tag:theconversation.com,2011:/global/topics/dialysis-7574/articlesDialysis – The Conversation2024-02-05T22:24:10Ztag:theconversation.com,2011:article/2209412024-02-05T22:24:10Z2024-02-05T22:24:10ZThe uncertain fate of patients needing life-saving dialysis treatment in Gaza<p>More than 100 days into the brutal assault on Gaza, over <a href="https://news.un.org/en/story/2024/02/1146157">27,000 Palestinians have been killed — of whom 60 per cent have been children and women</a> — and 66,000 injured, according to the World Health Organization (WHO).</p>
<p>The destruction of Gaza’s health-care system has been catastrophic. The <a href="https://news.un.org/en/story/2024/01/1145317#:%7E:text=Hundreds%20of%20facilities%20hit,seven%20deaths%20and%2052%20injuries.">WHO says</a> that, as of Jan. 5, there have been more than 600 attacks on health-care facilities, with 26 out of 36 hospitals in Gaza severely damaged and 79 ambulances targeted. Over <a href="https://doi.org/10.1136/bmj.q203">300 health-care workers have been killed and over 200 have been detained by Israeli forces</a>. </p>
<p><a href="https://www.msf.org/letter-gaza-un-security-council">In an open letter</a> to the United Nations Security Council, Médecins Sans Frontières (MSF) president Christos Christou wrote: </p>
<blockquote>
<p>“Israel has shown a blatant and total disregard for the protection of Gaza’s medical facilities. We are watching as hospitals are turned into morgues and ruins. These supposedly protected facilities are being bombed, are being shot at by tanks and guns, encircled and raided, killing patients and medical staff.”</p>
</blockquote>
<p>Most of the resources within the collapsing health-care system in Gaza are directed towards treating acute trauma victims, such as the injured <a href="https://www.reuters.com/world/middle-east/baby-saved-gaza-rubble-after-mother-killed-israeli-strike-2023-12-29/">babies pulled from rubble</a>, the toddlers requiring <a href="https://www.reuters.com/world/middle-east/gazas-child-amputees-face-further-risks-without-expert-care-2024-01-04/">limb amputations</a> and the civilians suffering from <a href="https://reliefweb.int/report/occupied-palestinian-territory/gaza-strip-msf-treating-patients-severe-burns-following-airstrike">severe burn injuries</a>. This leaves patients with chronic life-threatening diseases, such as cancer, heart failure and end-stage kidney disease, with severely limited access to the ongoing medical care they need to survive.</p>
<h2>Patients unable to access care for chronic conditions</h2>
<p>As nephrologists and internal medicine physicians, we are gravely concerned about patients in Gaza with chronic diseases who are unable to access care. There are more than <a href="https://www.aljazeera.com/features/2023/10/25/terrifying-hope-shrinks-for-gazas-dialysis-patients-at-packed-hospitals">1,100 dialysis patients, including 38 children, in Gaza</a>. </p>
<p><a href="https://kidney.ca/Kidney-Health/Living-With-Kidney-Failure/Dialysis">Hemodialysis</a> is a treatment for patients with kidney failure that involves removing blood from the patient’s circulation and circulating it through a dialysis machine that clears toxins and removes excess fluid. Without adequate dialysis, fluid and toxins accumulate and patients typically die within days to weeks from respiratory failure or cardiac arrest. </p>
<p>Dialysis is a resource-intensive therapy that requires a dialysis facility, dialysis machines, filters, water supply and fuel, along with a team of technicians, nurses and nephrologists. Each one of these components has been severely and directly compromised since Israel’s assault on Gaza. </p>
<p>Israel’s complete blockade of food, fuel and water has left over <a href="https://abcnews.go.com/International/500000-people-gaza-face-catastrophic-hunger-unrwa/story?id=106593939">500,000 Gazans facing catastrophic hunger</a> according to the United Nations Relief and Works Agency (UNRWA), and Gazan children face a <a href="https://www.unicef.org/press-releases/barely-drop-drink-children-gaza-strip-do-not-access-90-cent-their-normal-water-use">90 per cent reduction in access to water</a>.</p>
<p>Several hospitals, including Al-Aqsa, reported being completely out of fuel, putting all patients in grave danger, <a href="https://www.aljazeera.com/news/2024/1/13/blackout-in-gazas-al-aqsa-hospital-as-fuel-runs-out-babies-at-high-risk">particularly those on life support, babies in incubators and those requiring dialysis</a>. </p>
<p>Even before the current conflict, the 16-year blockade of Gaza put the lives of kidney failure patients at risk due to chronic shortages of fuel and medical supplies. Al Jazeera reports that since Oct. 7, <a href="https://www.aljazeera.com/features/2023/10/25/terrifying-hope-shrinks-for-gazas-dialysis-patients-at-packed-hospitals">the number of patients at Al-Aqsa Hospital requiring dialysis has more than doubled</a> from 143 to about 300, including 11 children, who have just 24 dialysis machines between them. </p>
<p>This has forced dialysis units to significantly cut treatments, with patients receiving two-hour sessions rather than the typically prescribed 3.5-hour treatments. Treatment frequency, typically prescribed three times weekly, are now only available one or two times per week. </p>
<p>This decrease in treatment time and frequency is grossly insufficient to sustain life. But in a health-care system under assault, patients are fortunate to receive any dialysis at all. </p>
<h2>Patients needing life-saving treatment</h2>
<p>Ismail Al Tawil was a 44-year-old patient in Gaza who died of kidney failure after he was unable to access dialysis. In an interview with Al-Jazeera’s AJ+ social media arm, <a href="https://www.instagram.com/ajplus/reel/C15bdLAOVVi/">his widow described desperately trying to get him to dialysis at Al-Shifa hospital</a>, but being shot at by Israeli snipers who surrounded the hospital. </p>
<p>She then attempted to access dialysis at Al-Awda and Kamal Adwan hospitals, but both facilities had insufficient capacity to treat him. </p>
<p>Since Oct. 7, <a href="https://www.hrw.org/news/2023/12/20/most-gazas-population-remains-displaced-and-harms-way">1.9 million people or 85 per cent of the population of Gaza have been internally displaced</a>, according to Human Rights Watch. This is a tremendous challenge for dialysis patients who are faced with the uncertainty of when, where or if they will access their life-saving therapy. </p>
<p>Anssam, age 12, was displaced from Jabaliya in northern Gaza to seek treatment in Deir El Balah in central Gaza. She had gone 15 days without dialysis and had to leave with her mother to receive life-saving medical treatment. <a href="https://www.thenationalnews.com/mena/palestine-israel/2023/12/18/gaza-dialysis-patients-hospital/">In an interview with <em>The National News</em></a>, Anssam said: </p>
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<p>“I hope for this war to end and for us to go back to the way we were, happy and playing, and to go back to doing dialysis three times a week… Now, without filters, I cannot have dialysis and so I will die. My life depends on dialysis.” </p>
</blockquote>
<h2>Loss of medical personnel</h2>
<p>Beyond the destruction of health-care facilities and a critical shortage of supplies, the loss of medical personnel may have the most devastating and longest-lasting impact on the health-care system in Gaza. </p>
<p>Dr. Hammam Alloh was one of the only nephrologists in Gaza, <a href="https://www.democracynow.org/2023/11/13/medical_workers_killed_colleagues_mourn_hammam">described as a committed physician and a beacon of light by his colleagues</a>. He was 36 years old and a father of two young children. He had hopes to expand dialysis care in Gaza and build a nephrology educational training program.</p>
<p><a href="https://www.cbc.ca/news/world/gaza-hamman-alloh-killed-1.7027623">He was killed on Nov. 12</a> by an <a href="https://www.frontlinedefenders.org/en/profile/hammam-alloh">Israeli airstrike to his family’s home</a>, where he was taking a short rest after a busy shift at Al Shifa Hospital. His loss resonated far beyond his family, patients and colleagues in Gaza. Dr. Alloh’s <a href="https://www.presstv.ir/Detail/2023/11/19/714879/humans-of-gaza-hammam-alloh-nephrologist-alshifa-hospital">courage and dedication has become a powerful source of inspiration</a> for physicians and health-care workers around the world. </p>
<p>Multiple sources have reported the number of civilians who have been killed by the bombs and bullets during the assault on Gaza. We may never know how many cancer patients will die from lack of chemotherapy; or diabetics from lack of insulin; or kidney failure patients from inadequate dialysis. The consequences of the collapsed health-care system in Gaza will be felt for years to come. </p>
<p>The <a href="https://www.cbc.ca/news/canada/chilling-effect-pro-palestinian-1.7064510">attempts to silence, intimidate and smear health-care workers</a> for calling out the atrocities in Gaza have been well documented. These efforts not only attempt to rob us of our freedom of speech, but of our professional and moral duty as physicians to promote global health and protect the vulnerable. </p>
<p>As physicians, we will not be silent as our colleagues in Gaza are being killed, as hospitals are being targeted and attacked, and as vulnerable patients are endangered. We <a href="https://news.un.org/en/story/2024/01/1145462">join the UN</a>, the <a href="https://doi.org/10.1016/S0140-6736(23)02627-2">WHO</a>, <a href="https://www.doctorswithoutborders.ca/msf-immediate-ceasefire-is-needed-in-gaza-to-stop-the-bloodshed/">MSF</a> and the <a href="https://www.bma.org.uk/what-we-do/working-internationally/our-international-work/bma-position-israel-gaza-conflict">British Medical Association</a>, along with millions around the world, who call for an immediate ceasefire and unimpeded humanitarian aid. </p>
<p>We stand in solidarity with the true health-care heroes of Gaza who continue to work in harrowing conditions, and we honour the legacies of those like Dr. Alloh who lost their lives while upholding the highest values of our profession.</p><img src="https://counter.theconversation.com/content/220941/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Patients with kidney failure need regular dialysis treatments to survive. However, the equipment, supplies and medical staff needed for dialysis have been largely destroyed by the assault on Gaza.Ali Iqbal, Transplant Nephrologist, Assistant Professor of Medicine, McMaster UniversityAliya Khan, Clinical professor, Faculty of Health Sciences, McMaster UniversityBen Thomson, Masters of Public Health student, Bloomberg School of Public Health, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2063922023-05-25T00:43:48Z2023-05-25T00:43:48ZTina Turner had a history of high blood pressure and kidney disease. Here’s how one leads to the other<p>Legendary singer Tina Turner, who <a href="https://www.abc.net.au/news/2023-05-25/singer-tina-turner-has-died-aged-83/102389716">died this week</a> at the age of 83 after a long illness, has <a href="https://www.showyourkidneyslove.com/articles/tina-turner/">written about</a> her history of high blood pressure and kidney disease, leading to a kidney transplant.</p>
<p>Turner should be applauded for her willingness to share her <a href="https://www.instagram.com/p/CpkhvaFBS0K/?utm_source=ig_web_copy_link&igshid=MzRlODBiNWFlZA%3D%3D">medical history</a> to publicise the importance of looking after your kidneys, just months before she died.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CpkhvaFBS0K/?utm_source=ig_web_copy_link\u0026igshid=MzRlODBiNWFlZA%3D%3D","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>Turner’s family has not confirmed how she died. But Turner’s openness with her long-standing illness is a reminder for us all to keep an eye on our blood pressure, and to control it, if we are to avoid complications.</p>
<p>Here’s why controlling your blood pressure is so important and what can happen if we don’t.</p>
<h2>Why is high blood pressure linked to kidney disease?</h2>
<p>There’s a bi-directional relationship between blood pressure and kidney disease. </p>
<p>That means high blood pressure increases the risk for kidney disease and once you have kidney disease, it further promotes high blood pressure. It’s a vicious cycle.</p>
<p>In some cases, it’s hard to determine which one came first. </p>
<p>Uncontrolled blood pressure exerts a lot of pressure on the kidney. That leads to scarring and damage. If we looked inside the kidney, we’d see large areas of scarring. Once you have scarring, that tissue isn’t working properly and can start to leak protein into the urine. That then pushes up the risk of progressive kidney disease, leading to kidney failure, heart disease and premature death.</p>
<p>The kidney itself is integral to maintaining blood pressure. Kidneys obviously maintain fluid balance by passing urine, but they also have important hormonal jobs which are vital to maintaining blood pressure.</p>
<p>So, once you get kidney disease, blood pressure can be really hard to manage. It’s like a hammer and nail, and the nail is the kidney. If you have high blood pressure, the hammer is hitting the nail really, really hard.</p>
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Read more:
<a href="https://theconversation.com/health-check-what-do-my-blood-pressure-numbers-mean-29212">Health Check: what do my blood pressure numbers mean?</a>
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<h2>Are there certain symptoms to look out for?</h2>
<p>Both high blood pressure and kidney disease are what we call “clinically silent”, so many people don’t realise they have problems until it is very far along. </p>
<p>Often a person with high blood pressure has no symptoms. There are times, in extreme cases, where people may get headaches or a feeling of thumping in the head. But their first sign may be a stroke or heart attack or some other major complication. That’s why checking blood pressure on a regular basis is smart.</p>
<p>For kidney disease, you can lose up 90% of kidney function before symptoms develop. They can be clinically silent right up until kidney failure. When symptoms do arrive, they can be very vague – things like poor concentration or feeling tired. </p>
<p>Often people just put it down to winter, being busy or getting older. </p>
<p>So we recommend screening for kidney disease if you have high blood pressure, diabetes, heart disease, excess abdominal weight, a history of smoking, acute kidney injury or a family history of kidney disease. This should be done on a one- to two-year basis.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kidneys-are-amazing-for-all-they-do-be-sure-to-look-after-yours-30966">Kidneys are amazing for all they do, be sure to look after yours</a>
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<h2>What are the treatments?</h2>
<p>In the past five years, there have been a swathe of newer medicines that bring down blood pressure and protect the kidney. For around 20 years, we have had a class of drugs called renin-angiotensin system blockade (usually just shortened to RAS blockade).</p>
<p>But more recently, we have a new group of medicines called <a href="https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/sodium-glucose-cotransporter-2-sglt2-inhibitors#:%7E:text=SGLT2%20inhibitors%20are%20a%20class,canagliflozin%2C%20dapagliflozin%2C%20and%20empagliflozin.">SGLT2 inhibitors</a>, which have really changed the landscape of kidney disease. The Therapeutic Goods Administration has just approved another medicine called finerenone, which is a non-steroidal MRA. </p>
<p>These have all been shown to protect the kidney, as opposed to just treating symptoms. They slow the progression of the disease and have shifted the paradigm to kidney preservation. </p>
<p>And it’s really crucial you address the lifestyle factors that increase your risk.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-chronic-kidney-disease-and-why-are-one-in-three-at-risk-of-this-silent-killer-81942">Explainer: what is chronic kidney disease and why are one in three at risk of this silent killer?</a>
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<h2>How can I reduce my risk?</h2>
<p>Don’t smoke. Being a smoker significantly increases your risk of high blood pressure and kidney disease.</p>
<p>Eat a nutrient-dense diet, including fresh, whole foods that are in season and avoid ultra-processed food and sugar. This approach will help to control blood pressure and protect the kidney. </p>
<p>Do all the usual things – get good sleep, maintain an active lifestyle and manage your stress. If you have a family history of kidney disease, that may prompt you to get checked. </p>
<p>Do the <a href="https://kidney.org.au/kidneyrisktest/">Kidney Health Australia quiz</a> and if you are deemed to be at risk, go to your GP to get a kidney health check. That involves a blood pressure check, urine test and a blood test.</p>
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Read more:
<a href="https://theconversation.com/health-check-what-can-your-doctor-tell-from-your-urine-74990">Health Check: what can your doctor tell from your urine?</a>
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<h2>Kidney disease is becoming more common</h2>
<p>The number of people with kidney failure is increasing dramatically. <a href="https://www.aihw.gov.au/news-media/media-releases/2021/august/recipients-of-kidney-replacement-therapy-more-than">According</a> to the Australian Institute of Health and Welfare, the number of Australians receiving kidney replacement therapy (either on dialysis or living with a transplant) more than doubled between 2000 and 2020, from 11,700 to 27,700. Over half of those receiving kidney replacement therapy were on dialysis.</p>
<p>While a kidney transplant improves quality of life and can extend a person’s life, it’s important to remember that high blood pressure can still persist and often requires ongoing treatment.</p><img src="https://counter.theconversation.com/content/206392/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Dwyer is Clinical Director of Kidney Health Australia. She has received honorarium from AstraZeneca, Boehringer Ingelheim and Bayer. She is on the clinical advisory committee for GMHBA. She has a current research grant through Servier.</span></em></p>What’s the relationship between high blood pressure and kidney disease, and how can they be prevented?Karen Dwyer, Professor, School of Medicine, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1808252022-04-12T17:22:42Z2022-04-12T17:22:42ZHemodialysis: New research could vastly improve this life-sustaining treatment for kidney failure patients<figure><img src="https://images.theconversation.com/files/457580/original/file-20220412-21-ir72f2.jpg?ixlib=rb-1.1.0&rect=384%2C118%2C4273%2C2974&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Hemodialysis treatment can be efficient at replacing some lost kidney function, but patients can experience complications and side-effects.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Around <a href="https://kidney.ca/KFOC/media/images/PDFs/Facing-the-Facts-2020.pdf">one in 10 Canadians has kidney disease</a> and millions more are at risk. According to the Kidney Foundation of Canada, the number of people living with end-stage kidney disease or <a href="https://kidney.ca/KFOC/media/images/PDFs/Facing-the-Facts-2020.pdf">kidney failure has grown 35 per cent since 2009, with 46 per cent of new patients under the age of 65</a>. </p>
<p>Hemodialysis is a life-sustaining treatment for kidney failure patients to clean and filter their blood of waste products, salts and excess fluid. However, this membrane-based therapy is not perfect, and hemodialysis patients experience acute side-effects, life-threatening chronic conditions and unacceptably high morbidity and mortality rates. </p>
<p>While hemodialysis treatment can be efficient at replacing some lost kidney function, patients experience some complications such as <a href="https://www.healthline.com/health/kidney-health/dialysis-side-effects">blood clots, heart conditions, cardiac arrest</a>, <a href="https://www.nhs.uk/conditions/dialysis/side-effects/">blood poisoning</a>, <a href="https://www.mayoclinic.org/tests-procedures/hemodialysis/about/pac-20384824">anemia, high/low blood pressure, bone diseases, itching, sleep problems, heart inflammation, fluid overload, infections and muscle cramps</a>. </p>
<p>As a membrane science researcher, I am working on creating hemodialysis membranes that are more compatible with the human body than current membranes. My short-term aim is to achieve reduced patient side-effects and increase quality of life. </p>
<p>My long-term goal is to design an artificial wearable kidney based on a membrane with greatly improved performance compared to those in use in hospitals today. This is the only research program in Canada to address key problems associated with dialysis membranes.</p>
<h2>Problems and challenges with hemodialysis</h2>
<p>First, dialysis treatment is expensive, <a href="https://kidney.ca/KFOC/media/images/PDFs/Facing-the-Facts-2020.pdf">costing the Canadian health-care system more than $100,000 per patient per year</a>. And while it does prolong life, it presents a number of challenges. </p>
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<a href="https://images.theconversation.com/files/457583/original/file-20220412-16-crw4w8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A patient's arm attached to tubes transporting blood to a machine" src="https://images.theconversation.com/files/457583/original/file-20220412-16-crw4w8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/457583/original/file-20220412-16-crw4w8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/457583/original/file-20220412-16-crw4w8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/457583/original/file-20220412-16-crw4w8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/457583/original/file-20220412-16-crw4w8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/457583/original/file-20220412-16-crw4w8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/457583/original/file-20220412-16-crw4w8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">In a hemodialysis session, a patient’s blood is diverted to a machine to remove waste products and excess fluid.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>In a hemodialysis session, a patient’s blood is diverted to a machine to remove waste products and excess fluid. A typical patient requires three dialysis sessions per week, each taking four to five hours, so even mild interactions between a patient’s blood and the dialysis membrane may lead to big problems over time. </p>
<p>Because the membranes in use today cannot perfectly mimic the function of a healthy kidney, some toxins can be poorly filtered from the blood, new ones can arise from blood-membrane interactions and blood clotting can occur. </p>
<p>The <a href="https://www.medscape.com/answers/238798-105284/what-are-the-mortality-rates-associated-with-chronic-kidney-disease-ckd#:%7E:text=Mortality%20then%20tends%20to%20improve,25%25%20in%20patients%20with%20diabetes.">five-year survival rate for hemodialysis patients is 35 per cent, and only 25 per cent for hemodialysis patients with diabetes</a>; both values are considerably worse than the <a href="https://cancer.ca/en/research/cancer-statistics/cancer-statistics-at-a-glance">five-year survival rate for cancer patients of approximately 64 per cent</a>. </p>
<p>Additional kidney failure patients are now requiring treatment as <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-kidney-damage-caused-by-covid19">more than 30 per cent of patients hospitalized with COVID-19 develop kidney injury</a>. Some studies in Canada showed that around <a href="https://doi.org/10.1177/20543581211027759">54 per cent of the Canadian patients who were hospitalized with COVID-19 developed acute kidney injury</a>. Although the rates of acute kidney injury have fallen from the early months of the pandemic, <a href="https://doi.org/10.1093/ndt/gfab303">high-risk patients should have their kidney function and fluid status monitored closely</a>.</p>
<h2>Research program progress</h2>
<p>My research group is working on creating hemodialysis membranes that are more compatible with the human body than current membranes. The first step was to conduct <a href="https://doi.org/10.1038/s41598-020-71755-8">in-depth investigations of the membranes available in Canadian hospitals</a> to determine how patient side-effects are related to the characteristics of the membranes and the clinical practices employed. We are getting answers to several key questions and taking steps towards new designs and new membrane materials.</p>
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<a href="https://images.theconversation.com/files/457266/original/file-20220410-21-z8jc37.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C579%2C504&q=45&auto=format&w=1000&fit=clip"><img alt="A woman adjusting equipment in a lab" src="https://images.theconversation.com/files/457266/original/file-20220410-21-z8jc37.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C579%2C504&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/457266/original/file-20220410-21-z8jc37.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=582&fit=crop&dpr=1 600w, https://images.theconversation.com/files/457266/original/file-20220410-21-z8jc37.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=582&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/457266/original/file-20220410-21-z8jc37.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=582&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/457266/original/file-20220410-21-z8jc37.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=731&fit=crop&dpr=1 754w, https://images.theconversation.com/files/457266/original/file-20220410-21-z8jc37.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=731&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/457266/original/file-20220410-21-z8jc37.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=731&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Amira Abdelrasoul uses Canadian Light Source synchrotron to get answers to several key questions about hemodialysis.</span>
<span class="attribution"><span class="source">(Amira Abdelrasoul)</span>, <span class="license">Author provided</span></span>
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<p>Innovative imaging techniques available at the <a href="https://www.lightsource.ca/index.php">Canadian Light Source</a> (CLS) synchrotron at the University of Saskatchewan have allowed my team to visualize and track the behaviour and deposits <a href="https://doi.org/10.1016/j.seppur.2020.118136">of blood proteins inside the membrane channels</a>. This is important because these protein deposits can bring about severe inflammation and are undesirable. Imaging at the CLS allows real-time 3D visualization at high speeds. </p>
<p>We are currently using customized gold nanoparticles to label and track specific blood proteins, which have different shapes and sizes, through the filtration process. This is a huge advance over other imaging techniques that only allow us to see the top layer of the membrane. </p>
<p>We can now monitor the flow at every layer of both new and existing hemodialysis membranes, which means we can assess protein deposits on the dialysis membrane surface, accumulation and blockage of the membrane pores at all points in the process. </p>
<p>Using advanced software, the 3D images we obtain are being converted into valuable models that can predict how these blood proteins behave when they interact with different types of membranes. These models also enable us to understand when, how and why proteins accumulate and block the membranes for different clinical conditions. </p>
<h2>Impact for patients</h2>
<figure class="align-right ">
<img alt="A black square with a wide yellow diagonal streak and a narrow yellow streak" src="https://images.theconversation.com/files/457493/original/file-20220411-24-ezm039.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/457493/original/file-20220411-24-ezm039.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=584&fit=crop&dpr=1 600w, https://images.theconversation.com/files/457493/original/file-20220411-24-ezm039.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=584&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/457493/original/file-20220411-24-ezm039.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=584&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/457493/original/file-20220411-24-ezm039.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=734&fit=crop&dpr=1 754w, https://images.theconversation.com/files/457493/original/file-20220411-24-ezm039.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=734&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/457493/original/file-20220411-24-ezm039.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=734&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Photo A, showing protein deposit on current clinical membranes.</span>
<span class="attribution"><span class="source">(Amira Abdelrasoul)</span>, <span class="license">Author provided</span></span>
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<img alt="A black square with very faint streaks of yellow particles" src="https://images.theconversation.com/files/457494/original/file-20220411-10942-8ujlex.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/457494/original/file-20220411-10942-8ujlex.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=581&fit=crop&dpr=1 600w, https://images.theconversation.com/files/457494/original/file-20220411-10942-8ujlex.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=581&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/457494/original/file-20220411-10942-8ujlex.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=581&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/457494/original/file-20220411-10942-8ujlex.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=731&fit=crop&dpr=1 754w, https://images.theconversation.com/files/457494/original/file-20220411-10942-8ujlex.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=731&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/457494/original/file-20220411-10942-8ujlex.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=731&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Photo B shows significantly lower protein deposits on newly developed membranes.</span>
<span class="attribution"><span class="source">(Amira Abdelrasoul)</span>, <span class="license">Author provided</span></span>
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<p>We are using this information to provide doctors with tools to optimize clinical practice and minimize the patients’ side-effects. For example, one recent study was the first to be able to predict the <a href="https://doi.org/10.1038/s41598-020-71755-8">inflammation that patients may experience after a dialysis session</a>. </p>
<p>Importantly, we are using all of this information to develop new membranes that better mimic the filtration ability of a healthy kidney. Again using gold nanoparticles to track blood proteins, imaging techniques at the CLS show the amount of attachment on <a href="https://doi.org/10.1016/j.surfin.2021.101505">current clinical membranes (Photo A) is greater than on membranes we developed with our new coating (Photo B)</a>. </p>
<p>The information from all of our studies is being integrated to allow us to tune membrane characteristics for individual patient characteristics, which directly works towards our goal of improving patient quality of life. </p>
<p>The results of our work will reduce acute side-effects and life-threatening chronic conditions, and increase the quality of life and survival of the millions of people who suffer from kidney failure.</p><img src="https://counter.theconversation.com/content/180825/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Amira Abdelrasoul receives funding from Social Sciences and Humanities Research Council, Natural Sciences and Engineering Research Council of Canada, and Saskatchewan Health Research Foundation.</span></em></p>Hemodialysis filters kidney patients’ blood through a machine. Improving the membranes that mimic kidney function could reduce complications and side-effects, with better treatment results.Amira Abdelrasoul, Assistant Professor, Chemical and Biomedical Engineering, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1573292021-03-25T14:36:58Z2021-03-25T14:36:58ZKenyans with chronic kidney disease know diet is important. But many don’t follow the guidelines<figure><img src="https://images.theconversation.com/files/390388/original/file-20210318-13-fbo7ts.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Patients on dialysis struggle to follow strict diets. </span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p>Chronic kidney disease is a condition that occurs when a person’s kidneys are damaged and can’t remove harmful waste from the blood. This can lead to high blood pressure and severe infections. The disease affects about <a href="https://doi.org/10.1007/978-981-13-8871-2_1">13.4%</a> of the population globally. Around <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30045-3/fulltext">1.23 million</a> people died of chronic kidney disease in 2017. </p>
<p>But this doesn’t have to be the outcome. Patients can be treated with <a href="https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/choosing-treatment">dialysis</a> to mechanically remove the waste material and excess fluid from the bloodstream. Or they could receive a kidney transplant to replace the damaged kidney. Patients and their caregivers can also <a href="https://doi.org/10.1093/ndt/gfaa336">minimise the symptoms</a> by carefully managing what they eat and drink.</p>
<p>For dialysis to succeed, it’s important to prevent overloading the kidneys. There is <a href="https://doi.org/10.1007/s11906-020-1020-1">convincing evidence</a> that following a healthy diet may lower the risk of disease complications and allow patients to live well despite having the disease.</p>
<p>The recommended diet involves keeping salt intake below <a href="https://doi.org/10.1016/j.jada.2003.12.028">5g per day</a> because damaged kidneys can’t excrete sodium very well. Retaining sodium in the body leads to fluid overload, which is bad for blood pressure and vascular health. Excluding table salt from the diet is a challenge for many patients, though. </p>
<p>It’s also important to reduce potassium content in food, because damaged kidneys aren’t good at excreting excess potassium in urine. Too much potassium can weaken the heart muscles, leading to irregular heartbeat and heart attack. One way to reduce potassium in the diet is by boiling vegetables and discarding the water. </p>
<p>Consumption of red meat is restricted as it leads to accumulation of toxic substances in the body. Patients can eat poultry and fish instead to get animal protein, but this may be expensive. Poor consumption of protein is likely to expose patients to <a href="https://doi.org/10.1053/j.jrn.2018.08.006">malnutrition</a>, which is a common feature in patients on dialysis. </p>
<p>Kenya has seen an increase in the number of patients undergoing dialysis. This is mainly because the service has become more widely <a href="https://doi.org/10.1016/j.kisu.2019.11.010">available</a>. We conducted a <a href="https://rrtjournal.biomedcentral.com/articles/10.1186/s41100-019-0237-4">study</a> with patients on dialysis to understand what factors influence their compliance or non compliance with dietary prescriptions for patients with kidney disease on dialysis.<br>
Understanding why it can be hard to follow the diet allows health practitioners to work with individual patients in finding solutions.</p>
<h2>Challenges with renal diet prescriptions</h2>
<p>The recommended diet can be <a href="https://www.jrnjournal.org/article/S1051-2276(18)30058-X/fulltext">difficult to follow</a> because patients and caregivers find it complex. And at times it may seem to contradict ideas about healthy eating, cultural norms, social functioning, and individuals’ sense of control.</p>
<p>We <a href="https://rrtjournal.biomedcentral.com/articles/10.1186/s41100-019-0237-4">found</a> that almost all participants (92.8%) in our study were aware of the dietary recommendations for patients with chronic kidney disease, but most of them were not following it. The main source of their information was the nutritionist (90.3%) at the health facility. More than half (61.8%) of them, however, had challenges in following the diet recommendations. Most of them considered the recommendations to be important, with health benefits. But 83.8% felt that the diets were restrictive and did not fit with their other ways of eating. </p>
<p>The main problems with the diets were the prescribed food types, preparation methods and sharing meals at social gatherings. Sometimes patients couldn’t avoid certain types of restricted foods, or the prescribed foods were costly or unavailable. Also, caregivers found it stressful, time consuming and expensive to prepare separate meals for the patient and other household members. </p>
<p>Respondents also said it was no longer possible to eat the foods they were most familiar with such as fried food, food with salt added, or locally accessible fruits like bananas or oranges. They couldn’t share family meals, or eat away from home because the foods served are what they are not allowed to eat. They sometimes withdrew from social gatherings for fear of explaining to people why they were avoiding certain foods. </p>
<p>A number of households were also constrained by the high cost of prescribed fruits, vegetables and white meat (chicken or fish) as well as cooking separate foods for the family. </p>
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Read more:
<a href="https://theconversation.com/lessons-from-a-diabetes-clinic-in-malawi-why-everyone-should-follow-a-healthy-diet-143909">Lessons from a diabetes clinic in Malawi: why everyone should follow a healthy diet</a>
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<p>About 39% of participants therefore found it difficult to give up certain foods and drinks. They considered renal diets unpalatable without salt, sugar, or cooking oil. They knew they should be eating boiled vegetables but found these didn’t taste good, or the cooking method seemed to contradict their idea of healthy food. Therefore, most were likely to consume food high in potassium, preferring not to eat food that had no taste and was less nutritious as the vitamins C and B-complex are removed in the preparation.</p>
<p>We observed that consuming unhealthy restricted foods that are palatable and affordable was common among more than half of the patients. This puts them at risk of disease complications, making dialysis less effective and increasing their risk of death. </p>
<p>Studies in developed countries have similarly found that more than half of adults on dialysis <a href="https://doi.org/10.2147/IJNRD.S76831">do not adhere</a> to their diet prescriptions.</p>
<h2>Way forward</h2>
<p>Nutritionists and dietitians can help patients by prescribing a more flexible, affordable, palatable, and nutritious diet. Patients should be involved in developing local recipes based on natural, locally available, and affordable whole foods that contain natural flavours and do not require additives. </p>
<p>To overcome nutrient loss, a variety of locally available vegetables and fruits with lower potassium and sodium content but high vitamins C and B-Complex should be encouraged. </p>
<p>Nutritional advice in chronic kidney disease is based on nutrient requirements linked to published evidence and guidelines. Where international guidelines are the main source of advice, development and use of national guidelines based on locally available foods should be a priority. A good starting point in Kenya would be developing local renal nutrition guidelines, which are currently lacking, based on the most recent, updated <a href="http://www.b4fn.org/resources/publications/publication-item/kenya-food-composition-tables-2018/">National Food Composition Database</a>.</p><img src="https://counter.theconversation.com/content/157329/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This research was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Carnegie Corporation of New York, Sida, the DELTAS Africa Initiative. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (UK) and the UK government. The statements made and views expressed are solely the responsibility of the authors.</span></em></p>Following a healthy diet may lower the risk of disease complications and allow patients to live well despite having the disease.Rose Okoyo Opiyo, Lecturer, University of NairobiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1370972020-05-04T11:04:21Z2020-05-04T11:04:21ZCoronavirus: what risks do people with kidney disease face?<figure><img src="https://images.theconversation.com/files/331963/original/file-20200501-42946-cuvuhk.jpg?ixlib=rb-1.1.0&rect=27%2C0%2C5979%2C4007&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Patients with kidney disease may develop more severe symptoms.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/waist-portrait-female-medical-worker-protective-1197022831">Olena Yakobchuk/ Shutterstock</a></span></figcaption></figure><p>The coronavirus pandemic is causing major healthcare issues for patients with kidney diseases throughout the world. Not only are these patients more likely to have severe complications if infected with COVID-19, anxiety because of the pandemic is also causing many patients not to seek medical care or advice for fear of contracting the virus.</p>
<p>Patients with chronic kidney disease are recognised by the NHS as being at a <a href="https://www.nhs.uk/conditions/coronavirus-covid-19/people-at-higher-risk-from-coronavirus/whos-at-higher-risk-from-coronavirus/">high risk from coronavirus</a>. Recent data also shows that patients needing dialysis <a href="https://renal.org/covid-19/data/">have higher mortality from COVID-19</a> than patients who don’t have kidney disease.</p>
<p>There are a number of potential reasons why patients with kidney disease are more likely to suffer severe complications if they contract COVID-19. </p>
<p>First, they’re more likely to have a <a href="https://www.niddk.nih.gov/health-information/kidney-disease/heart-disease">cardiovascular disease</a> caused by their kidney disease, including high blood pressure and susceptibility to heart attacks and strokes. Cardiovascular disease is known to <a href="https://www.world-heart-federation.org/covid-19-and-cvd/">increase your risk of death</a> if you contract COVID-19. This is likely due to the increased stress the patient’s damaged cardiovascular system is subjected to, and unable to cope with, when the lungs are no longer able to provide enough oxygen to the body. </p>
<p>Patients with advanced kidney disease are also <a href="https://cjasn.asnjournals.org/content/clinjasn/12/12/2032.full.pdf">more likely to be diabetic</a>. Diabetes can cause severe cardiovascular issues and has also been found to put patients at <a href="https://digital.nhs.uk/coronavirus/shielded-patient-list">risk of developing complications</a> from COVID-19.</p>
<p>Second, patients with kidney disease are commonly immunosuppressed – meaning they are less able to fight infections. This can be due to their underlying kidney disease or because they need to take medicines to treat their on-going kidney disease by suppressing their immune system. These drugs are crucial after a kidney transplant to ensure the <a href="https://www.nice.org.uk/guidance/ta481/resources/immunosuppressive-therapy-for-kidney-transplant-in-adults-pdf-82605021450181">body’s immune system</a> doesn’t reject the new kidney.</p>
<p>A suppressed immune system may make the body less able to clear the virus when infected. However, there’s also some evidence that an <a href="https://theconversation.com/coronavirus-cytokine-storm-this-over-active-immune-response-could-be-behind-some-fatal-cases-of-covid-19-136878">“over-active” immune system</a> after the first few days of infection causes more severe COVID-19 complications. Lessening the immune system’s response using immunosuppressive drugs may be beneficial – which is why <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144665/pdf/main.pdf">multiple clinical trials</a> are currently investigating this.</p>
<p>Finally, there’s a higher proportion of men and people from black, Asian and minority ethnic (BAME) groups with <a href="https://kidneyresearchuk.org/wp-content/uploads/2019/09/Health_Inequalities_lay_report_FINAL_WEB_20190311.pdf">severe kidney issues</a>, requiring kidney dialysis or a transplant. These factors have been shown to <a href="https://globalhealth5050.org/covid19/">predict a worse outcome</a> with COVID-19 infection.</p>
<p>Current data from <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30198-5/fulltext">China</a>, <a href="https://www.statista.com/statistics/1105061/coronavirus-deaths-by-region-in-italy/">Italy</a> and <a href="https://www.statista.com/statistics/1105061/coronavirus-deaths-by-region-in-italy/">Spain</a> shows children are much less likely to die of a COVID-19 infection compared to adults. This may possibly be due to the younger, evolving immune system being better at dealing with and clearing new viral infections.</p>
<p>However, children with kidney diseases may still be at <a href="https://pkdcharity.org.uk/news-events/blogs/404-coronavirus-covid-19-and-children-with-arpkd">higher risk of getting severely ill</a> from coronavirus. But their risk may be lower compared to adults, as many children with kidney disease don’t have a coexisting cardiovascular disease or other risk factors. Currently, in the UK, there are no reports of children with kidney disease experiencing severe complications from COVID-19.</p>
<h2>Healthcare changes</h2>
<p>Given that many adults with kidney disease face increased risk of contracting severe COVID-19 infections, it’s important that patients try to protect themselves from the virus as much as possible. Children with advanced kidney disease or who are heavily immunosuppressed are advised to take similar precautions.</p>
<p>It’s especially important to find ways to protect patients with kidney failure who need to regularly attend hospital for haemodialysis (or blood cleaning) treatment, often three to four times per week. Careful planning is needed to minimise unsafe human contact during dialysis delivery.</p>
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<img alt="" src="https://images.theconversation.com/files/331966/original/file-20200501-42962-1fmr6m0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/331966/original/file-20200501-42962-1fmr6m0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/331966/original/file-20200501-42962-1fmr6m0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/331966/original/file-20200501-42962-1fmr6m0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/331966/original/file-20200501-42962-1fmr6m0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/331966/original/file-20200501-42962-1fmr6m0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/331966/original/file-20200501-42962-1fmr6m0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Changes to dialysis delivery will be important to minimise risk.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/patient-monitored-by-electronic-sphygmomanometer-during-22262149">Picsfive/ Shutterstock</a></span>
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<p>The current pandemic has caused widespread anxiety and changes to the ways in which healthcare is being delivered. There’s been a dramatic decrease in <a href="https://www.thelancet.com/pdfs/journals/lanchi/PIIS2352-4642(20)30108-5.pdf">patients attending hospital</a> or seeking medical advice if unwell due to a fear of contracting COVID-19. This could have a detrimental cost to those with kidney disease. Many <a href="https://www.hsj.co.uk/commissioning/exclusive-nhs-trusts-suspend-life-saving-organ-transplants/7027301.article">kidney transplant programmes</a> have even been suspended, limiting treatment options for people with severely impaired kidney function (particularly those on dialysis). </p>
<p>Patients with kidney disease may also be worried about taking their regular medications, in case they may put them at greater risk of contracting COVID-19. An example of this are angiotensin converting enzyme (ACE) inhibitors, a drug that treats hypertension and reduces levels of protein in urine. These are both key to maintaining good cardiovascular and kidney health. ACE inhibitors block the stimulation of a receptor that is found on cells called the ACE2 receptor. The coronavirus, which causes COVID-19, gains entry to cells by <a href="https://doi.org/10.1016/j.cell.2020.02.052">going through this receptor</a>.</p>
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Read more:
<a href="https://theconversation.com/what-we-know-about-ace-inhibitors-high-blood-pressure-and-covid-19-133970">What we know about ACE inhibitors, high blood pressure and COVID-19</a>
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<p>Currently, there’s no evidence that <a href="https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang">taking ACE inhibitors</a> is beneficial or detrimental to coronavirus. Patients should know that stopping these medicines could have detrimental consequences for kidney and cardiovascular disease health. </p>
<p><a href="https://renal.org/covid-19/data/">Current evidence</a> suggests that adult patients with significant kidney disease are highly susceptible to the effects of COVID-19. People with kidney conditions should take more stringent precautions to protect themselves from the virus and prevent infection, such as staying at home, properly washing hands and avoiding direct human contact as much as is possible.</p><img src="https://counter.theconversation.com/content/137097/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Coward currently receives research funding from the Medical Research Council (MRC), Wellcome Trust, Kidney Research UK, and and the European Union. He has previously been awarded Research Funding from the charities Diabetes UK, British Heart Foundation and Wellchild. In the past he has also received science research funding from the companies Takeda and Novo Nordisk. </span></em></p>Patients with kidney disease may also have heart problems or diabetes – both of which have been linked with more severe COVID-19 infections.Richard Coward, Clinical professor, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1270202019-12-19T19:06:42Z2019-12-19T19:06:42ZHow a rethink of emergency care is closing the gap, one person at a time<figure><img src="https://images.theconversation.com/files/307569/original/file-20191218-11919-1epy5bl.JPG?ixlib=rb-1.1.0&rect=2%2C10%2C987%2C722&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Walpiri Transient Camp, Katherine: Western medicine can't be expected to work for disadvantaged Indigenous Australians unless housing and social disadvantage are also addressed.</span> <span class="attribution"><span class="license">Author provided</span></span></figcaption></figure><p><em>This is one of our occasional <a href="https://theconversation.com/au/topics/essays-on-health-32828">Essays on Health</a>, about one community’s attempt at closing the gap between Indigenous and non-Indigenous health in the Northern Territory. It’s a long read.</em></p>
<p>You can see <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/BriefingBook44p/ClosingGap">the gap</a> driving through the main street of Katherine in the Northern Territory.</p>
<p>The broken shop windows, the dust, the wheelchairs and crutches and bandaged bodies sing out poor health and inequity.</p>
<p>Overcrowding and homelessness are pervasive, and there is very little reprieve from the oppressive heat.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1204986670711558144"}"></div></p>
<p>Like many towns of its size, Katherine has its own hospital. Here, social and environmental determinants drive hospital attendance. </p>
<p>For instance, the town has <a href="https://www.katherinetimes.com.au/story/6419712/in-the-top-league-of-homelessness-rates-katherine-needs-a-plan/">some of the highest rates of homelessness</a> in Australia, in a jurisdiction with the <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4517.0%7E2018%7EMain%20Features%7ENorthern%20Territory%7E27">highest incarceration rates</a>, <a href="https://digitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/572/1/Mortality_in_the_NT_1967_2006_web.pdf">lowest life expectancy</a> and the <a href="https://nap.edu.au/docs/default-source/resources/2018-naplan-national-report.pdf?sfvrsn=2">poorest educational outcomes</a>. The gap in Katherine is a chasm.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/three-reasons-why-the-gaps-between-indigenous-and-non-indigenous-australians-arent-closing-91561">Three reasons why the gaps between Indigenous and non-Indigenous Australians aren't closing</a>
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</em>
</p>
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<h2>Who’s who in the emergency department?</h2>
<p>The hospital is a busy place, made even more so by the <a href="https://www.mja.com.au/journal/2008/189/10/frequent-attenders-emergency-departments-linked-data-population-study-adult">emergency department frequent attenders</a> who come and go through a constantly revolving door of admission and discharge. </p>
<p>Frequent attenders fall into two broad categories.</p>
<p>Roughly one-third are very sick, wracked by illness or chronic conditions, almost all underpinned by great social challenges. Despite stereotypes, this is a group that rarely drinks alcohol. </p>
<p>By contrast, grog is a driving force for the other two-thirds, often as a direct result of alcohol and its complications. Once again, illness and social exclusion are pervasive.</p>
<p>Most frequent attenders <a href="https://www.mja.com.au/journal/2016/204/3/factors-contributing-frequent-attendance-emergency-department-remote-northern#tbox1">are Indigenous</a>. They come from <a href="https://www.mdpi.com/1660-4601/16/22/4306/htm">around 30 different tribal nations</a>, each with unique language. Most are just three or four generations away from the first wave of colonisation.</p>
<p>Just over two-thirds are homeless, a situation shaped by subtle and ongoing forces of colonisation and subsequent displacement.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/making-space-how-designing-hospitals-for-indigenous-people-might-benefit-everyone-122550">Making space: how designing hospitals for Indigenous people might benefit everyone</a>
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</p>
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<p>Only one-fifth of frequent attenders have access to a car in a town with no public transport (other than school buses). This affects people’s health in the tropics where it’s a long, hot walk from where most Indigenous people live to the pharmacy. </p>
<p>It is really no wonder more than half of frequent attenders have not taken their medicines, contributing to their presentation to the emergency department.</p>
<p>For frequent presenters to Katherine Hospital, poverty and illness go hand in hand. When you are living in an over-crowded house, and the <a href="https://www.jacanaenergy.com.au/residential/metering/prepaid_meters">A$20 power card</a> feeding the air conditioner expires on a 43°C tropical day, when your heart, lungs and kidneys are chronically malfunctioning and the insulin in the fridge slowly warms, the only free number you can call for help is “000” for an ambulance trip to hospital.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1206693515377467392"}"></div></p>
<p>These are some of the real-world challenges of closing the gap in Indigenous health. But these challenges can be overcome. </p>
<h2>Here’s what worked</h2>
<p>We have <a href="https://www.mdpi.com/1660-4601/16/22/4306/htm">recently published evidence</a> of how a locally driven program can make a difference.</p>
<p>When some of the town’s most vulnerable people attend the emergency department, the program connects them to primary care and other supports. It also tackles underlying drivers of hospitalisation such as homelessness or inadequate housing.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/307574/original/file-20191218-11909-8s9b4l.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/307574/original/file-20191218-11909-8s9b4l.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/307574/original/file-20191218-11909-8s9b4l.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=797&fit=crop&dpr=1 600w, https://images.theconversation.com/files/307574/original/file-20191218-11909-8s9b4l.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=797&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/307574/original/file-20191218-11909-8s9b4l.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=797&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/307574/original/file-20191218-11909-8s9b4l.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1001&fit=crop&dpr=1 754w, https://images.theconversation.com/files/307574/original/file-20191218-11909-8s9b4l.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1001&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/307574/original/file-20191218-11909-8s9b4l.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1001&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">At the emergency department, people are supported to move away from inadequate housing, as well as being treated for their physical or mental illness.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The referral point taps into a critical moment when people choose to turn up to hospital, asking for help.</p>
<p>This is an opportunity to do things differently. As such, the program re-defines “help” beyond the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750953/">biomedical paradigm</a>, to both improve health and use limited resources more efficiently. </p>
<p>This contrasts with past approaches grounded in <a href="https://www.abc.net.au/news/2017-04-21/nt-mandatory-alcohol-rehab-has-little-health-impact-report-finds/8459998">discipline and law</a> that have failed to meaningfully help people who suffer the combined disharmony of sickness, homelessness and alcohol. </p>
<p>Among the 109 people supported in the first ten months of the program, there was a 23% reduction in emergency department presentations.</p>
<h2>More GP visits</h2>
<p>A <a href="https://grattan.edu.au/wp-content/uploads/2018/07/906-Mapping-primary-care.pdf">Grattan Institute report</a> found the most disadvantaged people living in the remotest areas are the least likely to see or have access to a GP.</p>
<p>In Katherine, many of the people presenting frequently to the emergency department with chronic diseases would benefit from being managed by their GP or other primary care provider.</p>
<p>As a result of the program, there was a 90% increase in GP attendance.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-the-housing-shortage-exacerbates-scabies-in-indigenous-communities-71337">Why the housing shortage exacerbates scabies in Indigenous communities</a>
</strong>
</em>
</p>
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<h2>Community support is vital</h2>
<p>The program has been developed gradually over the past five years, first with an understanding of <a href="https://www.mja.com.au/journal/2016/204/3/factors-contributing-frequent-attendance-emergency-department-remote-northern">who the hospital’s frequent attenders are</a>, and then getting the community on board. </p>
<p>Central to the program’s success is this community support. The four main partners include the hospital, the <a href="https://www.wurli.org.au/">Wurli-wurlinjang</a> local Aboriginal health service, the <a href="http://kalano.org.au/">local Aboriginal housing organisation</a> and <a href="http://www.krahrs.org.au/">Katherine Regional Aboriginal Health and Related Services</a>. </p>
<p>Other partners including the <a href="https://www.shelterme.org.au/katherine-doorways-hub">first ever homeless hub in Katherine</a> (a drop-in centre and community space for homeless people), as well as St John Ambulance, Mission Australia, Red Cross and the territory housing department.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/refugees-in-their-own-land-how-indigenous-people-are-still-homeless-in-modern-australia-55183">Refugees in their own land: how Indigenous people are still homeless in modern Australia</a>
</strong>
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<hr>
<h2>The harsh reality of the town camp</h2>
<p>Just off Katherine’s main drag is a patch of thick scrub that shields visitors from seeing the harsh realities of <a href="https://theconversation.com/refugees-in-their-own-land-how-indigenous-people-are-still-homeless-in-modern-australia-55183">Warlpiri Transient Camp</a>. This is where many people who frequently present to the emergency department live.</p>
<p>This <a href="https://dlghcd.nt.gov.au/town-camps/about-town-camps">“temporary” camp</a>, set up over 40 years ago, houses some of the sickest people in what is one of the sickest towns in Australia. </p>
<p>Up to 20 people live in small dwellings bursting at the seams. These structures often provide meagre refuge to people on dialysis, with failing hearts from rheumatic heart disease, and to the elderly and frail.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/307573/original/file-20191218-11924-ux1kcq.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/307573/original/file-20191218-11924-ux1kcq.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=640&fit=crop&dpr=1 600w, https://images.theconversation.com/files/307573/original/file-20191218-11924-ux1kcq.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=640&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/307573/original/file-20191218-11924-ux1kcq.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=640&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/307573/original/file-20191218-11924-ux1kcq.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=804&fit=crop&dpr=1 754w, https://images.theconversation.com/files/307573/original/file-20191218-11924-ux1kcq.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=804&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/307573/original/file-20191218-11924-ux1kcq.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=804&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Up to 20 people live in small dwellings bursting at the seams, some without electricity never mind air-conditioning.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Only a handful of these dwellings are air conditioned; some don’t even have electricity. Often it is sickness that drives people from ancestral lands into bigger towns like Katherine to access health services like kidney dialysis.</p>
<p>But <a href="https://www.katherinetimes.com.au/story/6434194/dialysis-patients-forced-onto-housing-waiting-list/">housing is less available than dialysis</a>. And the camp is not a destination of choice.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/want-to-improve-the-nations-health-start-by-reducing-inequalities-and-improving-living-conditions-64434">Want to improve the nation's health? Start by reducing inequalities and improving living conditions</a>
</strong>
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<p><a href="https://www.mdpi.com/1660-4601/16/22/4306/htm">Our analysis of the program</a> demonstrates some striking features of people who live in the camp and who frequently attend the emergency department.</p>
<p>First, they are very sick. Almost 10% had died before the end of the first year of the program. Participants had an average of 2.8 significant health problems, many fold higher than the <a href="https://www.aihw.gov.au/getmedia/666de2ad-1c92-4db3-9c01-1368ba3c8c98/ah16-3-3-chronic-disease-comorbidities.pdf.aspx">Australian average</a>.</p>
<p>Three out of five didn’t have reliable access to enough affordable, nutritious food. Almost one-third had chronic kidney disease, and 10% were on dialysis. Of the 11 people needing dialysis three times a week, eight met the <a href="https://www.abs.gov.au/websitedbs/censushome.nsf/home/factsheetsh">Australian Bureau of Statistics’ definition of homelessness</a>; three were living in a tent.</p>
<p>Needless to say, nowhere else in Australia is it imaginable that someone sick enough to require dialysis has to live in a tent in temperatures <a href="https://www.katherinetimes.com.au/story/6548992/tuesday-was-australias-hottest-day-ever/?cs=9397">regularly above 40°C</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-chronic-kidney-disease-and-why-are-one-in-three-at-risk-of-this-silent-killer-81942">Explainer: what is chronic kidney disease and why are one in three at risk of this silent killer?</a>
</strong>
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<hr>
<h2>A safe home, a working fridge and a good education</h2>
<p>Modern western medicine is the icing on the cake of a healthy and meaningful life. For people who do not have even the most fundamental building blocks of a normal urban existence, like the vast majority of people in this trial, applying western medicine is like icing a cake that has not yet been baked.</p>
<p>A safe home, a fridge that remains powered and relatively stocked, access to transport, and a good education, are ingredients that need to be slowly and systematically put together over a lifetime for western medicine to be an appropriate first step in resolving an individual health problem. </p>
<p>Applying a biomedical model of emergency care is nothing more than a very expensive band aid. But emergency departments can be structured in innovative ways to make a much bigger difference.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/to-close-the-health-gap-we-need-programs-that-work-here-are-three-of-them-91482">To close the health gap, we need programs that work. Here are three of them</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/127020/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Quilty set up and designed the project mentioned in the article.</span></em></p><p class="fine-print"><em><span>Lisa Wood evaluated the program mentioned in the article.</span></em></p>A safe home, a working fridge and access to transport are all needed before western medicine has a chance of working in the long term. But a new way of providing care can help.Simon Quilty, Senior Staff Specialist, Alice Springs Hospital. Honorary, Australian National UniversityLisa Wood, Associate Professor, School of Population and Global Health, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1214412019-09-13T03:27:35Z2019-09-13T03:27:35ZPolycystic kidney disease, the most common genetic kidney disorder you’ve probably never heard of<figure><img src="https://images.theconversation.com/files/290811/original/file-20190904-175700-vq8d1k.jpg?ixlib=rb-1.1.0&rect=53%2C0%2C6000%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If one parent has ADPKD, their child has a one in two chance of getting it.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>Autosomal-dominant polycystic kidney disease (<a href="https://pkdaustralia.org/adpkd/">ADPKD</a>) is the most common genetic kidney disorder, and the <a href="https://www.anzdata.org.au/report/anzdata-41st-annual-report-2018-anzdata/">fourth most common</a> cause of kidney failure in Australian adults. It affects about <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.13143">one in 1,000 Australians</a>. </p>
<p>In people with ADPKD, a mutation in one or two genes leads to the development and progressive growth of cysts in the kidneys, causing a decline in kidney function.</p>
<p>Labor senator Malarndirri McCarthy, a Yanyuwa woman, recently spoke publicly about having ADPKD after <a href="https://www.smh.com.au/politics/federal/senator-reveals-kidney-disease-that-saw-her-leave-question-time-for-hospital-20190802-p52d8w.html">she became unwell</a> with a kidney infection and had to leave the Senate. </p>
<p>But a newly available treatment for ADPKD shows promise for people with the disease.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-chronic-kidney-disease-and-why-are-one-in-three-at-risk-of-this-silent-killer-81942">Explainer: what is chronic kidney disease and why are one in three at risk of this silent killer?</a>
</strong>
</em>
</p>
<hr>
<h2>What is ADPKD?</h2>
<p>If one parent has ADPKD, the children have a 50% chance of inheriting the gene (though <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.13143">up to 10%</a> of patients don’t have a family history).</p>
<p>Where it is inherited, the age of diagnosis and rate of progression to kidney failure in the parent gives some indication of how the disease will develop in affected children. </p>
<p>The cysts are like balloons filled with water, which start small in childhood and increase in size over time.</p>
<p>Typically, the cysts don’t start to cause problems until later in life. The average age at diagnosis is <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1402685">27 years</a>. </p>
<p>As the cysts grow, normal working tissue in the kidney is replaced with enlarging cysts. So with time, the kidneys don’t work as well.</p>
<p>For about <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.13143">half of people with ADPKD</a>, their condition will eventually progress to kidney failure, which may be treated with dialysis or a transplant. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/288676/original/file-20190820-170918-1foruju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/288676/original/file-20190820-170918-1foruju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=442&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288676/original/file-20190820-170918-1foruju.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=442&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288676/original/file-20190820-170918-1foruju.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=442&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288676/original/file-20190820-170918-1foruju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=556&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288676/original/file-20190820-170918-1foruju.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=556&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288676/original/file-20190820-170918-1foruju.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=556&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cysts grow on the kidneys of a person with polycystic kidney disease, often impacting kidney function.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>While the loss of kidney function is paramount, the cysts may cause other symptoms and complications too. </p>
<p>Symptoms can include high blood pressure and chronic pain or heaviness in the back, sides and abdomen. The growth of cysts means the kidneys can grow to as large as <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1464-410X.2007.07229.x">5-6kg in size</a>.</p>
<p>Blood in the urine, urinary tract infections, kidney stones and infections in the cysts are not uncommon in people with ADKPD, and can all impact quality of life. </p>
<p>Other organs may also be affected. People with ADPKD can develop cysts in the liver, pancreas and bowel, and about 10% will experience balloon dilations of the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26260542">blood vessels in the brain</a>, called aneurysms.</p>
<h2>Treatment</h2>
<p>Until recently, treatment of ADPKD was directed towards early detection, control of blood pressure, lifestyle measures such as quitting smoking, weight control and diet, antibiotics for infections, analgesics for pain and the management of progressive kidney dysfunction via dialysis and transplantation. None of these therapies however directly slowed the growth of cysts. </p>
<p>But on January 1, 2019, tolvaptan <a href="https://pkdaustralia.org/news/">was listed</a> on the Pharmaceutical Benefits Scheme. Australia now joins the United States, the European Union, and several other countries where this drug was already available. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kidney-disease-in-aboriginal-australians-perpetuates-poverty-15031">Kidney disease in Aboriginal Australians perpetuates poverty</a>
</strong>
</em>
</p>
<hr>
<p>Tolvaptan, which is taken in tablet form, slows the growth of cysts by <a href="https://www.ncbi.nlm.nih.gov/pubmed/28379536">blocking a hormone called vasopressin</a>. Vasopressin is critical in triggering the formation of cysts. In this way, tolvaptan prolongs the time to kidney failure.</p>
<p>In one study, three years of treatment with tolvaptan <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1205511">reduced the rate of cyst growth</a> by around 50% in comparison to a placebo treatment. The authors suggested tolvaptan may delay dialysis or the need for a transplant for six to nine years for patients with ADPKD, particularly if started early. </p>
<p>People who took tolvaptan in this study also had lower incidence of ADPKD-related complications including urinary tract infections and kidney pain.</p>
<h2>Kidney disease and Indigenous Australians</h2>
<p>ADPKD is not actually more common in Aboriginal and Torres Strait Islander communities, as other causes of <a href="https://www.menzies.edu.au/page/Research/Indigenous_Health/Diabetes_and_kidney_disease/Kidney/">chronic kidney disease</a> are. This may be because ADPKD is inherited. </p>
<p>The majority of chronic kidney disease develops as a complication of diabetes, which affects Aboriginal and Torres Strait Islander populations more commonly and typically <a href="https://www.menzies.edu.au/page/Research/Indigenous_Health/Diabetes_and_kidney_disease/Diabetes/">at a younger age</a> than the overall Australian population.</p>
<p>Kidney disease, whatever the cause, remains a significant issue for Aboriginal and Torres Strait Islander communities. People in remote Indigenous communities in particular face challenges around accessing treatments in large urban centres, and have poorer access to organ transplants.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-simple-school-sores-often-lead-to-heart-and-kidney-disease-in-indigenous-children-86066">Why simple school sores often lead to heart and kidney disease in Indigenous children</a>
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<p>There are several nationally targeted activities and proposals aimed at reducing the burden of chronic kidney disease in Indigenous Australians.</p>
<p>The <a href="https://www.menzies.edu.au/icms_docs/281923_Roundtable_Towards_Roadmap_For_Renal_Health_-_Media_Release.pdf">Renal Health RoadMap</a> is designed to support health systems in early detection and management of diabetes and chronic kidney disease. It also seeks to address the social determinants of poor health in Indigenous communities, including housing quality and availability, and health infrastructure.</p>
<p>In 2018, Minister for Indigenous Australians Ken Wyatt commissioned <a href="https://www.tsanz.com.au/TSANZ%20Performance%20Report%20-%20Improving%20Indigenous%20Transplant%20Outcomes%20(Final%20edited)-1.pdf">a report</a> detailing how access to and outcomes of kidney transplants could be improved among Indigenous Australians. He also established a <a href="https://www.anzdata.org.au/anzdata/for-information-2/tsanz/">National Indigenous Kidney Transplantation Taskforce</a> to implement the recommendations from this report. </p>
<p>Some key recommendations include improving the communication between health-care teams, patients and their families, addressing cultural bias in the delivery of health care, and improving the quality of data around transplant access and outcomes.</p>
<p>Addressing transplant and treatment inequities will benefit Indigenous Australians with kidney failure sustained from ADPKD and chronic kidney disease more broadly. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/to-close-the-health-gap-we-need-programs-that-work-here-are-three-of-them-91482">To close the health gap, we need programs that work. Here are three of them</a>
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</em>
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<img src="https://counter.theconversation.com/content/121441/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jaquelyne Hughes receives funding from the National Health and Medical Research Council, is the convener of the Aboriginal and Torres Strait Islander Health Working Group of the Australia and New Zealand Dialysis and Transplantation Registry (ANZDATA), and the Deputy Chair of the TSANZ National Indigenous Kidney Transplantation Taskforce.</span></em></p><p class="fine-print"><em><span>Karen Dwyer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>You might have heard of polycystic ovary syndrome, but what about polycystic kidney disease? This genetic disorder sees cysts growing in the kidneys.Karen Dwyer, Deputy Head, School of Medicine, Deakin UniversityJaquelyne Hughes, Senior Research Fellow, Menzies School of Health ResearchLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1177472019-08-06T20:07:46Z2019-08-06T20:07:46ZCurious Kids: why is urine yellow?<figure><img src="https://images.theconversation.com/files/286166/original/file-20190730-43153-osy3ym.jpg?ixlib=rb-1.1.0&rect=11%2C7%2C2486%2C1699&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If you have been drinking more water than your body needs, the body tells the kidney filters to get rid of the spare water. That's when your urine will look paler.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=293&fit=crop&dpr=1 600w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=293&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=293&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=368&fit=crop&dpr=1 754w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=368&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=368&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>If you have a question you’d like an expert to answer, send it to curiouskids@theconversation.edu.au.</em> </p>
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<blockquote>
<p><strong>Why is urine yellow? – Ronan, aged 9, Greenslopes, Brisbane.</strong> </p>
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<p>Thank you for your question, Ronan. </p>
<p>Our bodies use nutrients from the food we eat. But the processes involved in digestion also create what we call “byproducts”. That’s where a new chemical is created along the way. </p>
<p>Some of these byproducts in the body are waste and our bodies have clever waste processing systems to get rid of them. </p>
<p>Some of the waste goes out in your poo. And waste that can be dissolved in water goes out in your wee. We call this “water-soluble” waste. Water-soluble means it can be dissolved in water. </p>
<p>And the parts of your body in charge of “making” the wee are called the kidneys. They’re shaped like kidney beans.</p>
<h2>A delicate balance</h2>
<p>The kidneys work around the clock to make sure the body has the right balance of water, salt and chemicals and not too much water-soluble waste in it. </p>
<p>Kidneys have special filters in them that help sort out the useful bits from the waste. They also are in charge of transporting the water-soluble waste from your kidneys, down two special pipes called “ureters” and into your bladder (which is down near the genitals). </p>
<p>When the bladder gets full, it sends a message along your nerves to your brain that makes you feel like you need to wee. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Kidneys also are in charge of transporting the water-soluble waste from your kidneys, down two special pipes called ‘ureters’ and into your bladder.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-we-have-two-kidneys-when-we-can-live-with-only-one-113201">Curious Kids: why do we have two kidneys when we can live with only one?</a>
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<h2>So…. why is it yellow?</h2>
<p>One of the water-soluble waste products that your kidneys put into your urine is a chemical called urobilin, and it is yellow. </p>
<p>The colour of your urine depends on how much urobilin is in it and how much water is in it. </p>
<p>If your urine is light yellow, it means you have been drinking a lot of water and there’s a lot of water in your urine. We call this being “hydrated”.</p>
<p>If your urine is dark yellow, that means there’s less water, and a relatively high amount of urobilin. It probably means you haven’t been drinking enough water and could be dehydrated.</p>
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<a href="https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=457&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=457&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=457&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=574&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=574&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=574&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">If your urine is light yellow, it means you have been drinking a lot of water.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<h2>Too much water versus not enough</h2>
<p>When you haven’t been drinking enough water, the kidneys get a message from your brain to try to keep more water in your body (and out of your bladder). You will also start to feel thirsty. </p>
<p>If people can’t drink water (because they have a vomiting illness, for example), they might need water put directly into their blood. This usually happens in a hospital using a drip (which is where a bag of salt water is put into your blood via a needle in your arm).</p>
<p>If you have been drinking more water than your body needs, the body tells the kidney filters to get rid of the spare water. That’s when your urine will look paler.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-what-is-a-headache-is-it-our-brain-hurting-112951">Curious Kids: what is a headache? Is it our brain hurting?</a>
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</em>
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<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to curiouskids@theconversation.edu.au</em></p><img src="https://counter.theconversation.com/content/117747/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Jaqui Hughes is a Torres Strait Islander woman, a specialist physician (kidney doctor) at Royal Darwin Hospital, and a kidney health researcher at Menzies School of Health Research in Darwin. She is employed by the Top End Health Service as a specialist nephrologist, and funded by the National Health and Medical Research Council to lead innovating kidney health research which advances health for Australians.</span></em></p>One of the waste products that your kidneys put into your urine is a chemical called urobilin, and it is yellow.Jaquelyne Hughes, Research Fellow, Menzies School of Health ResearchLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1164112019-07-12T19:44:45Z2019-07-12T19:44:45ZTrump’s order for more action on kidney disease may shrink organ transplant waitlists<p>Every year, thousands of Americans with kidney failure who could benefit from life-saving transplants <a href="https://doi.org/10.1111/ajt.15274">can’t get the organs they need</a>. </p>
<p>A record number of people are dying while waiting for an organ to become available that might have saved their lives. An <a href="https://www.hhs.gov/about/news/2019/07/10/hhs-launches-president-trump-advancing-american-kidney-health-initiative.html">executive order</a> President Donald Trump signed on July 10, 2019 could help some of them.</p>
<p>It calls for taking steps to <a href="https://www.vox.com/future-perfect/2019/7/10/20687507/triump-kidney-disease-transplant">increase the number of kidney donors</a>, improve care for <a href="https://www.kidney.org/atoz/content/kidney-transplant">people with kidney disease</a>, encourage the development of <a href="https://www.nibib.nih.gov/news-events/newsroom/artificial-kidney-development-advances-thanks-collaboration-nibib-quantum">artificial kidneys</a> and more. The intent is to drastically and quickly reduce the number of patients with end-stage kidney disease.</p>
<p>Among other things, the executive order outlines plans to compensate living donors for many of their expenses, make the bureaucracy controlling deceased organ donations more efficient and encourage <a href="https://www.healthcaredive.com/news/trump-executive-order-seeks-to-overhaul-us-kidney-care/558455/">more preventive care</a>.</p>
<p>As a <a href="https://www.researchgate.net/scientific-contributions/38447668_Amit_D_Tevar">transplant surgeon</a>, I believe that the new policy could increase incentives Americans have to become organ donors. Coupled with more public awareness about the need, doctors like me could be saving hundreds of thousands more people.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/283740/original/file-20190711-173360-14cxqoa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/283740/original/file-20190711-173360-14cxqoa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/283740/original/file-20190711-173360-14cxqoa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/283740/original/file-20190711-173360-14cxqoa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/283740/original/file-20190711-173360-14cxqoa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/283740/original/file-20190711-173360-14cxqoa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/283740/original/file-20190711-173360-14cxqoa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/283740/original/file-20190711-173360-14cxqoa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Nearly half a million Americans are on dialysis.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hemodialysis-machines-tubingtransplantationmedical-equipment-concept-1152229250?src=Mt7E59K3ty6nOgMhIFvJ9A-2-39&studio=1">KANOWA/shutterstock.com</a></span>
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<h2>Supply and demand</h2>
<p>About <a href="https://www.kidney.org/news/newsroom/factsheets/KidneyDiseaseBasics">37 million Americans</a>, more than 10% of the entire population, have some form of kidney disease. The most common causes of this disease are <a href="https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/causes">high blood pressure and diabetes</a>. Nearly 500,000 of these patients <a href="https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease">require dialysis</a>, using a machine to carry out the function of the kidneys by filtering toxins out of their blood. Approximately <a href="https://www.cdc.gov/kidneydisease/basics.html">340 people start using dialysis every day</a> – a big inconvenience because it’s usually done three times a week, for three to four hours at a time.</p>
<p>Only half of those people beginning dialysis today will <a href="https://www.srtr.org/media/1331/a-calculator-for-kidney-transplant-waitlist-outcomes.pdf">survive for more than five years</a>. Transplants lead to better long-term survival rates: About 86% of the patients who get a donated kidney live for at least <a href="https://doi.org/10.1053/j.ackd.2016.07.001">five more years</a>, but each year only about 20% of the Americans <a href="https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/#">waiting for kidney transplants</a> will get one.</p>
<p>Having a transplant from a living donor remains the best option for many patients, as the wait time for a deceased donor organ can be long. But the number of living donor transplants is rising very slowly. </p>
<p>Based on my experience, I believe that a lack of physician and patient awareness of the benefits for the recipient and the minimal risks for the donor may be one reason why kidneys are in short supply. Another issue is the <a href="https://www.doi.org/10.1111/ajt.14949">financial burden</a> on donors, who must undergo surgery. They don’t pay for operating costs – that is currently covered by recipient’s insurance – but having the procedure leads to lost wages, and spending on child care, travel and even pet care. That is one problem Trump’s order is designed to alleviate.</p>
<p><iframe id="4yL93" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/4yL93/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Record numbers</h2>
<p>Another problem is that there just aren’t enough kidneys to go around. Kidneys for transplantation are distributed based on the number of years a patient has been on dialysis or how long they have been waiting. </p>
<p>Even though a record 21,167 kidney transplants were performed in 2018, <a href="https://www.doi.org/10.1111/ajt.14124">most kidney-disease patients currently waiting for an organ</a> won’t ultimately get one because the average wait times exceed their life expectancy.</p>
<p>The <a href="https://optn.transplant.hrsa.gov/">federal government</a> oversees the distribution of donated kidneys through <a href="https://unos.org/about/">United Network of Organ Sharing</a>, an independently run nonprofit, and spends <a href="https://www.healthcaredive.com/news/trump-executive-order-seeks-to-overhaul-us-kidney-care/558455/">US$114 billion a year</a> on patients with kidney disease through Medicare.</p>
<p>In 2018, transplants from a total of <a href="https://scrubsmag.com/long-time-nurse-donates-multiple-organs-after-suffering-fatal-medical-incident/">10,722 deceased organ donors</a> resulted in just <a href="https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/">14,725 kidney transplants and 7,849 liver transplants</a>. Many procured organs are discarded because they are not suitable for transplants. </p>
<p>The need for lifesaving organs for transplant far exceeds the demand and the gap has been growing for years.</p>
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<h2>Liver disease</h2>
<p>If the number of organ donors rises as a result of new federal policies, it will also benefit people who need other organs.</p>
<p>For example, roughly <a href="https://www.cdc.gov/nchs/fastats/liver-disease.htm">4.5 million Americans have liver disease</a>. This is primarily due to cirrhosis, a condition in which your liver is scarred and permanently damaged – typically from developing long-term <a href="https://www.fda.gov/patients/get-illnesscondition-information/hepatitis-b-c">hepatitis B or C</a>, <a href="https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243">alcoholic liver disease</a> or <a href="https://www.mayoclinic.org/diseases-conditions/nonalcoholic-fatty-liver-disease/symptoms-causes/syc-20354567">non-alcoholic fatty liver disease</a>. </p>
<p>Early detection, treatment and referrals for a transplant has improved the outcomes for people who do get transplants – either an entire liver from someone who has died or a partial liver transplant from a living donor. Currently 90% of the people who get liver transplants survive for at least one more year and <a href="https://srtr.transplant.hrsa.gov/annual_reports/2017/Liver.aspx">75% live at least another five years</a>. Yet the death rate for patients with liver disease and cirrhosis who do not get transplants has <a href="http://dx.doi.org/10.15585/mmwr.mm6638a9">increased 31% in the past decade</a>.</p>
<p>As more patients and their doctors are understanding the benefits of organ transplantation, greater numbers of patients are being evaluated and placed on waitlists. Today there are more than <a href="https://optn.transplant.hrsa.gov/data/">121,000 patients waiting for a transplant</a>. Roughly 103,000 need a kidney transplant and more than 13,400 require a liver transplant. Most of the rest require a heart, lung or pancreas.</p>
<p><iframe id="q5kuy" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/q5kuy/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p><img src="https://counter.theconversation.com/content/116411/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amit Tevar receives funding from
National Institutes of Health
National Kidney Foundation - Medical Advisory Board
</span></em></p>The need for organs to transplant far exceeds the supply.Amit Tevar, Associate Professor of Surgery; Director, Kidney and Pancreas Transplant Program, Starzl Transplant Institute, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1132012019-03-18T22:08:03Z2019-03-18T22:08:03ZCurious Kids: why do we have two kidneys when we can live with only one?<figure><img src="https://images.theconversation.com/files/264074/original/file-20190315-28475-1vh4qe0.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3834%2C2160&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Right now, your kidneys are getting rid of all things your body does not need. They do this by 'cleaning' your blood. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em><a href="https://theconversation.com/au/topics/curious-kids-36782">Curious Kids</a> is a series for children. If you have a question you’d like an expert to answer, send it to curiouskids@theconversation.edu.au You might also like the podcast <a href="http://www.abc.net.au/kidslisten/imagine-this/">Imagine This</a>, a co-production between ABC KIDS listen and The Conversation, based on Curious Kids.</em> </p>
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<p><strong>Why do we have two kidneys when we can live with only one? – Question from the students of Ms Morris’ Grade 5 class, Ringwood North Primary School, Victoria.</strong> </p>
</blockquote>
<p>This is a really great question. The answer is scientists are not completely sure but we do have some theories. That is often the case with science.</p>
<p>Most of the animals you see above ground on Earth today, including humans, are the same on both sides. We have two eyes, two ears, and even two nostrils. Scientists gave this a fancy name called “<a href="https://nph.onlinelibrary.wiley.com/doi/full/10.1111/nph.13526">bilateral symmetry</a>.”</p>
<p>If you look in the mirror and draw an imaginary line down the middle of your reflection you will see that you have an arm and a leg on each side. If you had goggles that let you see your insides, you would see that you also have a kidney and a lung on each side too. </p>
<p>But it wasn’t always like this. And some <a href="http://molluscs.at/gastropoda/index.html?/gastropoda/morphology/organ_systems.html">animals</a> still only have one kidney.</p>
<p>Around 500 million years ago, our long-lost relatives that were living in the ocean (some of whom probably only had one kidney) decided to leave the water to walk and live on land. </p>
<p>This was a very important moment in our history because on land, animals could change to grow a very complicated body with all of the important organs that are inside you, including two kidneys. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-how-does-my-tummy-turn-food-into-poo-110353">Curious Kids: how does my tummy turn food into poo?</a>
</strong>
</em>
</p>
<hr>
<h2>Two kidneys better than one?</h2>
<p>Right now, your kidneys are getting rid of all things your body does not need. They do this by “cleaning” your blood. </p>
<p>All of this waste will exit your body when you go to the toilet to pee. But your kidneys do a lot more than just clean your blood. They help your bones stay healthy, tell your body when to make new blood cells, and even help you stay upright when you’re walking around all day by taking care of your blood pressure.</p>
<p>With all those important functions, scientist think having two kidneys must be important for our survival. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/264077/original/file-20190315-28471-gblrhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/264077/original/file-20190315-28471-gblrhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/264077/original/file-20190315-28471-gblrhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/264077/original/file-20190315-28471-gblrhk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/264077/original/file-20190315-28471-gblrhk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/264077/original/file-20190315-28471-gblrhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/264077/original/file-20190315-28471-gblrhk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/264077/original/file-20190315-28471-gblrhk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Kidneys ‘clean’ your blood and send waste to your bladder, so you can pee it out.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Growing up with one kidney</h2>
<p>It is true, you <em>can</em> live with only one kidney. Some people are <a href="https://www.ncbi.nlm.nih.gov/pubmed/18612657">born with only one</a> because the other one did not grow properly. Other times, the two kidneys touch each other when they are first growing and join together, making one kidney shaped like a <a href="https://www.ncbi.nlm.nih.gov/pubmed/27324557">horseshoe</a>. People with these types of kidneys have to be very careful because they might get sick more easily than someone who has two kidneys. </p>
<h2>Needing an extra kidney</h2>
<p>Sometimes our kidneys stop working. When this happens our blood cannot be cleaned and we can get very sick. The only way to stay alive is to be attached to a big machine that cleans your blood for you, or have a <a href="https://kidney.org.au/your-kidneys/support/kidney-transplant">kidney transplant</a>. </p>
<p>This happened to me when my kidneys stopped working properly. My dad gave me one of his kidneys. Thanks, Dad.</p>
<p>There are two people involved in a kidney transplant: a donor who is going to give their kidney, and a recipient who will receive the kidney. </p>
<p>After the new kidney is put into the recipient, both the donor and recipient only have one kidney that works properly. Both the donor and the recipient can live long happy lives with only one kidney. They just have to take extra care that they eat healthily and exercise to stay fit. <a href="https://www.heraldsun.com.au/leader/south-east/springvales-twanny-farrugia-marks-45-years-since-receiving-kidney-transplant/news-story/e9ece94308f61042f5f2d9d328823d4c">One person</a> living in Australia has been using a transplanted kidney for 45 years!</p>
<p>So, while your body works best when all of your organs are inside you and working properly, scientists still don’t exactly know why we have two kidneys. However, it is good to know that we have a few spare parts that we can live without.</p>
<p>And if you’re an adult reading this, it’s good to make sure you are <a href="https://donatelife.gov.au/register-donor-today">registered as an organ donor</a> and also chat to your family so they know you want to donate. You may one day save a life.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-are-burps-so-loud-108988">Curious Kids: why are burps so loud?</a>
</strong>
</em>
</p>
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<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to curiouskids@theconversation.edu.au</em></p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p><em>Please tell us your name, age and which city you live in. We won’t be able to answer every question but we will do our best.</em></p><img src="https://counter.theconversation.com/content/113201/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brooke Huuskes volunteers for Transplant Australia and Kidney Health Australia.</span></em></p>When my kidneys stopped working properly, my dad gave me one of his kidneys. Thanks, Dad.Brooke Huuskes, Lecturer in Human Anatomy, Physiology Anatomy & Microbiology, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/819422017-08-30T20:05:56Z2017-08-30T20:05:56ZExplainer: what is chronic kidney disease and why are one in three at risk of this silent killer?<figure><img src="https://images.theconversation.com/files/182897/original/file-20170822-5178-7hj97i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If you have high blood pressure, smoke or have diabetes, you're at risk of chronic kidney disease.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/548566606?src=x-GEGjPymnWjtBM2loJSTw-1-7&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>A 42-year-old man – a father, a husband, a son – has come to the emergency department with a splitting headache. It’s been there for months, slowly getting worse. Today it’s unbearable. </p>
<p>He has no significant past medical history to explain the headaches and takes no regular medications. But he smokes and his <a href="https://www.heartfoundation.org.au/your-heart/know-your-risks/blood-pressure/is-my-blood-pressure-normal">blood pressure</a> is sky high – 210/100 mmHg (good blood pressure is <a href="https://www.heartfoundation.org.au/your-heart/know-your-risks/blood-pressure/is-my-blood-pressure-normal">considered under</a> 120/80 mmHg).</p>
<p>A series of investigations including blood and urine tests reveal significant kidney damage – stage four chronic kidney disease. Stage five kidney disease would mean he needs dialysis or a kidney transplant. This is serious.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kidneys-are-amazing-for-all-they-do-be-sure-to-look-after-yours-30966">Kidneys are amazing for all they do, be sure to look after yours</a>
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<p>Kidney disease is silent. Currently <a href="http://kidney.org.au/cms_uploads/docs/state-of-the-nation--kidney-health-week-2016--chronic-kidney-disease-hot-spots.pdf">one in ten Australian adults</a> have evidence of chronic kidney disease, with many unaware of it. It’s not <a href="http://www.aihw.gov.au/chronic-kidney-disease/what-is-ckd/">until 90%</a> of kidney function is lost that symptoms become apparent.</p>
<p>While symptoms like nausea, loss of appetite, lethargy and poor concentration are hallmarks of kidney failure, they are quite non-specific. Most people will have had these symptoms at some stage.</p>
<p>Fluid retention - swollen ankles and puffiness around the eyes - can be a marker of kidney disease. That’s because the kidneys are key to regulating fluid in the body and a diseased kidney cannot do that as efficiently.</p>
<p><a href="https://theconversation.com/blood-tests-and-diagnosing-illness-what-can-blood-tell-us-about-whats-happening-in-our-body-80327">Doctors confirm kidney disease</a> using a blood and urine test. The blood test (serum electrolyes) gives you a “percent of kidney function”. And the urine test (urinanalysis) tests for blood and protein in the urine, markers of damage and inflammation.</p>
<h2>What happens when your kidneys don’t work well?</h2>
<p>Kidneys are responsible for removing fluid and waste from your body that accumulate each day. </p>
<p>But when kidney function declines, fluid accumulates in the body. So, your legs can swell, and fluid can build up in the lungs, making it difficult to breathe.</p>
<p>Impaired kidneys also mean you cannot efficiently get rid of waste products, so these accumulate too. Such toxins in the body account for much of the symptoms of fatigue, nausea and loss of appetite.</p>
<p>Loss of kidney function and the build-up of fluid may lead to high blood pressure, which in turn may further speed up decline in kidney function. High pressures pulsating through the kidney damages their delicate filters and cause scar tissue to form.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/182898/original/file-20170822-5328-19avxg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/182898/original/file-20170822-5328-19avxg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/182898/original/file-20170822-5328-19avxg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=325&fit=crop&dpr=1 600w, https://images.theconversation.com/files/182898/original/file-20170822-5328-19avxg4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=325&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/182898/original/file-20170822-5328-19avxg4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=325&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/182898/original/file-20170822-5328-19avxg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=408&fit=crop&dpr=1 754w, https://images.theconversation.com/files/182898/original/file-20170822-5328-19avxg4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=408&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/182898/original/file-20170822-5328-19avxg4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=408&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Loss of kidney function can lead to high blood pressure, which in turn can further speed up kidney disease.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/623268185?src=hOUHJYLNjSQ_6L_Pk8mtqA-1-26&size=medium_jpg">from www.shutterstock.com</a></span>
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<p>People with chronic kidney disease are <a href="http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/216833">20-times</a> more likely to die from a heart attack or stroke. So, many people will die from heart disease before reaching end-stage kidney disease, the final stage of chronic kidney disease in which the kidneys no longer function well enough to meet your body’s daily needs.</p>
<p>When healthy, kidneys secrete the hormone erythropoietin (or EPO), which stimulates red blood cells to form. But as kidney function declines, production of this hormone is impaired and anaemia (a low red blood cell count), follows. So, patients need to be injected with EPO to restore their red blood cell count. </p>
<p>The kidneys are also pivotal in maintaining calcium and phosphate levels in the blood. As phosphate builds up, severe itchiness can develop; calcium levels drop and, without attention, this can lead to fragile bones.</p>
<h2>Who is at risk?</h2>
<p>Kidney disease is related to and caused by a number of different factors and conditions. As many as <a href="http://kidney.org.au/your-kidneys/prevent/check-your-kidneys">one in three Australians</a> have at least one risk factor for chronic kidney disease.</p>
<p>Indigenous Australians are at risk with this risk increasing the more remotely they live. People with a family history of kidney disease are particularly vulnerable to it. Diabetes, high blood pressure, smoking, obesity, high cholesterol, heart disease, stroke and being over 60 are additional risks.</p>
<p>The number of people with chronic (long-term) kidney disease is forecast to increase by <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129547200">60% by 2020</a>, largely due to diabetes and obesity becoming more common.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kidney-disease-in-aboriginal-australians-perpetuates-poverty-15031">Kidney disease in Aboriginal Australians perpetuates poverty</a>
</strong>
</em>
</p>
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<p>Anyone who has had an episode of acute kidney injury is also at risk of later developing chronic kidney disease. </p>
<p>Less common causes of kidney disease are inflammation of the kidney, or glomerulonephritis. We don’t known what causes many forms of glomerulonephritis. But sometimes an infection triggers it.</p>
<p>For instance, while streptococcal infection that leads to glomerulonephritis is rarely seen in non-Indigenous people, this is a <a href="https://espace.library.uq.edu.au/view/UQ:275287/UQ275287_preprint.pdf">significant concern</a> in Indigenous Australian children living in remote communities, with 15-20% suffering from it.</p>
<p>In other cases, someone’s own immune system damages the kidney tissue (an autoimmune disease) to cause glomerulonephritis. This may be triggered by an infection such as hepatitis B or C or from a yet unidentified source.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dr-g-yunupingus-legacy-its-time-to-get-rid-of-chronic-hepatitis-b-in-indigenous-australia-81672">Dr G. Yunupingu's legacy: it's time to get rid of chronic hepatitis B in Indigenous Australia</a>
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<p>Taking certain medications for a long time can cause or hasten progressive kidney decline. That’s what happened with <a href="https://medicalsciences.med.unsw.edu.au/node/302500715">Bex</a>, the painkiller popular in the 1960s, advertised widely with the slogan:</p>
<blockquote>
<p>Have a cup of tea, a Bex and a good lie down.</p>
</blockquote>
<p>Bex was ultimately associated with <a href="http://www.news.com.au/national/cancer-council-nsw-bex-powder-killed-more-than-pain/news-story/7637adcfe85ce4aa20e1bc267b8113ac">serious kidney injury (and cancer)</a> and is no longer in use.</p>
<p>Anti-inflammatory medications are the current curse of people with kidney disease as they restrict blood flow to the kidney, possibly leading to acute kidney failure.</p>
<p>Other less well known causes for kidney disease include the growth of cysts on the kidneys (polycystic kidney disease), congenital abnormalities of the
kidney or urinary tract and damage due to the backward flow of urine into the kidneys (reflux nephropathy).</p>
<h2>How is kidney disease managed?</h2>
<p>Chronic kidney disease cannot be cured. And once started, it’s difficult to halt its progression. So, awareness of kidney disease and its <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089661/">early detection</a> offers the best opportunity to alter it course.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/183685/original/file-20170829-1590-1ltn0a7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/183685/original/file-20170829-1590-1ltn0a7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/183685/original/file-20170829-1590-1ltn0a7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/183685/original/file-20170829-1590-1ltn0a7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/183685/original/file-20170829-1590-1ltn0a7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/183685/original/file-20170829-1590-1ltn0a7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/183685/original/file-20170829-1590-1ltn0a7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/183685/original/file-20170829-1590-1ltn0a7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The number of people needing dialysis in Australia is forecast to increase.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>Making lifestyle changes including losing weight, stopping smoking, controlling blood sugar levels and making healthy dietary choices cannot be emphasised enough as these factors slow progression of kidney disease, mainly through improved blood pressure control.</p>
<p>Reducing levels of protein in the diet <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089661/">may slow disease progression</a>. However, people can have trouble sticking to a low-protein diet.</p>
<p>People with chronic kidney disease also need to be monitored, not just for declining kidney function but also so they don’t develop complications such as anaemia, bone disease, malnutrition and heart disease.</p>
<h2>Dialysis or a transplant is the only hope for some</h2>
<p>Concern of progressive kidney decline to end-stage kidney disease is real. It’s at this point that some people will receive dialysis or a kidney transplant, which is estimated to <a href="http://kidney.org.au/cms_uploads/docs/state-of-the-nation--kidney-health-week-2016--chronic-kidney-disease-hot-spots.pdf">cost Australia A$1 billion a year</a>.</p>
<p>And the number of people requiring dialysis or a kidney transplant is forecast to increase by <a href="http://kidney.org.au/cms_uploads/docs/state-of-the-nation--kidney-health-week-2016--chronic-kidney-disease-hot-spots.pdf">60% by the year 2020</a>.</p>
<p><a href="https://www.healthdirect.gov.au/dialysis">Dialysis</a> is needed when kidney disease has progressed to the point where toxins cannot be cleared from the blood and fluid builds up. A machine essentially cleans the blood of excess wastes and removes fluid. Although a lifesaving treatment, its demands and impact on quality of life are significant.</p>
<p>Compared to the general population, the life expectancy of people on dialysis is significantly compromised. The <a href="http://kidney.org.au/cms_uploads/docs/state-of-the-nation--kidney-health-week-2016--chronic-kidney-disease-hot-spots.pdf">five-year survival</a> on dialysis is only 46% - a much grimmer outlook compared to a lot of common cancers.</p>
<p>End-stage kidney disease can also lead to a kidney transplant. But there continues to be a shortage of donor organs. In 2015, despite 949 transplants being performed, <a href="http://www.anzdata.org.au/anzdata/AnzdataReport/39thReport">over 1,000 people</a> remained on the transplant waiting list. The median time to receive a transplant was 2.4 years then. An increasing demand coupled with static supply suggests this waiting time will increase substantially.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-quarter-of-kidney-donors-are-living-what-you-need-to-know-to-be-a-donor-78041">A quarter of kidney donors are living: what you need to know to be a donor</a>
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<p>Transplantation improves both quality and quantity of life compared to those who remain on dialysis. However the life expectancy of people who have had a transplant <a href="http://www.anzdata.org.au/v1/report_2016.html">still lags behind</a> an age matched population. People who have had a kidney transplant are at increased risk of heart disease and cancer afterwards.</p>
<p>So, if you are the one in three Australians with at least one risk factor for kidney disease, discuss this with your doctor. It could save your life.</p><img src="https://counter.theconversation.com/content/81942/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Dwyer is a member of the Australian and New Zealand Society of Nephrology (ANZSN) and the Transplantation Society of Australia and New Zealand (TSANZ).</span></em></p><p class="fine-print"><em><span>Ashani Lecamwasam is a member of the Australian New Zealand Society of Nephrology (ANZSN) and member of the International Society of Nephrology (ISN).
Currently on a partial PhD scholarship through the Medical Faculty of Deakin University.</span></em></p>The number of Australians with chronic kidney disease is set to rise, but there’s no cure for most people. Here’s what you need to know about this silent killer.Karen Dwyer, Deputy Head, School of Medicine, Deakin UniversityAshani Lecamwasam, PhD student, Faculty of Health, School of Medicine, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/780412017-06-18T19:53:14Z2017-06-18T19:53:14ZA quarter of kidney donors are living: what you need to know to be a donor<figure><img src="https://images.theconversation.com/files/172669/original/file-20170607-11330-15z6fwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People undergoing dialysis would have a better quality of life if they had a kidney transplant.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>At any one time, <a href="http://www.donatelife.gov.au/sites/default/files/Facts%20and%20Stats%20Fact%20Sheet%20-Feb%202017.pdf">more than 1,400 Australians</a> are on an organ transplant waiting list. The most common organs in demand are kidneys, followed by the liver and lung. </p>
<p>While the number of deceased organ donors in Australia has <a href="http://www.donatelife.gov.au/sites/default/files/Australian%20Donation%20and%20Transplantation%20Activity%20Report%202016.pdf">doubled since 2009</a>, rates of live donor transplantation – where a person donates one kidney or, rarely, a portion of their liver – are relatively static.</p>
<p>In 2016, 265 Australians <a href="http://www.donatelife.gov.au/sites/default/files/OTA%20Factsheet%20-%20Living%20Donation%20and%20AKX_05%20V2.pdf">donated a kidney</a> to a friend or relative, making up about a quarter of all kidney transplants. Live donor liver transplants are rare (only two occurred in Australia last year) and often donated from a parent to a child.</p>
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<h2>Who needs a kidney?</h2>
<p>Kidneys filter toxins from the blood and regulate fluid balance. When kidneys are functioning so poorly a person needs dialysis to do the work for them, we say the person has “end stage kidney disease”. </p>
<p>In 2015, there were <a href="http://www.anzdata.org.au/brochures/brochure_2016v4.0_20170102.pdf">nearly 12,500 Australians</a> undergoing dialysis. End stage kidney disease often occurs gradually and is commonly a result of diabetes, high blood pressure and types of autoimmune kidney disease called glomerulonephritis. </p>
<p>Many patients with end stage kidney disease <a href="https://www.ncbi.nlm.nih.gov/pubmed/10580071">would live longer</a> and have a better quality of life following a kidney transplant compared to staying on dialysis. But the shortage of donor organs means preference is given to those likely to have better outcomes and reasonable life expectancy after transplantation. </p>
<p>Australian <a href="http://www.donatelife.gov.au/sites/default/files/TSANZ%20Clinical%20Guidelines%20for%20Organ%20Transplantation%20from%20Deceased%20Donors_Version%201.0_April%202016.pdf">guidelines require</a> patients have an 80% likelihood of survival at five years after transplantation to be eligible for the wait list. Tests are done to ensure the potential transplant recipient has acceptable heart health to undergo the operation, and that there are no cancers or infections that will be made worse by medications that suppress the immune system (“anti-rejection drugs”). </p>
<p>The donor’s kidney function is assessed, and the risk of them developing a kidney disease in future is evaluated. This is both to ensure the donor enjoys good kidney function after removal of their kidney, and that the recipient receives a well-functioning kidney. Donors also routinely undergo psychological evaluation.</p>
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<a href="https://images.theconversation.com/files/172673/original/file-20170607-11301-z73n3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/172673/original/file-20170607-11301-z73n3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/172673/original/file-20170607-11301-z73n3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/172673/original/file-20170607-11301-z73n3o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/172673/original/file-20170607-11301-z73n3o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/172673/original/file-20170607-11301-z73n3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/172673/original/file-20170607-11301-z73n3o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/172673/original/file-20170607-11301-z73n3o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Kidneys work by filtering out toxins from the blood and regulating a person’s fluid balance.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<h2>Where do donors come from?</h2>
<p>A potential recipient is encouraged to ask friends and family if they would be willing to donate a kidney. If not, the potential recipient can go on the deceased donor list to wait for a compatible kidney.</p>
<p>People often donate organs to their blood relatives, but it’s also possible to give a kidney to someone who is not related, such as a spouse or close friend. Some people <a href="https://www.ncbi.nlm.nih.gov/pubmed/23600791">use social media</a> to solicit organ donations, and some have been successful. Specific matching sites also exist in countries such as the US, with the aim of getting healthy volunteers to altruistically donate a kidney. </p>
<p>But methods of acquiring a donor who is previously unknown to the recipient <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2011.03765.x/full">are controversial</a> and generally discouraged in Australia for ethical reasons. In Australia, a person could donate a kidney altruistically to someone on the waiting list. In this situation, the donor and recipient do not find out each other’s identity. </p>
<p>The Australian <a href="http://www.donatelife.gov.au/about-us/kidney-exchange-programme">paired-exchange program</a> allows greater numbers of live donor transplants to occur through paired kidney donor swaps. For example, if Jane’s potential donor John is unsuitable to give her a kidney because of matching issues, and Bob’s potential donor Barbara is unsuitable to give him a kidney, Barbara can donate a kidney to Jane, and John can donate a kidney to Bob. </p>
<p>Last year, an altruistic donation <a href="http://www.abc.net.au/news/2015-12-16/altruistic-kidney-donation-saves-seven-lives-in-one-day/7032292">kicked off a domino chain</a> of six paired-exchange donations, with the final kidney from a paired exchange donor going to a patient on the deceased donor waiting list.</p>
<p>Live donors must be over 18, but it’s preferable if they are over 30 as older age at donation minimises their chance of developing an unexpected condition that threatens their kidney health down the track. </p>
<h2>Do you need to be a ‘match’?</h2>
<p>Different people have different combinations of proteins on the surface of their cells that allow the immune system to determine what is part of the body (self) and what are foreign agents (non-self). These proteins are determined by genes called human leukocyte antigens (HLA). </p>
<p>The immune system is designed to recognise self HLA so it doesn’t target its own tissues. It is <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1399-0012.2012.01654.x/abstract;jsessionid=88CCDD1F42E1C2E3747A57660F0D7DA7.f02t04">advantageous to have high degrees</a> of HLA match (also called tissue match) between a donor and recipient, but it’s not absolutely necessary. A closer degree of HLA match means the immune system is less likely to reject the kidney.</p>
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<span class="caption">Blood relatives are most likely to donate an organ.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>Usually people need to be the same blood group to donate a kidney. But some living donor transplants can occur across different blood groups. These are called ABO incompatible transplantation. For this to happen, the recipient must <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5338156">undergo plasmapheresis</a> – a process in which antibodies (proteins that attack foreign invaders) are removed from their blood and they are given strong medication to suppress the immune system. </p>
<p>Only people with end stage kidney disease can be listed for deceased donor transplantation. But living donor transplants can be “pre-emptive”, taking place before the need for dialysis. </p>
<p>This has advantages, such as not having to take time away from work or study to do dialysis. People who undergo pre-emptive transplantion have a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384698/">lower risk of death</a> and loss of kidney transplant function compared to people who spend time on dialysis before getting a transplant.</p>
<h2>Are there risks to donors?</h2>
<p>Kidney donors usually remain in hospital for a few days after surgery, which is usually conducted as “keyhole surgery”. This involves a camera and instruments being inserted through a small incision and the kidney being pulled out through it.</p>
<p>Full recovery time is around six to eight weeks. Complications, such as bleeding or blood clots, <a href="https://www.ncbi.nlm.nih.gov/m/pubmed/20215610/">related to the operation</a> are rare. There is a very <a href="https://www.ncbi.nlm.nih.gov/m/pubmed/20215610/">small risk of death</a> around the time of the operation, estimated at 3.1 in 10,000 donors, or 0.031%. Although the patient populations differ, this is less than for other minor operations such appendicectomy (estimated in a <a href="https://www.ncbi.nlm.nih.gov/m/pubmed/27535664/">recent study</a> at 0.21%). </p>
<p>There is no long-term <a href="https://www.ncbi.nlm.nih.gov/m/pubmed/20215610/">increased risk of death</a> or heart disease. Donating a kidney is likely to cause a <a href="https://www.ncbi.nlm.nih.gov/m/pubmed/16880460/?i=5&from=/11502974/related">slight increase in blood pressure</a> over time. </p>
<p>After donation, the remaining kidney increases its capacity to filter blood, and <a href="https://www.ncbi.nlm.nih.gov/m/pubmed/11502974/">kidney function usually returns</a> to 70-80% of the previous level. This is adequate, and does not result in any symptoms related to kidney disease.</p>
<p>Studies comparing kidney donors to equivalently healthy non-donors found kidney donation <a href="https://www.ncbi.nlm.nih.gov/m/pubmed/26544982/">increases risk</a> of end stage kidney disease about three- to five-fold. But the risk is very <a href="https://www.ncbi.nlm.nih.gov/m/pubmed/26544982/">low to begin with</a> (around 0.06% for a white US man and 0.04% for a white US woman).</p>
<p>The kidney donation experience is usually positive. In one study, 95% of <a href="http://www.ajkd.org/article/S0272-6386%2812%2900003-0/abstract">kidney donors in the US</a> rated their experience as good to excellent. They reported an improvement in their sense of meaning in life and self-esteem. But a degree of psychological stress related to donation was common, and 20% reported a financial burden. </p>
<p>The Australian government <a href="http://www.immunise.health.gov.au/internet/budget/publishing.nsf/Content/budget2017-factsheet44.htm">gives A$4.1 million to run</a> the Supporting Living Organ Donors program. This scheme includes reimbursing employers for sick leave for those who donate an organ, as well as other initiatives that aim to remove financial barriers to organ donation.</p>
<hr>
<p><em>More information about living kidney donation is available at <a href="http://www.donatelife.gov.au/donor-family-support/living-donors">Donate Life</a>, <a href="http://kidney.org.au/your-kidneys/support/organ-donation/living-donors">Kidney Health Australia</a>, and the <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/leave-for-living-organ-donors">Supporting Living Organ Donors program</a>.</em></p><img src="https://counter.theconversation.com/content/78041/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Holly Hutton is the recipient of an NHMRC postgraduate scholarship. (Grant number 1075304)</span></em></p>Many patients with end stage kidney disease would live longer and have a better quality of life with a kidney transplant compared to staying on dialysis.Holly Hutton, Nephrologist, PhD candidate at Centre for Inflammatory Diseases, Monash University., Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/509382015-11-19T15:41:24Z2015-11-19T15:41:24ZExplainer: what is the kidney disorder that Jonah Lomu had?<figure><img src="https://images.theconversation.com/files/102517/original/image-20151119-18418-1ms6r53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Rugby legend Jonah Lomu had a rare kidney disorder</span> </figcaption></figure><p>All Blacks rugby player Jonah Lomu <a href="https://theconversation.com/legend-hero-gentleman-jonah-lomu-changed-the-face-of-rugby-50940">has died</a>, aged 40. Lomu died of a heart attack, thought to have been a complication of the rare kidney disorder he’d been suffering from for most of his adult life. </p>
<p>The disorder, nephrotic syndrome, is a fairly rare disease with just two or three new cases <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2394708/">per 100,000 of the population</a> each year. But what exactly is it?</p>
<p>A nephron is a functioning unit within the kidney. Each nephron has a filter (called a glomerulus) and a drainpipe (a tubule), and there are about a million nephrons in a kidney, each acting in concert to clean the blood and regulate the body’s salt and water content. </p>
<p>The kidney cleans the blood over and over, at an incredible rate <a href="http://www.worldkidneyday.co.uk/kidney-facts/">of 180 litres a day</a>. Most of us have two kidneys which normally allows a lifetime’s worth of blood filtering to be performed.</p>
<h2>Nephrotic syndrome</h2>
<p>There are several diseases of the kidney where the filters of the nephron become damaged. This leads to a loss of large amounts of protein in the urine (when there should normally be very little), which leads to low blood protein levels and body swelling, known as oedema. It is this combination of symptoms and signs that is called nephrotic syndrome. It was first described in 1821, yet we are still learning new features of this condition.</p>
<p>There may be many different underlying causes, which include rare inherited forms, specific diseases of the glomerulus and secondary causes due to other medical conditions, such as diabetes, and drugs, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2218757/">such as Gold</a>, which is used to treat rheumatoid arthritis. </p>
<p>The consequences of nephrotic syndrome are severe. Complications that commonly occur include blood clotting problems (due to urinary loss of key proteins that prevent blood clotting), risk of serious infections (due to low blood protein levels) and kidney failure. </p>
<p>There are treatments for nephrotic syndrome, but no cure. Treatment often includes high dose steroid therapy and anticoagulants to prevent blood clots as well as diuretic tablets to control body swelling.</p>
<h2>Dialysis</h2>
<p>Certain underlying causes of nephrotic syndrome will eventually lead to complete kidney failure. This has devastating consequences and often means the patient has to rely on renal dialysis - where a machine does the job of the kidneys - until a kidney transplant can be performed. People can survive for many years on dialysis, but survival is often a long way from full health. </p>
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<span class="caption">People can survive for many years on dialysis.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&search_tracking_id=L-tprIwabOA-H-CENhNYUw&searchterm=kidney%20dialysis&show_color_wheel=1&orient=&commercial_ok=&media_type=photos&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=172564250">www.shutterstock.com</a></span>
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<p>Dialysis may be performed by cleaning the blood three times a week using an artificial kidney (haemodialysis) or by using the abdominal cavity on a daily basis (peritoneal dialysis). Both treatments can be performed at home with the support of a healthcare professional.</p>
<p>However, life expectancy of a dialysis patient is severely limited, with the average being <a href="https://www.kidney.org/atoz/content/dialysisinfo">just five to ten years</a>. It is possible to live for 20 or more years on dialysis but this is the exception rather than the rule.</p>
<p>A <a href="http://www.nhs.uk/Conditions/Kidney-transplant/Pages/Introduction.aspx">kidney transplant</a> is the best treatment for kidney failure. A transplant returns life expectancy to <a href="https://www.kidneyresearchuk.org/health-information/kidney-transplantation">near normal values</a>. But transplanted kidneys tend to wear out faster than the kidneys you were born with and sometimes the original cause of nephrotic syndrome can recur after the kidney transplant. Often a second kidney transplant is needed when this happens. </p>
<p>It seems that, over several years, Lomu’s own kidneys failed and he received a transplant at the age of 29, which went on to function for the next seven years before failing. </p>
<h2>Understanding the genetic causes</h2>
<p><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4310431/pdf/sfu129.pdf">Research at Newcastle University</a> aims to understand the genetic causes of nephrotic syndrome. This is where an inherited change in a gene predisposes patients to kidney disease resulting in a protein leak. Although we are born with our set of genes, often it isn’t until adult life that these conditions appear. Knowing the underlying genetic condition can allow early detection of the disease in other family members and allow treatments to be developed. It also gives information about whether the condition will recur in a kidney transplant. </p>
<p>The Genomics England <a href="http://www.genomicsengland.co.uk/">100,000 genomes project</a>, which has been piloted at our university over the past few years, is a platform to study inherited kidney conditions such as nephrotic syndrome. Here, the genome is sequenced and analysed to identify disease causing variants. It was through this project that whole genome sequencing successfully identified the underlying genetic cause <a href="http://www.genomicsengland.co.uk/first-patients-diagnosed-through-the-100000-genomes-project/">in a Newcastle family</a> with an inherited form of nephrotic syndrome and kidney failure. </p>
<p>Knowing the underlying genetic predisposition for rare kidney disorders such as nephrotic syndrome is the starting point for developing a better understanding of the disease and developing treatments that can prevent the ongoing kidney damage that leads to kidney failure and all its devastating consequences.</p><img src="https://counter.theconversation.com/content/50938/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span><a href="mailto:john.sayer@ncl.ac.uk">john.sayer@ncl.ac.uk</a> receives funding from MRC, Kidney Research UK, Kids Kidney Research, Northern Counties Kidney Research Fund and Newcastle Hospitals Healthcare Charity. </span></em></p>All Blacks legend, Jonah Lomu, suffered from nephrotic syndrome for most of his adult life. Here is what we know about the rare condition.John Sayer, Senior clinical lecturer in nephrology, Newcastle UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/469652015-10-02T12:39:25Z2015-10-02T12:39:25ZWhy people with kidney disease opt for palliative care over dialysis<figure><img src="https://images.theconversation.com/files/95574/original/image-20150921-31500-1x74kip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Hard going and not for everyone. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-171182189/stock-photo-side-view-of-male-patients-undergoing-renal-dialysis-in-hospital-room.html?src=d1tLHLyZ1rA_QkILdJngSQ-6-44">Dialysis by Shutterstock</a></span></figcaption></figure><p>End-stage renal disease is a devastating illness that happens when the kidneys stop working. It is primarily caused by diabetes and high blood pressure and is on the increase. When the kidneys fail, people have to make a stark choice: take up treatment or a transplant, or die. </p>
<p>Treatments include haemodialysis, a demanding intervention that removes waste products and fluid which accumulate in the blood when the kidneys fail. It is usually carried out in hospital three times a week, indefinitely, with each session lasting around four hours. Peritoneal dialysis is another treatment where the lining of the abdomen acts as a filter and waste is removed by means of a cleansing fluid called dialysate, washed in and out of the abdomen in cycles. It is home-based and requires a level of dexterity, training and an ability to perform the treatment steps safely. </p>
<p>Kidney transplantation is the treatment of choice, but is not available <a href="http://www.nhs.uk/conditions/kidney-disease-chronic/Pages/Treatment.aspx">to many patients</a> who are frail and often suffering other illnesses such as advanced cardiac failure. These patients would likely not survive a transplant and may also find dialysis challenging. One problem with opting for dialysis is that it can also shorten life, particularly for those people with other problems such as heart disease. It is physically and emotionally draining, causes complications such as nerve problems, anaemia, bone disease and infection. In addition, an arduous regime of three days a week on dialysis can lead to symptoms including nausea, vomiting, cramps and depression. Subsequently some people end up in very poor health and others will die. </p>
<p>This has led to a fourth choice for patients – the “no dialysis” option where people opt for a supportive and palliative care provided by the multidisciplinary team, usually in liaison with a community palliative care team and their GP. For some patients this decision is easy to make, particular those who are old and frail and don’t wish to attend hospital three times a week, but for many it is a complex, multi-faceted choice, fraught with difficulty. </p>
<p>Some patients may be advised against dialysis while others remain undecided for some time – though we know that if dialysis is not started (and we can’t always be sure it will extend life) certain death will ensue.</p>
<h2>The best care</h2>
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<span class="caption">Mixed picture.</span>
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<p>Models of multidisciplinary care for supporting and providing palliative care for those with end-stage renal disease have developed <a href="http://www.ncpc.org.uk/sites/default/files/EndOfLifeCareInAdvancedKidneyDisease.pdf">mainly in England</a> and <a href="http://www.healthnetworks.health.wa.gov.au/modelsofcare/docs/RenalPalliativeCarePathway.pdf">in Australia</a>
and the approach <a href="http://www.isrctn.com/ISRCTN06857980">is being developed in Northern Ireland</a>. Yet we don’t know how many people are opting for this kind of care in preference to dialysis. Other parts of Europe have been slow to adopt this practice and it is likely that some people are advised to take up dialysis in order to prolong life, when it may not be the best option for them. </p>
<p>It is starting <a href="http://www.renalmed.co.uk/database/supportive-and-palliative-care">to be recognised</a> that some people with ESRD will not benefit from dialysis, particularly because it can shorten life. The difficulty is in identifying those for whom dialysis might hasten death. Increasing frailty, additional co-morbidities and poor functional status is likely to reduce your chance of effective dialysis.</p>
<p>Quality of life is another important issue. In order to help people make informed heath decisions we need to understand how quality of life is affected by treatments such as haemodialysis, peritoneal dialysis or palliative care with more research undertaken to explore these important questions – we can start by comparing these populations by following them over time in order to observe experiences and changes that happen. </p>
<p>Also key is the impact on carers when people opt out of dialysis. Carers, an often forgotten group, <a href="http://www.ncbi.nlm.nih.gov/pubmed/23652841">may be as frail as, or frailer</a> than the person they are caring for as they are often spouses – and people opting not to use dialysis are usually in an older age-group. Sometimes carers die before the person with renal disease. </p>
<p>Many carers sacrifice social and personal health needs in order to care for their loved one and we know little about how they cope and what interventions might help improve the experience. </p>
<h2>More than counting costs</h2>
<p>The other important thing to bear in mind is that when making decisions about healthcare treatments, costs cannot be ignored in an impoverished NHS. Haemodialysis costs about £35,000 and peritoneal dialysis £20,000-a-year per patient. We do not know how much it costs to manage a patient in palliative care as this has not been studied, but it is likely to be much cheaper. That said, prices shouldn’t dictate treatment decisions but should be made based on the best interests of the patient. Many patients making decisions about treatments for ESRD are also frail, have poor performance scores <a href="http://www.renalmed.co.uk/database/supportive-and-palliative-care">and impaired cognition</a>, and may not do well on a dialysis machine. </p>
<p><a href="http://www.biomedcentral.com/1471-2369/16/104">The PACKS study</a>, of which I’m a contributor, is a welcome piece of research. The study aims to examine quality of life, decision making, costs and mortality in patients with ESRD who have opted for palliative care. It will also explore care decisions made by patients from the perspective of the patient, carer and healthcare professionals, from the start of palliative care. An economic analysis gives greater transparency of how resources are allocated for people with ESRD, and it will lay the ground work for further work which should ultimately compare patients who opt for dialysis with those who opt for palliative care. When we’re better able to compare outcomes in these two groups, it will help us make sure that the options people have are the best ones for them.</p><img src="https://counter.theconversation.com/content/46965/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Noble receives funding from an NIHR Post-Doctoral Fellowship funded by HSC Research & Development Division</span></em></p>Palliative care is a choice and for some the preferable option.Helen Noble, Lecturer in the School of Nursing and Midwifery, Queen's University BelfastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/191932013-10-23T03:32:25Z2013-10-23T03:32:25ZHoney not a contender in the fight against superbugs<figure><img src="https://images.theconversation.com/files/33373/original/bncknv3d-1382333496.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research looked at whether applying medical grade honey to wound sites showed advantages over antibiotics.</span> <span class="attribution"><span class="source">Rachel/Flickr</span></span></figcaption></figure><p>If you haven’t heard about the threat “superbugs” (bacteria that are resistant to antibiotics) pose to our health, it’s likely you haven’t been conscious or on the planet for a couple of years.</p>
<p>There are <a href="https://theconversation.com/new-antibiotics-whats-in-the-pipeline-10724">no new drugs in the pipeline</a> to fix the superbug problem. And when times are tough, and we’re faced with life-threatening infections, we often turn to alternative, sometimes unproven methods. </p>
<p><a href="http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(13)70258-5/abstract">Research recently published</a> in The Lancet looked at whether applying medical grade honey to wound sites in patients undergoing dialysis showed advantages over standard antibiotic use. </p>
<p>We are susceptible to bacterial infection whenever our skin is punctured, which happens quite a lot during hospital treatment. The researchers worked with dialysis patients because having a catheter inserted is a regular procedure for the hundreds of thousands of kidney dialysis patients. </p>
<p>They found that using honey showed no advantages over standard antibiotic use, and was, in fact, worse for diabetic dialysis patients.</p>
<p>Getting something like honey to the market as a food product is pretty straightforward, but for medicines the bar is set higher. </p>
<h2>The drug approval process</h2>
<p>There are many different ways that new medicines are approved for public use. </p>
<p>Drugs made by pharmaceutical companies, for instance, go through many years of expensive, highly-controlled clinical trials comparing the effects of the new drug against a placebo control. And later, they are compared against competitor compounds already on the market. </p>
<p>But alternative, or “natural” medicines can be put straight to market provided they don’t do any harm and their makers don’t make outrageous claims about their health effects.</p>
<p>One such natural alternative is <a href="https://theconversation.com/honey-could-be-a-potent-medicine-as-well-as-a-tasty-treat-12032">bee honey</a>, which has long been known to have antibacterial activity. A commercial version of “antibiotic” honey, Medihoney, has actually been <a href="http://www.ncbi.nlm.nih.gov/pubmed/18752540">clinically evaluated</a> for the treatment of ulcers. </p>
<p>Honey is cheap and widely available, and while it cannot be used for systemic infections (for pneumonia, for instance, or bacteremia), it has been used for open wounds. It can kill many types of bacteria and is thought also to provide a barrier to moisture.</p>
<h2>The bake off</h2>
<p>The Lancet paper looked closely at how a naturally-derived honey preparation compares against a clinically-approved antibiotic – a drug called Bactroban that’s used to kill bacteria found in and around wounds. </p>
<p>The main culprit, <em>Staph aureus</em>, lives on our skin and can cause infection around catheters used during treatment of dialysis-related infections.</p>
<p>A total of 371 trial participants undergoing dialysis received either standard antibiotic therapy to prevent infection, or a daily application of medical grade honey, to the site of catheter insertion. </p>
<p>The study found no significant differences in infection rates or deaths from infection between most people given the antibiotic or people given honey. </p>
<p>But for people with diabetes, which is often associated with kidney disease, the honey actually increased the risk of infection. This is important because diabetes is the leading cause of kidney failure, so any therapy should work with normal and diabetic kidney dialysis patients. </p>
<p>The reasons for the diabetes-kidney failure link are not completely understood, but diabetics often have both high blood glucose levels and high blood pressure, both of which can cause kidney damage. </p>
<p>There’s also a hormone system called the renin-angiotensin system that regulates blood pressure and fluid balance involving the kidney, which is unbalanced in diabetics.</p>
<p>While honey therapy was worse than antibiotics for diabetics, the authors found the most important factor for preventing infection in all patients was how well the catheter was inserted and fixed. There was no placebo control possible in the trial (where no treatment is given) as these infections are sometimes fatal.</p>
<p>We can conclude that honey therapy instead of antibiotics at least does no harm for many dialysis patients, but also that it’s not good for diabetics. And because diabetes and kidney disease are commonly linked and 9% of the patients treated with either therapy still died, the bottom line is still that we need better therapies for bacterial infection – whether natural or man-made.</p><img src="https://counter.theconversation.com/content/19193/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Cooper receives NHMRC funding for research into new antibiotics and methods to diagnose superbug infections.</span></em></p>If you haven’t heard about the threat “superbugs” (bacteria that are resistant to antibiotics) pose to our health, it’s likely you haven’t been conscious or on the planet for a couple of years. There are…Matthew Cooper, Prof. Institute for Molecular Bioscience, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.