British Journal of Renal Medicine - 2019

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.

The BK virus (BKV) is a human polyomavirus. It was first isolated in 1971 and the first case of BK nephropathy (BKN) was reported in 1978.  It is the most important virus to infect the renal allograft, with BKN a well established and frequently encountered cause of graft dysfunction and loss. BKN in native kidneys is a far less common entity, although it has been increasingly described in recent years, with a number of cases reported among non-renal solid organ transplant, especially heart transplant, recipients and in those receiving bone marrow transplants for haematological malignancies. In addition, a very small number of cases of BKN in nontransplant patients have been described.

The NHS Long Term Plan (previously known as the ten-year plan) was published in January 2019. It sets out key ambitions for the service over the next ten years.

Assessment of the success of treatments for renal patients has historically been based on measures considered important by the professionals delivering care; however, these measures do not capture many other outcomes, which are of real importance to patients and have a big impact on their care. These include the symptom burden, patients’ experience of care and their readiness to engage in their own care. Many of the instruments assessing the patient’s perspective have been available for decades, but their incorporation into routine clinical practice and pathways of care has been slow.

The Renal Association and British Renal Society will again host UK Kidney Week (UKKW) together, from 3rd to 5th June 2019 at the Hilton Metropole in Brighton. Many of you have contributed to shaping UKKW 2019 and theplanning for the meeting is almost complete.

The National Kidney Federation (NKF) continues to offer help and support to all kidney patients throughout the UK. Our dedicated helpline is manned by fully trained advisers who are there to speak to patients about their renal concerns, which can be backed up by patient information leaflets that have been written especially for the NKF by medical professionals.

An update of the results of the Kidney Research UK-facilitated Proactive IV irOn Therapy in haemodiALysis patients (PIVOTAL)trial, designed to determine the optimum dose of intravenous (IV) iron for a kidney patient on haemodialysis, has been published in the New England Journal of Medicine.

An arteriovenous fistula is the access of choice for haemodialysis (HD). Unfortunately, its success is limited by a high rate (28–53%) of maturation failure,  which represents the most significant shortcoming of this type of vascular access. Complications associated with vascular access account for elevated morbidity and mortality levels among HD patients, as well as increasing the financial cost of managing these patients. 

Infection remains a major cause of morbidity and mortality among kidney transplant recipients; hence, protection against vaccine-preventable diseases is desirable. Guidelines recommend that every effort should be taken to complete the vaccination schedule prior to transplantation, as the immune response is better during this period compared with the immunosuppressed post-transplant period.

The results of the third patient-reported experience measures survey have just been released. This joint piece of work with the Renal Association tells us what nearly 14,000 kidney patients across the whole UK thought of their care in 2018. The questions were originally produced with patients and the survey is now validated by the University of Hertfordshire. The survey is also available in Welsh, Urdu and Gujurati. This year, for the first time and because patients had asked, there were free text boxes for people to add their comments. In addition to adding feedback on the questions, the comments attested to the value patients put on PatientView. Comments also emphasised the importance of continuity of care and reflected a negative experience where this was not possible. There was much praise for caring and supportive teams.