Page 20 - NKF-KL-issue-14-Autumn-2016-for-web

Medical Matters

Don’t try this at home!
Any changes to treatment reported in Medical Matters were carried out under
Bioengineering: the future of dialysis medical supervision. Never make changes to your medication by yourself. If you
access? are worried about your treatment, talk to your renal unit team.
Bioengineered human blood vessels
seem to offer an alternative to have a fistula, and were more likely Dialysis outcomes improving, but
synthetic grafts for haemodialysis to be receiving EPO and phosphate could do better
access, according to two small studies binders. The authors recommend that
A global study reports that dialysis
involving 60 patients in the USA and these differences should be taken into
patients are living longer, but identifies
Poland. One year after implantation, account when planning treatment.
important variations between
89% of the bioengineered vessels Clinical Kidney Journal 2016;9:486-93 countries. Survival is longest in Japan,
gave safe and effective dialysis
followed by Europe, and worst in the
access, with lower rates of clotting
USA, even though US patients are on
than seen in synthetic blood vessels.
average 2-3 years younger and Japan
The blood vessels are bioengineered Little evidence for acupuncture has very few transplant patients. The
from human vascular cells grown on in CKD authors comment that some of the
a biodegradable polymer framework, There is very little evidence that any differences can be explained by more
type of acupuncture can improve
which degrades over about eight frequent use of fistulas in Japan and
symptoms of chronic kidney disease
weeks. The human cells are then some European countries (including
and dialysis, such as pain, fatigue,
washed away, leaving a blood vessel the UK), and longer or more frequent
depression, sleep disturbance and
made of proteins that do not cause dialysis in countries such as Germany,
itching. These are the conclusions of
tissue rejection and can be implanted an analysis of 24 randomised trails Australia and New Zealand.
into a patient’s arm. including a total of 1787 patients. Lancet 2016;388:294-306
Lancet 2016;387;2026-34 According to the authors, the
studies were short term and poorly Smoking increases heart disease
Intravenous iron boosts designed, and many did not report risk in diabetes
haemoglobin potential harms. The analysed studies
examined conventional acupuncture, Smoking remains one of the most
An analysis of 24 clinical trials important modifiable risk factors
electro-acupuncture, acupressure, and
endorses current guidelines on iron moxibustion. for heart problems in people with
replacement by concluding that, diabetic kidney disease. This is the
Cochrane Database of Systematic
compared with oral iron tablets, message of a study including 671 type
Reviews 2016;6:CD009440
intravenous iron more effectively 2 diabetes patients (average age 65)
achieves haemoglobin targets in with protein in the urine. At the end
patients with stages 3-5 chronic kidney of three years, 28% of smokers had
disease, including those on dialysis. Lifetime risk of CKD had a cardiovascular event (e.g. heart
Patients receiving intravenous iron are attack or stroke) compared to 14% of
Overall, four out of 10 people with
more likely to experience hypotension non-smokers.
eGFR > 60 at age 50 years will have
(abnormally low blood pressure), but
developed chronic kidney disease American Journal of Cardiovascular
less likely to suffer gastrointestinal side
(CKD) in their lifetime (i.e. up to age Diseases 2016;6:66-9
effects.
90), according to a study including
Shepshelovich D, et al. American 3362 people (52% women). Not
CKD patients are not taking their BP
Journal of Kidney Diseases 2016 surprisingly, the risk is highest in
tablets
people with high blood pressure,
Long live the haemodialysis diabetes and obesity—all risk factors One year after starting treatment,
for CKD. Over one in two people nearly one third of chronic kidney
difference?
(56%) with all these risk factors at age disease (CKD) patients are not
An analysis of a large European
50 will develop CKD compared with taking the doses prescribed or have
database has identified important
one in three people (34%) without any stopped taking their blood pressure
differences between male and female
risk factors. According to the authors, tablets. The researchers add that CKD
haemodialysis patients. Compared
their findings highlight the importance patients are less likely to continue their
with men, women were likely to be
of early intervention to address CKD tablets if their initial treatment is with
older, with a higher body mass index,
risk factors. a diuretic.
lower haemoglobin and less weight
gain between dialysis sessions. McMahon GM, et al. Nephrology Patient Preference and Adherence
Women were also less likely to Dialysis Transplantation 2016 2016;10:1121-9
Want to know more?
The source of the studies is listed by publication title, year of publication, volume and page numbers (or for early-online studies: first author’s
family name and initials, publication title, date). For more details about a study, go to www.ncbi.nlm.nih.gov/pubmed/citmatch. Complete the
boxes and click ‘Search’. There may be a link to the complete article, but access may involve a fee.
20 Autumn 2016 www.kidney.org.uk HELPLINE 0845 601 02 09