PD in the United Kingdom — Past, Present, and Future Peritoneal Dialysis International, Vol. 31 (2011), Supplement 2 doi: 10.3747/pdi.2011.00015
0896-8608/11 $3.00 + .00 Copyright © 2011 International Society for Peritoneal Dialysis
PD IN THE UK: THE PAST, PRESENT, AND FUTURE
F
S34
these efforts, three stand out. Manchester, under the leadership of the now retired Ram Gokal, was involved in high profile clinical studies on almost every aspect of PD, ranging from the first comparative mortality studies to bone disease, adequacy, quality of life, and peritonitis. In particular, Manchester was the center that brought about the development and use in clinical practice of icodextrin, the first widely utilized non-glucose PD solution. Manchester’s contribution is reviewed here by Ray Krediet, from Amsterdam, and the remarkable story of icodextrin is told by Chandra Mistry, who was one of the key players in its development. Cardiff has played a major role over more than 20 years in applying the techniques of bench science to a better understanding of PD. In particular, in building the PD Biopsy Registry, the work of Nick Topley, Gerry Coles, and John Williams led to unique insights into the natural history of the peritoneal membrane when used for dialysis and into the structural changes that underlie membrane failure. This experience is reviewed by Simon Davies, from Stoke-on-Trent. The third center that has achieved so much, especially in the past 20 years, is Stoke-on-Trent, where the cohort studies led by Simon Davies have helped us understand how changes in peritoneal membrane function impact clinically on patients. This has led to a leadership role for that center in subsequent international prospective trials. All this has greatly enhanced our understanding of peritoneal transport. This experience is reviewed by Martin Wilkie and Sarah Jenkins, from Sheffield. This supplement does not deal only with the past glories of PD research in the UK. Researchers from the UK continue to have prominence in the international PD community. Graham Woodrow, from Leeds, has been a leader in the assessment of volume status in PD patients, particularly in the use and understanding of bioimpedance. Chris McIntyre, from Nottingham, has made seminal observations on the hemodynamic and cardiovascular effects of both PD and HD and is one of the most innovative researchers anywhere in contemporary dialysis. A worldwide debate is proceeding about the role of PD in providing renal replacement therapy for the growing elderly population with ESRD. Edwina Brown, from the Hammersmith Hospital in London, has been a major
This single copy is for your personal, non-commercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, contact Multimed Inc. at
[email protected]
Downloaded from http://www.pdiconnect.com/ by guest on January 18, 2016
or over 30 years, the United Kingdom (UK) has played a major role in the development of peritoneal dialysis (PD), and many of those involved with the therapy in that country have had major influence internationally. It is therefore appropriate that this supplemental issue of Peritoneal Dialysis International (PDI) is dedicated to looking at the past, the present, and the future of PD in the UK. From both a clinical and an economic perspective, PD has been critical to the delivery of renal replacement therapy to patients with end-stage renal disease (ESRD) in the UK. In the 1980s and 1990s, as many of half of all ESRD patients initiating dialysis were treated with PD. This was a controversial era in which dialysis treatment rates in the UK lagged behind those of European countries of similar wealth. Hemodialysis (HD) capacity was very limited, and it would be fair to say that widespread use of CAPD was required to keep the system going. In the past decade and a half, much has changed. Treatment rates have risen and are now similar to those seen in Sweden and The Netherlands although still lower than those in France and Germany. HD units have proliferated and HD capacity is much more ample. This has led to a decline in PD utilization to under 20%, but now in an era of cash constraints this huge switch to more costly incenter HD is being questioned widely. This history is reviewed in a number of articles in this supplement. Clare Castledine and colleagues from the UK Renal Registry, in Bristol, describe the trends in UK treatment rates and modality utilization, from the introduction of maintenance dialysis in the late 1950s up to the present time. Adnan Sharif and Kesh Baboolal review the contemporary economics of dialysis in the UK as well as possible funding formulas; they demonstrate clearly that PD is a cost-effective option that will become more attractive in the present fiscal climate. Mark Brady and Donal O’Donoghue review present UK healthcare policy in the area of dialysis, including a number of new initiatives, and discuss the need to regrow PD in a “back to the future” approach. However, the greatest UK contribution to PD has been, of course, in the area of research. For three decades, UK investigators have had a huge influence internationally. While many centers have contributed to
PDI
MARCH 2011 – VOL. 31, SUPPL. 2
and London, with an international link with the Hans Mak Institute in The Netherlands. The current collaborative portfolio efforts include a multicenter study involving Stoke, Leeds, and Sheffield that aims to establish whether bioimpedance adds value to the management of fluid status in PD patients. Also, Dr. Hilary Bekker, a psychologist at the University of Leeds, is leading a project funded by Kidney Research UK to develop a patient decision aid to support dialysis modality choice. All told, the story of PD in the UK over the past three decades has been a remarkable one and PDI is pleased to have the opportunity to publish this supplemental issue as a record of what has happened over that time period and of what may happen in both research and clinical delivery of PD in the years ahead. We thank all the contributors for their efforts. We thank Baxter UK for providing financial support for the supplement, but we would like to emphasize that all the topics and authors were selected by the two editors of the supplement. We hope it will be well received. Peter G. Blake
[email protected] Simon J. Davies
[email protected]
This single copy is for your personal, non-commercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, contact Multimed Inc. at
[email protected]
S35
Downloaded from http://www.pdiconnect.com/ by guest on January 18, 2016
contributor through important research initiatives such as the North Thames Dialysis Study and the more recent Broadening Options for Long-Term Dialysis for the Elderly (BOLDE). This supplement contains articles reviewing the work of all these investigators. Other ongoing research initiatives not reviewed in this supplement also deserve mention. In line with the recent reorganization of clinical research in the UK, and the instigation of a national research portfolio designed to facilitate and promote collaborative research, the PD Clinical Study Group has been formed and is one of 10 such groups developed by the UK Kidney Research Consortium. The PD group has defined a number of areas it wishes to develop, including a focus on questions related to encapsulating peritoneal sclerosis (EPS). Angela Summers and colleagues are leading the efforts to build an international EPS registry and DNA bank and applying novel diagnostic methodologies such as metabolomics and proteomics to samples obtained over many years for the GLOBAL Fluid Study. This is a truly national effort, involving Manchester, Cardiff, Sheffield, Stoke,
PD IN THE UK: THE PAST, PRESENT, AND FUTURE
