Medical Director talks to MPs about diabetes and kidney disease
Medical Director, Professor Kelvin Lynn, visited the Beehive on 25 May to speak to the Parliamentarians for Diabetes group of MPs about the links between diabetes and chronic kidney disease and ways to prevent or retard the progress of diabetic kidney disease. MPs from across the political spectrum attended and the talk was followed by a lively question and answer session.
Dr Lynn's attendance was made possible by Diabetes New Zealand. The visit to Parliament was an opportunity to underline the close ties developing between Kidney Health New Zealand and Diabetes New Zealand. Diabetes is the most important cause of kidney failure in New Zealand. In 2008, 492 New Zealanders began dialysis treatment and of these 226 diabetic kidney disease. Both organisations are committed to ensuring that our community hears the health messages about diabetes and kidney disease.
Click Here to view Dr Lynn's talk
Medical Director's November 2009 Report
Medical Director's News - Kidney Transplantation
Kidney transplantation has been a marvelous boon for people with kidney failure. For most people a successful transplant not only extends life but improves its quality in comparison to dialysis. As the number of organs donated after death has not increased in New Zealand over recent years there has been an increase in the proportion of kidney transplants from a living donor. In New Zealand nearly half of all kidney transplants are from a living donor.
In the developing world almost all transplants are from living donors. Over the past twenty years it has become apparent that in some communities vulnerable people have been exploited and become kidney donors, often without giving permission and having received only a fraction of the money paid by the recipient. Organ trafficking and transplant tourism is now thought to involve 5,000 to 8,000 transplants each year (or 10% of all transplants). Commonly the donors are illiterate and impoverished people, illegal immigrant, prisoners or economic and political refugees. Section 56 of the Human Tissue Act (2008) states that “Trading in human tissue generally prohibited” and makes organ trafficking in New Zealand illegal but people can still travel to other countries to purchase a kidney. Until now most nephrologists have felt that although they could not personally support this practice it was a matter for the individual patient.
The international transplant community is concerned that organ trafficking and transplant tourism poses a threat to the practice of transplantation worldwide. In May 2008 the Transplantation Society and the International Society of Nephrology convened a summit meeting in Istanbul. Dr Ian Dittmer and Professor Stephen Munn from Auckland were among the more than 150 representatives of scientific and medical bodies from around the world, government officials, social scientists, and ethicists.
The summit produced The Declaration of Istanbul on Organ Trafficking and Transplant Tourism. The full text can be viewed here. This declaration contains a definition of the problem, principles and universal approaches for living kidney donation and recommendations aimed at reducing the number of illicit transplants. The Istanbul Declaration makes it very clear that we all have a personal responsibility in preventing the abuse of kidney donors wherever they may live. The World Health Organisation has recently reviewed its “Guiding principles on human cell, tissue and organ transplantation” (http://www.who.int/transplantation/TxGP08-en.pdf) and also addresses the issues of informed consent and payment of living kidney donors.
Kidney Health New Zealand has lobbied for an increase in the reimbursement of expenses incurred by living kidney donors. The Declaration and the WHO guide allow the reimbursement of documented costs incurred during the evaluation of potential kidney donors and after donation surgery and recognise this as part of the legitimate expense of transplantation which does not constitute payment for organs.
What do we need to do in New Zealand in response to these important statements?
Kidney health professionals should embrace the principles of the Istanbul Declaration and present these to patients they are aware may be contemplating purchasing a kidney overseas.
Reduce the need for people to look elsewhere for a kidney by
- Ensuring that all potential deceased organ donors are identified and that there are trained staff to approach families for permission to donate
- Reduce local barriers to living kidney donation, both logistic and economic
Kelvin Lynn
Medial Director
Short daily dialysis – improved survival compared to conventional hospital dialysis
When maintenance dialysis was started in 1960 nobody knew what was the best frequency or duration of dialysis treatment. The first patients had dialysis for 24 hours each week and then this was changed to twice a week for 16-23 hours. Dialysis three times a week overnight, usually at home, became the early standard treatment. For a number of reasons – almost all unrelated to patient welfare – the world wide standard dialysis is three times a week for fours hours each session, usually in a hospital or dialysis centre.
Even in the early days of dialysis there were concerns that the “infrequency” of dialysis subjected patients to lots of dialysis-related symptoms that affected quality of life. Early attempts were made to dialyse patients each day but, although there appeared to be clear clinical benefits, these early programmes were not sustained.
Recently there has been renewed interest in increased frequency dialysis in two forms – daily overnight dialysis (6 to 7 very gentle dialyses each week overnight for about 8 hours) and short daily dialysis (6 to 7 dialyses each week fro 1.5 to 2 hours). Some of the kidney specialists involved with these new initiatives have reported on their experience with short daily dialysis. Of interest, one these nephrologists is Dr Christopher Blagg who was involved in the care of the first patients who were treated with dialysis in the early 1960s in Seattle, USA.
Their report which was published last month in the journal Nephrology Dialysis and Transplantation describes 415 patients (265 on home dialysis) in the USA, Italy and Europe who chose to change to short daily dialysis. Twenty percent of the patients had begun short daily dialysis between 1982 and 1996. Most patients had been on standard dialysis for about 5 years before starting short daily dialysis. The reasons for changing to short daily dialysis were to improve quality of life and survival or because of intolerance of standard dialysis. At the end of the study 41% were still on short daily dialysis, 18% had had a kidney transplant, 20% had died and 19% had returned to standard in-centre dialysis. The authors compared the survival of these patients to a similar group of American patients receiving standard in-centre dialysis.
The survival of the patients on short daily dialysis was 2-3 times higher than for the patients on standard dialysis (and the home dialysis patients on short daily dialysis had the best survival). What was more amazing was the finding that patients on short daily dialysis had a similar survival to people of the same age with a deceased donor transplant. On the basis of these results the authors suggest that short daily dialysis is now the best for of dialysis treatment (and even better at home - my comments)
In New Zealand at the end of 2006 there were 83 patients (7% of all haemodialysis patients) dialysing more than three times weekly. The high rates of home dialysis in New Zealand offer the chance for more patients to experience the benefits of daily dialysis.
Kelvin Lynn
Medical Director
Kidney Health New Zealand