Anemia Drugs May Speed Tumor Growth in Some Cancer Patients

SUNDAY, June 1 (HealthDay News) — Drugs used widely to treat anemia in cancer patients may actually speed progression of the cancer in certain individuals, but researchers report they may found a way to determine who those individuals are.

“We may have a test to predict whether a patient is susceptible to having their tumor progress if treated with erythropoietin and, alternatively, we may be able to predict patients it would be safe to treat with erythropoietin,” study author Dr. Tony Blau, of the University of Washington in Seattle, said during a Sunday news conference at the American Society of Clinical Oncology annual meeting in Chicago.

Recent controversy over erythropoiesis-stimulating agents (ESAs) such as Procrit, Epogen and Aranesp has centered around whether the blood-boosting drugs should be withdrawn from the market because of troubling side effects.

In March, a U.S. Food and Drug Administration advisory panel voted to recommend continued use of the drugs for patients on chemotherapy, unless the patient is likely to be cured. They also voted to recommend against the drugs’ use in patients with breast or head and neck cancer.

Eight clinical trials now suggest these medications actually speed the growth of tumors and shorten the lives of cancer victims.

The drugs’ manufacturers added a “black box” warning to the medications last November.

“There has been lots of controversy over these stimulating agents, and we have an FDA advisory committee to act on this as we speak,” said Dr. Julie Gralow, director of breast oncology at the University of Washington and Fred Hutchinson Cancer Center in Seattle and moderator of the Sunday news conference. “The drugs offer benefits in terms of reducing anemia and reducing transfusions, but several large trials in a variety of tumor types suggest that . . . these agents may have some stimulatory effects on tumor cells, faster progression in some cases, and more death in others.”

Until recently, Blau added, these drugs represented the biggest U.S. federal expenditures for oncology patients.

The results of the current study were based on analyses of tumor samples from 101 patients diagnosed with head and neck cancer who had participated in a previous phase III trial of erythropoietin.

Scientists measured levels of erythropoietin receptor (EpoR) messenger RNA (mRNA).

High levels of EpoR mRNA in patients who had undergone radiation but not surgery tended to signal a worse prognosis. There was a similar effect with Janus Kinase 2 (Jak2), the main intermediary of EpoR signaling, Blau added.

“These are preliminary findings, but they’re very exciting,” Gralow said. “If they hold up, they may mean that we may be able to use ESAs in targeted ways.”

“These findings must be considered preliminary until confirmed,” added Blau. “We believe that the definitive answer to this question lies locked in the filing cabinets of pathologists’ offices that contain tumors of patients who participated in already completed phase III studies.” That, of course, would be much easier than initiating entirely new studies.

A second study found the multiple drugs elderly cancer patients may already be taking could interact significantly with chemotherapy.

In particular, patients taking drugs that interfered with protein binding such as Norvasc for high blood pressure, Prilosec for heartburn, and the pain reliever Celebrex were more likely to experience hematologic side effects such as low white blood cell counts.

Patients taking drugs that act on a group of enzymes known as cytochrome p450 were more likely to experience effects such as fatigue or diarrhea. Examples of these drugs include the heart medications such as Pacerone and Cordarone.

“We found that all drugs patients are taking besides chemotherapy are likely to affect their tolerance to chemotherapy,” said study author Dr. Mihaela Popa, of the H. Lee Moffitt Cancer Center in Tampa, Fla.

More information

The American Cancer Society has more on cancer-related fatigue and anemia.

SOURCES: June 1, 2008, news conference with Tony Blau, M.D., associate professor, medicine, division of hematology, University of Washington, Seattle; Julie Gralow, M.D., director, breast oncology, University of Washington and Fred Hutchinson Cancer Center, Seattle; and Mihaela Popa, M.D., Ph.D., H. Lee Moffitt Cancer Center, Tampa, Fla.; June 1, 2008, presentation, American Society for Clinical Oncology, Chicago

By Amanda GardnerHealthDay Reporter

Last Updated: June 02, 2008

Copyright © 2008 ScoutNews, LLC. All rights reserved.

Iced Teas Pose High Risk of Kidney Stones

FRIDAY, July 25 (HealthDay News) — Men over 40 may want to avoid iced tea and start hitting the lemonade if they wish to lower their risk of kidney stones, according to experts.

Kidney stones, crystals that develop in the kidneys or the tubes that carry urine from the kidney to the bladder, affect 10 percent of the U.S. population, and men run a four times greater risk than women of developing them. The chance of forming kidney stones rises steeply after the age of 40.

Oxalate, a key chemical in the formation of kidney stones, comes in high concentrations in iced tea.

“For many people, iced tea is potentially one of the worst things they can drink,” John Milner, an instructor in the department of urology at Loyola University Chicago Stritch School of Medicine, said in a news release. “For people who have a tendency to form kidney stones, it’s definitely one of the worst things you can drink.”

The failure to stay hydrated is a common cause of kidney stones. Summertime heat and humidity, which causes excessively sweating and dehydration, combined with an marked increase in iced tea consumption in the United States, raises the risk of kidney stones during this time of year.

The Tea Association of the U.S.A. reports that Americans consume almost 1.91 billon gallons of iced teas a year, a dramatic rise given the belief that the beverage is healthier than other alternatives such as soda and beer.

Milner said drinking water is the best way to stay properly hydrated. If one is prone to developing kidney stones, though, flavoring water heavily with lemon or drinking lemonade may help.

“Lemons are very high in citrates, which inhibit the growth of kidney stones,” Milner said. “Lemonade, not the powdered variety that uses artificial flavoring, actually slows the development of kidney stones for those who are prone to the development of kidney stones.”

Other foods containing high concentrations of oxalates that people prone to kidney stones should avoid include spinach, chocolate, rhubarb and nuts. Going light on salt consumption, reducing the amount of meat consumed, drinking several glasses a water a day, and eating foods high in calcium, which counteract any oxalates the body absorbs, also helps.

More information

The National Kidney and Urologic Diseases Information Clearinghouse has more about kidney stones.

— Kevin McKeever

SOURCE: Loyola University Health System, news release, July 22, 2008

Last Updated: July 25, 2008

Copyright © 2008 ScoutNews, LLC. All rights reserved.

Young Man’s Decision to Donate Kidney to Stranger Results in 10 Transplants

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By Anne HardingWEDNESDAY, March 11, 2009 (Health.com) — A 28-year-old man from Michigan decided to donate a kidney to a total stranger, setting into motion a kidney swap that over many months has resulted in 10 people getting a donor organ—and the process is still ongoing. (You can see how the entire process worked in this animation from the Alliance for Paired Donation.)

It’s longest series of such transplants to date, although such “kidney chain” transplants are becoming increasingly common due to better computer programs for matching donors, according to a report published Wednesday in the New England Journal of Medicine.

“It is becoming more common, but it’s still not something that’s happening every day,” said Robert A. Montgomery, MD, DPhil, of Johns Hopkins University School of Baltimore, where 4 of the 10 transplants were performed. “It’s still really only being organized by a few places.”

There currently are more than 78,000 people on the United Network for Organ Sharing’s (UNOS’s) waiting list for kidney transplants from deceased donors. Last year, there were 10,551 deceased-donor kidney transplants, and another 5,963 from living donors.

Next page: How “domino transplants” work

Some people who need a kidney have a relative or friend who’s willing to donate, but sometimes the two aren’t a good match. That’s where a “paired donation” comes in. In its simplest form, this incompatible pair is hooked up with a similar pair, so that the recipient in the second pair is compatible with the donor in pair one. There have been procedures involving organ exchanges among three or more such pairs, but these are typically done simultaneously—a major logistical and surgical challenge—to avoid the possibility of a donor backing out at the last minute.

So-called “domino transplants,” initiated by altruistic donors willing to donate to anyone who’s a match, may sidestep this problem because they won’t leave a recipient high and dry if someone farther down the chain decides not to donate. In theory, this means the transplant swaps don’t have to be done simultaneously.

And, as this week’s report shows, the theory works. The process, known as a “nonsimultaneous, altruistic, extended donor” (NEAD) chain, was coordinated by two paired-donation registries and took place over eight months at six transplant centers in five different states. Five transplants involved simultaneous organ exchanges. In five other cases, donors had to wait until an appropriate recipient was identified; the longest stretch between transplants was five months.

Michael A. Rees, MD, PhD, of the University of Toledo Medical Center in Ohio, and his colleagues report that they used computer programs called optimization models to sift through hundreds of mismatched donor-recipient pairs to create long chains of matches; the more people in such databases, the better the chance for a match.

Dr. Montgomery and his colleagues estimate that paired kidney donations, altruistic and otherwise, have the potential to allow for 1,500 more transplants from live donors per year.

“It definitely has the potential to help a lot of people,” says Elizabeth Sleeman, a policy analyst at UNOS. The organization is developing a national paired-donor registry, Sleeman said, which is expected to be up and running by 2010. Paired donation has definitely been gathering steam in recent years, she added: “Just the way the math works out makes it a lot easier to find a compatible donor, and it certainly can be a lot quicker than waiting on the deceased donor list.”

Next page: Will such chains encourage kidney donation?

M. Utku Unver, PhD, an economist at Boston College who helped develop the optimization model used in the transplant series and is a co-author of the New England Journal of Medicine report, said reports on these transplant chains have led more people to come forward who are willing to donate to a stranger. “I think that people realized that in the past one person could help only one person, but now one person can initiate the chain and this chain can help potentially many, many people.”

And surgical advances are making kidney donation a much less arduous process, Dr. Montgomery noted; minimally invasive techniques allow donors to leave the hospital within 48 hours.

Right now it’s tough to get statistics on just how many NEAD-chain donations have taken place, because there are three regional registries of paired donors but no national system. Creating such a system would be a key step to realizing the potential of the technique, Dr. Montgomery said.

“What we would really like to see, at least the folks at Hopkins, would be to have this done at a national level in a much more thoughtful, organized, rational way,” he says. “But until then we’ll continue to do what we’re doing, which is to try to get as many people transplanted as possible.”


Related Links:The Real Gift of Life: How Medical Donations HelpTackling Everyday Life With Arthritis: Patient Struggles and StrategiesThree Sisters Find Kidney Donor for Dad Using CraigslistWhere the Money Goes: A Breast Cancer Donation Guide

George Lopez’s Kidney Transplant: a Life

Associated Press

By Kathleen DohenyTHURSDAY, March 12, 2009 (Health.com) — It’s barely past 8 a.m. on World Kidney Day, but funnyman and actor George Lopez is in overdrive, bouncing back and forth from television interviewers to radio remotes to Internet and print reporters, trying to spread the word about the importance of screening for kidney disease.

Nearby, his wife Ann, who donated her kidney when Lopez needed a transplant in 2005, is keeping pace with her own interviews, often stopping to hug a friend or wave hello across the room in between sound bites.

Both are quick with the quip, blending humor with education about the importance of kidney health and screening for kidney disease. Says Ann: “Be nice to your spouse. You never know when you’ll need spare parts.”On an early-morning radio interview a few moments earlier, George had urged listeners to come down, get screened, and, he added, have a drink, too.

World Kidney Day took place all around the world today, but this Hollywood version sponsored by the National Kidney Foundation of Southern California had its own unique twist. It was actually held at a bar—Guy’s North, a trendy watering hole in Studio City just upstairs from a bowling alley called Pinz, where the din of bowling pins can be heard over the clinking of glasses.

Ann and George Lopez are national spokespeople for the National Kidney Foundation. And dozens of celebrities attended the day’s event—called KEEP (Kidney Early Evaluation Program) it Hollywood—which included free mini-screenings for kidney disease.

Next page: “High blood pressure cost me my kidney and almost my life.”

Right before Lopez’s transplant, Ann recalls, he told her: “I’m not going to be the poster boy for kidney disease.” But as soon as the procedure was over, George felt so good that he wanted to give back, she says. Ever since, George and Ann have worked tirelessly for the National Kidney Foundation, taking part in World Kidney Day, supporting the foundation’s camp for kids, and hosting a celebrity golf classic.

Early detection and prevention are vital, George says. His kidney problem could have been prevented if it had been detected early. He had high blood pressure by age 18, in addition to other symptoms. “My family wasn’t one to go to the doctor,” he adds. “And it cost me my kidney and almost my life.”

Kidney disease affects about 26 million Americans, according to the foundation. And World Kidney Day is meant to raise awareness about the need for more research and for screening. High blood pressure and diabetes are the two leading causes of kidney failure, according to the National Kidney Foundation. When the diseases are treated, however, kidney problems can be avoided or delayed. To preserve kidney health, exercise regularly, eat a low-salt diet, control weight, monitor blood pressure, keep blood sugar and blood cholesterol at healthy levels. Also, don’t smoke, drink moderately (if at all), and get an annual physical, the foundation advises.

At KEEP it Hollywood, celebrities—such as Bryan Dattilo of Days of Our Lives, Kyle Kaplan of 10 Things I Hate About You, Joaquin Pastor of Californication, Nora Kirkpatrick of Transformers, and Josh Sussman of Wizards of Waverly Place—were invited to visit four stations manned by health-care workers. People who got screened were asked about their health history, and had their blood pressure and blood sugar measured and recorded; the final results were reviewed by a physician who looked for signs of kidney disease, which in the early stages can have no symptoms at all.

Later, the public was invited to a free screening. Linda Small, executive director of the National Kidney Foundation of Southern California, expected a few hundred people would be screened.

Next page: High blood pressure or diabetes? Get screened

Aimee Garcia, who appeared on The George Lopez Show (now in syndication), says she’s learned a lot from George and Ann. Before, she says, “I knew kidneys help flush out the system, and that’s it.” These days, Garcia supports foundation events and talks to elementary school children about the importance of staying healthy and treating their kidneys right.

Kyle Kaplan is just 18, and this is his second year participating. “I think it’s important for kids my age to come out here,” he says. “I hope to inspire more people to get tested.”

Sara Faden-Norman and her husband, Bobbie Norman, both in their Los Angeles Police Department uniforms, stood off to the side, watching the celebrity interviews. The two met in the police academy 14 years ago and have been together ever since.  When he got kidney cancer and later needed a donor, she was deemed a match. “It was no question for me,” she says.

Many people just don’t think to ask about kidney-health screening, says Susanne Nicholas, MD, a nephrologist at the University of California, Los Angeles, and volunteer supervisor for the KEEP screening program.  Who should think of screening? ”If you have a history of high blood pressure, a family history of kidney disease, diabetes, or are 60 and up,” you’re due for screening, she says.


Related Links:The Real Gift of Life: How Medical Donations HelpTackling Everyday Life With Arthritis: Patient Struggles and StrategiesYoung Man’s Decision to Donate Kidney to Stranger Results in 10 TransplantsWhere the Money Goes: A Breast Cancer Donation Guide Three Sisters Find Kidney Donor for Dad Using CraigslistHow One Doctor Helps Patients to Avoid Kidney DialysisHow You Can Stop Diabetes-Related Kidney Damage

Medical Mistakes: Nurse Throws Away Kidney Before Transplant

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Mistakes can happen, sure. But medical mistakes never fail to shock, including the story this week that a nurse at the University of Toledo Medical Center threw away a donated kidney intended for a recipient who was, at that very moment, waiting in the operating room to undergo a transplant.

The nurse, who didn’t realize she was carrying a life-saving organ, marched the kidney out of the operating room and down the hall, where she flushed it down a disposal hopper.

An investigation attributed the mistake largely to a communication error: The nurse hadn’t been in the operating room when the surgeon announced that the kidney was being stored in a chilled solution. The nurse who had been in the operating room didn’t pass on the all-important message.

While this serious of a gaffe is rare, mistakes do happen in hospitals and other healthcare settings. In fact, an estimated 100,000 people die each year in the U.S. due to preventable medical mistakes. Indeed, the federal government is asking more people to report medical mistakes, since they can often go unrecorded. (Can’t fix what you don’t know about!)

However, there are some things you can do to protect yourself:

Take notes on names of staff, medications, test results, and procedures, or have a family member or friend with you to jot down notes.   Make sure your healthcare providers know what medications you’re taking (it’s a good idea to keep a list in your wallet or, better yet, take the bottles with you to the doctor’s office). When you leave the doctor’s office or the hospital, make sure you know what your medications are and how to take them.   Ask questions if you don’t understand something and be wary if a staffer rolls their eyes or dismisses your concerns.

  Make sure the doctors and nurses coming into your hospital room sanitize their hands before touching you.

  Clarify with your surgeon exactly what procedure will be performed and on what specific body part. You don’t want an artificial knee in your left knee when it’s your right that hurts.  Identify yourself to all staff so they don’t mistake you for someone else and give you the wrong medication or perform the wrong procedure.

  Choose a hospital that has plenty of experience in performing the same procedure or surgery you’re planning to undergo. Check out surgeons or doctors with your state or local board of health before picking one.

  Once you find a doctor you like, stick with them. Continuity of care can go a long way towards minimizing mistakes. Electronic health records aren’t a must, but they help, too.

  Make sure you’re contacted about the results of every test, whether the results are positive or negative.

  Don’t count on urgent-care facilities for life-saving procedures. These are more useful for commonplace complaints such as the flu.

For more tips about preventing medical mistakes, check out the Agency for Healthcare Research and Quality.

Your Guide to Preventing Medical Mistakes

Study: Reluctance to Speak Up Encourages Medical Errors

How to Avoid Becoming a Medical Mistake

Too Much Red Meat Might Harm Kidneys, Study Suggests

By Karen PallaritoHealthDay Reporter

THURSDAY, July 14, 2016 (HealthDay News) — Eating red meat may boost the risk for kidney failure, but swapping even one daily serving of red meat for another protein may reduce the risk, a large study from Singapore suggests.

Red meat intake—in this case, mostly pork—was strongly associated with an increased risk of end-stage renal disease, the loss of normal kidney function. The relationship was also “dose dependent”—meaning the higher the consumption, the greater the risk.

The association held up even after compensating for factors that could skew the results, such as lifestyle and other health conditions, the study authors noted.

“Our findings suggest that patients with chronic kidney disease or the general population worried about their kidney health can still maintain protein intake but consider switching to plant-based sources,” said Dr. Woon-Puay Koh, professor in the Office of Clinical Sciences at Duke-NUS Graduate Medical School in Singapore.

“However, if they still choose to eat meat, fish/shellfish and poultry are better alternatives to red meat,” said Koh, one of the study’s authors.

The study adds new data to a conflicting body of evidence on the relationship between protein intake, particularly red meat, and kidney disease, experts noted.

“It adds useful and additional information to our knowledge base, but I’m not sure if it necessarily tips the scale one way or another,” said Dr. Allon Friedman, a nephrologist and associate professor of medicine at Indiana University School of Medicine in Indianapolis.

“My opinion is that it’s still perfectly fine for individuals who are otherwise healthy to consume red meat in moderation,” he said.

Dr. William Mitch, professor of nephrology at Baylor College of Medicine in Houston, said plenty of studies have shown that low-protein diets may benefit people who already have kidney damage.

However, “in the general population, there’s no persuasive evidence that eating a lot of protein causes kidney damage,” he said.

About 20 million Americans have chronic kidney disease, according to the U.S. Centers for Disease Control and Prevention.

Between 2000 and 2008, the number of new cases among people 65 and older more than doubled, says the U.S. National Institute of Diabetes and Digestive and Kidney Diseases. And while new cases have leveled off, recent data from a federal registry show the number of people requiring kidney dialysis continues to rise.

Red meat has been implicated in recent reports and studies as potentially harmful to human health. The World Health Organization last year warned of a possible link between red meat and cancer. And a November 2015 study in the journal Cancer found that meat cooked at high temperatures could potentially affect kidney cancer risk.

For the new study, researchers followed more than 63,000 Chinese adults in Singapore for an average of 15.5 years.

Food questionnaires were used to gather data on people’s daily protein consumption. Records on the incidence of end-stage renal disease came from a nationwide renal registry.

Ninety-seven percent of red meat intake in the study population consisted of pork. Other protein sources included poultry, fish/shellfish, eggs, dairy products, soy, and legumes.

Although pork may appear white after being cooked, it’s still considered red meat, says the U.S. Department of Agriculture.

People consuming the highest amounts of red meat had a 40 percent increased risk of developing end-stage kidney disease, compared with people who ate the lowest amounts, the study found.

No association was found with poultry, fish, eggs or dairy products, while soy and legumes appeared to be slightly protective.

The study also found that replacing one serving of red meat with another protein reduced the risk of kidney failure—up to 62 percent for poultry.

Betsy Booreni is vice president of scientific affairs at the North American Meat Institute in Washington, D.C., which represents U.S. meat packers and processors. She noted that the study, by design, does not establish cause and effect.

What’s more, the results should be viewed with caution due to differences between Chinese and American diets, meat production practices, ethnic backgrounds and genetics, Booren said.

“It is inappropriate and premature to attempt to apply these findings to the North American population as the cause of a medical condition,” she said.

The study, published July 14 in the Journal of the American Society of Nephrology, was supported by funding from the U.S. National Institutes of Health.

More information

The U.S. National Kidney Foundation has more on kidney disease prevention.


Kidney Stone Treatment: Riding a Roller Coaster May Dislodge Small Stones

Kidney stones are no fun—but a potential new treatment for them might be. It turns out riding a roller coaster may help people shake small stones loose, according to a new study by two physicians who took their research to Disney World.

Their paper, which was published in The Journal of the American Osteopathic Association, was an attempt to corroborate reports from “a notable number” of patients over the years who said they passed kidney stones within hours of riding Disney’s Big Thunder Mountain Railroad. One patient even said he passed three stones, one each after three consecutive rides.

So the researchers used a 3D printer to create a silicone replica of that patient’s kidney, filled it with urine and three kidney stones of varying sizes, and traveled to Orlando to test out the claim themselves. With permission from the park, they rode the Big Thunder Mountain Railroad roller coaster 20 times (oof), keeping the model kidney with them in a padded backpack. They checked the kidney after each ride, and analyzed the outcomes to determine the likelihood of the stones’ passage. 

They found that sitting in the back of the roller coaster resulted in a successful passage rate of 63.89%, while front-seat rides delivered a 16.67% success rate. Although their findings are preliminary, co-author David Wartinger, DO, said in a press release, they “support the anecdotal evidence that a ride on a moderate-intensity roller coaster could benefit some patients with small kidney stones.”

RELATED: 15 Weird Risk Factors for Kidney Stones

“Passing a kidney stone before it reaches an obstructive size can prevent surgeries and emergency room visits,” said Dr. Wartinger, a professor emeritus at Michigan State University College of Osteopathic Medicine. That could have significant impact, considering that more than 300,000 Americans seek emergency care each year for the tiny but painful mineral deposits, made up mainly of calcium crystals, that accumulate in the kidneys. Approximately 11% of men, and 6% of women, will experience them in their lifetime.

Riding a roller coaster after a treatment like lithotripsy (in which ultrasound is used to break large kidney stones into smaller pieces) may help facilitate passage of the deposits, the authors wrote, and may help prevent recurrence in people who’ve had stones in the past. Women with small kidney stones who plan to get pregnant might also consider such an approach, since they can cause complications during .

This isn’t the first time such an unconventional treatment for kidney stones has been proposed; the authors note in their paper that spontaneous stone passage has been associated with bungee jumping, roller-coaster riding, and other external applications of force anecdotally in the foreign press. This, however, is the first study of its kind to be published in a peer-reviewed medical journal. 

Big Thunder Mountain Railroad is a steel-railed coaster whose cars travel at a maximum speed of 35 miles per hour around sharp turns and quick drops. (It does not go upside down.) The researchers say their results should be replicated on other types of rides—ideally with human participants—before they can make broad recommendations. 

RELATED: 13 Foods That Are Saltier Than You Realize

They also caution that kidney stones larger than 6 millimeters in diameter only have about a 1% chance of passing without medical intervention—and that people diagnosed with stones that large might want to avoid these types of external forces, to reduce the risk of pain and urinary-tract obstruction.

“Many people in the United States probably live within a few hours’ drive of an amusement park containing a roller coaster with features capable of dislodging calyceal renal calculi,” the authors wrote, using the technical name for kidney stones. “However, physicians and their patients should consider renal calculi location and size as well as medical history.”

Many questions about this potential treatment remain, but Dr. Wartinger is optimistic about future research on the topic. “The osteopathic philosophy of medicine emphasizes prevention and the body’s natural ability to heal,” he said. “What could be more osteopathic than finding a relatively low-cost, non-invasive treatment that could prevent suffering for hundreds of thousands of patients?”