British Journal of Renal Medicine - 2015

Comment: Living longer on dialysis: the ethnic enigma
John Bradley
pp 3-3
Estimated life expectancy differs among ethnic groups in the UK. In 2001, life expectancy at birth in England and Wales was 76.4 years for White British men and 80.8 years for White British women. Bangladeshi men had the lowest life expectancy, estimated at 73.2–73.3 years. For women, the Pakistani group had the lowest life expectancy, but estimates varied between 77.1 and 79.3 years. In the USA, life expectancy at birth in 2009 was 78.8 years for the White population, and 74.5 years for the Black population. Differences in disability-free life expectancy at birth between different ethnic populations are even more striking. Disability-free life expectancy at birth was 61.7 years for White British men and 64.7 years for White British women. In comparison, disability-free life expectancy was reduced by six years for Pakistani men, 9.1 years for Pakistani women, 7.5 years for Bangladeshi men and 7.6 years for Bangladeshi women. It was also significantly lower for men and women from the White and Black Caribbean, Indian, other Asian and other Black communities.
Who waits longest for a kidney? Inequalities in access to kidney transplantation
Myfanwy Morgan, Jessica Sims, Neerja Jain, Gurch Randhawa, Shivani Sharma and Kirit Modi
pp 4-7
Black and Asian Minority Ethnic (BAME) groups are over-represented on active kidney transplantation waiting lists and have relatively long waiting times. This inequality arises from a particularly high need for kidney transplantation combined with a low rate of deceased donation among BAME groups, which limits the availability of a well matched graft. This article outlines the major barriers to donation and describes initiatives to increase donation and transplantation.
Dialysis access: a small centre perspective
Sarah McCloskey, Fiona Dallas, David Gledhill and Paul Mead
pp 8-11
The Cumberland Infirmary, Carlisle, provides care for a population of around 340,000 over a large geographical area. The number of patients receiving renal replacement therapy (RRT) is small in comparison to other units in the country and operations to place dialysis access tend to occur on an ad hoc basis.
Anion exchange and sevelamer carbonate: What’s in a name?
Clive Harland, Oliver Wrong and Robert Unwin
pp 12-14
Sevelamer is now one of the most widely prescribed phosphate binders used to manage hyperphosphataemia in advanced renal failure and end-stage renal disease. It is available in two forms: sevelamer hydrochloride, and sevelamer carbonate. Both forms are weak base anion exchange resins with a cross-linked polyallylamine structure; the former supplied partially in the chloride form and the latter claimed to be partially in the carbonate form. Although the wider nephrology readership may be less familiar, or even concerned, with the importance of accurate chemical nomenclature, in the case of sevelamer carbonate, it provides a useful reminder of some fundamental acid–base chemistry and the potential therapeutic properties of weak base anion exchange resins that are still used widely in nephrology.
What I tell my patients about encapsulating peritoneal sclerosis
Julia Ertner, Elaine Corden and Chris Watson
pp 15-18
Encapsulating peritoneal sclerosis (EPS) is an uncommon but serious condition that affects the bowel, meaning that it becomes partially or even completely blocked. EPS is most commonly a result of receiving peritoneal dialysis, usually for several years, although in some cases it can occur after just a few months.
Spontaneous splenic rupture: presentation of granulomatosis with polyangitis
Jay Hiremath, Victoria Stewart, Noshaba Naz, Anindya Banerjee and Yaser Shah
pp 20-21
Splenic involvement is a common manifestation of various connective tissue disorders, such as systemic lupus erythematosis, polyarteritis nodosa and rheumatoid arthritis. There have been well documented reports of splenic infarction and splenic haematoma in patients diagnosed with granulomatosis with polyangitis (GPA). However, spontaneous splenic rupture as a presenting feature is a very rare occurrence, with only three reported cases.4,5 We report an atypical presentation of GPA with spontaneous splenic rupture, when acute kidney injury improved temporarily following splenectomy, and re-admission five weeks later with clinical features of systemic vasculitis from GPA with established acute renal failure.
Policy matters: Safety first
Donal O’Donoghue
pp 22-23
Patients and the public often assume that healthcare is safe, but they are wrong. Our interventions carry risk and, at times, can cause harm. In healthcare, harm is not just confined to high-profile NHS failures, such as the Mid Staffordshire NHS Foundation Trust and Winterbourne View scandals that we have witnessed over the last few years. The risk of harm is greatest for those in high acuity situations, which includes patients with advanced kidney disease and acute kidney injury, and those receiving renal replacement therapy.
Patient-reported outcome measures in haemodialysis: a visual analogue model
Aamer J Mughal, Osasuyi U Iyasere and Edwina A Brown
pp 24-27
With the current focus on patient-centred care, there is increasing recognition of the limitations in utilising only biochemical and survival data to assess the quality of treatment for chronic disease. Therefore, efforts have been made to find patient-centred measures to help provide more holistic evaluation of treatment quality.

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)