Polycystic Kidney Disease

[mechanical31]

I have pkd and my brothers kidneys are expected to fail from same within a year or so. My sister , who is 6 years my junior also has the disease and it has progressed faster than my own. I have been recently tested and my kidneys are still functioning normal and not in near as bad of shape as my siblings. I have been thinking for months why is this? My brother is 2 1/2 years older than me within similar lifestyles our whole life. The dive shop called last night to confirm a trip and I i was dreaming of the hours underwater diving nitrox at 4 atmospheres and it hit me like a ton of bricks. Hyperbaric medicine! I read more and it seems in limited studies Nitrox in a hyperbaric chamber has stopped infection for sure and possibly could even help regenerate organ damage by stimulating bone marrow stem cells? I called the nephrologist and will probably not hear back from him and what a bummer. Surely this needs investigated farther. I also was just telling the guys at the plant that my IBD had been getting worse and low and behold Hyperbaric medicine is used to treat that also. Coincidence, maybe. But diving could be literally prolonging my life. Think my med insurance will cover my trip? jk about the insurance. I just wish I had the cash to do the before and after scans myself.
http://resources.metapress.com/pdf-preview.axd?code=606128t3082711pu&size=largest

 

[Duke Dive Medicine]

Hi Mechanical,
In the reference you cited, hyperbaric oxygen wasn't used to treat the polycystic kidney disease itself, it was used as an adjunctive treatment for a large abscess and sepsis that the patient experienced after surgery.
Hyperbaric oxygen is defined as oxygen given at a partial pressure greater than atmospheric, i.e. 1 ATA. That's not typically encountered in recreational diving, and even technical divers limit their PO2 to around 1.4 ATA, which technically qualifies as hyperbaric but is subtherapeutic for conditions that are amenable to hyperbaric oxygen.
Be careful what you believe about the effectiveness of HBO2. There are some pretty outlandish claims made; for example, if you do a google search, you'll come up with a place in Florida that claims HBO2 reduces wrinkles and has antioxidant properties, which is absolute nonsense. The Undersea and Hyperbaric Medical Society (UHMS) looks at available scientific evidence and determines which conditions are most likely to benefit from HBO2. Their website, Undersea & Hyperbaric Medical Society > Home ( DNN 3.2.2 ), has a list of indications that meet their criteria. Medicare and private insurance companies generally go by these indications when they decide which conditions they'll reimburse for HBO2 treatment.
Unfortunately, there is no evidence that HBO2 can help regenerate organs. I'm glad to hear that your disease is fairly mild.

 

[mechanical31]

Thanks for your information. I do regularly hit just a little below 1.4 ata. I do understand what they were using it for in the article, but that was just a small part of the article. I have found that there are successful tests of hbo2 treating diabetic nephropathy , even though I admit I am skeptical. I am sure you know much more about it than I do and thank you for the good thoughts. I did not mean this to be a sure fire cure, just thought it deserved some testing. Also it could be a multitude of factors, but my IBD seems to be less severe when I dive more.

 

[mechanical31]

wow, does that mean the women in the test was hitting over 3 ata?

 

[Duke Dive Medicine]

Mechanical,
If you're talking about the woman in the article, she was treated at 2.5 ATA. Breathing O2 under controlled conditions in a dry chamber is different than breathing O2 under water - at Duke, we routinely treat at 2 ATA and up to 3 ATA depending on what we're treating.
Cheers,
DDM

 

[mechanical31]

Thanks DDM. Could you explain to me how at 3 ata she does not convulse. I read some articles, but all they said was that at that level it would be a narcotic effect. I was taught that diving at 3 ata would be serious problems. How can it be so different? I understand if you don't have time. By the way, You have a COOL job.

 

[Duke Dive Medicine]

Thanks DDM. Could you explain to me how at 3 ata she does not convulse. I read some articles, but all they said was that at that level it would be a narcotic effect. I was taught that diving at 3 ata would be serious problems. How can it be so different? I understand if you don't have time. By the way, You have a COOL job.

Mechanical,
The risk of O2 toxicity increases with immersion, so in general, people tolerate O2 better in a dry hyperbaric environment. O2 toxicity is also influenced by the length of exposure. At 2.82 ATA, which we use to treat DCS, the diver only breathes O2 for 20 minutes at a time, with five minute air breaks in between. We use a 68 foot (3.06 ATA) table for clostridial gas gangrene and do the same thing. This resets the O2 toxicity clock, so to speak, and helps mitigate the oxidative stress that the central nervous system is under.
Thanks, the job is great, I couldn't think of anything I'd rather be doing!
Best regards,
DDM

 

[TSandM]

DDM, is it not true that people being treated with high ppO2s do, on occasion, developing CNS toxicity? It's just that seizing in a dry chamber is nowhere near the lethal risk that doing so underwater is . . .

 

[Duke Dive Medicine]

DDM, is it not true that people being treated with high ppO2s do, on occasion, developing CNS toxicity? It's just that seizing in a dry chamber is nowhere near the lethal risk that doing so underwater is . . .

They do, but it's less likely if they're at rest in a dry, temperature-controlled chamber. In the diving environment, immersion, exertion, CO2 retention and cold water exposure all increase the risk of CNS O2 toxicity, so a diver breathing O2 at 2.8 ATA is at a much higher risk of seizure than a hyperbaric patient at the same partial pressure.

In practice, we rarely see seizures. When we do, it's usually in a critical care patient with multiple comorbidities. We did have a non-compliant, brittle diabetic a while back who seized a couple of times at 2 ATA because of hypoglycemia. Both times, it was on a Monday when he'd been away from us nagging him for the weekend, and he'd lie about his pre-treatment glucose levels. We quit trusting him and started checking him ourselves after the second seizure. It was scaring the other patients, and he'd want to drive afterward despite having been given IV ativan. He stopped coming, if I remember right.