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E-News

Indigestion remedy significantly slows kidney function decline and improves survival in late-stage chronic disease

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As chronic kidney disease (CKD) progresses, the kidneys become less able to maintain a healthy balance of acids in the body, a condition known as metabolic acidosis.
To maintain healthy acid levels, people with CKD are treated with alkaline substances such as sodium bicarbonate, also commonly used to neutralize heartburn and indigestion. The UBI study, a large randomized controlled trial, shows that sodium bicarbonate halves the risk of kidney disease progression, the likelihood of starting renal replacement therapy (RRT; dialysis or transplantation) and the overall risk of death in people with CKD [1].
Defined as serum bicarbonate less than 22 mmol/L [2], metabolic acidosis is common in people with CKD stages 4-5 (eGFR < 30 ml/min/1.73 m2) and is directly related to worsening kidney function. Metabolic acidosis is a problem because it is associated with complications such as bone disease, muscle wasting, high levels of blood potassium (hyperkalaemia), insulin resistance, high cholesterol (hyperlipidaemia), and with a more rapid decline in kidney function—shown by rising blood creatinine—and increased risk of death [3].
International guidelines recommend that, when serum bicarbonate concentration falls below 22 mmol/l, CKD patients should be treated with oral sodium bicarbonate to maintain serum bicarbonate within the normal range, unless contraindicated [2]. However, until recently, very few studies have tested the effectiveness of bicarbonate therapy in improving metabolic acidosis or its potential benefits in patients with CKD.
Results of the UBI trial announced for the first time during the ERA-EDTA Congress in Budapest, now provide strong evidence for the benefits of correcting metabolic acidosis with sodium bicarbonate in people with late-stage CKD.
The prospective, open-label, randomized controlled trial assigned 740 patients with CKD-3b and CKD stage 4 to either sodium bicarbonate (376 patients) or standard care without sodium bicarbonate (364 patients). The patients had a mean age of 67.8 years, creatinine clearance 30 ml/min, and serum bicarbonate 21.5 mmol/l. At the end of three years, doubling of creatinine occurred in significantly fewer patients randomized to sodium bicarbonate: 6.6% versus 17.0% receiving standard care, p<0.001. This translates into a relative risk reduction of 64% in kidney disease progression (hazard ratio [HR] 0.36; 95% confidence interval [CI] 0.22-0.58; p<0.001).
Similarly, the likelihood of starting RRT was also significantly lower in the sodium bicarbonate group. At the end of the study, 6.9% of patients receiving sodium bicarbonate had started RRT compared to 12.3% of the standard care group—a relative risk reduction of 50% (p=0.004; HR: 0.5; 95% CI: 0.31-0.81; p=0.005).  The risk of death was also significantly lower among sodium bicarbonate-treated patients at 3.1% compared to 6.8 % of the standard care group—a relative risk reduction of 57% (p=0.004; HR 0.43; 95%CI 0.22-0.87; p=0.01). Treatment with sodium bicarbonate was well tolerated, with no significant effects on blood pressure, total body weight or hospitalizations.
“There are relatively few treatments that have been shown to slow progression of CKD.  As nephrologist, we have used sodium bicarbonate to correct metabolic acidosis in people with CKD for some time, but definite evidence of benefit has been lacking. Our study shows that this very cost-effective treatment is safe and improves kidney and patient survival,” concluded lead investigator Dr Antonio Bellasi.
[1] Bellasi A, et al. Treatment of metabolic acidosis with sodium bicarbonate delays progression of chronic kidney disease: the UBI study. LBCT Abstract ERA-EDTA Congress 2019, Budapest
[2] KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl 3(1) January 2013
[3] Ahmed AR, Lappin D. Oral alkali therapy and the management of metabolic acidosis of chronic kidney disease: A narrative literature review. World J Nephrol 2018 0; 7(6): 117–122. www.era-edta.org

Oxford COVID-19 policy ‘Supertracker’ wins support from OECD, World Bank

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Oxford has launched the ‘Oxford Supertracker’ < https://supertracker.spi.ox.ac.uk > – a global directory for COVID-19 policy trackers and surveys – to enable policy-makers and stakeholders to follow and evaluate policy changes and their impact on the COVID-19 pandemic in the UK, Europe and around the world.
Marek Naczyk, Oxford Associate Professor in Comparative Social Policy and project lead, said: “As social scientists and concerned citizens, we felt compelled to work on this tool to ensure policy-makers and the public can access information on policy measures in the wake of COVID-19. We have been encouraged by the interest to date from many international organisations, including OECD and the World Bank, highlighting how the Department of Social Policy’s interdisciplinary background is well placed for the continued development of the tool. Our ambition is for the Oxford ‘Supertracker’ to be the go-to portal sharing all known policy-related data sources in one place.”
Numerous organisations have produced trackers to allow policy-makers and stakeholders to follow and evaluate policy changes and their impact on the pandemic. The Oxford Supertracker project makes this information freely available with one tool, allowing users to search and identify international policy.
Sebastian Königs and Andrea Garnero, Economists at The Organisation for Economic Co-operation and Development (OECD) said: “The team behind the Oxford Supertracker have done an impressive job in assembling the rapidly growing data on countries’ COVID responses and in making them readily available and easily searchable. This is an enormous service to the research and policy community, including many here at the OECD.”
Ugo Gentilini, Global Lead for Social Assistance at the World Bank, commented on the Supertracker, saying: “The Oxford Supertracker offers a precious compass to help policy-makers, practitioners and researchers to navigate the rich and evolving set of trackers available globally.”
The COVID-19 policy tracker started in March as a Twitter thread by Oxford DPhil student Lukas Lehner. But it has evolved into the Supertracker, a comprehensive global directory of more than 100 data sources.
Compiling policy trackers and surveys, the Supertracker allows users to search by:

  • Policy area – such as ‘education’ or ‘social and economic’
  • Country coverage
  • Data format, and
  • Author.

It will be updated with input from policy-makers, researchers and users, to identify symmetries and gaps in existing trackers and propose concrete actions to address these. These will be particularly relevant to the social policy and economic inequality prevention measures, that are put in place as lockdown policies ease.
Visit the Oxford Supertracker here: https://supertracker.spi.ox.ac.uk A data summary can be downloaded as a CSV for offline analysis.

Pan-European consortium established to rapidly develop vaccine

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A pan-European consortium of biotech companies announced April 23 that they will collaborate to develop and manufacture on a large scale a novel adenoviral vector-based vaccine against COVID-19.
The vaccine candidate is expected to enter clinical trials mid 2020 with vaccine production planned to start following the successful trials. If all goes according to plan, approximately 6 million doses of the vaccine are expected to be available early in 2021.
The consortium comprises Italian company ReiThera, German LEUKOCARE, and Belgian Univercells. They provide expertise in vector-based vaccine development, vaccine formulation and manufacturing, respectively. Their combined expertise is expected to enable efficient and ultra-fast vaccine development.
The vaccine technology is based on a novel, ReiThera-proprietary simian adenoviral vector with strong immunological potency and low pre-existing immunity in humans. Vaccines based on simian adenoviral vectors have been extensively evaluated in Phase 1 and 2 clinical trials and proved to be safe and immunogenic. ReiThera is currently preparing for a COVID-19 first-in-human trial to be started in Italy in mid 2020.
In parallel to its clinical development, the consortium will start manufacturing and stockpiling the vaccine. With these pilot scale processes, approximately 6 million doses of the vaccine are expected to be available early in 2021. Based on the Phase 1/2 clinical results and a path agreed with regulatory authorities, the intention with these doses will be to vaccinate the most exposed people such as medical and healthcare professionals and highly vulnerable individuals.
LEUKOCARE will contribute to the drug product development by developing a highly stable liquid vaccine formulation based on its well-established technology platform for formulations of viruses and viral vectors.
Univercells will take advantage of the previous successes of its scale-X bioreactor and NevoLine biomanufacturing platform to adapt and scale-up the technology platform and enable the mass production of ReiThera’s vaccine candidate.
Michael Scholl, Chief Executive Officer of LEUKOCARE, commented: “By combining the experience of the partners, the advanced stages of this vaccine development will allow for a swift response to the COVID-19 pandemic. Facing the current challenges, our approach for the fast and low-risk development of drug products with superior stability characteristics is even more important regarding timelines and social impact.”

The 43rd World Hospital Congress rallies for people-centered health services in times of peace and crisis

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Hosted by the Ministry of Health of the Sultanate of Oman, the 43rd World Hospital Congress of the International Hospital Federation (IHF) will go over some of the most pressing subjects in the global healthcare community in over 40 sessions lined up for discussion on 6 to 9 November in Muscat.
In between times of peace, situations of humanitarian crisis always manage to creep in or sweep off the guards of healthcare systems and even governments. Epidemics, wars and terrorist attacks, natural disasters and man-made hazards, and major cases of poverty and famine often fall on the ground wrecking communities’ health defenses. The persistence of these phenomena and their prevailing nature demand collective attention and actionable long-lasting mitigation plans, which are best formulated with resilient health services, health investments for prosperity, and innovations for health impact.
Under an overarching theme “People at the heart of health services in peace and crisis”, the agenda of the World Hospital Congress will cover the stages of preparation while in peace, action when in crisis and moving forward to better healthcare services for communities.
The World Health Organization (WHO) will be hosting an opening keynote session on the role of hospitals in support of universal health coverage to be presented by Dr. Edward Kelley, Director of the Department of Integrated Health Services of WHO. It will be followed by a ministerial-level panel discussion to further explore how hospitals are integral to the UHC and PHC agenda and how they can contribute to transforming health systems.
In another keynote presentation, Dr. Akihiro Seita, Director of Health Programme of UNRWA (UN Relief and Works Agency for Palestine refugees in the Near East) will share about the challenge of UNRWA in providing Palestine refugees access to hospital services. In succeeding sessions, stories and perspectives taken right from the terrorist attacks in Kenya and the continuing displacement and refugee casualties in Afghanistan are ready to open many eyes to the bigger fights of the healthcare community against massive violence.
A number of sessions are equally dedicated to reviewing the central role of hospitals in the health system. In a keynote session, Dr. Agnès Soucat, Director of Health Systems Governance and Financing at WHO will help delegates further understand the role of hospitals and health services affecting population well-being. Likewise, Dr. Melinda Estes, President and Chief Executive Officer of the Saint Luke’s Health System in USA will share her knowledge about how hospitals and health systems can drive community health and prosperity.
Inspiring accounts about the birth of the Oman Cancer Association, an Omani community built from the sentiments of a cancer survivor now collaborating with several programs supportive of cancer patients, will also be told by Hon. Yuthar Mohammed Al Rawahy, Founder and Honorary Life President of the Oman Cancer Association. More sessions from this year’s congress host – the Ministry of Health of the Sultanate of Oman – will share about Oman’s stories of resilience, the integrated healthcare system they have established, as well as e-health innovations and achievements.
Innovation pathways will also take the floor in a keynote presentation to be delivered by Sir Andrew Dillon CBE, Chief Executive of the National Institute for Health and Care Excellence in UK.
More topics on health innovations will be tackled in detail through the inspiring digital transformation experience of Catalonia and the huge success of Taiwan’s healthcare IT transformation.
GS1 Healthcare has also arranged a session to share examples from several countries of enhanced healthcare results by the introduction of global standards, starting at procurement in healthcare organizations.
The concept of ‘anchor institutions’ will be elaborated by senior health service leaders and experts from the NHS Confederation.
Composed of several more currently relevant topics, the agenda of the Congress will once again serve eye-opener stories happening around the globe posting both serious challenges and ripe potentials to innovate and invest on people-centered health services whether in peace or in crisis.
The IHF Muscat World Hospital Congress will take place through four consecutive days of knowledge harvest including pre-Congress sessions on ‘Economics for Healthcare Leaders’ and ‘The “Fast Forward” Initiative for community- and person-centered hospitals and health services’. This annual event will close with a hospital tour to The Royal Hospital and the Sultan Qaboos University Hospital. https://worldhospitalcongress.org/

Stanford researchers create a wireless, battery-free, biodegradable blood flow sensor

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A new device developed by Stanford University researchers could make it easier for doctors to monitor the success of blood vessel surgery. The sensor monitors the flow of blood through an artery. It is biodegradable, battery-free and wireless, so it is compact and doesn’t need to be removed and it can warn a patient’s doctor if there is a blockage.
“Measurement of blood flow is critical in many medical specialties, so a wireless biodegradable sensor could impact multiple fields including vascular, transplant, reconstructive and cardiac surgery,” said Paige Fox, assistant professor of surgery and co-senior author of the paper.
Monitoring the success of surgery on blood vessels is challenging as the first sign of trouble often comes too late. By that time, the patient often needs additional surgery that carries risks similar to the original procedure. This new sensor could let doctors keep tabs on a healing vessel from afar, creating opportunities for earlier interventions.
The sensor wraps snugly around the healing vessel, where blood pulsing past pushes on its inner surface. As the shape of that surface changes, it alters the sensor’s capacity to store electric charge, which doctors can detect remotely from a device located near the skin but outside the body. That device solicits a reading by pinging the antenna of the sensor, similar to an ID card scanner. In the future, this device could come in the form of a stick-on patch or be integrated into other technology, like a wearable device or smartphone.
The researchers first tested the sensor in an artificial setting where they pumped air through an artery-sized tube to mimic pulsing blood flow. Surgeon Yukitoshi Kaizawa, a former postdoctoral scholar at Stanford and co-author of the paper, also implanted the sensor around an artery in a rat. Even at such a small scale, the sensor successfully reported blood flow to the wireless reader. At this point, they were only interested in detecting complete blockages, but they did see indications that future versions of this sensor could identify finer fluctuations of blood flow.
Stanford University https://tinyurl.com/y6g4qmng

European Commission raises €15.9 billion for Coronavirus Global Response

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The ‘Global Goal: Unite for our Future’ pledging summit organised 27 June by the European Commission and Global Citizen mobilised €6.15 billion in additional funding to help develop and ensure equitable access to coronavirus vaccines, tests and treatments. This brings total pledges under the Coronavirus Global Response pledging marathon, launched by European Commission President Ursula von der Leyen on 4 May, to €15.9 billion. The money raised will also support economic recovery in the world’s most fragile regions and communities..
The latest pledging session includes a €4.9 billion pledge by the European Investment Bank, in partnership with the European Commission, and €485 million committed by EU Member States.
Forty governments took part in the summit and committed to ensuring universal access to coronavirus medicines. They also vowed to help rebuild communities that have been hit hard by the pandemic, in a fair and just way.
As a landmark of global solidarity, the summit resulted in commitments for the production capacity of over 250 million vaccine doses for middle and lower income countries.
“The world will only be freed from this pandemic when vaccines, tests and treatments are available and affordable to everyone who needs them. Today’s pledges and Europe’s contribution bring us closer to this global goal. Europe is in this for the long haul. We will use all of our convening power for the common good. There is a strong alliance out there to beat this virus, together.” Von der Leyen said.
The European Investment Bank is building a pipeline of investment projects to develop and scale up production of coronavirus vaccines, tests and treatments, in partnership with the European Commission, the World Health Organization and the Coalition for Epidemic Preparedness Innovations (CEPI).
In recent weeks, the EIB announced a new Memorandum of Understanding with the WHO, an Advisory agreement with CEPI, a collaboration with the Israel Innovation Authority and a €50 million financing agreement with Pluristem to develop therapies for coronavirus vaccine development finance for BioNTech and increased cooperation with UN-Habitat.

Italian doctors call on world to change perspective on care

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Doctors at the epicentre of the COVID-19 outbreak in Italy have made an urgent call on the rest of the world to change the way they treat pandemic patients. In a paper published in NEJM Catalyst (21 March 2020) they say patient-centred care is no longer feasible in a pandemic and that ‘community-centred’ care should be the new norm.
They say that hospitals might be the main COVID-19 carriers as they are rapidly filled with infected patients.
“This disaster could be averted only by massive deployment of outreach services,” they emphasize.
The doctors (Nacoti M, et al – At the Epicenter of the Covid-19 Pandemic and Humanitarian Crises in Italy: Changing Perspectives on Preparation and Mitigation) who work at Papa Giovanni XXIII Hospital in Bergamo, a brand-new state-of-the-art facility with 48 intensive-care beds, say: “Our own hospital is highly contaminated, and we are far beyond the tipping point: 300 beds out of 900 are occupied by Covid-19 patients. Fully 70% of ICU beds in our hospital are reserved for critically ill Covid-19 patients with a reasonable chance to survive. The situation here is dismal as we operate well below our normal standard of care. Wait times for an intensive care bed are hours long. Older patients are not being resuscitated and die alone without appropriate palliative care, while the family is notified over the phone, often by a well-intentioned, exhausted, and emotionally depleted physician with no prior contact.
“But the situation in the surrounding area is even worse. Most hospitals are overcrowded, nearing collapse while medications, mechanical ventilators, oxygen, and personal protective equipment are not available. Patients lay on floor mattresses. The health care system struggles to deliver regular services — even pregnancy care and child delivery — while cemeteries are overwhelmed, which will create another public health problem.
They say pandemic solutions are required for the entire population, not only for hospitals.

  1. Home care and mobile clinics avoid unnecessary movements and release pressure from hospitals.
  2. Early oxygen therapy, pulse oximeters, and nutrition can be delivered to the homes of mildly ill and convalescent patients, setting up a broad surveillance system with adequate isolation and leveraging innovative telemedicine instruments.

https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0080

IHF Congress will convene health leaders from around the globe in Oman

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Health leaders and professionals from more than 40 countries will be in Oman on 6-9 November for the 43rd World Hospital Congress of the International Hospital Federation for in-depth discussions on people-centered health services in times of peace and crisis. The scientific sessions will bring up actionable ideas on how health services can be resilient to various issues, supported by investments contributing to the prosperity of the country and innovative to increase health gain.
IHF’s annual Congress, hosted this year by the Ministry of Health of the Sultanate of Oman, will showcase a comprehensive event experience with:

  • 150 notable Speakers who will present advancements and share best practices in leadership, management and service delivery;
  • 40 Sessions that will delve into various dimensions of resilience, contribution of the health industry to prosperity and impactful innovations;
  • Poster display of best practices from different hospitals and organizations;
  • Solid networking opportunity enhanced by a new mobile application – CERCA – for secure and privacy-protected network-building activity; 
  • Two intensive Pre-conference sessions: Economics for Health Leaders and The “Fast Forward” Initiative for Community- and Person-Centered Hospitals and Health Services;
  • 2019 IHF Awards where outstanding initiatives will be recognized;
  • A friendly exhibition environment to make new connections or reunite with peers;
  • Hospital Site Visits to The Royal Hospital and Sultan Qaboos University Hospital, of which funds collected will be donated to St. Gemma’s Hospice in Leeds, a charity supported by a life-changing campaign called #hellomynameis.


The World Hospital Congress is a one-stop shop for the healthcare professional seeking the opportunity and environment in which to engage in a 360-degree learning and knowledge-sharing experience among peers. http://worldhospitalcongress.org

On the frontline

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More than 9 in 10 surgeons encounter a needlestick injury

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95% of surgeons have either been personally affected by a needlestick injury or have seen a colleague experience one, a new global survey has found, increasing their risk of infection. The survey – the first of its kind undertaken – was conducted by SERMO for Mölnlycke, a wound care and surgical products company.
The survey looked at key opinions from 510 surgeons across six countries relating to infection prevention and the role of high-quality gloves in improving patient and clinician safety. In particular, it demonstrated the importance that surgeons place on high quality gloves in the fight against needlestick injuries and exposure to blood-borne viruses, like HIV.

An estimated two million needlestick injuries occur among health workers each year, resulting in increased exposure to HIV, Hepatitis C
and other blood-borne viruses. Needlestick injuries occur when a needle or other sharp instrument accidentally penetrates the skin, yet the underreporting to occupational health departments is well established.

The survey revealed that 93% of surgeons think that high quality gloves reduce the chance of exposure to blood-borne viruses and 83% said that the quality of gloves affects their sense of being protected from needlestick injuries.

On the topic of patient safety, 81% of surgeons believe that high quality gloves impact overall patient outcomes and 89% agreed that high quality gloves improve patient safety in the operating theatre. When asked about glove failure during an operation, 78% of surgeons responded that it increases the risk of surgical site infections.

Commenting on the survey findings, John Timmons, Clinical Staff Nurse and Internatio-
nal Medical Director, said: “Each year, millions of surgeons and their teams risk exposure to life threatening blood-borne viruses and this ground-breaking survey highlights the value that surgeons across the globe place on high quality gloves. Surgeons clearly recognise their role in both ensuring the safety of surgeons and improving outcomes for patients.

“Surgical gloves are one of the key factors that prevent infections in the operating room and should not be viewed as a commodity. High quality means fewer glove failures, yet we are increasingly seeing healthcare systems around the world prioritise price over quality.”

Healthcare-associated infections (HAIs) are the most frequent adverse event in healthcare delivery worldwide. Hundreds of millions of patients are affected by HAIs worldwide each year, leading to significant mortality rates. Of every 100 hospitalized patients at any given time, an estimated seven patients in developed countries will acquire at least one HAI. www.molnlycke.com/biogel/

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