Comment: Dialysis and travel
John Bradley
pp 4-4
Patients with renal failure need to be able to travel for both work and pleasure. For patients on continuous ambulatory peritoneal dialysis (CAPD) this should be simple to arrange. Supplies can be packed for short trips, and dialysis companies can ship supplies worldwide for longer trips or travel to more distant destinations. Arranging haemodialysis is clearly more complex. In the early days of haemodialysis the relatively lightweight sorbent cartridge REDY (regenerative dialysis) system could be fitted into a suitcase, providing travelling dialysis for those skilled in its use.
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Best practice for the management of anaemia in chronic renal failure
J Stewart Cameron
pp 6-8
Best practice guidelines recommend management strategies and attempt to set standards for optimal patient care, to guide physicians in the detail of their practice aimed at helping individual patients. The momentum towards formulating guidelines comes not only from the healthcare professions, but also from healthcare management organisations, who need some way of measuring the quality of the services they purchase.
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Managing nutrition in patients with ARF
Katie J Durman
pp 9-12
Acute renal failure (ARF) complicates approximately 30% of admissions to intensive care units. The major causes are abdominal aortic aneurysm, coronary artery bypass graft, other surgery, multiple organ failure (MOF), sepsis and trauma. It carries a high rate of mortality – 50% for all cases of ARF, rising to 80% in patients with MOF. Protein calorie malnutrition has been implicated as one of the comorbidities that contributes to the high rate of mortality. Feeding these patients is often a challenge.
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What I tell my patients about vasculitis
Gemma Browne and Neil Turner
pp 13-16
Vasculitis is inflammation of the blood vessels. Its effects depend upon the size of the blood vessels affected and the parts of the body involved. Commonly, vasculitis may only affect the skin (cutaneous vasculitis). Sometimes it affects several organs at the same time (systemic vasculitis). There are many varieties of systemic vasculitis, and they are often given complicated names. However, it is useful to be aware of this variety, as treatments may differ and some kinds of vasculitis are more likely to recur. Some types of systemic vasculitis begin by affecting a single organ such as the kidney.
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Sunday opening makes best use of resources
Brian Crosbie
pp 17-17
Strategies used to meet the increasing demand for haemodialysis include the development of satellite units, new units in district general hospital sites and the opening of overnight shifts. A less desirable approach is a reduction in dialysis from three times a week to two. In this article we consider one way of overcoming this problem – open renal units over seven days instead of the usual six. But can it be done? Yes – and not only does it increase overall capacity, but it can also make the best use of resources within the unit.
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Dialysis: higher quality, for more patients, with savings
Colin B Brown and Alison Smith
pp 18-20
Financial constraints on healthcare budgets continue to pressurise purchasers of clinical services – whether they are government- or privately-funded. While the medical community must continue to provide the best possible care for their patients, they also have a responsibility to make full use of their resources and, where possible, make savings that can be reinvested. Elizabeth Ward, President of the British Kidney Patient Association, has drawn attention to the inadequate funding and availability of dialysis resources. Indeed, despite Renal Association guidelines recommending three-times weekly haemodialysis, many units are only able to provide twice-weekly treatment, which is inadequate and results in higher morbidity and mortality.
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Non-adherence in renal transplant recipients
Janet Ann Butler and Hugh Cairns
pp 21-24
Non-adherence to medication (also termed non-compliance) is common, especially in chronic illness. In transplant recipients non-adherence to immunosuppressants appears to contribute to graft failure. Most studies suggest that after the immediate post-transplant period 10–30% of recipients fail to take their medication as prescribed and some studies indicate that 50% are partially non-adherent. It can be difficult for the practising clinician to recognise and manage non-adherence in a clinical setting. This article discusses some of the methods that are used to detect non-adherence and how they may be used in routine practice.
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Standard documentation for holiday dialysis
Maggie Farrell and Michael Almond
pp 25-27
Recently there has been an increase in the number of patients requesting holiday dialysis. To enable staff to deal more efficiently with this growing demand, there is a case for the introduction of a standard national document for holiday dialysis to replace multiple unit generated forms that are currently in use. The purpose of such a form would be to refine and standardise the process of arranging holiday dialysis.
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