British Journal of Renal Medicine - 2009

Comment: Money changes everything
John Bradley
pp 3-3
‘For the first time, improvements to quality will be recognised and rewarded’, declared the Secretary of State for Health on 30 June 2008. High Quality Care For All: the NHS Next Stage Review included a commitment to make a proportion of providers’ income conditional on quality and innovation, through the Commissioning for Quality and Innovation (CQUIN) payment framework.
New insights into phosphate homeostasis
Joanne Marks, Edward S Debnam and Robert J Unwin
pp 4-7
Extracellular phosphate is crucial for many bodily functions, including skeletal development, energy metabolism, cell signalling and the regulation of protein synthesis. Body phosphate homeostasis is determined by the regulation of intestinal uptake of dietary phosphate, renal phosphate reabsorption and the exchange of phosphate between extracellular and bone storage pools. On a day-to-day basis, phosphate balance is achieved largely through the control of phosphate reabsorption in the proximal tubule: in the steady state, renal phosphate excretion reflects dietary intake, and daily urinary phosphate excretion correlates with its absorption from the diet.
The management of intradialytic hypotension
Christopher W McIntyre and James O Burton
pp 8-11
It is well recognised that dialysis patients display hugely elevated rates of cardiac mortality. It is also becoming appreciated that this rate of cardiovascular attrition is not driven by the same variety of risk factors or pathophysiological processes that are important in the general population. Classical complicated atherosclerotic disease appears not to be the predominant mode of death in haemodialyis (HD) patients.
Patient information and decision-making processes
Hilary Bekker, Anna Winterbottom and Andrew Mooney
pp 12-14
Every renal unit in the UK aspires to help chronic kidney disease (CKD) and end-stage renal failure (ESRF) patients make good decisions about their care. Renal services spend considerable resources to provide information about treatment options in a variety of forms. However, little, if any, is informed by evidence or evaluated for its effectiveness to support patients’ decision-making. For example, 90% of the 31 different leaflets produced about dialysis were rated as being as difficult to read as the Financial Times, and none were designed in a way that would help patients reason about the information.
What I tell my patients about peritoneal dialysis
Raji Tejwani, Martin Wilkie, Bard M Shrestha and Jane Beaumont
pp 15-18
Peritoneal dialysis is a treatment that patients with kidney failure can learn to do for themselves at home, allowing them to remain as independent as possible from the hospital. It utilises the natural lining of the inside of your abdomen, called the peritoneum, to remove the toxins that accumulate in patients with advanced kidney disease, hence the name peritoneal dialysis.
A model of care for early chronic kidney disease
Robert Lewis
pp 19-22
Chronic kidney disease (CKD) and its management generate debate in both primary and secondary care. What constitutes ‘best practice’ in identifying and managing this condition has yet to be adequately defined and GPs remain uncertain as to where their responsibilities begin and end. This article aims to explain why such uncertainty persists and describes how secondary care might interact with colleagues working with CKD in the community.
Ocular drusen deposits: a case study and review
Moloy Dey and Nachiketa Acharya
pp 23-24
Renal disease is known to have associations with ocular abnormalities. Drusen are minute yellow deposits, which represent accumulations of extracellular material. They are found in preponderance in certain structures within the eye. The word is derived from the German Druse, the word for geode. The presence of drusen is largely associated with aging and macular degeneration when found within the retina.
Anti-TNF-a treatment in a patient with rheumatoid arthritis and renal disease
Sathish Kallankara, Jose James and Yusuf I Patel
pp 25-26
A 36-year-old man presented with seropositive rheumatoid arthritis in June 2003. He was treated with various combinations of disease-modifying antirheumatic drugs (DMARDs), including methotrexate, sulfasalazine, leflunomide and prednisolone for 18 months. His disease remained active despite this, with a disease activity score (DAS) of 4.17.
Pregnancy in renal transplantation patients
Amy Webster
pp 27-30
Fifty years since the first successful pregnancy in a kidney transplant recipient, medical advances have resulted in an increased chance of a successful outcome today. Throughout the intervening years, many studies have looked into the factors important in achieving this outcome.

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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ISSN 1365-5604 (Print)  ISSN 2045-7839 (Online)