Comment: Getting personal
John Bradley
pp 3-3
Genetic variation influences disease susceptibility and outcome, and is a key determinant of how individuals respond to treatment. Recent advances in genomic technology have opened up the possibility of personalised medicine – using an individual’s genotype and phenotype to determine their therapy – yet these correlations have achieved only limited utility in guiding treatment to date.
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Generic versus branded medication in transplantation
Heather Black
pp 4-6
In the current economic climate, the NHS is under huge pressure to save money. Use of generic drugs is a topical subject, as they are less expensive than the original brands and promote competition, potentially leading to savings of millions of pounds. In the last two years, a number of generic immunosuppressants have been introduced, notably generic ciclosporin, tacrolimus and mycophenolate mofetil. This could have considerable cost benefits, but there are concerns around possible clinical risks in terms of drug toxicity or graft rejection. The serious consequences of such complications may outweigh any potential savings.
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Are biosimilar medications the way forward? A review of their use and efficacy
Nick Pritchard
pp 7-10
The global economic downturn has resulted in substantial reductions in public expenditure in many developed countries, including the UK. By some projections, the NHS will have a budget shortfall of some £15 billion by 2014. Healthcare systems therefore need to plan for huge efficiency savings. Even before the global recession, many countries were facing a crisis in healthcare spending, driven by aging populations and the ever-increasing costs of treatment. Nephrology is not immune to such cost pressures, and nephrologists will be expected to do more while spending less.
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Gastric antral vascular ectasia in a patient with chronic kidney disease
Sujatha Kamalaksha and Faiz Ali
pp 11-11
Gastric antral vascular ectasia (GAVE) was first described by Rider et al in 1953, and was defined accurately by Jabbari et al in 1984. In 1989, Navab et al, based on a study on 65 patients, suggested that GAVE is observed in patients with chronic renal failure (CRF). Based on this and some later reports, an aetiopathogenetic association between the two disorders was postulated. However, the number of relevant publications is still very limited, especially in predialysis renal failure patients. The cause of angiodysplasia in patients with CRF is unknown.
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Counting tablets or something more? The role of the renal technician
Prema Nadesalingam
pp 12-13
Barts and the London ranks as one of Britain’s leading healthcare providers and comprises three renowned hospitals: The Royal London, St Bartholomew’s and The London Chest. These hospitals produce some of the best clinical outcomes, made apparent by the trust having one of the best survival records in the NHS.
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Stepping into the future
Donal J O'Donoghue
pp 14-14
You would have to be living in outer space not to have noticed that the NHS is changing – Sir David Nicholson, Chief Executive of the NHS, has said that the changes are so big they can be seen from the surface of Mars! So what will this mean for kidney care and what will it mean for kidney patients and their families?
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What I tell my patients about immunosuppression
Andrea Devaney
pp 15-18
It is recognised that for most patients with end-stage kidney disease, transplantation is the optimum treatment. It increases patient longevity and improves quality of life. Immunosuppression is the lifeline for a transplanted organ; it is needed to dampen down your natural defence system (immune system) to prevent it recognising and attacking the transplanted organ in a process called rejection. These immunosuppressive medications are also referred to as antirejection medicines, and they need to be taken every day for the life of the transplanted organ. It is important healthcare professionals work with you to establish a medication regimen that suits your lifestyle and that can be adhered to.
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New NICE guidance on PD
Janet Wild
pp 19-19
More than 30 years after the introduction of peritoneal dialysis (PD) in the UK, the National Institute for Health and Clinical Excellence (NICE) has published a short clinical guideline on its use in stage 5 chronic kidney disease (CKD). The guideline, published in July, is specifically focused on evidence-based best practice recommendations for PD.
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Managing high noise levels on dialysis units
Ray James
pp 20-22
Noise in hospitals is a significant problem, which appears to be getting worse, even in newly constructed buildings. High noise levels can potentially contribute to stress in staff and patients, and there is concern that hospital noise can negatively affect speech communication and cause an increased number of medical errors.
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A case of transplant renal artery stenosis-associated nephrotic syndrome
Beng H So, Jon G Moss, Grant M Baxter, Christian Delles and Colin C Geddes
pp 23-25
Transplant renal artery stenosis (TRAS) is a well-recognised cause of hypertension, extracellular fluid overload and transplant dysfunction, with a reported incidence of up to 12%. We present a case of nephrotic syndrome and hypertension occurring secondary to TRAS that resolved dramatically following transplant renal artery endovascular stent insertion. We postulate that the source of the heavy proteinuria was the patient’s native kidneys rather than the transplant kidney.
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Introducing a new, dedicated dialysis water system
Paul Roome and Kalpesh Shah
pp 26-27
The new Royal Derby Hospital (formerly Derby City General Hospital), which was officially opened in April 2010, is one of two teaching hospitals under the Derby Hospitals NHS Foundation Trust.
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Use of glucose-lowering drugs in diabetes complicated by CKD
Sally M Marshall
pp 28-31
Chronic kidney disease (CKD) in diabetes is common. Worldwide, diabetes is the single most common cause of end-stage renal disease (ESRD), accounting for up to 50% of individuals commencing dialysis in some countries. The majority are older, with type 2 diabetes and significant co-morbidities. Many more diabetic patients have renal impairment, but die of cardiovascular disease before reaching ESRD. In the UK, around 30% of people with diabetes have clinically significant CKD (stages 3–5), compared with 6.9% of those without diabetes. Thus, everyone caring for diabetic individuals must understand the interaction between the kidney, glucose metabolism and glucose-lowering drugs.
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