Blood Pressure Drug Delays Kidney Disease in Diabetics

By Serena Gordon
HealthDay Reporter WEDNESDAY, March 9 2011 (HealthDay News) 

A drug normally used to lower blood pressure may also help protect the kidneys of people with type 2 diabetes, researchers are reporting with a caveat.

In a new study, an international team of researchers found that the drug pressure-reducing medication olmesartan, brand name Benicar, could increase the time before any kidney problems were evident by 23%.

The study measured the possibility of kidney function problems by measuring the amount of albumin secreted in the urine (microalbuminuria).

"Olmesartan was associated with a delayed onset of microalbuminuria, even though blood-pressure control in both groups was excellent according to current standards," wrote the study's authors in a report published in the March 10 issue of the New England Journal of Medicine,

"Microalbuminuria is a marker for renal disease, and preventing renal disease is important for longevity," said Dr. Julie Ingelfinger, the deputy editor of the journal and author of an accompanying journal editorial. She added, "It is possible to use medications preemptively to delay or prevent the onset of microalbuminuria."

But news from the study wasn't all good. More patients in the olmesartan treatment group had fatal cardiovascular events compared to those in the placebo group. Fifteen people with preexisting heart conditions who were taking the drug died from heart problems versus three people taking the placebo.

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Early Dialysis Start Not Advantageous

Jody A. Charnow

Renal & Urology News August 01, 2010

 

MUNICH, GERMANY—Planned early initiation of dialysis does not improve survival or clinical outcomes among patients with end-stage renal disease, study findings show.

Investigators presented their findings of the Initiating Dialysis Early and Late (IDEAL) study during a symposium at the European Renal Association-European Dialysis and Transplant Association 2010 Congress, where one of the symposium's moderators, Johannes F.E. Mann, MD, of University of Erlangen Medical Center and KfH Kidney Center, Munich, Germany, said the results “will shake the nephrology world for some time.”

The study, presented by lead investigator Bruce A. Cooper, MB, BS, PhD, of Royal North Shore Hospital in St. Leonards, New South Wales, Australia, was conducted at 32 centers in Australia and New Zealand. The researchers randomized 828 adults (542 men and 286 women) to start dialysis when their estimated glomerular filtration rate (eGFR) was 10-14 mL/min (early start) or when their eGFR declined to 5-7 mL/min (late start). Subjects had a mean age of 60.4 years. The median time to initiation of dialysis was 1.8 months in the early-start group compared with 7.4 months in the late-start group. Nearly 76% of patients in the late-start group started dialysis when their estimated eGFR was the 7 mL/min target because of the development of symptoms. Of the 404 patients assigned to early-start dialysis, 383 started dialysis; of the 424 patients assigned to late-start dialysis, 386 started dialysis.

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Number of chronic kidney patients undergoing dialysis triples

The Malaysian Insider March 20, 2011

KUALA LUMPUR, March 20 — The number of chronic kidney patients in the country who have to undergo dialysis has increased from 79 per million population in 2000 to 146 per million in 2009, Health Minister Datuk Seri Liow Tiong Lai said today.

He said that based on the National Renal Registry, the total number of patients on dialysis had grown from 6,689 in 2000 to 21,159 in 2009, putting a serious strain on Malaysia’s health resources. 

“A whopping 58 per cent of these patients have diabetes and eight per cent have hypertension as the cause. This puts Malaysia in the unenviable position of probably having the highest percentage of patients in the world with diabetes as the cause of end-stage kidney failure,” he said in his speech at the opening of the national-level World Kidney Day Run 2011 at Dataran Merdeka, here.

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Daily home dialysis makes 'restless legs' betterShari Leventhal

sleventhal@asn-online.org
202-416-0658
American Society of Nephrology 

Short daily hemodialysis reduces common symptom in dialysis patients

For dialysis patients, performing daily dialysis at home can help alleviate sleep problems related to restless legs syndrome (RLS), according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). RLS, a common and troublesome problem for dialysis patients, affects hemodialysis patients about four times as often as people in the general population.

These results, from a study by lead author Bertrand L. Jaber, MD (St Elizabeth's Medical Center, Boston) and colleagues, add to the growing list of quality-of-life benefits received from home short daily hemodialysis (SDHD).

The preliminary report was part the FREEDOM study, which is evaluating SDHD as an alternative to dialysis center treatment. In SDHD, patients perform dialysis at home for a few hours, six days per week. "The FREEDOM Study is the largest U.S.-based observational study examining the potential clinical and economic benefits of home SDHD, which has witnessed an uptick in recent years," Jaber explains.

The researchers analyzed data on 235 patients to see how SDHD affected symptoms of RLS. Patients with RLS have abnormal feelings—such as "pins and needles" or crawling sensations—that are relieved by moving the legs. These feelings may lead to sleep problems, such as insomnia and daytime sleepiness. Although the exact cause is unknown, RLS has been linked to increased rates of cardiovascular complications and death.

For the FREEDOM study patients, switching to SDHD led to significant improvement in RLS-related symptoms. "Over 12 months, there was decline in the percentage of patients reporting RLS and in those reporting moderate-to-severe symptoms," says Jaber. The patients also reported lasting improvement in sleep disorders—even after adjustment for the presence of RLS and for use of anti-anxiety and sedative drugs.

Future FREEDOM study results will determine how SDHD affects hospitalization rates and overall non-treatment related costs in dialysis patients.

The study had some important limitations including selection bias—evident by the recruitment of a relatively young (although not necessarily healthier) patient population. The absence of a control group is another important limitation, although the observed improvements in quality-of-life measures persisted beyond four months.

Long-Term Prophylaxis Cuts CVC Infection Risk

Jody A. Charnow  - Renal & Urology News, 10th March 2011

Long-term use of a topical antibiotic application at central venous catheter (CVC) exit sites in hemodialysis (HD) patients may result in a sustained decrease in all CVC-related infections, according to a Canadian study.

Charmaine E. Lok, MD, MSc, of the University Health Network-Toronto General Hospital and the University of Toronto, and colleagues studied 228 long-term HD patients using a tunneled cuffed CVC. The researchers prospectively monitored the impact of routine topical polyantibiotic ointment application at CVC exit sites once a week as infection prophylaxis. This infection-control practice was fully implemented at the hospital in 2004. The researchers considered 2003 to be a transition period before full implementation of this protocol as standard care.

The hospital implemented the protocol based on the results of a randomized, double-blind trial (Hemodialysis Infection Prevention with Polysporin Ointment [HIPPO]), which showed that those who received the ointment had improved bacteremia and survival rates compared with those who did not.

From the transition period to the end of the study (December 31, 2009), 492 CVC-related infections developed in 228 patients, Dr. Lok's group reported in the American Journal of Kidney Disease(2011;57:432-441). During this time, the overall CVC related infection rate was 0.99 per 1,000 catheter-days and the overall bacteremia rate ranged0.26-0.70 per 1,000 catheter-days. These rates are lower than many reported in the literature, according to the investigators, who noted that a median rate of 3.0-4.0 per 1,000 catheter-days frequently is reported.

With respect to the causative organisms, gram-positive bacteria accounted for 61.2% of exit-site infections and 72.1% of bacteremias, the authors noted.

“Use of a topical polyantibiotic ointment at the CVC exit site with careful surveillance and guidance of infection management by a multidisciplinary team is an effective prophylactic strategy against HD catheter-related infections,” the researchers concluded.

Baxter shuts down production line due to contamination

The Irish Times - Thursday, January 27, 2011

A CONTAMINATED production line has forced a major healthcare firm in Castlebar, Co Mayo, to temporarily shed 150 workers – up to a 10th of its workforce – for a four-month period.

The shutdown at Baxter Healthcare, where a number of kidney dialysis products have been contaminated, will take effect from Monday next.

Baxter, which has more than 1,000 on its payroll and is the largest employer in Co Mayo is US-owned. Last November the company let 200 workers go because of the downturn.

An investigation is under way into the causes of the contamination in some kidney dialysis products.

The problem centres on the presence of endotoxins in peritoneal dialysis solutions that would be used by about 230 patients in the Republic and many more across Europe to treat kidney failure.

Endotoxins are harmful substances or toxins released from bacteria after they have died.

The European Medicines Agency, which was informed of the problem in December, said the products could not be taken off the market as no alternatives were available for patients. However, in the next few weeks it is hoped Baxter will be able to provide patients with “these life-saving treatments” from alternative manufacturing plants in the US, Canada, Turkey and  Singapore, the agency said.

It explained there was a risk that patients who received peritoneal dialysis solutions which contained endotoxins might develop aseptic peritonitis, an inflammation of the peritoneum that affects the way it filters blood. Symptoms would include abdominal pain, nausea, vomiting and sometimes fever. This could force the patient to stop dialysis for a time, which could have repercussions.

However the agency says the number of peritoneal dialysis bags affected is likely to be “very small and the overall risk to patients remains low”.

Its understood that there have been very few reports of adverse reactions to the product in the Republic.

The Health Service Executive said when it was informed of this matter by the Irish Medicines Board it communicated it to the 10 dialysis units providing the treatment to adults and children. This alerted healthcare professionals to look out for possible adverse reactions to the product.

Baxter, despite initial efforts to eradicate the problem by closing down two tanks with microscopic cracks at its Castlebar plant, has now told the medicines agency it cannot guarantee the production of endotoxin-free solutions in the short term. Even after closing the tanks, endotoxins were detected in new batches. Equipment at the plant is now to be replaced.

The implications for workers of the shutdown of the production line were discussed yesterday at a meeting between them and their Siptu trade union representatives.

Patients with concerns are advised to contact their doctor.

What dedication and determination can do........

Up Close and Personal with Tan Suet Guan

By TEE LIN SAY
linsay@thestar.com.my

TAN Suet Guan may be the CEO of Pantai Hospital in Kuala Lumpur, but you can regularly see her playing cashier and waitress in Kar Heong Restaurant, Subang Jaya over the weekends.

This is her family-run business selling curry hor fun and Hainanese chicken rice, which Tan claims, is better than the original one.

As the customers are pouring in, and staff is short, Tan says she simply has no choice but to help in the running of the business. Even when she is not helping out with the business, she is a regular fixture there, and you will probably see her sitting at a table with her husband and poodle.

On the corporate front though, this passionate and pragmatic CEO is a firm believer of compassion and good clinical outcome.

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