Wearable artificial kidney may improve peritoneal dialysis

Automated wearable artificial kidney is effective in removing toxins from the blood of patients during peritoneal dialysis, claims a recent study.

 The study was presented at ASN Kidney Week at the Walter E. Washington Convention Centre in Washington, DC.

Researchers are testing the potential of an automated wearable artificial kidney (AWAK) device for peritoneal dialysis (PD) treatments, which would allow dialysis to be performed on-the-go, overcoming the challenge of long hours of therapy and connection to large dialysis machines.

A sorbent-based regenerative technology in the AWAK PD therapy allows for high dose dialysis to be delivered with a low volume of dialysis solution.

The technology regenerates and reconstitutes used dialysis fluid into fresh fluid while removing toxins.

In a first-in-human study, 15 participants underwent over 100 AWAK PD sessions. There were no serious adverse events up to 1 month after treatment, and the AWAK PD sessions were effective at removing waste substances from the blood.

"The regenerative sorbent technology used in AWAK PD is an innovation with the potential to revolutionise the way peritoneal dialysis has been done in the past 40 years, providing portability and flexibility of treatment," said principal investigator.

"This technology also helps to reduce wastes and save resources by reusing dialysis fluids," she added.

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Gene testing for hereditary breast can be beneficial

More women may benefit from gene testing for hereditary breast or ovarian cancer, especially if they’ve already survived cancer once, an influential health group recommended Tuesday.

At issue are genes called BRCA1 and BRCA2. When they’re mutated, the body can’t repair damaged DNA as well, greatly increasing the chances of breast, ovarian and certain other cancers. Gene testing allows affected women to consider steps to lower their risk, such as when actress Angelina Jolie underwent a preventive mastectomy several years ago.

Most cancer isn’t caused by BRCA mutations — they account for 5 per cent to 10 per cent of breast cancers and 15 per cent of ovarian cancers — so the gene tests aren’t for everyone. But mutations cluster in families and the US Preventive Services Task Force has long recommended that doctors screen women who have relatives with BRCA-related cancers and refer those who might benefit from gene testing to a genetic counsellor to help them decide.

Tuesday, the task force expanded that advice, telling primary care doctors they should also assess women’s risk if:
—they previously were treated for breast or other BRCA-related cancers including ovarian, fallopian tube or peritoneal cancers, and now are considered cancer-free.

—their ancestry is prone to BRCA mutations, such as Ashkenazi Jewish women.

Why screen breast cancer survivors? After all, they already know there’s a risk of recurrence.

Take, for example, someone who had a tumour removed in one breast in their 40s a decade ago, when genetic testing wasn’t as common. Even this many years later, a BRCA test still could reveal if they’re at risk for ovarian cancer — or at higher than usual risk for another tumour in their remaining breast tissue, explained task force member. And it could alert their daughters or other relatives to potential shared risk.

“It’s important to test those people now,” the Dr. said. “We need to get the word out to primary care doctors to do this assessment and to make the referrals.” Private insurers follow task force recommendations on what preventive care to cover, some at no out-of-pocket cost under rules from former President Barack Obama’s health care law.

Cancer groups have similar recommendations for BRCA testing and increasingly urge that the newly diagnosed be tested, too, because the inherited risk can impact choices about surgery and other treatment.

Identifying BRCA mutation carriers “can be lifesaving, and should be a part of routine medical care,” Drs.  who weren’t involved with the new guidelines, wrote in an editorial accompanying them.

But too few high-risk women ever learn if they harbour BRCA mutations, they wrote. For example, cancer groups have long recommended that all ovarian cancer patients be tested, but several studies have found testing is done in less than a third.

Don’t skip the genetic counselling, said the task force’s Mangione. BRCA testing can cause anxiety and sometimes gives confusing results, finding mutations that might not be dangerous — things the counsellors are trained to interpret. There’s a shortage of genetic counsellors, particularly in rural areas, and she said counselling by phone can work.

There’s a wide array of gene tests, some that search just for BRCA mutations and others that test dozens of additional genes at the same time. There’s even a direct-to-consumer kit sold by 23and Me — but Domchek and Robson warned it only detects the three mutations found most in women of Ashkenazi Jewish descent, not dozens of other mutations.

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Rise in breast cancer leading to more ovarian cancer

Breast cancer, the leading cause of mortality among women in India, is being seen as an augmenting factor in the rise in ovarian cancer cases as well, according to medical experts.

A surgical oncologist , says women who have been diagnosed with breast cancer remain at a higher risk of contracting ovarian cancer due to the presence of the same gene that triggers both cancers.

“Genes are responsible for cancer. Owing to the rise in the incidence of breast cancer, we have observed that there is a considerable increase in cases of ovarian cancer as well in the past few years. Even at that hospital, there have been many cases where a female patient has been diagnosed with both,” the Dr. says.

BRCA1 and BRCA2 are human genes that produce tumor suppressor proteins. However, when either of these genes is mutated — meaning it doesn’t function correctly — the damage to the DNA may not be repaired properly. As a result, cells are more likely to develop additional genetic alterations that can lead to cancer.

“There are two types of genes — BRCA1 and BRCA2 — which are responsible for both breast and ovarian cancer. Dysfunction of these two genes increases the chances of getting diagnosed with both the cancers. An individual with breast cancer, therefore, remains at risk of facing ovarian cancer and vice versa,” Dr. Ray noted.

“If one has breast cancer, there are 30-35 percent chances of also having ovarian cancer. And if the person has ovarian cancer, there are 10-15 percent chances of getting diagnosed with breast cancer,” an oncologist noted.

Specific inherited mutations in BRCA1 and BRCA2 most notably increasing the risk of breast and ovarian cancer, but they have also been associated with increased risks of several additional types of the disease like fallopian tube cancer, peritoneal cancer, colorectal cancer, and pancreatic cancer.
Women who have inherited mutations in BRCA1 and BRCA2 tend to develop breast and ovarian cancers at younger ages than those without these mutations.

Although presumed to be more common among women above 50, Dr. noted that both breast and ovarian cancer cases are increasing among women below 35 as well.

“This is owing to poor lifestyle habits. And this is not confined to any particular economic class. A sedentary lifestyle further escalates it,” he added.

Since both cancers are related to genetics, medical experts suggested that women should start screening and gene-testing at an early age.

“For, say, if one or two family members had breast or ovarian cancer then all the women in that family should be tested for BRCA 1 and BRCA 2. Secondly, the screening for both breast and ovarian cancer should start early in life. Suppose a woman’s mother had breast cancer at the age of 45, then she should start mammography at the age of 35,” Dr. pointed out.

In India, however, gene tests are still costly which is why many women fail to get diagnosed in time. Dr.  said that a gene test would cost around Rs 25,000 to Rs 26,000.

“In India, almost 90 percent patients come to a doctor when in an advanced stage because they don’t get detected at an early stage. The main reason is that the symptoms of ovarian cancers are very vague. Despite all types of high-tech surgeries, the survival rate is less than 30 percent,” Dr. added.

The doctors claimed that if detected early, both cancers are curable.

“Nowadays, treatment is very good. If a woman diagnosed with breast cancer is detected and treated at an early stage, there are fewer chances of her having ovarian cancer,” Dr. explained.

According to the latest report, breast cancer is leading cancer among Indian women. The report also stated that ovarian cancer has the sixth-highest incidence rate with the majority in some states.

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