Comment: Modifying risk in chronic kidney disease: the future is Bright
John Bradley
pp 3-3
Most people with chronic kidney disease (CKD) do not progress to renal failure. In a cohort of 22,460 individuals with stage 3 or 4 CKD served by the health maintenance organisation Kaiser Permanente Northwest, the risk of progressing to renal failure and needing to start renal replacement therapy was just under 5%. In a similar cohort of 16,553 Kaiser Permanente Colorado members with stage 3 or 4 CKD, the risk was just over 2.5%. Predictors of risk included age, sex, estimated glomerular filtration rate (eGFR), proteinuria/albuminuria, haemoglobin levels, systolic blood pressure, antihypertensive medication use, and diabetes and its complications, but a model using age, sex, eGFR and albuminuria retained a strong predictive value.
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The National Chronic Kidney Disease Audit
David C Wheeler, Dorothea Nitsch, Ben Caplin and Sally Hull
pp 4-6
Chronic Kidney Disease (CKD) is a long-term irreversible deterioration in renal function, often found in patients who also have diabetes or hypertension. CKD affects approximately 5.5% of adults and is more common in older people. CKD can contribute to cardiovascular disease (CVD) and predispose to acute kidney injury during intercurrent illness. Although only a small number of cases progress to end-stage renal disease requiring renal replacement therapy, the personal and economic costs are high.
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British Renal Society: Tackling inequalities in kidney care
Maarten Taal
pp 6-6
Recent publicity given to problems in the NHS makes it easy to forget that the one big advantage it offers is the provision of healthcare to everyone who needs it, free at the point of delivery. This protects patients from the injustice of being denied care because they are unable to afford it. In this context, however, it is easy to be complacent about inequalities in healthcare. Numerous factors other than a requirement to pay for care may contribute to inequalities, and it is important to remind ourselves that many of these are potentially modifiable.
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Tolvaptan for autosomal dominant polycystic kidney disease
Grahame Wood and Elizabeth Lamerton
pp 8-10
In this new feature, we invite you to test your skills in patient management via a question and answer format. A detailed case history is provided, followed by a series of questions designed to test your knowledge and give you food for thought. The suggested answers can be found on page 30 of this issue.
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Sustainability and transformation plans
Donal J O’Donoghue
pp 11-12
Transformation has been a constant feature of the NHS since its inception in 1948. Our NHS has evolved to reflect changes in society, demography and clinical practice. Services have adapted throughout its history in efforts to meet the population’s healthcare needs.
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The Renal Association: UK Kidney Week 2017
Phil Kalra
pp 12-12
It is with great pleasure that I invite you, on behalf of the Renal Association, to join us at UK Kidney Week 2017, which will be held at the Arena and Convention Centre Liverpool on 19th–21st June 2017.
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What I tell my patients about preparing for haemodialysis
Christine Hall and Jeremy S Crane
pp 14-16
The main functions of the kidneys are to remove waste products and excess water from the blood. When a patient has kidney failure, their kidneys are less able to perform these tasks. This can result in a number of symptoms, including swelling, due to the build-up of fluid, and itching, due to the accumulation of waste products. Eventually, once kidney function has declined past a certain point, it is necessary for the blood-filtering role of the kidneys to be replaced. This is done through renal replacement therapy.
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An unusual case of acute interstitial nephritis
Durga Ghosh, Alison Almond, David Kipgen, Allistair Stark, Ken Donaldson and Thalakunte Muniraju
pp 19-21
Acute interstitial nephritis (AIN) is an important cause of acute kidney injury (AKI) and may be implicated in up to 15% of cases involving admission to hospital with AKI. The pathophysiology of AIN is an immune-mediated tubulointerstitial injury, characterised by interstitial infiltrates of predominantly T-cells and monocytes. The presence of eosinophils is associated with an allergic reaction, usually to a drug; if left untreated, this can transform into interstitial fibrosis. The cause of AIN often remains unknown, but the most common precipitants are infection or medication. Where medication is implicated, the most frequent offenders are antimicrobials (particularly penicillins, cephalosporins, rifampicin and ciprofloxacin), non-steroidal anti-inflammatory drugs (NSAIDs), allopurinol and proton pump inhibitors. It can also be caused by autoimmune disease and haematological malignancy.
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Book review: On the Toss of a Coin
Donal J O’Donoghue
pp 22-22
This is a gripping account of one man’s near-death experience of sudden kidney failure, his struggle to come to terms with existence on dialysis and ultimate success in regaining his life. A human story and a page-turner, from which everyone struck down with serious illness can take hope, it is also packed with insights for renal healthcare professionals, patients and carers.
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National Kidney Federation: The patient voice
Timothy F Statham
pp 22-22
If the presidential election in the USA and the EU referendum in the UK have taught us anything, it is that ‘the people’ are determined to be heard by the political establishment. Is there, then, a lesson to be learnt by the NHS, its leaders, commissioners and staff?
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British Kidney Patient Association: Social care challenges for kidney patients
Fiona Loud
pp 24-24
People with advanced kidney disease, especially those on dialysis, may find themselves in need of financial and welfare support, in addition to support for their physical and mental health challenges. Renal social workers play a vital role in helping kidney patients manage their lives but are not available in all areas. While some are funded by NHS trusts, others are funded by local councils. At a recent meeting of the renal special interest group of the British Association of Social Workers, we heard how patients who may need them now face further barriers in the form of stricter referral restrictions. The British Kidney Patient Association has a team of advocacy officers across the UK, who report that they are increasingly called upon to assist patients with benefit applications, something that can occupy between 30% and 80% of their time.
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Tuberous sclerosis complex and renal angiomyolipomas
Zahra Iqbal, John C Kingswood and John A Sayer
pp 25-29
Tuberous sclerosis complex (TSC) is a rare genetic condition, characterised by typical lesions affecting multiple systems, including the kidney, skin, brain and eyes. It results in a variable clinical spectrum and can be extremely debilitating. The prevalence of TSC across the EU is estimated to be between 1 in 6,500 and 1 in 10,000; therefore, the number of patients in the UK aged 18 or over is thought to be around 6,400.
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Tolvaptan for autosomal dominant polycystic kidney disease: answers
Grahame Wood and Elizabeth Lamerton
pp 30-30
In this new feature, we invite you to test your skills in patient management via a question and answer format. A detailed case history is provided, followed by a series of questions designed to test your knowledge and give you food for thought. Read the patients’ full case histories in the case study masterclass section on pages 8–10 of this issue.
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Kidney Research UK: Patients’ treatment preferences for hyperparathyroidism
Kidney Research UK
pp 31-31
Kidney Research UK has an evolving patient involvement programme, which aims to engage patients in research and ensure the patient experience is reflected in its work. In 2016, we conducted an online survey about hyperparathyroidism, gaining insight into patients’ treatment preferences – looking at phosphate binders, calcimimetics, surgery and dietary modification.
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