Are you taking your blood pressure medications properly?
High blood pressure is the commonest chronic disease in our community and is an important cause of heart, blood vessel and kidney disease. Together with diabetes, it accounts for about two thirds of the cases of kidney failure in New Zealand.
Treatment of blood pressure is well known to slow the progression of kidney disease particularly when caused by diabetes. Despite many people knowing about the benefits of treating blood pressure in reducing kidney disease risk, international studies show that between 30 and 60 per cent of patients on treatment have uncontrolled high blood pressure. An important cause for this failure of treatment is patients not taking their medications or not taking them as recommended.
A Canadian study involving 185,000 patients starting on treatment for high blood pressure showed that those patients that mostly took their drugs as prescribed were one third less likely to develop kidney failure over 5 years than those that managed their medication less well. An important message from the study was that it takes a long time for the benefits of blood pressure treatment to show. This underlines the importance of patients accepting that treatment for raised blood pressure is long term – usually for life.
If you are on treatment for high blood pressure make sure you know about your medications and how to take them properly. Your local chemist (pharmacist), practice nurse or GP can provide advice.
You can learn more about blood pressure and its treatment at the Heart Foundation website www.heartfoundation.org.nz/know-the-facts/conditions/high-blood-pressure
Kelvin Lynn
Medical Director
Adrian Buttimore retires after over 40 years service dedicated to the care of people on dialysis.
Kidney Health New Zealand acknowledges the unique contribution made by Adrian Buttimore to the treatment of patients with kidney disease in New Zealand. Adrian retired from his post as Clinical Manager of Dialysis Services at Christchurch Hospital in mid September 2012. Adrian started work in Christchurch in the late 1960s after being recruited by Dr Peter Little, the founder of the Christchurch Renal Unit. At first, he was employed as a dialysis technician but rapidly acquired a broad range of clinical and managerial skills that made him an indispensible member of the kidney team at Christchurch Hospital. Many of New Zealand current nephrologists trained in Christchurch and all benefited from exposure to Adrian’s skill in caring for patients’ fistulae, managing dialysis in clinically unstable patients and his support for patients with kidney failure and their families. There can be few people in New Zealand with a greater breadth of knowledge and experience in dialysis treatments.
Adrian shared Peter Little’s belief in the advantages of home dialysis in providing an improved quality of life and superior health benefits when compared to hospital dialysis. Home dialysis in the early days was challenging for all involved. Many home dialysis patients and their families are grateful for the skilled care and support provided by Adrian and his colleagues. Adrian always appeared to have a way to surmount barriers to a patient getting home on dialysis where others would have given up. Adrian is recognised nationally and internationally for his expertise in home dialysis.
Adrian was a key member of the team that established a computerised record keeping and data management at Christchurch Hospital in 1985 to support the care of patients with kidney disease. This was one of the first such systems in New Zealand and continues to provide essential support for renal services in Christchurch.
Adrian has taken a leading role in the development of accredited training and certification for dialysis technicians in New Zealand He established the New Zealand Board of Dialysis Practice, a professional body for clinical technicians and was a member of the National Renal Advisory Board that advises the Ministry and DHBs on the care of people with kidney disease. Adrian was a founding member of the New Zealand Branch of the Renal Society. In 2006 he received the RSA Award from the Society. This award recognises those individuals who have made an outstanding contribution and shown commitment to the RSA and the renal community at a local and national level. In 2012 he was made s Life Member of the RSA.
In recognition of Adrian’s extraordinary support for and rapport with patients and their families he was made an Honorary Life Member of the Christchurch Kidney Society.
Kidney Health New Zealand wishes Adrian a long and satisfying retirement.
23 Oct 2012
Messages from the Sixth New Zealand Dialysis Audit
The sixth New Zealand Dialysis Audit from the National Renal Advisory Board (NRAB) has been published and can be found elsewhere on the Kidney Health New Zealand website and the NRAB site. www.moh.govt.nz/nrab
The report notes that 567 people, eleven each week, started dialysis in 2009. The proportion starting dialysis at the ten renal units varied considerably. Regions with a predominantly päkehä population, such as in the South Island, had lower rates of people starting dialysis than regions with a large Maori or Pacific population. A major factor behind this variation is the high rates of diabetes and hypertension in Maori and Pacific people. This report confirms the importance of the efforts of government, health professional and organisations such as Kidney Health New Zealand in the early detection and treatment of diabetes and its kidney complications.
Kidney machine treatment (haemodialysis) requires reliable access to the circulation. The best form of circulatory access is an arteriovenous fistula. Other forms of circulatory access are associated with more complications and increased costs. The provision of optimal circulatory access for dialysis requires a co-ordinated team of surgeons, kidney doctors and nurses. Although some New Zealand renal units are achieving high rates of arteriovenous fistula use, some are not; almost certainly because of inadequate surgical support because of inadequate regional vascular surgery services.
Historically, New Zealand kidney machine patients have had longer hours of treatment each week compared to most other countries, partly because of the high rates of home dialysis and also because New Zealand kidney doctors were generally convinced that longer dialysis was beneficial. The impact of recent moves to further increase duration (and frequency) of dialysis are reflected in the Table on page 18 of the report.
Peritoneal dialysis is a common form of home dialysis in New Zealand. An important complication of this form of dialysis is peritonitis; usually from touch contamination of the dialysis tube. The rates of peritonitis in dialysis patients in New Zealand are high by international standards. More research is required into the reasons for these high rates. The re-establishment of the New Zealand Peritoneal Dialysis Registry, established by Assoc Professor John Collins is welcomed and should improve our understanding of this important clinical problem.
International Federation of Kidney Foundations Meeting
Professor Kelvin Lynn, Medical Director, presents the poster to delegates at the 12th International Federation of Kidney Foundations Meeting
Collaboration between Kidney Health New Zealand and Diabetes New Zealand recognized by an award at the recent meeting of the International Federation of Kidney Foundation (IFKF).
The poster entitled Kidney Health New Zealand and Diabetes New Zealand working together: Co-operation brings strength won the best poster prize for Kidney Foundation Activities at the 12th IFKF International Meeting in Vancouver in early April.
Recognition that both organisations have much in common and would have more impact working together has led to an agreement to work together in the area of diabetes and kidney disease.
Working together has improved our ability to achieve our organisations’ goals.
Further information regarding the work of Diabetes New Zealand can be found at www.diabetes.org.nz
Medical Director talks to MPs about diabetes and kidney disease
Medical Director, Professor Kelvin Lynn, visited the Beehive on 25 May to speak to the Parliamentarians for Diabetes group of MPs about the links between diabetes and chronic kidney disease and ways to prevent or retard the progress of diabetic kidney disease. MPs from across the political spectrum attended and the talk was followed by a lively question and answer session.
Dr Lynn's attendance was made possible by Diabetes New Zealand. The visit to Parliament was an opportunity to underline the close ties developing between Kidney Health New Zealand and Diabetes New Zealand. Diabetes is the most important cause of kidney failure in New Zealand. In 2008, 492 New Zealanders began dialysis treatment and of these 226 diabetic kidney disease. Both organisations are committed to ensuring that our community hears the health messages about diabetes and kidney disease.
Click Here to view Dr Lynn's talk
Medical Director's November 2009 Report
Medical Director's News - Kidney Transplantation
Kidney transplantation has been a marvelous boon for people with kidney failure. For most people a successful transplant not only extends life but improves its quality in comparison to dialysis. As the number of organs donated after death has not increased in New Zealand over recent years there has been an increase in the proportion of kidney transplants from a living donor. In New Zealand nearly half of all kidney transplants are from a living donor.
In the developing world almost all transplants are from living donors. Over the past twenty years it has become apparent that in some communities vulnerable people have been exploited and become kidney donors, often without giving permission and having received only a fraction of the money paid by the recipient. Organ trafficking and transplant tourism is now thought to involve 5,000 to 8,000 transplants each year (or 10% of all transplants). Commonly the donors are illiterate and impoverished people, illegal immigrant, prisoners or economic and political refugees. Section 56 of the Human Tissue Act (2008) states that “Trading in human tissue generally prohibited” and makes organ trafficking in New Zealand illegal but people can still travel to other countries to purchase a kidney. Until now most nephrologists have felt that although they could not personally support this practice it was a matter for the individual patient.
The international transplant community is concerned that organ trafficking and transplant tourism poses a threat to the practice of transplantation worldwide. In May 2008 the Transplantation Society and the International Society of Nephrology convened a summit meeting in Istanbul. Dr Ian Dittmer and Professor Stephen Munn from Auckland were among the more than 150 representatives of scientific and medical bodies from around the world, government officials, social scientists, and ethicists.
The summit produced The Declaration of Istanbul on Organ Trafficking and Transplant Tourism. The full text can be viewed here. This declaration contains a definition of the problem, principles and universal approaches for living kidney donation and recommendations aimed at reducing the number of illicit transplants. The Istanbul Declaration makes it very clear that we all have a personal responsibility in preventing the abuse of kidney donors wherever they may live. The World Health Organisation has recently reviewed its “Guiding principles on human cell, tissue and organ transplantation” (http://www.who.int/transplantation/TxGP08-en.pdf) and also addresses the issues of informed consent and payment of living kidney donors.
Kidney Health New Zealand has lobbied for an increase in the reimbursement of expenses incurred by living kidney donors. The Declaration and the WHO guide allow the reimbursement of documented costs incurred during the evaluation of potential kidney donors and after donation surgery and recognise this as part of the legitimate expense of transplantation which does not constitute payment for organs.
What do we need to do in New Zealand in response to these important statements?
Kidney health professionals should embrace the principles of the Istanbul Declaration and present these to patients they are aware may be contemplating purchasing a kidney overseas.
Reduce the need for people to look elsewhere for a kidney by
- Ensuring that all potential deceased organ donors are identified and that there are trained staff to approach families for permission to donate
- Reduce local barriers to living kidney donation, both logistic and economic
Kelvin Lynn
Medial Director
Short daily dialysis – improved survival compared to conventional hospital dialysis
When maintenance dialysis was started in 1960 nobody knew what was the best frequency or duration of dialysis treatment. The first patients had dialysis for 24 hours each week and then this was changed to twice a week for 16-23 hours. Dialysis three times a week overnight, usually at home, became the early standard treatment. For a number of reasons – almost all unrelated to patient welfare – the world wide standard dialysis is three times a week for fours hours each session, usually in a hospital or dialysis centre.
Even in the early days of dialysis there were concerns that the “infrequency” of dialysis subjected patients to lots of dialysis-related symptoms that affected quality of life. Early attempts were made to dialyse patients each day but, although there appeared to be clear clinical benefits, these early programmes were not sustained.
Recently there has been renewed interest in increased frequency dialysis in two forms – daily overnight dialysis (6 to 7 very gentle dialyses each week overnight for about 8 hours) and short daily dialysis (6 to 7 dialyses each week fro 1.5 to 2 hours). Some of the kidney specialists involved with these new initiatives have reported on their experience with short daily dialysis. Of interest, one these nephrologists is Dr Christopher Blagg who was involved in the care of the first patients who were treated with dialysis in the early 1960s in Seattle, USA.
Their report which was published last month in the journal Nephrology Dialysis and Transplantation describes 415 patients (265 on home dialysis) in the USA, Italy and Europe who chose to change to short daily dialysis. Twenty percent of the patients had begun short daily dialysis between 1982 and 1996. Most patients had been on standard dialysis for about 5 years before starting short daily dialysis. The reasons for changing to short daily dialysis were to improve quality of life and survival or because of intolerance of standard dialysis. At the end of the study 41% were still on short daily dialysis, 18% had had a kidney transplant, 20% had died and 19% had returned to standard in-centre dialysis. The authors compared the survival of these patients to a similar group of American patients receiving standard in-centre dialysis.
The survival of the patients on short daily dialysis was 2-3 times higher than for the patients on standard dialysis (and the home dialysis patients on short daily dialysis had the best survival). What was more amazing was the finding that patients on short daily dialysis had a similar survival to people of the same age with a deceased donor transplant. On the basis of these results the authors suggest that short daily dialysis is now the best for of dialysis treatment (and even better at home - my comments)
In New Zealand at the end of 2006 there were 83 patients (7% of all haemodialysis patients) dialysing more than three times weekly. The high rates of home dialysis in New Zealand offer the chance for more patients to experience the benefits of daily dialysis.
Kelvin Lynn
Medical Director
Kidney Health New Zealand