Jeff P. on LinkedIn: Can we say greed Fresenius Medical Care and DaVita Kidney Care Helen… (2024)

Dialysis has traditionally centered on urea clearance, but this narrow focus neglects a broader range of uremic toxins like indoxyl sulfate and p-cresol, which are more damaging. These toxins significantly contribute to cardiovascular and neurological complications, reducing the quality of life for dialysis patients.Indoxyl sulfate accelerates vascular calcification, raising the risk of heart attacks and strokes. P-cresol is linked to endothelial dysfunction, a critical factor in cardiovascular disease. These toxins also fuel chronic inflammation, worsening the severe comorbidities common in dialysis patients. Despite these dangers, current dialysis protocols primarily target urea, leaving these more harmful toxins in the body.The reason for this gap lies in the limitations of current technology. Standard dialysis membranes remove small, water-soluble molecules like urea but are less effective at filtering out larger, protein-bound toxins. This creates a significant shortfall in treatment, where the most dangerous toxins remain, continuing to harm the patient's health. It’s a glaring issue in dialysis care that urgently needs addressing.Fortunately, advances in dialysis technology are beginning to tackle this problem. High-flux dialysis membranes, which can remove larger molecules, represent a significant improvement. Additionally, research into adsorbent materials that specifically target protein-bound toxins offers a promising new approach. Integrating these materials into dialysis systems could significantly reduce harmful uremic toxins, potentially improving both quality of life and long-term outcomes for patients.Expanding our focus beyond urea is not just a technical challenge—it’s an ethical imperative. The current standard, prioritizing urea clearance, falls short of this ideal. The nephrology community must embrace a more comprehensive approach, considering the wide range of uremic toxins and the complex factors contributing to patient outcomes.To advance the field, there must be greater work on developing new dialysis strategies and materials that can target a broader array of toxins. This requires collaboration across disciplines, from bioengineering to clinical research, and a willingness to challenge established norms of what constitutes “adequate” dialysis. In conclusion, targeting uremic toxins beyond urea is not just a novel idea—it’s the next critical frontier in dialysis treatment. By shifting our focus to include the full spectrum of uremic toxins, we can offer patients a better chance at a healthier, more fulfilling life. This paradigm shift won’t happen overnight, but the potential benefits are too significant to ignore. References:Vaziri, N. D., & Pahl, M. V. (2022). Protein-bound toxins in chronic kidney disease: A new frontier in dialysis treatment. Clinical Journal of the American Society of Nephrology, 17(8), 1152-1161.#ESRD #ESKD #CKD #Nephrologist #Dialysis #HHD #PD #VascularHealth #CardiovascularCare

How Did Mpox Become a Global Emergency? What’s Next?By Apoorva MandavilliThe virus is evolving, and the newest version spreads more often through heterosexual populations. But the vaccines should still work.Published: August 15, 2024 at 11:49AMvia NYT Health https://ift.tt/jz3J2Ul

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The endothelial glycocalyx, a thin protective layer lining our blood vessels, plays a crucial yet often overlooked role in vascular health. This complex mesh of glycoproteins and proteoglycans regulates vascular permeability, fluid balance, and Mechan transduction. However, in patients undergoing hemodialysis, this vital barrier is frequently compromised, leading to significant vascular consequences that merit deeper attention.Hemodialysis, essential for those with ESRD, subjects the vascular system to substantial stress. The process involves rapid fluid shifts, high-flow rates, and exposure to bioincompatible materials, all of which can degrade the glycocalyx. This degradation results in blood vessels becoming more permeable and prone to inflammation and damage, initiating a cascade of vascular dysfunction. The loss of glycocalyx integrity facilitates the infiltration of inflammatory cells and promotes atherosclerosis, key contributors to the high rates of cardiovascular disease observed in dialysis patients.Why does this matter? The glycocalyx is not merely a passive structure; it protects the endothelium from leukocyte adhesion and platelet aggregation, crucial defenses against inflammation and thrombosis. In hemodialysis patients, the erosion of this layer heightens the risk of cardiovascular complications, which remain the leading cause of mortality in this population. Preserving the glycocalyx could be pivotal in improving long-term outcomes, yet this aspect of care is often neglected in traditional dialysis protocols.Current research suggests potential interventions to protect or restore the glycocalyx. Antioxidants that mitigate oxidative stress, adjusting dialysate composition, and incorporating glycocalyx-reinforcing agents are promising strategies. These emerging approaches underscore the necessity of evolving our dialysis protocols—not just to manage fluid overload and toxin removal but to enhance vascular health comprehensively.The stakes are high. The degradation of the glycocalyx significantly increases cardiovascular risks, fundamentally altering a patient’s health trajectory. Dialysis patients are already on a fragile path, and every effort should aim to minimize harm. By prioritizing the preservation of the glycocalyx, we can take a substantial step toward reducing the burden of cardiovascular disease in this vulnerable population.The nephrology community must reexamine dialysis protocols and technologies. It’s imperative to adopt strategies that protect the endothelial glycocalyx, thereby reducing vascular injury and improving patient outcomes. This shift won’t occur overnight, but the potential benefits are too substantial to ignore. References:Annecke, T., Rehm, M., Bruegger, D., Jacob, M., Becker, B. F., & Conzen, P. (2023). Shedding of the endothelial glycocalyx during hemodialysis. Journal of Vascular Research, 60(2), 121-130.#ESRD #ESKD #Nephrologist #Dialysis #HHD #PD #VascularHealth #CardiovascularCare

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Check out the latest in Kidney DiseaseSurprising mechanism of lupus kidney damage identified Learn more here https://buff.ly/4cqxU9o #kidneydisease, #CKD, #Dialysis, #nephrology, #somalunaconsulting, #clintech

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Earlier today, I briefly ranted about the PureFlow machines from NxStage Medical. After reflecting, I realized it’s critical to highlight the serious scientific and metabolic issues associated with this system. Here are six major problems:**⚠️ Chemical Contaminants and Oxidative Stress** PureFlow’s water purification can produce harmful byproducts like trihalomethanes and haloacetic acids. These compounds contribute to oxidative stress, leading to cell and tissue damage, increasing cardiovascular risks for dialysis patients【 [oai_citation:1,Waste & Toxics - Washington State Department of Ecology](https://lnkd.in/e5nzcJ5d)**☠️ Bicarbonate Solution and Metabolic Alkalosis** The bicarbonate-based dialysate can cause metabolic alkalosis if improperly managed. This disrupts metabolic processes, causing muscle twitching, nausea, and seizures, and impairing oxygen delivery to tissues【9 [oai_citation:2,PureFlow Bicarbonate Solution | NxStage Medical Inc.](https://lnkd.in/eMAYNzCG)**🚫 Chloramine and Hemolysis** Failure to remove chloramine during water purification can lead to hemolysis, the destruction of red blood cells. This causes severe anemia, compromising oxygen transport in the body【8 [oai_citation:3,Waste & Toxics - Washington State Department of Ecology](https://lnkd.in/e5nzcJ5d)**🔬 Chloroform Generation and Carcinogenic Risks** The interaction of chlorine with organic matter can produce chloroform, a known carcinogen. Long-term exposure to chloroform is linked to liver and kidney damage, significant concerns for dialysis patients【8 [oai_citation:4,Waste & Toxics - Washington State Department of Ecology](https://lnkd.in/e5nzcJ5d)**💀 CO2 Buildup and Respiratory Acidosis** The use of bicarbonate in PureFlow’s dialysate can cause CO2 buildup, leading to respiratory acidosis. This condition disrupts blood pH and metabolic processes, particularly in patients with respiratory issues【9 [oai_citation:5,PureFlow Bicarbonate Solution | NxStage Medical Inc.](https://lnkd.in/eMAYNzCG)**🛑 Aluminum Contamination and Neurotoxicity** Aluminum contamination in systems like PureFlow can lead to neurotoxicity, affecting cognitive function and bone metabolism. This can cause dialysis encephalopathy, characterized by speech difficulties, dementia, and death8 [oai_citation:6,Waste & Toxics - Washington State Department of Ecology](https://lnkd.in/e5nzcJ5d)These critical issues highlight the need for the dialysis industry to rethink its technology. The metabolic and chemical risks associated with PureFlow must be addressed for patient safety.#DialysisSafety #NxStage #PureFlow #PatientCare #MedicalTechnology #HealthcareReform #ChronicIllness #HomeDialysis #MedicalDevice #MetabolicHealth #HealthcareInnovation #PatientAdvocacy #KidneyHealthhttps://lnkd.in/enq6mzeU

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After thirty years of living with chronic kidney disease and surviving dialysis, I’ve seen the advocacy system fall apart. Groups like the National Kidney Foundation, once fierce defenders of patients, have become muted, thanks to the money flowing in from Large Dialysis Organizations. These LDOs have turned advocacy into a puppet show, where the voices that should be the loudest are instead whispering, careful not to upset their corporate sponsors.LDOs control the majority of dialysis centers in this country. Their funding of advocacy groups might seem like charity, but there’s a catch. This money has turned these groups into hesitant advocates, more concerned with pleasing their donors than fighting for patients. Instead of pushing for better treatment options, they’ve become reactive, only acting when problems reach a boiling point.Take home dialysis as an example. It’s a life-changing option for many, offering freedom and a better quality of life. But it’s not profitable for LDOs, so advocacy groups don’t push it. They stick to promoting in-center dialysis, the cash cow of the industry. This leaves patients stuck in a cycle of treatments that fit the profit margins of corporations, not their own lives.The conflict of interest is clear. When your funding comes from those profiting off the status quo, you can’t truly fight for change. It’s like asking a fox to watch the hens and wondering why they’re disappearing. We can’t keep relying on a system that’s rigged against us. We need a new kind of advocacy, one that isn’t tainted by corporate cash.This is where grassroots advocacy comes in. Unlike traditional groups, grassroots movements are driven by real experts—patients, their families, and their communities. These efforts aren’t about profit; they’re about survival, dignity, and quality of life. Grassroots advocacy is about taking back control and putting patients at the center where they belong.Grassroots movements aren’t weighed down by corporate dollars, so they can focus on what really matters. They can push for better options, like home dialysis, without worrying about the bottom line. They can empower patients with knowledge, helping them make choices that improve their lives rather than just feeding the machine. This level of advocacy builds communities, bringing patients together so they don’t feel so alone in their fight.We’ve seen what grassroots efforts can do in other areas of healthcare. Patient-led movements have changed policies, improved care, and raised awareness. There’s no reason why dialysis can’t be next. We’ve waited long enough for change that isn’t coming from the top down. It’s time to take matters into our own hands.#ChronicKidneyDisease #Dialysis #PatientAdvocacy #GrassrootsMovement #HealthcareReform #CKD #HomeDialysis #PatientRights

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A.L.S. Stole His Voice. A.I. Retrieved It.By Benjamin MuellerIn an experiment that surpassed expectations, implants in a patient’s brain were able to recognize words he tried to speak, and A.I. helped produce sounds that came close to matching his true voice.Published: August 14, 2024 at 05:12PMvia NYT Health https://ift.tt/xOikMjg

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Unresponsive Brain-Damaged Patients May Have Some AwarenessBy Carl ZimmerMany patients thought to be in vegetative or minimally conscious states may be capable of thought, researchers reported.Published: August 14, 2024 at 05:00PMvia NYT Health https://ift.tt/edsmwj3