Measurement of intestinal cholesterol absorption may be a valuable tool for predicting the benefit of statin therapy in patients undergoing hemodialysis, researchers wrote in the Journal of the American College of Cardiology.

In a post-hoc analysis, researchers evaluated 1,030 participants in the German Diabetes and Dialysis (4D) study. All participants had type 2 diabetes, were aged 18 to 80 years and had been on maintenance hemodialysis therapy for less than 2 years.

Participants with available data on levels of cholestanol, a known biomarker of cholesterol absorption, were randomly assigned to a regimen of once-daily atorvastatin 20 mg (n = 519) or placebo (n = 511). Follow-up was conducted at 4 weeks and every 6 months after randomization.

The primary endpoint was a composite of death attributable to cardiac causes, stroke and nonfatal MI. The secondary endpoint included all-cause mortality and all cardiac events. 

The researchers utilized tertiles of the cholestanol-to-cholesterol ratio to classify participants as high or low cholesterol absorbers.

In total, there were 454 occurrences of the primary endpoint. In multivariate analyses in which cholestanol-to-cholesterol ratios were stratified into tertiles, the researchers observed that atorvastatin decreased the risk for the primary endpoint in the first tertile (HR = 0.72; P= .049), but not the second (HR = 0.79; P= .225) or third (HR = 1.21; P= .287). Atorvastatin was associated with a steady, significant decrease in all-cause mortality and the risk for all cardiac events in the first tertile only, and was least beneficial for patients in the third tertile.

According to the researchers, these findings suggest that among patients on hemodialysis, those with lower rates of cholesterol absorption may derive benefit from atorvastatin treatment.

“We found that measurement of cholesterol absorption may help to identify hemodialysis patients who will benefit from treatment with statins,” the researchers wrote. “Beyond that, the data might argue in favor of a combination therapy that addresses both cholesterol synthesis and absorption to reduce CV risk in hemodialysis patients.” – by Jennifer Byrne

Disclosure:The researchers report no relevant financial disclosures.

...

A pan India study has revealed that more than 72% of the dialysis patients do not undergo the prescribed treatment. According to the study, which had surveyed 1,300 end-stage kidney patients between January 2013 to July 2014, found that of the 72%, 65% choose twice a week dialysis modality instead of thrice as prescribed. The study by NephroPlus also found that the reason behind kidney patients under-treating themselves is affordability.

Kamal Shah, co-founder and director of Patient Services, NephroPlus, who himself has been on dialysis for more than 18 years, said, "With more than 2 lakh people developing kidney failure every year, kidney disease has become one of the most chronic epidemics to affect the country. But it is widely neglected. While there has been some improvement with a few state governments coming forward and subsidising the dialysis treatment, the situation calls for greater participation from state and central governments as also large employers."

Clinically, worldwide, it is proven that under-treatment puts the patients at risk with most common outcome being cardiac arrest.

"Throughout the world, dialysis is reimbursed by governments since it's a very costly chronic treatment. I have seen that the thrice a week modality has much better compliance with medications when either the employer or a government scheme pays for the dialysis treatment. Adoption of innovative models such as public private partnership can definitely make dialysis accessible, affordable and thereby improve the clinical outcome in the country," added Dr Umesh Khanna, chairman, Mumbai Kidney Foundation.

In a private hospital, a dialysis will cost Rs1,200 to 1,500. Dr Rajesh Kumar, nephrologist at Dr LH Hiranandani Hospital, said: "Affordability is a major reason for many kidney patients to skip dialysis. We need more charitable trusts like Lalbaug Mandal where presently 180 patients are treated free of cost."

He further said that the government needs to have a well placed guidelines for people.

...

KSL.com

Making the dialysis decision: What you need to know KSL.com SALT LAKE CITY — Hundreds of thousands of Americans with kidney failure undergo dialysis treatments to keep them alive. While their reasons for needing the treatment can vary widely, many patients with kidney failure ultimately face the same dialysis ... and more »

...

Provincial fish and wildlife officers are asking people to leave potentially injured or orphaned wildlife alone, so as not to further agitate the animals. 

In a release, Blaine Burke, Education/Outreach Officer with Alberta Environment and Parks, said that although concerned residents have good intentions, they could introduce more anxiety to possibly already stressed animals, which creates an unsafe environment for both the animal and the people involved. 

“People shouldn’t be interfering with wildlife. If a mom is gone getting food, a lot of times mom leaves the baby alone, and people don’t realize that’s what nature is, that’s how they do it,” said Burke.  

He said that people should observe an animal for a 24-hour period from a distance, and then contact their local fish and wildlife office for advice instead of intervening themselves. 

Alberta Parks and Environment recommends against bringing an injured animal home to nurse, in most cases it is illegal to possess live wildlife. 

Burke said that they typically get more calls in the spring and summer time. 

“In the spring and in the summer is usually when animals are having their babies and when they’re fending for their food and whatnot.” 

City residents can contact the Grande Prairie Fish and Wildlife office at 780-538-5265. Other contact numbers are available at esrd.alberta.ca. 

...