British Journal of Renal Medicine - 2012

Comment: Living kidney donation – first, do no harm
John Bradley
pp 3-3
In recent years, over 1,000 living donor kidney transplants have been performed each year in the UK, accounting for around one-third of all kidney transplant activity. The benefits for the recipient, in terms of performing a timely transplant that offers optimum patient and graft survival, are clearly articulated by Lisa Burnapp in this issue of the British Journal of Renal Medicine.
Clotting in the HD circuit: a review of the anticoagulation options
Elizabeth H Lamerton
pp 4-7
Preventing clotting in the haemodialysis (HD) extracorporeal circuit is one of the ongoing challenges of effective HD and requires the judicious use of anticoagulation therapy. Effective anticoagulation needs both an understanding of the basic principles of haemostasis and the clotting cascades, and use of suitable anticoagulant therapies. Further, the delicate balance between anticoagulation and inherent increased bleeding risk in uraemic patients must be considered. Unfractionated heparin and low molecular weight heparins are now routinely used in centre-, satellite- and home-based HD.
The role of the renal social worker in promoting adherence
Jo Hall
pp 8-9
Are renal social workers really necessary? There is a growing body of evidence to suggest that social workers may not only improve quality of life for dialysis patients, but also have a positive effect on their physical health and well-being, thus improving the cost-effectiveness of renal dialysis units. In this article, the role of the renal social worker in the promotion of adherence will be explored in an attempt to justify this assertion.
What I wish I’d known about dialysis at home
Marion Higgins
pp 10-11
I was first diagnosed with kidney failure in about 1989. I was 53 years old, and apart from migraines over the previous three years, I’d always enjoyed good health. It was only after feeling irrational and odd for a while that I was finally talked into visiting my GP, who discovered my blood pressure was completely off the scale – he measured it several times just to make sure! He questioned me closely about my lifestyle, work and relationship with my husband to try to find a reason for my agitation, and sent me home with some tranquillisers, asking me to return the following week.
How can we learn from each other to improve outcomes for patients?
Hugh C Rayner
pp 12-14
Have you ever carried out an audit? If so, you probably found things that could be improved. But how often do audits lead to an improvement in performance? In my experience, not often. This article tries to explain why that might be.
What I tell my patients about salt restriction
Deepa Kariyawasam
pp 15-17
Traditionally, salt was used to preserve foods, but the high use of salt in the UK today is certainly not helping to preserve the nation! The efforts we as a country have made to reduce our salt intake have already saved 8,500 lives in the last year. The number of lives saved per year could be increased to 17,000 if salt consumption is reduced by a further 25%.
Towards corticosteroid-free immunosuppression in children
James McCaffrey and Nicholas JA Webb
pp 19-22
For the past 50 years, corticosteroids have formed an integral component of immunosuppressive regimens in children undergoing renal transplantation. Corticosteroids have proven efficacy, but their chronic usage is associated with numerous adverse effects, including impaired glucose and lipid metabolism, cardiovascular sequelae, cosmetic changes and impaired linear growth.
Vitamin D in renal disease
Thomas F Hiemstra
pp 23-27
Vitamin D is indispensible to skeletal health, and its deficiency results in rickets or osteomalacia. It is increasingly recognised as having many other functions, including immune modulation, cardiovascular health and regulation of cell proliferation. Vitamin D homeostasis depends on intact renal function: the dysregulation that results from renal impairment contributes significantly to the development of chronic kidney disease-bone and mineral disorder. This review considers the vitamin D endocrine system and its regulation, deficiency, supplementation and therapeutic use in patients with renal disease.
The UK strategy for living donor kidney transplantation
Lisa Burnapp
pp 28-30
By 2010, living donor kidney transplantation (LDKT) accounted for 38% of the total transplant activity in the UK, where the rate is 16 per million population (pmp). The number of transplants had trebled in ten years, and was on a par with comparable countries (for example, Norway at 17 pmp). Recognising the benefit of a planned, timely transplant with a higher chance of success, patients and their families started to actively seek the opportunity for LDKT, and clinicians responded with growing confidence and expertise.
Patient decision aids for end-stage kidney disease
Donal J O'Donoghue
pp 31-31
Of all the pressures facing our health system, it is the cultural challenge of putting patients at the centre of decision-making in end-stage renal disease (ESRD) that is likely to be most transformative for people with kidney failure. In the past ten years, the UK has led the way in developing conservative kidney care, and some units have been quick to adopt the Scandinavian model of pre-emptive live donor transplantation; we remain at the forefront of peritoneal dialysis research and the resurgent interest in home haemodialysis.

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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