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Researchers have completed the first successful in-patient trial of liver dialysis. The DIALIVE device, invented by researchers at UCL’s Institute for Liver and Digestive Health, was found to be safe and effective, research suggests. According to a new study, the device is associated with substantial improvement in the severity of symptoms and organ function in a greater proportion of patients with acute-on-chronic liver failure (ACLF), when compared with patients receiving standard of care. The next step would be a larger clinical trial, which if successful could see DIALIVE approved for clinical use within the next three years. Read full story Source: The Independent, 1 June 2023

A young woman receiving end-of-life care says she is “just waiting to die” as an agonising three-year wait for a kidney transplant has left her “living like a prisoner”. Diana Isajeva is one of approximately 7,000 patients who are on the waiting list, according to the NHS Blood and Transplant service (NHSBT) – the highest figure in a decade. The 29-year-old was due to have a transplant last year but was denied it at the last minute, after the living donor she was matched with pulled out just 24 hours before her planned surgery. Data from NHSBT shows that the rate of families giving consent for their loved ones’ organs to be donated has dropped – despite a change in the law in 2020 aimed at boosting the number of organs available, which means that consent for donation is now presumed after death. Professor Peter Friend, transplant lead for the Royal College of Surgeons (RCS), said decreasing donor rates are a “big challenge” and that it is concerning that the number of donations has not yet recovered to its pre-pandemic level. Read full story Source: The Independent, 27 March 2023

The family of a man who bled to death during kidney dialysis treatment at Royal Shrewsbury Hospital have said they believe lessons have been learned. Mohammed Ismael Zaman, known as Bolly, died after hospital staff failed to check the connection on his dialysis machine, despite it sounding an alarm after the catheter had become disconnected. During Mr Zaman’s treatment at the Royal Shrewsbury Hospital on October 18, 2019, his dialysis machine set off a venous pressure alarm. An unidentified member of staff reset the alarm without checking that the connection was still secure. As a result of the reset, Mr Zaman bled out for seven minutes losing 49% of his blood circulating volume. He was found unconscious in a pool of blood and despite resuscitation attempts, died two hours later. The coroner, Mr John Ellery concluded that the death was due to systems failure and individual neglect on the part of the unidentified staff member. Read full story Source: Shropshire Star, 16 January 2021

More than a quarter of patients with COVID-19 on ventilators also need renal support in the form of dialysis, raising concerns that there could be significant supply problems as countries attempt to stock up on the required fluid and plastic consumables. Nephrology consultant Graham Lipkin told The BMJ, “This is an under-recognised challenge. While the original focus has been on whether we have enough ventilators and intensive care beds, it has become apparent that there is a high incidence of acute kidney injury (AKI) requiring some form of renal replacement therapy (RRT) through dialysis. With the volume of people coming into intensive care, there are increasing challenges to capacity across the system.” Lipkin, who is president of the Renal Association, has been working with NHS England to develop new clinical guidelines for the prevention and optimal management of AKI in hospital. The guidance aims to reduce the incidence of AKI and therefore the demand for dialysis. Read full story Source: BMJ, 21 April 2020

New guidelines have been published to help doctors and nurses decide how to prioritise patients during the coronavirus pandemic. The advice from the National Institute for Health and Care Excellence (NICE) was produced amid concerns that the NHS would be overwhelmed by the demand for intensive care beds and ventilators. The three new NICE guidelines, which have been drawn up within a week rather than the usual timescale of up to two years, cover patients needing critical care, kidney dialysis and cancer treatment. They say all patients admitted to hospital should still be assessed as usual for frailty “irrespective of Covid-19 status”. Decisions about admitting patients to critical care should consider how likely they are to recover, taking into account the likelihood of recovery “to an outcome that is acceptable to them”. Doctors are advised to discuss possible “do not resuscitate” decisions with adults who are assessed as having increased frailty, such as those who need help with outside activities or are dependent for personal care. Read full story Source: Independent, 22 March 2020

The programme of giving third Covid vaccinations to people with compromised immune systems has been a “chaotic failure”, charities have said, with fewer than half of those eligible contacted about a third jab before an NHS deadline this month. Surveys by Blood Cancer UK and Kidney Care UK found that for both groups of patients, between 55% and 60% had yet to be invited to get a third injection, seen as particularly vital for conditions which affect people’s immune systems, as they are generally less protected by two jabs. The charities said many of those who responded were desperately worried and were struggling to get information about a third vaccination. Some people with blood cancer had resorted to going to vaccination centres without an appointment, pleading for a third dose, Blood Cancer UK said. Official figures show there were 45,066 confirmed new Covid cases in the UK on Thursday, the highest daily total since mid-July. Kidney Care UK said the poor communication highlighted what seemed to be a “woeful lack of preparation” for the programme, the guidance for which was agreed on 2 September. The third dose programme for people with compromised immune systems is separate to the wider rollout of booster jabs being offered to everyone over 50, and others with clinical vulnerabilities, which started on 15 September. Read full story Source: The Guardian, 15 October 2021

A senior medic has won a whistleblowing case after judges ruled she was dismissed after raising concerns about a new procedure her department was using. An employment tribunal found consultant nephrologist Jasna Macanovic was fired from Portsmouth Hospitals University Trust in March 2018 after telling bosses a dialysis technique called “buttonholing”, which had been “championed” there, was potentially dangerous. The trust’s case was that the way she had gone about raising concerns had made for an untenable working environment in the Wessex Kidney Centre. The process saw a Care Quality Commission complaint, an independent investigation and multiple referrals to the General Medical Council. Employment Judge Fowell said: “The plain fact is that after over twenty years of excellent service in the NHS, Dr Macanovic was dismissed from her post shortly after raising a series of protected disclosures about this one issue. It is no answer to a claim of whistleblowing to say that feelings ran so high that working relationships broke down completely, and so the whistleblower had to be dismissed.” Dr Macanovic resigned from the regional renal transplant team in July 2016 when she discovered two incidents had occurred that “had not been reported by either surgeon” and felt that one of the surgeons had misled the medical director over the issue, the tribunal heard. In an email sent after the resignation meeting, Dr Macanovic said the practice was considered inappropriate by the vast majority of experts in the field and that no other renal unit in England was using it. The case exposes some worrying governance, both within the trust and between it and the Care Quality Commission, with which the issues were raised in 2016. When the CQC asked the trust for more information the unit’s clinical director responded that in his view that the deaths and infections were not due to the buttonholing. The CQC made no further enquiries and wrote back saying “they were satisfied that there were no safety concerns and that appropriate governance had been followed”. Read full story Source: HSJ, 24 March 2022