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Objectives: To determine whether the prevalence of chronic kidney disease (CKD) in England has changed over time. Design: Cross-sectional analysis of nationally representative Health Survey for England (HSE) random samples. Setting: England 2003 and 2009/2010. Survey participants: 13 896 adults aged 16+ participating in HSE, adjusted for sampling and non-response, 2009/2010 surveys combined. Main outcome measure: Change in prevalence of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 (as proxy for stage 3-5 CKD), from 2003 to 2009/2010 based on a single serum creatinine measure using an isotope dilution mass spectrometry traceable enzymatic assay in a single laboratory; eGFR derived using Modified Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) eGFR formulae. Analysis: Multivariate logistic regression modelling to adjust time changes for sociodemographic and clinical factors (body mass index, hypertension, diabetes, lipids). A correction factor was applied to the 2003 HSE serum creatinine to account for a storage effect. Results: National prevalence of low eGFR (<60) decreased within each age and gender group for both formulae except in men aged 65-74. Prevalence of obesity and diabetes increased in this period, while there was a decrease in hypertension. Adjustment for demographic and clinical factors led to a significant decrease in CKD between the surveyed periods. The fully adjusted OR for eGFR <60 mL/min/1.73 m2 was 0.75 (0.61 to 0.92) comparing 2009/2010 with 2003 using the MDRD equation, and was similar using the CKDEPI equation 0.73 (0.57 to 0.93). Conclusions: The prevalence of a low eGFR indicative of CKD in England appeared to decrease over this 7-year period, despite the rising prevalence of obesity and diabetes, two key causes of CKD. Hypertension prevalence declined and blood pressure control improved but this did not appear to explain the fall. Periodic assessment of eGFR and albuminuria in future HSEs is needed to evaluate trends in CKD. [ABSTRACT FROM AUTHOR]

Background Acute kidney injury (AKI) is one of the most common complications affecting hospital inpatients around the world. It is associated with high mortality and adverse long-term outcomes, but there is uncertainty regarding its prevalence and cost. We estimate the prevalence of AKI in hospital inpatients in a universal health-care system, and the immediate and long-term impacts on survival, quality of life and health-care costs. Methods We examined prevalence of AKI in inpatients using both routine national data for the National Health Service (NHS) in England, and laboratory data from East Kent Hospitals. We used regression analyses to estimate the impact of AKI on mortality and length of hospital stay, and a Markov model to estimate the impact on quality-adjusted life years and NHS costs. Results AKI was recorded in 2.43% of hospital admissions in Hospital Episode Statistics (HES), but age- and gender-standardized estimates derived from laboratory data suggest the true prevalence may be more than five times as high (14.15%). We estimate that the annual number of excess inpatient deaths associated with AKI in England may be above 40 000. The annual cost of AKI-related inpatient care in England is estimated at £1.02 billion, just over 1% of the NHS budget. The lifetime cost of post-discharge care for people who had AKI during hospital admission in 2010–11 is estimated at £179 million. Conclusions AKI prevalence in inpatients may be considerably higher than previously thought, and up to four fifths of cases may not be captured in routine hospital data. AKI is associated with large numbers of in-hospital deaths and with high NHS costs. Comparison of HES and East Kent data suggests that most of the cases recorded in HES may be relatively severe AKI (AKIN 2–3). [ABSTRACT FROM AUTHOR]

The article presents a study which aims to develop and explore a REnal specific Advanced Communication Training (REACT) programme to meet the need of patients with End-Stage Kidney Disease, as well as of renal professionals. They study piloted the programme with 16 participants in two teaching hospitals in Great Britain. Results showed that the developed programme was feasible and acceptable, and was linked with a non-significant increase in confidence in conveying about end-of-life issues.

Key points Cystic fibrosis (CF) is a common genetic disease caused by loss-of-function mutations in the cystic fibrosis transmembrane conductance regulator gene, which encodes a channel protein, selective for anions., In the lungs, the site of the most severe symptoms, CF causes abnormal electrolyte transport in epithelial cells which line the airways., Airway epithelial ion transport can be assessed by measuring the trans-epithelial potential difference ( Vt) which shows characteristic changes in CF individuals. We developed a biophysical model of ion transport in human nasal epithelia, in order to investigate quantitatively which transport parameters underlie these observed bioelectric changes., We found that loss of apical Cl− permeability alone is insufficient to explain the bioelectric properties of CF epithelia. An increase of apical Na+ permeability must also occur., This insight has important implications for our understanding of the physiology of CF disease, and hence for potential therapies aimed at correcting the CF ion transport defect., Abstract Cystic fibrosis (CF) is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, which encodes an anion channel. In the human lung CFTR loss causes abnormal ion transport across airway epithelial cells. As a result CF individuals produce thick mucus, suffer persistent bacterial infections and have a much reduced life expectancy. Trans-epithelial potential difference ( Vt) measurements are routinely carried out on nasal epithelia of CF patients in the clinic. CF epithelia exhibit a hyperpolarised basal Vt and a larger Vt change in response to amiloride (a blocker of the epithelial Na+ channel, ENaC). Are these altered bioelectric properties solely a result of electrical coupling between the ENaC and CFTR currents, or are they due to an increased ENaC permeability associated with CFTR loss? To examine these issues we have developed a quantitative mathematical model of human nasal epithelial ion transport. We find that while the loss of CFTR permeability hyperpolarises Vt and also increases amiloride-sensitive Vt, these effects are too small to account for the magnitude of change observed in CF epithelia. Instead, a parallel increase in ENaC permeability is required to adequately fit observed experimental data. Our study provides quantitative predictions for the complex relationships between ionic permeabilities and nasal Vt, giving insights into the physiology of CF disease that have important implications for CF therapy. [ABSTRACT FROM AUTHOR]

Rebecca Brown and colleagues examine the association between BMI and kidney disease progression among 499 adults with established stage 3-5 CKD in the absence of diabetes...the analysis showed no significant difference in annual eGFR decline by obesity status...Background Chronic kidney disease (CKD) is increasingly prevalent worldwide. Furthermore, obesity is now a global problem with major health implications. There is a clear association between obesity and the development of CKD but it is not known whether obesity is a risk factor for the progression of pre-existing kidney disease. We examined the relationship between the body mass index (BMI) and the rate of progression of CKD in non-diabetic adults. Methods The Chronic Renal Insufficiency Standards Implementation Study (CRISIS) is a prospective observational study in a predominantly white population in Greater Manchester. From the CRISIS database, we assessed rate of progression of CKD in 499 adults attending the hospital. Baseline measurements including BMI were obtained and estimated glomerular filtration rate (eGFR) was monitored. The rate of deterioration of eGFR was derived over time, defined as ΔeGFR (mL/min/1.73m2/year) and assessed using univariate analysis of variance. Results In the groups as a whole, no relationship between BMI and ΔeGFR was shown. Dividing the subjects into obese (BMI ≥ 30) and non-obese (BMI < 30) groups and further breakdown into CKD stages 3, 4 and 5, also showed no relationship between BMI and ΔeGFR. Univariate analysis of variance was used. Conclusions Neither BMI as a continuous variable nor obesity (BMI ≥ 30) as a categorical variable was associated with an increased rate of progression of existing CKD in this predominantly white population. [ABSTRACT FROM PUBLISHER]

Background. Diabetes Meillitus (DM) and hypertension (HT) are important causes of end-stage renal disease (ESRD) and renal replacement therapy (RRT) is the standard active treatment. Financially, incentivized quality initiatives for primary care include pay-for-performance (P4P) in DM and HT. Our aim was to examine any effect of disease prevalence and P4P on RRT incidence and regional variation. Methods. The incidence of RRT, sex and ethnicity data and P4P disease register and achievement data were obtained for each NHS locality. We calculated correlation coefficients for P4P indicators since 2004/05 and socio-demographic data for these 152 localities. We then developed a regression model and regression coefficient (R2) to assess to what extent these variables might predict RRT incidence. Results. Many of the P4P indicators were weakly but highly significantly correlated with RRT incidence. The strongest correlation was 2004/05 for DM prevalence and 2006/07 for HT quality. DM prevalence and the percentage with blood pressure control in HT target (HT quality) were the most predictive in our regression model R2 = 0.096 and R2 = 0.085, respectively (P < 0.001). Combined they predicted a fifth of RRT incidence (R2 = 0.2, P < 0.001) while ethnicity and deprivation a quarter (R2 = 0.25, P < 0.001). Our final model contained proportion of population >75 years, DM prevalence, HT quality, ethnicity and deprivation index and predicted 40% of variation (R2 = 0.4, P < 0.001). Conclusion. Our findings add prevalence of DM and quality of HT management to the known predictors of variation in RRT, ethnicity and deprivation. They raise the possibility that interventions in primary care might influence later events in specialist care. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses several articles including one regarding education in contemporary art, second regarding research in educational settings, and last regarding art as a pedagogical force in society.

The purpose of this article is to invite focused discussion and critical debate about the instruments currently used to select students for art colleges in Europe and North America. At this time of significant expansion and diversification in practices of art making, we must ask if current selection instruments still work. What evidence is there to support their continued use? Are they good indicators of success in art college? Who do they advantage, and whose interests do they serve? In what ways do they contribute to, or legitimate class reproduction and class advantage in the cultural sphere? In taking up these questions, this article addresses four topics of particular relevance to the selection and admission debate: reliability, validity, predictability and equality. It reports findings from two national longitudinal research studies that examined the predictive validity of selection instruments in relation to performance in art college in Ireland. While these findings are specific to the Irish higher education context, they have relevance beyond this context given that the selection instruments used by Irish art colleges are the same as those used by the majority of art colleges across Europe and North America. [ABSTRACT FROM AUTHOR]

Background. There have been few attempts to estimate progression of kidney disease in people with diabetes in a single large population with predictive modelling. The aim of this study was to investigate the rate of progression of chronic kidney disease in people with diabetes according to their estimated glomerular filtration rate (eGFR) and presence of albuminuria.Methods. Data were collected on all people with diabetes in Salford, UK, where an eGFR could be calculated using the four-variable MDRD formula and urinary albumin–creatinine ratio (uACR) was available. All data between 2001 and 2007 were used in the model. Classification of albuminuria status was based on the average of their first two uACR measurements. A longitudinal mixed effect dynamic regression model was fitted to the data. Parameters were estimated by maximum likelihood.Results. For the analysis of the population, average progression of eGFR, uACR and drug prescribing were available in 3431 people. The regression model showed that in people with diabetes and macroalbuminuria, eGFR declined at 5.7% per annum, while the eGFR of those with microalbuminuria or without albuminuria declined at 1.5% and 0.3% per annum, respectively, independently of age (P < 0.0001).Conclusions. The longitudinal effect of time on eGFR showed that people with diabetes and macroalbuminuria have an estimated 19 times more rapid decline in renal function compared with those without albuminuria. This study demonstrates that the progression of kidney disease in diabetic people without albuminuria is relatively benign compared with those with albuminuria. [ABSTRACT FROM AUTHOR]

Background: Knowing how kidney disease progresses is important for decision making in patients with chronic kidney disease (CKD) and for designing clinical services. Study Design: Prospective cohort study. Setting & Participants: We examined renal function trajectories in CRISIS (Chronic Renal Insufficiency Standards Implementation Study), in which 1,325 patients with CKD stages 3-5 and mean age of 65.1 years were followed up prospectively for a median of 26 months after referral to a regional nephrology center in the United Kingdom. By protocol, estimated glomerular filtration rate was determined every 12 months. Predictors: CKD stage defined as estimated glomerular filtration rate ≤45 (stage 3a), 30-44 (3b), 15-29 (4), and <15 (5) mL/min/1.73 m². Outcomes: Onset of renal replacement therapy (RRT), death, the composite end point of RRT or death, or decreasing CKD stage. Results: During a median follow-up of 26 months, 13% reached the end point of RRT (5.1 events/100 patient-years), 20% died (9.6 deaths/100 patient-years), and 33% reached the combined end point of RRT or death (14.7 events/100 patient-years). For stage 3a, baseline prevalence and annual probabilities of decreasing CKD stage, RRT, and death were 18.0%, 0.41, 0.01, and 0.02, respectively. Corresponding values for stage 3b were 32.5%, 0.22, <0.01, and 0.06; for stage 4, 36.5%, 0.17, 0.03, and 0.10; and for stage 5, 13.2%, zero (by definition), 0.31, and 0.08, respectively. Markov model projections suggested a steady decrease for proportions with stages 3a, 3b, and 4; a steady increase for death and RRT; and a biphasic pattern for (non-RRT) stage 5, with a plateau in the first 2 years followed by a steady decrease. Limitations: Single-center observational study. Conclusion: This study suggests that death and RRT are the dominant outcomes in patients referred for management of CKD and that most patients spend comparatively little time in late stages without RRT. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is common, harmful and treatable but has, until recently not been recognised in its early stages. The British National Health Service (NHS) provides a unique opportunity to study CKD because it is in effect a closed-managed care system. This single healthcare system for the United Kingdom is funded by the Government and paid for by general taxation. All UK citizens are registered with primary care physicians who control access to secondary care services. As a managed care system it should be able to offer integrated care across the whole patient pathway—allowing early identification of CKD, interventions to reduce risk and prompt management of complications. In reality, there are professional, organisational and institutional barriers to coordination and delivery of care in the NHS. The establishment of general-practice-based disease registers linked to a quality and outcomes framework in 2004 provides a basis for implementing the chronic disease model of care. The publication of the National Service Framework for renal services complemented by these changes in primary care has resulted in a paradigm shift from kidney disease being viewed as a secondary care condition to being a primary care priority as part of vascular control and management. In the first two years of the initiative, over 40% of the expected CKD stage 3 to 5 population has been registered in primary care. Kidney disease is now recognised as a public health problem in the United Kingdom, preventative strategies are being integrated into comprehensive vascular risk assessments and management programmes and kidney disease has become an NHS priority area. [ABSTRACT FROM AUTHOR]

Summary: The British National Health Service is a closed managed care system. This single health care system for the United Kingdom is funded by the government and paid for by general taxation. All UK citizens are registered with primary care physicians who control access to secondary care services. As a managed care system it should be able to offer integrated care across the whole patient pathway. In reality there are professional, organizational, and institutional barriers to coordination and delivery of care in the NHS. Historically, the United Kingdom has been among the lowest health care spenders of organizations for economic cooperation in developed countries, in absolute terms as well as proportion of the gross domestic product. However, since a Government pledge to place quality at the heart of the NHS and a commitment in 2000 to increase spending on the NHS, the NHS budget has more than doubled—an unprecedented rate of growth, roughly by 7.5% annually in real terms. A quality and outcomes framework has been introduced into primary care to systematically incentivize process measures such as computerization and chronic disease management by establishing practice-based disease registers. The strategic planning for kidney services in England has been developed in this national environment complemented by local research findings and the wider international consensus that has emerged since the publication of the classification of chronic kidney disease in 2002. This program of work has resulted in a paradigm shift from kidney disease being viewed as a secondary care condition to being a primary care priority as part of vascular disease control and management. In the first 2 years of the initiative more than 40% of the expected chronic kidney disease stage 3 to 5 population have been registered in primary care. Kidney disease now is recognized as a public health problem in the United Kingdom, preventative strategies are being integrated into comprehensive vascular risk assessment and management programs, and kidney disease has become an NHS priority area. [Copyright &y& Elsevier]

This article examines if and to what extent a set of pre-enrolment variables and background characteristics predict first year performance in art college. The article comes from a four-year longitudinal study that followed a cohort of tertiary art entrants in Ireland from their time of entry in 2002 to their time of exit in 2006 (or before, for those who failed or dropped out). Using descriptive and inferential statistics, the article shows that portfolio score at entry and school leaving examination results predict performance in first year. The predictive validity of both measures, however, was not particularly strong. Combined, portfolio score at entry and school leaving examination only accounted for 15.5 per cent of variance in first year marks, leaving a large percentage of variance unexplained. [ABSTRACT FROM AUTHOR]

Presents correspondence concerning medical related issues in Great Britain. Introduction of new drugs for respiratory disorders; Discussion on parathyroid hypertension; Description of the calcium antagonist withdrawal syndrome.

Introduction 21% of NHS staff are from Black, Asian and minority ethnic (BAME) backgrounds yet account for a disproportionately high number of medical-staff deaths from COVID-19. Using data from the published OpenSAFELY Collaborative, we analysed consultant physicians to determine those at increased risk of COVID-19 related death. Methods Data from 13,500 consultant physicians collected by the Royal College of Physicians were analysed to determine those at an increased risk of death from COVID-19, assuming no comorbidities. Results The data reveal a picture in which a third of consultant physicians have a hazard ratio (HR) >1 for dying from COVID-19; one in five have HR >2; one in 11, HR >3; and one in 40, HR >4. Of concern are the risks to male physicians aged ≥60 with HR >3.8. Sub-specialties including cardiology, endocrine and diabetes, gastroenterology, haematology, neurology and rheumatology have a greater risk profile due to high proportion of men, physicians of older age, and proportion of BAME individuals. Conclusion A third of consultant physicians have an increased risk of a COVID-19-related death, and one in five have a higher relative risk (HR >2). The risk is mainly driven by age, gender, and ethnicity, the risk is highest in male consultant physicians over 60, especially from BAME backgrounds. [ABSTRACT FROM AUTHOR]

The article discusses a study which aims to determine mortality according to stage of chronic kidney disease (CKD) together with the confounding affects of diabetes and anemia conducted in Salford, England. Subjects were aged 20 years or older who had a serum creatinine performed between July 1, 2000 and December 31, 2001 using data from the hospital electronic patient record (EPR). Findings revealed the increased prevalence of anemia in diabetics and increased mortality associated with anemia.