Dramatic treatment advances being made

[okarol]

Dramatic treatment advances being made

By Rebecca Hyman
Fri Apr 25, 2008, 03:38 PM EDT

Taunton - There has never been a better time to be a kidney patient.

Researchers are making dramatic advances in transplant techniques and have fine-tuned dialysis.
But kidney disease has also never been so widespread.

“The increase in obesity and the increase in junk food will probably lead to more people on dialysis. That’s the tragedy of the whole thing,” said Dr. Allan Lauer, director of the Taunton Kidney Center.

The number of kidney patients has been increasing by about 5 percent a year, Lauer said.

The good news is the rate of increase is starting to slow, he said.

Lauer said 40 to 50 percent of kidney disease nationwide is caused by diabetes. The high blood sugar level that is the hallmark of the disease damages the kidneys.

High blood pressure is the other major culprit, Lauer said. The kidneys can’t handle the pressure and scar.

Lauer said avoiding kidney disease is yet another reason to lead a healthy lifestyle.

That is not to say that behavior alone is the “cause” of kidney disease, said Dr. Nina Tolkoff-Rubin, medical director of dialysis and transplantation at Massachusetts General Hospital in Boston and a professor of medicine at Harvard Medical School.
There is a large genetic component, she said.
“There tends to be a predisposition,” Tolkoff-Rubin said.

For many people, as is the case with Carmen Morales, high blood pressure runs in the family. Diabetes as well, particularly juvenile diabetes, can be genetic.

In an ideal world, a person with kidney failure would go straight to a transplant, Tolkoff-Rubin said.

A successful transplant means leading a relatively normal life, whereas dialysis is very time-consuming and many find it debilitating.
The survival rate for transplants is much higher, she said.
There is a 20 percent annual mortality rate on dialysis.

With transplants, there’s a 90 percent graft survival rate at the end of one year and then a 5 to 7 percent dropoff annually after that, she said.

But there is a four- to five-year wait for a deceased donor kidney.

And many people aren’t eligible for transplants due to age or other illnesses.

A living donor is also an option, since we have two kidneys, but many patients do not have an available donor who is willing and able to give, be it a friend, relative or altruistic stranger.
For those people, dialysis is a life preserver.
“It’s a great medical advancement,” Lauer said.

Until the Taunton Kidney Center opened about a decade ago, dialysis patients had to make the trip to Brockton on an old GATRA bus without air conditioning for treatment.

Having a facility closer to home is an enormous advantage, said Lauer, who helped found the center.
“It’s like night and day,” Lauer said.

Making dialysis relatively convenient is crucial because a positive attitude is key to long-term survival, he said.
He’s had patients on dialysis for 30 years.

He encourages patients to look at it as “one more chore to do,” like brushing your teeth.
“It’s just part of your life,” he said.

Tolkoff-Rubin said transplantation techniques are advancing in leaps and bounds.
When she started 35 years ago, the field was in its infancy.
“It was a pioneering kind of effort,” she said.

“It’s gone from an experiment in biology to an everyday occurrence.”

The goal now is to crack two big nuts in the transplant arena: incompatibility and rejection.

And scientists are well on their way to pulling it off, she said.

“What you’re trying to hope for is to get the kidney to be perceived as self,” Tolkoff-Rubin said.

Tolkoff-Rubin is co-author of a January report in the “New England Journal of Medicine” on a major advance in overcoming rejection.

A team from Mass General developed a procedure to “induce tolerance” that holds out the promise of allowing patients to avoid a lifetime of anti-rejection drugs.

“The hope is we can do transplantation without pills,” Tolkoff-Rubin said.

Researchers have also developed procedures to allow patients to receive a kidney from a live donor with an incompatible blood type. That also represents a major advance given the shortage of deceased donor kidneys, experts say.

Several hospitals already have incompatible kidney transplant programs in place, including Johns Hopkins in Baltimore. According to the hospital’s Web site, the success rate has been similar to that achieved with compatible transplants.

“The options are there and the science is obviously burgeoning and exciting,” Tolkoff-Rubin said.

http://www.wickedlocal.com/taunton/news/x883024934

[stauffenberg]

The huge mass of chronically ill, incurable people must be getting tired of all the hype about the wonderful progress of modern medicine.  The sad fact is that since the development of the calcineuron inhibitor class of transplant drugs in the later 1970s, there has not been any groundbreaking progress in transplant medicine, at least not since it was figured out how to dose cyclosporine properly in the early 1980s.

The article also does a profound disservice by the emphasis it puts on poor lifestyle as causing renal failure.  The Merck Manual estimates that 80% of all serious disease is not preventable, and a majority of cases of renal failure are due to genetics or factors which cannot be successfully controlled by any known intervention over the long term.