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Open heart, or coronary artery bypass, surgery can be done two ways: on-pump or off-pump, depending on whether the patient is put on a heart-lung machine. Off-pump surgery allows a surgeon to perform a bypass without stopping the heart. This may help cut down on kidney injuries that can arise after heart surgery, which can deprive the kidneys of normal blood flow.

While patients with CKD often have heart problems, they're usually excluded from heart bypass clinical trials and are often undertreated for heart disease.

Lakhmir Chawla, MD (George Washington University) and his colleagues looked to see if off-pump bypass surgery helps protect the kidneys of CKD patients compared with on-pump surgery. The investigators studied 742,909 bypass surgery patients (158,561 or 21.4% of whom underwent off-pump surgery) from 2004 to 2009.

CKD patients with particularly poor kidney function were more than three times as likely to die or need dialysis during the study when they underwent on-pump surgery compared with off-pump surgery.

"Our data suggest that excluding CKD patients from clinical trials of off-pump surgery may have resulted in an underestimation of potential benefit for this patient subgroup," said Dr. Chawla. "If you need to have bypass surgery and you have CKD, an operative approach that does not involve the heart-lung machine may help avoid the need for dialysis," he added.

More information: The article, entitled "Off-Pump versus On-Pump CABG Outcomes Stratified by Pre-Operative Renal Function," will appear online on May 17, 2012, doi: 10.1681/ASN.2012020122

Journal reference: Journal of the American Society of Nephrology

Provided by American Society of Nephrology

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by Irene C, This e-mail address is being protected from spambots. You need JavaScript enabled to view it . Posted on May 18, 2012, Friday

KUCHING: The Persatuan Dialisis Cahaya Kuching (PDCK) dialysis centre is now open to the public.

The centre, operated by the Kuching Methodist East and West District Social Concern Group, has finally obtained the licence to operate as a non-profit organisation with a non-government organisation (NGO) status.

The centre’s board president Hii Jui Ting said that the centre would provide dialysis treatment to the poor regardless of race and religion.

“Currently, PDCK has 12 machines to serve a maximum of 60 patients. It is serviced by voluntary nephrologists and trained dialysis nurses. It has facilities to satisfy the requirement of the Health Ministry,” said Hii at a press conference yesterday.

He said the aim of the Methodist churches under the Sarawak Chinese Annual Conference in setting up the PDCK was to demonstrate the sacrificial love of Christ and to bring hope to the marginalised groups.

The centre, located at Tabuan Desa, has been operating for the past two weeks and currently has three patients from Desa Wira, Pending and Tabuan Jaya.

He explained that since the centre only has three patients, it was running on one shift, but when it was at full capacity, it would run on three shifts, from 7am to 9pm, Mondays to Saturdays.

Apart from that, he also urged members of the public to come forward and donate generously to help run the centre.

They can write cheques payable to PDCK and contact the administrator, Carol Ng at 082-360248 or by fax at 082-360853.

PDCK is located at Lot 3710-3711, Lorong Keranji 4, Jalan Keranji, Tabuan Desa Commercial Centre (near the police station) here.

Also present at the press conference were the board treasurer Kiu Tung Hwa, advisor of Methodist Church Kuching West, District superintendent Chin Sai Hin and Methodist Church Kuching East District superintendent Mok Ing Huat.

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Renal denervation may protect the kidneys and reduce heart risks

60 million people globally have chronic kidney disease.

Newswise — Washington, DC (May 17, 2012) — Disrupting certain nerves in the kidneys can safely and effectively lower blood pressure in patients with chronic kidney disease (CKD) and hypertension, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings indicate that the procedure might improve CKD patients’ heart health.

Overactivity of neurons in the sympathetic—or fight or flight—nervous system is very common in patients with CKD. It not only contributes to high blood pressure and heart problems in these patients, but also to worsening of their kidney disease.

A minimally invasive procedure called renal denervation—which uses radiofrequency waves to disrupt the overactive sympathetic nerves running along the arteries in the kidneys—can lower blood pressure in individuals with hypertension and normal kidney function. Dagmara Hering, MD, Markus Schlaich, MD (Baker IDI Heart & Diabetes Institute, in Melbourne, Australia) and their colleagues looked to see if the procedure can also safely help CKD patients with hypertension.

The investigators performed renal denervation in 15 patients with hypertension and CKD. Normal blood pressure in the general population is 120/80 mmHg. Patients’ average level at the start of the study was 174/91 mmHg despite taking numerous antihypertensive drugs. Patients’ blood pressure readings dropped considerably at one, three, six, and 12 months after the procedure (-34/-14, -25/-11, -32/-15, and -33/-19 mmHg, respectively). Renal denervation did not worsen patients’ kidney function, indicating that it is safe even when CKD is present.

“These initial findings now open up an entirely new approach to better control blood pressure in CKD and potentially slow down progression of CKD and reduce cardiovascular risk in these patients. said Dr. Schlaich.

Approximately 60 million people globally have CKD. Heart disease is the leading cause of death in these individuals.

Study co-authors include Felix Mahfoud, MD, Antony Walton, MD, Henry Krum, MBBS, PhD, Gavin W Lambert, PhD, Elisabeth Lambert, PhD, Paul A Sobotka, MD, Michael Böhm, MD, Bodo Cremers, MD, Murray Esler, MBBS, PhD.

Disclosures: This study was funded in part by grants from the National Health and Research Council of Australia (NHMRC) and the Victorian Government’s Operational Infrastructure Support Program. Professor Schlaich, Prof Esler, Dr E Lambert, and Dr G Lambert are supported by career fellowships from the NHMRC. Dr Dagmara Hering is currently supported by Research Fellowship from the Foundation for Polish Science KOLUMB/2010-1. Dr Felix Mahfoud is supported by the Deutsche Hochdruckliga. Dres Schlaich, Mahfoud, Walton, Krum, Boehm, Esler are principal investigators in studies sponsored by Medtronic, the company that manufactures the renal deneravtion device and have received consultancy/lecture fees from Medtronic.

The article, entitled “Renal Denervation in Moderate to Severe CKD,” will appear online at http://http://jasn.asnjournals.org/ on May 17, 2012 2012, doi: 10.1681/ASN.2011111062.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 13,500 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

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