CVS to Offer Home Dialysis, Kidney Age, Bionic Kidney Development, Help for Battling Transplant Surgery

Kidney News

From MedicalXpress, 
Nuffield Department of Primary Care Health Sciences, University of Oxford

'Kidney age', not kidney disease

There should be a rethink in how doctors talk to some patients with reduced kidney health, replacing the term 'chronic kidney disease' (CKD) with different bands of kidney age, according to a group of experts writing in the Canadian Medical Association Journal.

From the Universities of Oxford, Bristol and Johannesburg, the researchers argue that for some people a reduced level of kidney function is not necessarily a disease, but a normal and asymptomatic sign of ageing, given the clear link between decreasing kidney health and increasing age.

Since 2002, the different stages of CKD have been used by doctors to label reduced glomerular filtration rate (GFR) – the rate at which blood passes through tiny capillaries in the kidney each minute, but this leads to confusion and worry for some patients.

"Qualitative studies show that communicating a diagnosis of 'CKD' to patients can be uncomfortable and unsatisfactory for all concerned, and primary care physicians often face an up-hill battle to retrieve the situation with reassurance," said lead author Richard Stevens, an Associate Professor at Oxford University's Nuffield Department of Primary Care Health Sciences.

"Some doctors prefer not to mention the condition to patients so as to avoid any unnecessary worry, given that a reduced but stable kidney function in elderly patients requires regular monitoring rather than immediate intervention."

CKD stage 5 (where the filtration rate falls below 15 ml/min/1.73m2) is classed as disease at any age, since the kidneys no longer function and dialysis is required.

However, after analysing previously published data from the National Health and Nutrition Examination Survey (2015/16), the researchers argue that CKD up to stage 4 (where GFR declines from 90 to 15 mL/min/1.73m2), does not meet the criteria for disease. Instead they link this with increasing age, from 51 to 95 years old respectively, since this gradual decline in kidney function is not abnormal in older age groups.

When a person's kidney age is higher than their actual age, the researchers suggest doctors communicate this with discussion of further monitoring and in the context of potential health implications, such as the risk of cardiovascular disease or end-stage renal disease.

Co-author Professor Richard Hobbs, an inner-city Birmingham GP and Head of Oxford University's Nuffield Department of Primary Care Health Sciences says that applying the same concepts used by doctors to describe heart or vascular age would likely have greater resonance with patients.

"Relabelling CKD stages up to 4 as categories of normal kidney ageing would clear up a common misconception by patients that they require dialysis and transplant due to the use of terms 'chronic' and 'disease', when their condition is just a normal sign of ageing. For example, a doctor would tell their patient that their kidney age is 68 to 77 years, instead of diagnosing CKD stage 3A."

The researchers stress that kidney disease remains a significant health concern for many and the term kidney age should only apply to age-related kidney decline. Conditions affecting the kidney such as nephrotic syndrome and polycystic kidneys fall outside the scope of the definition of kidney ageing.

Before a widespread adoption of the kidney ageing terminology by health professionals, the researchers call for further discussion with patient groups and broader studies of kidney decline across different populations and ethnic groups to better understand the link between kidney health and ageing.

The research is funded by the National Institute for Health Research (NIHR) School for Primary Care Research.

From Chain Store Age, BY DAVID SALAZAR

CVS Health delves deeper into monitoring, providing care for chronic diseases

CVS Health wants to help improve patient outcomes and control costs for patients with chronic kidney disease.

The company is launching a new initiative that will focus on early identification of kidney disease and an expanded home dialysis offering designed to help optimize care and contain costs for patients with chronic kidney disease. The program, which includes the introduction of new home hemodialysis technology, positions the company to positively disrupt and reshape the kidney care space, CVH Health said.

“In dialysis today, there is an enormous unmet medical need with high levels of mortality, frequent hospitalizations and poor quality of life for affected patients,” said Alan Lotvin, M.D., executive VP and head of CVS Specialty. “As we explored this area it became clear that our enterprise assets from our experience with complex patient home care through Coram, the breadth of our chronic disease management capabilities with CVS Specialty and Accordant, and our deep payer relationships at CVS Caremark will enable us to create a unique value proposition to help reshape dialysis treatment.”

The company will approach the new program in stages, with the initial efforts focused on early identification and patient education, followed by the development of a comprehensive home dialysis program. As part of the program, CVS Health will begin a clinical trial to demonstrate the safety and efficacy of a new hemodialysis device that it plans to submit to the FDA to get market clearance.

“The device has been designed with features intended to make home hemodialysis simple and safe for patients, in order to facilitate longer, more frequent treatments,” CVS Health stated. “In published clinical research, longer, more frequent hemodialysis treatments lead to better outcomes in appropriate patient populations.”

Roughly 700,000 Americans have end-stage renal disease, and roughly half a million of them are on active dialysis, with 120,000 new cases diagnosed annually. In addition to the cost burden associated with the illness — it costs Medicare nearly $65 billion a year and another $34 billion related to patient care — its outcomes lag. Mortality rates for in-center dialysis patients are 10 times higher than the general Medicare population.

“While in-center dialysis clinics are currently the most common choice for hemodialysis treatment, published clinical research has shown improved cardiac health, metabolic control, and survival for patients who are treated with longer, more frequent dialysis treatments,” said CVS Specialty chief medical officer Bruce Culleton. “This treatment paradigm is best delivered in the convenience of a patient’s home. CVS Health is uniquely positioned to build a solution that will enable us to identify and intervene earlier with patients to optimize the management of chronic kidney disease, while at the same time making home dialysis therapies a real option for more patients.”

From The Salem News, MA, By Jean DePlacido Correspondent

Jean DePlacido column: Adams sets up website to help those battling transplant surgery

Linda Adams knows how difficult it can be to go through transplant surgery — and the former Beverly resident wants to help others.

She set up the Live and Battle web site (liveandbattle.com) and, after years of dialysis three times a week for three-and-a-half hour sessions, was fortunate to have a former co-worker donate a non-matching kidney for her transplant at Georgetown University Hospital in 2009.

A Beverly High graduate, Adams has been through a lot: sickness, surgeries, depression. But through it all, she has remained determined to help others.

Setting up her charity — live the dream, battle the nightmare — was the first step.

"I was going through a hard time with the dialysis treatment while waiting for a kidney, and I always thought I had to make the best of a really bad situation. So I talked to other people every time I went to the clinic," said Adams, who is married to Tommy Hayes, a former Beverly High quarterback (Class of 1984). His late father Bill was a well-known basketball coach and high school football referee.

"I realized I was making people a little happier, and want to continue to do all I can to help make the situation a little better."

Adams works out regularly and eats healthy foods. Doctors encourage kidney transplant recipients to keep up physical activity. She had polycystic kidney disease, something her mother suffered from for years and causes kidney failure.

Following the donation of a life saving kidney by former co-worker John Willinger, Adams suffered acute rejection, which landed her back in the hospital. She was later diagnosed with T cell lymphoma and, five years ago, with melanoma.

While the list of health problems would discourage anyone, Adams kept thinking positive thoughts, and her goal to help others never wavered.

Former Peabody High football star Mike Ryan urged Adams to keep lifting weights and reach out to others going through similar health difficulties. When Adams and Hayes lived in Las Vegas two years ago before moving to Jupiter, Fla., they traveled to Venice, Calif. to visit Ryan, who is a famous trainer for the stars, and work out at his facility.

"Mike is a great friend of ours and I worked out with him," said Adams. "He encouraged me to do all the things I need to in order to be as healthy as I possibly can.

"Through my live and battle charity, I hope to raise money to help others. For one thing, those dialysis chairs are the most uncomfortable things. I would like to see something better used. I want to raise money to travel to hospitals to talk to people waiting to undergo transplants, and another goal is getting hotels in big cities to offer discounts to families with loved ones in the hospitals nearby. I know of one family that had to spend three months in a hotel, which is so expensive. Those are some of the things I want to help with through this charity."

Artificial Kidney

From WSMV, Channel 4, NBC Affiliate Nashville, TN, Reported by Alan Frio

Vanderbilt doctor working to develop a bionic kidney

There are two options for a person with kidney failure. A kidney transplant or dialysis, a machine that filters the blood of toxins, normally cleaned by healthy kidneys.

Thanks to research conducted at Vanderbilt University Medical Center and five other universities around the country, a third option may be available that can mean people on dialysis can lead a normal life as if they didn't have kidney failure at all.

Right now without dialysis, a person with kidney disease can live for only a few weeks, perhaps months.

A tiny device that can fit in the palm of your hand may be a game changer. It’s called the bionic kidney.

Vanderbilt nephrologist Dr. William Fissell is part of a nationwide team of doctors and biologist who have been working on the device for 17 years.

"It's fair to call it a bionic kidney because it's a hybrid of technology and living cells," said Fissell.

It's been a long journey for Fissell. He hopes to begin clinical trials on the bionic kidney later this year and to get the device to kidney patients as soon as safety permits.

"Know that we are doing it as fast as we can, and know that the rest of the country has mobilized in a way you may not expect," said Fissell.

If the bionic kidney makes that huge jump from clinical trials to where it becomes available to all kidney patients, the implications for someone in renal failure is huge.

"What I want to do is enough, so that sick people can become well, not burdened by the disease, so that patients aren't stuck to a machine plugged into a wall 15 hours a week, so they don't have to have a special diet, so that patients don't have to starve themselves to avoid intoxication with waste products," said Fissell.