British Journal of Renal Medicine - 2000

Comment: Living donor transplantation
John Bradley
pp 4-4
Living donor kidney transplantation provides patients in end-stage renal failure with the best chance of good long-term rehabilitation. Kidneys obtained from live donors have a better outcome than those from cadavers, offering a partial solution to the severe shortage of cadaveric organ donors. The main objection is, of course, that it exposes the healthy donor to the risks associated with major surgery and life with a solitary kidney. Accordingly, it must be undertaken with the highest possible standard of clinical care as part of a properly planned programme.
The role of palliative care in patients with renal failure
Allison Rich
pp 6-8
Palliative care is a relatively new discipline. The first modern hospice was founded by Cicely Saunders in the late 1960s, and palliative medicine was only recognised as a speciality by the Royal College of Physicians in 1987. It aims for a holistic approach to patients whose disease is incurable; encompassing physical, spiritual and psychosocial aspects – and employing a multidisciplinary approach – to achieve total care. Of course, this approach is not unique and one of the objectives of palliative care teams is to educate and support other professionals.
Preventing CVD in the diabetic patient with CRF
Waqar Ayub, Paul O'Hare and Simon Fletcher
pp 9-10
Improved control of diabetes and hypertension, particularly with ACE inhibitors, are important aspects of the treatment of patients with diabetic nephropathy. Traditionally all patients with renal anaemia have been managed without regard to the underlying aetiology of their renal failure. There is an increasing consensus that anaemia may be an important risk factor for cardiovascular disease (CVD) in chronic renal failure (CRF) patients. Patients with diabetes mellitus (DM) and renal failure are at particular risk of CVD and may benefit more from early detection and treatment than their nondiabetic counterparts.
The medical technician in the renal department
Andy Mosson
pp 11-12
Technicians have played an important part in renal dialysis units since the 1960s, when dialysis started to become more readily available. As equipment has become more sophisticated, technicians have changed to match the advances. These changes have involved not only learning new skills, but also adjustments to the very nature of the work. In the Sixties, dialysis was still a pioneering technique. To improve patient treatment, equipment was being developed by doctors and technicians. Technicians at this stage were very much innovators, craftsmen who could look for new ideas and source the components. During this time equipment started to be commercially manufactured.
What I tell my patients about hypertension
David Goldsmith
pp 13-16
Hypertension, perhaps better known as high or raised blood pressure, is very common in the general population and an important cause of premature illness and early death. More often than not, blood pressure (BP) is found to be raised as part of a routine medical examination or when another matter has caused you to seek advice from a doctor. You are probably not aware of your BP, whether raised or not. You may understandably resent the new diagnosis and may resist the idea of treatment with drugs.
Immunosuppression for renal transplantation: what’s next?
Christopher Watson
pp 18-23
The last decade has seen an unprecedented number of new immunosuppressive agents entering clinical trials to complement the newly registered tacrolimus and mycophenolate mofetil. The purpose of this article is not to review the existing therapies, but to look into the future to see what agents are on the immediate horizon and how they might be used. Tolerance induction remains the Holy Grail of transplantation. Until that goal is realised, what new therapies can we offer our patients?
When the patient, not the doctor, wants to stop dialysis
Christopher Pugh
pp 24-27
The decision to discontinue dialysis is seldom straightforward. When the patient makes this decision against medical advice there are special considerations. The individual circumstances of each case clearly must be considered. The approach to a patient with chronic renal failure who wishes to stop dialysis during an intercurrent illness will be different from that of a patient with acute renal failure following a suicide attempt, or a newly diagnosed patient who finds it difficult to even contemplate dialysis. Yet, the legal framework within which we must act is the same and needs to be understood.

The British Journal of Renal Medicine was previously supported by Baxter Healthcare from 2011 to 2013, by Sandoz in 2011, by Shire Pharmaceuticals from 2006 to 2011, by Ortho Biotech and Shire Pharmaceuticals in 2005, by Ortho Biotech from 2000 to 2005 and by Janssen Cilag from 1996 to 2000.

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