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Drinking more water doesn’t slow kidney disease in chronic kidney patients

Raghu Kshitiz

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KATHMANDU — Drinking more water is generally advised — the common advice is to drink eight glasses per day –and has been associated with better kidney function and a reduced risk of kidney stones.

But drinking an extra four to six extra glasses of water per day won’t slow the decline of kidney functions for chronic kidney disease patients, according to a new study in Britain and Canada.

A study, published in JAMA (Journal of the American Medical Association) by researchers at LaLawson Health Research Institute in Ontario and Western University in London found that coaching patients with Chronic Kidney Disease (CKD) to drink more water does not slow down the decline of their kidney function.

“Despite widespread beliefs, little scientific data exists on the optimal amount of water to drink,” explains Dr. William Clark, Scientist at Lawson and Professor at Western’s Schulich School of Medicine & Dentistry.

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“While many claims about the benefits of increased water intake remain untested, a growing body of evidence suggests that increased water intake improves kidney function through the suppression of the antidiuretic hormone.”

Researchers studied whether increased hydration made a difference in people with kidney disease. The clinical trial was published Tuesday in the Journal of the American Medical Association.

The randomized clinical trial included 631 patients at London Health Sciences Center and several other hospitals in Ontario with stage 3 kidney disease from April 2013 to June 2017. At stage 3, patients have lost up to 70 percent of their kidney function.

Half of the participants were coached to drink more water — 1 to 1.5 liters per day, depending on sex and weight. Those in the control group were asked to maintain usual intake or not decrease it by more than one-quarter to a half-liter per day. One liter of water is about 34 fluid ounces.

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The researchers, after one year, found the increase of water consumption did not slow the loss of kidney function. They found, however, that the reduction significantly suppressed antidiuretic hormone release, particularly when the participant’s previous intake was low.

“This research indicates that for most patients with CKD, increasing fluid intake will not stop further loss of kidney function. It does allow us then to focus our efforts on other potential therapeutic options,” Clark said.

The researchers hope to conduct another study with a longer followup, according to them.

With Agency Inputs

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Suicide can’t be predicted by asking about suicidal thoughts : Study

Gorkha Post

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Most people who died of suicide deny they experience suicidal thoughts when asked by doctors in the weeks and months leading up to their death, a major Australian study has found.

The findings, co-authored by clinical psychiatrist and Professor Matthew Large from UNSW’s School of Psychiatry, Sydney that published in the journal BJPsych Open The meta-analysis challenge the widely-held assumption that psychiatrists can predict who will suicide by asking if they are preoccupied with thoughts of killing themselves.

The study showed that 80% of patients who were not undergoing psychiatric treatment and who died of suicide reported not to have suicidal thoughts when asked by their psychiatrist or GP.

“If you meet someone who has suicidal ideation there is a 98 per cent chance that they are not going to suicide,” said Professor Large, an international expert on suicide risk assessment who also works in the emergency department of a major Sydney hospital.

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“But what we didn’t know was how frequently people who go on to suicide have denied having suicidal thoughts when asked directly,” he added.

“This study proves we can no longer ration psychiatric care based on the presence of suicidal thoughts alone. We need to provide high-quality, patient-centred care for everyone experiencing mental illness, whether or not they reveal they are experiencing suicidal thoughts,” Professor Large said.

About one in 10 people will have suicidal ideation in their lifetime. But the study showed suicidal ideation alone was not rational grounds for deciding who gets treatment and who does not, Professor Large said.

“We know that suicide feeling is pretty common and that suicide is actually a rare event, even among people with severe mental illness,” Professor Large added.

Suicidal ideation tells us an awful lot about how a person is feeling, their psychological distress, sometimes their diagnosis and their need for treatment but it’s not a meaningful test of future behaviour.

Suicidal feelings can fluctuate rapidly and people may suicide very impulsively after only a short period of suicidal thoughts.

But, people had good reasons not to disclose thoughts of suicide, fearing stigma, triggering over-reactions or upsetting family and friends, and being involuntarily admitted for psychiatric treatment, Professor Large said.

Professor Large emphasized that clinicians should not assume that patients experiencing mental distress without reporting suicidal ideas were not at elevated risk of suicide.

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