Comment: Obesity and renal disease: weighing up the risk
John Bradley
pp 31-31
In 2014, 41% of men and 31% of women in England were overweight (defined as a body mass index [BMI] from 25 to less than 30 kg/m2), and around a quarter of adults were obese (BMI of 30 kg/m2 or more). Two per cent of men and 4% of women were morbidly obese, with a BMI of 40 kg/m2 or higher. The association between being overweight or obese and an increased risk of diabetes, cardiovascular disease and some cancers is well established.
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The London Renal Obesity Network protocol for bariatric surgery in patients with chronic kidney disease
Helen L MacLaughlin, Iain C Macdougall, Nicholas Finer, Lina Johansson and Andrew H Frankel
pp 32-35
Obesity is associated with chronic kidney disease progression and end-stage kidney failure. While the exact mechanisms remain unknown, factors including insulin resistance, dyslipidaemia and inflammation contribute to obesity-related kidney damage. In the USA, the mean body mass index (BMI) at initiation of dialysis rose from 25.7 kg/m2 to 27.5 kg/m2 between 1994 and 2002, and now almost one-third of incident dialysis patients are obese. Similar data for the UK are currently not accessible, as data on BMI at initiation of dialysis are incomplete in the UK Renal Registry.
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Resources: Allied Health Professional Fellowships reintroduced
Kidney Research UK
pp 35-35
Kidney Research UK has recently announced the reintroduction of its fellowship awards for allied health professionals. Researchers from any clinical discipline (for example, nurses, psychologists, pharmacists or dieticians) who wish to undertake research in the renal field can apply. The initiative acknowledges that, as an entire care team looks after kidney patients, these health professionals each have an insight into ways in which patients’ quality of life and outcomes could be improved, which can only be verified through dedicated research.
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The importance of taking a family history in the nephrology clinic
Sarah McCloskey, Laura Yates and John A Sayer
pp 38-42
When reviewing patients in the nephrology clinic, it is always important to include a detailed family history of renal and non-renal disease. This should be done, ideally, at the first clinic visit but should be regularly updated at subsequent review clinics. It remains a valuable exercise, even in follow-up clinics, as the passage of time from an index case presenting with renal disease may allow other family members with related phenotypes to present. In addition, it may highlight the need for the original diagnosis in the index case to be reconsidered.
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UK Renal Registry, NHS England and the British Kidney Patient Association join forces for patient experience
Fiona Loud
pp 42-42
The kidney community has for some time collected biochemical outcomes, such as phosphate and potassium levels, via the UK Renal Registry. However, individuals experience their service in different ways, depending on the choices that are available to them and, perhaps, where they receive their care. Environment, communication and transport are common themes, and the latter remains a cause for concern. The Health Foundation states that the experiences of patients and their families are key components of the quality of healthcare and that collecting information from patients can help organisations make better decisions about how to improve services. However, there have been no national surveys of transport for dialysis patients since 2012; therefore, if improvement is to be made, an understanding of current patient experience is essential.
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Sustainability and Transformation Planning
Donal J O'Donaghue
pp 45-46
On a snowy January morning in Washington DC in 1961, at his inauguration as the 35th President of the United States of America, John F Kennedy memorably said ‘ask not what your country can do for you – ask what you can do for your country’. It was a watershed moment – the start of the 60s, a generation of hope. The world seems very different now, and while portraying the NHS as a generation in despair may be overstating things, I do sense a lot of uncertainty and real anxiety about our health system.
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Resources: British Renal Society
Simon Ball
pp 46-46
This is my final column as President of the British Renal Society (BRS). It has been a privilege to work with colleagues throughout the kidney community to promote multiprofessional care and I am particularly grateful to the Vice Presidents and Treasurer for their unflinching dedication and hard work. I know they will provide great support for incoming President, Maarten Taal over the next three years.
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Anti-neutrophil cytoplasmic antibody-associated vasculitis secondary to infective endocarditis
Noshaba Naz, Joanne Heaton, Sarah Hardy, Howida Shawki and Janice Harper
pp 47-48
Renal disease due to infective endocarditis (IE) is well documented and was originally perceived to be primarily an embolic phenomenon. However, the association with rapidly progressive glomerulonephritis is now recognised. Secondary anti-neutrophil cytoplasmic antibody-associated vasculitis has been linked to infections, drugs and malignancy and, in some cases, to IE.
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Resources: The good, the bad and the ugly
Timothy F Stratham
pp 49-49
It is no surprise that kidney patients are left wondering what is around the corner. On the one hand, there are the increasing number of stories of altruistic organ donation from wonderful people like Babes Fairhurst, and the exciting development by Professor Shuvo Roy in California of an artificial kidney, which holds the promise of making human kidney transplantation unnecessary.
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Pre-CT renal risk assessment: a review of UK practice
Sara Meredith, Teck Chin, Chinedum Anosike and Akash Ganguly
pp 51-55
Contrast-induced acute kidney injury (CI AKI) is an acute deterioration of renal function, typically occurring within two to three days of intravascular administration of iodinated contrast media, in the absence of other nephrotoxic insults. It is the third most common cause of AKI in hospitalised patients, occurring in 0.6–2.3% of all patients and affecting up to 25% of patients with coexist- ing renal disease/risk factors. CI AKI is associated with serious implications for patients’ prognosis, including increased length of hospitalisation, greater risk of cardiac events and higher mortality rates.
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