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This article outlines a specialist renal young adult service that has been supporting young adult patients at two hospital renal units since 2011. This innovative collaboration has successfully adopted a research-driven, evidence-based approach using the philosophy and skills of youth work to support young adult patients aged 18 to 30 years with their psychosocial needs, together with supporting younger patients to navigate the transition process. [ABSTRACT FROM AUTHOR]

Dialysis is a costly and resource-heavy treatment for people with kidney disease (Roberts et al, 2022). One longer term solution is a kidney transplant, but one third of people on dialysis have a body mass index (BMI) that is above the transplant threshold. However, they struggle to lose weight due to extensive dietary and fluid restrictions, co-morbidities, reduced activity levels and frequent low mood (Oniscu et al, 2021). Existing local weight management services are often unable to support complex patients with kidney disease and existing renal services do not often have the resources to provide the intensive, specialist and tailored treatment required. Funding from the Nottingham University Hospitals Trust Charity supported a pilot multidisciplinary team (MDT) kidney weight management service. The successful outcome of this pilot has secured further funding to continue this vital service. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Young people with chronic kidney disease (CKD) have a number of key issues and life changes to manage while also possibly transitioning into adult care. During this time, the nature of their support networks including, social, romantic, family and health care relationships, is changing. Objective: To explore these young people's experience and perceptions of their past, current and future relationships and support networks. Design: Qualitative study. Participants and Methods: Fourteen young adults (8 male, 6 female, aged 18–26 years) with CKD Stages 3–5 participated. Semi‐structured interviews were conducted in order to explore the relationships (friends, family and partners) of young adults with CKD at two UK NHS hospitals. These were transcribed and thematically analysed. Results: There were four themes identified. 'Disclosure—To tell or not to tell?' identified the challenges young adults face when disclosing their condition to friends and prospective partners. 'Managing support networks' showed that participants appreciated support from other young adults with CKD but also desired just 'being normal' with their friends. While family support is still significant and much appreciated, some young adults also found it harder to develop their independence. 'Relationship strains and carer needs' highlights the impact of CKD on all relationships. Participants were also aware of the needs of their 'carers'. In 'Happy ever after?' young adults expressed concerns about meeting a partner and having children. Conclusions: Young adults with CKD need support in helping them manage new and existing relationships, at a time where relationships are taking on different forms and significance. Moreover, support needs for young adults extend beyond the patient, to those who support them; support services need to reflect this. [ABSTRACT FROM AUTHOR]

Background Good blood pressure (BP) control reduces the risk of complications in people with type 2 diabetes, yet many do not achieve this. Guidelines for managing hypertension recommend increasing antihypertensive medications until control is achieved, but the effect of such recommendations in routine primary care is unknown. Aim To evaluate the effectiveness of a BP treatment algorithm in primary care patients with type 2 diabetes. Design of study A cluster randomised controlled trial of 1534 patients with type 2 diabetes. Setting Forty-two practices in Nottingham, UK. Method Practices were randomised to continue usual care or to use a treatment algorithm designed so that practice nurses and GPs would increase antihypertensive treatment in steps until the target of 140/80 mmHg was reached. Participants were assessed by a clinical interview and case note review at recruitment and at 1 year. The primary outcome measure was the proportion of participants achieving target BP at 1 year. Results At 1 year there was no difference between the proportions of participants with well controlled BP in the intervention and control arms (36,6% versus 34.3%; P = 0.27), Mean systolic and diastolic blood pressure were identical in the two arms (143/78 mmHg). There was some evidence that participants in the intervention arm were more likely to be receiving higher doses of their antihypertensive drugs, although there was no significant difference in the number of different antihypertensive drugs prescribed. Participants in the intervention arm had a higher rate of primary care BP-related consultations over 12 months than those receiving usual care {rate ratio = 1.55, 95% confidence interval [Cl} 1.26 to 1.88, P<0.001). Conclusion Despite increased monitoring and possibly higher doses of medication there was no improvement in blood pressure control. Improvements achieved by specialist nurse-led clinics in secondary care may not translate to people with type 2 diabetes in primary care settings. [ABSTRACT FROM AUTHOR]

Severe worsening lactic acidosis in an elderly patient following an episode of atrial fibrillation, who is not haemodynamically compromised, usually indicates an intra-abdominal vascular catastrophe. We describe a unique case of severe peri-renal sepsis in a patient with long-standing dialysis-dependent chronic kidney disease unrelated to urolithiasis that masqueraded as an acute abdominal condition requiring emergency laparotomy and nephrectomy. [ABSTRACT FROM PUBLISHER]