British Journal of Renal Medicine - 2005

Comment: Choice – who decides?
John Bradley
pp 4-4
Giving patients more choice about how, when and where they receive treatment is a cornerstone of the government’s health strategy. To make choice work, people need the right information, at the right time, with the support they need to use such information. If you have end-stage renal disease (ESRD) and you want to live longer, renal transplantation remains the best choice of treatment, but those eligible for a transplant usually require dialysis while waiting.
Developments in the design of peritoneal dialysis fluid
Simon J Davies
pp 6-9
‘Mankind always sets itself only such problems as it can solve – since, looking at the matter more closely, it will always be found that the task itself arises only when the material conditions for its solution already exist ...’ (Karl Marx, 1859). There can be little doubt that Marx had a point; in the case of peritoneal dialysis (PD), existing developments in plastics technology, which enables the production of permanent catheters and sterile disposable delivery systems, made the therapy possible. Indeed, for the first 15 years, with the focus on infective complications, this was the principal area of treatment development in PD. More recently, however, it is the development of the best solutions – apologies for the pun – in solving the various clinical problems faced by dialysis patients that have taken centre stage.
Urokinase for dysfunctional haemodialysis catheters
Mick Kumwenda, Alison Cornall, Laura Corner and Donal O’Donoghue
pp 10-11
The number of patients accepted for haemodialysis in the UK grows annually at a rate of 10–20%. Despite recommendations for the provision of arteriovenous fistulae (AVF) to most patients, 20–32% currently rely on tunnelled cuffed haemodialysis catheters (TCCs). The elderly, and diabetics with poor vasculature, are at risk of AVF failure. Patients referred late with uraemic symptoms may require dialysis before AVF surgery is performed, when the use of TCC for dialysis is necessary. Furthermore, a small proportion of patients with needle phobia prefer TCCs, despitehaving functioning AVFs. Catheter-related infection and dysfunction increase the risk of mortality. However, in some centres, waiting lists for AVF surgery remain unacceptably long, such that patients have to receive haemodialysis via TCCs until AVFs are created and become functional.
Biogenerics, biosimilars and follow-on biologics
Jonathan Cooke
pp 12-14
Spending on medicines is an increasing share of health costs in many Organisation for Economic Co-operation and Development (OECD) countries and growth in drug spending has outpaced total health expenditure over the past five years in most OECD countries. Spending on drugs has grown more than twice as fast as total health expenditure in the USA and Australia between 1998 and 2003. Spending on medicines represented, on average, around 18% of total health spending in OECD countries in 2003. In the UK, this is over £8 billion in primary care alone.
What I tell my patients about chronic kidney disease
David Ferenbach and Morwenna Wood
pp 15-18
Our kidneys perform a number of vital tasks. The most important and obvious is the production of urine, whereby the kidney excretes waste and toxins, and regulates the amount of fluid within the body. This is important for maintaining a normal blood pressure. There are also other less obvious but important functions.
Advances in phosphate control – phosphate binders
David Goldsmith and Behdad Afzali
pp 19-22
Raised phosphate levels are seen in chronic kidney disease (CKD) once renal function has dropped to glomerular filtration rate (GFR) values of around 50 ml/min or less. The progressive elevation of plasma phosphate as renal function declines is one of the cardinal drivers of renal bone disease; there is increasing skeletal resistance to parathyroid hormone (PTH), and the parathyroid gland’s intimate and carefully regulated homeostasis with respect to plasma calcium is progressively deranged.
Vasculitis and systemic lupus erythematosus in children
Stephen D Marks and Kjell Tullus
pp 24-27
Systemic vasculitic syndromes and systemic lupus erythematosus (SLE) are relatively rare conditions in childhood, which require management in specialised centres with multidisciplinary teams. The key clinical dilemma with these conditions is balancing the morbidity from disease activity against the risks of infection from immunosuppression.
Fluid requirements for oral medication dosing
Mandy Wan, Roger Fernandes and Chris Streather
pp 28-30
Compliance with therapeutic regimens has been recognised as an important component of the successful management of end-stage renal disease (ESRD). However, compliance rates in this group of patients are often low, with more than 40% of ESRD patients being classified as noncompliant. ESRD patients are often required to comply with a tripartite regimen of attendance at hospital dialysis sessions, fluid–diet restrictions and complex medication schedules. Given the demanding and restrictive nature of the regimen, which extends into nearly all aspects of patients’ lives, it is not surprising that they find it difficult to maintain this high level of expected compliance.
The STEPP programme to study transplant outcomes
James F Medcalf
pp 31-31
Renal transplantation is an increasingly successful therapy, as judged by progressive improvements in patient and graft survival over the last 25 years. Transplant registries have provided invaluable information on large patient cohorts.

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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