British Journal of Renal Medicine - 2007

Comment: The burden of proof
John Bradley
pp 3-3
The appointment of a national clinical director for kidney services is proof that the Department of Health recognises renal disease as a national priority. Donal O’Donoghue outlines his vision of a world-class service for people with, or at risk of, kidney disease, and highlights the urgent need to improve the evidence base in renal medicine through increased investment in research.
Ethnicity and increased susceptibility to renal disease
John Feehally
pp 4-6
People from indigenous or migrant Black and minority ethnic populations (BMEPs) have increased susceptibility to chronic kidney disease (CKD). This article discusses our current knowledge of the epidemiology of CKD in ethnic minority populations, the likely reasons for this increased susceptibility and the interventions that are likely to have a significant impact on detecting and reducing the epidemic, as well as the public health implications of the increased demand for renal replacement therapy in these populations.
Kidney care: can we deliver a world-class service?
Donal O'Donoghue
pp 7-10
Chronic kidney disease (CKD) is common, harmful and treatable. Improving the care of people with, or at risk of, kidney disease is now a national priority. The National Service Framework for Renal Services, Dialysis and Transplantation (Part 1, 2004) and Chronic Kidney Disease, Acute Renal Failure and End of Life Care (Part 2, 2005) provided the standards and quality requirements that we need to deliver for our patients. There has been much progress over the past three years but more needs to be done before we can answer ‘yes’ to the question ‘are we delivering a world-class service?’
Renal biopsy – understanding the patient's experience
Rachel J Bradley and Clive L Hall
pp 11-12
Percutaneous renal biopsy is an essential investigation for many patients with renal disease. Being an invasive procedure, it can cause severe, and occasionally life-threatening, haemorrhage and other complications. Several nephrology services have audited and published the results of large series of renal biopsies. Our results, which are representative, show an average success rate of 96.7%, a mean of 2.1 biopsy attempts per patient with a 2% macroscopic haematuria and a 1% blood transfusion requirement. However, there are few – if any – thorough investigations of the patient’s experience of undergoing percutaneous renal biopsy. We have addressed this shortfall, employing a structured questionnaire designed to identify the patient’s perception of the procedure and to identify areas in need of improvement.
Organ donation following the UK Transplant merger
John LR Forsythe
pp 13-14
NHS Blood and Transplant (NHSBT) was created by merging UK Transplant (UKT) and the National Blood Authority, a merger predicated on the notion of a natural fit between two organisations based on an altruistic act that results in a precious gift that can save life or improve quality of life.
What I tell my patients about polycystic kidney disease
Lukas Foggensteiner
pp 15-18
Polycystic kidney disease (PKD) is an inherited condition that is characterised by the development of cysts in the kidneys. It also may cause cysts to form elsewhere and often is associated with high blood pressure (hypertension) and other features. It is a common cause of kidney disease in the UK and may lead to kidney failure requiring treatment with dialysis or transplantation. In this article we will discuss the inherited nature of the condition, some common symptoms you may get and the treatment options that are available.
Examining patient perceptions of phosphate binders
Steve Riley, Rob Bradley, Kate Craig and Louise Wells
pp 19-21
It has become increasingly clear that hyperphosphataemia is a major contributor to cardiovascular disease in patients with chronic kidney disease (CKD). The paper by Block et al in 2004 demonstrated a dramatic increase in mortality associated with serum phosphate levels over 1.8 mmol/l and serum calcium levels in the high normal range. This analysis of over 40,000 patients from the USA suggested that the attributable risk associated with disorders of mineral metabolism was in the order of 17.5%.
Supply versus demand in the renal dietetic workforce
Sarah Crooks, Ruth Devenish, Julia Hill, Natalie James, Rebecca Walker and Jan Flint
pp 22-24
The number of end-stage renal failure patients is expanding rapidly in the UK. There was a 15% increase in patients accepted onto renal replacement programmes between 2000 and 2003. The number of renal dietitians has not expanded at the same rate; therefore, it is often difficult to meet the growing demands of the service. It is important to know how many dietitians are required to provide an effective and safe service so that renal units have evidence to submit a business case for more as required.
Renal failure in myeloma – a haematologist's perspective
Judith Behrens and Graham H Jackson
pp 25-27
Renal failure is one of the most challenging complications of multiple myeloma to manage and is responsible for increased early mortality and additional long-term morbidity. The fundamental reason why patients with myeloma experience renal damage more than patients with other lymphoproliferative diseases is that light chains, produced in excess by malignant plasma cells, damage renal tubular cells. There are, however, a number of other factors, including dehydration, hypercalcaemia, non-steroidal anti-inflammatory agents, hyperuricaemia, infection and amyloid protein deposition, one or more of which may operate in concert with the light chains to precipitate renal failure in individual cases.
The UK Renal Registry – what makes it better than other registries?
Alex Hodsman, Terry G Feest, David Ansell and Charlie Tomson
pp 28-31
The Renal Association UK Renal Registry (UKRR) was established initially as a two-year pilot project in April 1995. It is a charitable, independent, organisation managed by a subcommittee of the Renal Association and was set up to provide epidemiological data about UK patients with established renal failure (ERF).

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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ISSN 1365-5604 (Print)  ISSN 2045-7839 (Online)