Patients with end-stage renaldisease (ESRD) in the regions affected by Hurricane Sandy in October 2012 experienced higher rates of emergency department (ED) visits and hospitalization as well as a slightly higher 30-day mortality rate, according to a new study. 

Using claims data from the Centers for Medicare & Medicaid Services, researchers compared a study group of ESRD patients in the areas most affected by the hurricane (New Jersey and New York City) with 2 comparison groups: (1) ESRD patients living in states unaffected by Sandy during the same period; and (2) ESRD patients living in the Sandy-affected region a year prior to Sandy (October 1, 2011 through October 30, 2011). 

Of 13,264 study group patients, 59% received early dialysis in 70% of the New York City and New Jersey dialysis facilities. The ED visit rate was 4.1% for the study group compared with 2.6% and 1.7% of comparison groups 1 and 2, respectively, the researchers reported in the American Journal of Kidney Diseases (2015;65:109–115). The hospitalization rate for the study group was 4.5%, which was significantly higher than the 3.2% and 3.8% rates for comparison groups 1 and 2, respectively. 

In addition, among patients who visited the ED, those in the study group were significantly more likely to receive dialysis there than those in comparison groups 1 and 2 (23% vs. 9.3% and 6.3%, respectively). 

The 30-day mortality rate for the study group was significantly higher than that of comparison group 1 (1.47%) and slightly but not significantly higher than that of comparison group 2 (1.6%). 

Early dialysis important 

“Our findings support the feasibility of using early dialysis as a potential standard of care and protective measure when a hurricane or other ‘notice event' is anticipated to interrupt dialysis treatment,” the authors wrote.

 “Emergency preparedness and response depend on good planning and strong day-to-day systems. Many dialysis providers routinely organize early dialysis for patients in advance of major holidays, suggesting that systems are in place to provide such care in advance of a major storm.” 

The investigators stated that, from a preparedness perspective, “dialysis facilities should consider having plans in place to provide early dialysis to patients in advance of predictable disasters such as hurricane and to ensure their ability to function in a disaster.”

In a statement prepared by the National Kidney Foundation (NKF), which publishes the American Journal of Kidney Diseases, corresponding author Nicole Lurie, MD, Department of Health and Human Services Assistant Secretary for Preparedness and Response, stated that the research clearly showed that delaying dialysis can have devastating health effects for patients with ESRD. 

“The good news is that we saw a lot of patients receiving dialysis before the storm hit. That type of advance planning by patients and their facilities should become routine nationwide,” she said. “Everyone involved should know what to do when their facilities might close—patients should know where to go, and facilities should be able to provide a surge in early dialysis care so treatment is not delayed. At the end of the day, that helps people and their communities be more resilient.” 

Room for improvement 

Dr. Lurie pointed out that 40% of patients did not receive early dialysis, meaning “there is still plenty of room for dialysis patient and facility improvement. I hope these findings serve as a rallying cry not just for the dialysis community, but for all people with any type of chronic health condition and their care providers to plan for emergencies.” 

“This is an important analysis of the impact of Hurricane Sandy in October 2012 on individuals treated with in-center hemodialysis that ultimately helps the dialysis community better anticipate what might go wrong, improve emergency plans for disaster scenarios, and more rapidly respond to protect the health of our patients during emergencies,” said Joseph Vassalotti, MD, NKF's Chief Medical Officer. “The study reflects another step forward to improve the education and training of patients and dialysis clinic staff, following the widely recognized poor response to Hurricane Katrina in August 2005.” 

Although the new study had a number of strengths—such as the use of Medicare data, which cover nearly all of the nation's ESRD patients—it also had some limitations, including lack of access to sufficiently granular data on sustained power outages and facility damage, “which may have enabled us to better understand the utilization pattern seen.” 

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Researchers in Italy have created a Phosphorus Pyramid to help teach patients with chronic kidney disease how to reduce dietary phosphorus.

According to the researchers, the aim of the phosphorus pyramid is to support dietary counseling in order to reduce the dietary phospohorus load. The Phosphorus Pyramid is a visual tool that was designed to present the phosphate load of various foods. It was built upon the current nutritional databases and the existing literature on dietary phosphorus content, bio-availability, and processing, the researchers said. The objective is to help the viewer identify which foods cause a lower or a higher effective phosphate load without the need to memorize the phosphorus content of each food item.

Read also:

Some drugs prescribed to dialysis patients contain high levels of phosphorus

The pyramid consists of six floors in which foods are arranged on the basis of phosphorus content, phosphorus to protein ratio and phosphorus bioavailability. Each level has a colored edge (from green to red) that corresponds to recommended intake frequency.

The pyramid is shown and described in an open access article on BMC Nephrology.

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A new study of veterans demonstrated no link between prostate cancer (PCa) recurrence and metabolic syndrome (MetS), in contrast to some previous studies. Elevated low-density lipoprotein (LDL) levels and impaired fasting glucose, however, might have an effect.

“This analysis of a large cohort of veterans supports a role for lipid and glucose metabolism in PCa recurrence and contributes to a developing body of evidence that may support preventive recommendations if these findings are confirmed,” stated lead researcher Liam Macleod, MD, of the University of Washington School of Medicine in Seattle, and colleagues.

For the retrospective study, the investigators analyzed the relationship between MetS and biochemical recurrence of localized PCa (after prostatectomy or radiotherapy) among 1,706 predominantly Caucasian veterans. Most men had clinical stage T1a–T2a disease, Gleason 7, and PSA less than 10 ng/dL. Patients receiving active surveillance or androgen-deprivation therapy were excluded.

MetS was defined as any 3 of the following features:

•       blood pressure greater than 130/85 mm Hg
•       fasting blood glucose 100 mg/dL or higher
•       waist circumference above 102 cm (40 inches)
•       high-density lipoprotein (HDL) less than 40 mg/dL
•       or triglycerides 150 mg/dL or above.  

The researchers also separately examined LDL cholesterol levels (greater than 130 mg/dL).

After a median 41 months, 279 men experienced PCa recurrence. Contrary to previous research, the investigators found no associations between recurrence and MetS or any number of its components, according to results published in Prostate Cancer and Prostatic Disease. Although the researchers could not confirm a link between hypertension and PCa recurrence, for example, “the role for hypertension merits further investigation,” they stated.

Having a high LDL cholesterol level was associated with 33% greater odds of disease recurrence. “Our findings of an association between elevated LDL and PCa recurrence support the concept that cholesterol interactions may have a role in the protective effects of statins noted by some researchers,” the investigators stated.

In addition, having an impaired fasting glucose level was linked to 54% greater odds of PCa recurrence. The cytotropic effects of glucose and insulin-mediated stimulation of cancer growth factors are among the possible mechanisms, according to the researchers.

In light of the specialized population and the results of previous studies, the investigators encourage further research.

The new findings differ from those of other recent studies. For example, in a study published recently in European Urology (2015;67:64-70), Bimal Bhindi, MD, of the University of Toronto, and colleagues found that men with MetS versus no component of MetS had 54% increased odds of a PCa diagnosis, 56% increased odds of clinically significant PCa, and 56% increased odds of intermediate- or high-grade PCa. The study included 2,235 men without a prior PCa diagnosis who underwent a prostate biopsy. 

1. Macleod, LC, et al. Prostate Cancer and Prostatic Disease; doi: 10.1038/pcan.2015.12.

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The switch from beds to recliners at the dialysis unit in Corner Brook has some patients complaining that the chairs are uncomfortable.

Western Health, meanwhile, is promising to do what it can to address any concerns.

Manuel Herritt of Lark Harbour said the new chairs are hard on his back and hips, and leaves him "sore all over" when his treatment is completed.

Herritt has been receiving dialysis — four hours per visit, three times a week — at Western Memorial Regional Hospital for the past eight years. 

Until recently, he was able to lie in bed as a machine purified his blood.

His wife, Kim, said the switch to recliners was a step backwards.

She has heard of other patients complaining about back pain as well.

"I seen a man come in 90-odd years old and sit for six hours because he refused to get in the chair because his back is so bad when he gets out," she said.

Recliners are used across the country

Some patients are OK with the recliners, but those who don't have no option, added Kim.

"They can't say no I won't do it, because they won't live to see the next day," she said.

The Herritts said special gel packs were promised, but never materialized.

They have brought their concerns to Health Minister Steve Kent.

The director of patient services at Western Health, Tara Freake, said the recliners are used across the country.

'We're open to all suggestions and feedback, and we'll continue to work with the patients and family to make this as comfortable and we can for them.'- Tara Freake, Western Health

However, she said patients in Corner Brook seem to be having more problems with the transition.

"We're open to all suggestions and feedback, and we'll continue to work with the patients and family to make this as comfortable and we can for them," Freake said.

The manufacturer has told Western Health that the recliners are stiff when they're new, but will get softer with use.

Freake said the recliners are safer because they can help patients recover quicker if there's a drop in blood pressure.

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