Comment: Timing it right: living kidney donation
John Bradley
pp 3-3
The number of living donor kidney transplants in the UK continues to rise. In the year 1 April 2007 to 31 March 2008, 2,282 renal transplants were performed in the UK, of which 829 were living donor transplants. In the previous year, 690 living donor transplants were performed. In almost one-third of cases, the recipient received a kidney transplant from a living donor before the need for dialysis. In contrast, only 6% of deceased donor transplants were performed pre-emptively.
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Reviewing the NICE guidance
Paul Stevens and Kathryn Griffith
pp 4-7
The recently published National Institute for Health and Clinical Excellence (NICE) clinical guideline for the early identification and management of chronic kidney disease (CKD) affirms much of what we think we know and believe. It also challenges a few widely held beliefs. For some, it probably goes too far and for others, not far enough.
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Patient education: a step on the road to better adherence
Saurabh Chaudhri, Sally Altree and Steve Riley
pp 8-10
With much of healthcare going down the route of target-driven outcomes, it is becoming increasingly important to recognise the impact of poor adherence to medication in the ability to attain these treatment goals. This was acknowledged by a World Health Organization report, which estimated that 50% of medicines prescribed for chronic diseases are not taken as directed in developed countries.
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Disorders of antibody production and the kidney
Deena Iskander, Neil Turner and Huw Roddie
pp 11-14
Clonal disorders of antibody (immunoglobulin [Ig]) production are caused by a proliferating B lymphocyte clone that overproduces a particular antibody, which is then known as a paraprotein. The mature B-cells that produce antibodies are plasma cells, so these conditions are also known as plasma cell dyscrasias, or dysproteinaemias.
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What I tell my patients about benefits and entitlements
Mary Braybrooke
pp 15-18
Most patients (or clients, as renal social workers tend to call them) are in a state of denial and disbelief when they are first diagnosed with chronic kidney disease; even more so, sometimes, when they are nearing the need for dialysis. Conflicting emotions, such as awareness of mortality, family pressures, insecurity and fear of changes in lifestyle make it difficult to take in all the implications. There is a need for repetition and reassurance and a gentleness as the news sinks in. If there is acute renal failure leading to a chronic condition with no preparation, this is even more difficult because of the immediate hospital treatment. For those who have time to consider and attend predialysis groups and meet members of the multidisciplinary team, the renal journey is possibly easier, although the implications remain the same.
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Following the 18-week pathways for kidney care
Lawrence Goldberg and John Scoble
pp 19-22
From December 2008, all patients in England must begin their first definitive treatment within 18 weeks of initial referral. This poses particular challenges for long-term conditions such as chronic kidney disease (CKD), where patients develop a range of complications over their lifetime and often remain under long-term specialist care. How do you define what starts or stops the 18-week ‘clock’ for such patients? It is certainly much less clear than for referrals for one-off surgical treatments.
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The need for a fresh look at patient information
Jo Moore
pp 23-23
Research conducted by Kidney Research UK (KRUK) has highlighted the need for better patient information related to chronic kidney disease (CKD) and end-stage renal failure (ESRF).
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A donors view on improving live donation services
Helen Seymour
pp 24-25
My brother, Douglas, is 48 years old and has had rheumatoid arthritis for almost 30 years. In 1992, following a renal biopsy, the suspicion of chronic kidney disease was confirmed and he was advised that it was almost certain he would need renal replacement therapy within five years. At that point, I made it clear to Douglas, before he would require dialysis, that I would be happy to be a living donor. His renal function deteriorated steadily as the years passed. Eventually his estimated glomerular filtration rate (eGFR) reached around 15 ml/min 18 months ago.
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Ways to make living kidney donation faster and simpler
John Scoble and Lisa Burnapp
pp 26-31
The concept that living kidney donation offers the patient with end-stage kidney disease opportunity and choice and the best chance of longterm rehabilitation is uncontroversial, but healthcare professionals are faced with a challenging agenda in this rapidly advancing and increasingly complex field. A clear strategy for ongoing service improvement is required to respond effectively to the needs and expectations of patients and their families.
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Measuring best practice: the National Kidney Care Audit
Ursula Turner
pp 29-31
The best way to make improvements to services is to build on a firm evidence base. The new National Kidney Care Audit is, for the first time, collecting a comprehensive national set of data on two key areas for kidney patients.
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