Would you give the gift of a kidney to a stranger in need?

 

As far as generous Christmas presents go, donating your kidney seems for many at the extreme end. However, for a few lucky kidney disease patients, this is the gift of a lifetime. Known as unspecified or non-directed altruistic kidney donation, this form of live organ donation is on the rise, and could potentially wipe the waiting list if more stepped forward. I met Frank Dor, a consultant transplant surgeon and Head of Transplantation at Imperial College Healthcare NHS Trust, who has carried out hundreds live organ donations.

The waiting game

Frank receives a phone call notifying him that a kidney from a deceased donor has been allocated to one of the recipients at Imperial. This single kidney is in high-demand as there are around 5,000 people on the UK NHS Blood and Transplant (NHSBT) waiting list for a kidney; some waiting for up to five years. Unfortunately, a few hundred of these will die in the meantime for lack of one.

These patients have chronic kidney disease, meaning they have lost their kidney function so dialysis three times per week becomes the norm. However, life on dialysis is debilitating, difficult and time-consuming. “Dialysis is merely a way of keeping people alive, it’s just a temporary measure that can never fully replace the kidney function,” Frank tells me. “Eventually patients on the waiting list get to a point where they start to lose hope and stop making plans for the future”.

The long-term solution is receiving a kidney transplantation, of which there are two types – living and deceased. Transplantation provides patients with the opportunity for a longer and better quality of life, with patients typically gaining 10-20 years of life compared to dialysis. However, the odds for receiving one are not favourable: there are 1,500 patients on dialysis in Imperial College Healthcare NHS Trust but only around 200 of those get transplanted every year. There is a huge gap between supply and demand nationally and internationally. (more…)

Festive feasting: the good, the bad and the microbiome

As the festive season approaches, one wonders how our bodies prepare for the enormity of food that will be ingested in a relatively short space of time.  In the UK alone, the average person consumes 7000 calories on Christmas Day alone.  This is three times the recommended calorie intake per day, and most of us will have reached the recommended calorie intake before Christmas lunch has even been served. And of course, it’s not just about eating more. We are also a great deal more sedentary, with the average person in the UK spending 5.5 hours a day in front of the television over the Christmas period desperately awaiting reruns of Blackadder and yet another Christmas special!

Of course, this massive increase in consumption over the festive period inevitably means we put on weight, with research showing maximum weight gain reached within 10 days of Christmas Day, peaking around 3 January, and then falling.  However, despite this relatively rapid increase in weight in the space of a few days, approximately half of the weight gained seems to remain until the summer months or beyond.  The cumulative effects of this annual increase in weight during the holiday period likely contribute to one’s overall lifetime weight gain.

Obesity results from a mismatch between food intake and energy expenditure.  So is this festive weight gain a result of eating too much and spending too much time on the sofa?  What if it was more than just that? We now know that the gut is a crucial organ in the maintenance of energy homeostasis.  It releases a whole host of hormones such as glucagon-like peptide-1 and peptide YY that regulate appetite in response to nutrient intake.  Much of my work has focused on looking at the effect of dietary protein on appetite.  High protein diets reduce food intake and improve body composition, and if people can stick to them, they lose weight.  (more…)

How COPD patients can sing their way to better health this Christmas

Carol Singers (CC BY 2.0)

Singing carols is a big part of Christmas cheer, but not many people realise that singing can also be helpful for people with lung disease. COPD is an extremely common condition – there are 1.3 million people with this diagnosis in the UK. Existing treatments help to some extent, but do not reverse the underlying pathology, meaning that even with optimal care many patients remain breathless with activity limitation and poor quality of life. This symptom burden represents a major area of unmet need. Singing for Lung Health (SLH) groups are a potential way for patients to gain skills to improve control of their breathing and posture, reducing symptom burden and enhancing wellbeing.

What is singing for lung health?

Singing for lung health involves taking part in classes led by a specially trained singing teacher. Patients learn techniques to help control their breathing and posture as part of a group activity which is fun and sociable. The goal for the groups is to get better at singing, an artistic objective. By doing this individuals gain skills that help them to cope with their lung condition, a health improvement objective. The classes have a particular focus on activities and exercises that are helpful for people with lung disease and so differ from more generic “singing for well-being” groups.

Singing for lung health has grown from a few small clinical trials to more than 80 groups nationally. As well as the plausibility of an approach based on learning to control the breath in people with lung disease, singing is also a fun social activity. Results from the Royal College of Physicians COPD audit show that provision of pulmonary rehabilitation is still limited, so there is a need for activities to sustain the physical and social benefits that these produce once people have completed them. For some people, taking part in a singing group may be a useful stepping stone to agreeing to join a formal rehabilitation program. (more…)