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DENVER & RIYADH, Saudi Arabia—DaVita Inc. announced today that it has acquired a controlling interest in Lehbi Care, a leading Riyadh-based kidney care company.

DaVita will actively manage the three Lehbi clinics in operation in Riyadh and is planning to expand home modality options and build a vascular access center.

“Saudi Arabia is an important market for DaVita in the Middle East,” said DaVita Chairman and CEO Kent Thiry. “We will continue to look for areas of solid, long-term growth that are a fit and close a gap in needed services.”

Lehbi Care currently treats 400 patients at three hemodialysis clinics throughout Riyadh. Patients will have greater access to treatment options and more effective care with a vascular access center and home hemodialysis and peritoneal dialysis.

“It has been exciting to develop a strong relationship with Dr. Allehbi and the nurses,” said Dennis Kogod, DaVita chief operating officer. “The collaboration between DaVita and Lehbi Care will be one where both sides gain and patients benefit.”

As a leading provider of kidney care services for those diagnosed with chronic kidney disease (CKD) in the United States, DaVita has achieved clinical outcomes that have improved year-over-year for more than a decade and will share that expertise through its active management of the company.

“To have DaVita as a partner and utilize their expertise is a gift to the Lehbi staff and patients,” said Dr. Ali Mohammed Allehbi, founder of Lehbi Care.

DaVita is a registered trademark of DaVita Inc. All other trademarks are the property of their respective owners.

About DaVita
DaVita Inc., a Fortune 500 company, is a leading provider of kidney care in the United States, delivering dialysis services to patients with chronic kidney failure and end stage renal disease. DaVita strives to improve patients’ quality of life by innovating clinical care, and by offering integrated treatment plans, personalized care teams and convenient health-management services. As of December 31, 2011, DaVita operated or provided administrative services at 1,809 dialysis facilities in the United States, serving approximately 142,000 patients. The company also operated 11 outpatient dialysis centers located in three countries outside the United States. DaVita supports numerous programs dedicated to creating positive, sustainable change in communities around the world. The company’s leadership development initiatives and social responsibility efforts have been recognized by Fortune, Modern Healthcare, Newsweek and WorldBlu. For more information, please visit www.davita.com.

Forward-Looking Statements
This release contains forward-looking statements within the meaning of the federal securities laws, including statements related to prospective near-term and long-term growth, development and strategy for certain of our international operations, expected patient benefits and projected clinical outcomes. Factors which could impact future results include the risks and uncertainties associated with expansion of our operations and services to markets outside the United States, local laws and regulations, general economic and other market conditions, competition, and the risk factors set forth in our SEC filings, including our Annual Report on Form 10-K for the year ended December 31, 2011. The forward-looking statements should be considered in light of these risks and uncertainties. We base our forward-looking statements on information currently available to us at the time of this release, and we undertake no obligation to update or revise any forward-looking statements, whether as a result of changes in underlying factors, new information, future events or otherwise.

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Johannesburg - People suffering from kidney failure can now receive dialysis treatment at night, private service provider National Renal Care (NRC) said on Thursday.

"Going for haemodialysis at night frees patients up during the day, allowing them to be more productive, working, attending school or university and sharing in family activities," said NRC CEO Noeleen Phillipson.

While haemodialysis is usually done over a four-hour period, overnight dialysis is performed over a period of eight hours.

This allows for a slower blood and dialysate flow rate, which tends to have a less severe effect on the vascular system. Patients reported feeling stronger and less tired.

"Another important advantage of the overnight procedure is that it usually removes more toxins and fluids from the blood than the traditional form of therapy," said Phillipson.

She said a study published in the Journal of Nephrology indicated that those undergoing the treatment had an improved survival rate.

Research had also shown a reduction in medication usage.

The overnight option was offered at centres in Greenacres, Port Elizabeth, Netcare Sunninghill Hospital in Johannesburg and at Netcare Umhlanga Hospital in KwaZulu-Natal.

A fourth facility would be available at Netcare Garden City Hospital in Mayfair West, Johannesburg towards the end of the year.

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A man aged 69 years has coronary artery disease, type 2 diabetes, hypertension, multiple myeloma and end-stage renal disease. He started dialysis last year and did very well. About three months after starting dialysis, he complained of painful nipples bilaterally (especially the right nipple).

The pain eventually spread to the entire breast. A mammogram and ultrasound showed tissue growing in both breasts and a mass in the right. The patient was referred to a breast surgeon and an endocrinologist. Is there any association between gynecomastia and hemodialysis. — Eileen Scarinci, DNP, APN ACRN, Scotch Plains, N.J.

Gynecomastia is extremely common in dialysis patients. In one study, almost 50% of the patients on hemodialysis had gynecomastia (J Nephrol. 2012;25:31-42). The cause is multifactorial.

Leydig-cell dysfunction will cause disruption of the pituitary-testicular axis in men (N Engl J Med. 1977;296:1245-1249). Certain medications commonly used in renal patients can also cause gynecomastia, including spironolactone (Aldactone), cimetidine (Tagamet), amiodarone (Cordarone, Pacerone), omeprazole (Losec, Omesec, Prilosec), cyclosporine (Gengraf, Neoral, Sandimmune, Sangcya), ACE inhibitors and angiotensin receptor blockers, calcium channel blockers and highly active antiretroviral therapy. Discontinuation of the offending medication will often reverse the breast enlargement.

The third factor causing gynecomastia in dialysis patients is high serum prolactin levels (Greenberg A. Primer on Kidney Diseases, 5th ed. Philadelphia, Pa.: Saunders Elsivier; 2009:515). The mechanism for the hyperprolactinemia is a decrease in the metabolic clearance of prolactin along with a three-fold increase in production, which can mean a prolactin level six times higher than normal in your standard dialysis patient. These prolactin levels will drop to normal after renal transplant.

When presented with gynecomastia in a dialysis patient, adjust any offending medications, and order a CT scan to rule out a pituitary tumor and a mammogram to rule out breast cancer before referral to endocrinology and/or surgery. — Kim Zuber, PA-C, Chair National Kidney Foundation Council of Advanced Practitioners, Alexandria, Va. (162-4)

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