (1.8%) patient. On the other hand, the causes of transfer from PD to HD were refractory peritonitis in 61 (64.9%), catheter-related problems in 14 (14.9%), inadequate dialysis in 8 (8.5%), increased intraabdominal pressure-related problems in 7 (7.4%), patient
preference in 2 (2.1%), and ultrafiltration failure in 2 (2.1%) patients. Alkaline phosphatase and calcium ¡¿ phosphorus products were significantly higher in Group 1 compared to Group 2. The presence
of diabetes mellitus, Kt/Vurea, and 24-h residual urine volume were significantly higher in Group 2 than in Group 1. There was no significant difference in terms of other parameters.
Conclusion Vascular access problems were the most frequent cause of transfer from HD to PD. On the
other hand, the most frequent cause of transfer from PD to HD was refractory peritonitis. Preservation of residual urine volume was better in PD patients compared to HD patients.
Abstract read here
Friday, September 24, 2010
How Australian Nephrologists View Home Dialysis
How Australian Nephrologists View Home Dialysis: Results of a National Survey
Submitted by Mr CS Soong
Nephrology - Accepted Article (Accepted, unedited articles published online for future issues) -DOI: 10.1111/j.1440-1797.2010.01403.x
Marie J Ludlow 1, Charles RP George 2, Carmel M Hawley 3, Timothy H Mathew 4, John W M Agar 5, Peter G Kerr 6, Lydia A Lauder7
1 Medical Project Manager, Kidney Health Australia
2 Department of Nephrology, Concord Hospital, Concord, New South
3 Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland
4 Medical Director, Kidney Health Australia
5 Department of Renal Medicine, Geelong Hospital, Victoria
6 Department of Nephrology, Monash Medical Centre, Clayton, Victoria
7 National Manager Strategic Health Projects & Publications, Kidney Health Australia
Abstract
Aim Australia's commitment to home dialysis therapies has been significant. However, there is marked regional variation in the uptake of home haemodialysis (HD) and peritoneal dialysis (PD) suggesting further scope for the expansion of these modalities.
Methods Between 1 April and 5 August 2009, Australian nephrologists invited to complete an online survey. Seventy-six questions were asked covering characteristics of the dialysis units, responders¡¯ experience, adequacy of facilities and support structures, attitudes to the use of home HD and PD and issues impeding the increased uptake of home dialysis.
Results Completed surveys were received and analyzed from 71 respondents; 27from Heads of Units (35% response rate) and 44 (16%) from other nephrologists. There was strong agreement that HD with long hours was advantageous and that this was most easily accomplished in the home. PD was not considered to be an inferior therapy. A ¡°PD first¡± policy existed in 34 of Renal Units. The most commonly reported impediments to expanding home dialysis services were financial disadvantage for home HD patients, and lack of physical infrastructure for training, support, and education. Areas of concern for expanding home dialysis programs included psychiatry support, access to respite care and home visits, and lack of support from administration and government. The majority of medical nephrologists would recommend home dialysis to more patients if these impediments could be overcome.
Conclusion This survey identified support from nephrologists for the expansion of home dialysis in Australia and highlighted important barriers to improving access to these therapies.
Abstract found here
Submitted by Mr CS Soong
Nephrology - Accepted Article (Accepted, unedited articles published online for future issues) -DOI: 10.1111/j.1440-1797.2010.01403.x
Marie J Ludlow 1, Charles RP George 2, Carmel M Hawley 3, Timothy H Mathew 4, John W M Agar 5, Peter G Kerr 6, Lydia A Lauder7
1 Medical Project Manager, Kidney Health Australia
2 Department of Nephrology, Concord Hospital, Concord, New South
3 Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland
4 Medical Director, Kidney Health Australia
5 Department of Renal Medicine, Geelong Hospital, Victoria
6 Department of Nephrology, Monash Medical Centre, Clayton, Victoria
7 National Manager Strategic Health Projects & Publications, Kidney Health Australia
Abstract
Aim Australia's commitment to home dialysis therapies has been significant. However, there is marked regional variation in the uptake of home haemodialysis (HD) and peritoneal dialysis (PD) suggesting further scope for the expansion of these modalities.
Methods Between 1 April and 5 August 2009, Australian nephrologists invited to complete an online survey. Seventy-six questions were asked covering characteristics of the dialysis units, responders¡¯ experience, adequacy of facilities and support structures, attitudes to the use of home HD and PD and issues impeding the increased uptake of home dialysis.
Results Completed surveys were received and analyzed from 71 respondents; 27from Heads of Units (35% response rate) and 44 (16%) from other nephrologists. There was strong agreement that HD with long hours was advantageous and that this was most easily accomplished in the home. PD was not considered to be an inferior therapy. A ¡°PD first¡± policy existed in 34 of Renal Units. The most commonly reported impediments to expanding home dialysis services were financial disadvantage for home HD patients, and lack of physical infrastructure for training, support, and education. Areas of concern for expanding home dialysis programs included psychiatry support, access to respite care and home visits, and lack of support from administration and government. The majority of medical nephrologists would recommend home dialysis to more patients if these impediments could be overcome.
Conclusion This survey identified support from nephrologists for the expansion of home dialysis in Australia and highlighted important barriers to improving access to these therapies.
Abstract found here
Tuesday, September 21, 2010
Daily Hemodialysis Improves Depression
Daily Hemodialysis Improves Depression and Recovery Time
Kidney.org - September 1, 2010Submitted by Mr CS Soong
(New York, NY) – -- Hemodialysis patients who transitioned
from in-center to daily home dialysis regimens experienced
significant improvements in depressive symptoms and
post-dialysis recovery times, according to a new report
published today in the American Journal of KidneyDiseases,
the official journal of the National Kidney Foundation.
Patients who made the switch from the normal, thrice weekly
in-center treatment regimen to a daily schedule, defined as
six times per week, reported more than a 30% decline in
depressive symptoms and an 87% drop in post-dialysis
recovery time over a 12 month period.
The research team assessed 128 patients making the
treatment regimen switch. Patients were assessed upon enrollment
and then again four months and 12 months afterward. The
average training period to complete the transition was 27
days.
“Depression and post-dialysis fatigue are important concerns
for patients with kidney failure,” said Kerry Willis, PhD,
National Kidney Foundation’s Senior Vice President of
Scientific Activities. “These findings suggest that increasing
the number of times a patient dialyzes can improve their
quality of life, which has been linked to fewer trips to the
hospital and a lower mortality rate.”
This report is part of the FREEDOM (Following Rehabilitation,
Economics and Everyday-Dialysis Outcome Measurements)
Study, an ongoing prospective cohort study investigating the
clinical and economic benefits of daily haemodialysis.
“The improvement in depression symptoms may be
directly related to the shortened recovery time and less dramatic
chemical changes with more frequent dialysis,” said Dr.
Fredric Finkelstein, of Yale University School of Medicine and
member of the FREEDOM Study The National Kidney Foundation
is dedicated to preventing andtreating kidney and urinary tract
diseases, improving the health and well being of individuals and
families affected by these diseases and increasing availability of
all organs for transplantation. For more information on kidney
disease, dialysis or a schedule of kidney screenings
visit www.kidney.org.
Friday, September 17, 2010
New Drug Clears Hemodialysis Catheter Clots
New Drug Clears Hemodialysis Catheter Clots
John Schieszer March 31, 2010
Renal & Urology News
TAMPA, Fla.—Tenecteplase, a thrombolytic agent, may significantly improve the function of hemodialysis (HD) catheters blocked by blood clots, according to data from a phase 3 open-label trial.
“It is tremendously promising,” said study investigator Steven Fishbane, MD, Chief of Nephrology at Winthrop University Hospital in Mineola, N.Y. “Clotting has been a big problem. This gives us the first opportunity to help. This agent is a very important development. There are currently no FDA approved agents [for clearing HD catheter clots] so this could become the first approved drug for this purpose.”
Tenecteplase is a recombinant fibrin-specific plasminogen activator and is currently under FDA review. It is derived from tissue plasminogen activator, with modifications at three sites of the protein structure. Tenecteplase binds to the fibrin component of the thrombus and selectively converts thrombus-bound plasminogen to plasmin.
This subsequently degrades the fibrin matrix of the thrombus. The agent is indicated as a thrombolytic therapy for the acute phase of myocardial infarction (MI) for reduction of mortality associated with acute MI.
Read full text here
John Schieszer March 31, 2010
Renal & Urology News
TAMPA, Fla.—Tenecteplase, a thrombolytic agent, may significantly improve the function of hemodialysis (HD) catheters blocked by blood clots, according to data from a phase 3 open-label trial.
“It is tremendously promising,” said study investigator Steven Fishbane, MD, Chief of Nephrology at Winthrop University Hospital in Mineola, N.Y. “Clotting has been a big problem. This gives us the first opportunity to help. This agent is a very important development. There are currently no FDA approved agents [for clearing HD catheter clots] so this could become the first approved drug for this purpose.”
Tenecteplase is a recombinant fibrin-specific plasminogen activator and is currently under FDA review. It is derived from tissue plasminogen activator, with modifications at three sites of the protein structure. Tenecteplase binds to the fibrin component of the thrombus and selectively converts thrombus-bound plasminogen to plasmin.
This subsequently degrades the fibrin matrix of the thrombus. The agent is indicated as a thrombolytic therapy for the acute phase of myocardial infarction (MI) for reduction of mortality associated with acute MI.
Read full text here
Wednesday, September 15, 2010
Tuesday, September 14, 2010
Effect of intravenous ascorbic acid in hemodialysis patients
Effect of intravenous ascorbic acid in hemodialysis patients with anemia and hypeferritinemia
Keyhanian Shahrbanoo1, Omolbanin Taziki2
1 Department of Oncology, Azad University of Tonekabon, Ramsar, Iran
2 Department of Nephrology, Mazandaran University of Medical Science, Sari, Iran
Saudi J Kidney Dis Transpl 2008;19:933-6
Hemodialysis (HD) patients with functional iron deficiency (FID) often develop resistance to recombinant human erythropoietin (Epo). The contributory role of chronic inflammation and oxidative stress in its pathogenesis is poorly understood. We assessed the effect of vitamin C, an antioxidant, on Epo-hyporesponsive anemia in hemodialysis patients with unexplained hyperferritinemia levels.
Thirty-one of 132 with Hb < 11 g/dL were prospectively followed up after exclusion of reasons for Epo hyporesponsiveness. Patients were randomly divided into two groups: 15 patients received standard care and 300 mg of intravenous vitamin C with each dialysis session (group 1) and 15 patients received standard care (group 2). After 3 months, Hb and transferrin saturation levels significantly increased in group 1 but not in group 2 (p < 0.05%).
Hemoglobin content in reticulocyte and serum ferritin decreased significantly in group 1 but not in control group. In conclusion, hemodialysis patients with refractory anemia and adequate iron stores, vitamin C improved responsiveness to Epo by augmenting iron mobilization and possibly via antioxidant effect.
Read full text here
Keyhanian Shahrbanoo1, Omolbanin Taziki2
1 Department of Oncology, Azad University of Tonekabon, Ramsar, Iran
2 Department of Nephrology, Mazandaran University of Medical Science, Sari, Iran
Saudi J Kidney Dis Transpl 2008;19:933-6
Hemodialysis (HD) patients with functional iron deficiency (FID) often develop resistance to recombinant human erythropoietin (Epo). The contributory role of chronic inflammation and oxidative stress in its pathogenesis is poorly understood. We assessed the effect of vitamin C, an antioxidant, on Epo-hyporesponsive anemia in hemodialysis patients with unexplained hyperferritinemia levels.
Thirty-one of 132 with Hb < 11 g/dL were prospectively followed up after exclusion of reasons for Epo hyporesponsiveness. Patients were randomly divided into two groups: 15 patients received standard care and 300 mg of intravenous vitamin C with each dialysis session (group 1) and 15 patients received standard care (group 2). After 3 months, Hb and transferrin saturation levels significantly increased in group 1 but not in group 2 (p < 0.05%).
Hemoglobin content in reticulocyte and serum ferritin decreased significantly in group 1 but not in control group. In conclusion, hemodialysis patients with refractory anemia and adequate iron stores, vitamin C improved responsiveness to Epo by augmenting iron mobilization and possibly via antioxidant effect.
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Thursday, September 9, 2010
Monday, September 6, 2010
Body Composition and Outcomes in Chronic Hemodialysis Patients
Body Composition and Outcomes in Chronic Hemodialysis Patients
Hirachan P, Thijssen S, Levin N, Kotanko P
Ronco C, Cruz DN (eds): Hemodialysis - From Basic Research to Clinical Trials. Contrib Nephrol. Basel, Karger, 2008, vol 161, pp 108-114 (DOI: 10.1159/000130422)
Abstract:
In contrast to epidemiological data from the general population, maintenance hemodialysis (MHD) patients with a naturally small body size experience an increased mortality rate compared to their larger fellow patients. Since body mass index is a poor surrogate of body composition, attempts were made to delineate muscle, fat and visceral organ mass in MHD patients. Several lines of evidence indicate that (a) increased fat and muscle mass exerts protective effects, (b) some markers of inflammation may be increased with fat mass, and (c) a high visceral mass per body weight is associated with a reduced survival time. The reasons for the positive effects of fat and muscle mass on survival are not clear. A novel hypothesis predicts lower uremic toxin concentrations in larger subjects. This is based on the observation that both in healthy subjects and in dialysis patients, visceral organ mass is inversely related to body mass. Since visceral organs are the most prominent source of uremic toxins, large patients may have a lower toxin production rate per unit of body mass. Moreover, large patients have a greater volume of distribution (total body water, fat mass) resulting in lower toxin concentrations. Future studies should aim to tackle the Janus-like duality of obesity by a system biology approach.
PMID: 18451665 [PubMed - indexed for MEDLINE]
Hirachan P, Thijssen S, Levin N, Kotanko P
Ronco C, Cruz DN (eds): Hemodialysis - From Basic Research to Clinical Trials. Contrib Nephrol. Basel, Karger, 2008, vol 161, pp 108-114 (DOI: 10.1159/000130422)
Abstract:
In contrast to epidemiological data from the general population, maintenance hemodialysis (MHD) patients with a naturally small body size experience an increased mortality rate compared to their larger fellow patients. Since body mass index is a poor surrogate of body composition, attempts were made to delineate muscle, fat and visceral organ mass in MHD patients. Several lines of evidence indicate that (a) increased fat and muscle mass exerts protective effects, (b) some markers of inflammation may be increased with fat mass, and (c) a high visceral mass per body weight is associated with a reduced survival time. The reasons for the positive effects of fat and muscle mass on survival are not clear. A novel hypothesis predicts lower uremic toxin concentrations in larger subjects. This is based on the observation that both in healthy subjects and in dialysis patients, visceral organ mass is inversely related to body mass. Since visceral organs are the most prominent source of uremic toxins, large patients may have a lower toxin production rate per unit of body mass. Moreover, large patients have a greater volume of distribution (total body water, fat mass) resulting in lower toxin concentrations. Future studies should aim to tackle the Janus-like duality of obesity by a system biology approach.
PMID: 18451665 [PubMed - indexed for MEDLINE]
Monday, August 30, 2010
Friday, August 27, 2010
Sexual functioning in hemodialysis patients....
Sexual functioning in hemodialysis patients and their spouses: results of a prospective study from Turkey
Ayşegul YILMAZ1, Ceren GOKER2 Orhan Murat KOCAK3 Bahire AYGOR4 Vesile ŞENTURK2 Gokhan NERGİZOĞLU5 Atilla SOYKAN1 Hakan KUMBASAR1
1 Division of Consultation Liaison Psychiatry, Faculty of Medicine, Ankara University,Ankara - TURKEY
2 Department of Psychiatry,Faculty of Medicine, Ankara University, Ankara - TURKEY
3 Department of Psychiatry, Kırıkkale University, School of Medicine, Kırıkkale - TURKEY
4 Division of Consultation Liaison Psychiatry, Faculty of Medicine, Ankara University,Ankara - TURKEY
5 Department of Nephrology, Faculty of Medicine, Ankara University, Ankara - TURKEY
Turk J Med Sci 2009; 39 (3): 405-414
Abstract
Aims: This study aimed to evaluate sexual functioning among hemodialysis patients and their spouses.
Materials and Methods: The study was conducted by the Consultation Liaison Psychiatry Division at the Hemodialysis Unit of the Department of Nephrology, Ankara University, School of Medicine as well as 3 private dialysis centers in Ankara. The study group consisted of 45 hemodialysis patients and their spouses. All couples filled out a socio-demographic and occupational data form and a validated Turkish version of the Arizona Sexual Experiences Scale. The couples were also evaluated by a psychiatrist using the Hamilton Depression Scale, Hamilton
Anxiety Scale, and Mini Mental State Examination.
Results: Forty-five patients undergoing hemodialysis treatment and their spouses participated in the study. The mean age of the patients was 47.15 �} 10.25 years and the mean age of the spouses was 45.20 �} 10.34 years. The Structured Clinical Interview for DSM Disorders-Clinical Version revealed that among 45 couples, 30 patients and 13 spouses fulfilled the diagnostic criteria for a psychiatric diagnosis (P = 0.001), commonly for depression. Comparisons of the Arizona Sexual Experiences Scale items (drive, arousal, penile erection/vaginal lubrication, ability to reach orgasm, and satisfaction with orgasm) revealed higher scores for arousal, erection/lubrication,satisfaction subscales, and the total Arizona Sexual Experiences Scale (P < 0.05) in the patient group than in the spouse group, and sexual problems were significantly more common in female spouses (P < 0.05).
Conclusions: Sexual function disorders were mostly seen in male hemodialysis patients, but in the spouse group, the incidence of sexual disorders was higher in female spouses. We suggest that sexual assessment of these patients should be integrated into routine examination, and cooperation of nephrology and psychiatric team is essential for the therapy of hemodialysis patients and their spouses.
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Ayşegul YILMAZ1, Ceren GOKER2 Orhan Murat KOCAK3 Bahire AYGOR4 Vesile ŞENTURK2 Gokhan NERGİZOĞLU5 Atilla SOYKAN1 Hakan KUMBASAR1
1 Division of Consultation Liaison Psychiatry, Faculty of Medicine, Ankara University,Ankara - TURKEY
2 Department of Psychiatry,Faculty of Medicine, Ankara University, Ankara - TURKEY
3 Department of Psychiatry, Kırıkkale University, School of Medicine, Kırıkkale - TURKEY
4 Division of Consultation Liaison Psychiatry, Faculty of Medicine, Ankara University,Ankara - TURKEY
5 Department of Nephrology, Faculty of Medicine, Ankara University, Ankara - TURKEY
Turk J Med Sci 2009; 39 (3): 405-414
Abstract
Aims: This study aimed to evaluate sexual functioning among hemodialysis patients and their spouses.
Materials and Methods: The study was conducted by the Consultation Liaison Psychiatry Division at the Hemodialysis Unit of the Department of Nephrology, Ankara University, School of Medicine as well as 3 private dialysis centers in Ankara. The study group consisted of 45 hemodialysis patients and their spouses. All couples filled out a socio-demographic and occupational data form and a validated Turkish version of the Arizona Sexual Experiences Scale. The couples were also evaluated by a psychiatrist using the Hamilton Depression Scale, Hamilton
Anxiety Scale, and Mini Mental State Examination.
Results: Forty-five patients undergoing hemodialysis treatment and their spouses participated in the study. The mean age of the patients was 47.15 �} 10.25 years and the mean age of the spouses was 45.20 �} 10.34 years. The Structured Clinical Interview for DSM Disorders-Clinical Version revealed that among 45 couples, 30 patients and 13 spouses fulfilled the diagnostic criteria for a psychiatric diagnosis (P = 0.001), commonly for depression. Comparisons of the Arizona Sexual Experiences Scale items (drive, arousal, penile erection/vaginal lubrication, ability to reach orgasm, and satisfaction with orgasm) revealed higher scores for arousal, erection/lubrication,satisfaction subscales, and the total Arizona Sexual Experiences Scale (P < 0.05) in the patient group than in the spouse group, and sexual problems were significantly more common in female spouses (P < 0.05).
Conclusions: Sexual function disorders were mostly seen in male hemodialysis patients, but in the spouse group, the incidence of sexual disorders was higher in female spouses. We suggest that sexual assessment of these patients should be integrated into routine examination, and cooperation of nephrology and psychiatric team is essential for the therapy of hemodialysis patients and their spouses.
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