Report Clinical Affairs Board Clinical Director’s Forum Kevin Harris 7th March 2008

Clinical Affairs Board Created in 2004 Function: to contribute to the development of all aspects of local and national policy relevant to clinical practice in nephrology integrate and plan the work of the: The UK Renal Registry The Clinical Practice Guidelines Committee and The Clinical Service Committee Influences through the RA but has no power Meets three times a year

Current membership of CAB Chair and Clinical Vice President Chris Winearls until August 2007 Kevin Harris from September 2007 Committee Chairs Registry:Charlie Tomson Guidelines:David Wheeler until to Nov 2007 Robert MacTier from Nov 2007 Clinical Services:Kevin Harris until Sept 2007 Martin Raftery from Oct elected members of the Executive J Kwan (Phil Kalra from 2008) L Goldberg (Andrew Lewington from 2008) National Clinical Director (ex officio)

Guidelines Committee COMPLETION OF 4th EDITION OF CLINICAL PRACTICE GUIDELINES TOPICSTATUS CKDComplete 2007 HaemodialysisComplete 2007 ComplicationsComplete 2007 Medical TransplantationDraft posted Jan 2008 Acute kidney injuryDraft posted Jan 2008

Guidelines Committee THE REDESIGN OF MODULES FOR THE 5th EDITION Subdivide modules into component parts giving a total of 15 modules. Lead author to draft the new module/next update in consultation with the second co-author, involving other experts as necessary. The second author becomes the lead author for the next update in 2011/2012 and works with a new co- author Liaison with international guideline development groups KDIGO, KDOQI, CARI and EBPG etc

Module number UK Renal Association Clinical Practice Guideline Modules ( ) Module LeadsDate of final version of 4 th Edition on RA Date of update or new CPG 1aDetection and management of CKD stages 1-3Maartan Taal, Mark MacGregorApr 07Mid bInvestigation of haematuriaLawrence Goldberg, John Kelly (BAUS)(in progress)Mid aCardiovascular disease in CKDMichael Cassidy Mid bMineral metabolism in CKD Stages 3-5Michael Cassidy, Simon Steddon Early cNutrition in CKD Stages 4-5Colin Jones Late dAnaemia in CKD Stages 4-5Donald Richardson Late eInfection control in the renal unitColin Geddes, Neill Duncan(in progress)Late aPlanning, initiation and cessation of renal replacement therapy in CKD Stages 4-5 Ken Farrington, Graham Warwick(in progress)Early bHaemodialysis (CKD Stage 5H)Robert Mactier, Cormac BreenMar 07Mid cPeritoneal Dialysis (CKD Stage 5P)Simon Davies, Graham WoodrowMay 07Mid dVascular access (CKD Stage 5H)Richard Fluck, Mick Kumwenda(in progress)Early ePeritoneal access (CKD Stage 5P)Martin Wilkie, Badi Shrestha (FRCS)(in progress)Early aEvaluation of the kidney transplant candidate in CKD Stages 4-5 Chris Dudley, Paul HardenFeb 08Early bMedical management of the kidney transplant recipient (CKD Stage 5T) Alan Jardine, Richard Baker(in progress)Late Acute Kidney InjuryAndrew Davenport, Paul StevensMar 08Early 2010 Planned Modules for 5th Edition Guidelines Committee

CAB workstreams 18 week pathways ( General nephrology Live donor work up Liaison with BAUS to ensure consistency over haematuria guidelines PD access working party – chaired by Dr Martin Wilkie Briefing and guidance for adult renal units in the UK during an influenza pandemic

CAB workstreams Liaison with NICE CKD – Kevin Harris and Lawrence Goldberg Due out for consultation 11 March - 6 May 2008 home HD guidelines Pregnancy and hypertension Machine perfusion of kidneys Specialised Services Definition set Martin Raftery and Hugh Cairns

CAB workstreams Payment by Results RRT indicative tariff planned for 2009/10 mandatory for 2010/11 Outstanding issues: incentivising quality avoiding perverse incentives Ongoing workstreams Year before dialysis Supportive and Palliative care

Turbulent times (Chris Winearls. CD forum 2007) Financial imbalance in many Trusts Changing Health Authority structures Target culture – 18 week pathway Capital drought Commissioning uncertainty – who and how? Unnecessary re-engineering Manpower and Training - MMC Healthcare associated infections

Emerging political support? Speech on the NHS 7 January 2008 “So there will soon be check-ups on offer to monitor for heart disease, strokes, diabetes and kidney disease”