Even though the great majority of kidney patients choose to visit a dialysis center three a week for dialysis, more doctors today are recommending home dialysis for eligible patients.

If you are interested in home dialysis, here’s what you need to know. With home dialysis, you have two options:

1. Filtering your own blood. Hemodialysis requires the removal, filtering and return of blood to your body. Patients also can do this process at home, says nephrologist Sheru Kansal, MD. “Generally, they can do what we call ‘short daily,’ which is hemodialysis five to six times a week, but for shorter sessions than they generally do at the center,” Dr. Kansal says. Patients also can do overnight dialysis, anywhere from every other day to five days a week. Dr. Kansal says patient training for hemodialysis usually takes about a month at a dialysis center. Patients learn how to do the home procedure, including how to insert the needles themselves.
2. Using clean fluid to absorb toxins. With a process called peritoneal dialysis, you place clean fluid in the abdomen and let that fluid sit and absorb toxins from the blood. Then, you drain the fluid away. “We teach patients how to do it, and they do that process at home several times a day,” Dr. Kansal says. “That’s how they get their dialysis.” The training usually takes between three and five days. Once the process is underway, patients see their doctor once a month to review how they are doing and check their blood pressure, blood work and so on.

What the studies say about home dialysis

Dr. Kansal says a significant amount of observational evidence and one randomized control trial suggest that hemodialysis done more than three times a week is better for the patient’s survival.

As to whether peritoneal dialysis is superior to standard hemodialysis 3X/week, the results are inconclusive.

“There are some studies that indicate that it’s worse, while some studies show that it’s better,” Dr. Kansal says. “Most of the recent studies suggest that peritoneal dialysis is superior to standard hemodialysis, but I generally tell patients it’s about the same as three-times-a-week hemodialysis, assuming the patient does not have to start with an IV.”

Caveats involving both types of home dialysis

Patients new to the three-times-a-week hemodialysis would ideally start with a fistula, or a connection between an artery and a vein, which is created in the arm through a minor surgical procedure. This allows access to the blood without the use of synthetic material, but it takes time to develop.

In situations where patients with kidney disease have not had this placed in advance of needing dialysis, an IV is needed to get access to the blood stream. These IVs are associated with infections, recurrent hospitalizations, and death. Unfortunately, almost 80 percent of patients that start dialysis in the U.S. start with an IV.

“We can’t repeatedly stick a needle into an artery, and a vein is too small,” Dr. Kansal says. “So the connection between the artery and vein strengthens the vein, and after a while, that connection matures, so we can repeatedly insert needles into that vein without problems to gain access to the patient’s bloodstream.”

If you compare to peritoneal dialysis, which does not involve an IV, there are other risks to consider. Peritoneal dialysis involves sugar exposure. The fluid placed in your abdomen contains sugar to draw out salt and water, and patients can absorb some of that sugar. This can lead to other problems for some patients. Overall, the risks associated with an IV for hemodialysis far outweigh any possible risk associated with peritoneal dialysis

In weighing these risks, it’s important to talk to your doctor. He or she will be able to consider your individual health history in making recommendations about whether you are a good candidate for at-home dialysis, and if so, what type is the most appropriate.

Advantages of home dialysis

The most obvious benefit of home dialysis is being at home, which is much more comfortable and relaxing than a dialysis center. It also reduces the typical post-dialysis symptoms that result from having fluid removed and returned to your body.

“People often feel pretty badly after dialysis,” Dr. Kansal says. “So, when they’re doing a little bit less dialysis more frequently, you don’t feel as bad.”

Why you need support

While home dialysis is very safe, the thought of doing it yourself or with someone’s help at home can be intimidating. When it comes to the overall safety of in-home dialysis versus the use of a dialysis center, experts say the overall risks are similar but it’s important to have support.

“There’s not a lot of evidence that patients are at an increased risk of complications any more than in the in-center unit,” Dr. Kansal says. However, you should always have someone available, in case you do need help.

...

Even though the great majority of kidney patients choose to visit a dialysis center three a week for dialysis, more doctors today are recommending home dialysis for eligible patients.

If you are interested in home dialysis, here’s what you need to know. With home dialysis, you have two options:

1. Filtering your own blood. Hemodialysis requires the removal, filtering and return of blood to your body. Patients also can do this process at home, says nephrologist Sheru Kansal, MD. “Generally, they can do what we call ‘short daily,’ which is hemodialysis five to six times a week, but for shorter sessions than they generally do at the center,” Dr. Kansal says. Patients also can do overnight dialysis, anywhere from every other day to five days a week. Dr. Kansal says patient training for hemodialysis usually takes about a month at a dialysis center. Patients learn how to do the home procedure, including how to insert the needles themselves.
2. Using clean fluid to absorb toxins. With a process called peritoneal dialysis, you place clean fluid in the abdomen and let that fluid sit and absorb toxins from the blood. Then, you drain the fluid away. “We teach patients how to do it, and they do that process at home several times a day,” Dr. Kansal says. “That’s how they get their dialysis.” The training usually takes between three and five days. Once the process is underway, patients see their doctor once a month to review how they are doing and check their blood pressure, blood work and so on.

What the studies say about home dialysis

Dr. Kansal says a significant amount of observational evidence and one randomized control trial suggest that hemodialysis done more than three times a week is better for the patient’s survival.

As to whether peritoneal dialysis is superior to standard hemodialysis 3X/week, the results are inconclusive.

“There are some studies that indicate that it’s worse, while some studies show that it’s better,” Dr. Kansal says. “Most of the recent studies suggest that peritoneal dialysis is superior to standard hemodialysis, but I generally tell patients it’s about the same as three-times-a-week hemodialysis, assuming the patient does not have to start with an IV.”

Caveats involving both types of home dialysis

Patients new to the three-times-a-week hemodialysis would ideally start with a fistula, or a connection between an artery and a vein, which is created in the arm through a minor surgical procedure. This allows access to the blood without the use of synthetic material, but it takes time to develop.

In situations where patients with kidney disease have not had this placed in advance of needing dialysis, an IV is needed to get access to the blood stream. These IVs are associated with infections, recurrent hospitalizations, and death. Unfortunately, almost 80 percent of patients that start dialysis in the U.S. start with an IV.

“We can’t repeatedly stick a needle into an artery, and a vein is too small,” Dr. Kansal says. “So the connection between the artery and vein strengthens the vein, and after a while, that connection matures, so we can repeatedly insert needles into that vein without problems to gain access to the patient’s bloodstream.”

If you compare to peritoneal dialysis, which does not involve an IV, there are other risks to consider. Peritoneal dialysis involves sugar exposure. The fluid placed in your abdomen contains sugar to draw out salt and water, and patients can absorb some of that sugar. This can lead to other problems for some patients. Overall, the risks associated with an IV for hemodialysis far outweigh any possible risk associated with peritoneal dialysis

In weighing these risks, it’s important to talk to your doctor. He or she will be able to consider your individual health history in making recommendations about whether you are a good candidate for at-home dialysis, and if so, what type is the most appropriate.

Advantages of home dialysis

The most obvious benefit of home dialysis is being at home, which is much more comfortable and relaxing than a dialysis center. It also reduces the typical post-dialysis symptoms that result from having fluid removed and returned to your body.

“People often feel pretty badly after dialysis,” Dr. Kansal says. “So, when they’re doing a little bit less dialysis more frequently, you don’t feel as bad.”

Why you need support

While home dialysis is very safe, the thought of doing it yourself or with someone’s help at home can be intimidating. When it comes to the overall safety of in-home dialysis versus the use of a dialysis center, experts say the overall risks are similar but it’s important to have support.

“There’s not a lot of evidence that patients are at an increased risk of complications any more than in the in-center unit,” Dr. Kansal says. However, you should always have someone available, in case you do need help.

...

July 15th, 2015 Radiant Insights, Inc

Global Markets Direct’s, ‘Metastatic Renal Cell Carcinoma – Pipeline Review, H2 2014?, provides an overview of the Metastatic Renal Cell Carcinoma’s therapeutic pipeline.

This report provides comprehensive information on the therapeutic development for Metastatic Renal Cell Carcinoma, complete with comparative analysis at various stages, therapeutics assessment by drug target, mechanism of action (MoA), route of administration (RoA) and molecule type, along with latest updates, and featured news and press releases. It also reviews key players involved in the therapeutic development for Metastatic Renal Cell Carcinoma and special features on late-stage and discontinued projects.

Access Full Report With TOC @ www.radiantinsights.com/research/metastatic-renal-cell-carcinoma-pipeline-review-h2-2014

Global Markets Direct’s report features investigational drugs from across globe covering over 20 therapy areas and nearly 3,000 indications. The report is built using data and information sourced from Global Markets Direct’s proprietary databases, Company/University websites, SEC filings, investor presentations and featured press releases from company/university sites and industry-specific third party sources, put together by Global Markets Direct’s team. Drug profiles/records featured in the report undergoes periodic updation following a stringent set of processes that ensures that all the profiles are updated with the latest set of information. Additionally, processes including live news & deals tracking, browser based alert-box and clinical trials registries tracking ensure that the most recent developments are captured on a real time basis.

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The report enhances decision making capabilities and help to create effective counter strategies to gain competitive advantage. It strengthens R&D pipelines by identifying new targets and MOAs to produce first-in-class and best-in-class products.

Note*: Certain sections in the report may be removed or altered based on the availability and relevance of data for the indicated disease.

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Approximately 50 years ago, kidney failure was virtually a death sentence.

Fortunately, in 1972, Congress had the foresight and compassion to create the Medicare end-stage renal disease (ESRD) benefit. In doing so, Congress ensured that regardless of age or income, any American would have access to life-saving dialysis care. That, along with kidney transplant advances and technology, was the turning point in kidney care, giving patients hope and life.

ADVERTISEMENTToday in the U.S., more than 636,000 Americans suffer from ESRD, and 430,000 are on dialysis, a number that is expected to double over the next decade. Nearly 100,000 of these individuals are on a kidney transplant waiting list, which takes years on average for those who are even able to obtain one. 

And while we’ve made measurable improvements in both kidney care and disease awareness, the toll of kidney disease is vast and constantly growing. It is also expensive, costing patients and taxpayers billions of dollars each year and — even more significant — impacting millions of lives. For that reason, we have now introduced legislation that can make a difference in the lives of millions and impact many, many more.

The Chronic Kidney Disease Improvement in Research and Treatment Act, H.R. 1130, would empower physicians and nephrologists to build upon the quality improvements in kidney care both now and in the future — all while crafting a more cost-effective health delivery system. 

First, the bill would make kidney care more efficient by focusing on existing resources together with common-sense Medicare policy changes, emphasizing coordinated care and allowing kidney patients greater choice and access. 

Coordinated care is an effective approach to medicine that facilitates communication among specialists treating the same patient, often across numerous care settings. Expanding such a system would prove vital for individuals with kidney disease, especially for those living with several co-morbidities, such as diabetes and hypertension, which complicate care and impact health outcomes. H.R. 1130 would incentivize nephrologists and dialysis providers to further develop innovative coordinated care organizations that better serve patients.

In addition, to ensure the benefits of coordinated care, we must allow Americans with ESRD access to Medicare Advantage plans. Currently, dialysis patients on Medicare are not given the choice of enrolling in Advantage plans, which can provide broader coverage at lower patient cost. The bill would eliminate the antiquated — and truly senseless — restriction.

The legislation also would bolster biomedical research and fortify efforts to better treat, avoid and possibly even cure kidney disease and ESRD. The bill advances these goals by requiring an assessment of federal funding for chronic kidney disease research and identifying gaps in current research efforts. The bill also requires a strategic plan to better coordinate research efforts among multiple federal agencies. Finally, the legislation establishes an in-depth research study to better understand the disproportionate effect of kidney disease on minority populations. 

Through these three measures, kidney research would be set on a path to truly make a difference without levying an undue burden on taxpayers.

The bill also opens up additional pathways to enhanced kidney care. For instance, it explores largely untapped options for underserved dialysis patients by increasing access to health professionals through telemedicine and also facilitates greater economic stability among providers treating patients with chronic kidney disease, securing future investment and making innovations in kidney care. 

Ultimately, as far as investments go, there is nothing smarter than supporting better health. Each provision in H.R. 1130 bolsters efficiency and access to care, which will reduce both federal and individual spending on kidney care. Most importantly, though, the legislation delivers hope to millions of Americans suffering from kidney disease and many more to come. 

Marino has represented Pennsylvania’s 10th Congressional District since 2011. He sits on the Foreign Affairs, the Homeland Security, and the Judiciary committees.

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