Comment: Decline and fall: a brief history of peritoneal dialysis
Peritoneal dialysis (PD) is in decline. There has been a sustained fall in the proportion of patients receiving PD in the UK over the last decade: between 2005 and 2008, the number of patients receiving PD fell at an average annual rate of 5.35%. From 2007 to 2008, numbers fell by 9.2%, with 40 of 72 centres reporting a decrease in prevalent patients on PD. This fall is largely due to a reduction in the number of new patients starting PD.
Examining the progression of CKD – findings from CRISIS
Richard Hoefield, Helen Eddington, Rachel Middleton and Philip Kalra
Globally, chronic kidney disease (CKD) is a significant public health issue. In the UK, it affects up to 10% of the adult population. CKD is associated with increased cardiovascular risk and premature mortality. However,
at least 25% of all new renal replacement therapy (RRT) recipients are ‘crash landers’,
suggesting that, at present, resources are not being directed efficiently. It is increasingly recognised that a better understanding of the
progression of CKD to end-stage renal disease (ESRD) and cardiovascular disease (CVD), as well as of mortality outcomes in those with earlier stages of CKD, is needed.
A dietitian’s perspective on correcting acidosis
Suzanne Haworth and Sharmila Bandyopadhyay
Patients with advanced kidney disease often present with metabolic acidosis. This is characterised by a decrease in the body’s bicarbonate stores and is perceived by clinicians as low plasma bicarbonate. Acidosis has attracted a wealth of interest over the past decade but, although it is common, its effects on health are poorly understood due to a lack of well-designed,
Catheter-related bacteraemia in renal units in the UK
Tarek Sobka, Mick Kumwenda, Christopher Brown and Rachel James
Catheter-related bacteraemia (CRB) is a major complication in haemodialysis (HD) patients who are dependent on central venous catheters (CVCs), occurring at a frequency of 2.5–5.5 episodes per 1,000 catheter-days (between 0.9 and two episodes per patient per year).
What I tell my patients about diet in chronic kidney disease
Debbie Sutton and Fiona Symes
Decades ago, when dialysis was unavailable and artificial erthyropoietin (the hormone that regulates production of red blood cells) was a dream, relief and control of uraemic symptoms was largely achieved, albeit inadequately, by dietary manipulation. If kidney failure was sufficiently advanced as to reduce adequate excretion of waste products of metabolism, then there had to be strict control of what went in as food and drink.
The Optimal Renal Care programme
The National Service Framework (NSF) for Renal Services (Part Two) highlighted the growing
problem of chronic kidney disease (CKD) and its complications. Published in 2005, the NSF focuses on measures that can be taken, predominantly in primary care, to prevent CKD developing in the first place, or to slow down the progression of renal damage once a diagnosis has been made.
Quality must be the guiding principle of kidney care
Donal J O’Donoghue
Quality is the only organising principle of the NHS – this statement runs through Equity and Excellence: Liberating the NHS. But what does it mean for our kidney strategy? Quality isn’t
some loose ‘touchy feely’term. It can be, and must be, defined and measured. The measures need to be looked at, understood and acted upon.
Pure red cell aplasia after tacrolimus therapy
Ebraheem Alskaf, Barbara Maxwell, Andrew Bowe and Paul Mead
Pure red cell aplasia (PRCA) describes a condition in which red blood cell precursors in the bone marrow are nearly absent, while megakaryocytes and white blood cell precursors
are usually present at normal levels. In 1922, Kaznelson recognised that this condition was a different entity than aplastic anaemia, where patients have lower counts of all three blood cell types: red
blood cells, white blood cells, and platelets – termed pancytopenia.
A discussion of haemolytic uraemic syndrome related to Streptococcus pneumoniae
Richard Dillon, Ian Mackie and Beverley J Hunt
Streptococcus pneumoniae-associated atypical haemolytic uraemic syndrome (aHUS) is a well described but rare condition in children, accounting for 5% of all cases of haemolytic
uraemic syndrome (HUS). It is characterised by acute renal failure, microangiopathic
haemolytic anaemia and thrombocytopenia starting seven to nine days after the
onset of pneumococcus-related symptoms. Compared with the more common Escherichia coli-associated HUS, children present at a younger age and have longer hospital
stays, increased transfusion requirements, and more than double the rate of death (12.3%) and end-stage renal failure (10.1%).
Assisted automated PD using community nurses
Angela Ridge and Isobel Banks
Elderly renal patients requiring dialysis are the fastest growing category of patients needing renal replacement therapy. As the general population lives longer and the elderly ‘fit’ patient becomes commonplace in the renal clinic, there is a greater need for appropriate
dialysis for this group of patients. Despite the fact that clinical outcomes and quality of life in the elderly are similar for peritoneal dialysis (PD) and haemodialysis (HD), the number of patients on PD is declining.
The risks of heart failure in the dialysis population
Muhammad Shahed Ahmed and Pearl Pai
Chronic kidney disease patients are at high risk of cardiovascular (CV) morbidity and mortality. The coexistence of chronic heart failure (CHF) is common in patients with renal dysfunction, with a 30% incidence of CHF in those on dialysis. Hypertension,
chronic volume overload, anaemia, activation of the sympathetic nervous system and
renin-angiotensin system, and presence of an arteriovenous fistula (AVF) or shunt, may all
play a role in the development of heart failure (HF) in dialysis patients.