Higher Death Rates Seen in Central Line Dialysis Patients: Study

Doctors Lounge (http://www.doctorslounge.com/index.php/news/hd/19539)

Randy Dotinga HealthDay Reporter

THURSDAY, April 21 (HealthDay News) -- Doctors should avoid delivering hemodialysis to kidney failure patients through a central line catheter because that method is associated with a higher risk of death shortly after beginning dialysis, a new study contends.

Researchers examined the medical records of more than 38,500 Canadian patients who began dialysis from 2001-08. Patients who received hemodialysis through a central line catheter into a large vein had an 80 percent higher risk of death in the first year after starting dialysis than patients who received:

• Peritoneal dialysis (through a tube into the abdomen).
• Dialysis through an arteriovenous fistula (in which a surgeon connects an artery directly to a vein).
• Dialysis through an arteriovenous graft (in which a surgeon connects an artery to a vein with a synthetic tube, or graft, implanted under the skin in one arm).

Both the surgically created fistula and graft access sites are at less risk of infection than a central line, with a fistula least likely to become infected, the study authors said. Among central line patients, the risk of death was 20 percent higher five years after dialysis began than in the others. "Our results emphasize the importance of predialysis care and education, and the need to avoid central venous catheter use in our [hemodialysis] patients," Dr. Jeffrey Perl, of St. Michael's Hospital in Toronto, said in an American Society of Nephrology news release.

The researchers cautioned that the study was observational, not a randomized controlled trial, and that there was no information on the reasons why patients started dialysis with a central catheter vs. the other methods.

The study appeared in the Journal of the American Society of Nephrology.

In the study, about 63 percent of the patients received hemodialysis using a central line catheter, 17 percent began the treatment with an arteriovenous fistula or graft, and 19 percent performed peritoneal dialysis on themselves at home.

Those who got treatment through an arteriovenous fistula or graft when starting hemodialysis survived at about the same rate as those on dialysis through a tube in the abdomen.

Prior research has also suggested that peritoneal patients have a lower risk of death, Perl said.

Wishing all our 

Christian Brothers and Sisters

A Blessed & Sacred Good Friday

(Remembrance and Appreciation)

Warmest Regards and Best Wishes

Malaysian KidneySPA

Effects of Different Levels of Endotoxin Contamination on Inflammatory Cytokine Production by Peripheral Blood Mononuclear Cells after High-Flux Hemodialysis

Article contributed by Mr CS Choong  

Kearkiat Praditpornsilpa^a, Khajohn Tiranathanagul^a, Paweena Susantitaphong^a, Pisut Katavetin^a, Thananda Trakarnvanich^b, Natavudh Townamchai^a, Talerngsak Kanjanabuch^a, Yingyos Avihingsanon^a, Kriang Tungsanga^a, Somchai Eiam-Ong<sup>a

a</sup>Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and
^bRenal Unit, Department of Medicine, Bangkok Metropolitan Administration Medical College, Bangkok, Thailand

Blood Purif 2011;32:112-116 (DOI: 10.1159/000324394)


Abstract    

                                                                                             

Background: 
In Thailand, dialysate endotoxin contamination levels vary from less than 0.001 to 2.0 EU/ml. This difference has prompted an investigation on the production of proinflammatory cytokines and counter inflammatory mediators of peripheral blood mononuclear cells (PBMCs) after high-flux dialysis.                                                                                
                                                                                                   
Methods: 
Patients from four hemodialysis (HD) centers who met the inclusion/exclusion criteria were enrolled into the study. PBMCs were isolated by Ficoll density gradient centrifugation and cultured. Supernatants were tested for interleukin 6 (IL-6), IL-1β and IL-1 receptor antagonist (IL-1Ra) concentration by ELISA.                                                                   
                                                                                                   
Results: 
HD centers 1, 2, 3 and 4 had mean dialysate endotoxin contamination levels of 0.001, 0.026, 0.558 and 1.960 EU/ml, respectively. HD center 4 had the highest levels of IL-6 (1,052.3 ± 240.7 pg/106 PBMCs), IL-1β (1,297.1 ± 334.6 pg/106 PBMCs) and IL-1Ra (2,713.4 ± 1,255.3 pg/106 PBMCs). There were no significant differences in cytokine production between HD centers 1 and 2.                                                                       
                                                                                                   
Conclusion:  
Our study showed that ultrapure dialysate can minimize the risk of stimulating inflammatory cells. Ultrapure dialysate may prevent or delay endotoxin exposure-related complications. 

Wishing all our

Hindu Brothers and Sisters

A Happy and Blessed 

Vaisakhi

"We can never live in this world alone"

Warmest Regards and Best Wishes,

Malaysian KidneySpa

Solve the shortages before going strictly by the book

Letter by SS Lim PJ, The Star Online, 14th April 2011

I REFER to “Relief for kidney patients” (The Star, April 13). The comments made by the director-general of health are indeed welcome news for dialysis patients, and the positive tone shows clear willingness to respond to the concerns of the interested parties, especially the patients.

However, allow me to add some perspective to three critical issues.

The requirement for a resident or visiting nephrologist remains a major obstacle to licensing. As the director-general of health noted, there are 618 dialysis units in Malaysia (437 non-government and 181 public dialysis centres), but only about 100 nephrologists.

The mathematics shows that it is difficult for non-government dialysis centres to engage the services of a nephrologist. The Health Ministry needs to address this issue before making it a strict requirement.

Perhaps foreign nephrologists can be allowed to practise in Malaysia while efforts are made to increase the number of doctors being trained in nephrology.

Read letter in full here

D-G: No plans to close down 437 private haemodialysis centres

By LESTER KONG
lester@thestar.com.my , 13th April 2011

PUTRAJAYA: The Government has no intention of closing down the 437 non-government haemodialysis centres nationwide, said health director-general Datuk Dr Hasan Abdul Rahman.

He said the service provided by the centres was much needed as there were only 181 public haemodialysis centres.

Dr Hasan said the non-government centres were safe if they complied with the minimum criteria set by the ministry and obtained their operating licences.

Non-government centres nationwide care for 16,307 patients while government centres treat 7,115 patients.

“Even if they can't comply by getting the necessary training for their doctors, nurses and medical assistants, we will still work out a timeframe for them to relocate their patients,” he said yesterday.

It was reported that five Health Ministry officials visited the Pertubuhan Hemodialysis Seberang Perai Selatan in Simpang Ampat, Nibong Tebal, and ordered it to shut down by May 1 as it did not have a full-time nephrologist.

Read full text here

Al-Fatihah

Our Deepest and Heartfelf Condolences to

the family of the late

Ahmad Sarbani Bin Mohamed

(A humble man with a great heart)

on his untimely demise

"May his soul be blessed and rest in peace"

 A Friend and Comrade in Dialysis

Batch 25 (Seremban)

Protest held against impending closure of city’s first treatment centre

By FLORENCE A. SAMY and JASTIN AHMAD TARMIZI newsdesk@thestar.com.my 10th April 2011

KUALA LUMPUR: The impending closure of the city’s first dialysis centre run by the National Kidney Foundation (NKF) has left patients in a quandary.

The kidney patients have been told the centre in Jalan Hang Lekiu will close its doors at the end of the month due to licensing problems.

Exasperated patients, some of whom have been seeking treatment at the centre for over 12 years, staged a protest outside the centre yesterday over the move.

With little money in their pockets, the patients who are mostly senior citizens get subsidised treatment three times a week at the centre, which opened in 1993. More than 40 are currently seeking dialysis treatment there.

“Please help us. We do not want to move. This place is in a strategic location as it is in town with public transport nearby. We cannot afford to travel far,” said amputee A. Kolendaisamy, 60.

NKF chief executive officer Chua Hong Wee said their hands were tied as their registration certificate, which expired last August, was not renewed by the Health Ministry due to safety reasons.

“We have been looking for a suitable location over the last six months but to no avail. It is too expensive to rent in this area as an NGO. We have exhausted all our avenues,” he explained.

The centre is located at the National Welfare Foundation’s Bangunan Ehsan which has been used since late last month as a temporary shelter for the homeless.

Read article in full here

Let Specialist Visit Centres


Letter by Evelyn Yee, Penang, Sun2Surf.com, 8th April 2011


I WAS shocked to read about the closure of a haemodialysis centre in Simpang Empat, Penang.

Someone wrote to say that the Health Ministry disallowed such centres to function because they had no nephrologists.

The public knows that many patients cannot afford the financial costs of dialysis for life.

The government does not have enough haemodialysis machines to meet the rising number of renal failures. Hence these patients depend on the kindness of charitable and non-governmental organisations (NGOs) to help them.

Surely the least the ministry can do is to provide these centres with its nephrologists who can make weekly visits to the centres, similar to what is being done for district hospitals where there are no residential specialists of certain disciplines.

So for now, where can the patients from this "closed down" centre go? All the government dialysis centres are full, and other charitable dialysis centres are likely to be full too.

Does anyone have an answer?

Ensure continued care for renal patients

Letter by SSLim PJ, The Star Online, 8th April 2011

THE recent discussions generated by the closure of a dialysis centre in Penang is timely and welcome.

However, we must keep in mind that whatever action taken to regulate this area of healthcare must benefit the patients ultimately.

Let’s not assume that the closure of dialysis centres will always mean depriving patients of treatment and may lead to the death of the patients.

I suggest that the authorities prioritise continuation of treatment for patients in their noble efforts to regulate the provision of dialysis services.

They may do this by licensing all existing centres, but set them a “to do” list for improvements that are required for the renewal of their licences in two years.

This will have the desired effect of ensuring the continuation of treatment while improvements are made.

Among the many requirements for the licensing of dialysis centres, the physical ones can be readily met. The more difficult ones are the need for visiting nephrologists and for renal trained nurses.

Read letter in full here

Get nephrologists to visit centres

KAS, Shah Alam, Your Opinions @The Star Online  6th April 2011

ONCE a person has contracted a chronic kidney problem which requires haemodialysis treatment, he is faced with Hobson’s choice – seek treatment or die.

He will also be burdened with other inherent problems which entail a change in lifestyle.

Each patient needs to undergo haemodialysis treatment three times a week and each treatment takes four hours.

To many poor or lower income patients, the major problem is finance because the cost for each treatment may vary from RM150 to RM250 depending on where the treatment is conducted. Apart from this there is also the travelling expenses involved.

The cost of treatment at RM150 per session three times weekly, 12 times a month and 144 times a year, amount to RM23,400 a year without taking into consideration the travelling expenses. At RM250 per session, the amount is RM39,000 a year.

Read letter in full here

Support charitable healthcare centres 


Letter by Vijay Shanmugam, The Sun 4th April 2011


I WAS shocked to read that the Health Ministry had decided to issue a one-month notice to close down the Pertubuhan Haemodialysis Seberang Perai Selatan in Simpang Empat, Seberang Perai, Penang.

According to a report five Health Ministry officials had visited this centre on March 30 and ordered it to close by May 1 or be fined RM500,000. This centre is run using contributions from the public. It does not rely on any financial aid from the government. I do not know the reason and the rational as to why the ministry had to come up with such an inconsiderate and inhumanitarian decision.

This centre is doing a fine job by saving lives of poor kidney patients who cannot afford the expensive cost for dialysis. Renal failure patients need the treatment three to four times a week. Each treatment costs from RM180 to RM200.

Instead of closing down the centre the ministry should help the centre meet any criterion that it lacks, thus encouraging more charitable centres.

Health costs have sky-rocketed and the lower-income group has been badly affected. Charity organisations involved in healthcare are a blessing for the needy. Every man, woman and child is guaranteed under the Federal Constitution their rights to have free medical care. By right the government should provide these kind of free medical support and centres.

The government should support any charitable organisation that voluntarily fulfils these noble roles instead of slapping them with closure orders and heavy fines

Read letter in full here

No reason to shut dialysis centre

theStarOnline 4th April, 2011

IT was shocking to read “Blow to kidney patients” (Sunday Star, April 3), about a haemodialysis centre in Penang being ordered to shut down for not having a resident nephrologist.

According to the report, the centre, run by a charitable organisation, offers free treatment for the poor, with trained nurses monitoring the progress of the patients.

The financially-tight patients undergoing dialysis at this centre can count their lucky stars as they are getting free treatment. Other dialysis centres often charge for each session.

More often than not, end-stage renal failure (ESRF) patients come from the low-income group, their paycheck just sufficient to see them through their daily lives. How can they afford expensive treatment?

According to the chairman of the affected centre, the state has 11 nephrologists in total.

The state in which I reside has much fewer than that number. I do not see a reason to shut down the centre for lack of a resident nephrologist. Not all dialysis centres have one.

Read full article here