The re-emergence of short daily haemodialysis

DT Plus (2011) 4 (suppl 3): iii29-iii31. doi: 10.1093/ndtplus/sfr122

Brigitte Schiller-Satellite Healthcare, Medical Affairs, San Jose, CA, USA

Abstract

Thrice weekly in-center hemodialysis is the standard of care for dialysis patients with end-stage renal disease (ESRD). However, there is ongoing debate as to whether more frequent hemodialysis, with its readier management of both toxin and fluid removal, benefits patients. New evidence from recent studies, both in center dialysis and in home haemodialysis patients, adds further confirmation of improved cardiovascular outcome and quality of life in patients undergoing short daily hemodialysis. A paradigm shift in ESRD care delivery may be facilitated due to new technology enabling daily therapy at home.

Discovery could help develop new treatment options for organ rejection

Nephrology News and Issues 17/4/2012

http://www.nephrologynews.com/kidney-transplant/article/discovery-could-help-develop-new-treatment-options-for-organ-rejection

Loyola researchers have reported findings about a molecule that helps ramp up the immune system in some cases and suppress it in others.

Researchers studied mouse cells grown ex vivo in laboratory dishes and focused on a molecule called transforming growth factor beta (TGF-β). TGF-β is known to be a powerful regulator of the immune response -- generally suppressing the strength of the response. In this study, however, the researchers demonstrated that TGF-β can amplify the immune response and result in a more effective targeted response under specific conditions.

 "Understanding the dual role of TGF-β could help in the development of drugs to either activate or suppress the immune system, as needed," said senior author Makio Iwashima, PhD, an associate professor in the Department of Microbiology & Immunology of Loyola University Chicago Stritch School of Medicine.

The study is published online ahead of print in the Journal of Immunology.

To our Tamils, Skihs & Malayalees

Brothers and Sisters

Wishing you 

A Blessed and Joyous

Puthandu, Vaisakhi & Vishu

Best Wishes and Warmest Regards

Malaysian KidneySPA

Daulat Tuanku! 

Daulat Tuanku! 

Daulat Tuanku!

Woman receives kidney from husband's mistress

Malaysian Chronicle

http://www.malaysia-chronicle.com/index.php?option=com_k2&view=item&id=31496:woman-receives-kidney-from-husbands-mistress&Itemid=4

 A 34-year-old Turkish woman discovered that she would die without a kidney transplant, her unlikely saviour came in the form of her husband's mistress.

Meliha Avcı's kidneys had both failed her 12 years ago, resulting in the need for dialysis three times a week, four hours per session.

During this time, her husband of 16 years, Mehmet Avcı, met another woman while accompanying his wife on a hospital trip.

After getting to know 34-year-old Ayse Imdat, Mehmet asked her to move to his mother's home, under a pretence that she was the new babysitter for the couple's son.

After his wife found out about the affair, she pleaded with her husband to marry Imdat after she died.

As Meliha's condition continued to deteriorate, Imdat made the suggestion that Meliha be saved with one of her kidneys, as the two women shared the same blood type.

Upon Imdat's insistence that she take her kidney, Meliha agreed.

"We shared a husband, and now we shared a kisney," she reportedly said.

She added that she has her husband and Imdat to thank for completely changing her life. Imdat on her part has promised to continue taking care of Meliha after the surgery.

-YourHealth, AsiaOne

Anatomic configuration affects the flow rate and diameter of porcine arteriovenous fistulae

Mahesh K Krishnamoorthy^1,2, Rupak K Banerjee^1,3,6, Yang Wang², Ann K Choe⁴, David Rigger⁵ and Prabir Roy-Chaudhury^2,6

1. ¹Department of Mechanical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
2. ²Division of Nephrology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA
3. ³Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
4. ⁴Department of Radiology, University of Cincinnati, Cincinnati, Ohio, USA
5. ⁵Vascular Laboratory, University of Cincinnati, Cincinnati, Ohio, USA

Kidney International (2012) 81, 745–750; doi:10.1038/ki.2011.468; published online 22 February 2012

Abstract

Although arteriovenous fistulae are currently the preferred form of vascular access, early failure is a significant problem. Since wall shear stress is thought to play an important role in the pathogenesis of early failure, and this stress varies markedly in different fistula configurations, we assessed the influence of configuration (curved or straight) on longitudinal changes of flow rate and lumen diameter in a porcine fistula model. 

Fistulae were created in eight pigs between the femoral artery and vein, with each animal having a curved and a straight configuration on opposite sides. Velocity measurements were obtained by ultrasound at the time of surgery and at intermediate time points up to 28 days. 

Quantification of both the configuration and the internal diameter of the fistulae was determined by CT scans. The overall rate of increased flow during each time interval (0 to 2 days, 2 to 7 days, and 7 to 28 days) was more pronounced with the curved fistulae. Moreover, the luminal diameter of curved fistulae had dilated more from the time of surgery to 28 days as compared to the straight fistulae. 

Thus, anatomical configuration of fistulae plays a major role in flow-mediated dilatation. Identifying the optimal configuration may result in increased diameter and consequently blood flow, and perhaps reduce the incidence of early failure.

Read full article here

Prevalence of sleep apnea and excessive day time sleepiness in patients with end-stage renal disease on dialysis

Hamdan Al-Jahdali

Department of Medicine, Sleep Disorders Centre, King Saud University for Health Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia

Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2012 Apr 3];23:251-61

Abstract

Sleep apnea (SA) and excessive daytime sleepiness (EDS) are common sleep disorders among patients with end-stage renal disease (ESRD). This cross-sectional study, carried out in two dialysis centers in Saudi Arabia, assessed the prevalence of sleep apnea and sleepiness in Saudi patients with ESRD who are on maintenance dialysis with either peritoneal or hemodialysis. 

We used questionnaires to assess the prevalence of SA and EDS. The association between sleep apnea, EDS, and other sleep disorders, the underlying causes of renal failure, and other demo graphic data were also examined. Among 227 enrolled patients, the mean patient age was 55.7 years ΁ 17.2 years; 53.7% were male, and 46.3% were female. The overall prevalence of SA as defined by the Berlin questionnaire (BQ) was 37% in males and 34% in females, which was not a statistically significant difference (P = 0.459). Sleep apnea was significantly associated with age, neck size, afternoon and evening hemodialysis shift, obesity, diabetes, and hypertension (P-values, 0.001, 0.029, < 0.0001, < 0.0001, < 0.008, 0.002, and < 0.001, respectively). 

Sleep apnea was also significantly associated with other sleep disorders such as restless leg syndrome, insomnia, habitual snoring, and EDS (P-values, < 0.001, < 0.001, < 0.001, and < 0.001, respectively). The prevalence of EDS was 44%, and EDS was significantly more prevalent in patients undergoing peritoneal dialysis (P < 0.001); it was also associated with older age, diabetes mellitus, and other sleep disorders. SA and EDS are common in dialysis patients and are significantly associated with other sleep disorders.

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