Comment: The effects of obesity
John Bradley
pp 3-3
Being fat is not good for you. Except when it is. Almost one-third of obese adults in the USA have a healthy metabolic profile, leading to the description of a ‘healthy obese phenotype’. Dialysis patients who are overweight or obese appear to live longer, but being overweight is not good for the kidneys.
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Differing binding potential of oral phosphate binders
Anu Jayanti, Stephen Bonny and Alastair Hutchison
pp 4-7
Practising nephrologists are familiar with the difficulties encountered in achieving phosphate balance in patients with chronic kidney disease (CKD). We are well aware that an increase in serum phosphate concentration is an independent risk factor for death in patients with CKD and end-stage renal disease on dialysis. Therefore, although no interventional, phosphate-
lowering outcome studies have been performed, it is generally held to be important that control of phosphate is achieved.
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The future of ‘green’ nephrology in the UK
Kirsty Langton and Frances Mortimer
pp 8-9
Questions such as, ‘What will kidney care look like in ten to 15 years’ time, when carbon rationing is reshaping the NHS?’ and, ‘Will patients still travel three times a week to access dialysis or cover hundreds of miles to a transplant clinic?’ were just a few of those posed by the first ever Green Nephrology Summit, which was attended by Donal O’Donoghue, the National Clinical Director for Kidney Care.
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Fatigue in early renal disease
Julia L Newton, Ashley Brown, David EJ Jones and Neil Sheerin
pp 10-14
The prevalence of chronic kidney disease (CKD) is increasing in the West, with recent studies suggesting that over 10% of the population may have some form of CKD. A significant proportion of these patients will progressively lose renal function and finally require either dialysis or transplantation. Therefore, many initiatives exist to encourage early identification of patients with CKD and minimisation of the risk factors that predispose to progressive loss of function.
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What I tell my patients about obesity and renal disease
Andrew Connor and Renuka Coughlan
pp 15-18
People who are obese have an excess amount of body fat (more than 25% for men and 30% for women). Although a relatively crude tool, the body mass index (BMI) has become the established method of testing for obesity, and is calculated from a person’s weight and height. For most people, an optimal BMI is between 20 and 25 kg/m2. Those with a BMI between 25 and 30kg/m2 are considered ‘overweight’, while a BMI greater than 30 kg/m2 usually indicates obesity.
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Advancing renal supportive and end-of-life care
Helen Noble and Alistair Chesser
pp 19-21
A national meeting, the first of its kind and
arranged by the Department of Health (DH), was
held in London in late 2008. It brought together professionals with an interest in how to best manage those patients opting not to dialyse. It is well recognised that we know little about this population, and that their needs and experiences remain largely unidentified.
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Pain in end-stage renal disease: a physician survey
Joanne C Bowen, Benoit ME Ritzenthaler and Clare E Marlow
pp 22-24
There is increasing interest in the palliative care needs of patients with end-stage renal disease (ESRD). Many complications may occur as a result of ESRD or its treatment and most patients have significant associated illnesses which can contribute to the morbidity and mortality associated with the disease. A recent systematic review has demonstrated that a wide variety of symptoms are common in this patient population, with the overall symptom burden being high. A better understanding of, and approach to, symptom assessment and control is needed.
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Digital ischaemia and mitral stenosis due to calcification in a dialysis patient
Muhammad Imran, Prasad Rajendran, Vineeth Chikthimmah, John Alexander and Asma Chadhri
pp 25-25
Cardiovascular disease is the single most common cause of morbidity and mortality in renal patients. Metastatic calcification is a biochemical disorder that results from disturbed calcium and phosphate metabolism. It can affect virtually any organ or part of the body (the digital vasculature and mitral valve in the case of this patient) and it is more common in those renal patients who are suffering from secondary hyperparathyroidism.
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Assessing altruistic donation
Stephen G Potts
pp 26-28
Waiting lists for cadaveric kidney transplantation continue to grow worldwide, prompting various measures to increase the donor organ pool. The use of kidneys from live donors unknown to the recipient (non-directed, altruistic, stranger, anonymous or ‘Good Samaritan’ donors) is well established elsewhere, but has only been possible in the UK since the implementation of the Human Tissue Act in 2006.
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A review of minimal change disease in adults
David J Meredith and Philip D Mason
pp 29-31
Minimal change disease (MCD) is the cause of the nephrotic syndrome in 10–15% of adults who have the condition. MCD is characterised by no discernable histological abnormality on light microscopy. Ultrastructural examination by electron microscopy reveals fusion of the podocyte foot processes, although this is not pathognomonic of the disease.
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