Tag Archive | "kidney failure"

Study Finds Another Risk of Fall in Blood Pressure During Dialysis

A recent study led by researchers at the Stanford University School of Medicine found that there is an increased risk of blood clotting at the point where the patient’s blood vessels are connected to the dialysis machine known as the point of vascular access.  Researchers from the University of Utah also contributed to the study.  The study was published in the Journal of the American Society of Nephrology. This is yet another diverse consequence associated with a fall in blood pressure during dialysis for patients

Dialysis is a life-extending procedure for patients with kidney failure.  It involves sitting in a chair three or more times a week connected to an artificial kidney machine.  The patient’s blood is cleansed by exchanging fluid and electrolytes across a membrane during each three to four-hour session.

The fistula is one of the most common forms of vascular access.  It is created surgically from the patient’s own blood vessels.  The tubes used to transport blood to and from the body to the dialysis machine are connected to the body at this access point.  Clotting is one of the problems of an access point and can lead to its closure.

This study was based on results from the Hemodialysis study, known as HEMO, a National Institutes of Health-sponsored randomized clinical trial that collected data from 1,846 patients on hemodialysis from 1995 to 2000.  This study included data from 1,426 of these patients.

The team found that patients who had the most frequent episodes of low blood pressure during dialysis were two times more likely to have a clotted fistula than patients with the least episodes.

Roughly $2 billion a year is spent on vascular access in dialysis patients in the United States. Low blood pressure during dialysis occurs in about 25 percent of dialysis sessions.

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Dipstick Urine Test Can Help Identify Risk for Kidney Function Decline

According to a recent study published in the Journal of the American Society Nephrology, a simple and inexpensive urine test routinely done in family doctors’ offices may be the key to identifying individuals who are silently undergoing rapid kidney function decline.

William Clark, MD, of the University of Western Ontario and London Health Sciences Centre in London, Canada and his colleagues analyzed whether simple and routine screening tests for urine protein could be used to identify people at highest risk for rapid kidney function decline because these patients would benefit the most from serial kidney function monitoring and early treatments to prevent kidney failure.

The study analyzed 2,574 participants in a community-based clinic for an average of seven years.  The research team found that a positive dipstick urine test (with a protein concentration of at least 1g/L) was a strong predictor of rapid kidney function decline.  In total, 2.5 percent of participants in the study had a urinary protein concentration of at least 1g/L at the beginning of the study.  If all of the participants were followed with serial monitoring of kidney function, one case of rapid kidney function decline would be identified for every 2.6 patients followed.

This test correctly identified whether individuals had rapid kidney function decline in 90.8 percent of participants, mislabeled 1.5 percent as having the condition, and missed 7.7 percent who were later identified as having the condition.  Among participants with certain risk factors including cardiovascular disease, being older than 60 years, diabetes, or hypertension, the chance of identifying rapid kidney function decline from serial kidney function measurements increased from 13 percent to 44 percent after incorporating a positive dipstick test.

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IV Fluids Lowers Chances of Kidney Failure in Children

According to researchers at Washington University School of Medicine in St. Louis and other institutions, giving children intravenous fluids early in the course of an E. coli O157:H7 infection seems to lower the chances of developing severe kidney failure.  The results of this study were recently published in the Archives of Pediatric and Adolescent Medicine.

Children with E. coli O157:H7 have a high risk of hemolytic uremic syndrome (HUS), the most common cause of short-term, sudden-onset pediatric kidney failure.  Roughly 15 to 20 percent of children with this type of E. coli infection develop HUS.  Although most children recover and their kidneys heal, the syndrome can be fatal and might cause permanent kidney damage.

The first symptoms of E. coli O157:H7 are diarrhea and severe abdominal pain, and later symptoms include bloody diarrhea.  Kidney failure occurs because this strain of E. coli, called Shinga toxins, which hurt blood vessels. The kidneys are especially susceptible to the reduced blood flow that results from this injury. More than half of children with HUS develop kidney failure severe enough to require dialysis.

E. coli O157:H7 infection can come from eating undercooked hamburger, sprouts, unpasteurized fruit juices, dry-cured salami, lettuce, game meat and unpasteurized milk products, as well as exposure to contaminated water and contact with cattle. In the developed world, E. coli O157:H7 is the most common cause of acute kidney failure in otherwise healthy children.  The research team analyzed 50 children under 18 years old who were treated for diarrhea-associated HUS at 11 pediatric hospitals in the United States (St. Louis; Seattle; Sacramento, Calif.; Albuquerque, N.M.; Little Rock, Ark.; Milwaukee; Cincinnati and Columbus, Ohio; Indianapolis; and Memphis, Tenn.) and in Glasgow, Scotland.

Overall, 68 percent of the children stopped urinating. Of the 25 patients who had received no intravenous fluids in the first four days of illness, 84 percent stopped urinating. But in the other 25 patients who were given IV fluids to keep their kidneys working, only 52 percent stopped urinating.  Christina Ahn Hickey, MD, a third-year pediatrics resident at Washington University School of Medicine in St. Louis and St. Louis Children’s Hospital and the first author on the study, says that intravenous fluids are better for children than oral fluids because most of the children infected with E. coli O157:H7 are vomiting and having frequent bouts of diarrhea, so they cannot stay hydrated.

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