The growingneed for home haemodialysis By Donal O'Donoghue, National Clinical Director for Kidney Care inside... Liver therapy Successful treatment for acute and chronic indications Clinical corner High- flux dialysis, daily HD and button hole cannulation reviewed Maintenance support Partnership Support Agreements back- up your own technical resources No 24 - JULY2008 I am pleased to say that there is renewed interest in haemodialysis, particularly home haemodialysis. This is coupled with a recognition that however good we are at prevention and increasing kidney donation, haemodialysis remains the cornerstone of renal replacement therapy. cont. page 4 To view this issue online visit www. gambro. co. uk/ highlights- july08 Indeed, our recent focus on early detection is likely to increase timely referral of individuals with advanced, stage 4, chronic kidney disease for specialist advice and assessment of options for treatment at stage 5 or end stage renal failure. One consequence of that strategy has been improvement in vascular access - we know waiting times have fallen and prevalence rates are better. Soon we will have regular data on the percentage of people who start haemodialysis via an arterio venous fistula. Starting via a fistula has an enormous impact on survival at three years - a 30% improvement. This is probably mainly due to reduced sepsis which we know is a major predictor of outcomes. A single episode of bacteraemia has a substantial impact on death rates up to and beyond five years. Donal O'Donoghue sees a long- term future for high quality dialysis

The Gambro team were delighted to have an opportunity to see so many of you at the renal conferences in May, and to share news about our product and service developments. In particular, the BRS/ RA conference was an ideal opportunity to demonstrate the new AK 96 HD machine. If you were unable to make one of these previews, please contact the marketing team who will be glad to update you. Meanwhile, at the ERA- EDTA Congress in Stockholm the main theme for the Gambro stand was innovation, which of course is central to our Gambro DNA programme. Visitors here had a preview of seven new products which will be launched across Europe later this year and during 2009. Our staff on the stand spoke to customers from around the world, ' from Ireland to India' as someone put it, and there was a very positive response to Gambro's innovation programme. New division focuses on water The wide- ranging nature of Gambro DNA is also clear from our investment in creating a new Water Systems division to strengthen further our commitment to all areas of renal care. The division is headed up by our new water purification specialist Becky Lacey, who brings 18 years of knowledge in the water sector with her, backed up by her scientific qualifications in chemistry and microbiology. Becky and her team will be responsible for all areas of our water quality provision, from the centralised water system approach using our established CWP range through to the single patient WRO units. I am very excited about what this new division will help us achieve for our customers and their patients. For more information about our water products, please contact Becky Lacey 01480 444035 rebecca. lacey@ gambro. com Make the most of your support resources The Technical Services area of our website has been updated offering you more information and support, while our Customer Service team remains available for non- technical enquiries. At www. gambro. co. ukyou can find technical newsletters covering modification messages, rebuild orders and general updates. There are also service, operator, accessory and tools manuals, the latest spare parts price list and ordering details, software downloads and details of training courses. The Technical Services phone line is also a useful resource for technical information. The line is open Monday to Friday from 8.30am to 5.00pm - call 01480 444056. You can also email the team at techsupportuk@ gambro. com for the same support. Customer Service for non- technical enquiries Don't forget that you can contact Gambro's Customer Service team for free by phone or fax, for everything from placing and tracking orders to general enquiries. The numbers are: Telephone 0800 652 1380 Fax 0800 652 1390 This free service applies to all UK mainland customers, including Northern Ireland. ( In the Republic of Ireland please check with your network provider.) For all other services, you can still contact our UK Head Office at Huntingdon on 01480 444000. 2 Investment in products and services continues DNA update Becky Lacey heads up our new Water Systems division MARS ® proves itself for efficient liver therapy Over the past decade the use of MARS, the therapeutic procedure for treating liver failure, has grown in its application internationally. More than 5,000 patients in 30 countries have been treated and now Gambro is investing in helping UK intensive care units and others benefit from what the therapy offers. MARS ( Molecular Adsorbents Recirculating System) is an extracorporeal liver support therapy that is being used to treat patients with a variety of indications. These include acute decompensation of chronic liver diseases, acute liver failure and liver dysfunction, poisoning of various types including drug overdose and mushroom poisoning, liver transplant failure, multiple organ failure and therapy resistant pruritis in cases of liver disease. Gina Greenwood, Gambro's MARS Therapy Specialist, explains how it works: " In cases of liver failure, albumin- bound toxins accumulate in the blood because blood detoxification carried out