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New drug, Belatacept, for kidney transplant recipients effective in humans

February 24th, 2010 · post-transplant, research

Initial results of a study conducted at 100 centers worldwide indicate that belatacept, a first-in-class costimulation blocker can prevent the immune system rejecting new organs. The results also suggest that it may provide similar patient and graft survival to cyclosporine but with fewer side effects and superior kidney function after 12 months.

The study, published today in the American Journal of Transplantation, provides the first findings to come from BENEFIT Belatacept Evaluation of Nephroprotection and Efficacy as First-line Immunosuppression Trial.Although advances in transplantation have reduced rates of organ rejection and improved outcomes after one-year, corresponding improvements in long-term survival rates have not been observed. The kidney allograft transplant from another human donor with different genes survival rate is 95% for transplants from living donors and 89% for transplants from deceased donors during the first year. BENEFIT is a three-year, randomized, active-controlled, parallel-group, set up to evaluate the efficacy of belatacept for post-transplant maintenance immunosuppressive management.

“Our findings show that this will be a novel and more specific way of suppressing the immune system with less toxicity,” said lead researcher Dr. Flavio Vincenti, of the University of California, San Francisco Medical Center. “It will target the specific responses that cause rejection of transplanted organs with less damage to other systems of the body.”Belatacept is different from calcineurin inhibitors CNI, such as cyclosporine, which is the class of drugs most commonly used to suppress the immune system in transplant patients, because it does not cause the toxicities associated with CNI – such as nephrotoxicity and aggravating cardiovascular risk factors. Belatacept selectively blocks T-cell activation which plays a key part in immune response and the results suggest that this selectivity allows effective immunosuppression, better preservation of renal function and an improved cardiovascular/metabolic risk profile.

via New drug for kidney transplant recipients effective in humans.

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Young Patients with Chronic Illnesses Find Relief in Acupuncture

February 13th, 2010 · alternative therapies, clinical trials

Has anyone had success with using acupuncture in relieving pain associated with chronic kidney disease?

Doctors at Rush University Medical Center are offering pediatric patients diagnosed with chronic illnesses acupuncture therapy to help ease the pain and negative side effects like nausea, fatigue, and vomiting caused by chronic health conditions and intensive treatments. The confluence of Chinese and Western medicine at Rush Children’s Hospital is part of a study to analyze and document how acupuncture might help in reducing pain in children and increase quality of life.

“Treating children with acupuncture is a new frontier,” said Dr. Paul Kent, pediatric hematology and oncology expert, Rush Children’s Hospital. “We are looking to see if there is an effective pain management therapy we can offer that does not have the serious side effects that can be caused by narcotics and other serious pain medications.”

The lack of options for pain management in children has been reported as one of the most difficult aspects of providing care to pediatric patients. Research indicates that up to 70 percent of pediatric patients experience pain and those with chronic illnesses often do not have adequate relief or prevention of pain.

“Acupuncture could be a potential solution to this dilemma of controlling pain in pediatric patients,” said Angela Johnson, Chinese medicine practitioner at Rush.

Acupuncture is the use of tiny, hair-thin needles which are gently inserted along various parts of the body. The therapy is based on the premise that patterns of energy flowing through the body are essential for health. This energy, called Qi, flows along certain pathways. It is believed that placing the tiny needles at points along the pathways reduce pain and improve the healing process.

The National Institute of Health (NIH) has published a statement concluding that acupuncture is effective for treating adults for nausea following chemotherapy and for pain after dental surgery. The agency also said that the therapy might be useful in treating other health issues such as addiction, migraines, headaches, menstrual cramps, abdominal pain, tennis elbow, fibromyalgia, arthritis, low-back pain, carpal tunnel syndrome and asthma. In some pediatric studies, both patients and parents have stated that acupuncture treatments were both helpful and relaxing.

Rush will be offering acupuncture therapy to pediatric patients between the ages of 5-20 years of age, who are experiencing pain. A practitioner who is licensed in acupuncture by the State of Illinois and certified by the National Certification Commission for Acupuncture and Oriental Medicine will be giving the treatments. Study participants will receive eight acupuncture treatments at no charge.

“Many children with chronic or acute health issues turn to complementary or integrative approaches after all other conventional treatment options are exhausted,” said Johnson. “Parents should be aware that integrative therapies like acupuncture can be helpful from the onset of disease and can have a tremendously positive influence on a child’s quality of life.”

via News Releases.

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Stent grafts for dialysis patients

February 13th, 2010 · renal replacement therapy (dialysis), research

Research showing that stent grafts perform better than balloon angioplasty for maintaining access for dialysis patients:

A randomized multicenter study of 190 patients at 13 medical centers shows– for the first time– the superior benefit of stent grafts over balloon angioplasty for the maintaining function of dialysis access grafts in kidney failure patients who undergo dialysis. Until now, no other therapy has proven more effective than angioplasty.  At six months, the stent grafts allowed dialysis patients to continue
life-saving treatment with significantly fewer interruptions and invasive procedures

via Society of Interventional Radiology.

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Research Warns of Risks of Low Potassium in Heart Failure Patients With CKD

February 13th, 2010 · potassium, research

We struggle with high potassium, but this research shows that low potassium can be as much of a problem:

New research from the University of Alabama at Birmingham UAB says low potassium levels produce an increased risk of death or hospitalization in patients with heart failure and chronic kidney disease CKD.

In findings reported in January in Circulation: Heart Failure, a journal of the American Heart Association, the researchers say that even a mild decrease in serum potassium level increased the risk of death in this patient group.

“Hypokalemia, or low potassium, is common in heart-failure patients and is associated with poor outcomes, as is chronic kidney disease,” said C. Barrett Bowling, M.D., a fellow in the UAB Division of Gerontology, Geriatrics and Palliative Care. “But little is known about the prevalence and effect of hypokalemia in heart-failure patients who also have CKD.”

Bowling, a graduate of the UAB Internal Medicine residency program, said these findings indicate that in patients with heart failure and CKD the serum potassium levels should be monitored routinely and carefully maintained within a safe range.

via UAB Research Warns of Risks of Low Potassium in Heart Failure Patients With CKD.

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Adalimumab and rosiglitazone in FSGS

February 5th, 2010 · FSGS, adalimumab, research, rosiglitazone

Promising early results for the novel therapies rosiglitazone and adalimumab in FSGS:

19 patients completed the 16-week FONT treatment phase. The observation period pre-FONT was 18.3+/-10.2 months and 16.1+/-5.7 months after the study. A similar percentage of patients, 71% and 56%, in the rosiglitazone and adalimumab cohorts, respectively, had stabilization in GFRe, defined as a reduced negative slope of the line plotting GFRe versus time without requiring renal replacement therapy after completion of the FONT treatment period P=0.63.

Conclusion: Nearly 50% of patients with resistant FSGS who receive novel antifibrotic agents may have a legacy effect with delayed deterioration in kidney function after completion of therapy. Based on this proof-of-concept preliminary study, we recommend long-term follow-up of patients enrolled in clinical trials to ascertain a more comprehensive assessment of the efficacy of experimental treatments.

via Abstract | Follow-up of phase I trial of adalimumab and rosiglitazone in FSGS: III. Report of the FONT study group.

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Experiences of Parents Who Have Children With Chronic Kidney Disease: A Systematic Review of Qualitative Studies — Tong et al. 121 (2): 349 — Pediatrics

February 3rd, 2010 · living with ns, parents of children with ckd, research

Reading this paper reminded me that I am not alone in feeling a whole raft of things as a parent of a child with CKD.

The objective of this study was to describe the experiences of parents who have children with chronic kidney disease.

Ten themes emerged, which we grouped into 3 interrelated clusters: intrapersonal (living with constant uncertainty, stress, and maintaining vigilance despite experiencing fatigue), interpersonal (medicalization of the parental role, dependence on and conflict with staff, and disrupted peer relationships), and external issues (management of the medical regimen, pursuit of information, organizing transportation, accommodation and finances, adhering to the child’s liquid and diet restrictions, and balancing medical care with domestic responsibilities).

CONCLUSIONS. In addition to “normal” parental roles, being a parent of a child with chronic kidney disease demands a high-level health care provider, problem solving, information seeking, and financial and practical skills at a time when the capacity to cope is threatened by physical tiredness, uncertainty, and disruption to peer support within and outside the family structure. Parents of children with chronic kidney disease need multidisciplinary care, which may lead to improved outcomes for their children.

via Experiences of Parents Who Have Children With Chronic Kidney Disease: A Systematic Review of Qualitative Studies — Tong et al. 121 (2): 349 — Pediatrics.

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Even mild kidney disease harms a child’s quality of life

February 3rd, 2010 · children, living with ns, research, side effects of ckd

Early intervention for children with setbacks resulting from kidney disease may be a good idea:

Challenging prevailing wisdom that only children with end-stage kidney disease suffer physical, social, emotional and educational setbacks from their disease, research led by Johns Hopkins Children’s Center shows that even mild to moderate kidney disease may seriously diminish a child’s quality of life.

The findings, reported in the February issue of Pediatrics, suggest that earlier attention to quality-of-life issues in children with chronic kidney disease is needed.

via Even mild kidney disease harms a child’s quality of life. Paper in Pediatrics

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Simple Steps Prevent Life-Threatening Bloodstream Infections in Children

January 23rd, 2010 · children, hospitalization, print outs, research

This is another one I will print out fo my ‘hospitalisation file’ (the file we take with us to hospital that contains all our son’s notes and any aspects of treatment, like this, I want to keep an eye on). The staff at our hospitals are wonderful but they are busy and in hospital I’m not, so I see it as a chance to work with the docs and nurses to keep my son well rather than me being a pain or trying to do their job for them :) .

This research shows that focussing on careful placement of catheters and basic daily cleaning of the devices can have a significant impact on reducing life-threatening infections:

Pediatric hospitals can significantly decrease the number of bloodstream infections from central venous catheters by following some low-tech rules: Insert the catheter correctly and, above all, keep everything squeaky clean after that.

…

Each year, 250,000 central line infections occur in the United States, researchers estimate, and up to one-fourth of patients die from them. Between 10 and 20 percent of children who get such infections die from them, researchers believe, and each infection carries a cost of $50, 000.

via Simple Steps Prevent Life-Threatening Bloodstream Infections in Children | Children’s Hospital at Johns Hopkins. Results are to be published in the February issue of the journal Pediatrics.

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Omega-3 Fatty Fish Cuts Kidney Cancer Risk

January 22nd, 2010 · omega-3, research

Although this research is about renal cancer and the benefits of Omega-3, I thought the sentence about abnormal cellular growth in the kidney (highlighted below) was interesting. It would be interesting to know if any research has been done on omega-3 and cellular changes in kidneys associated with non-cancerous kidney diseases.

Eating omega-3 rich fatty fish at least once a week lowered women’s risk of renal cell carcinoma, while lean fish and crustaceans – shrimp and lobster – offered no benefit, explaining the inconsistent results of previous studies analyzing total fish consumption.

In this population-based prospective study performed in Sweden, over 61,000 women between 40 and 76 years old filled out a food frequency questionnaire when first entering the study, then seven to 10 years later. After adjusting for potential confounding factors, there was an inverse relationship with consumption of fatty fish such as salmon, mackerel and herring and risk of developing abnormal cellular growth within the kidney.

Wolk, A. et al, “Long-term Fatty Fish Consumption and Renal Cell Carcinoma Incidence in Women” JAMA 2006; 296:1371-1376.

via Research – Omega-3 Fatty Fish Cuts Kidney Cancer Risk.

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More research showing the benefits of vitamin D

January 22nd, 2010 · research, vitamin d

European research has suggested that vitamin D supplements could cut the risk of developing bowel cancer:

The results of this large observational study indicate a strong inverse association between levels of pre-diagnostic 25-(OH)D concentration and risk of colorectal cancer in western European populations. Further randomised trials are needed to assess whether increases in circulating 25-(OH)D concentration can effectively decrease the risk of colorectal cancer.

via BMJ.

Read more about vitamin and its link with kidney disease specifically here:

Low vitamin D levels and the link with a wide variety of diseases including CKD

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