James F. Medcalf

Estimating the financial cost of chronic kidney disease to the NHS in England.

Background Chronic kidney disease (CKD) is a major challenge for health care systems around the world, and the prevalence rates appear to be increasing. We estimate the costs of CKD in a universal health care system. Methods Economic modelling was used to estimate the annual cost of Stages 3–5 CKD to the National Health Service (NHS) in England, including CKD-related prescribing and care, renal replacement therapy (RRT), and excess strokes, myocardial infarctions (MIs) and Methicillin-Resistant Staphylococcus Aureus (MRSA) infections in people with CKD. Results The cost of CKD to the English NHS in 2009–10 is estimated at £1.44 to £1.45 billion, which is ∼1.3% of all NHS spending in that year. More than half this sum was spent on RRT, which was provided for 2% of the CKD population. The economic model estimates that ∼7000 excess strokes and 12 000 excess MIs occurred in the CKD population in 2009–10, relative to an age- and gender-matched population without CKD. The cost of excess strokes and MIs is estimated at £174–£178 million. Conclusions The financial impact of CKD is large, with particularly high costs relating to RRT and cardiovascular complications. It is hoped that these detailed cost estimates will be useful in analysing the cost-effectiveness of treatments for CKD.

Role of transforming growth factor beta in peritoneal fibrosis

SUMMARY: Technique survival of peritoneal dialysis is seriously limited by the development of peritoneal fibrosis. the mesothelial cell layer lining the peritoneum is important in the pathogenesis of peritoneal fibrosis. Mesothelial cells are able to produce transforming growth factor beta (TGF‐β), and respond to stimulation by this cytokine. In this review, we will detail the evidence available so far for the role of the complex interaction between TGF‐β and mesothelial cells in the development of peritoneal fibrosis.

25(OH) vitamin D deficiency among SE Asians and Caucasians with CKD 3 and 4, and its role in hyperparathyroidism

The letter to the editor from Kosmadakis et al.1 references our findings of 25-hydroxyvitamin D (25OHD) levels in the National Health Examination Survey (NHANES III).2 In their subjects, no significant differences in 25OHD levels between stage III and IV chronic kidney disease (CKD) were observed, although both levels were consistent with 25OHD insufficiency.3 These findings are contrary to what was observed in NHANES III where the major decline in 25OHD was observed in stage IV CKD.