Comment: Lightening the blues
John Bradley
pp 2-2
In 2007, the cost of services for depression in England was estimated to be £1.7 billion, but the costs of the associated misery and disability are greater. The consequences of lost employment bring the total to around £7.5 billion.
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Standards for water used in haemodialyis: an update
Nicholas A Hoenich and Rob Levin
pp 3-5
Dialysis uses large volumes of water in the
preparation of the dialysis fluid, which is
separated from the patient’s blood by a
semipermeable membrane contained in the
dialyser. The transport of solutes from the
patient’s blood into the dialysis fluid across
the membrane is predominantly concentration-
driven, although latterly there has been
a shift towards convective therapies such as
haemodiafiltration.
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The NICE guidance on depression in chronic illness
Rachel Attfield, Janette Moran and Andrew Mooney
pp 6-8
Psychological distress has long been recognised
as having a high prevalence among
patients with chronic illness, including
chronic kidney disease (CKD). Recently, the
National Institute for Health and Clinical
Excellence (NICE) published Clinical Guideline
91: Depression with a chronic physical health
problem (CG91), addressing the management
of depression in adults with chronic physical
health problems. These guidelines are to be
welcomed for raising awareness of depression
and outlining a structure for intervention.
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Practice development unit accreditation in renal care
Marie Bosworth, Lauren Gould, Jonathan Casey and Alex Crowe
pp 9-12
The practice development unit (PDU) accreditation
process focuses on patient care at a
multidisciplinary team level, where most significant
and direct influence on quality of
care can be achieved. This process drives
healthcare professionals towards lasting, sustainable
and realistic achievements, which
are systematically planned and not reactive.
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A new approach to contrast-induced nephropathy
Athat Badar, Azfar Zaman and Saeed Ahmed
pp 13-14
Contrast-induced nephropathy (CIN) is a
common cause of acute kidney injury (AKI) in
hospitals. A variety of different definitions
have been used to describe CIN. One, from
Mehran and Nikolsky, described CIN as an
‘absolute (x 0.5 mg/dl) or relative increase (x
25%) in serum creatinine 48–72 hours after
exposure to a contrast agent compared to baseline
serum creatinine values, when alternative
explanations for renal impairment have been
excluded’.
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What I tell my patients about MRSA infection
Philip Masson and Wendy Metcalfe
pp 15-18
Methicillin-resistant Staphylococcus aureus (MRSA) – also known as multidrug-resistant Staphylococcus aureus or a ‘superbug’ – is a bacteria that is responsible for several difficult-to-treat infections. It includes any strain of Staphylococcus aureus bacteria that is resistant to conventional antibiotics.
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A prospective study of acute kidney injury in Cornwall
Katie Wallace, Kassie Adain, Paul Johnston, Jonathon Stratton and Robin Parry
pp 19-21
Acute kidney injury (AKI) is an abrupt (within
48 hours) reduction in kidney function currently
defined as an absolute increase in serum
creatinine of more than or equal to 0.3 mg/dl
(=26.4 µmol/l), a percentage increase in serum
creatinine of more than or equal to 50% (1.5-
fold from baseline), or a reduction in urine
output (documented oliguria of less than 0.5
ml/kg per hour for more than six hours).
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Alcoholic ketoacidosis: common but not so familiar
Hasnain Raza, Naushad A Junglee and Mahdi M Jibani
pp 22-24
Alcoholic ketoacidosis (AKA) is a common but
frequently missed cause of high anion gap
metabolic acidosis. It is usually identified in
chronic alcohol abusers during an abrupt cessation
of alcohol. We report a case of alcoholic
ketoacidosis presenting with severe metabolic
acidosis and a remarkable degree of respiratory
compensation. Prompt recognition and
treatment resulted in an excellent recovery.
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Physical function assessment in chronic kidney disease
Pelagia Koufaki, Patrick F Naish and Tom H Mercer
pp 25-27
Measures of physical function have been
shown to be related to clinically important
outcomes (survival, morbidity and quality of
life [QoL]) in patients receiving dialysis-based
renal replacement therapy. Given the prognostic
potential of these factors, it is recommended
that their measurement should form
part of the routine assessment (and management)
of patients receiving maintenance dialysis
therapy. The available literature suggests
that, if good practice is followed, exercise tolerance
and functional capacity assessment of
the patient with chronic kidney disease (CKD)
(stages 3–5) is safe, feasible and may be
clinically useful.
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Gadolinium and the risk of nephrogenic systemic fibrosis
Tara A Collidge, Scott T Morris and Giles Roditi
pp 28-31
In the renal failure population at high risk of
contrast-induced nephropathy from traditional
iodinated agents, the last decade initially
saw a dramatic rise in the use of
gadolinium-based contrast agents (GBCAs)
used for contrast-enhanced MRI. This trend
reversed late in 2006 following the first report
of association between GBCA use and the rare
condition nephrogenic systemic fibrosis
(NSF); this observation was substantiated
and the US Food And Drug Administration
(FDA) issued an alert.
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