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Experts Outline Strategies for Boosting Equity in Chronic Kidney Disease

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Physicians and advocates explored ways to improve access to clinical trials, dialysis, and transplants for racial and ethnic minorities with chronic kidney disease during a webinar hosted by U.S. News & World Report and sponsored by the American Kidney Fund (AKF).

When the COVID-19 pandemic struck, people with chronic kidney disease, particularly those in kidney failure, could not isolate the way other people could because they needed to go to dialysis or other medical appointments, explained LaVarne Burton, president and CEO of the AKF.

During the first year of the pandemic, people with kidney failure were far more likely to contract COVID than other patients on Medicare and more likely to die from it. People of color, especially Black and Latino Americans, were also more likely to get and die from COVID.

“So, if you were a patient who had kidney failure, and you were a patient of color, it was devastating,” Burton said.

Inequities in Wait Lists and Transplantation

One obvious solution for addressing kidney failure is, of course, kidney transplant. The problem is that there are 100,000 people on the transplant list, most of whom are seeking kidneys, and only about 25,000 people received kidney transplants last year, Burton said. “So, we just don’t have enough organs to go around.”

People of color, women, and older adults have historically been disadvantaged on wait lists for both living and deceased donor transplantations, said Elaine Ku, MD, of the University of California San Francisco.

Policy changes were implemented to the kidney allocation system and wait list rules to try to improve inequities in access to kidney transplantation beginning in 2014, and included allowing patients on dialysis to have their wait time back-dated to the date they started dialysis, rather than when they were first referred and validated by a transplant center.

Those changes, Ku noted, have helped to reduce some of the racial inequities in access.

In addition, last year clinicians began using a race-free equation to assess kidney function — specifically estimated glomerular filtration rate (eGFR) values — to determine eligibility for organ donation, Ku said. Previous calculations incorporated misguided thinking about African Americans’ muscle mass that led to results showing less severe kidney disease in this population.

“So, I think that there has been efforts to try to address some of the inequities that were introduced through the use of a race-inclusive equation to estimate kidney function and there have been some changes there,” Ku added.

Live Organ Donation

According to Burton, live organ donation is economically, medically, and socially one of the most effective options for transplantation, but it also has its challenges.

One of the “most awful things,” she explained, is that a person can donate an organ and then be penalized in terms of access to certain insurance, or unable to take time off work. They might also struggle financially with the costs they bear as part of the donation process, she added.

The AKF has lobbied for legislation to protect living donors from insurance discrimination, and to allow them to take time off work. Today, close to 30 states have passed laws that encourage and protect live donors, Burton said.

Access for Undocumented Patients

Lilia Cervantes, MD, of the University of Colorado, Anschutz Medical Campus in Aurora, noted that roughly 180 to 200 undocumented patients in Colorado find themselves critically ill in the emergency department each week in need of emergency dialysis. In February 2019, Colorado opted to expand access to dialysis to undocumented immigrants with kidney failure. Since then, 20 states have passed similar laws.

“I think people realized that it’s important to keep undocumented immigrant patients receiving good care but also outside of the emergency department, especially during the pandemic when ED resources were quite tight,” she said. Coalition building around these issues has also led to “lots of really great legislation.”

Advocates also helped pass the Health Benefits for Children and Pregnant Persons or the “Cover All Coloradans” bill, which expanded Medicaid for all children and pregnant persons no matter their immigration status, as well as the Health Insurance Affordability Enterprise, which gives 10,000 uninsured people access to free insurance on the healthcare exchange.

Furthermore, the AKF also offers the Health Insurance Premium Program, which provides financial support to people in kidney failure to help them pay their insurance premiums. In 2022, AKF supported 60,000 people facing such challenges, Burton said.

Clinical Trials, Prevention

As for clinical trials, Burton said she’s seen the research become more inclusive of patients of color compared with past years.

“It’s very important that as new therapies are developed, that they are appropriate and effective for all of those dealing with kidney disease and especially for those populations that are most disproportionately affected,” she noted.

To that end, Deidra C. Crews, MD, ScM, of the Johns Hopkins Center for Health Equity in Baltimore, highlighted the need for early engagement.

Instead of asking for patient feedback after a clinical trial has been developed, she recommended asking patients to “co-design” trials so that they focus on outcomes and issues that matter most to patients.

She also recommended that researchers consider study designs that allow for more remote data collection or allow data to be collected at “a time and place that’s convenient for broader groups of people.”

Finally, the panelists spoke about prevention and the importance of educating patients and communities about kidney disease. This is the reason that the AKF developed its Health Equity Coalition, Burton said.

“One of the great positives about kidney disease is that, in an awful lot of cases, it is actually preventable,” she noted. “Or if not totally preventable, you can slow down the progression, if you know your risk, and if you follow the regimens that are recommended for you, as well as some lifestyle changes.”

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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