Benefits of more frequent dialysis

Blog Post on Home Dialysis Central on "Thanks for the Giving" by Amy Staples

"Thanks For The Giving"

This blog post was made by Amy Staples on November 23rd, 2017.

Its that time of year again when “Happy Thanksgiving” abounds and surrounds us.  What thoughts are conjured in your mind when the word “Happy Thanksgiving” is heard? A big turkey meal with all the wondrous side dishes of mashed potatoes, gravy, salad, pie and more. A home full of friends, neighbors, family or co-workers who’re enjoying a good movie or playing football, watching a great game or busy in the kitchen preparing the meal or cleaning up after.

I suppose it's no different for those of us with kidney disease.  But, what if the words were changed from “Happy Thanksgiving” to a phrase of “Thanks for the Giving”? What thoughts are then brought forth? Go ahead, think about it.  Ponder, wonder.  I’ve thought about this for several weeks and here is what I’ve come up with.

Thanks to all those who work in organizations and periodicals like Home Dialysis Central (HDC), Home Dialyzors United (HDU), American Association of Kidney Patients (AAKP), Polycystic Kidney Disease (PKD), National Kidney Foundation (NKF), American Kidney Fund (AKF), ESRD Networks, American Society of Nephrology (ASN), Annual Dialysis Conference (ADC), Nephrology News & Issues (NN&I), Renal & Urology News (RUN) and more.  Thanks to all those who work tirelessly to promote, advocate, educate and empower all those who are new, and the seasoned kidney persons.  Thanks for answering questions and providing the knowledge and camaraderie so fiercely needed.  Thanks to those who have no affiliation with the illness yet continue to give time and effort and yes passion to those of us who struggle daily with kidney disease. Thanks for the giving.

Thanks for the doctors, nurses, dietitians, social workers and more.  Thanks for the informed, educated and interaction.  Thanks for the focus and patience as we learn and understand the value of our own role in the pyramid as a patient and the support you give us as we steer our destiny in the right direction.  Thanks for being open to hearing us regarding our chosen modality, our frequency of treatments and more. Thanks for listening to hear instead of listening to respond.  Thanks for continuing to educate yourselves with the ever changing field of medicine and the dialysis community. Thanks for the giving.

Thanks for the amazing out of the box thinkers in research and development. Thanks for those who continue to search for a cure to illnesses like Alports Syndrome, Polycystic Kidney Disease, Diabetes, High Blood Pressure and more.  Thanks to searching for a cure for all those diseases whom contribute to kidney failure. Thanks to those thinkers in developing things like new, improved and advanced dialysis machines.  Thanks to those great developers of things like implantable artificial kidneys, and preserving and lengthening the durability and life of A/V fistulas and grafts.  Thanks for the giving.

Thanks to the friends and acquaintances, oftentimes faceless yet still vital in our quest. Thanks for your presence as we try to rise above the complications and perils of living with kidney disease or failure.  Thanks for listening to us vent.  Thanks for all the answers to question, advice, comfort, laughs and good wishes. Thanks for the giving.

Thanks to all the owners and admins to groups, blogs and more for opening your hearts and cyber homes in an effort to assist and empower all those with kidney disease.  Thanks for moderating, breaking up fights, reminding us to be adults.  Thanks for the links, the photos, the literature and the help on our collective and singular journeys in this maze of obstacles and discovery through kidney disease. Thanks for the friendships.  Thanks for the giving.

Thanks to fellow patients, care-partners and more involved in groups like NKF’s Kidney Advisory Committee (KAC), PEERS Mentor Program, the Kidney Health Initiative (KHI), ESRD Networks’ Patient Advisory Committee (PAC), Learning Area Network (LAN), Network Patient Representative (NPR) and more. Thanks for all your advocacy in our behalf and despite your own health issues.  Thanks for the passion, endurance and hope for the future.  Thanks for the giving

Thanks to all the care-partners and friends who stand with us side by side through thick and thin.  Thanks for helping us clean up after blood spills.  Thanks for going with us to appointments, taking notes and doing research for us online.  Thanks for the hugs, kind words, sleepless nights of worry and “good job” comments.  Thanks for the perseverance of mind and spirit and the gentleness of heart.  Thanks for the giving.

Lastly and most heartfelt with tears and sadness yet uplifting of hearts thanks to those who’ve passed on.  Thanks for your courageous spirits through your own crusades of kidney disease.  Thanks for your impervious drive for research, answers, advocacy and hope.  Thanks for your endeavors and heroic efforts to befriend, buoy up and strengthen those around.  Thanks for your friendships.  Thanks for your voices, and the echos we still hear.  Thanks for the giving.

Does this make you think a little differently about “Thanks for the Giving”? I hope so. May we all be reminded of those who give in our behalf each day, week, month, year. May this remind us that in our own heroic efforts, we are never alone.  So, Thanks for the Giving.

http://homedialysis.org/news-and-research/blog/232-thanks-for-the-giving 

URGENT MESSAGE! Please take action and stand with me.

URGENT MESSAGE! I've been on dialysis going on 16 years! Yep, 16 years. I owe it all to availability of doing dialysis treatments 4-6 times per week. You see in 2003 I began doing more treatments per week than standard and I felt so great I went out and acquired a job. I worked as a cashier (not a sedentary job) at about 30 hours per week. I was able to work, travel and raise a family. During that time I also had both kidneys removed. No, I've never yet had a transplant

 so I am one of those extraordinary persons who walk around with 2 of my vital organs missing. How you say? Because of the opportunity and availability of doing more than the standard 3X/week dialysis. I can drink more, and eat the foods I like because of this more frequent treatments. I don't want to imagine my life if my treatments were cut or limited to the standard again (shudder). I have complex health issues and need those more frequent treatments. This policy would end that for me. Dialysis is tough, but more frequent dialysis actually gives those persons a sense of normalcy again. A chance to work, go to school, travel, volunteer, raise a family and live life to the fullest. This policy would remove that opportunity for them. Please take a stand with me. Let your voice be heard for me and all those whom this policy would so negatively impact those lives. Stand with me and be counted, be heard, be understood. Follow the link below and share my story. Share your story. Be counted. Be heard. Blessings, Amy Staples

ACCESS TO MORE FREQUENT DIALYSIS THREATENED BY MEDICARE CONTRACTOR ACTIONS!

VOTERVOICE.NET

What does patient-centered care mean?

HHS implements strategy to shore up Puerto Rico health facilities

HHS implements strategy to shore up Puerto Rico health facilities: Also this week: Joint Commission updates life safety prepublication standards.

A New "in the works" Truly PORTABLE Dialysis Machine called EasyDial

Here is an amazing "in the works" truly Portable dialysis machine called EasyD which only uses 5 liters of dialysate, is stored in a case on wheels and weighs about 20 lbs. What do y'all think? This is already in human clinical trials in Europe.  Please share this blog with *everyone* you know.  Thank you and Blessings

http://dev.easydialhdbs.com/

Corporate Jargon - Lying by Obscurity

National Kidney Foundation "Disaster Preparedness"

https://www.kidney.org/sites/default/files/11-10-0807_IBD_disasterbrochure.pdf

EMERGENCY!! Home Dialysis Central article on Disaster Planning for Home Dialysis

Disaster Planning For PD And Home HD

Epic tornados. Earthquakes. Hurricanes. Tsunamis. Nuclear power plant meltdowns! It seems as if a good part of the news each day reports on a fresh disaster. No one wants to have to deal with events that disrupt vital services—like dialysis. But if life throws a fire storm or flood your way, you'll have a better chance of making it through if you prepare.

Gather Key Papers

In any type of disaster, you'll be a step ahead if you know where your vital documents are and can grab them in a hurry. Make a folder or binder with:

• Your health history, meds list, recent lab test results, and Advance Directive
• Insurance plan information (health, home or renter's, car)
• Phone numbers for loved ones, the power and water companies, your doctor(s), drugstore, and your dialysis clinic and backup clinic
• Proof of I.D. (copies of driver's license, passport, Medicare card, etc.)
• Bank and credit card information
• Home deed and car registration

Keep your folder in a safe place that will be easy to reach when you need it, like a nightstand, dresser drawer, or kitchen cupboard. You might even store it in a plastic Ziploc bag in the fridge. Update the contents as things change in your life. Always be sure your clinic knows how to reach you.

For the purpose of home dialysis, disasters fall into one of two types:

1. You must stay at home (with or without power and water)
2. You can't stay at home (you have to evacuate)

When You Must Stay At Home

A pandemic flu, huge blizzard, or flood may keep you in your home and off the roads. If the power is on and you have PD or home HD supplies on hand—you're in luck! Being able to do your treatments at home in an emergency is one of the unsung benefits of home options. In the Kobe, Japan, earthquake of 1997, PD patients fared far better than those who were doing in-center HD. 1

Make An Emergency Kit

In a plastic bin, gather:

• Flashlight and batteries
• Weather band radio (a hand crank type won't need batteries)
• A week's supply of your meds
• A first aid kit
• Chemical hand warmers (be very careful about using these—they do get hot)
• Paper plates and cups, and plastic forks, knives, and spoons
• A scissors and knife
• A can opener
• Trash bags
• Bleach or iodine to purify water

For PD, you'll need to have these supplies: 2

• 5 cases of solution (1.5%, 2.5%, and 4.25%)
• Masks
• 1 case of lines and caps
• Betadine and hand sanitizer
• Extra batteries for your blood pressure monitor

For home HD, you'll need to have these supplies: 3

• 7 days of home HD supplies (If you use a NxStage machine with a PureFlow device, have backup bags on hand. Be sure they have not expired.)
• Nxstage cartridges or dialyzers and lines
• Saline bags
• Needles
• Tape and scissors
• Syringes and heparin
• Gloves and hand sanitizer
• Meds you use

You may want to do treatments somewhat less often to stretch out your supplies, if you are not sure how long an emergency will last. If there is no water :

• You can use hand sanitizer and do PD.
• You can do home HD with a NxStage machine and bags, but not with a standard home HD machine.

If there is no power :

• You can do PD by hand. You may want to have chemical hand warmers on hand to heat your bags. Ask your PD nurse if you could safely use these in an emergency, with a towel on top to protect the PD bags from the heat.
• You would need backup power to do home HD

Back-Up Light & Power

You're doing a home treatment at night and the power goes out. It's pitch dark! What do you do? We hope you think about this ahead of time and get an emergency light. These flashlights plug into a power outlet. When the power goes out, they come on. You can find these for under $25 online or in hardware stores, so you can see what you're doing for a safe disconnect for PD, or a manual rinseback for HD.* Or, keep a flashlight or camping lantern with fresh batteries in easy reach—just in case. A "headlight" type flashlight will leave your hands free. LED bulbs last longer than the standard ones.

* When the power is out, the air detector on an HD machine will not work. Shine a flashlight on the blood tubing as you do a manual rinseback to be sure that you are not getting air in the lines. If you see bubbles, don't rinse back the blood. It's better to lose what's in the circuit than risk an air embolism.

You can get short-term power (from 15 minutes to a few hours or so) from an uninterruptable power supply (UPS). Office supply stores carry these to prevent damage to computers. Hardware stores may have them, too. You plug a UPS into the wall, and plug your machine into the UPS. The battery in the UPS charges while the power is on. When the power goes out, the UPS keeps the machine running long enough for you to safely disconnect. The longer the back-up power, the more they cost—from a couple of hundred dollars to over $1000. So, if you go this route, you might think about how much time you would need to safely return your blood—not run a whole treatment.

Someone at the store may be able to help you choose a UPS. You will need to know how many watts the machine uses (this should be in the manual or on the back of the machine, or you can call the company and ask them).

If you really want to be self sufficient, you can get longer-term power from a generator that runs on gasoline (or propane, which is safer to store). You can't run a generator indoors. It could create a carbon monoxide build-up. Generators can also be quite noisy. So, you'd need a sheltered place outside to run it, and a long power cord to reach your machine. You'd also need a partner to plug in the generator for you if the power goes out during a treatment.

Emergency Food & Water Supply

When you can do your treatments, you just need to have jugs of water, and food on hand that will not spoil. If you use canned or dried foods, you'll need to rotate them, since the shelf life is only about 6 months.

But...if you lose power, you may not be able to do your treatments. Or, you could run out of PD or home HD supplies. So, you need to have foods for the emergency dialysis meal plan that do not have to be cooked or kept cold. Your clinic can tell you about this plan, or it's in the Planning for Emergencies booklet from the National Kidney Foundation. 4

Coast Guard approved food bars have calories with very little salt, and a 3-day bar costs less than $4. The bars will keep for 5 years (look on Amazon.com). Talk to your dietitian. These bars would be boring to eat for days on end, but may be a good way to have a back up food supply that is safe for you with no dialysis.

Keeping In Touch With Loved Ones

In an emergency, phone lines may be down:

• If you can't leave your home, charge your cell phone while you have power, in case it goes out later.
• If there is a signal, call loved ones and they can tell others that you're okay—or pass along a message about what you need.
• Sometimes a text message will go through even if there is not enough of a signal for a call.
• Your land line phone may or may not work. If it doesn't, keep trying.
• While the power is on, you might try sending an email or a Facebook message.

When You Can't Stay At Home

In some types of disasters, it is not safe for you to stay in your home. You must evacuate. You may have warning ahead of time—if a hurricane is coming, or forest fires are moving your way. Or, you may not have a lot of time to react. When you know ahead of time, try to get things ready:

• Fill up your car with gas, or make plans for how you'll get out. NOTE: In stop-and-go traffic, gas can run out quickly. Just 10 seconds of idling uses more gas than shutting off your engine.
• No car? Ask your clinic what type of transportation may be able to pick you up. Chances are, it will not be able to bring your dialysis supplies.
• Look at a map and work out a safe route. Bridges, trees, or power lines may be down.
• Gather your key papers, meds (or at least the empty bottles), some emergency food and water, a few days of PD or home HD supplies*, small valuables, cell phone and charger, and clothes.
• Load your car with the biggest items first, then the next biggest, and so on. Put small things in around big ones. This will let you fit more in. (You can fit more clothes in a suitcase by using the same tip.)
• Watch TV or listen to the radio to find out where the shelters are near you, or go on to another town. Your clinic may call and tell you where to go. 5
• Hide valuables you can't bring in unlikely places, like under clothes in a laundry hamper, in the veggie drawer of the fridge, or behind books in a bookcase. Lock all doors and windows to your home when you leave.
• Call your loved ones to tell them where you plan to go, or set up a meeting place. Again, text messages may work when phone calls do not. The American Red Cross Safe and Well List 6 on the web lets you tell your loved ones that you are okay.
• You can bring pets with you if you plan to leave town—but most shelters can't take them.
• If you go to a shelter tell the shelter staff that you are on dialysis when you arrive.

* If you can get to a town that is not part of the disaster, you can pick up new supplies at a dialysis clinic or have them shipped to you.

If you do PD and can't find a clean room for exchanges, don't do them . The risk of peritonitis is higher than the risk of not doing PD for up to a week. 1 Follow the emergency dialysis diet if you don't do your treatments. A red or sore exit site can be treated with a vinegar solution made in a very clean jar, with: 7

• 6 oz. (3/4 cup) boiled or bottled water
• 4 oz (1/2 cup) white vinegar
• 1 ¾ teaspoons table salt

Shake the jar until the salt dissolves and pour the solution into a clean spray bottle. It keeps for one week.

Spray on the vinegar after you clean your exit site with antibacterial soap and rinse off the soap. You can also soak a 4x4 gauze pad with the solution and lay it around your catheter for 20 minutes. It should feel soothing. If not, don't use it and seek medical attention.

Home Dialysis Emergency Resources

There are some very good emergency resources that can help you:

• The American Association of Kidney Patients has a free online service calledMy Health where you can enter your lab test results and health information—and then get to it from any computer with internet access.
• DaVita Patient Hotline: 800-400-8331.
• Fresenius Patient Hotline: 800-626-1297.
• The Kidney Community Emergency Response (KCER) Coalition has up to date information about emergencies. Visit kcercoalition.com, or call 1(813)-383-1530.
• The National Kidney Foundation has a free 40-page booklet called Planning for Emergencies: A Guide for People with Chronic Kidney Disease that you can download.
• NxStage offers a free 22-page disaster planning guide called Are You Ready? .

No one wants to have to deal with a disaster. But if one strikes, being ready ahead of time can make all the difference.

References:

1. Sakai R. The Japanese experience during the Kobe earthquake: Management of continuous ambulatory peritoneal dialysis patients in a disaster. Renal Failure. 1997;19(5):693-99.
2. Disaster preparedness for peritoneal dialysis patients. Florida Kidney Disease Coalition. Accessed 4/18/11.
3. Are you ready? NxStage Home Hemodialysis Patient Planning Guidebook for Non-Medical Emergencies. Accessed 4/18/11.
4. National Kidney Foundation. Planning for Emergencies: A Guide for People with Chronic Kidney Disease. Accessed 4/18/11.
5. Kleinpeter MA, Norman LD, Krane NK. Disaster planning for peritoneal dialysis programs. Adv Perit Dial. 2006;22:124-9.
6. American Red Cross Safe & Well List. Accessed 4/18/11.
7. Centers for Disease Control and Prevention. Infection control for peritoneal dialysis (PD) patients after a disaster. Disaster Recovery Fact Sheet. Accessed 4/18/11.

Home Dialysis Central "Heading Off The Dreaded Cramp!" by Dr. John Agar

http://homedialysis.org/news-and-research/blog/32-heading-off-the-dreaded-cramp

Heading Off The Dreaded Cramp!

This blog post was made by Dr. John Agar on August 24th, 2017.

Cramp in patients with late stage chronic kidney disease (CKD5)—and on dialysis (CKD5d) when it is hard to get up and move around—is one of the worst symptoms of CKD5 and CKD5d. It is also one of the hardest to fully explain to patients, and to treat. We are not sure why some suffer more cramp than others. Despite how common and painful they are, the cause of cramp is poorly understood and under-researched...the latter, a real shame.

In CKD5d, cramp is most often found with a high ultrafiltration rate, and towards the end of a dialysis run. But, this is not always the case, as patients with a low UFR may also sometimes cramp.

In the dialysis patient, cramp tends to occur or to be worse late in a run. It tends to parallel the magnitude of change—in speed or degree—of change to the blood volume. Change to the inter-compartmental balance of salts like sodium, potassium, magnesium and calcium (electrolytes) is also a factor. Any acute change to blood volume and/or levels of electrolytes will also change extracellular and intracellular fluid volumes and electrolyte levels. The more abrupt or brief a treatment, the greater the risk of trans-compartmental electrolyte imbalance, and altered homeostasis.

An intra-dialytic change in the concentration of key electrolytes will result from:

1. Losses or gains across the dialyzer membrane
2. Fluid movement between the four major fluid spaces: intra-cellular, extra-cellular, intra-vascular and within-dialyser

Changes to stable homeostasis in dialysis within or between these four "compartments" is the key factor in provoking cramp. The more 'brutal' the treatment, the faster it is, the more likely that cramp will occur.

Why, then, do some patients also have cramps in bed at night, when noton dialysis?

The certain answer is unknown. But, we may forget that major shifts in blood volume occur as a function of normal physiology when moving from standing to lying down, then back to standing. It is a well-known fact that, upon lying down, adult blood volume expands at the expense of the extra-vascular fluid volume by a mean 600-700 ml in a 70 kg man (or ~10 ml/kgm).i

This fluid shift reverses upon standing up. The blood volume contracts back by the same amount, as fluid shifts back to the extravascular compartment.

These erect-to-supine-to-erect changes in blood volume take just a few minutes. As fluid moves back and forth between compartments, levels of common salts also change, depending on the direction of movement. As fluid moves into a compartment, the electrolyte levels in that compartment will fall. As fluid moves out, the electrolytes become more concentrated. This dilution/concentration phenomenon, based on fluid movement, also affects albumin. This is important as, though not an electrolyte, albumin plays a key part in fluid mechanics. For example, serum albumin is ~8% lower when lying supine than when standing, as it has been diluted by movement of fluid from the intravascular to the extracellular compartment.

These changing salt (electrolyte) and albumin levels affect electrical conductivity—the impulse a nerve fibre uses to stimulate a muscle cell...and, as you will see below, the stage is set for posture-related symptoms to result.

All of this happens in the setting of both CKD5 and CKD5d – and, in the case of CKD5d, homeostasis is already under an added threat from the dialysis treatment itself. In either case, a change in posture may magnify any pre-existing tissue electrolyte disturbance, and harm neuromuscular function. Holding that thought, let us turn to nerve and muscle function.

The junction between each microscopic nerve fibre and the single muscle cell fibre it supplies is known the "motor end plate". Here, the nerve ending touches the muscle cell fibre, just like the wiring of a house touches the back of a toaster plug to bring it power. When messaged from the brain, the nerve 'fires' the muscle cell, causing it to contract. The electrical signal to the nerve ending releases a slew of chemicals—neurotransmitters (or nerve-to-muscle stimulators)—from the nerve ending that then trigger muscle cell contraction.

Neurotransmitters depend on a stable mix of electrolytes in the fluid "soup" that bathes and surrounds the neuromuscular junction. The neurotransmitters and the electrolyte bath they work in, form a chemical "switch" that lets each nerve ending "talk" to its muscle cell. While there are conflicting data on the relative importance of each electrolyte, that they matter—and matter a lot—is not disputed.

Dialysis disturbs the balance between the electrolyte levels in the blood and tissue fluid. The effect is larger if the treatment is done quickly. The motor end plates become "super-trigger-happy"! While clearly a gross over-simplification, this results in the motor end plates firing off in an uncoordinated way. Muscle cells contract even when the brain has notsent a message. This unplanned muscle contraction leads to cramp.

Lots of treatments for dialysis cramp have been tried, with mixed success. Clearly the key step is to slow down the dialysis, so there is more time for electrolyte "equilibration" (= re-balance). This is the key reason why patients using slower, longer, extended-hour and higher frequency regimens (like frequent nocturnal dialysis) do not cramp. Those who use more frequent but shorter-time dialysis (eg: short daily dialysis) are not as well cramp-protected. Twice the frequency but half the time = an unaltered rate of fluid removal and homeostatic disturbance.

Taking extra salt is also not a good idea, it simply drives up blood pressure and activates thirst. Thirst causes a greater weight gain and the need to dial a higher UFR the next time round. This leads to greater, not lesser, chemical shifts and more, not less, cramp.

We use here—with good effect—an anti-epileptic drug (clonazepam). In our experience it works best of all. Other drugs and supplements have been tried, but with questionable value, including:

• Vit E
• Biotin
• Leptin
• L-carnitine

Evidence is not convincing that these are useful. Codeine can help some patients. Others get some relief from magnesium or quinine sulphate, though the latter carries the risk of platelet abnormalities and has dropped from favour.

But, the best treatment of all is to:

1. Slow the ultrafiltration rate to allow within-dialysis fluid and electrolyte equilibration and eliminating the need for saline resuscitation during dialysis.
2. Lessen post-dialysis thirst by avoiding acute volume contraction and reducing, not increasing, oral salt intake.
3. By ensuring both (1) and (2), thereby avoiding the next large fluid gain/volume contraction cycle.

Above all, dialysis cramp is best remedied by longer slower dialysis, and not by taking the patient off early!

References

1. Young DS, Bermes EW. Specimen collection and processing: Sources of biological variation. In: BurtisCA, AshwoodER eds. Tietz Textbook of Clinical Chemistry. 3rd ed. Philadelphia, PA: WB Saunders and Company; 1999:79–81.

NN&I Article on KIDNEY TRANSPLANT Study: Treatment with enzyme from bacteria reduces antibodies in kidney transplant recipients

KIDNEY TRANSPLANT

Study: Treatment with enzyme from bacteria reduces antibodies in kidney transplant recipients

---

NN&I STAFF — AUGUST 9, 2017

 Getty Images/iStockphoto/ThinkStock

An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

The study, published in the New England Journal of Medicine, found that treating patients with the drug IdeS before transplantation significantly reduced, and in most cases eliminated, donor-specific antibodies that can cause rejection or failure of the new organ.

IdeS is derived from an enzyme in the bacteria Streptococcus pyogenes, which causes disorders ranging from sore throats to life-threatening infections.

Stanley C. Jordan, MD, medical director of the Kidney Transplant Program at Cedars-Sinai, said the enzyme is the only one that can completely remove organ-rejecting antibodies and allow kidney transplantation to take place.  One hour after infusion of the enzyme, antibodies declined drastically.

“We found that IdeS could immediately cut patient antibodies in half, making them powerless to attack and injure a newly transplanted kidney,” said Jordan, who received a consulting fee from Hansa Medical of Sweden, the company that produced the enzyme and funded the research. “We can put a new kidney in a patient without it being rejected.”

The study involved two coordinated investigations, with a total of 25 patients treated in the U.S. and Sweden. Twenty-four of the patients were transplanted successfully after receiving the investigational therapy.

“We need larger studies to confirm the promising results of this unique approach to removing patient antibodies that threaten newly transplanted organs,” Jordan said. “And we want to investigate any long-term impact IdeS therapy may have on overall antibody production in patients.”

NN&I Article on Hand Hygiene Compliance

CLINICAL

Hand hygiene compliance improves when patients are empowered to speak up

---

NN&I STAFF — AUGUST 16, 2017

 Hand-wash

Armed with new tools to help them, patients and parents felt empowered to remind health care providers to perform hand hygiene, successfully improving compliance rates, according to a new study published in the August issue of the American Journal of Infection Control. But less than 60% of health care providers surveyed felt that patients should be involved in reminding providers to perform hand hygiene.

Allison Lastinger, MD, of the West Virginia University (WVU) School of Medicine, led a multidisciplinary research team that performed a cross-sectional survey of parents of hospitalized children, adult patients, and primary care physicians at the WVU Medicine J.W. Ruby Memorial Hospital, a 645-bed tertiary care teaching hospital in Morgantown, W.V.

Patients and their families were given one of the five patient empowerment tools (PETs, pictured) upon admission to the hospital and asked to use the tools to remind health care workers to perform hand hygiene.

Allison Lastinger, MD, holds a collection of patient empowerment tools, which are used by patients to remind nurses and doctors to wash their hands when entering their room.

Using an anonymous, self-administered questionnaire, the multidisciplinary research team— which included Kayeromi Gomez, PhD, of the WVU School of Public Health, Ellen Manegold, BA, of the WVU Department of Psychology, and Rashida Khakoo, MD, of the WVU School of Medicine — examined their attitudes toward the new patient empowerment tool at the hospital. The parent and patient surveys were distributed from December 2015 to June 2016; the physician survey was distributed in November 2015.

“Patient involvement is increasingly recognized as an important component of hand hygiene improvement strategies,” said Linda Greene, RN, MPS, CIC, FAPIC, 2017 president of the Association for Professionals in Infection Control and Epidemiology. “Organizations must realize that patients and families are an important part of the health care team, and their involvement in hand hygiene campaigns should be encouraged.”

A total of 222 adult patients and parents completed the survey (108 adult patients and 114 parents). Most adult patients (64%) and parents (70%) said the PET made them feel more in control of their care. Most parents (77% for physicians and 81.4 % for nurses) and adult patients (64.8% for physicians and 71.2% for nurses) felt comfortable using the PET to remind health care workers to perform hand hygiene.

Researchers noted, however, that parents were nearly 20% more likely than adult patients to speak up if a physician did not perform hand hygiene. In Ruby Memorial Hospital, hand hygiene rates increased from 48% in 2015 to approximately 75% in 2016 as a result of the hospital’s multipronged initiative to increase handwashing rates among its healthc are providers. “Forty-eight percent is pretty standard,” said lead study author Dr. Lastinger, “so 75 percent is phenomenal.”

Among 89 health care provider responses (29 residents and 60 attending physicians), only 54.9% felt that patients should be involved in reminding providers to perform hand hygiene. Overall, physicians indicated that they would prefer a patient make the request verbally, rather than using the PET to remind them to perform hand hygiene.

Of the physicians who did not support patient involvement, 37%f elt that it was not the patient’s responsibility to remind physicians to perform hand hygiene; 16% felt that it was embarrassing to the doctor; and 13% felt that it would have a negative impact on the patient-physician relationship.

“Based on the results of this study, patient empowerment appears to be an effective strategy to facilitate health care workers’ adherence to hand hygiene, but acceptance of the PET by providers remains a challenge,” said Lastinger. “Barriers to hand hygiene adherence among health care providers should be identified and addressed.”

Science Daily Article - Breakthrough device heals organs with a single touch

Breakthrough device heals organs with a single touch

Device instantly delivers new DNA or RNA into living skin cells to change their function

Date:

August 7, 2017

Source:

Ohio State University Wexner Medical Center

Summary:

Researchers have developed a device that can switch cell function to rescue failing body functions with a single touch. The technology, known as Tissue Nanotransfection (TNT), injects genetic code into skin cells, turning those skin cells into other types of cells required for treating diseased conditions.

Share:

     

FULL STORY

---

Researchers demonstrate a process known as tissue nanotransfection at The Ohio State University Wexner Medical Center. In laboratory tests, this process was able to heal the badly injured legs of mice in just three weeks with a single touch of this chip. The technology works by converting normal skin cells into vascular cells, which helped heal the wounds.

Credit: Courtesy The Ohio State University Wexner Medical Center

Researchers at The Ohio State University Wexner Medical Center and Ohio State's College of Engineering have developed a new technology, Tissue Nanotransfection (TNT), that can generate any cell type of interest for treatment within the patient's own body. This technology may be used to repair injured tissue or restore function of aging tissue, including organs, blood vessels and nerve cells.

Results of the regenerative medicine study published in the journal Nature Nanotechnology.

"By using our novel nanochip technology, injured or compromised organs can be replaced. We have shown that skin is a fertile land where we can grow the elements of any organ that is declining," said Dr. Chandan Sen, director of Ohio State's Center for Regenerative Medicine & Cell Based Therapies, who co-led the study with L. James Lee, professor of chemical and biomolecular engineering with Ohio State's College of Engineering in collaboration with Ohio State's Nanoscale Science and Engineering Center.

Researchers studied mice and pigs in these experiments. In the study, researchers were able to reprogram skin cells to become vascular cells in badly injured legs that lacked blood flow. Within one week, active blood vessels appeared in the injured leg, and by the second week, the leg was saved. In lab tests, this technology was also shown to reprogram skin cells in the live body into nerve cells that were injected into brain-injured mice to help them recover from stroke.

"This is difficult to imagine, but it is achievable, successfully working about 98 percent of the time. With this technology, we can convert skin cells into elements of any organ with just one touch. This process only takes less than a second and is non-invasive, and then you're off. The chip does not stay with you, and the reprogramming of the cell starts. Our technology keeps the cells in the body under immune surveillance, so immune suppression is not necessary," said Sen, who also is executive director of Ohio State's Comprehensive Wound Center.

TNT technology has two major components: First is a nanotechnology-based chip designed to deliver cargo to adult cells in the live body. Second is the design of specific biological cargo for cell conversion. This cargo, when delivered using the chip, converts an adult cell from one type to another, said first author Daniel Gallego-Perez, an assistant professor of biomedical engineering and general surgery who also was a postdoctoral researcher in both Sen's and Lee's laboratories.

TNT doesn't require any laboratory-based procedures and may be implemented at the point of care. The procedure is also non-invasive. The cargo is delivered by zapping the device with a small electrical charge that's barely felt by the patient.

"The concept is very simple," Lee said. "As a matter of fact, we were even surprised how it worked so well. In my lab, we have ongoing research trying to understand the mechanism and do even better. So, this is the beginning, more to come."

Researchers plan to start clinical trials next year to test this technology in humans, Sen said.

Funding for this research was provided by Leslie and Abigail Wexner, Ohio State's Center for Regenerative Medicine and Cell-Based Therapies and Ohio State's Nanoscale Science and Engineering Center.

Video: https://www.youtube.com/watch?v=tMQ51Kj2tS0

---

Story Source:

Materials provided by Ohio State University Wexner Medical Center. Note: Content may be edited for style and length.

---

Journal Reference:

1. Daniel Gallego-Perez, Durba Pal, Subhadip Ghatak, Veysi Malkoc, Natalia Higuita-Castro, Surya Gnyawali, Lingqian Chang, Wei-Ching Liao, Junfeng Shi, Mithun Sinha, Kanhaiya Singh, Erin Steen, Alec Sunyecz, Richard Stewart, Jordan Moore, Thomas Ziebro, Robert G. Northcutt, Michael Homsy, Paul Bertani, Wu Lu, Sashwati Roy, Savita Khanna, Cameron Rink, Vishnu Baba Sundaresan, Jose J. Otero, L. James Lee, Chandan K. Sen. Topical tissue nano-transfection mediates non-viral stroma reprogramming and rescue. Nature Nanotechnology, 2017; DOI: 10.1038/nnano.2017.134

NN&I Article As kidney function decreases, risk for AFib increases

CLINICAL

As kidney function decreases, risk for AFib increases

---

NN&I STAFF — AUGUST 15, 2017

A new study published in the Clinical Journal of the American Society of Nephrology indicates that individuals with kidney disease have a higher risk of developing atrial fibrillation, or an irregular heartbeat.

Nisha Bansal, MD, MAS from the University of Washington, and her colleagues analyzed the results of three prospective studies: the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study.

In the analysis of 16,769 community-dwelling individuals without atrial fibrillation, there was a step-wise increase in the risk of incident atrial fibrillation with decreasing kidney function. In patients with the lowest kidney function or the greatest amount of proteinuria, the risk for developing atrial fibrillation was approximately two-fold higher compared with those without kidney disease.

This link held even after accounting for a wide range of possible contributors, including measures of cardiovascular health, and it was consistent across subgroups of participants categorized by age, sex, race, and comorbidity.

“This study found that even modest abnormalities in kidney function were linked with a higher risk of developing atrial fibrillation later in life,” said Bansal. “Atrial fibrillation may affect the selection of cardiovascular therapies and is associated with poor clinical outcomes. Thus, an understanding of the risk of atrial fibrillation across a broad range of kidney function is important.”

Dr. Bansal noted that additional studies are needed to determine the mechanistic link between kidney disease and atrial fibrillation.

Study co-authors include Leila Zelnick, PhD, Alvaro Alonso, MD, Emelia Benjamin, MD, ScM, Ian de Boer, MD, MS Rajat Deo, MD, Ronit Katz, DPhil, Bryan Kestenbaum, MD, MS, Jehu Mathew, MD, Cassianne Robinson-Cohen, PhD, Mark Sarnak, MD, MS, Michael Shlipak, MD, MPH, Nona Sotoodehnia, MD, MPH, Bessie Young, MD, MPH, and Susan Heckbert, MD, PhD.