A day to celebrate

If it weren’t for your kidneys where would you be?

You’d be in the hospital or infirmary,

If you didn’t have two functioning kidneys.

(with apologies to John Clarke aka Fred Dagg)

Happy World Kidney Day everyone.

This blog started off life as $100 Dialysis because I believe that if we can make a computer for $100 then surely we can do the same for dialysis!  Dialysis is a life saver, yet its cost kills as so many can not afford the treatment.

There’s some good news in the dialysis world.

Schematics of the zeolite nanonfibres and how they may look in practice

Schematics of the zeolite nanonfibres and how they may look in practice

Just last week the MANA – International Centre for Materials NanoArchitectionics announced  they have developed a method to remove waste from the blood using an easy-to-produce nanofibre mesh.  Importantly, they claim it is cheap to produce.  Details were published in Biomaterials Science (free access).  Despite the photograph, there have been no human studies yet, but I expect that won’t be too long in the future.

Dr Victor Gura and the Wearable Artificial Kidney (WAK)

Dr Victor Gura and the Wearable Artificial Kidney (WAK)

In the meantime, the FDA gave approval last month for human trials of a wearable dialysis device produced by Blood Purification Technologies Inc (the WAK).

New Zealand, and Dunedin and Christchurch in particular, lead the way in Home Dialysis.  One Dunedin tradesman has even taken Home Dialysis a step further and turned it into portable dialysis by dialysing in his work van during his lunch hour. Of course, those needing a holiday may go on the road in specially equipped camper vans (http://www.kidneys.co.nz/Kidney-Disease/Holiday-Dialysis/).

Cause for celebration in the New Zealand kidney community was the gong (Office of the New Zealand Order of Merit) given to Adrian Buttimore who for 40 years managed Christchurch’s dialysis service.

These are just a few pieces of good news as doctors and scientists work around the world to improve the lives of dialysis patients.

_________________

Hot off the Press… I couldn’t resist adding this…. Pee, the answer to the world’s energy problems. http://www.bbc.com/future/story/20140312-is-pee-power-really-possible

 

Happy WKD

I love living in NZ, it enables me to be the first in the world to wish everyone a happy World Kidney Day.  May your kidneys never lack oxygen, be always filtering, and ever distant from the nephrologists biopsy needle!

Let me remind you:

 If it weren’t for your kidneys where would you be

You’d be in the hospital or mortuary

If you didn’t have functioning kidneys

(with apologies to John Clarke)

Better, take a look at this video too (from www.worldkidneyday.org):

This year’s theme for World Kidney Day is “Kidneys for Life: Stop Kidney Attack.”  If you’ve not caught up with my myriad of other posts, Kidney Attack (aka Acute Kidney Injury) is the rapid loss of kidney function and/or structural damage brought about by toxic damage to the kidneys or temporary loss of blood to the kidneys.

This week I published a blank post entitled “A list of effective treatments for Kidney Attack.”  There is no known treatment – merely acute dialysis, a support for the kidneys, not a treatment. There is no treatment because detection is delayed and difficult and because not enough research has been done.

The good news is that I and many others around the world are engaged in finding new ways of detecting this disease.  Before I list some of the good news I want you all to repeat after me “30,000 kidney attacks a year in New Zealand, 1300 deaths.”  If you live out of New Zealand you may say “Two million die of Kidney Attack each year.”  Now tell someone else … anyone … the next person you see (not your boss if you read this at work).  Well done, thank you.

So, for some good news:

Hooray – we have for the first time means of measuring structural damage to the kidneys.  For us, this is the X-ray moment.  Imagine life before the X-ray – all that could be said is that you could no longer bowl a bouncer (throw a curve ball), play the piano, or dance a jig (whatever that is).  In other words, all that could be said was function was lost.  With the X-ray actual injury to the bone could be observed.  Importantly, it could be observed before function was lost permanently.  The measurement of various molecules we make in the urine are to us like the X-ray – they are measures of injury to the kidney (we call them biomarkers).

We are busy investigating how best to use these biomarkers and have been discovering:

  • which are best after Cardiac surgery, Contrast procedures or in the ICU (all risk factors for Kidney Attack),
  • what the optimal timing is for measurement of each biomarker,
  • how to use the biomarkers in Randomised Controlled Trials aimed at testing new treatments,
  • which biomarkers are best for detecting Kidney Attack when someone has additional co-morbidities like sepsis, and
  • which biomarkers add the most value to what we already know and enable the best assessment of risk of poor outcomes.

In the meantime, some of my work has shown how we can better utilise the information we already have with urine output and the mainstay of nephrology, the plasma creatinine measure:

  • the discovery that even when creatinine does not change after Cardiac Arrest there is likely to be Kidney Attack (it had been thought that it was only when creatinine was elevated there was a problem),
  • a combined measurement of plasma & urine creatinine and urine flow rate (called creatinine clearance) over a short period of time in the ICU helps identify Kidney Attack patients otherwise missed,
  • how best to estimate someone’s “normal renal function” so that a judgment can be made if it has recently changed, and
  • how best to utilise creatinine in Randomised Controlled Trials to tell if an intervention is improving kidney function.

All these add up to progress.  My own and my group’s work over the last 6 years has received funding from a number of funders (see logos attached) some of which originate with your tax dollar – hence my commitment to keep the tax payers informed. I am indebted to my boss, Professor Zoltan Endre, not only did her hire me (I think he mistook Physicist to mean Physician!), he has taught me heaps and consequently we have formed a strong collaboration. Our work has also depended on the good staff of Dunedin and Christchurch Hospital ICU’s, Christchurch Emergency Department, and the Canterbury Health Laboratories.  Without the commitment to research these people make, progress would not have been made.  Most important are the patients or their families who have consented for us to take extra samples or enroll them in a trial. The decision to participate is often made at a difficult time – families wrestling with issues of possible death or long term health issues of their loved ones.  I salute them.  I thank them.  New hope, new medicines, new tests, and new procedures are built on the courage and generosity of the patients and families who participate in research.

Sponsors who have provided grants (top row), or run assays (middle row), or provided free accommodation (me!) for the Christchurch Kidney Research Group, University of Otago.

Sponsors who have provided grants (top row), or run assays (middle row), or provided free accommodation (me!) for the Christchurch Kidney Research Group, University of Otago.

A list of effective treatments for a Kidney Attack

blank-page

1300

Today’s number brought to you by Funeral Directors of New Zealand.

 

1300

 

Kidney Attack (aka Acute Kidney Injury) is responsible for at least 1300 deaths a year in New Zealand.  It used to be said that people died with Acute Kidney Injury rather than of Acute Kidney Injury.  The paradigm has shifted in the last few years.  Now it is recognised that an acute attack on the kidneys is a killer all by itself.  Of course, the attack is still most often precipitated by another event – heart attack, serious infection, cardiac surgery etc etc etc.

How did I come up with 1300?

A comprehensive study of nearly 20,000 hospital admissions showed that there was a 4.1 times increase in risk of death in hospital for those with Kidney Attack compared to those without.  The Ministry of Health in New Zealand do not report hospital mortality data, but a very helpful MOH information analyst, Chris Lewis (thanks Chris), dug out some numbers for me.  There were 7582 patients out of 548,965 discharges from public hospitals in 2011/12 who were “Discharged Dead”, Died in the emergency department, or Discharged for organ donation.  This does not necessarily capture all deaths (eg Private Hospitals are not included).  However, it gives me enough to go on using the proportion who died overall, the increased odds of death with Kidney Attack (4.1), the estimated number of Kidney Attack patients (30,000), and a little bit of math. The result is at least 1300 Kidney Attack deaths.

 

30,000

Today’s number brought to you by <You could have your name here, contact the blog writer to arrange sponsorship>

30,000 – the number of Kidney Attacks in New Zealand each year.

30000

Where does this number come from?

Research in other parts of the world has Kidney Attack, or Acute Kidney Injury, at ~5% of all hospital admissions.  Estimates range from 2% to >9%.  5% is the generally accepted incidence.  New Zealand has more than 1.1 million hospital admissions a year, with 410,000 of them day cases.  5% of the 690,000 longer stays is 34,500.  30,000 is, therefore, a conservative estimate.  The NZ health stats don’t report these numbers because they are not collected.  They are not collected because nearly always the cause for hospital admission is something else – heart attack, infection etc.  These “something elses” all can cause Kidney Attack.   Kidney Attack raises the chances of dying in hospital 4 fold.

I’d like to find the NZ incidence of Kidney Attack instead of relying on estimates based on overseas numbers.  In particular, I’d like to see if there are any differences related to ethnicity.  I’m searching for funding to do this.

How many times do you wash your blood each day?

Stop Kidney Attack.  See this great short video from last year’s World Kidney Day as to why it is so very very important to look after your kidneys. Or as Fred Dagg may sing “If it weren’t for your kidneys, where would you be? You’d be in the hospital or infirmary.”

Lives to be saved on March 14th 2013

Kidney’s are being attacked every day.  Yours could be next.  So common and deadly are kidney attacks that the theme for this year’s World Kidney Day is “Kidneys for Life: Stop Kidney Attack!

WKD2013-Campaign-Image

Kidney Attack, or as Physicians and scientists call it “Acute Kidney Injury,” is a syndrome which affects several thousand people a year here in New Zealand.  It is notoriously difficult to detect and can be deadly.  For more than 5 years now I have been researching how better to detect, and ultimately to treat, Kidney Attack.  Over the past 12 months I have posted several times about this – here are links to just a few of the previous posts:

There will be more as we lead up to World Kidney Day 2013.