Speaking of dialysis…

1-IMG_1532As I hoped, here is the video of my speech to the Diaverum Annual Conference at Cascais, Portugal, last month.  It was called: The View from the Chair, a Patient’s Perspective.

It covers a bit of ground, but the highlights (apart from the joke at the start!) are: (more…)

Off to the Diaverum Global Dialysis Conference

I’ve been missing in action for the last few weeks, for a couple of reasons.

Josie & Liam Firstly, our No.2 Son just married his lovely fiancé here in sunny Melbourne (on the beach at Elwood).  It was a great wedding, but they live in London, so Julie and I have been pretty busy preparing. Not much time for blogging.

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Coming Soon: the new Number 1 thing to do on Dialysis

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Virtual undersea world

Before I begin, welcome to the holiday season! I wish you all a Merry, Happy or otherwise Delightful CABAH (Celebration-Accompanied-By-A-Holiday), and a restful break.

Like many BigD-ers, I love reading.  I love being taken away to exotic worlds with almost real technology, or interesting times in history, or tricky or stirring adventures or Very Big Picture books (the ones with almost no pictures) that help me understand how the world or civilisation or the universe works).  (more…)

Choose your holiday dialysis chair by App

I recently had the privilege of attending a workshop hosted by the Victorian Renal Health Clinical Network at the state Department of Health, and to contribute to the future State-wide Clinical Pathway for Victorians with Chronic Kidney Disease and End Stage Renal Disease.  A bit of a mouthful, but it was a collection of 60 people from all areas of renal services, including head nephrologists from the major state hospitals, private nephrologists, private dialysis service providers, renal nurse practitioners, key clinicians including nurses and allied health, peak bodies and ‘consumers’ like me, looking at our “could be/should be” future. (more…)

Future Dialysis: no needles, no machine, no dialysis?

I’ve always enjoyed Science Fiction.  For two reasons:  One, it’s hugely escapist, taking me from a rainy afternoon on the couch to an alien settlement on the frontier of our federation or to a future where mental man simply thinks of something to make it happen.  Two, it expands my thinking with new ideas of the possible (or desirable). Who wouldn’t like to download their brain into permanent memory, or live for centuries free of the constraints of the body?

Another powerful Sci Fi benefit is that way-out ideas often become reality within a few years. Asimov invented the term “Robotics”, now they are manufacturing cars; Princess Leia asked Obi Wan for help via a projected 3D hologram, and one is due within a few months; scientists have actually started teleporting things (very little things) from one place to another, just like Captain Kirk; genetic manipulation is a reality.

It’s in this spirit that I have decided to create a few visions of future BigD.  There seems to be very little new in the dialysis department, and it’s time we had a few ideas to hang our dreams on.

So, I’m thinking short term – the next 10 years and medium term – the next 15 years.  And long term?  Things are changing so quickly, we may be a different species by then.

Short Term

We are making great strides in biomedical science, but I think we will still be cleaning the toxins directly from our blood in 10 years.  The two big downers of dialysis currently are the time it takes and the needles (in that order).  These are related problems: the time it takes to clean the blood depends on how much we can clean at one time.  With needles and a fairly slow pump speed, the answer is not much.  Here are a few ideas that get rid of the needles and/or cut down the time it takes:

My Blood Bank. Early in 2013, we will trial complete replacement:  soon after, each of us BigD club members build up and store an additional 5.6 litres of blood (or borrow it from a blood bank) and in each BigD session we simply run out the old blood and run in the new blood.  The old blood is cleaned later, while we are living our life and we repeat the exchange at the next session.  Estimated time: 30-60 minutes.

Mum’s the Cord. In 2014, we get bigger access.  Before we were born, we exchanged our blood continuously with our mother via the umbilical cord.  What happened to that connection?  We re-create it and tap directly into the aorta for a high-speed clean.  Estimated time: 60 minutes.

Socket to Me. Permanent access sockets have been tried before and were rejected due to infection problems.  However in a successful variation, the current approach to getting started with buttonholing is to insert a plug into each needle hole for a couple of weeks, so that button hole and tunnel formation are accelerated.  Once it is formed, the plugs are removed and buttonholing can begin.  Around 2015 we will expand on this technique by growing some special sockets with cartilage “connectors” from our own tissue on a biodegradable scaffold (remember the mouse the human ear on its back)?  Maybe we will also grow the needle connectors…  Estimated BigD time: still too long, but, look, no needles.

Swallow this Pill. Around 2015, biochemists will have joined the party, by creating a chemical cocktail that identifies and binds to blood toxins to create large, easily filtered molecules.  Dialysis uses a dialyser impregnated with a chemical to attract the molecules in a single pass.  Estimated time: 60 minutes.

Medium Term

By the early 2020s, we will have worked out a few less intrusive ways to clean our blood.  No needles, no time sitting at a BigD machine.  Treatment will be continuous, just like our kidneys used to do it.

One small prick for mankind… In an old Star Trek Original Series Movie, Dr McCoy travelled back to the Twentieth Century and met a woman in a wheel chair.  When he finds that she is headed for dialysis, he says “How barbaric!” and gives her an injection that fixes the problem for good.

What was in that injection?  Intelligent nanofilters. Millions of the molecule-sized nanotech filters are injected (or more likely infused through the skin and make their way) into the bloodstream where they identify and bind to toxins in the blood.  They then travel to the gastrointestinal tract, reacting with the mucous lining to form large inert molecules that are eventually excreted from the body.  The nanofilters then return to the bloodstream and repeat the process.  Nanofilters can be programmed and controlled remotely and can be replaced when required.

Cell Me My new Kidney. About 2022 the first successful stem cell kidney will be grown in a lab and transplanted into a happy recipient.  By 2025 stem cell kidneys, from our own stem cells will be the standard treatment for End Stage Kidney Failure.  Stem cells will initially be embedded by surgery, but eventually they will be transported to the replacement site via nano technology carriers.

So, the New, Better BigD vision begins.  These ideas have been floating around in my head for a while.  Some may be possible, others maybe not.  But let’s start putting ideas down: everyone, everywhere.  And hopefully in the Short Term, a practical advance will come and turn our dream into reality!

It doesn’t matter how off-the-wall is sounds, write it down here, now.  Who knows where it will lead?