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.

Read full article here

Patients Receiving Dialysis Are at a Heightened Risk for Sudden Cardiac Death 

Northwestern Memorial Hospital, 

Nov 14, 2010 - 12:09:54 PM

HealthNewsDigest.com

Understanding sudden cardiac death in dialysis patients will aid in developing better standards for prevention

(HealthNewsDigest.com) - CHICAGO, Nov. 14, 2010 -- Approximately 500,000 Americans require dialysis to treat kidney disease; of that population nearly half of the deaths that occur are caused by cardiovascular disease. Dialysis patients are at elevated risk for sudden cardiac death, but physicians are unclear why these deaths occur because little research has been done to examine how to best manage heart disease in this high-risk population.

Northwestern Medicine cardiologist Rod Passman, MD, medical director for the Center for Atrial Fibrillation at the Bluhm Cardiovascular Institute of Northwestern Memorial Hospital will present a paper at the American Heart Association's Scientific Sessions being held November 13 through 17 in Chicago about sudden cardiac death in dialysis patients. Passman is working to increase understanding within the medical community about this heightened mortality risk and how to prevent sudden cardiac death among this rapidly growing patient population.

"Dialysis patients have extraordinarily high mortality rates with cardiac disease accounting for 43 percent of deaths in this population; data indicates that approximately 27 percent of the mortalities are due to sudden cardiac death," said Passman, who is also an associate professor of cardiology at Northwestern University's Feinberg School of Medicine. "Patients on dialysis are excluded from clinical trials examining sudden cardiac death because of their kidney disease. The lack of research complicates clinicians' ability to understand the connection between renal disease and cardiovascular disease. The medical community needs to stop neglecting this community of patients because it is a rapidly growing group.

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Why Assistive Technology Is Needed for Probing of Dry Weight
Arjun D. Sinha
Division of Nephrology, Indiana University School of Medicine, Indianapolis, Ind., 


13th International Conference on Dialysis: Advances in Chronic Kidney Disease 2011
Blood Purification, S. Karger AG, Basel

Abstract

Despite advancements in dialysis therapy, the subjective clinical examination still remains the standard of care in managing volume removal in chronic dialysis. While there is no definitive trial establishing that dry weight management guided by an assistive technology is superior to the clinical method, there is ample evidence that there is a need for these technologies to be developed. Mortality, cardiovascular morbidity, and sequelae of volume overload remain far too common under the current paradigm. Recent studies indicate that the mortality associated with volume overload is independent of hypertension, suggesting that if mortality is to be improved, then a measure of volume independent of blood pressure must be developed. Even when considered as an integrated whole, the clinical method is inaccurate at setting dry weight when compared to the use of assistive technologies. 

A recent secondary analysis of a randomized trial showed that relative plasma volume (RPV) slope is responsive to change in volume status and may be useful in guiding therapy for hypertension. The only large randomized trial to investigate the ability of an assistive technology to manage volume removal in hemodialysis patients is the Crit-Line Intradialytic Monitoring Benefit Study, which found harm associated with RPV monitoring. However, the design of this trial did not require the RPV group to actually receive this intervention. Assistive technologies offer an opportunity to improve on the subjective clinical exam for the setting of dry weight, but well designed and adequately powered clinical trials are needed.

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Drug Dosing by the Numbers for Patients with Chronic Kidney Disease

By Oregon State University
Feb 8, 2011 - 3:00:03 PM
HealthNewsDigest.com


CORVALLIS, Ore. – Pharmacists at Oregon State University have developed a new approach to developing drug dosages for patients with chronic kidney disease that shows promise for improving the therapeutic value of drugs while minimizing adverse effects.

The process, which provides a systematic analysis of the complex interplay among biological, chemical and pharmaceutical processes in the patient’s body, was created by Ali Olyaei, a professor in the OSU College of Pharmacy, who also has an appointment at Oregon Health and Science University.

“Chronic kidney disease (CKD) can affect nearly every organ system in the body,” said Olyaei, who specializes in renal and transplant medicine at the OSU/OHSU Division of Nephrology and Hypertension in Portland. “Patients with CKD require a careful and thorough evaluation when medications are being prescribed.”

Patients with chronic kidney disease face significantly greater risks from medications than patients with normal kidney function – as much as three times higher, according to researchers at OSU. Kidney disease compromises the body’s ability to absorb, metabolize and eliminate drugs. Compounding the dangers are the multiple health problems that often accompany kidney disease.

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To good to be true.....

Researchers Unlock the Potential for Exploring Kidney Regeneration

ScienceDaily (Feb. 1, 2011) — Researchers  have identified a cell in zebrafish that can be transplanted from one fish to another to regenerate nephrons, providing the potential to improve kidney function.

It is estimated that up to 10 percent of the U.S. population may have some form of renal disease, with 450,000 patients with end stage renal disease (ESRD) requiring hemodialysis. Researchers at Brigham and Women's Hospital, Massachusetts General Hospital and the University of Pittsburgh have identified a cell in zebrafish that can be transplanted from one fish to another to regenerate nephrons, providing the potential to improve kidney function. These findings are published in the February 3 edition of Nature.

Currently, the five-year survival rate for patients on dialysis is 33 percent, worse than the survival rate for many forms of cancer. This epidemic of renal failure is projected to grow as obesity, poor nutrition and lack of exercise increase the incidence of diabetes and hypertension. There is also evidence that intra-uterine growth retardation and low birth weight/prematurity reduce the number of nephrons in each kidney thereby increasing the risk of  hypertension and renal failure when these premature infants become adults. The cost of treating end stage renal disease is currently 32 billion dollars annually and is likely to double in the next decade.

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