Kidney Dialysis News: 2013

Sunday 22 December 2013

Billboard Advert - I Need a Kidney

When you need a transplant, things can get a bit desperate after a long wait with no sign of success. so one couple decided to take a bold step and advertise for a donor.

Sharon Nelson, 73, had been on the waiting list for quite some time when she and her husband James decided to rent a billboard on the Interstate 70. After that James went out, climbed up a ladder and painted the problem in rather large letters.

A nurse at their clinic said she knew a Milwaukee man who had found a donor for himself after renting a billboard. So they decided to give it a try.

Hopefully they will find someone. Until the right donor comes through it's just a matter of waiting, so she and husband can move on with their lives, Nelson said.

According to the National Kidney Foundation, over 96,000 people in the United States are waiting for a kidney transplant.

Original article can be seen here.

Wednesday 4 December 2013

FDA Approves Velphoro for Kidney Disease Patients

Velphoro® (sucroferric oxyhydroxide) has received US Food and Drug Administration (FDA) approval for the control of serum phosphorus levels in patients with Chronic Kidney Disease (CKD) on dialysis. Velphoro® will be launched in the US by Fresenius Medical Care North America in 2014.

Velphoro® (previously known as PA21) is an iron-based, calcium-free, chewable phosphate binder. US approval was based on a pivotal Phase III study, which met its primary and secondary endpoints. The study demonstrated that Velphoro®successfully controls hyperphosphatemia with fewer pills than sevelamer carbonate, the current standard of care in patients with CKD on dialysis. The average daily dose to control hyperphosphatemia was 3.3 pills per day after 52 weeks.

Hyperphosphatemia, an abnormal elevation of phosphorus levels in the blood, is a common and serious condition in CKD patients on dialysis. Most dialysis patients are treated with phosphate binders.

Read Vifor Pharma's press release

Viforo Pharma are part of of the Galenica Group, which in turn is part of Fresenius.

Friday 15 November 2013

Scottish Kidney Project Receives Major Grant!

A EUROPEAN-wide project, being co-ordinated by experts at Dundee University, has received a grant of £2.2 million to investigate new ways of improving kidney dialysis treatment. The European Union’s Marie Curie Partnership and Pathways programme has award £2.2 million to further the project's work. (That's about $3.5 million for our American readers.) A vast number of patients receive hemodialysis three times a week, in sessions lasting three to four hours. The dialysis equipment is connected to their blood supply through an access point grafted in to their body. A Dundee University spokesman explained: “The problem is that these vascular access sites fail in at least half of patients within the first year, leading to increased infections, hospital stays and operations. The ReDVA consortium will examine the problems that occur during long-term haemodialysis and look to improve the performance of vascular access that underpins the life-supporting dialysis techniques. “The academic members of the consortium will work with work with biotechnology experts at the University of Limerick in Ireland, Guerbet, a global imaging contrast company in France and Dundee-based Vascular Flow Technologies to investigate venous access and develop new clinical technologies, methodologies and devices to improve their performance.” He added: “The four-year project will see staff seconded between the universities and the industry partners as well as creating five new research posts.” “New techniques in imaging the vessel with ultrasound and MRI before it blocks, combined with improved surgical technique and vascular devices offers a real prospect of improving the lives of kidney failure patients. The research group offers an unparalleled range of expertise in surgery, imaging, and engineering to tackle this problem.” The grant is to the ReDVA Project. The ReDVA (Development of hemodynamic solutions in Renal Dialysis Venous Access) project is a team of scientists from the Dundee University Medical School, Birmingham's Queen Elizabeth Hospital and developers from industry. There are a few more details in the story published in

Wednesday 13 November 2013

Overnight Dialysis Boosts Heart and Kidney Health

Regular dialysis can really wear you out! Three days a week in a clinic for hours on end certainly takes its toll. Overnight dialysis is less tiring, taking place while you sleep, but recent research suggests it gives you more than just a rest! Have a read of the research paper in the Canadian Journal of Cardiology

Nocturnal home hemodialysis (NHD) could soon become a popular way to be treated. And it can be quite straightforward as well. After examining 17 patients responses to NHD, the spokesman for the group of medical scientists from Toronto, cardiologist Dr. Christopher Overgaard, said that "Longer dialysis, done while patients are sleeping, may improve the health of arteries and could lower the risk of developing heart disease."

While they are sleep, the patients are clearing their systems of more waste, and in a less disruptive manner, than they would be by going to their normal clinic several times a week.

And the heart benefit? The scientists found that coronary endothelial responsiveness — or how well the layer of cells along the inner lining of blood vessels functions — was partially improved with overnight dialysis. This finding is crucial for patients with impaired endothelial function, which is linked to accelerated atherosclerosis — or the hardening of arteries leading to the heart—in kidney disease patients.

Just imagine - a simple change in how the treatment is given and the patient's health improves. And it is less stressful than the standard hemodialysis treatment too!

Friday 13 September 2013

Baxter closes deal for Gambro

Baxter, the dialysis American specialist, has completed a deal with Gambro, a deal that started quite some time ago, one they have been after for even longer.

Baxter International Inc. said on 6th September that it has completed its $3.9 billion acquisition of Gambro AB, a private Swedish medical technology company founded in 1964.

This is the biggest acquisition for Baxter, making it an even bigger player in the large and expanding kidney dialysis market.

Baxter has tried for some time to arrange a tie-up with Gambro, the world's third-largest dialysis equipment maker, to help it broaden its kidney business. Baxter's dialysis business is focused on peritoneal dialysis, a treatment that can be performed at a patient's home, while Gambro makes equipment for dialysis performed in a hospital or health clinic (Baxter dropped out of this market in 2005). This means Baxter are now active in all the major forms of dialysis treatment. They can expand their current product range in to Europe, Gambro's territory, and Gambro can expand their equipment into Latin America and Asia.

The acquisition started with an offer accepted on 4th December 2012, and regulators in different areas have gradually given their approval. Gambro was a privately held company. Combined manufacturing and marketing should cut costs dramatically for the new joint business. The acquisition deal is valued at $3.9 billion, so it will be a while before the costs are recovered.

Wednesday 21 August 2013

Mount Sinai specialist promotes home dialysis

A recent article in New York Daily News covers home dialysis and the advantages for the patient.
"We now have the technology to deliver dialysis at home, an approach that has better outcomes for patients and is cheaper,” says Dr. Jaime Uribarri of Mount Sinai Hospital."

According to the report, out of approximately 400,000 Americans on dialysis, fewer than 30,000 of them across the country receive peritoneal dialysis, the most common form of home dialysis. Although home dialysis might sound extremely technical, just about anyone willing to participate in their own care can be trained to do it. And studies have shown that hemodialysis (the main dialysis centre treatment) and peritoneal dialysis are equally effective.

So what's stopping you from trying home dialysis?

Number of patients may affect YOUR health

There are many factors affecting your health if you have chronic kidney disease and need dialysis.
Just how busy your kidney specialist is may affect your health!

Dialysis patients receiving treatment from kidney specialists with a higher patient caseload have a greater risk of dying prematurely than those receiving care from specialists with a lower caseload, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The study is the first of its kind to examine the association between nephrologist caseload and mortality risk in a large urban US setting.

It seems logical to me that a specialist who has to see two or three times as many patients than the average must be giving each one less time, and one who sees 66% or 50% of the average can be giving each one more time. Hence it should come as no surprize when this was reported.

But scientists never just assume, they should always check. So a group from University of California Irvine Medical Center investigated whether or not those with a high work load had more than the average risk of patients suffering premature death, and whether those with a lower number of patients lead to a better survival rate.

Among the major findings:
• Nephrologists whose dialysis patients had the best survival had a significantly lower patient caseload than nephrologists whose patients had the worst survival.
• For every additional 50 patients cared for by a nephrologist, patients had a 2% higher risk of dying during the study period.

You can read the abstract online.

Wednesday 31 July 2013

Love and a Transplant

After splitting up with a girlfriend, contact often fades away. One thing you don't expect to do 20 years later is donate a kidney, and fall in love again.

The UK's Telegraph reports in a recent issue that's exactly what Gordon Henry has done, after splitting up from Jo Macfarane in 1993.

After hearing that Jo's chronic kidney condition meant she was in need of a transplant, Gordon decided to step in and lend a hand, or a kidney to be more exact. And amazingly he turned out to be a perfect match. After the operation, with the donor and recipient waking up in adjoining beds, nurses dropped a hint that Gordon might secretly still want her back. and now they are back together again.

They split up after they had a son, and 20 years on Gordon thought that donating a kidney "was a chance to repay her for all she's done for our son, she's brought him up all these years."

You can read the story here.

Monday 29 July 2013

Kidney Transplants May Help Obese Patients with Kidney Problems

Often, medical treatment has to balance the overall benefit and life expectancy of the patient. When resources are limited or expensive, someone with several problems may be considered less likely to benefit from expensive treatment for one problem when another problem makes the treatment just a stop gap before the other life threatening problem drags their health down even more.

However a recent article suggests that in the case of a kidney transplant, obese patients are just as likely to make good progress as normal or thin patients. The risk of death over the next year decreases by about 66% in obese patients who receive a transplant, compared to obese patients staying on dialysis. This is very much the same as for non-obese patients.

This report on some recent research seems to contradict earlier research which suggested that obese patients on dialysis did better than thin patients and worse after a transplant.

You can read the article here; the research was conducted at the University of British Columbia and St. Paul's Hospital in Vancouver, Canada.

Monday 8 July 2013

Don't just sit there...

Dialysis, by its very nature, requires patients to do a lot of sitting around (or lying around) during the actual treatment. Dialysis however, tends to break down protein within the muscle fibre, and so patients become weak and less mobile.

Doctors from the University of Virginia, echoing what has been said many times over the years, recommend patients should take some exercise to stay healthy. They are recommending a program called Sit Fit - exercises that can be done while sitting, for patients during the dialysis itself. It uses a type of exercise bike, and the pedalling required benefits patients.

A search using Google reveals reports on this sort of exercise going back many years. So while not exactly new news, and there are alternatives to the Sit Fit program, it might be news to some of you. So in conclusion, don't just sit there, get those pedals working. You'll feel so much better afterwards.

Here's a link to a pdf from the famous Guys and St Thomas hospital in the UK, on dialysis and pedalling towards a better life. And an image of the exercise bike in action.

Monday 17 June 2013

New Vascular Access Port Design

The trouble with hemodialysis is that you need an access port to extract the patient's blood and feed it into the dialysis machine, then return it. There are several common access ports that are routinely used, described in more detail here. The access port however can get infected, become sore and irritating, and lead to blood clots being formed. They can fail of the course of a patient's treatment and need replacing. Now a new type of access is available.

The new system, created by a set of former students and staff at the world famous Johns Hopkins Hospital, is claimed to be less troublesome and be longer lasting than other techniques. The new system, called the Hemova Port, has progressed to the animal trial stage after two years of development work. The special feature that is hoped to reduce problems is that it is only interacting with the flow of blood during dialysis sessions. It is claimed that this will lead to improved patient safety and treatment outcomes. The device sits just under the skin. It has a built-in cleaning loop, and is said to be usable much sooner than normal fistulas or grafts. It should benefit patients on long term treatment who have suffered from damaged access points.

The group have received several grants and awards to fund their research. Their website can be found here

Tuesday 28 May 2013

Elvis is Alive!

Elvis the Kitten, of course, who did you think I was referring to?

Elvis may only be one year old but he has had an eventful life already. He started by trying to eat some lilies on a Valentine's Day bouquet that his owner Bob Armstrong bought for his wife, Paula. Lilies are not something kittens should try eating, and they poison the poor little things, and soon Elvis was mopping around, lethargic and not eating. A visit to the vet and mention of the lilies set alarm bells ringing, and things just got worse for the poor little guy. his kidneys were failing, as shown by a blood test. He was recommended to be put on dialysis. Yes, cat dialysis does take place. A visit to The School of Veterinary Medicine at Pennsylvania, soon gave him some relief, but his live was only being extended for the short term. He needed a transplant. Yes, pets do get transplants too.

The School of Veterinary Medicine at Penn. has done about 150 animal kidney transplants. Rescued cats get a new home with the owner of the cat they are a donor for, so a donor was sought to save Elvis. When a suitable donor was found, a health check ws made and then, on April 1st, (not this is not an elaborate hoax), on April 1st 1st, both cats were prepared for surgery, but at the last minute it had to be postponed (Elvis had had so many transfusions, it caused problems), and another donor was sought. And the surgery took place. Want to guess the donor cat's original name, found after a bit of research by the team involved? Elvis of course!

However, things didn't go as smoothly as planned, and poor Elvis (the sick one) was rushed off again for emergency treatment,as blood was not getting to his new kidney. His heart stopped for five minutes on the operating table, but the surgeons managed to save him.

Here he is! (No blue suede collar though.) Isn't he sweeeet?

So Elvis has returned from the dead! He still needs a daily dose of drugs to keep him okay. But hey, lots of rock legends...

Rock and Roll!
Read the story here if you don't believe me

What will these skilled vets get up to next, MRI scans for pets perhaps?

Saturday 4 May 2013

Kidney Disease In Older Age Linked To Overweight Starting In Early Adulthood

More research linking weight to possibility of kidney problems in later life.

This research suggests that being overweight early in your life could significantly increase the risks of developing kidney disease by the time people reach old age, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). Once again excess weight is showing up as a risk factor for chronic kidney disease.

It doesn't help that globally there is a trend for many people to become overweight, if not obese. In some countries it is more of a problem than others.

The research looked at a group of people born in one particular week in March 1946 in England, who were part of a long term data collection study. This gave information about the body weight of 4,584 individuals at six points in their life.

Among the major findings where the following points:

Participants who were overweight beginning early in adulthood (ages 26 or 36 years) were twice as likely to have CKD at age 60 to 64 years compared with those who first became overweight at age 60 to 64 years or never became overweight.
The link between overweight and CKD was only in part explained by taking diabetes and hypertension into account.
Larger waist-to-hip ratios ("apple-shaped" bodies) at ages 43 and 53 years were also linked with CKD at age 60 to 64 years.

According to one quote, up to 36% of chronic kidney disease cases at age 60 - 64 could be avoided if the patients hadn't become overweight until later in life. The exact timing of when the weight gains start to affect things is currently unclear however.

Monday 22 April 2013

Smoking may be affecting young people's kidney function

A recent news release from some Johns Hopkins research scientists suggests that smoking, both actively and exposure to passive / second hand smoke may be affecting the kidney function of adolescents. Their research suggests that the effects of tobacco smoke of the kidneys starts in childhood.

It's a bit of an understatement to say that smoking is associated with health problems (even if for literally decades the tobacco companies denied this!). This new research found that exposure to tobacco, including secondhand smoke and active smoking, was associated with lower estimated glomerular filtration rates — a common measure of how well the kidneys are working.

A surprising number of young people try smoking, trying to pretend they are cool and grown-up - forgetting that most grown-ups don't smoke and thus showing that they are children. And along the way they are affecting their kidney function.

“Small changes in the distribution of estimated glomerular filtration rate levels in the population could have a substantial impact in kidney-related illness, as it is well known for changes in blood pressure levels and hypertension-related disease. Evaluating potential secondhand smoke exposure and providing recommendations to minimize exposure should continue to be incorporated as part of children’s routine medical care,” noted Jeffrey Fadrowski, MD, MHS, co-author of the study and an assistant professor in Pediatric Nephrology at the Johns Hopkins School of Medicine.

“Tobacco as a chronic kidney disease risk factor is of great concern given the high prevalence of use and the chronicity that most often accompanies this exposure. Protecting young people from active smoking is essential since nearly 80 percent of adults who smoke begin smoking by 18 years of age,” said Navas-Acien.

Wednesday 17 April 2013

Apples and Pears - the Difference Really Matters

People's body shape can be classified as being an apple or a pear. Apple people, apart from buying expensive phones, carry excess weight around their abdomen, making them round, like an apple. Pear shaped people carry any excess weight a bit lower, around their hips. And why does this matter?

Because carrying excess weight around the abdomen is linked to an increased risk of kidney disease, a recent study suggests.

It was already known that being apple-shaped, as opposed to pear-shaped, added to the risk of developing cardiovascular problems. The new research, in the Journal of the American Society of Nephrology, found signs of kidney problems in even otherwise healthy apple-shaped people.

The study, by a team at the University Medical Center Groningen, in the Netherlands, examined 315 healthy individuals with an average BMI of 24.9 kg/m2 (normal weight range BMI 18.5–24.9 kg/m2) and found people with apple-shaped bodies tended to have lower kidney function, lower kidney blood flow, and higher blood pressure within the kidneys than people with pear-shaped bodies –even after adjusting for sex, age, mean arterial pressure, and BMI. They looked at the waist to hip measurement ratio as a way of quantifying a person's body shape.

High blood pressure in the kidneys of people with apple-shaped bodies may be responsible for their increased risk of developing kidney disease later in life.

So, what shape are you in? Would a bit of exercise and diet be a good idea?

Thursday 11 April 2013

Racial differences in survival on dialysis

A recent article suggests that your genetic background dictates how long you might survive on dialysis. The work suggests that Hispanics tend to live longer than blacks and whites.

It's known that your ethnic background can affect how likely you are to need dialysis - diabetes is more common among some races for example, as mentioned here, so should it be surprizing that your survival time is also dependent on your race?

A number of theories exist as to why Hispanic and black dialysis patients tend to live longer than whites. It may be that Hispanic and black patients are more likely to die before they develop kidney failure, and those who survive are generally healthier and thus more likely to live longer than white patients, the researchers suggested.

The researchers examined data from the United States Renal Data System involving 1,282,201 adults on dialysis between 1995 and 2009.

Source: Clinical Journal of the American Society of Nephrology, news release, March 28, 2013
Abstract

Sunday 24 March 2013

Four kidneys and three pancreases

When we saw this headline, our initial thought was that someone had gone through a series of unsuccessful transplants, involving removal of a failed organ and replacement with a donor organ. We were wrong.

The article in the UK paper The Sun is about Carl Jones, aged 32. He has undergone several transplant operations, with a small difference. They left his original organs in place. So now he is living with four kidneys and three pancreases in his body. Carl had diabetes and spent a lot of time on a dialysis machine. He had his first kidney and pancreas transplant in 2004. Then in 2008 he had a second set implanted.

His diabetes has been cured, and he no longer goes through the regular dialysis treatment he endured for many years.

Friday 8 March 2013

New risk factor for heart disease.

Kidney failure affects 25 million individuals in the U.S. and many, many more throughout the world. Loss of kidney function means the majority of these patients must undergo dialysis treatments to remove excess fluids and waste products. Although dialysis therapy coupled with medication has improved the life expectancy for people with kidney failure, for unknown reasons, patients' risk of sudden heart failure and death remains 10 to 20 times greater than average.

A new study helps explain why this may be the case. Appearing on-line in Science Translational Medicine, the new findings show that a process known as protein carbamylation contributes to heart disease risk among patients with kidney failure undergoing dialysis, and demonstrates that a blood test to measure carbamylated albumin protein can help clinicians better gauge the effectiveness of dialysis and identify patients at risk of cardiac complications. The findings additionally suggest the need for further investigation to determine if therapy with supplemental amino acids could help to prevent the carbamylation process.

The problem arises due to accumulation of urea in patients blood. Although urea is generally non-toxic, in some cases it can degrade into cyanate, a toxic chemical that binds to and permanently modifies proteins through a process known as carbamylation.

In two independent clinical experiments, the investigators demonstrated that increased carbamylated albumin is strongly associated with an elevated risk of premature death in patients on dialysis. They additionally found that increased carbamylated albumin in dialysis patients was linked with low blood concentrations of amino acids, the building blocks of proteins.

Reported in a Eureka press release

Thursday 7 March 2013

Forget dialysis, get a transplant

According to a report in the Jamaican paper The Gleaner, doctors are suggesting that transplants are cheaper than dialysis, and thus the logical answer to keep health service costs down is to give the patient a transplant. The dialysis patient may require treatment for 20 - 30 or more years, and Professor Everard N. Barton, director of the Caribbean Institute of Nephrology based at the University of the West Indies, Mona, says transplants are far cheaper.

The suggestion is that transplants start to become cheaper overall after two and a half years compared to dialysis, and thus would reduce the strain on the health system. And reduce the long waiting list to get dialysis.

The public should be encouraged to take part in organ donation schemes, thus increasing the number of patients who could be considered for a transplant.

You can read the article in The Gleaner

Monday 11 February 2013

Frequent dialysis poses risks for kidney disease patients

A soon to be published article in Journal of American Society of Nephrology, reported initial by Science Codex, it is stated that frequent dialysis poses problems for patients, requiring patients to undergo more repair procedures to the site through which blood is removed and returned.

Rita Suri, MD (Western University and Lawson Health Research Institute, in London, Canada) and her colleagues conducted two separate 12-month clinical trials in which they randomly assigned 245 patients to receive either in-center daily hemodialysis (6 days/week) or conventional hemodialysis (3 days/week) and 87 patients to receive either home nocturnal hemodialysis (6 nights/week) or conventional hemodialysis. Three access events were recorded: repair, loss, and access-related hospitalizations.

Among the major findings:

In the Daily Trial, 77 (31%) of 245 patients experienced one of these events, with the daily group having 33 repairs and 15 losses and the conventional group having 17 repairs, 11 losses, and 1 hospitalization.

Overall, the risk for an access event was 76% higher with daily hemodialysis compared with conventional hemodialysis.

Similar trends were seen in the Nocturnal Trial, although the results were not statistically significant.

"Our study is the first randomized trial to show that dialyzing more frequently may have potential harmful effects on the hemodialysis vascular access. This has important implications for patients and physicians considering or performing frequent hemodialysis," said Dr. Suri.

Saturday 9 February 2013

Home-Made Dialysis Machine

I thought I was imagining things when I read this (it is in the UK's Daily Mail for a start, and that usually means unreliable. But here goes anyway.

The article claims that a Chinese man found dialysis at his local center was proving to be just too expensive. So he built his own dialysis machine. Yes, that's what it says. And it goes on to say that he has used it for 13 years so far. Hu, who suffers from kidney disease, made it from kitchen utensils and old medical instruments after he could no long afford hospital fees. He also makes his own dialysis fluid.

Liberally illustrated with images, it shows Hu Songweb connected to his device.

Although a Communist country, China does not have a cradle-to-grave free-at-the-point of use healthcare system.
Instead around half of the population buy basic medical insurance which covers for half the costs of their healthcare. The remainder is paid either by patients or their health insurer. However, this leaves the poorest in China struggling to meet medical bills for serious conditions.

He said two of his friends had died after building and using similar machines - hmmm, not much of a surprize there.

Now perhaps I'm being a bit cautious here, but I would NOT recommend anyone trying this themselves. No, seriously, don't try this.

Sunday 27 January 2013

Kidney tissue grown from stem cells

In what could be breakthrough research for those with damaged kidneys, a group of Japanese scientists at Kyoto University report potential revolutionary results - they have grown human kidney tissue from stem cells.

Stem cells are famous for their ability to grow into any type of human tissue under the right conditions.

The team of pioneers had progressed to the point of formulating intermediate mesoderm tissue from the stem cells, a type of tissue developed midway to fully fledged organ tissue.

A scientist on the project, Kenji Osafune, said that the mesoderm tissue also known as embryonic intermediary could be developed in human beings into ‘specific kidney cells’ or artificially via a test tube.

It should be stressed that this is just the beginning of what could be a long journey to produce artificial kidneys from stem cells, but all such research has to begin somewhere. Indeed this initial work was not aimed at growing an entire kidney.

You can read more in this report and also here The original research was published in Nature Comms

Saturday 19 January 2013

Shares in DaVita being bought

The most famous and successful investor in the world is Warren Buffet, and his company Berkshire Hathaway Inc now owns 15% of DaVita, reported on many financial web sites this week. As more people are given dialysis, obviously his company see this as a good investment.

According to the Davita web site, as of September 30, 2012, DaVita operated or provided administrative services at 1,912 outpatient dialysis centers located in the United States. Plus 24 centers in other countries. Not bad for a company that was founded in 1999. That sort of growth must be what attracted Buffet's company to regularly buy shares in the company.

Thursday 17 January 2013

Controversial Kidney-Dialysis Law Upheld

A law that has been around in Florida since 2002 was challenged in the court, and upheld. Florida doctors will continue to be barred from referring kidney-dialysis patients to labs in which the doctors have financial stakes.

The three-judge panel agreed with a lower court that, among other things, the law did not discriminate against Fresenius and Davita and didn’t violate their constitutional rights.

“Because it is reasonably conceivable that Florida ESRD (end-stage renal disease) patients would be better served if their physicians were prohibited from making self-referrals to associated laboratories, we conclude that the Florida act survives rational basis scrutiny and that the law does not deprive appellants (Fresenius and Davita) of their rights to substantive due process,” part of the ruling said.

It seems to me that if the doctors have to refer patients to a client that doesn't reward the doctor directly, then the doctor must be referring the patient to some other clinic. How does that go against Fresenius and Davita, who challenged the law?

If a doctor who has an interest in a DaVita clinic refers a patient to a Fresenius owned clinic, and vice versa, are they going to give a false report because the patient might end up in the other company's dialysis center? I wouldn't have thought so, it's more of a second opinion from someone who probably will have nothing to gain. So the two companies should stop complaining, IMHO.

You can more read about this here