Baxter ShareSource System: A New Dialysis Option for You

Chronic kidney disease is a quite underestimated subject by ordinary people. This issue is much more socially extended than many people believe, and, in fact, statistics suggest that one in every hundred people may be suffering from this terrible illness today. This problem is one of the main public health issues in several countries, not only because of its disastrous health consequences and because of its high frequency in the population, but because the treatments (dialysis, eminently) to respond to this issue are usually expensive. The main consequence when it comes to chronic kidney disease is that the patient must depend on a kidney transplant or a machine to survive in his or her remaining time of life.

The only option for thousands of people around the world is to sit or lay for three or four hours connected to a machine that removes toxins from the blood system. This is the only way to filter out a series of toxins as well as the excess of fluids in the body, which the kidneys eliminate in normal conditions. This is the normal life situation of millions of patients diagnosed with renal failure who cannot afford a kidney transplant, or who, although they can actually afford it, must wait for a donor for years. The process of dialysis, in any of its forms, must be carried out for life. The body has no vacations, after all.

This therapy has two modalities: hemodialysis, which can be performed three times a week in a health center, and peritoneal dialysis, which is done daily from the home of patients, four times a day. Each month, the specialist in charge of the process monitors the treatment and the condition of each patient and, if something is not going well, he or she makes the appropriate changes to improve the therapy.

Since the end of last year, a new technology allows doctors and patients to change that traditional way of doing dialysis (in any of both ways.) We are talking about the ShareSource platform of Baxter International, a system that automatically transmits (in real time) the data on what is happening with each patient throughout the dialysis therapy. This system not only saves time and money for patients, who no longer have to travel to hospitals or other places where their therapy is carried out, but doctors permanently know if one of their patients stopped using the dialysis system at home, as well as the frequency of use and if it is working properly.

Read also: Great Alternatives to Perform Dialysis at Home, by Joe Cosgrove

This technology for remote patient management was created to improve the patient’s treatment in peritoneal dialysis, in addition to significantly increase the efficiency of hospital centers. This bidirectional communication platform is based on the cloud and is incorporated into the automated peritoneal dialysis system. It not only offers physicians a more accurate and timely visibility of the compliance of the therapy by their home patients, which, in turn, allows the identification and early intervention of possible complications, but it also allows collecting important data that can be later become useful information for new researchers on chronic kidney disease. After all, this system monitors patients permanently. Perhaps, the most positive thing about this technology is the possibility of accessing the patient’s compliance data in time, and thus manage possible clinical complications in advance.

The most common drawbacks that usually occur with dialysis are problems with the catheter performance, which is the hose used for fluid exchange. This is the main cause that usually spoils dialysis treatments. When this kind of issues are identified, the doctor has the possibility of making a prescription to solve what is going wrong with the dialysis on time and avoid hospitalizations or other health complications that may be derived from a poorly carried therapy. This also means saving money to the health system since patients get sick much less.

This may be a good option for those patients who live in remote areas and who find it difficult to travel frequently to health centers to carry out their dialysis therapies or to be checked by their doctors. Actually, thanks to this intelligent system, it is possible to reduce the frequency of medical check-ups to one every two months. This gives patients much more freedom and saves doctors a lot of time.

Video: Connectivity Platform Provides Telemedicine Capabilities for Remote Patient Management

Actually, it is a simple platform to manage, that even works like any smartphone app. There is a main menu which shows a list of patients and what has happened during the last week of treatment with each one of them and generates alerts in case of trouble (if a patient skipped a dialysis session, if there was a problem with the connection, or if there were complications in the process of eliminating toxins, for example.)

Internet and Big Data technology has revolutionized all aspects of human life, including health. In this case, it has meant a great advance, which, in an intelligent and practical way, can help to improve the quality of life of patients, as well as the job of millions of doctors.

* Featured Image courtesy of EdTech Stanford University School of Medicine at Flickr.com

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Dialysis and The Elderly: Solution or Mistake?

The elderly seem to depict some degree of declivity soon after they start dialysis. Although dialysis is perhaps one of the world’s most renowned medical development, nursing home individuals and patients who undergo dialysis in hopes of treating any sort of kidney disease showed sustained and evident declivity in their mere ability to perform basic activities. Joe Cosgrove has previously covered the topic of dialysis from different angles; however, it is important to mention the possible complications of starting dialysis in later stages of life.

According to a study, patients with end-stage renal disease worsened within three months soon after starting the treatment: A year after starting the treatment, almost 60% of patients in the aforementioned study passed away, and only 12% still manage to have a decent life—at the same level—as they did prior to undergoing dialysis. In short, and resorting to the findings, although dialysis has been linked to extending the lives of patients and individuals at nursing homes, it does not, however, seem to bring back the kidneys to their initial functional status. The elderly and nursing home residents under dialysis are clearly open to suffering a sustained and evident decline in their kidneys, which also raises the question about whether it does increase the rate of mortality.

An increasing number of elderly individuals with end-stage renal disease in America are starting dialysis: nursing home individuals account for almost 5% of new end-stage renal disease patients and almost 12% of them are above the age of 75. Although dialysis is a viable treatment for individuals with renal disease—at least to some extent—, the benefits and the perks commonly associated with the treatment seem to be uncertain in elderly patients. According to the study, the rate of mortality in the first year soon after starting the treatment surpasses the 35% among patients older than 75 years of age and surpasses 55% among those individuals older than 85 years of age. Additionally, the alleged benefits on the quality of life and the extent to which the treatment seems to extend the patient’s lifespan, especially in the elderly, are still to be determined.

Researchers and physicians gathered information from a national databank of patients currently undergoing dialysis with that from a national databank of nursing home and elderly patients to identify up to 3,700 different individuals who started the treatment between 1998 and 2000. The functional performance of the subjects was initially measured using a monthly-based scale; however, researchers deemed more suitable a 3, 6, 9 and 12 months scale to measure the alleged effects of the treatment on nursing home patients. After assessing the findings, the scores were compared to a previous assessment made soon before they started the treatment.

The period before and after the beginning of the treatment is definitely the riskier stage, for the vast majority of subjects and patients have increasingly tough conditions, and many end up passing away in the following months.

Efforts to offset the risk commonly associated with the treatment, and efforts to make special emphasis on the goals of actually improving the quality of life of the patients ought to be addressed during this period rather than after individuals have started to undergo the treatment. Be that as it may, these findings are not 100% conclusive, for the lack of a control group may have resulted in the inevitable misinterpretation and underestimation of the functional declivity that occurs after the beginning of the treatment. Nonetheless, many physicians and clinicians assume that starting a somewhat conservative therapy is basically a death sentence for all those nursing home patients and the elderly; however, they also acknowledge that there have been small studies that suggest that both mortality and the aftermath of the treatment is quite similar in both demographics, and even in those elders who start the treatment and those who do not.

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Prior to starting dialysis, the study concludes, nursing home patients and elderly individuals must acknowledge the real benefits of starting the treatment at such age, and they must be informed about the possibility of choosing a different approach aside from dialysis, for the risk, in light of the findings of the study is quite high. According to a recent survey, almost 95% of patients irrespective of their age and their families want to be given clear and concise information about the benefits of starting the treatment and whether or not their lifespan will be extended. As mentioned in previous articles, nephrologists and physicians must discuss these issues with their patients, for there is a really high percentage of clinicians who never address the possibilities their patients have at hand. Providing the elderly with precise information may mark the difference between having a good end or making it a nagging, excruciating, time.

* Featured Image courtesy of Pixabay at Pexels.com

Acid-Base Compensation: What is it, and how to prevent it?

Acid-base Compensation is the relative constancy of the acid-base relationship of the internal environment of a living organism, particularly when it comes to the renal system. Also called acid-base balance, acid-base balance, equilibrium of acids and bases. It is an integral part of homeostasis. Quantitatively it is characterized either by the concentration of hydrogen ions in moles per one liter or by the hydrogen pH. The tissues of a living organism are very sensitive to fluctuations in the pH value – outside the permissible range, protein denaturation occurs: cells are destroyed, enzymes lose their ability to perform their functions, and the body can die. Therefore, the acid-base balance in the body is tightly regulated. There are several buffer systems that reversibly bind hydrogen ions and prevent any changes in pH. The bicarbonate buffer system (the most powerful and most controllable among buffer systems) is particularly important: an excess of protons interacts with bicarbonate ions (metabolic alkalosis) to form carbonic acid. Further decrease in the amount of carbonic acid occurs as a result of an accelerated release of carbon dioxide as a result of hyperventilation of the lungs (concentration is determined by the pressure in the alveolar gas mixture.)

There are several approaches for the evaluation and classification of acid-base balance alterations. The physicochemical proposal is the most recent and is based on the difference of strong ions, the total concentration of weak plasma acids and the partial pressure of arterial carbon dioxide. Of great acceptance among anesthesiologists and intensivists, it is a tremendous complex approach, both technical and interpretation. Therefore, in this post, the physiological approach will be used, based on pH, and plasma bicarbonate, which is the simplest, most rigorous and practical way to systematically classify and treat alterations in the acid-base balance.

First of all acid-base disorder must answer three basic questions. The first has to do with what disorder it is. The second, if the secondary response is adequate. The third, about the cause of the disorder. Metabolic acidosis is divided according to the value of the anionic hiatus. Acidosis with increased anionic hiatus: acid gain, endogenous or exogenous, predominates. They are normochloremic acidosis. Acidosis with normal anionic hiatus: the loss of bicarbonate outside the body predominates. They are called hyperchloremic acidosis.

Approximately three-quarters of the value of the anion hiatus correspond to serum albumin, which is an anion, so in the assessment of the anion, hiatus should be taken into account if hypoalbuminemia, as well as other circumstances.

The acid-base balance of the organism is possible thanks to the interrelation of three systems: intracellular and extracellular tampons, which cushion in a minute the acute changes of acid-base balance; respiratory compensation, which starts in minutes and is completed in hours, and renal excretion of excess acids, which takes more time. The total buffer capacity of the organism is about one thousand mMol (forty percent in the extracellular space, and sixty in the intracellular space.)

To plan an adequate treatment, and as in any acid-base disorder, it is essential to identify secondary responses (compensation mechanisms), whether these are adequate or not, and whether there are other acid-base mixed disorders or associated electrolyte disorders.

Read also: How to reduce the chances of suffering renal failure, by Joe Cosgrove

In metabolic acidosis, the key aspect of treatment lies in blocking the source of acid production (eg, by providing insulin in diabetic ketoacidosis,) always taking into account the compensations that exist, the rate of acid production and its cause (lactic acidosis due to hypoxia or alcohol intoxication are more serious due to its rapid evolution.) Special caution when planning treatment deserves the detection of hypokalemia since it implies a serious potassium deficit. The replacement of bicarbonate should be very cautious, applied only in certain circumstances (eg, extreme hyperkalemia, potentially fatal drops in pH,) and always assessing the risks and benefits. The only objective is to gain time until the homeostatic mechanisms manage to increase the pH.

To the problem of acidosis due to keto acids caused by insulin deficiency, water deficit, circulating volume deficit, the coexistence of lactic acidosis and potassium deficit, which in turn depends on the duration and magnitude of polyuria secondary to poor glycemic control, and the degree of replacement of losses.

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The general treatment plan should include, therefore: Insulin, re-expansion of the extracellular volume, correction of possible potassium deficit, and the decision to administer or not bicarbonate should be valued with great caution. The alterations in the bicarbonate concentration or the partial pressure of carbon dioxide in the arterial blood are accompanied by a compensatory response in the other element. If the compensation is adequate or it will not allow detecting if there is a second or third associated disorder, in what constitute the mixed disorders that are very frequent in clinical practice and that implies a greater severity.

In order to detect mixed disorders, it must be taken into account that a compensation will never be able to normalize the pH. Its treatment and the priority of the actions to follow will depend on the cause and predominant acid-base disorder, always taking into account the associated electrolyte alterations.

Recommended: Acid-Base Disorders

* Featured Image courtesy of Pixabay at Pexels.com