British Journal of Renal Medicine - 2012

Comment: the carousel of progress
John Bradley
pp 3-3
Almost 30 years ago, two papers were presented at the European Dialysis and Transplant Association meeting in London, giving opposing views on the optimum duration of dialysis treatment. These papers appeared back to back in Volume 20 of the Proceedings of the European Dialysis and Transplant Association. Professor Vincenzo Cambi described the experience in Parma, Italy, where the survival of patients who dialysed for four hours, three times a week, was superior to that of the European population treated with quite variable dialysis schedules.
Home haemodialysis for children
Daljit K Hothi and Lynsey Stronach
pp 4-7
Home haemodialysis (HD) started in the early 1960s, but fell out of favour over the next decade as patients considered the practical issues of frequent, long dialysis sessions. The 1970s and 1980s saw a rapid rise in in-centre, intensive, ‘conventional’ dialysis prescriptions (four hours, three times per week). In the 1990s, there was a renewed interest in home HD, driven by the growing demand on dialysis that was starting to exceed in-centre capacity.
The benefits of more frequent haemodialysis
Cormac Breen
pp 8-10
For the majority of patients who are reliant on haemodialysis, this treatment is delivered via a thrice-weekly schedule in staffed dialysis units. There is limited choice as to the duration and frequency of treatment sessions, these variables being determined by the hours of operation and the availability of dialysis machines, and achieving adequate treatment for the majority of these patients depends on the high efficiency of modern dialysis technology.
Putting patients at the centre of kidney care
Donal J O'Donoghue
pp 11-11
Up and down the country, challenges are being faced in delivering timely, efficient and effective healthcare for people with kidney disease. Our healthcare system is changing; there is less money to solve problems, and organisational changes to the NHS in England are putting greater pressure on hospital-based services. These challenges are part of broader changes occurring around the world as we shift from a 20th-century cure-focused system to a 21st-century chronic disease management paradigm.
Haemodialysis-associated cramping: role and implications of exercise
Hannah ML Young, Maurice Dungey, James O Burton and Alice C Smith
pp 12-14
Patients undergoing haemodialysis (HD) are susceptible to sudden painful, involuntary contractions of skeletal muscle, commonly known as cramps. The exact aetiology of cramps in dialysis patients is unclear; however, as they predominantly occur during the latter stages of a dialysis session, changes in plasma osmolality and extracellular fluid volume have been implicated. Muscle cramping is a widespread problem in the dialysis population and primarily affects the lower limbs.
What I tell my patients about over-the-counter medications
Charlotte Mallindine
pp 15-17
People with kidney impairment or transplants are able to treat themselves for minor illnesses and ailments using medicines bought over the counter from local pharmacies. This article gives guidance on which medicines can be used safely, which should be avoided and when medical advice should be sought.
Assessing potential nondirected altruistic kidney donors: a case note audit
Abhijit Nadkarni, Patricia Schartau, Lisa Burnapp and Alastair Santhouse
pp 19-23
Kidney transplantation is now generally accepted as the preferred mode of renal replacement therapy, as it has superior long-term survival compared with dialysis treatment. However, kidney transplantation is limited by the shortage of donor organs; currently, approximately 7,500 patients are on the transplant list for a kidney donation in the UK.
Supporting Malawi’s dialysis services with the international community
Gavin Dreyer, Hamish Dobbie, Richard Banks, Theresa Allain, Andrew Gonani, Neil Turner and Valerie Luyckx
pp 24-26
Malawi has a population of 13 million, more than half of whom are under the age of 18. It is the tenth poorest country in the world, with more than 70% of the population living on less than $1.25 per day. A high prevalence of HIV (10.6%) contributes to the median lifespan of 54 years. There are very considerable health needs in Malawi, although the country has had a number of significant health successes over the last few years, including improved vaccination rates and a reduction in perinatal mortality.
Heparin-induced thrombocytopenia in haemodialysis
Christopher Hill and John Harty
pp 27-29
Heparin-induced thrombocytopenia (HIT) is a well-recognised complication of treatment with unfractionated or low molecular weight heparin. HIT can present itself in a variety of ways – from asymptomatic thrombocytopenia to life-threatening thrombosis. We present a case of HIT causing chronic access dysfunction and the rare pseudopulmonary embolus syndrome. We also highlight the challenges of managing HIT in haemodialysis patients.
Does using a guideline for AKI improve patient care?
Girish Bommayya, Alex Harrison, Stephen Dickinson, Paul Johnston, Jon Stratton and Rob Parry
pp 30-31
Acute kidney injury (AKI) is a serious problem in hospitalised patients, affecting 7–18% of hospital admissions. The reported incidence of AKI in the UK is 250–600 per million population [pmp]/year – and even this figure is likely to be an underestimate. AKI is associated with increased morbidity and mortality, including increased length of stay in hospital. Not surprisingly, AKI is associated with a significant cost burden to the NHS.

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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