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Is anatomic complexity associated with renal tumor growth kinetics under ... - UroToday
image

INTRODUCTION: Linear growth rate (LGR) is the most commonly employed trigger for definitive intervention in patients with renal masses managed with an initial period of active surveillance (AS).

Using our institutional cohort, we explored the association between tumor anatomic complexity at presentation and LGR in patients managed with AS.

METHODS AND MATERIALS: Enhancing renal masses managed expectantly for at least 6 months were included for analysis. The association between Nephrometry Score and LGR was assessed using generalized estimating equations, adjusting for the age, Charlson score, race, sex, and initial tumor size.

RESULTS: Overall, 346 patients (401 masses) met the inclusion criteria (18% ?cT1b), with a median follow-up of 37 months (range: 6-169). Of these, 44% patients showed progression to definitive intervention with a median duration of 27 months (range: 6-130). On comparing patients managed expectantly to those requiring intervention, no difference was seen in median tumor size at presentation (2.2 vs. 2.2cm), whereas significant differences in median age (74 vs. 65y, P< 0.001), Charlson comorbidity score (3 vs. 2, P< 0.001), and average LGR (0.23 vs. 0.49cm/y, P< 0.001) were observed between groups. Following adjustment, for each 1-point increase in Nephrometry Score sum, the average tumor LGR increased by 0.037cm/y (P = 0.002). Of the entire cohort, 6 patients (1.7%) showed progression to metastatic disease.

CONCLUSIONS: The demonstrated association between anatomic tumor complexity at presentation and renal masses of LGR of clinical stage 1 under AS may afford a clinically useful cue to tailor individual patient radiographic surveillance schedules and warrants further evaluation.

Written by:
Mehrazin R, Smaldone MC, Egleston B, Tomaszewski JJ, Concodora CW, Ito TK, Abbosh PH, Chen DY, Kutikov A, Uzzo RG.   Are you the author?
Department of Urology & Oncological Science, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Surgical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA; Biostatistics & Bioinformatics Facility, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA; Department of Surgery, MD Anderson Cancer Center at Cooper, Rowan, University School of Medicine, Camden, NJ; Department of Surgical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA.  This email address is being protected from spambots. You need JavaScript enabled to view it.

Reference: Urol Oncol. 2015 Apr;33(4):167.e7-167.e12.
doi: 10.1016/j.urolonc.2015.01.013


PubMed Abstract
PMID: 25778696

UroToday.com Renal Cancer Section

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Making the dialysis decision: What you need to know - Statesboro Herald
Hundreds of thousands of Americans with kidney failure undergo dialysis treatments to keep them alive. While their reasons for needing the treatment can vary widely, many patients with kidney failure ultimately face the same dialysis decision.

Here's what you need to know:

What is dialysis?

When your kidneys fail, your body cannot filter toxins, regulate body fluids, or sustain electrolyte balance vital to survival. Dialysis takes the place of kidney function by cleaning a person's blood.

The first successful dialysis machine, or “artificial kidney,” was invented in 1945 by Willem Johan Kolff, then a doctoral student at the University of Groningen in Holland. Today, about 450,000 Americans are on dialysis, according to the National Kidney Foundation.

Dialysis is used as a bridge to kidney transplant, in recovery from acute kidney failure, or for an end-of-life, life-sustaining purpose. In general, life expectancy after starting dialysis is five years.

Who gets dialysis treatment?

The No. 1 reason a person needs dialysis treatment is kidney failure due to diabetes. The disease is responsible for 44 percent of all dialysis patients’ kidney failure, according to the U.S. Renal Data System's 2013 Annual Data Report.

The report names the second-largest group of dialysis patients, at 28 percent, as people with kidney failure due to high blood pressure. Other conditions often leading to dialysis treatment are glomerulonephritis, polycystic disease, kidney inflammation, genetics, auto-immune disease, drug use, etc.

Signs and symptoms of kidney failure are often hard to pinpoint because they mimic multiple other medical conditions. For early detection, lab testing should be part of your yearly physical. By analyzing a person's blood urea nitrogen and creatinine levels, a doctor will be able to determine the level of kidney function.

Patients who have lost more than 75 percent of their kidney function are often referred for dialysis treatment. The worse your kidney function is, the more complications you will have.

The decision to undergo dialysis treatments is the first and most important discussion you will have to make with your health care provider, and you should understand doing so will complicate any other medical problems you have.

Realities of dialysis treatment

It’s important to note dialysis is not a cure for kidney failure. Dialysis is a life-support treatment — without functioning kidneys you cannot live.

Once the decision is made to move forward with dialysis, there are two types of treatments you can use: hemodialysis and peritoneal dialysis.

Hemodialysis is when an external machine attaches directly to your body through the blood stream. This is done at least three times a week at a dialysis facility, with the treatments usually lasting three to five hours, a WebMD article comparing the two types of dialysis explains.

Peritoneal dialysis is done at home but is more labor intensive. This type of dialysis "uses the lining of your belly, which is called the peritoneal membrane, to filter your blood," the WebMD article explains. A catheter is surgically implanted in your stomach, which becomes the access point for your daily "exchanges." These exchanges are done four to six times a day.

Dialysis treatments are very hard on the body and its organs. Complications from dialysis vary and are different for every patient.

Some complications include:

  • Chronic anemia
  • Life-threatening electrolyte imbalance
  • Uremic syndrome (causing nausea, vomiting and frequent sleep disturbances)
  • Heart disease
  • Bone disease
  • Fluid regulation problems
  • Need for a multiple-medication regime
The younger you are when you undergo dialysis, the better your options and results are. No one over the age of 65 years old is eligible for transplant, and any dialysis patient over the age of 70 has a higher risk of death because of the treatments and frequent complications.

My mother died from kidney failure at the age of 70. She was on home dialysis prior to her death, and watching her go through her illness and multiple dialysis treatments each day was horrendous. It is something I would not wish on anyone.

When considering dialysis, please realize you are making a lifelong choice that will impact many people and change your level of independence.

Jordan Ormond contributed to this story.

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Making the dialysis decision: What you need to know - The Herald-Times (subscription)

Hundreds of thousands of Americans with kidney failure undergo dialysis treatments to keep them alive. While their reasons for needing the treatment can vary widely, many patients with kidney failure ultimately face the same dialysis decision.

Here's what you need to know:

What is dialysis?

When your kidneys fail, your body cannot filter toxins, regulate body fluids, or sustain electrolyte balance vital to survival. Dialysis takes the place of kidney function by cleaning a person's blood.

The first successful dialysis machine, or “artificial kidney,” was invented in 1945 by Willem Johan Kolff, then a doctoral student at the University of Groningen in Holland. Today, about 450,000 Americans are on dialysis, according to the National Kidney Foundation.

Dialysis is used as a bridge to kidney transplant, in recovery from acute kidney failure, or for an end-of-life, life-sustaining purpose. In general, life expectancy after starting dialysis is five years.

Who gets dialysis treatment?

The No. 1 reason a person needs dialysis treatment is kidney failure due to diabetes. The disease is responsible for 44 percent of all dialysis patients’ kidney failure, according to the U.S. Renal Data System's 2013 Annual Data Report.

The report names the second-largest group of dialysis patients, at 28 percent, as people with kidney failure due to high blood pressure. Other conditions often leading to dialysis treatment are glomerulonephritis, polycystic disease, kidney inflammation, genetics, auto-immune disease, drug use, etc.

Signs and symptoms of kidney failure are often hard to pinpoint because they mimic multiple other medical conditions. For early detection, lab testing should be part of your yearly physical. By analyzing a person's blood urea nitrogen and creatinine levels, a doctor will be able to determine the level of kidney function.

Patients who have lost more than 75 percent of their kidney function are often referred for dialysis treatment. The worse your kidney function is, the more complications you will have.

The decision to undergo dialysis treatments is the first and most important discussion you will have to make with your health care provider, and you should understand doing so will complicate any other medical problems you have.

Realities of dialysis treatment

It’s important to note dialysis is not a cure for kidney failure. Dialysis is a life-support treatment — without functioning kidneys you cannot live.

Once the decision is made to move forward with dialysis, there are two types of treatments you can use: hemodialysis and peritoneal dialysis.

Hemodialysis is when an external machine attaches directly to your body through the blood stream. This is done at least three times a week at a dialysis facility, with the treatments usually lasting three to five hours, a WebMD article comparing the two types of dialysis explains.

Peritoneal dialysis is done at home but is more labor intensive. This type of dialysis "uses the lining of your belly, which is called the peritoneal membrane, to filter your blood," the WebMD article explains. A catheter is surgically implanted in your stomach, which becomes the access point for your daily "exchanges." These exchanges are done four to six times a day.

Dialysis treatments are very hard on the body and its organs. Complications from dialysis vary and are different for every patient.

Some complications include:

  • Chronic anemia
  • Life-threatening electrolyte imbalance
  • Uremic syndrome (causing nausea, vomiting and frequent sleep disturbances)
  • Heart disease
  • Bone disease
  • Fluid regulation problems
  • Need for a multiple-medication regime

The younger you are when you undergo dialysis, the better your options and results are. No one over the age of 65 years old is eligible for transplant, and any dialysis patient over the age of 70 has a higher risk of death because of the treatments and frequent complications.

My mother died from kidney failure at the age of 70. She was on home dialysis prior to her death, and watching her go through her illness and multiple dialysis treatments each day was horrendous. It is something I would not wish on anyone.

When considering dialysis, please realize you are making a lifelong choice that will impact many people and change your level of independence.

Jordan Ormond contributed to this story.

image Suzanne Carlile, KSL

Suzanne Carlile, "Nurse Suzy," has been a nurse since 1982. Her main focus is critical care and nursing education. She holds a master's degree in nursing, is a Certified Emergency Nurse, and a member of NNSDO Intermountain West Chapter.

image

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Invokana Lawsuits for Renal Failure And Ketoacidosis Being Explored - Legal Examiner

Potential lawsuits are currently being considered regarding individuals who have experienced kidney or renal failure as the result of taking Invokana*, a new generation diabetes drug that has been linked to renal damage and other kidney problems.

What is Invokana?

InvokanaInvokana is part of a new class of type 2 diabetes drugs known as sodium-glucose-cotransporter-2 (SGLT2) inhibitors, along with Invokamet, Farixga, Jardiance, Glyxambi, and Xigduo. If left untreated, type 2 diabetes can lead to serious problems, including blindness, nerve and kidney damage, and heart disease.

SGLT2 inhibitors help control diabetes by blocking reabsorption of glucose by the kidneys, impacting normal kidney function and allowing more sugar to be passed from the body through urine. Common side effects of Invokana include vaginal yeast and urinary tract infections according to reports.

Invokana Concerns

In May 2015, a report by the Institute of Safe Medication Practices (ISMP) discussed potential concerns regarding a potential link between Invokana and kidney damageafter reviewing adverse event reports submitted to the FDA during the drug’s first year on the market after its approval in 2013. The group identified more than 457 incidents that implied signs of renal toxicity, including:

  • Kidney failure
  • Impaired renal function
  • Kidney stones
  • Dehydration
  • Urinary tract infection
  • Hypersensitivity

That same month, the FDA warned that SGLT2 inhibitor use might lead to ketoacidosis, a serious condition in which the body produces high levels of blood acids known as ketones that may require a patient to be hospitalized. According to the FDA:

The U.S. Food and Drug Administration (FDA) is warning that the type 2 diabetes medicines canagliflozin, dapagliflozin, and empagliflozin may lead to ketoacidosis, a serious condition where the body produces high levels of blood acids called ketones that may require hospitalization. We are continuing to investigate this safety issue and will determine whether changes are needed in the prescribing information for this class of drugs, called sodium-glucose cotransporter-2 (SGLT2) inhibitors.

Patients should pay close attention for any signs of ketoacidosis and seek medical attention immediately if they experience symptoms such as difficulty breathing, nausea, vomiting, abdominal pain, confusion, and unusual fatigue or sleepiness. Do not stop or change your diabetes medicines without first talking to your prescriber. Health care professionals should evaluate for the presence of acidosis, including ketoacidosis, in patients experiencing these signs or symptoms; discontinue SGLT2 inhibitors if acidosis is confirmed; and take appropriate measures to correct the acidosis and monitor sugar levels.

Considering the severe implications of ketoacidosis and renal failure, those pursuing SGLT2 side effects lawsuits may demand damages for:

  • Medical expenses
  • Lost wages
  • Diminished earning capacity
  • Pain and suffering
  • Emotional distress
  • Rehabilitation costs
  • Funeral expenses

Plaintiffs may also decide to pursue punitive damages against Janssen Pharmaceuticals, the manufacturers of Invokana, to hold them accountable for their alleged negligence and to further help to prevent future misconduct that may have occurred. The investigations of Invokana are ongoing at this time.

*Invokana is a registered product of Janssen Pharmaceuticals and their other related corporate entities. Their interests are adverse to ours as a law firm representing patients suffering from potentially related injuries.

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Peritoneal Dialysis Market Segment Forecasts up to 2022, Research Reports ... - Medgadget.com (blog)
Medical_Devices18

Dialysis refers to the process of cleaning the blood in case of kidney failure or improper functioning of kidneys. There are two types of dialysis; hemodialysis and peritoneal dialysis. Hemodialysis involves pumping out of the blood to an artificial kidney system and is returned back to the body with the help of tubing accessories. Peritoneal dialysis involves the cleansing of blood along with removal of extra fluids by utilizing body’s natural filter, the peritoneal membrane. Peritoneal membrane is the lining that surrounds the abdominal cavity comprising spleen, stomach, liver and intestines.

Browse Full Report with TOC @ http://www.transparencymarketresearch.com/peritoneal-dialysis-market.html

The solution or dialysate is placed in the peritoneum and the membrane filters fluids and waste from the blood into the solution which is then drained from the peritoneum after several hours and is again substituted with fresh dialysate. Peritoneal dialysis renders a lot of advantages or benefits such as minimal clinic visits (once in a month), no use of needles, supplies continuous therapy similar to natural functioning of kidney. The therapy is easy to perform even while travelling and sleeping thereby avoiding frequent visits to the dialysis center. On the other hand, peritoneal dialysis possesses some disadvantages such as need for the placement of a permanent catheter and imposing risk of infection. This type of dialysis is one of the great treatment modalities available for the patients interested to perform the dialysis at home.

Currently, it is perceived that the rate of peritoneal dialysis is declining worldwide. However substantial evidence is rarely available in the public domain. Assessment of longitudinal trends in the use of peritoneal dialysis was published in the Journal of the American Society of Nephrology (JASN). The study was focused on assessing the global trends of peritoneal dialysis from 1997 to 2008 spread across 130 countries. As per this data, around 59% patients were treated with peritoneal dialysis in developing countries and around 41% were treated in developed countries. Over the period of 12 years, the number of peritoneal patients increased in developed countries (by 21.8 per million population) and developing countries (by 24.9 patients per million).

The market for peritoneal dialysis can be segmented on the basis of the type of products, services and application. Peritoneal dialysis catheters, implantation systems, peritoneal solution and other accessories constitute some of the products used in the dialysis process. Services include homecare services and education about the peritoneal dialysis process. Application segment can be further analyzed by two types namely, automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). Geographically, North America and Europe would account for the major revenue contributors due to increased awareness and high accessibility to the products and services in these regions. On the contrary, Asia Pacific and Rest of the World (RoW) promise lucrative opportunities for the market growth due to large patient population base and unmet healthcare needs. Regulatory policies elucidating the safety and precautionary measures to reduce the risk of infection would govern the market growth.

The major factors favoring the market growth are increasing number of patients suffering from chronic ailments such as diabetes and hypertension which would result in kidney failure and inturn increase the demand for peritoneal dialysis. For instance, as per the data enumerated by the International Diabetes Federation (IDF) and World Heart Federation (WHF), there are more than 300 million diabetics and more than 900 million people suffering from elevated blood pressure. In addition, increasing prevalence of renal diseases would further propel the market growth. On the other hand, factors such as risk of infection and permanent placement of catheter outside the body might hamper the market growth. Baxter International, B. Braun Melsungen AG, Fresenius Medical Care, Diversified Specialty Institute Holdings and DaVita Healthcare Partners are some of the key players operating in this market.

This research report analyzes this market on the basis of its market segments, major geographies, and current market trends. This report provides comprehensive analysis of

  • Market growth drivers
  • Factors limiting market growth
  • Current market trends
  • Market structure
  • Market projections for upcoming years

This report is a complete study of current trends in the market, industry growth drivers, and restraints. It provides market projections for the coming years. It includes analysis of recent developments in technology, Porter’s five force model analysis and detailed profiles of top industry players. The report also includes a review of micro and macro factors essential for the existing market players and new entrants along with detailed value chain analysis.

Read More Reports on Medical Devices Market: http://www.transparencymarketresearch.com/medical-devices-market-reports-6.html

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