Comment: Who wants to live forever?
John Bradley
pp 3-3
Life expectancy continues to rise. Figures issued in November 2006 by the Office for National Statistics showed that men aged 65 could expect to live a further 16.6 years and women a further 19.4 years. Circumstances have a considerable effect on life expectancy. A boy born in Kensington between 2003 and 2005 can expect to live to 82.2 years, whereas half of the boys born in Glasgow need not start to plan their 70th birthday parties.
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Patient safety: systems for controlling renal MRSA
David New, Laurie Crosby and Shabeer Kolakkat
pp 4-6
Methicillin-resistant Staphylococcus aureus(MRSA) causes severe healthcare-associated bacterial infection. In 2003, there were 321 deaths directly attributable to MRSA in the UK. Furthermore, the estimated additional cost of a bloodstream infection is £6,209 per patient. MRSA survives on skin and on surfaces and is transmitted by contact. Thorough hand washing and drying, or the use of alcoholic hand rubs if an individual’s hands are not visibly soiled, are the most important measures in preventing cross infection.
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Calcium and phosphate management: a five-year audit
Colin Jones, Louise Wells, Donald Richardson and Lynn Ridley
pp 7-9
The Renal Association standards document, European Best Practice Guidelines and the Kidney Disease Outcomes Quality Initiative (K/DOQI) recommend target levels for calcium and phosphate in haemodialysis (HD) patients. Values outside the target range are associated with an increased risk of vascular calcification, morbidity and mortality. Despite these guidelines, target values are not achieved in many UK dialysis patients. In addition, there are wide variations in the percentage of patients achieving target values in different UK renal units.
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Surviving the floods
Valerie Gannon, Preetham Bodanna and Richard Banks
pp 10-10
In June and July, high rainfall and rising river water levels led to extensive flooding across England and Wales, with Gloucestershire taking the brunt of the flood fury. Many roads, some under several feet of water, were made impassable. Many villages and the town of Tewkesbury were completely cut off by road.
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Estimating life expectancy of UK HD patients if clinical practice guidelines are met
Hugh Rayner, Roger Greenwood, Robert MacTier, Jennifer Bragg-Gresham, Marga Eichleay, Ron Pisoni and Fritz Port
pp 11-14
Clinical practice guidelines for haemodialysis (HD), based on the best available evidence, have been developed in Australasia, Canada, Europe and the USA, as well as the UK. The fourth edition of the Renal Association’s Clinical Practice Guidelines in HD1 is currently undergoing peer review. Guidelines in these countries have helped identify and promote best practices in the delivery of haemodialysis and have set clinical standards to allow audits of key aspects of the haemodialysis prescription, laboratory data and patient outcomes. The annual reports of the UK Renal Registry have shown that performing regular audits improves clinical standards.
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What I tell my patients about the Human Tissue Act 2004
Audrey Hyde
pp 15-18
The Human Tissue Act 2004 refers to changes in the law regarding the way all human tissue must be handled. It is responsible for the storage and/or disposal of all human tissue for whatever purpose, whether it is used for research, teaching or for transplantation. This Act covers England, Wales and Northern Ireland; Scotland has its own separate legislation to deal with these issues.
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One renal unit's experience in managing renal bone disease
Victoria James, Chui Han Li, Victoria Johnson, Christine Sluman, Jonathan Casey and Peter McClelland
pp 19-21
Increasingly, there is evidence that disturbances in phosphate and calcium metabolism play an important role in the development of cardiovascular disease for patients with chronic kidney disease (CKD). Extensive calcification is common even in younger patients (age <30 years) receiving haemodialysis (HD). Prevalence rates are reportedly as high as 88% for patients with stage 5 CKD. Concern over vascular calcification has led the Kidney Disease Outcomes Quality Initiative (K/DOQI) to issue more rigorous guidelines regarding the control of serum phosphate (1.1–1.8 mmol/l), calcium (2.1–2.4 mmol/l) and parathyroid hormone (PTH) (16.5–33 pmols/l) in patients with stage 5 CKD.
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Non-medical prescribing – pharmacists and renal patients
Mark Lee
pp 22-23
Renal patients who currently have dedicated, specialist pharmacists should be among the first to benefit from recent extensions of the law enabling so-called ‘non-medical’ prescribing (by pharmacists, nurses, physiotherapists, radiographers and optometrists). The changes have elicited strong feelings and arguments, for and against, but are now firmly on the statute books.
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Renal artery stenosis: a retrospective study
Ihab El Madhoun, Neeraj Sethi and Habib Akbani
pp 24-26
Renovascular hypertension is one of the leading causes of secondary hypertension. Estimates suggest that the prevalence of renovascular disease as a cause of hypertension ranges from 0.5% to 5% in the general population. In patients who exhibit specific clues that indicate renovascular hypertension, the probability of having the disease increases to up to 40%.
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Web 2.0, social networking and renal medicine
Simon Watson
pp 27-29
The internet is now a part of our everyday lives having started out as a tool for scientists and Cold Warriors. The uses of the internet in renal medicine were outlined in Neil Turner’s article, Nephrology and the internet – a revolution only just starting, in issue 11.4 of the British Journal of Renal Medicine. However, this is an area of rapid change and, in particular, the Web 2.0 movement offers new opportunities for us all.This article will explain what Web 2.0 is and how it could help the renal community work together within new social networks.
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Assessing and recording haemodialysis tolerance
Muhammad Kanaa, Elizabeth J Lindley, Cherry Bartlett, Eric J Will and Mark J Wright
pp 30-31
Dialysis intolerance refers to the symptoms experienced by patients during haemodialysis (HD), which can range from feeling generally unwell to symptomatic intradialytic hypotension (IDH). IDH can result in significant ischaemic events, dialysis disruption, cardiac arrhythmia and impairment of patient wellbeing. IDH occurs in 25–50% of all HD sessions, despite improvements in dialysis technology. This is mainly due to an increase in the numbers of elderly and diabetic patients, as well as a high prevalence of cardiovascular disease (CVD) among those needing dialysis.
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