UK Renal Registry 11th Annual Report (December 2008): Chapter 7 Survival and causes of death of UK adult patients on renal replacement therapy in 2007: national and centre-specific analyses.

Introduction: These analyses examine survival from the start of renal replacement therapy (RRT), based on the total incident UK dialysis population reported to the Registry, including the 21% who started on PD and the 5% who received a pre-emptive transplant. Survival of prevalent patients and changes in survival between 1997-2006 are reported. The article includes a discussion on the technical definition for the date of start of both PD and HD.

Health outcomes following liver function testing in primary care: a retrospective cohort study.

Background: patients who present with abnormal liver function tests (LFTs) in primary care and no obvious symptoms can be difficult to manage.

Objective: The objective is to follow-up a cohort of liver function tested patients to determine their outcome.

Methods: This population-based retrospective cohort study was conducted in Tayside, Scotland, from 1989 to 2003.

Associations between chronic kidney disease and age-related macular degeneration.

Purpose: Age-related macular degeneration (AMD) and renal impairment are both associated with cardiovascular risk factors and with alterations in the complement pathways. There are few data on the association of AMD with chronic kidney disease.

Methods: People who were visually impaired (binocular acuity < 6/18) due to AMD (ascertained from review of medical notes; n = 516) were compared to people with normal vision (6/6 or better; n = 2755).

Development of a decision support tool for primary care management of patients with abnormal liver function tests without clinically apparent liver disease: a record-linkage population cohort study and decision analysis (ALFIE).

Objectives: To determine the natural history of abnormalities in liver function tests (LFTs), derive predictive algorithms for liver disease and identify the most cost-effective strategies for further investigation.

Data Sources: MEDLINE database from 1966 to September 2006, EMBASE, CINAHL and the Cochrane Library.

Methods: Population-based retrospective cohort study set in primary care in Tayside, Scotland, between 1989 and 2003.

Diagnostic strategies using DNA testing for hereditary haemochromatosis in at-risk populations: a systematic review and economic evaluation.

Objective: To evaluate DNA testing for detecting hereditary haemochromatosis (HHC) in subgroups of patients suspected of having the disorder and in family members of those diagnosed with HHC.

Data Sources: Major electronic databases, searched from inception to April 2007.

Review Methods: A systematic review was undertaken using a priori methods and a de novo model developed to assess costs and consequences of DNA testing.

CKD and mortality risk in older people: a community-based population study in the United Kingdom.

Background: The prevalence of chronic kidney disease (CKD) increases with age; however, the prognostic significance in older people is uncertain. This study aims to determine the association of CKD with all-cause and cardiovascular mortality in community-dwelling older people 75 years and older.

Study Design: Cohort study of people 75 years and older recruited in 1994 to 1999 to 1 arm of a trial of multidimensional health assessment with mortality follow-up.

Ethnicity, socioeconomic status, and attainment of clinical practice guideline standards in dialysis patients in the United kingdom.

Background And Objectives: The role of socioeconomic status (SES) and its contribution to ethnic differences in standards attainment among dialysis patients is not known.

Design, Setting, Participants, & Measurements: We examined associations between area- level SES (Townsend index) and ethnicity (white, black, South Asian) and standards attainment in 14,117 incident dialysis patients (1997-2004) in the UK.

Results: Deprived patients were less likely to achieve hemoglobin (Hb) > or = 10 g/dl (trend P < 0.

Psychosocial aspects of DNA testing for hereditary hemochromatosis in at-risk individuals: a systematic review.

Aim: To review the psychosocial benefits and harms of DNA testing for HFE-related hereditary hemochromatosis (HH) in at-risk individuals.

Background: HH is a common genetic disease in people of European descent. DNA-based predisposition testing is used for diagnosis or in the context of family testing, but there are concerns about potential psychosocial consequences.

A randomised controlled trial of structured nurse-led outpatient clinic follow-up for dyspeptic patients after direct access gastroscopy.

Background: Dyspepsia is a common disorder in the community, with many patients referred for diagnostic gastroscopy by their General Practitioner (GP). The National Institute of Clinical Excellence (NICE) recommends follow-up after investigation for cost effective management, including lifestyle advice and drug use. An alternative strategy may be the use of a gastro-intestinal nurse practitioner (GNP) instead of the GP.

Chronic kidney disease and hip fracture-related mortality in older people in the UK.

Background: Dialysis patients have increased hip fracture rates when compared to the general population of the same age and sex. There have been few studies of the association of earlier stages of chronic kidney disease (CKD) with hip fractures amongst older people in the general population. The aim of this study was to examine whether CKD at older ages is associated with hip-fracture-related mortality.

A decision analysis model for diagnostic strategies using DNA testing for hereditary haemochromatosis in at risk populations.

Background: New techniques for diagnosing hereditary haemochromatosis (HHC) have become available alongside traditional tests such as liver biopsy and serum iron studies.

Aim: To evaluate DNA tests in people suspected of having haemochromatosis at clinical presentation compared to liver biopsy, and in family members of those diagnosed with haemochromatosis compared to phenotypic iron studies in UK.

Methods: Decision analytic models were constructed to compare the costs and consequences of the diagnostic strategies for a hypothetical cohort of people with suspected haemochromatosis.

Socioeconomic disadvantage and kidney disease in the United States, Australia, and Thailand.

Objectives: We sought to determine whether an elevated burden of chronic kidney disease is found among disadvantaged groups living in the United States, Australia, and Thailand.

Methods: We used data on participants 35 years or older for whom a valid serum creatinine measurement was available from studies in the United States, Thailand, and Australia. We used logistic regression to analyze the association of income, education, and employment with the prevalence of chronic kidney disease (estimated glomerular filtration rate<60 mL/min/1.

Is there unmet need for implantable cardioverter defibrillators? Findings from a post-mortem series of sudden cardiac death.

Aims: To establish whether sudden cardiac death (SCD) victims could have been identified prior to their event and considered for an implantable cardioverter defibrillators (ICDs).

Methods And Results: Consecutive post-mortem cases of adult SCDs presumed to be caused by a ventricular arrhythmia over 12 months (2002-03) from a defined catchment population, Southampton, UK (n = 443 824 adults aged >or=16 years). Pathological data were extracted from the post-mortem reports.

A systematic review of the clinical validity and clinical utility of DNA testing for hereditary haemochromatosis type 1 in at-risk populations.

Objective: To evaluate the clinical validity and clinical utility of DNA testing in people suspected of having hereditary haemochromatosis and in family members of those diagnosed with the disorder.

Design: A systematic review.

Methods: 15 electronic databases were searched up to April 2007.

Detecting chronic kidney disease in older people; what are the implications?

Background: national policy is focused on early identification, referral and management of chronic kidney disease (CKD) to prevent both progression to endstage renal failure and cardiovascular disease. However, the significance of identifying CKD in older people is unclear.

Objective: to determine the frequency of CKD in older people using estimated glomerular filtration rate (eGFR), and its associations with morbidity and functional measures.

Survival of incident RRT patients in the UK (chapter 12).

This analysis presents the survival of patients starting renal replacement therapy (RRT) in UK renal units ('centres'), and includes an analysis of survival by centre. Data from 59 of the 70 UK centres are included. This is the first year that UK centre anonymity has been removed from analysis of patient survival by centre.

Noninvasive markers of fibrosis in nonalcoholic fatty liver disease: Validating the European Liver Fibrosis Panel and exploring simple markers.

The detection of fibrosis within nonalcoholic fatty liver disease (NAFLD) is important for ascertaining prognosis and the stratification of patients for emerging therapeutic intervention. We validated the Original European Liver Fibrosis panel (OELF) and a simplified algorithm not containing age, the Enhanced Liver fibrosis panel (ELF), in an independent cohort of patients with NAFLD. Furthermore, we explored whether the addition of simple markers to the existing panel test could improve diagnostic performance.

Patients with diabetic nephropathy on renal replacement therapy in England and Wales.

Background: The incidence of patients with diabetic nephropathy (DN) who start renal replacement therapy (RRT) is increasing.

Aim: To describe the characteristics and survival of patients with DN starting RRT in the UK.

Design: Retrospective cohort study.

International Study of Health Care Organization and Financing of renal services in England and Wales.

In England and Wales, the quantity and quality of renal services have improved significantly in the last decade. While acceptance rates for renal replacement therapy appear low by international standards, they are now commensurate with many other northern European countries. The major growth in renal services has been in hemodialysis, especially at satellite units.

Development of a decision support tool to facilitate primary care management of patients with abnormal liver function tests without clinically apparent liver disease [HTA03/38/02]. Abnormal Liver Function Investigations Evaluation (ALFIE).

Background: Liver function tests (LFTs) are routinely performed in primary care, and are often the gateway to further invasive and/or expensive investigations. Little is known of the consequences in people with an initial abnormal liver function (ALF) test in primary care and with no obvious liver disease. Further investigations may be dangerous for the patient and expensive for Health Services.

Correction of chronic metabolic acidosis for chronic kidney disease patients.

Background: Metabolic acidosis is a feature of chronic kidney disease (CKD) due to the reduced capacity of the kidney to synthesise ammonia and excrete hydrogen ions. It has adverse consequences on protein and muscle metabolism, bone turnover and the development of renal osteodystrophy. Metabolic acidosis may be corrected by oral bicarbonate supplementation or in dialysis patients by increasing the bicarbonate concentration in dialysate fluid.

Social deprivation and survival on renal replacement therapy in England and Wales.

This study examines the association between social deprivation and patient characteristics and outcomes in a nationally representative cohort of incident renal replacement therapy (RRT) patients. All Caucasian patients reported to the UK Renal Registry between 1997 and 2004 by centers in England and Wales with high data completeness were included. Social deprivation was assessed using the Townsend index.

Haemodiafiltration, haemofiltration and haemodialysis for end-stage kidney disease.

Background: Renal replacement therapy (RRT) for end-stage kidney disease (ESKD) can be achieved by several interventions including haemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation. HD, haemofiltration (HF), haemodiafiltration (HDF) and acetate-free biofiltration (AFB) are extracorporeal RRT methods. It has been suggested that HF and HDF may reduce the frequency and severity of intradialytic and post-dialytic adverse symptoms and may be more effective than HD in the removal of high molecular weight molecules.

Non-invasive markers associated with liver fibrosis in non-alcoholic fatty liver disease.

The diagnosis of fibrosis within liver disease is important for prognosis, stratification for treatment, and monitoring of treatment efficacy. The rising incidence and prevalence of non-alcoholic fatty liver disease (NAFLD) has driven the search for accurate non-invasive tools of liver fibrosis within this condition. With the aid of a systematic review, we explore how the field has evolved from the discovery of simple blood parameters to panel markers of liver fibrosis.

End-of-life care in community hospitals: the perceptions of bereaved family members.

Objectives: The perceptions of bereaved family members were obtained to evaluate the nature and quality of end-of-life care in community hospitals.

Design: During organizational case studies in six community hospitals in the South East and South West of England, bereaved family members were asked to participate in semi-structured interviews.

Participants: Fifty-one interviews were conducted with family members of patients who had received end-of-life care in a community hospital within the previous year.