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Monday, November 17, 2014

Kidney Stone Lifestyle Changes


1. Drink 2 L of water. Make sure you are measuring this! It is really easy to think you have increased fluid intake with only few glasses of water. I recommend to buy a 1 L bottle of water and measure your water intake. (If you have heart failure, kidney failure or liver disease, discuss this with your doctor first as you can easily accumulate fluid). Drinking water helps you with digestion and prevents constipation. In addition, drinking water helps excreting toxins through your kidney. Try to form a habit of drinking 2 L water per day. This habit will encourage you to live healthy and actually helps with weight loss. Leave the bottle of water at your work and on your table. This way, by seeing the bottle on your table, you slowly form this habit. This is an excellent way of forming healthy habits and avoid kidney stones.


2. The most common cause of kidney stone is calcium oxalate. Even if you have other kind of kidney stones, calcium oxalate usually complicates the picture. As such, it is highly important to avoid the diet that contains the oxalate! Cola beverages, coffee, and tea should be limited to two cups a day because these fluids contain oxalate. Remember, I said avoid oxalate and not the calcium! One of the common mistakes that I hear from my patients and occasionally from physicians is to decrease calcium intake as well. This is a mistake. You should continue to have normal calcium intake. The normal calcium intake in gut will bind to oxalate and prevents it from absorption from the intestine.



3. Drinking lemonade made from fresh lemons or lemon juice may help reduce the risk of kidney stone formation. Lemon juice increases the level of citrate in the urine which in turn prevents the formation of kidney stones. Citrate will increase the solubility of the stones in your urine. It helps with preventing new kidney stone formation AND shrinking the previous kidney stones. Remember this is part of life style modification. Depending to the size and kind of your kidney stone, you may need procedures or medications. Do not forget to follow up with your physician closely. Discuss this different life style modifications with your doctor. As a nephrologist and a kidney doctor, I love it when my patients come to clinic prepared to ask questions about their health. This tells me they are proactive.

4. Decrease salt intake to 2 gram per day. (A tablespoon of salt contains 2,325 mg of salt.) What does salt have to do with kidney stones? The higher salt intake, the more kidney has to excrete the salt. In this process, kidney will also excrete other electrolytes that will make you prone to forming kidney stones. Limiting salt intake has 2 benefits. First, limiting salt intake is important with controlling hypertension. Secondly, by limiting salt intake, you prevent new kidney stone formation or worsening of existing kidney stone. 

5. Eat a healthful amount of calcium. Many people think that if they have kidney stone, they need to decrease their calcium intake. On the contrary, you need healthful amount of calcium. Please read # 2 point above. I explained this in detail. But again, if you have kidney stones, you should not limit calcium intake. Normal calcium intake is highly important. 

6. Moderating consumption of animal protein such as: red meat, poultry, eggs, and seafood. Animal proteins increased uric acid levels in your body. High levels of uric acid will increase your chance of gout and uric acid kidney stones. In addition, a high-protein diet reduces levels of citrate, the chemical in urine that helps prevent stones from forming. Now I don't say do not eat meat. The key is moderation. Limit your daily meat intake to a quantity that is no bigger than a pack of playing cards. This is also a heart-healthy portion.

7. Decrease consumption of oxalate-rich foods. The highest amounts of oxalate are found in dark-green leafy vegetables such as kale, beet greens, okra, spinach, and swiss chard. Other plants that are rich in oxalate include instant coffee, rhubarb, starfruit, soy nuts, tofu, soy yogurt, soy milk, beets, and sweet potatoes. Limiting consumption of these foods may help prevent calcium oxalate stones from forming. 

8. Discuss the over the counter medications that you are using with your doctor. Over the counter medications do not need FDA approval and some of them contain substances that can damage your kidney or worsen your kidney disease.


What kind of kidney stone do you have? Were you ever hospitalized? Do you know if you have any kidney damage from the stone?

Resources:
http://health.usnews.com/health-conditions/urology/kidney-stones/prevention
http://www.health.harvard.edu/blog/5-steps-for-preventing-kidney-stones-201310046721
http://kidney.niddk.nih.gov/KUDiseases/pubs/kidneystonediet/

Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Sunday, November 2, 2014

Living Kidney Donation: Act of Kindness from the Donors but no Incentives from the Government

When I started my nephrology fellowship training, I was saddened with the quality of life our dialysis patients live. I started this blog with the goal of dedicating time and effort to add some quality to these patients lives.

Dialysis patients are by far the most complicated patients in medical field. Even with their best adherence to medical therapy, their survival is only 20%. Yet, if they get a living kidney donation, they can live much longer with close to normal quality of life.

As a society, we have focused for paying medical bills for the dialysis patient but have not looked at how to provide incentives to encourage living kidney donation. I have seen this youtube video and was blow away with the facts this speaker presented. Please look at this video and let me know what do you guys think are possible incentives that might increase living kidney donation.





Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Sunday, October 26, 2014

Home Dialysis Los Angeles

There are 2 kinds of home dialysis modalities:
1. Home hemodialysis
2. Home peritoneal dialysis.

Home dialysis has several benefits when compared to in-center hemodialysis. In both choices of home dialysis, patients receive more frequent dialysis session than in-center hemodialysis. As such, they have better blood pressure control. This may reduce stress on the heart and blood vessels.

Patients on home dialysis and nocturnal dialysis are able to eat more and use fewer medications. In addition, patients can do more of their daily activities and continue working.

If you are on home dialysis and planning to travel, you need to talk to your dialysis nurses. They are usually available 24 hours - 7 days of the week. They will arrange for you for either hemodialysis or continuing peritoneal dialysis at your destination.

Patients who do home dialysis are more involved in their care, and as such, are more proactive in living healthy and getting better. On the other hand, in-center hemodialysis patients have better support group as they meet with nursing staff and case managers on regular basis.

When making a decision about the type of treatment, you should take into consideration that home dialysis is usually a daily process, similar to the working of the kidney and may be more gentle with fluid removal from the body. Both home peritoneal dialysis and home hemodialysis are excellent choices in treatment on end stage renal disease patients. They are both as effective form of dialysis as in-center hemodialysis.

There are some people for whom home dialysis may not be appropriate. Home dialysis requires independent patients with good family and social support that can help the patient in this process. Home dialysis is not for everyone. People must receive training and be able to perform correctly each of the steps of the treatment. A trained helper may also be used.


Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Sunday, June 22, 2014

Peritoneal Dialysis Frequently Asked Questions Part 5

This is Peritoneal Dialysis Frequently Asked Questions Part 5
Click here for Part 1
Click here for Part 2
Click here for Part 3
Click here for Part 4

15. Can I remain sexually active once I begin dialysis?
Yes. You are encouraged to maintain a normal lifestyle. Some patients may experience a decrease in sexual drive. If this becomes a problem for you, talk to your doctor. Decrease sexual drive on dialysis is multifactorial. If you are feeling sad or depressed, please make sure to talk to your doctor. Some peritoneal dialysis patients find it difficult to accept a permanent PD catheter. They worry that the catheter may affect their sexual activity and their relationship with their partner. Peritoneal dialysis nurses can help with tips on how to disguise the PD catheter.National Kidney Foundation has a very good and detailed page on sex and dialysis which you can access by clicking here.

16. Should I cancel my current Insurance?
This is a good question. Most of the patients when they start dialysis have many questions about the insurance and their coverage. Each insurance is different and have different requirement. The social worker will do everything for you. Do not worry about insurance too much. The social worker will be in touch with your insurance and try to arrange everything for you. Do not cancel any insurance policy without discussing your options with your social worker. Being on dialysis will qualify you for medicare. Discuss your options with your dialysis center social worker.

17. How will I get the supplies I need for peritoneal dialysis?
Supplies will be delivered to your home on a regular basis. A nurse will order your first shipment. A customer service representative will call you to set up future deliveries. Make sure to keep the information for you supplier so you can easily reach them. If you ever had any difficulties, call your peritoneal dialysis team. They will help you to get your peritoneal dialysis supplies. Make sure to not wait until the last day to order the new supplies. Also, if you are planning to travel, make sure to talk to your peritoneal dialysis team and supplier in advance so they can arrange the dianeal fluid to be sent to your destination. To access you Baxter account Click Here. If you need to contact Baxter Click Here. This is a video of peritoneal dialysis delivery if you would like to watch. Video

18. How often will I need peritoneal dialysis? 
Peritoneal dialysis is done every night. At night time, you or your loved one will connect you to the peritoneal dialysis machine and in the morning, you will get disconnected and can go to work. One of the benefit of the peritoneal dialysis is that because you do dialysis on daily basis, your fluid balance is well controlled and as such your blood pressure will be better controlled. Another benefit of peritoneal dialysis is that it gives the patients much autonomy and ability to continue life and have active life style. Your doctor will determine your exact peritoneal dialysis “prescription.” You can always talk to your doctor about your daily activities and see if he/she can change the prescription to be suitable to your lifestyle. If you are going to travel, make sure to arrange for the peritoneal dialysate (fluid for PD) to be delivered there in advance. You peritoneal dialysis team can help you with that. In addition, if you are going to miss a peritoneal dialysis session, make sure to contact you dialysis team and update them.

This is Peritoneal Dialysis Frequently Asked Questions Part 5
Click here for Part 1
Click here for Part 2
Click here for Part 3
Click here for Part 4



Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Friday, June 20, 2014

Peritoneal Dialysis Frequently Asked Questions Part 4


This is Peritoneal Dialysis Frequently Asked Questions Part 4
Click here for Part 1
Click here for Part 2
Click here for Part 3
Click here for Part 4

11. How long does a peritoneal dialysis treatment take?
Peritoneal dialysis is done every day at night time. The average time is about 8-10 hours, depending on what your doctor prescribes. Some patients may need to have an additional exchange during the day. Since peritoneal dialysis is done every day, patients' blood pressure is much better. In addition, because peritoneal dialysis is done at home, it can be very time saving for patients. If you are going to travel or miss your dialysis, make sure to call your peritoneal dialysis team and let me know.

12. How long will it take me (or a family member/caregiver) to learn to do the treatment?
This is a very good question. The reality is some people may need more time. The important thing is to not rush. In addition, always call your dialysis team if any questions comes up. Remember, asking question is a good sign. It means you care about doing your treatment in best way. And this will make your dialysis team happy. Do not get frustrated. Frustration will not help you. Establish a good relationship with your peritoneal dialysis team especially the nurses. Make sure you have their 24 hours number handy.

13. What happens to my job? Can I continue to work? 
The answer to this question depends to your overall wellbeing. In my experience, peritoneal dialysis patients remain more independent compared to hemodialysis patients. Peritoneal dialysis is done mostly at night time. In addition, your doctor can change the prescription so it can fit your schedule better. Many peritoneal dialysis patients continue to work. Sometimes, hours or duties may need to be changes. Continuing to work helps dialysis patients to retain a better quality of life and have higher self satisfaction. Do not take guilt feeling or be shy at work because your kidneys have failed. This was not your fault. Also, ask around at work and see if any of co-workers is interested to participate in a blessing act of kidney donation. Remember, it does not hurt to ask!

14. Will I qualify for disability?
Once you start peritoneal dialysis, your doctor and peritoneal dialysis team will see you on monthly basis. They will evaluate your health and type of work environment to determine if you can continue your job. If you are unable to work, your social worker will help you determine what benefits you are entitled to and how to apply. Do not fall in the trap of taking a sick patient role. Continuing your job and profession can have many positive psychological benefits in addition to financial benefits. One of the distinguishing factors in peritoneal dialysis is that you can continue to work. Now I understand some times, this will not be possible. Talk to your dialysis team. They will try to help you through this. If your dialysis team and you decided not to continue work, the social worker will assist you with different benefit plan. This is noting to be ashamed off. Dialysis team and social worker will assist you to improve your financial shortcomings.

This is Peritoneal Dialysis Frequently Asked Questions Part 4
Click here for Part 1
Click here for Part 2
Click here for Part 3
Click here for Part 4



Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Monday, June 16, 2014

Peritoneal Dialysis Frequently Asked Questions Part 3


This is Peritoneal Dialysis Frequently Asked Questions Part 3
Click here for Part 1
Click here for Part 2
Click here for Part 3
Click here for Part 4

8. How will dialysis affect my family?
Family and social support is very very important in dialysis patients. As you start peritoneal dialysis, some of the roles in family will change. With peritoneal dialysis, you will be able to remain much more independent than hemodialysis. Remember, you will need your family for support as you begin dialysis, and your family will need your support as well. It is hard to see a loved one starting dialysis. Some patients start becoming frustrated on dialysis and may start blaming themselves or their family members. Try to stay positive. Family members are very important. I can not stress enough on this. Make sure to take your family members to the dialysis unit too. This way, they will see some of the challenges you are facing. In addition, try to make a close friendship with your family members and dialysis team. When you get referral to a transplant center, one of the main things they look at is who is your family members and how much social support you have to help you through transplant. Also remember, family members could be best possible source of kidney donation.

9. Will I still take the same medications once I start dialysis?
This is a good question. I know as a patient with kidney disease, you may have many medications to take. Your nephrologist (kidney doctor) will decide what medications are needed once you begin dialysis. No new medications (over-the-counter or prescriptions from other doctors) should be taken without checking with your nephrologist. If any doctor starts you on new medications, let them know that you are on peritoneal dialysis. Different medications need different dose adjustment once a patient native kidneys fail and start peritoneal dialysis. Always always always have an updated list of your medications and their dosages you are taking and show it to your dialysis team. If the dialysis team wants to change or add new medication write down their name and indications. Remember, try to stay active. It is easy to lose hope and be passive. If you want to get better, you need to stay positive and take role. Be involved.

10. Will I qualify for Medicare to help pay for the peritoneal dialysis?
Yes. In United States all dialysis patients qualify for medicare. Your dialysis unit social worker will assist you with Medicare and other sources that might be available to help pay for dialysis. Each peritoneal dialysis center should have at least one social worker. Try to know the social worker closely. These people can make your life much easier. Talk to them. Let them know about what you do. Tell them your financial and social needs. The dialysis social workers have resources to help you in many ways. Before your monthly peritoneal dialysis check up, take a piece of paper and write down your questions and difficulties you face on peritoneal dialysis. The dialysis team and social worker will try to help you with them.

This is Peritoneal Dialysis Frequently Asked Questions Part 3
Click here for Part 1
Click here for Part 2
Click here for Part 3
Click here for Part 4



Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Sunday, June 15, 2014

Peritoneal Dialysis Frequently Asked Questions Part 2

This is Peritoneal Dialysis Frequently Asked Questions Part 2
Click here for Part 1
Click here for Part 2
Click here for Part 3
Click here for Part 4

4. Is Peritoneal Dialysis a painful therapy?
Contrary to hemodialysis, there is no needle involved in peritoneal dialysis. As such it should not be painful. Occasionally, after the dialysis catheter is inserted, abdominal discomfort may occur for one week. If discomfort continues, adjustments can usually be made to your dialysis exchange. Always report pain or discomfort to your doctor or nurse. Pain at the exit site or around it can mean skin infection or even more importantly peritonitis. If you start having pain or abdominal discomfort, you should notify your peritoneal dialysis team. They will obtain culture of abdominal fluid and try to treat you accordingly.

5. Will my kidneys ever work again?
The answer to the question depends to what was the underlying reason for kidney loss. Some patients have had chronic kidney disease for many years, and now, their disease has progressed to end stage renal disease. On the other hand, some patients has had acute kidney injury and may recover some kidney function. Some of the patients on dialysis still make urine. This does not mean that they can come off of dialysis. One of the most important issues is to prevent further deterioration in kidney function. This requires close follow up with dialysis team and avoid any medications that can cause kidney damage such as contrasted imaging.

6. I still make urine, so why do I need to start dialysis now?
Kidney's job is to control your body's fluid status, correct your electrolytes, and get rid of toxins. Making urine is only part of what kidneys do. Dialysis will help you to get rid of extra fluid, balance your electrolytes and more importantly get rid of toxins. Many patients, at first, are hesitant to start dialysis. They associate dialysis with death and pain. However, many of these patients start feeling much better after few sessions of dialysis. This is because dialysis helps to remove many toxins from their body that had been gradually accumulate with decrease in kidney function. In addition, once patients start on dialysis, they start feeling bette, more energetic, and can continue their normal activities. Make sure you ask your dialysis team to refer you to transplant center as soon as possible to be evaluated for kidney transplant. Also make sure to ask around from friends, family members, and church people to see if they like to be a donor.

7. What will happen if I miss a dialysis treatment?
This depends to the patient's residual renal function and whether the patient does hemodialysis or peritoneal dialysis.  Missed treatments allow waste products and extra fluid to build up in your body, which often leads to health problems. Peritoneal dialysis patients are on dialysis seven days of the week. As such peritoneal dialysis patients fluid status is much better that hemodialysis patients. Also toxins are removed in continuos manner vs hemodialysis patient that receive dialysis 3 times per week. If you are going to miss a dialysis session you need to inform you dialysis team.

This is Peritoneal Dialysis Frequently Asked Questions Part 2
Click here for Part 1
Click here for Part 2
Click here for Part 3
Click here for Part 4



Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Friday, June 13, 2014

Peritoneal Dialysis Frequently Asked Questions Part 1

This is Peritoneal Dialysis Frequently Asked Questions Part 1
Click here for Part 1
Click here for Part 2
Click here for Part 3
Click here for Part 4

When I see patients in PD clinic, I encounter similar questions. This page should answer many commonly asked questions regarding peritoneal dialysis in different languages. If you have any other questions, please write it on this blog post, and I will try to answer them to the best of my ability.

1. How often will I have to come in for check ups?
Most dialysis centers would like to see their patients at least once a month unless your doctor or nurse instruct you otherwise. If you are not sure, call you PD nurse. There should be a 24 hour nurse available to answer questions. Remember, on each visit, the doctor will go over you lab results and try to optimize your dialysis. Studies show, patients who have good followup with their dialysis team, have good compliance and better outcomes.

2. Do I need a special place to do my dialysis?
One of the most important issues with PD is the setup. Another words, if you dedicate a special place for PD machine and have all the materials ready in one place, it should make it easier for you to connect yourself to the PD machine. Hand hygiene is very important. In addition, the room that you choose to do your dialysis in should be clean and free of clutter, have good lighting and have enough room for all the dialysis supplies.

3. How long will I need to undergo this therapy?
This is a very good question. If you are asking this question, it means you want to get better as soon as possible. With advanced kidney disease, dialysis or kidney transplant is a lifelong therapy. That being said, keep in mind that with other organ failures, such as heart failure and liver failure, there is no such therapy like dialysis to keep patient alive and functioning. In addition, if you have good follow up with your dialysis team and otherwise in good health, you should be referred to a transplant center as soon as possible. Remember, ask around from family members, relatives, friends, and church members to see if they are willing to donate their kidneys. Do NOT be shy. Do NOT be ashamed. Being on dialysis is not your fault. A lot of people would love to be part of such a good act and make a difference.

This is Peritoneal Dialysis Frequently Asked Questions Part 1
Click here for Part 1
Click here for Part 2
Click here for Part 3
Click here for Part 4



Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Thursday, June 12, 2014

How to do Peritoneal Dialysis?

http://www.pinterest.com/amashhadian/peritoneal-dialysis/
There are 2 ways to do dialysis. 1. Hemodialysis and 2. Peritoneal dialysis. When I discuss starting dialysis on my patients, I will talk to them about both.

However, personally I like peritoneal dialysis more because patient has much mo autonomy. In addition, with peritoneal dialysis, you can control extra fluid more easily, and this may reduce stress on the heart and blood vessels. With peritoneal dialysis you are able to eat more and use fewer medications. You can do more of your daily activities and it is easier to work or travel.

However, unfortunately, there are some people for whom peritoneal dialysis may not be appropriate. The abdomen or belly of some people, particularly those who are morbidly obese or those with multiple prior abdominal surgeries, may make peritoneal dialysis treatments difficult or impossible. Peritonitis (infection of abdomen) is an occasional complication although should be infrequent with appropriate precautions. When making a decision about the type of treatment, you should take into consideration that peritoneal dialysis is usually a daily process, similar to the working of the kidney and may be more gentle with fluid removal from the body.

Peritoneal dialysis is an effective form of dialysis, has been proven to be as good as hemodialysis.Peritoneal dialysis is not for everyone. People must receive training and be able to perform correctly each of the steps of the treatment. A trained helper may also be used.


Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Wednesday, March 19, 2014

Living Donor Outcomes in Kidney Trasnplantation

A major concern about living donors is the long-term impact of uninephrectomy on risk of hypertension, proteinuria, and chronic kidney disease. One of the more important recent reports regarding the long-term impact of living donation has been provided by Ibrahim and colleagues. This report described almost 3,700 kidney donors who donated kidneys over 44 years. At a mean of 12 years after donation, 85% of a subset of the living donors had a GFR of 60 ml/min or higher, 32.1% had hypertension, and 12.7% had albuminuria. Older age and a higher body mass index, but not a longer time since donation, were associated with both a lower GFR and hypertension. More time from donation was independently associated with albuminuria. Most importantly, the survival of kidney donors was similar to that of controls matched for age, gender, and ethnicity. ESRD developed in 11 donors, a rate of 180 cases per million persons per year, compared with a rate of 268 per million per year in the general population. Most donors had quality-of-life scores that were better than population norms, and the prevalence of coexisting conditions was similar to that among controls from the National Health and Nutrition Examination Survey (NHANES) who were matched for age, sex, race or ethnic
group, and BMI.



Ibrahim HN, Foley R, Tan L, Rogers T, Bailey RF, Guo H, Gross CR, Matas AJ: Long-term consequences of kidney donation. N Engl J Med 360: 459–469, 2009

Overall Outcomes for Living Kidney Donors

http://www.pinterest.com/amashhadian/kidney-donation/
Accurate information about the effects of donor nephrectomy is important in counseling potential live kidney donors. Issues involve both the short-term risk – the risks of surgery and the immediate peri-operative period – and the long-term risks – overall health and specifically the function of the remaining kidney. Review of peri-operative mortality and long-term survival from registry data in over 80,000 live kidney donors from 1994 through 2009 revealed an overall 90 day mortality rate of 3.1 per 10,000 live donor nephrectomies. Surgical mortality was higher in men than women (5.1 vs. 1.7 per 10,000) and in African American/Hispanic compared with white donors (7.6 vs 2.6 per 10,000). Neither increased donor age, smoking, nor obesity (BMI > 30) was associated with higher surgical mortality. The long-term survival of living kidney donors was no different than that of age- and co-morbidity-matched National Health and Nutrition Examination Survey participants for all patients stratifies by age, sex, and race. Obesity is a common issue in potential live donors: a review of the OPTN database of over 5,000 live donors with known BMI data who donated over a 1.5 year period between July 2004 and December 2005 revealed that 40% were overweight, 17.8% were obese (BMI 30-35) and 4.7% were very obese (BMI >35). At baseline and at 6 month follow-up, higher BMI was associated with higher systolic BP, but changes in BP were similar across the groups. There were no apparent differences in decline in GFR or percent change in serum creatinine across these categories of obesity in 6 month follow-up. Others studies have shown that there is no greater decline in renal function in obese patients compared with non-obese patients. Lifetime risk of requiring renal replacement therapy after kidney donation is less than 1%.


Tavakol, MM, Vincenti, FG, Assadi, H, Frederick, MJ, Tomlanovich, SJ, Roberts, JP, Posselt, AM:
Long-term renal function and cardiovascular disease risk in obese kidney donors. Clin J Am Soc
Nephrol 4:1230-8, 2009

Nogueira, JM, Weir, MR, Jacobs, S, Breault, D, Klassen, D, Evans, DA, Bartlett, ST, Cooper, M: A study
of renal outcomes in obese living kidney donors. Transplantation 90:993-9, 2010

Reese, PP, Feldman, HI, Asch, DA, Thomasson, A, Shults, J, Bloom, RD: Short-term outcomes for
obese live kidney donors and their recipients. Transplantation 88:662-71, 2009

Axelrod, DA, McCullough, KP, Brewer, ED, Becker, BN, Segev, DL & Rao, PS: Kidney and pancreas
transplantation in the United States, 1999-2008: the changing face of living donation. Am J Transplant
10:987-1002, 2010

Davis, CL, Cooper, M: The state of U.S. living kidney donors. Clin J Am Soc Nephrol 5:1873-80, 2010

Segev, DL, Muzaale, AD, Caffo, BS, Mehta, SH, Singer, AL, Taranto, SE, McBride, MA, Montgomery,
RA: Perioperative mortality and long-term survival following live kidney donation. JAMA 303:959-66, 2010

Lentine, KL, Schnitzler, MA, Xiao, H, Saab, G, Salvalaggio, PR, Axelrod, D, Davis, CL, Abbott, KC,
Brennan, DC: Racial variation in medical outcomes among living kidney donors. N Engl J Med
363:724-32, 2010


Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Friday, January 31, 2014

Future of Human Kidney Transplant

http://www.pinterest.com/amashhadian/regenerative-nephrology/
Since starting my training in the field of nephrology, my biggest dream has been to see my patients independent of dialysis and having a normal life. Kidney represents the human organ in highest demand among 120,000 U.S. patients waiting for organ donations. 

The usual and most frequent source of kidneys for transplantation has been donation before cardiac death, formerly known as the heart-beating cadaveric donor. The increasing worldwide discrepancy between the availability and need for renal allografts has led to the increasing use of alternative sources of organs, including donation after cardiac death and live donors. 

Approximately 18 people die every day waiting for an organ transplant. But that may change someday sooner than you think -- thanks to 3D printing.

Over a year ago, I started this blog when I saw printing human kidney shown on TED.com. Like other forms of 3D printing, bio-printing lays down layer after layer of live cells to form a solid human tissue. The major stumbling block in creating tissue continues to be manufacturing the vascular system needed to provide it with life-sustaining oxygen and nutrients.

Researchers hope that new generations of 3D printers can use living human cells to build replacement organs — especially organs such as livers, hearts and kidneys.

A 3D-printed kidney, like other 3D-printed replacement organs, likely won't become a reality within the next 10 or 15 years, researchers say. But they plan to use the simplified, miniature versions of 3D-printed organs created so far as guinea pigs for pharmaceutical drug testing — an idea that could help scientists to discover drugs suitable for humans more efficiently and ethically than animal testing.

Currently, there are about 120,000 people on the organ waiting list in the U.S., and even those who receive a donated organ face the prospect of ongoing medical challenges because of organ rejection issues. However, if a patient's own stem cells could be used to regenerate a living organ, rejection would become moot.

To date, the researchers have been able to create a piece of tissue the size of a thumbnail and keep it alive for two weeks.

What do you guys think about this technology? Could this be a reality or a science fiction?






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Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328