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Stories from the dialysis comunity across the globe.



Exercise Training Effective for CKD Patients - Renal and Urology News PDF Print
April 28, 2015 Exercise Training Effective for CKD Patients - Renal and Urology News
The goal was 150 minutes per week of moderate-intensity aerobic and resistance exercise.

Supervised exercise training at the gym followed by home-based exercise significantly improves exercise capacity in patients with chronic kidney disease (CKD) who are at risk of cardiovascular disease, an Australian study finds.

The study was a secondary analysis of the Longitudinal Assessment of Numerous Discrete Modifications of Atherosclerotic Risk Factors in Kidney Disease 3 (LANDMARK 3) trial. Patients had non-dialysis CKD stage 3 or above and at least 1 cardiovascular risk factor, such as elevated blood pressure or lipid levels, overweight, or poor diabetic control.

Participants were screened with an exercise stress test before joining the exercise program. A multidisciplinary team monitored their health, including a nurse practitioner, exercise physiologist, dietitian, psychologist, diabetes educator, and social worker.

More than 80 CKD patients were randomly assigned to the intervention or usual care. The exercise prescription consisted of 8 weeks of supervised training at the gym followed by 10 months of home-based training. The goal was 150 minutes per week of moderate-intensity aerobic and resistance exercise. Aerobic activities included walking, jogging, cycling, or rowing. For resistance exercises, participants performed the wall squat, bench press, lunge, wall pushup, seated row, bicep and tricep extension, and bridge holds.

The routine was adjusted for individuals with co-morbid conditions. People with arthritis, for example, were trained in a swimming pool to reduce stress on their joints.

According to results published in the American Journal of Kidney Diseases (2015; 65(4):583-591), exercise training for 12 months significantly improved participants' activity level (METs) and exercise capacity. The gains were supported by increases in distance for the 6-minute walk test and improvements in body composition. Notably, lower limb strength was preserved in the intervention group, while it declined in the control group.

“With this team approach, we found that patients were able to exercise safely,” revealed the research team led by Nicole M. Isbel, PhD, of Princess Alexandra Hospital in Queensland, Australia. “The paucity of information regarding the safety and effect of training may be a barrier to the lack of recommendations by nephrologists for patients with CKD to perform physical activity. Therefore, results from this study should encourage nephrologists to ensure that exercise is recommended routinely to all patients with CKD.”

Adherence to the exercise training was 70% and decreased after 6 months. Ongoing supervision may be more effective, according to the researchers, and should be evaluated in future studies.

Source
  1. Howden, EJ, et al. American Journal of Kidney Diseases,2015 Apr;65(4):583-91;doi: 10.1053/j.ajkd.2014.09.017.

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El Camino Hospital now working with dialysis company - Mountain View Voice PDF Print

El Camino Hospital now working with dialysis company
Mountain View Voice
The deal marks a culmination of several years of work between the hospital and Satellite, according to Glenn Davis, chief innovation and commercial officer for the dialysis company. With the partnership, El Camino now has a nearby dialysis center that ...

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Brokerage Firm Focus: Rockwell Medical, Inc. (NASDAQ:RMTI) - The Markets Daily PDF Print

On a consensus basis, Street analysts are expecting Rockwell Medical, Inc. (NASDAQ:RMTI) to report earnings per share of $-0.1 for the quarter ending 2015-03-31. The company is next slated to report quarterly earnings on or around 2015-05-11. Rockwell Medical, Inc. (NASDAQ:RMTI) last reported quarterly EPS of $-0.14 for the quarter ended 2014-12-31 on 2015–0-2-26. This number was $-0.08 away from what analysts were expecting, resulting in a surprise factor of -133.33%.

There are 5 covering research analysts that have issued an anticipated price level where they predict the stock will reach within the next year. The consensus target for these analysts sits at $16 for Rockwell Medical, Inc.. The highest analyst target sees the stock at $26 within the year. The lowest analyst target sees the stock at $4 over the same time period. Wall Street analysts have a mean estimate for long-term growth of $25 on the stock. When looking at the three months ago number, they had a long-term growth mean estimate of $25 on the company. Placing analyst ratings on a recommendation scale, Rockwell Medical, Inc. has a mean rating of 1.8. Using this scale, a one would represent a Strong Buy recommendation and a five would represent a Strong Sell recommendation. There are 5 broker recommendations that this rating is based on. Profile Rockwell Medical, Inc., formerly Rockwell Medical Technologies, Inc., manufactures hemodialysis concentrate solutions and dialysis kits, and it sells, distributes and delivers these and other ancillary hemodialysis products primarily to hemodialysis providers in the United States, as well as internationally primarily in Asia, Latin America and Europe. Hemodialysis duplicates kidney function in patients with failing kidneys also known as End Stage Renal Disease (ESRD). ESRD is an advanced-stage of chronic kidney disease (CKD) characterized by the irreversible loss of kidney function. Its dialysis solutions (also known as dialysate) are used to maintain life, removing toxins and replacing nutrients in the dialysis patient’s bloodstream. As of December 31, 2011, it was licensed and was developing renal drug therapies. During the year ended December 31, 2011, it acquired an abbreviated new drug application (ANDA) for a generic version of an intravenous Vitamin-D analogue, calcitriol.

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Cardinal Health buys Metro Medical - NephrologyNews.com PDF Print

NephrologyNews.com

Cardinal Health buys Metro Medical
NephrologyNews.com
Metro “has a presence in rheumatology and nephrology offices—two segments where Cardinal has minimal share,” said Fein. Metro listed warehouses in Nashville and Reno, Nevada, according to NN&I's 2014 edition of the Renal Resource and Buyer's ...
Cardinal Health buys Nashville drug distributor, industry source says Columbus Dispatch

all 5 news articles »

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Onboard fuel polishing serves as dialysis for your diesel - The Triton PDF Print

The cornerstone of a diesel fuel maintenance program aboard a yacht is installing an onboard system that will polish the fuel and clean all the tanks.

Fuel polishing systems can be powered by direct current or alternating current, depending on the available electrical supply aboard the yacht and the pumping capacity of the system. The fuel polishing process can be automated with a fully programmable control unit or operated with manually controlled timers, depending on one’s budget.

The ideal tank cleaning system has dedicated pick-up and return tubes plumbed into each tank, including the day tank. The dedicated pick-up tube is placed lower in the tank than the normal pick-up tube for the engines. While a normal pick-up tube is located about 6 inches above the tank bottom, the dedicated tank cleaning pick-up tube is located less than an inch above the bottom of the tank. This allows more water and sludge to be suctioned up during the fuel polishing process, which assures a better job of tank cleaning.

The dedicated pick-up and return tubes from each tank are led into a distribution manifold that feeds the tank cleaning system. This arrangement allows each tank to be cleaned separately by the same piece of fuel polishing equipment. Since the hoses plumbed for tank cleaning are independent of the fuel supply and return hoses for operating the engines, the fuel can be cleaned while the vessel is under way and the engines are running.

The best tank cleaning systems are multistage systems that use a variety of inline fuel conditioning and filtration technologies. Sizing the equipment to match the job is important. The flow rate of the pump that circulates the fuel through the tank cleaning equipment must match the capacity of the tank being cleaned.

If a 3,000 gallon tank is being cleaned using a pump that has a flow rate of 150 gallons an hour, it will take 20 hours to clean that tank. But if the flow rate is 600 gallons an hour, the process will only take five hours.

The first phase of fuel polishing is to pass the fuel through a magnetic conditioner that breaks apart the large clusters of hydrocarbon contaminants. The permanent magnets generate a weak electrical field that separates the bonds holding together the large sediment molecules and disperses them.

The next phase is a water coalescer and particulate filter, which removes free water, sludge, and organic and inorganic matter greater than 30 microns in size. The waste solution of oily water and sludge filtered out during this step is a biohazard and must be disposed of in an environmentally responsible manner.

The last phase is final filtration in which particles down to a diameter of 3 microns or less are removed. This is the most critical step in the fuel cleaning process since particulate contamination is the No. 1 cause of failure in electronically controlled common rail fuel delivery systems in diesel engines. Newer common rail injectors spray fuel into cylinders at a pressure of up to 44,000 pounds per square inch (psi). That is an astounding amount of force since Niagara Falls only has a pressure of 870 psi.

A tiny particle, less than a tenth of the width of a human hair, propelled at extremely high pressure will cut into the ball seat of an injector like a water jet metal cutter. Not only will the injector be permanently damaged, the piston can be damaged as well. Associated repairs can tally into the tens of thousands of dollars per engine.

During the tank cleaning process, an additive is used to dissolve sludge and slime that accumulates on the walls and baffles of the tanks. This procedure assures that mold and bacteria are removed from all tank surfaces to inhibit future growth. Use of a full spectrum additive during this step will also add lubricity to the diesel fuel, prevent corrosion, reduce carbon build up and stabilize the fuel.

Ideally, fuel should be polished and the tanks cleaned whenever the yacht is refueled, or monthly if the yacht is not fueled frequently.

Diesel fuel is the lifeblood of the main engines and generators aboard every yacht. Implementing and strictly adhering to a fuel preventive maintenance program is a simple and inexpensive alternative to the cost of repairing severely damaged high pressure pumps, injectors and pistons.

Capt. Jeff Werner has been in yachting for more than 20 years on private and charter yachts, both sail and power. He is an instructor for RYA, MCA, USCG and US Sailing courses and owns Diesel Doctor (MyDieselDoctor.com). Comments on this column are welcome at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 

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