Comment: Grow your own organs
John Bradley
pp 4-4
The discovery of insulin provided a life-saving treatment for patients with type 1 diabetes — but also uncovered long-term complications, such as renal failure. Improving diabetic control with intensive insulin treatment reduces the rate and progression of complications, but increases the incidence of hypoglycaemia.
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Upgrading treatment of dialysis water
Nicholas A Hoenich and Robert Levin
pp 6-8
Haemodialysis and related therapies make extensive use of water in the production of dialysis fluid. In addition, within a dialysis unit water may be used in the reprocessing of dialysers or in the production of online infusate for use with the newer modalities of treatment such as haemodiafiltration. The water used for these applications is derived from the domestic or municipal supply, which, in the UK, complies with the requirements of the Water Industry Act (1991) and European Commission water directives for drinking water.
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Renal disease in minority populations
Liz Lightstone
pp 9-11
Caucasians of European descent are relatively protected from renal disease compared with almost all other ethnic groups. Migration to the UK from the Indian subcontinent (often via east Africa) and the Caribbean has generated growing, and aging, ethnic communities at markedly increased risk of end-stage renal failure (ESRF). The high incidence of ESRF combined with low rates of transplantation in these groups is leading to a growing number of ethnic patients in renal units serving large ethnic communities. It is timely to consider how these trends can be reversed, both by reducing the incidence of ESRF and by increasing rates of renal transplantation.
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What I tell my patients about pancreas transplantation
Murat Akyol
pp 13-16
In the past, pancreas transplantation did not enjoy the same success as other solid organ transplants. However, in the last five or six years, results have improved to match the success rate of other organ transplants, and the number of pancreas transplants performed worldwide has increased rapidly. A range of new procedures has also been introduced, so that diabetic patients now have a choice when considering transplantation.
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Delivering standards to improve patient care
Donal J O'Donoghue
pp 17-17
A symposium looking at the commissioning of renal services opened the British Renal Society (BRS) annual meeting at the Manchester International Convention Centre on 13 June. The audience comprised a mix of NHS commissioners and healthcare professionals.
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Hazards of using modern anticoagulants in renal impairment
Lorna K Henderson and Lorna Thomson
pp 18-19
A 41-year-old man was admitted via A&E after having taken a combination of metformin, bisoprolol, paracetamol, ibuprofen and simvastatin 14 hours earlier. He had taken it because of abdominal pain experienced over the past several days. Type 2 diabetes had been recognised two years before. He also had a history of hypertension, hypercholesterolaemia and depression.
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Anticipating the impact of the Renal National Service Framework
Paul E Stevens
pp 20-24
The plan to publish a national service framework (NSF) for renal services was announced at the Secretary of State’s Summit on Organ Donation on 26 February 2001. We are assured that the NSF will be a document aimed at raising standards, reducing variations in services and improving the healthcare of renal patients. The development process is scheduled to take place over three years with the staggered production of four distinct modules. Like the NSF for diabetes, it is anticipated that there will be in the region of 12 standards and each module will contain standards for a particular area of renal care.
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Nurse consultants for chronic haemodialysis patients
Brian A Crosbie
pp 25-27
With the growing demand for renal services, the evolution of the nurse consultant post has been a timely development. Renal services expanded in the UK during the 1980s, partly as a result of the investment prompted by a national target set in 1984 in chronic ambulatory peritoneal dialysis. This allowed the treatment of a greater number of patients without the need for additional haemodialysis facilities.
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