BNF advice on drug doses adjustments in CKD

The British National Formulary has revised its guidance on drug dose adjustments in Chronic Kidney Disease. For most drugs, for most patients over 18 years of age of average build and height, the eGFR (derived from the modification of diet in renal disease formula) can be used to determine dosage adjustments in place of creatinine clearance. Exceptions include potentially toxic drugs with a small safety margin, and patients at both extremes of weight. The BNF have replaced its references to creatinine clearance with eGFR where applicable and revamped its Appendix 3 to include a table grading renal function according to eGFR. Why don’t you try your hand at the case study?

Better quality of life in Essex

Better quality of life is the goal of Essex County Council and its Health Overview and Scrutiny Committee is determined to ensure that includes people with kidney disease. Scrutiny’s hard hitting report on dialysis services in Essex lays out an ambitious agenda for improvement and identifies some key areas where action is needed – home haemodialysis, transport and parking, dialysis away from home and the importance of social care. This is the first report I am aware of by a Health Overview and Scrutiny Committee focussing on dialysis services but where there is local cause for concern or kidney care is in need of improvement, I expect we will see more aimed at improving provision and support for people with kidney disease.

Bedtime reading: National policy on antiviral medicines for CKD

Read the letter here

Q & A: Single sex areas - hospital dialysis

Q: Dear Dr O'Donoghue, we are currently being advised by our Trust management team that we will soon be required to adhere to the single sex areas rule, which has been decreed by the Department of Health. As you can imagine, this was met with horror; finding dialysis slots for all patients can be hard enough, without having to think of that too. Hospital transport would also be an issue, as patients may be grouped on dialysis shifts for geographical area not gender!

We think that our patients would not feel the need or like this as the social aspect of mixing with others, especially for younger patients is important to them. We understand that the idea in principle may be better for sick, underdressed inpatinets and would welcome your thoughts on its application to fairly well, fully clothed outpatients. Thank you. Kind regards, Nicky Moncrieff (Renal Nurse Specialist, Addenbrookes Hospital, Cambridge).

A: Dear Nicky, thank you for your question, it is something that is being raised by several renal units. The existing guidance on the Department of Health website actually uses dialysis as an example where common sense needs to prevail. To quote directly "Staff in these areas will need to make decisions on a day-to-day basis. For instance, in a renal dialysis unit, if all patients are well-established on treatment, wear their own clothes and have formed personal friendships, mixing may be a good thing. By contrast, a new dialysis patient, with a femoral catheter, and wearing a hospital gown, should be able to expect a much higher degree of privacy." I do hope this is helpful. Kind regards Donal.