demand. Since the NSF recommended that all patients suitable for transplant should be listed prior to dialysis - within six months of the predicted date of starting dialysis or when the GFR falls below 15 mls per minute - we have seen that the national transplant list has grown at a much faster rate than prior to 2005. In addition the change in the organ allocation rules that have benefited long waiters has also meant that people awaiting a deceased donor kidney are now on average waiting over a year longer than at the turn of the century. So the need for high quality dialysis is not going to go away! National renal audits Everyone reading this, I am sure, will be aware of the importance of monitoring and measuring to improve safety and drive up quality. The wider kidney community also shares this ethos. We are fortunate to have the UK Renal Registry that allows comparative audit between centres. To that we have recently added a programme of national renal audits. The first two national renal audits both concern haemodialysis. For the next three years these programmes will concentrate on vascular access for haemodialysis and transport for in- centre dialysis. These aren't the only important topics in dialysis but together do represent substantial components of safety, quality and patient experience. The audits will of course cover all units - main, satellite, general practice based, commercial and independent sector treatment centres in England. I hope they can be extended to cover the whole of the United Kingdom and that they become embedded into our routine data collection for the Registry and our commissioners. Finally, companies like Gambro, through their commitment to innovation and customer service, have a vital role to play in improving the experiences and outcomes of people on dialysis. I am pleased therefore that ' Highlights' has given me an opportunity to speak to you directly and I hope to do this again in future editions. If you have questions or queries, check things out on my blog at www. renaltsar. blogspot. com, or please don't hesitate to contact me directly: ContactDonal O'Donoghue, National Clinical Director for Kidney Care donal. o'donoghue@ srft. nhs. uk 5 " Home dialysis brings the opportunity to tailor the prescription around the individual." Technical training schedule Here's a breakdown of what's available from our technical training team over the next few months. AK 200 S Basic course 11- 15 August This course enables participants to handle simple maintenance and trouble shooting. WRO 300 H and WSF 300 course 19- 20 August This two- day course gives service engineers a deeper knowledge of these systems. AK 95 S Basic course 14- 17 October Any service engineer working with the AK 95 S should attend this four- day course as it provides participants with a thorough grounding in the relevant systems. Prismaflex Technical course 21- 22 October and 25- 26 November This two- day course provides Prismaflex technicians and engineers with the ability to perform basic calibration, fault finding and simple maintenance. Prismaflex Study Days Monthly during September- December These study days are for anyone in the clinical environment and provide further knowledge on the principles of CRRT therapies and an understanding of using and trouble shooting the Prismaflex machine more effectively. The schedule is: • 4 September - Bristol. • 28 October - Manchester. • 18 November - London. • 16 December - Huntingdon. To book a place on a course or for more information please contact Louise Young 01480 444033 louise. young@ gambro. com Complete peace of mind for your renal equipment Our new Partnership Support Agreements ensure you have guaranteed access to the services you need to support your own resources. There are four levels of Agreement to choose from, each one bringing you support from Gambro's service technicians. Support starts with the entry- level Basic Agreement, which provides technical telephone support and preventative maintenance kits. At the other end of the scale, the Full Agreement gives you inclusive service and repair visits, including spare parts and labour time. In addition to the core services within each Agreement level, a number of extra options are available. These include additional technical training vouchers, spare parts, a repair service with 24- hour response time and holiday cover for when your technicians are absent. " We are receiving a very positive response to the new Agreements," says Richard Dixon, Technician Team Leader, North Region. " Hospitals welcome the fact that we can provide essential cover to suit their individual requirements when their resources require additional support." Call our sales and marketing department on 01480 444000 to discuss your service needs, or e- mail us at TSAgreements@ gambro. com

The choice of dialyser matters The recently presented initial data from the European Membrane Permeability Outcome ( MPO) study strengthens the evidence that the middle molecule removal offered by high- flux dialysis membranes is clinically important. This study enrolled only new patients to dialysis and focused on those at risk, characterised by having a serum albumin level below 4 g/ dl. Patients randomised to start dialysis with a high- flux rather than a low- flux membrane showed a significant 37% risk reduction for all- cause death, after case mix adjustment. Diabetic dialysis patients also showed a significant risk reduction with high- flux membranes. We eagerly wait for the full MPO study data to be published. Meanwhile the HEMO study, which reused dialysers to a large extent, failed to show a significant effect of membrane flux on all- cause mortality in the full study population of prevalent dialysis patients. However, patients already on dialysis for some years responded differently, with improved survival when randomised to a high- flux membrane. Recently published post hoc analysis of the HEMO study data indicates that in these patients cardiac death is significantly associated with the amount of middle molecule removal, expressed as b2- microglobulin ( b2m) Kt/ V. Each 0.1 unit increase in b2m Kt/ V was associated with a 7% risk reduction for cardiac death. A similar risk reduction, although not significant, was seen for infectious death. A recent paper from US investigators highlighted that synthetic high- flux membranes may differ significantly in their capacity to remove middle molecules during HD treatments. In direct cross- over comparisons of different high- flux dialyser brands, they found small molecule removal to be mainly unaffected by membrane composition, while large molecule removal depended significantly on membrane composition and morphology. Polyflux ® high- flux dialysers showed efficient removal of b2m as well as of other middle molecules ( angiogenin, leptin and complement factor D). Presentation by Prof. F. Locatelli during the ERA- EDTA Congress 2007. Cheung AK, et al: Effects of high- flux hemodialysis on clinical outcomes: results of the HEMO study. J Am Soc Nephrol. 2003; 14( 12): 3251- 63. Cheung AK, et al: Association between serum 2- microglobulin level and infectious mortality in hemodialysis patients. Clin J Am Soc Nephrol. 2008; 3( 1): 69- 77. For more information about the Polyflux dialysers mentioned in this piece, contact Samantha Ford 01480 444006 samantha. ford@ gambro. com Long term follow- up of clotting incidence at reduced heparinisation with the AN69ST dialyser In a single- centre study, 170 regular HD patients were randomised to be dialysed either with a heparinised AN69ST dialyser at a reduced dose of unfractionated heparin ( 2718± 1388 U) or another dialyser at regular heparin dose ( 4800± 1555 U). Over 15 months 26,626 sessions were provided with registration of clotting events. Making HDF easier Raigmore Hospital in Inverness has experienced excellent results with the use of ULTRACONTROL, which uses pressure control haemodiafiltration ( HDF) instead of the traditional HDF with volume control. Ward Manager Anne Allan says: " We are already finding it a simpler, safer tool to use, with easy treatment set up. There is a reduced risk of excessive haemoconcentration and the exchange volumes are greater." Raigmore's renal unit has 16 dialysis stations and is equipped with the latest Gambro AK 200 Ultra S dialysis machines, and ULTRACONTROLis integrated into these, although it can also be adopted as an upgrade to earlier machines. Volume control can be difficult to perform successfully, with pressure control demanding great operator experience. But with ULTRACONTROL, simply set the weight loss required and the treatment time, initiate ULTRACONTROL to carry out an initial scan, then scan again every hour to maintain the optimal infusion volume. A detailed case study is available that introduces ULTRACONTROLand the benefits presented to both the patient and clinical team. For a copy of the case study, contact Brian May 01480 444016 brian. may@ gambro. com 6 clinical corner Gambro's quality systems put to the test Gambro's commitment to high- quality processes and procedures was tested recently by independent third party audits carried out by both MHRA and BSI. " It was very pleasing that we passed these tests without significant issues," says Shaun Hurlow, Gambro's Quality and Process Manager, North West Europe. " But of greater satisfaction for all involved were the complimentary comments made during both inspections. " It was very encouraging to hear government agencies and our notified body praise our working methods, the way we manage our business through key performance measures and our use of customer feedback to drive improvements. That is not to say that we will rest on our laurels and we will always look to improve what we do. Through the ongoing development and implementation of good processes we will continue to strive to be the best company in the renal care environment." ContactShaun Hurlow 01480 444010 shaun. hurlow@ gambro. com