July 2022 Issue 04 www.renalinterventions.net
In this issue:
UK Kidney Week: Home dialysis takes centre stage page 8
Late-breaking clinical trials reinforce importance of early detection and treatment in CKD THREE LATE-BREAKING CLINICAL trials presented at the 59th European Renal Association (ERA) congress (19–22 May, Paris, France) have placed increased focus on the need to quickly detect and treat chronic kidney disease (CKD). Annette Bruchfeld (Karolinska Institute, Solna, Sweden), who is chair of the Scientific Committee and facilitated a press briefing on these new data, said: “CKD is a progressive condition that impacts both life expectancy and quality of life. The results of these late-breaking clinical trials highlight potential new strategies for early detection and treatment of CKD, and its complications, heralding new hope as we work towards ERA’s goal to improve kidney care for every patient.” The first of these presentations—the THOMAS study—detailed a prospective, randomised trial in which Ronald Gansevoort (University of Groningen, Groningen, The Netherlands) and colleagues evaluated two different homebased albuminuria screening strategies, concluding that home-based screening in the general population has a high participation rate, identifies individuals with unknown CKD and cardiovascular disease (CVD) risk factors, and is cost-effective compared to usual care (no screening). Further late-breaking research presented at ERA 2022 saw Franz Schaefer (Heidelberg University Hospital, Heidelberg, Germany) and colleagues assess the usefulness of urinary Dickkopf-3 (uDKK3) in determining the short-term risk of CKD progression in children. They concluded that uDKK3 is associated with a greater short-term risk of declining kidney function, potentially allowing a personalised pharmacological approach to kidney function preservation. Finally, data from the TIPS3 trial were delivered on behalf of Johannes Mann (University of Erlangen-Nuremberg, Erlangen, Germany) and an international team from Canada and India. In an effort to assess the effects of aspirin in preventing CVD among CKD patients, they analysed more than 5,700 participants and found that cardiovascular risks may be substantially alleviated, either with aspirin alone, or in combination with a polypill.
Profile: Aisha Shaikh
page 12
Ziv Haskal on recent DCB data
“Age is just a number” Frailty and vascular access
page 17
page 19
Physicians hear global patient perspectives about life on dialysis From insights on living with different treatment modalities, to problems created by poor physician-patient communication and long-term psychological challenges, kidney care physicians heard a range of perspectives from dialysis patients during two recent conferences—the Vascular Access for Hemodialysis Symposium (VASA; 9–11 June, Charleston, USA) and UK Kidney Week (UKKW; 7–9 June, Birmingham, UK).
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“The focus is often on how your dialysis is going, but not how well you are living,” Hill added. He also said some form of mental therapy may have helped him overcome issues with self-confidence, and a loss of identity, when he started dialysis. These difficulties, according to Hill, are even harder to cope with alongside the fear of dying from kidney disease. This point was stressed by Ramos-Multani too, who told the audience: “When you say ‘end-stage kidney disease’ to a patient, to them, that means they are dying. That is the beginning of their depression.” Another message emphasised by patients throughout VASA was ‘no one told me’, with Ramos-Multani saying that a lack of vital information creates even more uncertainty for the patient. “People are going through all sorts of emotions, from fear to denial, and I think trying to overlay information on that emotional fog creates poor communication,” one physician averred. “The message I am hearing is that our community needs to do much better when it comes to communicating and reinforcing these things—because they are obvious to us, but not to the patient.”
Effective communication A common theme at VASA was the need for improved physician-patient communication. Dialysis patients Fred Hill and Lissette RamosMultani both highlighted this when detailing their own experiences—with Hill calling for “true education” on how each modality will impact a patient’s life. He noted that, beyond simple explanations of how fistulas and catheters work, “it needs to be more about how we live our lives” on dialysis.
Dialysis burnout The long-term psychological toll these treatments can take featured prominently at UKKW, with nocturnal HD patient Nikki Fretwell drawing on the 30-plus years she has spent on dialysis. Fretwell detailed her experience of living in denial, to some extent, and refusing to let dialysis define her for many years before succumbing to “total burnout” and seeing a renal psychologist. “We talk about tiredness, exhaustion and fatigue,” she said, “but, for me, these words are not powerful enough to describe it.” Fretwell also alluded to putting off everyday tasks until tomorrow, but feeling like “tomorrow never comes” due to a constant lack of energy. Struggles relating to self-worth and independence, as well as a desire to live life to the full in spite of dialysis, were among other overarching messages here. “I was so determined to be normal that I ignored all my symptoms, and never told anyone how I felt or how hard life actually was,” Fretwell continued, but went on to add that, more recently, she has learned to accept help from others and acknowledge her limits. “Your life is the priority, and dialysis gives you that life,” she stated, addressing fellow patients. At VASA, Hill concluded with a similarly positive outlook: “Dialysis is the battery that means you can live—so go and live! And, understand that it is a second chance at life, and a part of your life, but it is not your whole life.”
ne such perspective was offered by Lorin Jackson, who discussed her experiences on peritoneal dialysis (PD), and both home and in-centre haemodialysis (HD) at VASA 2022. “For me, PD is the best-case scenario,” she said. “It gives me the most flexibility and freedom, and is more gentle, whereas HD is intense and can make you very tired.” She also noted that PD can be done nocturnally, allowing her to wake up, disconnect and go about her day after dialysing overnight, while she found HD more limiting, requiring greater time and effort. “I would argue that, sometimes, it felt like a full-time job, and I really did feel like I was my own nurse,” Jackson said, also relaying difficulties she experienced on HD, including an access graft occlusion, learning how to cannulate—which was “awful”—and fainting. “It was always really scary if something went wrong with HD,” she added. “There was a lot of blood, and it was overwhelming. But PD is not like that. It is much more controlled and contained, and it feels safer and more manageable for me.” Jackson relayed that, with some adjustments, she is still able to travel for work, volunteer and focus on her religion with PD—concluding: “You just have to make it work for you.”
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“The focus is often on how your dialysis is going, but not how well you are living.”