Local researchers working with Windsor dialysis patients have made a groundbreaking discovery that could save the health-care system millions.
“This could be practice-changing throughout the world,” Windsor kidney specialist Dr. Albert Kadri said Friday, explaining the results of his team’s trial that examined the best dosage for an expensive clot-busting drug used to clear clogs in dialysis catheters.
Alteplase — a clot buster also used for strokes and heart attacks — is the only drug used for this vital job, and up to now the proper dosage was undetermined, Kadri said. So most doctors went with the higher two milligram dose on each of the two catheters leading into and out of the dialysis machine that cleans the blood for people with kidney failure.
The study conducted in Windsor on about 50 local dialysis patients who use catheters showed that using a lower one mg dose works just as well, Kadri said. The results mean the cost of this drug can be cut in half to clear out catheters, something that has to be done as many as 25 times a year for some dialysis patients.
“The amount this medication is used is astronomical, and to cut the cost in half is crazy — it’s crazy,” he said, explaining that patients coming in multiple times per week for dialysis need the drug an average of at least 10 times a year.
Derrick Soong, a local pharmacist who participated in the study and works with dialysis patients, said a two mg treatment with the drug costs $120. The local dialysis centre spends $5,000 to $8,000 a month on Alteplase, so cutting dosage in half could save up to $50,000 a year, he said. And Windsor’s just an intermediate dialysis centre. Larger centres in Toronto would save much more.
If you multiply the savings across all the centres in Canada, the total would be significant, Soong said, explaining that the cost of the drug is borne by taxpayers. In the United States, there are many more dialysis patients and higher drug prices.
Windsor has about 400 dialysis patients and Ontario has more than 11,000, a number that’s been growing 3.3 per cent annually in recent years due to the aging population and rising rates of hypertension and diabetes that can lead to kidney failure. About 60 per cent of dialysis patients use catheters.
“The catheter is the lifeline for dialysis patients,” said Soong. “If the catheter doesn’t work, we can’t clean their blood,” and a patient could die as toxins build up in his or her body.
He said showing you need just half the dosage of this clot-busing drug “could be potentially a game-changer.”
The study, said Dr. Kadri, is the first randomized controlled trial spearheaded in Windsor and conducted solely in Windsor. It was funded by a grant of almost $100,000 from the Kidney Foundation of Canada.
The trial involved giving some patients 1 mg and others 2 mg, and monitoring the results, with neither the patients nor the researchers knowing the dosages until the final data was analyzed. The funding came after the same Windsor group did a retrospective study several years ago, which involved looking back at previous data.
The randomized controlled trial is the highest level of evidence you can get when you’re doing a study, said Kadri.
“We just finished it and we analyzed the data and the data actually showed us something that could be groundbreaking.”
The group, which also includes University of Windsor nursing professor Maher El-Masri and pharmacist Wasim El Nekidy, is one of two local research projects asked to present their results at this fall’s conference of the American Society of Nephrology in New Orleans. As far as Kadri knows this is the first time Windsor-based research has been presented at the conference.
The other presenter, Kadri’s nephrology colleague Dr. Syed Obaid Amin, is presenting his experience with a patient, a young man who’d been treated for a rare lymphoma (a cancer of the lymph nodes and lymphatic system) with a new chemo drug and ended up in renal failure with hard-to-treat hypertension.
This side effect had never been reported before with this particular drug called Potaninb, said Amin, who’ll relate to the conference the nature of the side effect and how he treated it. Amin arrived in Windsor from Ottawa a few months ago, so the patient he treated is from there. A CT scan showed that the blood vessels to the man’s kidneys had been blocked.
“After we stopped the drug and after we opened up his arteries by angioplasty, his kidney function got significantly better and he came off a lot of his blood pressure medication,” Amin said.