British Journal of Renal Medicine - 2005

Comment: Mind the gap
John Bradley
pp 4-4
Renal services are expensive. The cost of treating people with established renal failure has been estimated at 1–2% of the total NHS budget, yet such patients comprise only 0.05% of the total population. There is currently marked regional variation in how the costs of treating renal patients are calculated and reimbursed. Establishing and revising these financial arrangements uses considerable resources, and often creates tension between commissioners and providers. The introduction of Payment by Results and national tariffs for the treatment of patients categorised by Healthcare Resource Groups provides an opportunity for NHS trusts to be reimbursed fairly and transparently for renal services.
Exploring the NICE guidance on immunosuppression
Christopher JE Watson and J Andrew Bradley
pp 6-9
In 2001, the National Institute for Clinical Excellence (NICE) – renamed the National Institute for Health and Clinical Excellence from 1 April 2005 – published a scoping document on immunosuppression for renal transplantation. The transplant community took a deep breath. Was our clinical freedom about to be challenged, or would NICE provide guidelines that facilitated best practice and enabled access to funding for modern immunosuppressive protocols from hard-pressed primary care trusts (PCTs)? Since January 2002, the NHS has been legally obliged to provide funding and resources for medicines and treatments recommended by NICE. Three years after this, following much anxiety and several meetings involving both industry and clinicians, the NICE guidance, Immunosuppressive therapy for renal transplantation in adults, was published in September 2004. What does it say, what does it mean, and what happens next? This article attempts to answer those key questions.
Patient involvement in developing renal services
Puchimada Uthappa, Vivienne Dodds and Robert M Higgins
pp 10-12
This review is written in two parts: the first by doctors on our unit and the second by a patient from the local kidney patient association, who has many years of experience in talking to renal unit staff and other patients. The perspectives that come across from the two parts of the review are very different. One concentrates on setting up the right structures, while the other concentrates on taking time to listen, to understand and then to take appropriate action. We felt it best to leave these two parts separate.
Vascular access services in a small district general hospital
Tamilsalvan Sivashanmugam, Fahaaz Mohammed, John Holdsworth and Paul Mead
pp 13-14
The forearm arteriovenous (AV) fistula for dialysis was first described by Brescia et al, with later modifications including the elbow, the transposition of the basilic vein and the use of synthetic materials. Adequate management of renal failure in these patients requires permanent vascular access providing a good flow, long-term patency and low rate of complications. Demand for vascular access continues to increase and problems with access account for a large proportion of renal unit admissions in Carlisle. A dedicated vascular access service was introduced in 1998 to support the local renal unit and renal failure patients of the local community.
What I tell my patients about blood and urine tests
Ihmoda A Ihmoda and Neil Turner
pp 15-18
The most important thing the kidney does is get rid of waste products and excess water and salts through urine. Kidney diseases disrupt this, so that more waste products can be found in blood, and salt and water balance may be upset. However, the kidney does other important things too. It controls blood pressure – so this is often high in people with kidney diseases. It makes erythropoietin (EPO), which prevents anaemia. It excretes excess acid. Here we explain the common blood and urine tests for people with kidney diseases.
Integrated care of patients with chronic kidney failure
Hugh C Rayner, Bill A Bartlett and Steve A Smith
pp 19-21
Chronic kidney disease (CKD) affects about 10% of the population. As CKD is asymptomatic until renal function is severely reduced, its importance is often underappreciated. Even mild CKD is a significant risk factor for coronary heart disease (CHD), and is as important as diabetes mellitus. Effective control of blood pressure in patients with progressive CKD preserves remaining renal function and can delay dialysis or avoid it altogether.
An update on membranes for renal replacement therapy
Nicholas A Hoenich
pp 22-23
Haemodialysis and related processes use a membrane to remove fluid and metabolites elevated due to renal failure. The membrane also acts as a barrier between the sterile blood circuit and the non-sterile dialysis circuit. Although considerable technological advances have been made, it remains a non-selective sieve and represents a bioreactive surface. It is increasingly recognised that these aspects play a role in the evolution of complications associated with end-stage renal disease (ESRD) treatment. A primary aim of manufacturers has been to work towards the elimination or minimisation of adverse effects.
Compliance or concordance – what’s in a word?
Jean Mossman
pp 25-27
Until available treatments are 100% effective and safe, with no associated adverse effects, the search will continue for new and better treatments for renal diseases. The development of a new drug is expensive; it is estimated to cost between $800 million and $1 billion to bring a new drug to market. Some of this cost will be incurred in undertaking trials to assess the efficacy of the drug, including how and when it should be taken.
High-quality, focused research
Donald Ward
pp 28-28
The National Kidney Research Fund’s (NKRF’s) 2005 Fellow’s Day was hosted and chaired by Professor Peter Maxwell (Belfast City Hospital), in the Waterfront Hall in Belfast, on 4–5 April, 2005. Following the chairman’s introductory welcome, Professor Charles Pusey (Chairman of NKRF Trustees) delivered an update on the work of the Fund. We learned that three-quarters of charitable expenditure goes to research, with the remainder used for patient care and raising awareness of kidney disease. Professor Pusey stressed the high demand for fellowship funding, with only 15% of applications being successful.
Working with confused and challenging patients
Kirsty Thorne, Lisa Nelmes and Tracy Packer
pp 29-31
This article reports on the process, outcome and evaluation of a training initiative designed to skill nursing staff in the understanding and management of confused and challenging patients in renal care. It also outlines two psychosocial models that were used to help staff develop a more holistic and person-centred approach to working with these patients.

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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