Immunosuppressive Drug Coverage Legislation Introduced

E-Kidney Newsletter November 2009

More Kidney Patients Avoiding Dialysis on Path to Transplant

15% of transplants now "pre-emptive"

More and more people with failing kidneys are skipping dialysis and going directly to transplant, new national data shows. These "pre-emptive" kidney transplants still represent only 15% of the total number of kidney transplants performed every year. But new data from the U.S. Renal Data System (USRDS) show that percentage is growing steadily.

Find out more information on organ donation
and check out NKF's End the Wait! initiative.

 

 

Simple TestsThe Top Five Questions to Ask Your Doctor About Kidney Disease

by Dr. Leslie Spry

Chronic kidney disease (CKD) is a diagnosis established by finding evidence of kidney damage or a decreased level of kidney function for at least three months. Kidney function is estimated by calculating the glomerular filtration rate (eGFR), based on blood testing. Kidney damage can often be assessed by finding blood, protein or pus cells in the urine. If the diagnosis of CKD has been suggested to you, click here for five questions to ask your physician.

 

 

Dialysis Technician's Generosity towards Patient Helps Make Medical History

When Kaaren Johanson and John Foley are together, people assume they're dating or married. Whether the two are hugging or finishing each other's sentences, there's an obvious unspoken connection. What most people don't expect to hear is that North Carolinian John donated his kidney to someone in Oklahoma so that Kaaren could receive a kidney from a donor in Detroit. To find out how it happened, read on.

Find out more information on organ donation
and check out NKF's End the Wait! initiative.

 

The Kidney Kitchen Visits the Apple Orchard

Between soccer games and dance recitals this fall, why not bring the whole family together to visit the nearest apple orchard? Take in the foliage on your way and enjoy the picking when you get there. The orchard makes for a fun-filled afternoon and supplies you with the main ingredient in this month's Kidney Kitchen Apple Tart recipe.

 

 

 

 

Celebrate 60 Years with the NKF

From a small gathering of parents determined to fight the disease that had stricken their young children back in 1950, the National Kidney Foundation has grown to become the nation's leading organization supporting millions of patients, funding research, advocating for legislation and promoting the lifesaving power of early detection and organ donation. Help celebrate NKF's 60th anniversary coming up in 2010 by entering our National Art Contest or by purchasing our special NKF 2010 Commemorative Calendar.

 

 


 

 

More Kidney Patients Avoiding Dialysis on Path to Transplant

15% of transplants now "pre-emptive"

More and more people with failing kidneys are skipping dialysis and going directly to transplant, new national data shows. These "pre-emptive" kidney transplants still represent only 15% of the total number of kidney transplants performed every year. But new data from the U.S. Renal Data System (USRDS) show that percentage is growing steadily.

Fifteen percent of all transplants performed in the U.S. in 2007 were pre-emptive, according to USRDS's 2009 annual report. That's up from 9 to 10 percent in the early 1990s.

"This is a big step up in pre-emptive transplants and speaks to efforts that have been undertaken by all parties within the transplant community to address early transplantation," said Bryan Becker, MD, National Kidney Foundation President. "There has really been a big shift in making pre-emptive transplantation a much greater reality for patients in the U.S."

Kidney specialists have known for years that patients with chronic kidney disease will do better if they have transplants before they need to go on dialysis, or after only a short period on dialysis (typically six months or less). Analysis of large datasets from the early 2000s shows that the shorter the amount of time a patient is on dialysis before transplant, the better the prognosis for the transplanted organ—and the patient.

When a patient can go directly to transplant and avoid dialysis, the transplanted organ is more likely to start working fast, and to function well. Pre-emptive transplantation can also slash medical costs; Medicare spends about a third less on patients who go straight to transplant.

"More and more, the entire healthcare community is recognizing dialysis and transplantation as treatments for kidney failure, but not necessarily ones that have to be done in sequence," said Becker.

Efforts must continue to promote awareness of pre-emptive transplantation among people with kidney disease and potential living donors, he added.

"It is important to make the public aware of this improvement in transplant efficiency," Dr. Becker said. "We should continue to examine factors that led to this trend and work to enhance them further."

The National Kidney Foundation recently embarked on a comprehensive action plan to improve the transplantation system in the U.S. and end the wait for a kidney transplant within 10 years.

This END THE WAIT! initiative is a virtual call-to-arms designed to put in place tested and proven actions relating to education, financial and medical practice. One of the major End the Wait! Recommendations is Improving Outcomes of First Transplants by educating patients with stage 4 chronic kidney disease (CKD) about the opportunities for and benefits of early transplantation and by changing medical practice to ensure that every Stage 4 CKD patient is evaluated for a transplant prior to the initiation of dialysis.

For more information on transplantation and a full list of END THE WAIT! recommendations visit www.kidney.org/endthewait

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The Top Five Questions to Ask Your Doctor About Kidney Disease

by Dr. Leslie Spry

Chronic kidney disease (CKD) is a diagnosis established by finding evidence of kidney damage or a decreased level of kidney function for at least three months. Kidney function is estimated by calculating the glomerular filtration rate (eGFR), based on blood testing. Kidney damage can often be assessed by finding blood, protein or pus cells in the urine. If the diagnosis of CKD has been suggested to you, here are five questions to ask your physician:

#1 What is the cause of the CKD? While many times a specific diagnosis may not be possible, a presumptive cause can usually be offered. The most common causes of CKD are diabetes and hypertension. If you have a history of either of these conditions, this may be the presumptive cause. In other cases, especially if there is both blood and protein in the urine, a kidney biopsy may be the best way to determine the cause. The decision to have a kidney biopsy must weigh the risk of the procedure with the potential benefit of knowing a diagnosis. Only your doctor can determine this risk versus benefit. Sometimes a kidney ultrasound is indicated to further clarify the cause of CKD. Only a specific diagnosis leads to specific treatment.

#2 What is the appropriate treatment for my stage of CKD? Many times this should include the use of blood pressure medications such as ACE-Inhibitors or ARB agents. This might include a low salt diet to help control blood pressure. Better diabetic management and dietary changes for better sugar control may stall the progression of diabetic kidney disease. Ask for targets to be achieved with therapy. Consultation with a dietitian may be appropriate. Treatment of infections and checking for blockage with the use of ultrasound pictures of the kidney may be indicated with certain diseases that cause CKD. If the cause of the CKD is a form of nephritis, then a biopsy may be needed to point to the proper treatment.

#3 What are the changes in medication that are necessary and are there any drugs that I should avoid? Doses of many medications must be adjusted for kidney disease. Certain drugs need to be avoided altogether in kidney disease. Some drugs may alter the testing for kidney disease or actually decrease kidney function and should be monitored closely. This may be information that can be provided by either your physician or your pharmacist.

#4 How often should I re-test kidney function and monitor protein, blood or pus in the urine? This has to be individualized for each person and each stage of CKD. The CKD staging system found on the NKF web site (www.kidney.org) makes some recommendations, but these should be reviewed with your physician. The equation for calculating the eGFR can also be found at this web site.

#5 When should I be seen by a kidney specialist for consultation and possible
transplantation? This depends on the cause of your kidney disease and whether your physician feels comfortable treating your disease. In most circumstances, at Stage 4 CKD, it is helpful to consult with a kidney specialist.

Click here for more on CKD.

Click here to ask Dr. Leslie Spry, MD, FACP, your own question.

 

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Dialysis Technician's Generosity towards Patient Helps Make Medical History

When Kaaren Johanson and John Foley are together, people assume they're dating or married. Whether the two are hugging or finishing each other's sentences, there's an obvious unspoken connection. What most people don't expect to hear is that North Carolinian John donated his kidney to someone in Oklahoma so that Kaaren could receive a kidney from a donor in Detroit.

John Foley, a dialysis technician in Durham, North Carolina, understands the plight of those whose kidneys have failed and need dialysis in order to live. As his patients spend time tethered to a machine that provides this life-saving function, John saw that over time the routine could sap a patient's strength.

But Kaaren was a patient who seemed to have boundless energy.

An operations manager for a an academic testing organization and dedicated supporter of numerous organizations that aid the poor, Kaaren always arrived at the clinic with her cell phone fixed to her ear, working through her three hour long treatment, while many of the other clinic patients slept. "I was truly impressed with her," says John. The two developed a friendship over time and then one day, Kaaren asked John for a kidney.

In the 20+ years that John had worked in the field, he'd never been asked this question. Although John knew immediately that he wanted to say yes, he asked his grown children what they thought and they said, "Go for it."

But it turned out that Karen's and John's tissue types were incompatible. Undeterred, John identified a program at Johns Hopkins University where available kidneys are swapped among a pool of committed donors and recipients and the two became part of history when a domino transplant involving 16 donors and recipients took place earlier this year.

The procedure, kidney paired donation, takes a group of incompatible donor-recipient pairs and matches them with other pairs in a similar predicament. By exchanging kidneys between the pairs, it is possible to give each recipient a compatible kidney. In this way, each recipient receives a kidney from a stranger, and transplants are enabled that otherwise would not have taken place. John and Kaaren's domino transplant was performed eight ways, in four hospitals and involved six men and ten women in four states.

Today both donor and recipient are thriving and teaming up with the National Kidney Foundation to promote organ donation . The two even appeared on the "Dr. Oz" show this fall to help spread the word. They'll pound the pavement together this summer as they celebrate their second chance at life at the NKF's 2010 U.S. Transplant Games.

Find out more about NKF's End the Wait! initiative.

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The Kidney Kitchen Visits the Apple Orchard

Between soccer games and dance recitals this fall, why not bring the whole family together to visit the nearest apple orchard? Take in the foliage on your way and enjoy the picking when you get there. The orchard makes for a fun-filled afternoon and supplies you with the main ingredient in this month's Kidney Kitchen Apple Tart recipe.

 

Apple Tart

6 servings

Dough

1 cup AP Flour

1/3 cup butter

5 to 8 T of ice water

Cut the butter into the flour until it becomes small pieces, the size of walnuts. Make a well in the center of the flour mixture and add 5 tablespoons of ice water. Fold the flour mixture over the ice water until the dough sticks together, if the dough is still dry, add more ice water. Wrap dough in plastic wrap and let rest in the refrigerator for 1/2 hour. Roll out dough on a floured surface and place in a tart pan.

Filling

3 Apples, peeled, cored and sliced

¼ cup sugar

2 T. cornstarch

¼ teaspoon cinnamon

Pinch of pumpkin pie spice

¼ cup apple jelly

Mix sugar, cornstarch, cinnamon and pumpkin pie spice together, sprinkle over sliced apples. Layer apples in the tart pan. Bake at 400 F. for 30 to 40 minutes, or until the crust is browned and the apples are soft. After the tart is cooled, melt the apple jelly over a double boiler. Brush the top of the tart with the melted jelly.

Analysis:

Calories 253, total fat 8.7 g, saturated fat 5.3 g, monounsaturated fat 2.2 g, polyunsaturated fat 0.5 g, cholesterol 21.7 mg, calcium 10.9 mg, sodium 63.6 mg, phosphorus 28 mg, potassium 102.6 mg, total carbohydrates 43.7 g, dietary fiber 2.9 g, sugar 22.5 g, protein 2 g

This recipe was submitted by CKD patient Chef Duane Sunwold.