"The procedure involves putting a catheter inside the renal arteries and giving short currents to burn off sympathetic nerve terminals outside the arteries at multiple places. It has no side effects and reduces blood pressure over a few months. It has been used in the west and we are thinking of starting soon," said Dr Akshay Mehta, consultant cardiologist at Nanavati Hospital. The procedure needs approval from the Indian Food and Drug Administration and hospitals also need to procure the machines, he said.

"It started recently and we are waiting for it to stabilise. But one must examine all the secondary causes and try to change medication timings before terming HBP as resistant hypertension," said Dr Rawat.

Although this procedure is meant for relatively uncommon type of hypertension, doctors are using different methods to monitor blood pressure among people, like self-examination and ambulatory methods.

Doctors are also adopting diagnosis through ambulatory blood pressure, which involves periodic monitoring of BP for 24 hours. "Sometimes people show high blood pressure at clinics because of anxiety. That may lead to inaccurate diagnosis. Either they could check at home or do an ambulatory check-up so that exact pattern is documented," said Dr Mehta. "Through this we can observe how BP behaves in natural settings, day and night." Ambulatory care is a type of medical care which is provided to patients who do not need to be admitted to a hospital for treatment.

Patients, who may have episodic (at certain times in the day, say during office hours), borderline (when the BP is not very high but could still lead to complications) hypertension, can benefit by his method, doctors said.

"Now there are machines to check blood pressure at home, ambulatory check, better drugs and technologies such as renal denervation for extreme cases. But what works is weight loss, reduction in salt and alcohol intake, and daily exercises such as walking and swimming," said Dr Brian Lobo, consultant cardiologist at Holy Family Hospital.

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Damaged blood vesselsare about as fun as they sound, and they tend to come part in parcel with other problems. Dialysis patients for example, who already have problems with their kidneys, get hit with the double whammy that dialysis is pretty rough on the blood vessels in the arm. Granted, the benefit is greater than the cost, but doing damage is never good. One possible solution to the problem would be replacing the damaged blood vessels with fresh, new ones. But how do you get those? If current research pays off, you get them by weaving them out of strips of artificially-grown human flesh. It’s as awesome as it is gory.

Cytograft has been working on this pursuit for a while, and they’ve made some pretty big advances. We’re still a far cry from widespread blood vessel transplants, but we’re headed in that direction. Originally, the idea was to take huge sheets of what is essentially lab-grown flesh and roll it into tubes. The problem that presented itself there was that the tubes needed to be fused shut somehow, to prevent leakage. The solution to this problem, it seems, is to take a whole different approach entirely and slice those sheets of flesh into strands, and then robotically weave dozens of these strands into a tube by wrapping them around a spindle. For science.

So far, Cytograft is doing pre-clinical testing in dogs and have found that the artifical vessels are quite robust and free of leaks. To boot, they typically aren’t rejected by the recipient since the woven tubes are made of cellular material but not the actual donor cells. Thanks to that, the implanted vessels generally aren’t seen as a threat by the patient’s nervous system.

The hope for the future is that this process can be perfected to the extent where hospitals could conceivably have “spare blood vessels” on hand somewhere. So far, Cytograft’s product is proving to be effective with no need to be personalized for the recipient in any way; these fake vessels would work just as well for me as they would for you. The main challenge now, aside from clinical testing, is coming up with a better way to grow the flesh, preferably into fibers that could be used right away. Somewhere, someone is thinking really, really hard about the best way to grow flesh. Though I guess if it’s for the good of sick people everywhere, maybe that’s okay.

(Technology Review via Discover)

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ST. JOHN'S, NEWFOUNDLAND—Recent study findings add to mounting evidence of the deleterious consequences of early dialysis initiation, prompting researchers to question this approach, especially among older patients.

Investigators documented a doubling of the withdrawal rate from 1.5 to 3.0 per 100 patient-years of dialysis in the Canadian Organ Replacement Registry (CORR) from 2001 and 2009. Each 10-year increase in age was associated with an 84% greater likelihood of withdrawal, and early-start dialysis is associated with a 15% greater probability of withdrawal than late starts. Meanwhile, the researchers observed a sharp rise in the proportion of deaths due to withdrawal among deceased dialysis patients, from 7.9% in 2001 to 19.5% in 2009.

“More and more patients are starting dialysis early, especially elderly patients, with higher residual renal function, and then a lot of them go on to just withdraw,” said Amanda Ellwood, MD, who led the study while she was completing her nephrology fellowship at the University of Western Ontario in London. “So the question is, should we be starting them on dialysis or should we be considering another approach, such as multidisciplinary conservative management?”

Working under Louise Moist, MD, Associate Professor of Nephrology at the university, and in conjunction with other researchers, Dr. Ellwood examined CORR data from 2001-2009. They focused on patients who started dialysis in that period.

 The 3,339 patients who withdrew from dialysis and the 42,842 who did not had divergent demographic and medical characteristics. For example, the mean age of those who stopped dialysis was 73.2 years compared with 63 years for those who remained on dialysis, with 51.5% and 26.9% of the two groups, respectively, aged 75 or older. Furthermore, 39.8% of the withdrawal subjects had early dialysis initiation compared with 34.4% in the no-withdrawal group. The only statistically significant similarities between the two groups were their rates of hypertension and diabetes, at about 80% and 45%, respectively.

Overall, the median time to withdrawal was 15.9 months and 15.6 months for patients aged 75 and older and those with early-start dialysis, respectively. The respective median times for patients with late-start dialysis and those younger than 75 years were 20.2 and 21.6 months.

Dr. Ellwood's group also found that factors most significantly associated with withdrawal were increased age, early versus late dialysis initiation, late versus early referral to a nephrologist, initiating dialysis from 2006-2009 rather than 2001-2005, and starting dialysis in Nova Scotia (compared with Ontario, the reference province).

Factors associated with not withdrawing from dialysis were being male, being black or native Indian rather than white, and starting dialysis in Alberta, British Columbia, or New Brunswick.

Dr. Ellwood presented these results at the 2012 annual meeting of the Canadian Society of Nephrologists. One of the audience members asked whether the results with respect to early initiation could have been confounded by the emaciated state—and hence falsely low creatinine levels—among many patients with end-stage renal disease. Dr. Elwood agreed that this may have been a confounding factor and that they were not able to correct for this in their analysis because virtually all methods for calculating glomerular filtration rate include creatinine levels.

She added that two other limitations were that CORR is a voluntary database and under-or over-reporting may affect results, and that dates of death were not available for approximately 25% of the patients in the analysis.

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