Tag Archives: Diabetes

Hot oil baths and other things to do on World Kidney Day 2015

“In ancient times the Persian philosopher Avicenna [Ibn Sina] noted that urine may be retained in crisis of fever (s393) and prescribed hot oil baths (s413)(1). Unfortunately, apart from the supportive therapy of dialysis, there has been little progress since in the treatment of acute kidney injury (AKI).”(2)

Given that getting AKI at least doubles your chance of dying in hospital “no progress” is a major health issue.

Today is World Kidney Day and I get to post quite possibly the first blog post in the world on this day. I believe Avicenna would be thrilled with the attention paid to the organ which delivers urine. He may not be so thrilled that hot oil baths have been abandoned. Of course there is the obvious safety issues of scalding and drowning. Also, as Herod the Great found out, syncope (sudden loss of consciousness) is also a possible side effect (probably just because the heat constricted his blood flow [vasoconstriction] causing too little oxygen to reach his brain [cerebral anoxaemia].(3) Nevertheless, I think Avicenna is the type of person who would have welcomed a randomised controlled trial of hot oil baths verse today’s standard treatment.

91467137

The statue of Avicenna (Ibd Sina) to be found in Hamaden, Iran. http://www.panoramio.com/photo/91467137

If you don’t fancy a hot oil bath this World Kidney Day, then there are other things to do to minimise the possibility of Acute Kidney Injury. Have you got high blood pressure, diabetes or Chronic Kidney Disease? Be warned, ~10% of the adult population have Chronic Kidney Disease, many of whom are not aware, and many more are at risk of developing it. All add to your risk of multiple illnesses any one of which can trigger acute kidney injury. If you happen to have a heart attack or sepsis (very serious infection) you are more likely to get AKI and more likely to die because of these underlying conditions.

So, on the assumption that readers of this blog are smarter than the average bear, I shall give you some sound advice – for the sake of yourselves and your family LOOK AFTER YOURSELF (yes, I’m shouting and therefore sinning against the internet protocol police – but this is important). Cut the sugar intake, quit smoking, take a walk around the block. It ain’t rocket science (one of the simpler sciences that involves cylinders with fins and lots of explosives) – it’s easier than that.

Former World Kidney Day posts

2014 A day to celebrate https://100dialysis.wordpress.com/2014/03/13/a-day-to-celebrate/

2013 Happy WKD https://100dialysis.wordpress.com/2013/03/14/happy-wkd/

2012 I am a pee scientist https://100dialysis.wordpress.com/2012/03/07/i-am-a-pee-scientist/

References

  1. Avicenna: The Canon of Medicine [Internet]. 2nd ed. New Yourk: AMS Press; 1973. Available from: http://archive.org/stream/AvicennasCanonOfMedicine/9670940-Canon-of-Medicine_djvu.txt
  2. Pickering JW, Endre ZH: The definition and detection of acute kidney injury. Journal of Renal Injury Prevention 2014; 3:19–23 http://www.journalrip.com/Archive/3/1
  3. Retief FP, Cilliers JFG: Illnesses of Herod the Great. S Afr Med J 2003; 93:300–303
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100 days to do something about diabetes

So the NZ election is about 100 days away.  I want action from the political parties on an issue that in the next decade could affect a million of us, shortening lives, and cost us tens of billions of dollars.  The issue is simply diabetes.  Already 7% of adults have diabetes and another 18.6% is on the way to getting it (“pre-diabetic”). For our medical system  – and all tax payers – this means billions.  For individuals it means shortened lives, amputations, dialysis, blindness etc etc etc.  For employers it means workers taking sick days. For communities and families it means missing grandparents. Surely this is the biggest health issue and one of the biggest economic issues facing the country.  Where is the media about it?  Where are the questions to the politicians? I’ve blogged before about the lack of specific and evidence based policy amongst the political parties.  Where are their new policies?

Here’s a promise – I will publish on this blog any policy of any registered NZ political party specifically aimed to slow the diabetes epidemic. Along side that policy I’ll publish any evidence that is supplied as to why the party thinks that policy will work.

Free advertising – surely all the parties will take this up?

Diabetes in NZ – new scary data

If this doesn’t scare you, you are an Ostrich.  Otago University researcher Dr Kirsten Coppell has released new data on the prevalence of diabetes in New Zealand.  See here for the press release.

Basic data:

  • 7% of New Zealanders over the age of 15 have diabetes
  • 18.6% have pre-diabetes which typically leads to Type II diabetes (therefore the prevalence is likely to go higher than 7%).
  • The pre-diabetes prevalence increases with age – it was 45% in 55-64 year age group.

For those interested in reading the research, it can be found in the NZ Medical Journal.  NZMJ 1 March 2013, Vol 126 No 1370; ISSN 1175 8716  URL: http://journal.nzma.org.nz/journal/126-1370/5555/  Dr Coppell kindly sent me a copy (*I’ve made a few more observations about the details of the study for those who are interested below).

In the meantime, this is rightly hitting the headlines.  We should be afraid, very afraid.  Our politicians must stop arguing over that which is petty (like selling less than half of a small fraction of our assets) and get focussed on what matters.  Next year is election year – we should demand a comprehensive diabetes policy from each political party.  Below is a letter I wrote to the Christchurch Press prior to the last election – not much has changed.  As for you – you can stop attacking the sugar – you don’t need it and it may kill you.  Beware of “fat free” food which substitutes sugar instead.  Get some advice – see your doctor.  Don’t become a statistic in the next survey.

As for the link with my work (Kidney Attack a.k.a. Acute Kidney Injury), the little diagram explains.Diabetes AKI

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*  The study was a representative sample of New Zealanders.  The study size was large (for an NZ study) – 4,721.

From the results

Overall the prevalence of diabetes was 7.0% (95% CI: 6.0, 8.0). Diabetes was more common among men (8.3%; 95% CI: 6.4, 10.1) compared with women (5.8%; 95% CI: 4.7, 7.0). The prevalence of diagnosed diabetes was 6.0% (95% CI: 4.5, 7.5) among men and 4.0% (95% CI: 3.1, 4.8) among women, and the prevalence of undiagnosed diabetes was 2.1% (95% CI: 1.2, 3.0) among men and 1.5% (95% CI: 1.0, 2.0) among women.

Scary for me is the percentage of undiagnosed diabetes.  This represents tens of thousands of New Zealanders!

Tables in the paper show how the prevalence increases with age and body mass index and that there are marked differences according to ethnicity.  One third of Pacific people over the age of 45 had diabetes, yet about 40% of this was undiagnosed diabetes!

By the way – 95% CI with two numbers following means a that the 95% confidence interval for the prevalence is between the two numbers.  What this means is that there is a 95% chance that confidence interval contains the true prevalence (which can only be known if everyone is measured).  Eg There is a 95% chance that the 6% to 8% confidence interval contains the true prevalence of diabetes (note – 7% should be thought of as an estimate).

How can donor rates be increased? : guest post

I read the following in Kidney Health New Zealand’s annual report and with KHNZ and Paula Martin’s permission I have reproduced her great report.  I am thrilled to see such important research being undertaken and as you’ll read, Paula has great motivation.  Paula is a PhD Candidate in the Health Services Research Centre, School of Government, Victoria University, Wellington, New Zealand.

Kidney Health New Zealand Research Grant

Paula Martin

In 2006 I donated a kidney to my husband. At the time, I was just focusing on getting through the year long donor work up and supporting my husband while we coped with the impacts on our lives of him being on peritoneal dialysis. Only after the transplant did I realise just how few living donor transplants are done each year in New Zealand. In 2006, only 46 other live donors gave a kidney to someone; last year the number had climbed to 57 live donors, but the number of people needing a transplant had also increased dramatically, with around 600 on the official waiting list.

What could be done to increase the current rate of kidney donations? The low number of transplants is a concern because we know that for most people with end stage renal failure, a transplant is the best treatment. In addition, it is cheaper than keeping people on dialysis. In order to develop solutions, we needed research to tell us what the barriers to living donor kidney transplantation are in New Zealand; how similar to, or different from, barriers in other countries these are; and what people involved in the renal community here think could be done about those barriers, so that more people wanting a transplant can get one.

In 2010, I decided to do some research on this topic to fill this gap. Supported by a research grant from Kidney Health New Zealand, I’m currently undertaking a PhD in Public Policy based at the Health Services Research Centre in the School of Government, at Victoria University of Wellington. My focus is solely on living donation, not deceased. Around half of all kidney transplants now come from living donors and with the increasing demand for kidney transplants and the shortage of deceased donors, living transplantation has to be a critical part of solving the problem. The barriers to living donation and deceased donation are different so it’s important to think about them separately.

We know from overseas research that there can be many different barriers: for example, patients needing a transplant often find it difficult to approach their family and friends about whether they might consider living donation; people who want to be donors can face practical barriers such as loss of income while they take time off to recover from the surgery; and many people who would like to be donors discover that they aren’t compatible with the person they want to donate to, or that they have a medical problem of their own which makes them unsuitable. A particular problem in NZ is that Maori and Pacific people often find it harder to get a transplant than European/Pakeha. There are likely to be many different reasons for this. Cultural attitudes to organ donation may be one factor, but a bigger issue may be that it can be harder for these patients to find a donor who meets the strict medical suitability criteria because of things like the high rates of Type II diabetes in these populations.

There is no single solution to this problem – this is an extremely complex issue and we’ll need a variety of different initiatives to make a difference to it. So, I’ve been looking at our legislation and current policies as well as how renal services operate on the ground, and talking to a range of different people – patients, renal specialists, transplant coordinators, patient support groups, managers in District Health Boards and senior government officials and politicians – to find out what they think the issues are.

Finding out what the issues are from a patient perspective has been a big part of the research. With the assistance of the three renal transplant units, I carried out a postal survey last year of all the people on the kidney transplant waiting list and received nearly 200 replies. I’ve followed that up with a small number of in-depth patient interviews. The early results of this part of the research suggest that, as in other countries, patients find it very difficult to “ask” someone to be a kidney donor which often stops them talking to their family and friends about living donation. Furthermore, patients that do get offers from people to be kidney donors often find they are incompatible or the potential donor is medically unsuitable for some reason. Health professionals I’ve interviewed have provided valuable insights into what the issues are from their perspective inside the health system.

I’m aiming to finish this research in 2013. I hope it will be of use to practitioners, policy makers, patient groups and anyone else interested in making a difference to this problem.

Thanks to Kidney Health New Zealand for supporting this work with a grant towards the costs of doing research.

Have you got diabetes?

I am sitting in a meeting of the Australian and New Zealand society of nephrologists.  I want to do them out of a job.  Will you help?

Diabetes is the number one risk factor for Chronic Kidney Disease (CKD).  High blood pressure is number two.

About 10% of the population has CKD.  They are much more likely to die than the rest of us.  Some of them will go on to need dialysis or a transplant.

Scared?  You should be.

What can you do?  Eat well, shut your computer and go for a 30 minute walk.  Do the same tomorrow.  Take a friend with you, especially if they are overweight and at risk of diabetes themselves.  If you are wise, you are already out the door and not reading this, if not…please act soon.

The critical 1st 6 months post dialysis

Know someone about to start dialysis?  I am sitting in a conference hall and have just heard a fascinating talk by Prof Chris MacIntyre about the danger to other organs for those undertaking dialysis.  The stress dialysis puts on the vasculature is the culprit.  Myocardial stunning can occur in nearly 2 out of 3 paients each dialysis session .  The effect in creases many fold with every extra litre of fluid removed.  The death rates are much higher amongst those who exhibit the stunning than those who don’t.

It is not all bad news.  Cold dialysis and more frequent dialysis seem to help.  Randomised Control Trials are underway to test these interventions.  A portable continuous $100 Dialysis machine may not just be cheaper, but may have less side effects!

In the meantime, support from friends and family are all the more important in those few months.

The costs and inequalities of diabetes