Comment: Washing machines at home: the changing face of haemodialysis
John Bradley
pp 4-4
Important scientific discoveries and innovations are often rejected by peer review when first proposed. Dr Nose was recently able to reflect that home haemodialysis was regarded as a ‘crazy idea’ when his abstract, Haemodialysis at home: utilizing the domestic electric washing machine, was rejected by the 9th American Society for Artificial Internal Organs (ASAIO) Congress in 1963. Home haemodialysis went on to play a major role in the expansion of long-term dialysis facilities that occurred during the first decade of treatment. By the early 1970s, approximately 40% of all dialysis patients in the USA were on home haemodialysis.
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High quality dialysis for more patients with savings: linking theory to clinical practice
Alison L Smith and Colin B Brown
pp 6-9
The economic dynamics affecting the delivery of healthcare require a refocusing of how healthcare professionals work. The challenge to clinical staff and to those managing the healthcare system is to maximise the use of resources so that quality care is provided with less cost. Healthcare workers must also become more involved in clinical effectiveness issues, and ensure that what is done is really effective. Healthcare leaders must identify ineffective practices and replace them with more effective measures. This may be difficult, as staff are often reluctant to change what they have always done.
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PCTs and shared care
Nigel Starey
pp 10-11
In my previous article1 I looked at primary care groups, what they are and what power they have. I went on to consider how they might influence the care of patients with renal disease as the boundary between primary and secondary care is reassessed. With the arrival of primary care trusts (PCTs) in April 2000 and their subsequent rapid development around the country, this article moves on to anticipate the effects that they will have on shared care arrangements for people with renal disease.
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What I tell my patients about nephrotic syndrome in adults
Peter W Mathieson
pp 13-16
Nephrotic syndrome describes the condition which results from leakage of proteins from the kidneys, leading to depletion of the body’s protein stores. Typical symptoms include swelling of the feet and ankles (oedema); sometimes the swelling also affects other parts of the body such as the face (often most noticeable around the eyes first thing in the morning), the abdomen and the lungs. Tiredness and lack of energy are often evident and patients may notice that the urine is frothy (with a ‘head’ on it like beer!).
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Foot problems in patients with diabetic nephropathy
Samson O Oyibo, Ann Knowles, Andrew Findlow and Andrew JM Boulton
pp 17-20
Diabetic nephropathy is the single most important cause of chronic renal failure in developed countries, but survival of diabetic patients with renal replacement therapy continues to be poor. Foot problems remain the commonest reason for hospitalisation of patients with diabetic nephropathy. To reduce the increased morbidity and mortality associated with the combination of these diabetic complications, a multidisciplinary approach to patient care is required.
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Dry weight assessment
Bernard Mark Garrett
pp 21-24
Patients requiring dialysis must rely on their therapy to remove ingested water. The assessment of accurate dialysis dry weight is important, but is more complex than it appears. Developing a precise and easily-applied method for all patients remains an aspiration for nephrologists and nephrology nurses. In current practice, clinicians still rely on a variety of techniques and a large degree of clinical experience and skill.
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Staff attitudes to home haemodialysis
Phillip Lunts
pp 25-27
It has long been recognised that medical staff attitudes towards the different dialysis modalities are highly predictive of the proportion of patients on each modality. Home haemodialysis has undergone a serious decline in numbers, both quantitively and as a proportion of total patients over the last 20 years, from being the primary dialysis modality to numbering less than 5% of dialysis population. Before commencing a home haemodialysis programme at our own centre, we felt it would be instructive to assess the views of dialysis staff in the UK on the state of home haemodialysis.
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