Is it possible to turn unusable organs into transplantable organs? Ex vivo pulsatile machine perfusion of donor organs is a proven technique for superior organ preservation, reduced delayed graft function, and reduced ischemia-reperfusion injury. This has been the standard of care for over four decades in high-volume transplant centers.
The perfusate solutions used for kidneys are typically crystalloids with several additives, such as antioxidants, electrolytes, antibiotics, nutrients, vasodilators, and corticosteroids. The perfusion temperatures are typically kept at 4°C to 8°C to help minimize cell metabolism and hence, have a better preserved organ. However, the significant drawback of this hypothermic perfusion
Fowler: In December 2000, I began to notice lower back pain. Initially, I attributed the pain to carrying large amounts of wood to our fireplace, but in the back of my mind, I knew the source of my pain could be something else. My deceased mother had polycystic kidney disease (PKD). I saw her suffer from constant back pain due to the enlarged size of her kidneys caused after PKD. Up until this time, I never had the courage to determine if I too had PKD. I was too scared after seeing
What in your field hasn’t changed? What could be improved? What could be made less invasive? The impetus to improve on the way we currently do things will be a driving force in 2018.
This series of questions several years ago led to the Ellipsys® system for percutaneous placement of proximal radial arteriovenous fistulas for dialysis access. The system requires 2 mm arteries and veins. With the patient under sedation and local anesthesia, the device is placed through an antecubital venipuncture and threaded to the point where the vein lies adjacent to the proximal radial artery. The device
The ASN communications team interviewed ASN President Mark D. Okusa, MD, FASN, about challenges and goals for nephrology in the near future.
WHAT ISSUES OR CHALLENGES DO YOU ANTICIPATE ASN AND THE DISCIPLINE OF NEPHROLOGY WILL NEED TO ADDRESS OVER THE COURSE OF THE NEXT YEAR?
The discipline of nephrology is at a crossroads. We face challenges that in some instances are common to other professional societies (e.g., health care delivery) and in other instances are unique to nephrology. ASN continues to staunchly advocate for the discipline of nephrology, establishing programs that undergird the future
Intensive home hemodialysis (IHHD) has become an apparent alternate treatment option for ESRD patients with several clinical benefits. Several studies have shown that, compared with in-center hemodialysis (HD), IHHD provided survival advantage, improvements in BP regulation, regression of left ventricular hypertrophy, restoration of left ventricular ejection fraction, normalization of phosphate control, better quality of life related to kidney disease, decreased recovery time from dialysis treatments, and improved pregnancy outcomes. Quality of sleep and sleep apnea have also been improved, especially in the case of nocturnal home HD (1, 2). Moreover, with more frequent therapies, it also
It is said that the only constant in life is change. Throughout my career, health care policy changes have often been seen as harbingers of more difficult times for physicians in American medicine. Many of these changes, such as Medicare and Medicaid reform, the Health Maintenance Organization experience of the 1980s and 1990s, the consolidation of health insurance companies, and the enactment of the Affordable Care Act, had major impacts on the provision of health care. However, on balance, these changes have had positive effects, including allowing more patients access to see their physicians and to participate in preventive care
Understanding DNA has helped science make major strides in understanding and treating disease.
But “we [still] can’t explain most of the variability leading to most human disease,” said Andrew Feinberg, MD, MPH, director of the Center for Epigenetics at Johns Hopkins University in Baltimore. Changes in the genetic code explain only about 20% of disease risk, noted Feinberg, who presented a State-of-the-Art lecture at Kidney Week 2017.
Epigenetic studies may help unravel how the environment and gene–environment interactions contribute to that remaining disease risk. Already there is emerging evidence that epigenetic changes may contribute to kidney disease. Feinberg and others
Late 2017 found a push in the Senate to pass a companion bill to H.R. 3166, which would allow “deemed status” of ESRD facilities. Deemed status allows use of a survey by an accreditation agency to substitute for a survey by a state agency in outpatient dialysis facilities and could speed up the accreditation process.
The original law extending Medicare coverage to patients with ESRD prohibited the Centers for Medicare & Medicaid Services (CMS) from granting deemed status to accreditation agencies. If the Senate passes the companion bill and it is signed into law by the President, accreditation agencies will
Exercise during dialysis reduces the length of stay for subsequent hospitalizations by three days, according to a recent study.
Patients on dialysis are often sedentary, which may contribute to poor outcomes. Yet efforts to engage patients in exercise outside of dialysis sessions have high drop-out rates, said Daniel March, PhD, a clinical trial facilitator at the University of Leicester in the United Kingdom. This has led to several small studies of whether engaging patients in exercise during dialysis would improve patient outcomes. So far, they have suggested that exercise is feasible and may improve patients’ physical condition (Anding K, et
Most dialysis in the developed world occurs as three sessions per week, typically about 4 hours per session. This provides us with fairly dismal outcomes—yes, we keep people alive for a period of time (hopefully for some, until they are transplanted)—but our outcomes are worse than breast cancer. It is not enough to claim that there have been improvements; we still have a long way to go. Most people working in nephrology accept that this is not something we should sit back and accept—we must strive for improved mortality for our patients. The question arises then: Is it our regimen