Chronic kidney disease (CKD) is is a major 21st century medical challenge. More than 650,000 patients per year in the United States and an estimated 2 million patients worldwide are affected by end stage renal disease (ESRD). These patients will require renal replacement therapy to survive. The rapid rise of common risk factors such as diabetes, hypertension and obesity, especially among the poor in developing nations, will result in even greater and additional burdens on medical communities.
Excerpted from Emily Lockhart
Sunday, March 25th, 2018
The gradual progression from unhealthy kidneys to chronic kidney disease (CKD) and finally to kidney failure is often very subtle with very few symptoms in the early stages. Fifteen of the most common signs of kidney failure include:
Kidney Care UK is the United Kingdom’s leading kidney patient support association, providing practical, financial and emotional support for renal patients and their families. It campaigns to improve care services across the United Kingdom.
For more than 40 years, the association has been working to improve the quality of life for kidney patients and their families. It works tirelessly to improve renal care policy and practice in order to improve patient lives. It gives renal patients a strong and influential voice at the highest level.
Historically, there have been significant differences in the choice of a vascular access between Europe, Canada, and the United States. The Dialysis Outcomes and Practice Patterns Study (DOPPS) studied international practice patterns which revealed large variations in vascular access practiceamong different countries.
In their comprehensive 2018 Clinical Practice Guidelines for Vascular Access the European Society for Vascular Surgery (ESVS) address pre-operative imaging for assessment of a vascular access. In addition to a detailed pre-operative history and physical examination, they accord non-invasive ultrasound imaging an important role in vascular access selection.
Access to health services is defined as "the timely use of personal health services to achieve the best health outcomes." Access to health care impacts one's overall physical, social, mental health status, and quality of life. It requires three distinct steps:
Almost two million Americans suffer heart attacks and strokes each year. Heart disease and strokes account for about 30% of all deaths in the United States and are the first and fourth leading causes of death, respectively. But the good news is that the major risk factors for heart disease and stroke—high blood pressure, cholesterol, smoking, and obesity—can be prevented and controlled.
Over the past decade the health of Americans has improved in some areas: Life expectancy at birth has increased; rates of death from coronary heart disease and stroke have decreased. Nonetheless, public health challenges remain, and significant health disparities persist.
A serious error in the 2019 proposed National Kidney Foundation’s (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) is their grouping of all methods of vascular access surveillance as comparable. They are not! For instance, venous pressure measurements (Vasc Alert), can identify an outflow vascular access stenosis but cannot detect an inflow stenosis. In contrast, Transonic’s indicator dilution measurements can identify inflow and outflow stenoses as well as stenoses between the needles. This is significant because Asif et al, reported in his 2005 study “Inflow stenosis in arteriovenous fistulas and grafts: a multicenter, prospective study,” that 35% of vascular accesses sent for intervention do have inflow stenosis.1
The 2019 proposed National Kidney Foundation’s (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) recommends a regular physical examination by a knowledgeable and experienced health practitioner to detect flow dysfunction. The proposed Guidelines cite five references to support their position.1-5 Asif’s 2005 reference “Accuracy of physical examination in the detection of arteriovenous fistula stenosis” from the Miller School of Medicine at the University of Miami was referenced several times. Two other studies3-4 also originated at that same institution. All four studies1-4 cited the use of interventionalists, interventionalist fellows, or physicians trained in vascular access physical examinations to monitor for and detect AV-access flow dysfunction.