Tuesday, December 31, 2019

We'll miss you, Ananth Pagadala

I woke up this morning to some shocking news. Ananth Pagadala passed away around 1:30 AM. On dialysis for the last twenty five years, Ananth succumbed to a heart attack after complaining of breathlessness. Kidney disease patients from around the country including me were left in shock as we got to know about Ananth's passing.

Ananth had helped so many of us over the years holding our hands as we navigated the traumatic journey that kidney disease often entailed. He was very active on Facebook groups always pitching in with a helpful tip or putting to ease an agitated mind as it tried to make sense of the vagaries of life on dialysis.

Founder of Kidney Patients Support Foundation, Ananth also ran a successful business, Global Meditronic, distributing Dialysis and other Medical Consumables. An ardent believer in leading a normal life despite having kidney disease, Ananth employed people who were suffering from this disease.

Ananth had very good knowledge about kidney disease and the technical aspects about dialysis. He used this knowledge to answer several doubts that patients had on various online groups. He would often be one of the first to answer questions posted on the Kidney Warriors group on Facebook.

Ananth always helped dialysis patients. Going through this suffering first hand, he knew that dialysis patients needed all the help they could get. He helped several patients with free Erythropoietin injections among other things. He held several events to promote awareness and provide support for dialysis patients.

Perhaps the most remarkable thing about Ananth was his ever-cheerful demeanour. No one could even guess that he was on dialysis. He traveled regularly on work and to visit places. An avid foodie, he lived life to the fullest and knew of all the good food joints.

Ananth was an inspiration to all of us and his loss will be felt for a long, long time to come.

Saturday, December 28, 2019

Are your medicines getting washed out during your dialysis session?

I have been suffering from sinusitis for the past month or so. I was prescribed antibiotics but to no avail. I was then referred to a pulmonologist who advised a CT scan of the Paranasal Sinuses and simultaneously put me on two potent antibiotics along with an anti-allergic medicine. I started taking all these medicines in the hope that the sinusitis would resolve.

One thing I have learnt in the past is that dialysis can remove some drugs rendering them useless. Whenever I am prescribed a new drug, I make it a point to refer to a guide such as this one or this one. These guides have a lot of very useful information about the drugs that get dialysed out during a dialysis session including information for Low Flux Hemodialysis, High Flux Hemodialysis and Peritoneal Dialysis.

So what do you do if a drug that has been prescribed can get dialysed out?

It all depends on when you are supposed to take the drug and when your dialysis session is. For example, if you have to take the drug after breakfast and you have your dialysis session in the morning, you should check with your doctor if you can take the drug after your morning session? Things can get tricky if your session is in the afternoon and you have to take the drug in the morning. What do you do then? What if you have to take the same drug in the evening? If your morning dose is going to get washed out during your dialysis session, then you will be getting only about 50% of the dose every other day (assuming you are getting thrice weekly dialysis).

One more option that is explored at times is to increase the dosage of the drug to account for the removal of the drug during dialysis. This is done assuming that the drug is removed only partially. However, this can be quite complicated as you would need to know how easily the drug is dialysed out and this information is rarely available.

All this can lead to serious problems.

While there are no easy answers, it is important that we be aware that the drugs we take can be removed during the dialysis session. Remember, there are thousands of drugs that doctors can prescribe to different patients and it is impossible for them to remember which drugs get dialysed out and which do not. It is up to us, the patients, to read up on this and have a meaningful discussion with our doctors. More often that not, doctors can come up with solutions for this on the lines above.

One important consequence of this is with Blood Pressure medications. Some patients report their Blood Pressure rising after a couple of hours of dialysis. One possible suspect in this case is that the Blood Pressure medications they are on could be getting dialysed out during dialysis. It could be worth exploring switching to a drug that does not get removed or tailoring the dose.

I realised when I referred to the files I linked to above that one of the antibiotics and the anti-allergic were removed during dialysis. I called my nephrologist and asked him what to do. He advised to change the time I take those medicines so that they get enough number of hours in the body and thus, an opportunity to act.

I am glad I did this because otherwise, I would not be getting the adequate dose of those drugs and my problem would take longer to resolve or may not resolve at all.

Saturday, December 14, 2019

3rd Dialysis Olympiad in Pune next Sunday (22nd December)

Come for the 3rd edition of the Indian Dialysis Olympiad being held in Pune's Balewadi Boxing Stadium on Sunday, the 22nd of December from 9 AM to 5 PM.  Show the world you have the Will to Win!

Aashayein in Kolkata tomorrow

If you are on dialysis in Kolkata, come for Aashayein tomorrow.

Sunday, December 1, 2019

Don't hold your breath for the Artificial Kidney, it is still a long time away

I got a call a few weeks back from the friend of someone I know very well. This gentleman was diagnosed with kidney failure recently and was advised dialysis. He had decided to do Peritoneal Dialysis but was debating whether to opt for the manual exchanges or to get a PD cycler and do the exchanges at night. He had come across a video that was floating around the internet about the Artificial Kidney. After seeing this video, he thought since the Artificial Kidney was anyway coming next year, why invest money on buying a PD cycler?

Well, many dialysis patients got excited when this news hit the market. This is a device being developed by Dr. Shuvo Roy and his team. Unfortunately, this article and the video linked to above are yet another example of how the quality of news has deteriorated so completely in recent times. If you went through the video, the first thing that would strike you was the poor quality.

The article linked to above is no better. The headline screams, "Artificial Kidneys Could Be In Patients By 2020". This would lead people, especially dialysis patients to think that they could get the Artificial Kidney by 2020. However, the body of the article says, "There’s still a lot to be done, but the group has just been given $6 million (£4 million) to play with, and said Tuesday at the American Society of Nephrology Kidney Week that human trials within this decade are on the agenda."

Human trials within this decade are on the agenda? Human trials take several years even for simple drugs. This is a completely new class of a device. It is going to implanted into the human body. Common sense dictates that the trials be very stringent. I hate to dash the hopes of my fellow dialysis patients but honestly, I think it is going to take a minimum of five more years for this to get to a point where this will be available for patients in the US to use. In other countries, it will take even longer. This is assuming that everything in the trials goes as planned. And that is a big if.

India? I can't even guess. Take the NxStage System One. It has been in the US for more than a decade now. There are no signs of it coming to India. Conversations with people in the know have yielded that there is a major concern around affordability in India. How many people can afford a machine that costs around 10L and more importantly the consumables that cost around 4-5K per session?

There are a couple of other such breakthrough devices in various stages of development. One is Dr. Victor Gura's Wearable Artificial Kidney (WAK) and the other is the AWAK which is a device for PD. These devices are likely to come out sooner but even they will take a few more years.

It is good to be hopeful. However it is important to be pragmatic as well. When we take decisions pertaining to our health, we should never get fooled by such poorly written articles. All this may sound depressing. Many dialysis patients would be sorely disappointed. It is better to know the truth than to take a wrong decision not based on facts but on 'clickbait' headlines and sensational articles.

I explained all this to the gentleman who had called. I could sense his incredulous tone when I told him this but I hope he has taken the right decision.


For accurate information about the Artificial Kidney project, click here or checkout their Facebook Page. Also checkout their FAQ page especially the question on how long will the clinical trials take to complete.
For more information about the Wearable Artificial Kidney, check out their Facebook Page.
For more information about the AWAK for PD, see this.
Also see Dr. John Agar's summary of new dialysis technologies.