British Journal of Renal Medicine - 2008

Comment: Small steps and giant footprints
John Bradley
pp 3-3
The majority of patients receiving hospital-based dialysis rely on patient transport services. Sarah Griffiths and Richard Fluck show that travelling continues to add considerably to the treatment time of some patients, and travel to and from dialysis units remains one of the major concerns for patients.
Fistula cannulation – the buttonhole method
James A Milburn, Ewan M Macaulay, Jacqueline Annand, Jacqueline Ross, Anne Humphrey and Nick Fluck
pp 4-7
Many worldwide initiatives currently aim to increase the proportion of haemodialysis patients with autogenous arteriovenous fistulae (AVF) due to their superior long-term patency rates compared with prosthetic grafts. AVF survival depends on a number of surgical and haematological considerations but also on the method of cannulation. A number of different methods of AVF cannulation have been described, of which the rope-ladder and area puncture (AP) are most commonly used. Recently there has been interest in the constant site, or buttonhole (BH), method, included for the first time in the 2006 National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines.
Insurance for people with chronic kidney disease
Hugh Gallagher, Kevin Somerville and Donal ODonoghue
pp 8-11
The introduction of estimated glomerular filtration rate (eGFR), using the abridged modification of diet in renal disease (MDRD) formula, and the adoption of the National Kidney Foundation Kidney Disease Outcomes Quality Initiatives (KDOQI) classification of chronic kidney disease (CKD), have highlighted the high prevalence of this condition. It is estimated that 8.5% of the UK population have stage 3 to 5 CKD, with over 90% of these in the stage 3 category (eGFR 30–60 ml/min/1.73 m2).
Phosphate binders: dietetic management using PGDs
George H Hartley
pp 12-14
Dietitians play a central part in managing bone biochemistry in chronic kidney disease (CKD). Traditionally, their role has been limited to providing dietary advice on how to reduce phosphate intake, while medical staff prescribe phosphate binder medication. Although dietitians may feel well placed to advise on phosphate binder medication, their involvement in this area is strictly controlled by the Medicines Act 1968 and other secondary legislation. Unlike medical staff, dietitians are not permitted to order, in writing, the supply of medicine or to authorise their supply by means of an NHS prescription.
What I tell my patients about renal bone disease
Andrew Connor
pp 15-18
Chronic kidney disease (CKD) has been classified as having five stages. Stage 1 describes mild disease and stage 5 describes severe disease. As CKD progresses in severity, its effects on the rest of the body become apparent. The bones are an area that may be affected. Patients with CKD may develop a number of different types of bone problems. These are collectively known as renal bone disease (sometimes called renal osteodystrophy). Renal bone disease (RBD) is a complex problem. This article explains the different types of renal bone disease and their treatments.
Acute kidney injury – best practice and staging system
Robert Mactier
pp 19-21
Acute renal failure is a clinical syndrome resulting from a rapid reduction in renal excretory function and may be caused by a wide range of prerenal, renal (intrinsic) and postrenal causes. Acute kidney injury (AKI) has been adopted as the term to describe the full spectrum of acute renal failure. Acute tubular necrosis (ATN) is the cause of more than 75% of all episodes of AKI. The reported incidence and clinical outcomes of AKI vary widely and depend upon the criteria used to define AKI and the population under observation.
ABLE in Leicester: South Asians and renal disease
Azhar Farooqi, Neerja Jain and John Feehally
pp 22-25
In the UK, the prevalence of established renal failure (ERF) is at least three times greater among people with a South Asian background than the native white population. This is in part due to the higher prevalence of type 2 diabetes, which is four times more common among South Asians. Kidney failure as a complication of diabetes is ten times more common in South Asians compared with white populations.
Efficacy of transport services for patients on dialysis
Sarah Griffiths and Richard Fluck
pp 26-28
Consistent with national and international trends, the number of patients on dialysis is increasing by 6–8% per annum. This is in part due to the aging population, with many more elderly patients now receiving dialysis. Haemodialysis is a lifesaving treatment, but one which, for many, is also aggressive and tiring. Most hospital haemodialysis patients dialyse three times a week for an average of three or four hours per session. Delays in transport to and from dialysis further disrupt patients’ lives and can jeopardise compliance with treatment altogether.
Comparing transplant practice in Spain and the UK
Victoria Gonzalez Martin, Manuel Arias and Martin Drage
pp 29-31
Organ transplantation is a well established treatment for irreversible renal, cardiac and liver failure, as well as for some respiratory diseases, which is limited by a shortage of organs. A reluctance of families to give consent for the donation of organs contributes to this shortage. Strategies to increase the rates of organ donation must include increasing both cadaveric and living donation. Living donation can be increased by the use of kidneys and livers from living-related donors, living-unrelated donors, paired donors and altruistic donation.

The British Journal of Renal Medicine was previously supported by Baxter Healthcare from 2011 to 2013, by Sandoz in 2011, by Shire Pharmaceuticals from 2006 to 2011, by Ortho Biotech and Shire Pharmaceuticals in 2005, by Ortho Biotech from 2000 to 2005 and by Janssen Cilag from 1996 to 2000.

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