Thursday, April 23, 2015

Self Motivation Is Key To Phosphorus Control In Late Stage Kidney Disease

From the Journal of Renal Nutrition comes this important article about controlling phosphorus.Objective Hyperphosphatemia is common in end-stage renal disease and associates with mortality. Phosphate binders reduce serum phosphorus levels; however, adherence is often poor. This pilot study aims to assess patients' self-motivation to adhere to phosphate binders, its association with phosphorus control, and potential differences by race. Design and Methods Cross sectional design. Subjects were enrolled from one academic medical center dialysis practice from July to November 2012. Self-motivation to adhere to phosphate binders was assessed with the autonomous regulation (AR) scale (range: 1-7) and self-reported medication adherence with the Morisky Medication Adherence Scale. Linear regression models adjusting for age, sex, health literacy, and medication adherence were applied to determine associations with serum phosphorus level, including any evidence of interaction by race.
Results Among 100 participants, mean age was 51 years (±15 years), 53% were male, 72% were non-white, 89% received hemodialysis, and mean serum phosphorus level was 5.7 ± 1.6 mg/dL. More than half (57%) reported the maximum AR score (7). Higher AR scores were noted in those reporting better health overall (P = .001) and those with higher health literacy (P = .01). AR score correlated with better medication adherence (r = 0.22; P = .02), and medication adherence was negatively associated with serum phosphorus (r = −0.40; P < .001). In subgroup analysis among non-whites, higher AR scores correlated with lower serum phosphorus (high vs lower AR score: 5.55 [1.5] vs 6.96 [2.2]; P = .01). Associations between AR score (β 95% confidence interval: −0.37 [−0.73 to −0.01]; P = .04), medication adherence (β 95% confidence interval: −0.25 [−0.42 to −0.07]; P = .01), and serum phosphorus persisted in adjusted analyses. Conclusions Self-motivation was associated with phosphate binder adherence and phosphorus control, and this differed by race. Additional research is needed to determine if personalized, culturally sensitive strategies to understand and overcome motivational barriers may optimize mineral bone health in end-stage renal disease.

Wednesday, April 15, 2015

Leading Cause of Kidney Failure

Diabetes is the leading cause of kidney failure.
Diabetes causes 44.9% of all new cases of kidney failure. In 2011 it was the primary diagnosis for 232,984 kidney failure patients.2 An estimated 25.8 million people have diabetes; 7 million of them are undiagnosed.8 About 40% of people with diabetes will develop CKD.7 African Americans with diabetes are 2.6 to 5.6 times more likely than whites to develop kidney disease.6 Most people (69%) participating in a 2011 nationwide survey by the American Kidney Fund could not name diabetes as a leading cause of kidney disease, despite the fact that over half (55%) had a loved one with diabetes. Source-American Kidney Fund

Sunday, April 12, 2015

Dining Out Can Aggravate High Blood Pressure

A new study shows that eating out can lead to higher blood pressure. Researchers from Duke-NUS Graduate Medical School Singapore surveyed 501 adults between the ages of 18 and 40. They collected data on the adults' blood pressure, body mass index, and lifestyle — including how much they work out and how often they eat meals from restaurants. Researchers found that of the 501 participants, nearly 28 percent of them had pre-hypertension, or "slightly elevated blood pressure" levels. Those with pre-hypertension are at a "very high risk" for hypertension which is "the leading risk factor for death associated with cardiovascular disease." Of the 28 percent that had pre-hypertension, 38 percent ate more than 12 meals from restaurants per week.
Researchers also found a staggering difference between genders: Of the men that participated, 49 percent had pre-hypertension, while only nine percent of women did. Overall, the study showed that those who had pre-hypertension and hypertension "were more likely to eat more meals away from the home." Shockingly, researchers found that even eating one meal out raised a person's odds of developing pre-hypertension by six percent. Meals out at fast food restaurants are especially dangerous. In 2012, researchers at Washington University in St. Louis found that people who ate a 1,000 calorie meal from well-known fast food chains each day quickly gained upwards of 5 percent of their body weight in three months or less.

Wednesday, March 25, 2015

Information on the Artificial Wearable Kidney

- Around 31 million Americans have chronic kidney disease. For patients with irreversible kidney problems, dialysis is a life-saving therapy. But it's also a tough treatment that requires a lot of time. Now, an artificial kidney may offer patients more freedom. Toby Munoz Jr. sits in a chair, three times a week for up to five long hours at a time. Munoz Jr. told Ivanhoe, “And it just drives me up the wall. I'm not a sit down person; I can barely make it through a movie at a theatre.” Toby needs dialysis to do the work of his failing kidneys. But the treatments have taken over his life, even forcing him to quit his job. Victor Gura, M.D., FASN, Associate Clinical Professor of Medicine of The Geffen School of Medicine at UCLA told Ivanhoe, “The quality of life of dialysis patients leaves a lot to be desired.”
Now researchers are studying a wearable artificial kidney. It does the same job as dialysis but it's portable, so it offers patients the ability to move while they receive therapy. Jonathan Himmelfarb, M.D., Director of the Kidney Research Institute at the University of Washington in Seattle, Washington says, “Live their life and move around not be tethered to a machine while receiving dialysis therapy.” The artificial kidney runs continuously on batteries and weighs 10 pounds. Researchers will study the device in up to 10 patients as part of a clinical trial. The goal is to give dialysis patients more freedom. “We hope to give them basically their life back” Dr. Gura explained. Toby says it would be a welcome change! This clinical trial will be the first human study in the U.S. conducted on the wearable artificial kidney. The researchers hope the device will allow patients to walk, shop, or perform other chores while receiving their treatments. They believe the portable device would also save money because patients will require fewer medications and hospital visits. While the current prototype weighs 10 pounds, they hope to make a smaller, lighter version soon. Contributors to this news report include: Cyndy McGrath, Supervising Producer; Marsha Hitchcock, Field Producer; Cortni Spearman, Assistant Producer; Rusty Reed, Videographer and Jamison Koczan, Editor. BACKGROUND: Kidney disease is the eighth leading cause of death in the United States and more than 10 percent of the U.S. population suffers from chronic kidney disease. Kidney disease is the gradual loss of the function of the kidneys. The kidneys filter waste and excess fluid from your blood which is then excreted through urination. Kidney disease is so dangerous because once it reaches an advanced stage, dangerous levels of fluids, electrolytes and wastes can build up in your body. The buildup of these wastes can cause symptoms such as nausea, vomiting, loss of appetite, fatigue or weakness, sleeping problems, changes in urine output, muscle twitches and cramps, swelling of feet and ankles, and a decrease in mental sharpness. Many of the signs and symptoms of kidney disease can be nonspecific and can also be caused by other illnesses. It is best to be checked by a doctor if you notice any signs or symptoms. (Source:, TREATMENT: There are several treatments for chronic kidney disease. The correct treatment for you depends on the stage of the illness. Many treatments include: · High blood pressure medications · Cholesterol lowering medications · Anemia medications If your kidneys are not able to keep up with the waste and fluid clearance on their own, you may go into near or complete kidney failure. This is called end-stage kidney disease. Treatment for end stage kidney disease includes dialysis or a kidney transplant. Many patients with end-stage kidney disease are put on dialysis in order to remove waste products and extra fluid from the blood. A machine is able to filter waste and excess fluids from your blood and return the blood back into your body cleaned. The downside to dialysis is that it is a long process and requires patients to sit for many hours weekly while receiving treatment. (Source: NEW TECHNOLOGY: A new wearable artificial kidney has been developed and is being tested in clinical trials. In essence, patients will be able to receive dialysis while on the go. The new artificial kidney machine will be wearable and will allow patients to have the freedom from traditional stationary dialysis machines. The wearable artificial kidney does the same job as regular dialysis machines just in a more physiological, or natural way. FOR MORE INFORMATION ON THIS REPORT, PLEASE CONTACT: Victor Gura, MD, FASN 310-550-6240 If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Marjorie Bekaert Thomas at Victor Gura, M.D., FASN, Associate Clinical Professor of Medicine at UCLA talks about a wearable artificial kidney that could give dialysis patients their freedom back. Interview conducted by Ivanhoe Broadcast News in November 2014. Dr. Gura: My endeavor has been for many years to come up with a better way of treating dialysis patients. Why is that so important to you? Dr. Gura: The plight, the suffering, the difficulties in life, the quality of life of dialysis patients leaves a lot to be desired. They have a very high mortality, they go to the hospital a lot, and they sit for untold hours in the machine. We have draconian impositions on their diet, they have to swallow a large amount of pills, and it's not a good life. Treating them forever, I felt we have to come up with a better way of doing that so that's why we're doing what we're doing. How will the wearable artificial kidney help them? Dr. Gura: We hope to give them basically their life back. We want to liberate them from the need of sitting on a chair hooked to a machine for untold hours. We want to reduce the amount of times they go to the hospital. We want to give them a better diet, we want to reduce the amount of complications, hospitalizations and last but not least we want to reduce the costs of dialyzing patients in the United States which is staggering and going up. How much is the cost? Dr. Gura: It's estimated that the U.S. tax payers spends about 30-billion dollars per year to keep patients alive with end stage renal disease. What would be the difference with the wearable kidney do you have any numbers with that? Dr. Gura: We have not had numbers because we never did it. But we would hope we have the potential to decrease the amount of medications, the amount of hospitalizations and several other things. This has yet to be proven, make no mistake, so we hypothesize that that's what will happen. And we have good reason to believe so but we still need to prove that of course. How does the wearable artificial kidney work? Dr. Gura: Well we had some challenges when we went to build a better device. If you want to afford the people mobility you have to give them freedom from being hooked to an electrical outlet; which means you have to have a device that works on batteries. We also had to find a way to give them a way to purify the water without the requirement of 40 gallons of fresh water per treatment, which is what we use today. That meant we had to basically find a mechanism to regenerate and cleanse the water so it could cleanse their blood, pick up the impurities, clean up the water and recycle it all the time. We were fortunate enough to achieve those two things. Make a small device that works on a battery and does not require 40 gallons of water. How much does it weigh? Dr. Gura: The present prototype, and this is simply a crude prototype, weighs about 11pounds. Given the resources that we need we would hope to make it much smaller and less voluminous. We have not accomplished that and it still needs to be done and it's just a matter of having the resources to accomplish that but it's do-able. What would this eliminate for patients, would it eliminate ever going back to the dialysis center or would it eliminate two trips out of three a week? D. Gura: I think I would be very cautious and say what it will eliminate. I would like to eliminate them having to go three or four times a week, sit by the machine for hours on end so they can go and do something else with their lives. I want to believe that we would eliminate a lot of the pills that they have to eat every day, what we call the pill burden which is humungous. Taking 20 pills a day, it's a big deal. It hurts your stomach and costs a lot of money. We would hope that we can give them a better diet where they can eat what they like. A dialysis patient would literally commit suicide by having a couple of glasses of orange juice and two bananas because their potassium would go up. We want to do away with that if we can. With this wearable device would you use it every day? Dr. Gura: Oh yes. People dialyze three times a week for 12 hours even if they are indicated that's not the way to do it. With your native kidneys, you don't take them off and put them on the nightstand, you use them 24/7. If we can make something that is small enough, miniaturized enough that can better mimic a native kidney then we would hope we can make this wearable 24/7. Make no mistakes I'm not making promises that in fact we'll achieve all that we have a lot to prove, but we're trying. Are you're starting a clinical trial? Dr. Gura: Oh yes, this is actually the third clinical trial ever done but the first in the United States and it's the first for 24 hours. We're very proud to do this in Seattle. The FDA approved the human use in the U.S. and supported us in this endeavor so this is what we're doing now. Is it a safety trial? Dr. Gura: Every trial in the eyes of the FDA has to prove two things, safety and efficacy. Until we have not proven that for good this will not be in the market. We have to satisfy criteria to prove that this is safe and efficient. As for your results, was your study overseas for this? Dr. Gura: The studies overseas were very preliminary and indicated preliminary data that this would be safe and efficient. But we're far yet from a definite proof. It would take several more trials and more work to get to that point. We're not there yet. If it all goes well, when could dialysis patients possibly see this? Dr. Gura: Patients are seeing it today as they were being treated. But if the question is when is this going to be available to the public, it would be too presumptuous for me to say now if and when because I don't have enough basis to support a clear date or a clear time. It's going to take a lot of work and it's going to take a lot of resources. We're working very hard to make that happen but I would not commit to a time line. You're very passionate about these patients what would it do to you to be able to get this to them? Dr. Gura: To me? Why would somebody go to medical school for any reason except because you want to alleviate pain and suffering or save lives. If you go to medical school that's what you want. And I would be basically fulfilling my endeavors and my hopes of becoming a physician. Alleviate suffering, make life better and hopefully save a few lives. This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.

Monday, March 23, 2015

Becoming A Potential Organ Donor

In March, we celebrate National ‪#‎Kidney‬ Month. But for families with a loved one on dialysis, everyday is a day about the struggle with kidney disease and ‪#‎ESRD‬. Like this little guy, BJ, whose dad, Bernard, a local police officer, is on hemodialysis, and waiting for a kidney ‪#‎transplant‬. Bernard's best bet for a transplant is from a living donor due to his particular kidney disease. Bernard inspires us for the way his lives his life, while waiting-working, coaching little league, raising a beautiful family with his wife, never losing faith. But the hardship living life with advanced kidney disease causes continues for him and his family everyday. Because it is not just the patient who suffers. All those that love him suffer too. How can you help? Become a potential organ donor. It is our hope that each of you signs an organ donor card when you get you driver's license renewal. That's how we celebrate kidneys...and not just in March.

Thursday, February 26, 2015

Kidney Disease Statistics

Kidney disease is the 9TH leading cause of death in the United States.1 An estimated 31 million people in the United States (10% of the adult population) have chronic kidney disease (CKD).2 9 out of 10 people who have stage 3 CKD (moderately decreased kidney function) do not know it.3 CKD is more common among women, but men with CKD are 50� more likely than women to progress to kidney failure (also called end-stage renal disease or ESRD).4 Some racial and ethnic groups are at greater risk for kidney failure. Relative to whites, the risk for African Americans is 4 times higher, Native Americans is 1.6 times higher, Asians is 1.4 times higher. People of Hispanic background also have increased risk, relative to non-Hispanics. Source: American Kidney Fund

Monday, December 15, 2014

The Kidney And Hypertension Group of South Florida's Rapid Response Clinic Is A Huge Success

We asked for our patient feedback and one thing we heard frequently is that patients don't want to wait for an appointment when they are sick, or having a medical issue. So a year ago, we began our "Rapid Response" Clinic or same day office visits when you don't feel you can wait for an appointment. Our patients have let us know, overwhelmingly, how much they love having this option. And it has reduced our patients hospital admissions and Emergency Room visits! If you need a Rapid Response appointment, please tell the receptionist when you call, and one of our board certified nephrologists will see you that day. (954)771-3929.

Black Americans Are At High Risk of Kidney Disease. Click Picture To Learn What Can Be Done

Black Americans Are At High Risk of Kidney Disease. Click Picture To Learn What Can Be Done
A Black Kidney Transplant Patient Warns Other Members of the Black Community of the Need To Be Aware of Their Increase Risk of Kidney Disease and What They Can Do About It

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Van C. (Dr. Gabriel Valle's patient-kidney-University of Miami, Cathy O. (Dr. Carlos Bejar-Kidney at University of Miami),Will E. (Dr. Ajuria-kidney-Miami Transplant Institute;Bob I. (Dr. Valle's patient, University of Miami-Kidney), Orlando T. (Dr. Valle's patient, University of Miami, kidney), Sara A. (Dr. Valle's patient, kidney, University of Miami),Steve I. (Dr. Jorge Ajuria's patient, kidney, University of Miami),Sandy L. (Dr. Carlos Bejar's patient, kidney, University of Miami),KATHY C. (kidney-University of Miami, patient of Dr. Valle,MARTIN O. (Dr. Valle patient-Heart/Kidney -University of Miami), ROBERT I. (Dr. Valle's patient Kidney at University of Massachusetts), DREW P.(kidney-University of Florida),BILL L. (University of Florida-kidney), BARBARA L. (University of Miami-kidney), FRANCIS L. (kidney at U. of F.), JONATHAN I. (kidney-at U of F), THERESA L. (kidney-pancreas at University of Miami),JEFF T. (kidney at University of Florida), TERESA R. (kidney-University of Miami), JEANNIE O. (kidney-University of Florida), ELOISE O. (Univ of Florida), JOHN E. (kidney-University of Florida), GENE J. (Kidney-University of South Florida), CAL. M. (kidney- Florida Transplant Hospital in Orlando), TERRY A. (Perfect Match! University of Florida-kidney), TIM A.(kidney-University of Miami), GLORIA R. (kidney -University of Miami), BRAD R. (Kidney (and never on dialysis!!)-at University of Miami),(*both Brad and Gloria got kidneys on the same day!!!), BELINDA (kidney-University of Miami), TOM (kidney-University of Miami), JIM E. (Kidney-University of Miami), HERBERT A., (Kidney-University of Miami), Belinda R. (University of Miami-kidney),




South Florida's Top Nephrologists-(Left to Right) Drs. Ajuria, Hernandez, Bejar, and Valle

Living longer by living smarter.

Living longer by living smarter.
find 20 minutes a day to meditate. It reduces stress, lowers blood pressure, and reduces signs of aging.


Click picture to learn what PD is all about from a Nurse Clinical Educator