Does hypertension pose a health risk to older adults who wish to donate a kidney?

Does hypertension pose a health risk to older adults who wish to donate a kidney?


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In an analysis of clinical information on older living kidney donors, hypertension was linked with a higher risk of developing kidney failure. The study, which is published in an upcoming issue of CJASN, provides new information that may help inform discussions with older individuals when they consider donating a kidney.

Receiving a kidney from a living donor is the best treatment for patients with kidney failure, but it is important to ensure that individuals who wish to donate an organ are able to safely do so. Older age is not a barrier for kidney donation; however, for many older individuals hypertension is common. It is unclear whether hypertension elevates the risk of kidney failure or early death among older donors .

To investigate, Fawaz Al Ammary, MD, Ph.D. (Johns Hopkins University School of Medicine) and his colleagues analyzed national registry data on 24,533 older kidney donors from 1999 to 2016, including 2,265 who had hypertension at the time of donation. This information was linked to data from the Centers for Medicare & Medicaid Services and the Social Security Death Master File to determine which donors developed kidney failure or died. The study is the largest to examine what risks older donors with hypertension may face in the long term.

Donors were observed for a median follow-up time of 7.1 years after kidney donation (and up to a maximum of 18 years). During the study period, 24 donors developed kidney failure and 252 died. Hypertension at the time of donation was linked with higher risk of kidney failure, but not mortality. The 15-year risk of kidney failure was 0.8% for older donors with hypertension vs. 0.2% for older donors without hypertension. The risk of kidney failure was 3.1-times higher for donors with hypertension compared with those without hypertension who had otherwise similar clinical characteristics.

When the researchers restricted their analysis to include only donors from the 2004-2016 period (because documentation of antihypertensive therapy was unavailable before this time), they observed a stronger association—a 6.2-fold higher risk for kidney failure among donors with hypertension. There was no significant association between donor hypertension and 15-year mortality.

“Fortunately, the number of kidney failure events in this population is small. Albeit a rather small risk, practice guidelines for live kidney donor evaluation need to be revisited,” said Dr. Al Ammary. “While controlled hypertension in otherwise eligible older individuals may not be viewed as an absolute contraindication for kidney donation, these findings may inform conversations between the provider and the older individuals with hypertension when they consider donating a kidney.”

The investigators plan to conduct additional studies in this area to advance the field of organ transplantation in light of the growing number of older individuals who may offer an important source of organs for living donation.

In an accompanying editorial, Kenneth Newell, MD, Ph.D. (Emory University School of Medicine) and Richard Formica, Jr., MD (Yale University School of Medicine) noted that the findings “should not be used to ‘allow’ or ‘exclude’ individuals from proceeding with living kidney donation but rather should be incorporated into a comprehensive educational program to better inform donors about the long-term consequences of their decision to be a living kidney donor. In addition these findings identify a cohort of medically complex living kidney donors who should be offered the opportunity to enroll in specialized programs to provide lifetime surveillance for and treatment of conditions associated with an increased risk of end stage kidney disease.”


Older kidney donors with hypertension may have good kidney health following donation


More information:
“Risk of End-Stage Kidney Disease in Older Live Kidney Donors with Hypertension,” DOI: 10.2215/CJN.14031118

Provided by
American Society of Nephrology

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Does hypertension pose a health risk to older adults who wish to donate a kidney? (2019, June 25)
retrieved 26 June 2019
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Maine legalizes assisted suicide

Maine legalizes assisted suicide


(HealthDay)—Maine has become the eighth state to legalize medically assisted suicide.

“It is my hope that this law, while respecting the right to personal liberty, will be used sparingly,” Gov. Janet Mills, told the Associated Press.

Under the law, doctors can prescribe a lethal dose of a drug to terminally ill patients, and it will not legally be a suicide. The bill had failed to pass in a state referendum and also a number of times in the State Legislature. It finally passed by one vote in the House and a narrow margin in the Senate.

The new law was praised by Staci Fowler, who took on the fight for the law in honor of her friend Rebecca VanWormer, the AP reported. VanWormer died of breast cancer in 2017 and had pressed for such a law for years before her death. “This is what she wanted,” Fowler told the AP. “And now everybody has the option that she didn’t have.”


Vermont becomes third US state to legalize assisted suicide


More information:
AP News Article

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Maine legalizes assisted suicide (2019, June 15)
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Twins study links type 2 diabetes in midlife with stroke and brain artery narrowing in late life

Twins study links type 2 diabetes in midlife with stroke and brain artery narrowing in late life


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A new study shows that type 2 diabetes in midlife is associated with a 30% increased risk of a serious blockage of the brain arteries, often leading to stroke, and a doubling of the risk of narrowing of the brain’s arteries in people over 60 years. The research is based on a cohort of twins in Sweden and published in Diabetologia, the journal of the European Association for the Study of Diabetes (EASD).

Cerebrovascular disease (CBD) includes a variety of medical conditions that affect the blood vessels of the brain. It falls into two main classifications: ischaemic, in which the blood flow is restricted; and haemorrhagic, in which bleeding occurs. CBD and type 2 diabetes mellitus (T2DM) are common disorders that the World Health Organization places amongst the top ten causes of death—between them killing approximately eight million people worldwide in 2016.

Both T2DM and CBD are complex genetic and lifestyle-related disorders. Genetic and familial environmental factors (e.g. foetal environment, maternal smoking and childhood socioeconomic status) have been shown to be involved in the development of both conditions. Accumulating evidence from previous studies suggests that T2DM is independently associated with an increased risk of CBD, especially ischaemic CBD.

This study—conducted by Ph.D. candidate Rongrong Yang, Tianjin Medical University, Tianjin, People’s Republic of China, and Dr. Weili Xu, Karolinska Institute, Stockholm, Sweden and Tianjin Medical University together with their colleagues—examined the link between type 2 diabetes in midlife and the risk of the different types of CBD in late life.

Also, by focusing on data from twins, the study aimed to explore whether genetic and familial environmental factors could explain the link between T2DM and CBD. Because twins generally share the same genetic backgrounds as well as the same family life, in the uterus and in childhood and adolescence, comparisons made within pairs of twins provide an ideal opportunity to explore the possible confounding effects of genetics and familial environment on any association between the two conditions.

The study involved twins from the nationwide Swedish Twin Registry (STR), which started in the 1960s. During 1998-2002, all living twins above 40 years of age were invited to participate in the Screening Across the Lifespan Twin study (SALT), a full screening process that gathered data via computer assisted telephone interview. Of the participants in SALT, this study focused on those twins who were still alive on the follow up on 31st December 2014.

Individuals who did not reach the age of 60 years by 31 December 2014, who had type 1 diabetes, had T2DM onset before age 40 years or at or over age 60 years, and/or CBD onset before 60 years old, or had suffered a transient ischaemic attack (mini-stroke), were excluded—leaving 33,086 people remaining for the current analyses. The SALT data included information on demographics (age, gender and educational attainment); lifestyle (smoking, alcohol consumption); anthropometric measures (weight and height, from which BMI was calculated); zygosity (genetic similarity); and medication use.

Both diabetes status and CBD incidence were obtained from Sweden’s comprehensive National Patient Registry. The 33,086 twins included 14,969 men and 18,117 women. Of them, 1248 (3.8%) had T2DM at ages 40 to 59 years and 3121 (9.4%) had CBD at or over 60. The data were adjusted for possible confounders including: age, gender, education, BMI, smoking, alcohol consumption, marital status, hypertension, and heart disease. The co-twin matched analysis considered data from discordant twin pairs i.e. one twin with each condition and the other one without.

The study found that whilst there was no significant association between midlife T2DM and subarachnoid or intracerebral haemorrhage (brain bleed stroke) in late life, individuals who developed T2DM at ages 40 to 59 years had double the risk of cerebral occlusion (artery narrowing) and a 30% higher risk of cerebral infarction (ischaemic stroke). Further analysis of twin-pairs appeared to show that genetic and early-life familial environmental factors do not appear to play a role as confounders in the association between midlife T2DM and ischaemic CBD in late life.

The mechanisms underlying the association of T2DM with cerebral infarction and occlusion of the cerebral arteries are complex, state the authors, and not completely understood. They note that individuals with T2DM develop dyslipidaemia (abnormal amounts of lipids in the blood) and accelerated atherogenesis—the formation of fatty deposits in the arteries. In addition, metabolic disturbances such as insulin resistance, increased insulin production in response to this resistance, inflammation, increased fat deposits and abnormally high blood sugar in T2DM may also contribute to cerebrovascular events.

The authors suggest that increase in the number of the endothelial cells lining the blood vessels, and thickening of the basement membrane, induced by T2DM, lead to an increased risk of blocking of, but not rupture of the vessels—hence a the negative association between the condition and haemorrhagic CBD (rupture of the arteries) and a positive association with ischaemic CBD (blockage of the arteries).

The authors note some limitations to the study. There were only a limited number of discordant twins (one twin with CBD) in the analysis. They also note that both monozygotic twins (sharing 100% genetic material) and dizygotic twins (sharing only 50%) were included in the study—such that the analysis could not completely control for genetic make-up. In addition, the SALT data did not include information on dietary intake and physical activity or allow for these factors to be considered as potential confounders in the association.

The authors conclude: “This large-scale, nationwide, population-based study of Swedish twins provides evidence that midlife T2DM is associated with some types of ischaemic CBD but not haemorrhagic CBD in the over 60s. Our findings highlight the need to control midlife type 2 diabetes to help prevent blockage or narrowing of cerebral arteries in late life and reduce the incidence of stokes caused by such blockages.”


T2DM is risk factor for liver fibrosis progression in NAFLD


More information:
Diabetologia (2019). doi.org/10.1007/s00125-019-4892-3

Citation:
Twins study links type 2 diabetes in midlife with stroke and brain artery narrowing in late life (2019, June 5)
retrieved 6 June 2019
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Should measles vaccination be compulsory?

Should measles vaccination be compulsory?


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As measles cases in Europe hit their highest levels this decade, should the UK adopt compulsory vaccination? Experts debate the issue in The BMJ today.

“We need to increase uptake of this vaccine, as we run the risk of measles becoming endemic,” argues Eleanor Draeger, sexual health doctor and medical writer.

Uptake of the measles, mumps, and rubella (MMR) vaccine in the UK is 94.9% for the first dose, but this drops to 87.4% for the second dose, which falls short of the 95% needed to produce herd immunity, she explains.

She points out that mandatory vaccination has increased uptake in other countries, and that in UK society, many things are already legislated to improve individual or public health. “We would argue that the UK now needs to legislate to increase vaccination rates, as current measures aren’t keeping rates high enough to ensure herd immunity.”

Many parents wrongly believe the rhetoric that vaccines are harmful, unnatural, and an infringement of civil liberties, she says.

Ethicists have argued that compulsory vaccination is acceptable because people who don’t vaccinate their children are potentially putting other people’s health at risk, particularly those who can’t be vaccinated and are therefore more vulnerable.

“Passing a law that stops children attending nursery or school unless their vaccinations are up to date or they are medically exempt would allow free choice while protecting vulnerable children,” she concludes.

But Helen Bedford and David Elliman at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital argue that rather than mandatory vaccination, the UK should concentrate on other methods to increase vaccine uptake, such as improving access to services.

For example, ensuring that general practices have an immunisation lead and adequate appointment reminders in place, making immunisation settings child and family friendly, and ensuring staff have adequate time to talk to parents, and have been trained to tackle any issues that arise.

“Only when these components are in place should we consider mandatory vaccination,” they say.

Even then, they warn of potential unintended consequences. For instance, would parents still trust the NHS and healthcare professionals if GP data were used to decide whether a child was admitted to school or whether a family were allowed certain welfare benefits?

If school entry were denied, some parents may resort to home-schooling, and if vaccination were attached to welfare benefits it would be the less well off, but determined, parents who would suffer disproportionately, they add.

They welcome a recent House of Lords debate that favoured improving services rather than compulsion, and say “we believe that the UK should concentrate on improving its infrastructure and not risk alienating parents unnecessarily.”


Should childhood vaccination be mandatory?


More information:
Should measles vaccination be compulsory? BMJ (2019). DOI: 10.1136/bmj.l2359

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Should measles vaccination be compulsory? (2019, June 5)
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Childhood respiratory disorders may be diagnosed with a smartphone

Childhood respiratory disorders may be diagnosed with a smartphone


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Automated cough analysis technology incorporated in a smartphone app could help to diagnose childhood respiratory disorders, according to a study published in the open access journal Respiratory Research.

Researchers at Curtin University and The University of Queensland, Australia, showed that a smartphone app had high accuracy (between 81% and 97%) in diagnosing asthma, croup, pneumonia, lower respiratory tract disease and bronchiolitis.

Dr. Paul Porter, corresponding author of the study, said: “It can be difficult to differentiate between respiratory disorders in children, even for experienced doctors. This study demonstrates how new technology, mathematical concepts, machine learning and clinical medicine can be successfully combined to produce completely new diagnostic tests utilising the expertise of several disciplines.”

To develop the app, the authors used similar technology to that used in speech recognition, which they trained to recognise features of coughs which are characteristic of five different respiratory diseases. The researchers then used the app to categorise the coughs of 585 children between ages 29 days to 12 years who were being cared for at two hospitals in Western Australia. The accuracy of the automated cough analyser was determined by comparing its diagnosis to a diagnosis reached by a panel of paediatricians after they had reviewed results of imaging, laboratory findings, hospital charts and conducted all available clinical investigations.

The authors note that the technology developed for this study is able to provide a diagnosis without the need for clinical examination by a doctor in person, addressing a major limiting feature of existing telehealth consultations, which are used to provide clinical services remotely. Removing the need for a clinical examination may allow targeted treatments to begin sooner.

Dr. Porter said: “As the tool does not rely on clinical investigations, it can be used by health care providers of all levels of training and expertise. However, we would advise that where possible the tool should be used in conjunction with a clinician to maximise the clinical accuracy.”


Cough app targets US success


More information:
A prospective multicentre study testing the diagnostic accuracy of an automated cough sound centred analytic system for the identification of common respiratory disorders in children, Respiratory Research (2019). DOI: 10.1186/s12931-019-1046-6

Provided by
BioMed Central

Citation:
Childhood respiratory disorders may be diagnosed with a smartphone (2019, June 5)
retrieved 6 June 2019
from https://medicalxpress.com/news/2019-06-childhood-respiratory-disorders-smartphone.html

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