What’s new at ADC - An update from Seattle

By Jim Smith

As this years ADC comes to an end in Seattle, I had a chance to reflect on what was said and shown to many of the attendees during the last 4 days.

On the professional side there were two significant developments first announced on Saturday during the Successful Home Hemodialysis preconference seminars:

1. Dr Robert Lockridge disclosed his research after 12 years, showing strong evidence that long term nocturnal dialysis produces mortality results approximating those of cadaveric transplant recipients. In other words, the life expectancy of in center patients is the lowest of all dialysis patients, with short daily dialysis next and cadaveric transplant along with long term nocturnal dialysis patients enjoying the best and almost equal life expectancy.


2. Two reasons for this longevity include significant reduction in phosphorous levels and the reduction and in some cases elimination of the need for hypertension meds. Looks like it is time to consider nocturnal if you haven’t already. As for this writer, having recently found out that I am no longer a candidate for a transplant, I will be switching to nocturnal as soon as possible.
   

Dr. Jon Agar from Geelong, Australia, introduced a new way of measuring adequacy of dialysis. While the traditional measure of Kt/V has long been the accepted method , Dr Agar, has proposed a more extensive 20 point system that includes many more factors than just Kt/V. The additional areas of review include various non-quantitative measures that reflect quality of life issues. This is a survey you can complete yourself and take with you when visiting your own nephrologist and use as a starting point for improved discussion and review of your own condition and care. Look for the 20 question review in another posting in the near future.

While there were many presentations during the 4 days of conference, the Monday afternoon session on the future of dialysis proved quite interesting. A number of speakers discussed their continuing research and development of various aspects of dialysis in the near future. Here are a few highlights:

Dr Andrew Davenport of the London College, brought all of us up to date on the development of the wear-able kidney ( WAK ) . The various problems of power and filtering seem to be well on the way towards solving. New rechargeable battery technology along with miniaturization of pump mechanisms and filters have resulted in an effective unit weighing a mere 3 pounds. The problem of effluent disposal is one area still to be worked -on. The stoma-sack arrangement leaves something to be desired but overall progress is good. Regardless with the requirements of FDA, don’t look for something for a number of years yet.

Dr Eli Friedman, discussed his extended Micro-biotic theory of using the stomach and intestine as a filter for Urea and waste. Using empirical evidence dating back as far as 46 BC, he proposes that not unlike PD, the use of Pro-biotic substances can successfully sustain life in humans who have lost all renal function. This is based on research done on cows with their ruminant stomachs and no kidneys. They pass waste that eliminates the build up of toxins and fluids usually handled by the kidneys. I am not sure a diet of alfalfa and charcoal sounds appetizing.

Following on the discussions of improved health as a result of longer term nocturnal dialysis, Jim Curtis of Home Dialysis Plus in Portland, Oregon discussed his next generation dialyzor that would utilize advanced water saving technology that could regenerate dialysate and reduce the water used in a conventional dialysis session from 140 liters to a only 6 liters. The horizon shows the ability to use almost any water source without the need for ultra-pure H2O. While this has more impact for dialysis centers, HD+ is working on a home machine that uses your own tap water in nocturnal dialysis.

Also David Updyke from Fresenius discussed their ongoing work to improve the absorbent as well as adsorbent qualities of various filters for water and dialysate regeneration.

Lastly The NxStage group isn’t standing still either. A new model 172 cartridge is now available which allows for the connection of a heparin pump thus solving the problem of anti-coagulents during nocturnal runs. For those of you using Pure-Flow, it looks like NxStage will be starting up business in England, Holland and Scandinavia later this year. Maybe someday soon we will be able to travel to parts of Europe and realize the possibility of venturing beyond the 48 states with our machines.

Next years ADC will be in Phoenix, Arizona, February 20-22 with the Home Hemo conference on February 19. Usually the Feb 19 gathering is open to the public at minimal cost. Keeping abreast of the new trends and research in Dialysis and Nephrology is one of the best ways to keep yourself informed and prepared to live your life to the fullest on dialysis.

Comments or questions ? Let me hear from you.