Advanced kidney disease patients can survive, with quality life, without dialysis

People with advanced chronic kidney disease who decide against maintenance dialysis treatment still can survive for many years with a high quality of life, an analysis published on Monday found.

However, this may change late in the course of their illness, when many of them may require hospitalization or surgical procedures to address complications due to declines in kidney function, the researchers said. 

"Many patients who forgo dialysis can live for several years and experience sustained quality of life after their decision," study co-author Dr. Susan P. Y. Wong told UPI in an email.

"Our study highlights how dialysis shouldn't be the only option for treating advanced kidney disease, although it can often seem this way to patients," said Wong, a kidney specialist at the University of Washington and the VA Puget Sound Health Care System in Seattle. 

In dialysis, a machine is used to remove excess water and toxins from the blood, according to the National Kidney Foundation.

These are functions normally performed by the kidneys, when they are healthy, the foundation says.

Dialysis treatments can last up to four hours and are often needed several times per week, it says. 

Advanced chronic kidney disease, or when the organs' function has declined enough to be life-threatening, can be a complication of a number of health problems, including Type 2 diabetes and severe heart disease, according to the Mayo Clinic.

However, starting dialysis earlier does not necessarily improve the prognosis in people with advance kidney disease, recent studies suggest, and it may cause side effects, including an increased risk for infections, the National Kidney Foundation says.

As a result, many patients, working with their care team, opt for a more "conservative" approach that includes prescription medications that help manage symptoms and reduce the risk for complications, Wong said.

For this study, she and her colleagues analyzed data from 41 studies that included more than 5,100 patients with advanced kidney disease.

Patients who opted against maintenance dialysis survived four up to four years after forgoing the treatment, the data showed.

Those who skipped the treatments reported improved quality of life and mental well-being, based on results from several commonly used measures, compared with those who decided to pursue dialysis, the researchers said.

However, in a typical year, those who opted against dialysis were admitted to the hospital twice, spent up to 16 days in the hospital, visited a healthcare clinic eight times and needed emergency room care twice due to symptoms and complications of kidney failure, according to the researchers.

"Each option has different pros and cons, and each set of pros and cons will be different for every patient," Wong said.

"I encourage patients to talk with their clinicians about what is most important to them and their health goals," she said.

 

 

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Many factors influence decisions to withdraw life-support brain injury patients

There are several factors that determine the decisions to withdraw life support treatments in critically ill patients with severe brain injury, says a recent study.

The study provides a new understanding of the decision-making processes for this patient population, which accounts for most hospital deaths from trauma.

One of the researchers said, many clinicians struggle to make recommendations to withdraw life-sustaining treatments because decision-making is often complicated by uncertainty from trying to match family or caregiver opinions about  what they think the patient would have wanted in terms of quality of life and how well physicians can predict a prognosis.

The death rate in critically ill patients with severe traumatic brain injury is generally high as it occurs after a decision to withdraw life-sustaining treatments.

This patient population differs from the general intensive care unit (ICU) population as most patients were healthy before admission to the ICU, as compared with older patients who may already have a poorer quality of life due to pre-existing illness.

Therefore, decisions to withdraw life-sustaining treatments are made differently, mainly based on long-term prognosis and quality of life.

The researchers performed a descriptive qualitative study of interviews with critical care physicians from across Canada to understand the factors that determine a critical care physician's decision to discuss with families the withdrawal of life-sustaining treatments in patients with severe traumatic brain injury.

Results show that several factors are accountable including the patients' pre-expressed wishes and the family's wishes, severity, and location of the injury, along with evidence.

Past physician experience, legislation, opinions of colleagues and time are additional factors influencing decisions. The incidence of withdrawal of life-sustaining treatments and of death in critically ill patients with traumatic brain injury varies between hospitals.

Better evidence, tools to help predict patient outcomes, standardisation, better ways to integrate patient values and preferences into decision-making, improved training during critical care fellowships and more time to estimate prognosis are some things that could improve decision-making whether to withdraw life-sustaining treatments.

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It’s not “Just Asthma”: Asthma and its Impact on Quality of Life

We conducted a large survey of people living with asthma where we asked questions about their diagnosis, medications, and treatments, and how asthma impacts one’s quality of life. The survey revealed to us that asthma is not just about taking your inhaler and is a complex condition where major aspects of one’s life are impacted by it.

For many people, asthma symptoms can be ever-present. While some asthma symptoms can be invisible like fatigue and exhaustion from constantly trying to breathe easier, other symptoms like shortness of breath can be straight-up be scary. And so many of our community members have shared with us experiencing chronic cough which those who don’t live with asthma mistake as the contagious kind of cough.

Asthma symptoms are not only annoying but impact one’s day to day life too. Those living with asthma report that various aspects of their lives are impacted by it, including, but not limited to their physical and emotional well-being. Many people who don’t live with asthma are unaware of the profound impact asthma can have on one’s quality of life, including sleep.

It is not only difficult to identify asthma triggers, but also very tough and sometimes simply impossible for people to change their living situation or environment to control the triggers that cause their symptoms to exacerbate.

There is a common misconception among those who don’t live with asthma that it is “easy to manage”. People think one just has to “take the inhaler” and it’s done. But managing control medications, rescue inhalers, avoiding triggers, dealing with asthma attacks and exacerbation, dealing with hospitalization due to asthma episodes, growing old with asthma and what that entails, are only some of the things that put a significant burden of disease management for those who live with this condition.

All in all, living with asthma impacts all aspects of one’s life. Awareness about this aspect of asthma is key in order to fully support those who grapple with this diagnosis and management. 

I can tell you, for others, Oh, just asthma, only those who have it know what we go through. As now, I've graduated to COPD !, people don't mistake it for NYPD /LAPD ! 

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Motor neuron disease symptoms may be relieved by cannabis sativa plant

An oral spray containing two compounds derived from the cannabis sativa plant reduces spasticity in patients experiencing motor neuron disease symptoms.

Researchers from Italy, have found that chemical compounds derived from the cannabis sativa plant given as an add-on treatment could potentially help to ease motor neuron disease symptoms such as tight or stiff muscles.

Reducing motor neuron disease symptoms

The findings show for the first time that adults with motor neuron disease experienced less spasticity and pain at a 6-week follow-up compared with those given placebos. Patients involved in the study took first-line anti-spasticity drugs and were then treated with an oral spray (nabiximols) containing equal parts delta-9 tetrahydrocannabinol THC and cannabidiol (THC-CBD) derived from the cannabis sativa plant.

While there are several drugs to relieve spasticity, evidence for their effectiveness is limited and they do not sufficiently improve symptoms in all patients. Moreover, they have the possibility of causing undesirable side effects, such as increasing muscle weakness and fatigue.

Dr.  who led the research explained: “There is no cure for motor neuron disease, so improved symptom control and quality of life are important for patients.”

“Our proof-of-concept trial showed a beneficial effect of THC-CBD spray in people on treatment-resistant spasticity and pain. Despite these encouraging findings, we must first confirm that THC-CBD spray is effective and safe in larger, longer term phase 3 trials.”

The cannabis sativa plant

Common motor neuron disease symptoms are usually spasticity. The disease itself occurs to a variable degree in people with amyotrophic lateral sclerosis (ALS), the most common and severe form of motor neuron disease and is a crucial characteristic of primary lateral sclerosis (PLS), which progresses more slowly.

Previous research has found possible therapeutic benefits of cannabinoids (components of the cannabis sativa plant) to include muscle relaxation, pain-relieving, and anti-inflammatory effects in patients with other neurological conditions.

Moreover, cannabinoids have been licensed in several countries for symptomatic treatment of spasticity in multiple sclerosis and are increasingly recognised as a valuable alternative option to manage pain.

Utilising extracts from the cannabis sativa plant to reduce motor neuron disease symptoms

The results of the research found that spasticity was significantly improved in the THC-CBD spray group compared with the placebo group.

Overall, THC-CBD spray was well tolerated, and adverse events were mild to moderate and typical of cannabinoids i.e. asthenia (loss of energy and fatigue), somnolence (sleepiness), vertigo, and nausea.

However, researchers have noted that it is vital to ensure that before gaining the approval of utilising aspects of the cannabis sativa plant for symptomatic treatment of spasticity in patients showing motor neuron disease symptoms or suffering from the condition, further studies are needed.

THIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES.                                                                                                                                                                                                                                                                                        PS- THOSE INTERESTED IN RECIPES ARE FREE TO  VIEW MY BLOG-                                                                                           https://gseasyrecipes.blogspot.com/                                                                                                                                                                             FOR INFO ABOUT KNEE REPLACEMENT, YOU CAN VIEW MY BLOG-                                                                                                                             https:// kneereplacement-stickclub.blogspot.com/                                                                                       FOR CROCHET DESIGNS                                                                                                                                                                                                                                 https://gscrochetdesigns.blogspot.com