Comment: The salt have lost its savour John Bradley pp 3-3 Once regarded as a precious
commodity because of its ability
to preserve food, salt is now recognised as
an important dietary contributor to
cardiovascular morbidity and mortality.
High salt intake is associated with increased
risk of stroke and cardiovascular disease,
and reducing sodium intake lowers blood
pressure and reduces cardiovascular risk.
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A safety comparison of the available phosphate binders Claire MacEwan pp 4-6 There is a strong association between hyperphosphataemia
and morbidity, hospitalisation
and mortality in dialysis patients. Altered vitamin
D homeostatis is associated with hypocalcaemia
and hyperphosphataemia, contributing
to the development of hyperparathyroidism and
mineral bone disease. There are no prospective
studies demonstrating a reduction in mortality
by lowering phosphate with specific agents (retrospective
studies are to come), but the use of
binders is associated with reduced mortality,
compared with untreated patients.
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Green waste management for renal medicine units Andrew Connor, Mary Thomson and Frances Mortimer pp 7-11 The disposal of waste contributes to the environmental
impact of healthcare. Kidney care, and
dialysis in particular, produces large amounts of
plastic and packaging waste. If explored further,
the fundamental principles of waste reduction,
‘reduce, reuse, recycle’, can be applied to kidney
care and lead to financial savings.
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Salt and fluid in dialysis patients: a review of practice Elizabeth Southcott and Elizabeth Lindley pp 12-13 Fluid balance to prevent fluid overload or dehydration,
both of which can result in negative
outcomes, is an integral part of haemodialysis
treatment. High interdialytic weight gain
(IDWG) and fluid overload can result in hypertension,
oedema, shortness of breath, pulmonary
oedema and heart failure. Low IDWG,
however, has been associated with poor nutritional
status and, therefore, can also be a negative
factor and should be investigated.
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What I tell my patients about the importance of calcium and phosphate Caroline Ashley pp 15-18 Calcium and phosphate are two minerals found in abundance in the body, and they are both vital for the maintenance of good health. If blood levels of calcium and phosphate become either too high or too low, this can affect normal bodily functions.
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The BOLDE project: widening patient choices for dialysis Edwina A Brown, Lina Johannsson, Maria da Silva-Gane, Ken Farrington and Hugh Gallagher pp 19-22 BOLDE (Broadening Options for Long-term
Dialysis in the Elderly) is a multicentre study
funded by Kidney Research UK through a grant
from Baxter Healthcare Ltd and supported by
the Renal Association (RA) and the British Renal
Society (BRS). There are three parts to the study:
a comparison of the quality of life (QoL) of
older patients on peritoneal dialysis (PD) and
haemodialysis (HD); a questionnaire-based
study to determine how older patients perceive
their involvement in decision-making around
choice of dialysis modality; and a qualitative
study of patients six months after starting PD or
HD to determine how dialysis has affected their
life and what factors they regard as important in
terms of choice of dialysis modality.
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GFR estimation: is cystatin C preferable to creatinine? Ahmir Ahmad pp 23-24 The glomerular filtration rate (GFR) is the
volume of fluid filtered from the glomerular
capillaries into the Bowman’s capsule over time.
The accurate measurement of renal function is
clinically important, as it has an impact on diagnosis,
treatment and prognosis. This measurement
will become increasingly significant in the
future, as our aging population is contributing
to the rising incidence of kidney disease.
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Mycophenolic acid therapies for autoimmune disease: a consensus statement David Jayne, Lorraine Harper, Steve Harper, Alan Salama and Marius Scholtz pp 25-31 Mycophenolic acid (MPA) was first isolated from
Penicillium brevicompactum in 1896 by Gosio,
and was named by Alsberg and Black in 1913.
Activity against bacteria, fungi and leucocytes
was first demonstrated by Sir Howard Florey in
1946. Antitumour activity was investigated in
the 1960s and, in 1969, the compound was
found to inhibit nucleic acid synthesis.
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