British Journal of Renal Medicine - 2010

Comment: A good way to die
John Bradley
pp 3-3
‘In this world nothing can be said to be certain, except death and taxes.’ We all die sooner or later, but death is likely to occur sooner if you are receiving renal replacement therapy. In the UK, the relative risk of dying on renal replacement therapy compared with the general population is falling, but remains high. In 2007, the age-standardised mortality ratio for prevalent patients receiving renal replacement therapy compared with the general population was 28.6 at the age of 30, and 4.6 at the age of 80.2. In dialysis patients, treatment withdrawal accounted for 14% of deaths.
A year on the Liverpool Care Pathway in renal medicine
John J Dixon, James E Marsh, Valerie Crooks and Martine Meyer
pp 4-7
Patients with renal failure have a high mortality rate despite major advances in treatment over recent decades. Reasons for this include: the increasing number of older people with other co-morbidities commencing dialysis; the fact that acute renal failure is often a consequence of other serious illnesses (for example, vasculitis or myeloma); and the fact that renal disease causes stress on other body systems (such as cardiovascular [CV] and immunological), thus predisposing the individual to death from CV disease and sepsis. Another recognised cause of death is withdrawal from treatment.
A five-year review of the use of IDPN in renal patients
Elizabeth Southcott, Jeanette Calder and Mark Wright
pp 8-10
Intradialytic parenteral nutrition (IDPN) is the rapid infusion of a mixture of amino acids, carbohydrates and lipid emulsion directly into the circulatory system. It is attached to the haemodialysis circuit after the bubble trap and infused during a four-hour dialysis session, three times per week.
Setting up a Cause for Concern register
Maria Da Silva-Gane, Martina Bowser and Ken Farrington
pp 11-14
Replacement of renal function by dialysis is a highly successful, life-prolonging treatment, but it is invasive and can place great demands on patients and their families. Increasing numbers of patients on modern dialysis programmes are elderly and many have significant extrarenal co-morbidity. Mortality is, therefore, high. The number of expected remaining life-years for a 65-year-old dialysis patient is 3.9 compared with 17.2 for a similar person in the general population.
What I tell my patients about anti-GBM disease (or Goodpasture's disease)
Harry Bilkhu and Neil Turner
pp 15-18
As a young naval doctor during the flu pandemic of 1918–1920, Ernest Goodpasture described a young man with lung haemorrhage and kidney failure. He thought this was probably related to influenza. In the 1950s, it became possible to see antibodies in kidney biopsies, and antiglomerular basement membrane (anti-GBM) disease was described. Goodpasture’s name was given to the disease, although his main life’s work was on the chickenpox virus.
How one renal unit dealt with endemic MRSA infection
Stephen Kardasz
pp 19-21
Over the past several years, methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HCAIs) have increased, particularly in certain high-risk specialties such as renal medicine, and have become a bête noire among many journalists and popular commentators. This media interest is not without reason: MRSA infection, and particularly MRSA bacteraemia, carries high morbidity and mortality. MRSA sepsis places a considerable burden on the NHS in terms of cost and resources and, perhaps most importantly, is frequently avoidable.
Achieving excellence in kidney care
Donal O'Donoghue
pp 22-22
The National Service Framework (NSF) for Renal Services laid out a vision of kidney care centred on the needs of those with, or at risk of, kidney disease. Achieving Excellence in Kidney Care, the mid-term report of the NSF, celebrates the progress the kidney community has made in delivering improvements in health, patient experience and outcomes of care over the past five years. It also sets goals for the future – it challenges kidney services to go from good in many places to great everywhere.
Awareness of kidney disease in west London South Asians
Gurch Randhawa, Muhammad Waqar, Champa Jetha, Balbir Gill, Sangeetha Paramasivan and Elizabeth Lightstone
pp 23-27
The seminal report Tackling Health Inequalities: A Programme for Action has revitalised national interest in reducing inequalities. Provision of coronary heart disease, mental health and diabetes services for minority ethnic groups has become a particularly important area of concern, in part due to the high rates of these conditions within particular minority ethnic groups.
Implications of high levels of phosphate in predialysis chronic kidney disease
Clare Jones, Kanagasabapathy Kamaraj and Steven Riley
pp 28-31
Over the last ten years in the UK, there has been a steady improvement in one-year survival of both incident and prevalent dialysis patients. However, the age-standardised mortality ratio for prevalent dialysis patients is almost 30 times that of the general population at age 30, and is still five times higher at age 80. This excess mortality seems, in part, to be accounted for by cardiovascular disease, with the UK Renal Registry reporting 29% of deaths in prevalent dialysis patients as being related to this cause.

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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