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.

Image courtesy of Porapak Apichodilok at Pexels.com

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

Understanding Acid-Base Disorders: Metabolic Acidosis

Pentec Health CEO Joe Cosgrove has addressed before the topic of dialysis in several occasions; however, and given the variety of health issues related to renal failure, it is also important to discuss and clarify the doubts people may have about other renal pathologies such as acid-base disorders.

Image courtesy of Steve Davis at Flickr.com

Since acid-base disorders entails the deep study of kidneys, and every case depends on the patient, if one were to fully understand this topic, one would need to go through all the formulas in order to completely get the full picture of a given case, nevertheless, there is a way for readers to understand what is this thing commonly referred to as “compensation”—or renal compensation in an acid-base disorder, for this matter—, and furthermore understand what is going on under these circumstances. To understand compensation, it is advisable to take a few steps back in order to see a depiction of what is happening in the blood when it has a lot of acid as in metabolic acidosis, for instance.

Actually, acid-base disorders comprise four scenarios: metabolic acidosis, metabolic alkalosis, respiratory acidosis and respiratory alkalosis, however, and since each scenario demands a succinct study, this article focuses on metabolic acidosis. In a metabolic acidosis, what normally happens is that patients experience a drop in their serum bicarbonate, and what physicians strive to assess is how far the patients’ CO2 will fall, since it is expected to drop. This might sound very technical, so for people to understand this much easier, simply put, metabolic acidosis refers the condition where there is too much acid in the body fluids—which causes the bicarbonate drop mentioned before—; and, as in every pathology, there are some possible causes that can ultimately result in metabolic acidosis, specially three main categories: either patients have a lot of acid being produced in the body: patients suffering from DKA (Diabetic Ketoacidosis) are more likely to suffer from metabolic acidosis given their increased and extremely high blood sugar levels and ketones production which causes bicarbonate to go down; or patients experience a decreased acid excretion: patients who suffer from kidney failure cannot filter all the waste products and byproducts causing the acid to stay in the body and consequently rise its levels; and the another cause is the loss of bicarbonate: people can lose bicarbonate from diarrhea, for instance, and as consequence the acid stays in the body. In general, metabolic acidosis causes the arterial blood gases values to exceed their normal levels while the body struggles to compensate: the respiratory system sees that there is too much acid in the body and starts to breathe more rapidly so that the CO2 can be expelled out of the body in hopes of raising the blood pH back to normal, and consequently increase the bicarbonate level.

Image courtesy of Laura Whitehead at Flickr.com

Patients suffering from severe metabolic acidosis are commonly seen doing deep rapid breaths in order to expel all the CO2 (which is an acid) so that the blood pH can get to its normal values. Other causes that can result in metabolic acidosis can be found aside the three mentioned before. For example, aspirin toxicity has been correlated with metabolic acidosis: patients who have taken a lot of aspirin accidentally will experience a dramatic rise in their acid levels once the body has absorbed it. This will likely cause them to hyperventilate since, as explained before, the respiratory system will try to get rid of the excess of acid by expelling CO2 (causing, furthermore, respiratory alkalosis). Another cause has been linked to carbohydrates not being properly metabolized: there are plenty of metabolic issues and it is often seen the case where patients struggle to metabolize carbohydrates which in turn prevents the body to break down pyruvic acids due to the lack of oxygen. Not being able to break down the pyruvic acid, the body turns it into lactic acid, which almost shuts down the body and causes the bicarbonate levels to drop.

A third cause is inherently related to kidney failure: the kidneys, which are responsible for filtering the waste out of the body, fail to do so causing the body to store waste and acids in the blood. As readers might have already imagined, having increased acid levels causes the bicarbonate levels to fall. Actually, every single thing that causes either a loss of bicarbonate or alkaline fluids, or retention of acids, might result in metabolic acidosis, moreover, even a wrong diet can be directly linked with this pathology: an intake of high-fat diet increases the likelihood of increasing the waste, acids, and ketones in the body. Since the body is not a perfect machine and sometimes fail, one can certainly assert that an excess of fat, or any excess, results in something bad for the body: having a good and healthy lifestyle will surely help patients to keep their kidneys functioning for much longer.

Conservative Care and Types of Donors

Joe Cosgrove has spoken widely about kidney malfunctions and the alternative treatments that exist and serve as a different approach to addressing common kidney diseases.  Kidney failure is something that can be treated using different approaches — like dialysis, for instance. When to start dialysis and when to start dialysis can be easily assessed after having a quick look at kidneys that are currently failing.

Image courtesy of John Campbell at Flickr.com

In order to understand this in more detail, readers should be aware of how kidneys work exactly: it is often talked about balance and health, where the kidneys are the ones responsible for that first word: balance; whether it is food or body chemistry or blood pressure, the kidneys work alongside other major organs to keep this equilibrium, or balance for this matter, going and functioning on a daily basis while eliminating and filtering out all the waste byproducts and products created by the body’s metabolism. If kidneys start to fail, meaning they cannot longer hold this balance, the body starts to struggle at keeping such equilibrium and is more likely to retain fluids, or food, or could result in having abnormal potassium and sodium levels, or could rise blood pressure, etc. which will result in increasing the risk for a serious kidney illness. If this were to happen, the body would absolutely need another way to filter and balance all these fluids and electrolytes, and this, as readers might have already guessed, is where the decision of dialysis or kidney transplant comes in.

Although the need for a kidney transplant or a dialysis might be imperative, it, nonetheless, takes a time to plan it. A person’s primary physician will likely star planning either a transplant or a dialysis when a person’s GFR (which stands for Glomerular Filtration Rate) is around 20, which is the equivalent to a 20% kidney function, in case readers want to have something to have a deeper understanding; nevertheless, this does not necessarily mean that a dialysis or a kidney transplant is immediately needed as most people start dialysis when their GFR is around 13 or so. Actually, doctors and physicians have started questioning whether it is necessary to start dialysis based on just a number since the people who started dialysis this earlier did not seem to show a major improvement in their condition. Now, doctors and kidney specialists are leaning towards starting dialysis once the patient has already shown symptoms of kidney failure like severe fatigue, nausea, decreased appetite, shortness of breath, etc. This symptoms assessment might be a little tricky and deceptive, mostly if the patient is suffering from something else, which is why now doctors in charge of assessing a patient should include a nephrologist in their teams to recognize the symptoms that would improve after dialysis.

Moreover, people often start thinking about their plausible treatment options a year before they need to start dialysis since it takes three to six months to make dialysis happen, which is why there are several dialysis options instead of just one. One option would be actually doing nothing: patients might feel this way because of where they are in life. They might feel that perhaps their best choice would be letting their kidney failure run its course, which is the attitude that describes the “Conservative Care”. Conservative Care suggests that patients should aim at maintaining their kidney function for as long as possible through diet and medication, knowing that the decline of their kidney function will not stop, and will ultimately lead to death. This option is generally considered by people who are also suffering from other severe medical conditions who are candidates for transplants and feel that the liability and discomfort caused by dialysis outrun the potential benefits.

Image courtesy of Karol Franks at Flickr.com

The next option would be to acquire a donated kidney, either from a living person — generally a relative or a friend — or from a deceased donor. As readers might imagine, not everyone is a candidate for receiving a donated kidney, which is why doctors and physicians might take some time to find out whether the transplant is the most suitable option for patients. Since there are two types of kidneys, deceased donor kidneys are not immediately available; in fact, up to 20% of people who are on dialysis are waiting for a kidney transplant, which is why it takes five up to 8 years to have one. If the having a transplant is possible after prior assessment, it is definitely the best options as it allows receivers to live longer and better than if they were on dialysis, which is why it is advisable to start thinking on the other type of kidney donor: the living donor. People usually consult their friends or relatives first since the likelihood of them matching the receiver are higher; they will last longer unlike kidneys coming from a deceased donor and the transplant can happen earlier: even before dialysis.