John Bradley, BJRM editor, writes a moving and personal tribute to Professor Donal O'Donoghue, who tragically lost his life earlier this year after becoming unwell with COVID-19. A consultant renal physician since 1992, Professor O'Donoghue worked for more than 30 years to improve the care of patients with kidney disease and held a number of roles in the field, including as the inaugural President of the British Renal Society, President of the Renal Association, the first National Director of Kidney Care at the Department of Health and Royal College of Physicians Registrar. He was a long-standing member of BJRM's editorial board, and will be sorely missed.

Bed occupancy in the NHS normally runs at around 90%. Between April and June 2019 the daily average number of overnight beds available in England was 128,621, of which 101,762 were in the acute and general sector (NHS Digital, 2020). Of these acute and general beds 90.1% were occupied.

In 1964 Baruch Blumberg recognised that individuals transfused with blood from another individual develop antibodies against the donor’s serum proteins when they differ slightly from their own. These ‘isoprecipitins’ could be identified by their ability to precipitate the protein or antigen. Most of these isoprecipitins reacted with serum lipoproteins, but an isoprecipitin was also identified that reacted with an as yet unidentified protein. This isoprecipitin was found in patients who had received multiple blood transfusions, and was commoner in certain populations including Australian aborigines (Blumberg, 1964).¹

Editor John Bradley discusses dialysis catheter insertion including selecting the right side, the right place and anatomical variation. 

Renal units now offer comprehensive education and support to prepare patients with progressive chronic kidney disease for renal replacement therapy. Despite this, patients can feel that they are uninformed and have limited scope for independent decision-making, with family members or healthcare professionals often strongly influencing their decision.

Chronic kidney disease impacts on many aspects of a child’s life. Even children with mild-to-moderate chronic kidney disease tend to experience a reduced health-related quality of life, with functioning at school being a particular concern. Physical illness, interference with school attendance because of medical care, and impairment of neurocognitive function may all contribute to poorer academic performance.

Value in healthcare has been defined as health outcomes divided by cost. The first step in solving this equation and delivering value in healthcare is knowing how to measure both health outcomes and the cost of achieving them. Both are challenging.