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									                   Minutes of the Renal Association
                        Clinical Affairs Board

                  Wednesday 19th March 2008, 4.00 pm
            Library Annexe, The Novartis Foundation, London

Kevin Harris (Chair)                  Donal O’Donohue
Charlie Tomson                        Robert Mactier
Martin Raftery                        Phil Kalra
Andy Lewington

   1.      Apologies

   Lawrence Goldberg                  Jonathan Kwan

   2.      Minutes of last meeting – (Paper A)

   Agreed as a true record

   3.      Matters Arising

   a. MR to contact Colchester, to explore the specific issues, they have in making
      returns to RR – no update
   b. CT to produce a simple guide to the required RR fields on co-morbidities. To
      be circulated to all CDs – work in progress
   c. Data managers and clinical directors, to be provided with performance data
      on their units completeness of returns – work in progress

   4.      CAB report to the Executive February 2008 (Paper B)


   5.      Renal Registry:
        a) Verbal update from Chair

        Improving the completeness of the returns to the Renal Registry remained an
        ongoing issue. In addition to the plan to provide CDs and data managers
        with performance reports, this would also be sent to commissioners.

        Vascular access audit was a new data item. A pilot involving seven sites had
        been initiated with data collection on peritoneal and vascular access.
        Vascular access survey will be undertaken in “partnership” with the
        Information Centre, with funding from the Health Care Commission. There
        were some ongoing contractual issues. It was hoped that these could be
        resolved but, if necessary CT would enlist the help of DO’D to resolve.

        The RR report had been published three months earlier than in previous
        years. There were no paediatric chapters, because of ongoing problems
        related to electronic capture of data within paediatric units. Mark Taylor
        (chair BAPN) was optimistic these would be resolved, recognizing the complex
     governance arrangements that were required. RA to offer support to help
     resolve this issue if required.

     b) Displaying RR data on the RA website and “NHS choices” website

     The display of RR data on the RA website was approved
     New data items for display would be proposed by the RR and agreed by the
     CAB. Alternatively, new data items might be proposed by the CAB after
     feedback from the CSC.

     There had been no further contact from NHS Choices. Action: CT to chase

6.      Clinical Guidelines Committee:
     a) Verbal update from Chair

     AKI and transplantation guidelines still in draft. Action: RM to resolve.

     A discussion took place about the process by which guidelines came to be
     signed off. It was agreed to continue with the protocol proposed by the
     previous clinical vice president but to ensure specific time limits were adhered
     to for responses. The chair of the RR was to have a specific responsibility for
     commenting on the audit measures. It was the responsibility of authors to
     take account of the comments made on the guidelines following posting of
     the draft. The CAB had a responsibility to reassure themselves that the
     comments had been appropriately listened to before they signed them off. A
     template for creating guidelines would be created by RM along with some
     clear advice about what constituted an audit measure.

     The frequency of guideline updates should be every two to three years.

     The guideline writing workplan and proposed authors were noted and agreed.

     The joint RA / BAUS investigation of haematuria guidelines were noted and
     supported. It was felt that this guideline should be put on the RA website
     (subject to agreement with BAUS over publication).

     b) ESA use and MHRA guidelines (Paper C and D)

     MHRA response was noted. They had acknowledged that discontinuing ESAs
     was inappropriate, once target haemoglobin achieved. However, the
     remainder of the guidance was unchanged. It was felt there was little to be
     gained by pursuing this matter further.

     c) Funding for Guidelines

     The proposal to upgrade the presentation of the guidelines was discussed.
     There was no clear source of funding for this at this point, and the benefits of
     seeking funding for this were not apparent. It was agreed this would not be
     pursued at this point.

     d) Renal Disease in Pregnancy Study Group - consensus statements – Rob
        MacTier (paper E)
     The renal disease in pregnancy study group recommendations were
     discussed. Some reservations were discussed about the recommendations,
     and it was felt that it would not be possible for the RA to endorse these
     without consultation from members. However, it was agreed that it would be
     useful for the RA to have a guideline for the management of pregnancy in
     patients with CKD. Action: RM to take forward.

     e) Conflict of Interest Statements for Co-authors

7.      Clinical Services Committee:
     a) Verbal update from Chair

     The next meeting would be at lunchtime at the RA meeting in May 2008.
     A representative from Yorkshire still needs to be found.
     The recent CD forum had been extremely well attended with positive

     b) CD forum 2009

     The general consensus was that London remained the best venue and that
     the Governor's Hall, St Thomas's Hospital was a suitable venue offering good
     value. Action: MR to arrange CD forum at the Governors Hall, St Thomas's
     Hospital. Suggested topics should be forwarded to MR.

     c) NICE CKD guideline consultation

     The CDs would be asked to forward their comments to MR who would collate
     them and pass on to the President. The President would respond to NICE on
     behalf of the RA.

     d) Research in commercial HD units

     CDs had been alerted to the importance of considering research, when
     agreeing commercial tenders for haemodialysis units.

     e) Specialised services definition set

     There were ongoing discussions with Bob Couch. Hugh Cairns was pursuing
     appropriate HRG definitions.

8.      Current National Issues:
     a) Verbal update from National CD

     There was a proposal to create a National Diabetes and Kidney Support
     Team. The structure and function was under discussion, with a proposal for
     a central knowledge management function and a presence in each SHA. Bev
     Matthews was to lead this development for the kidney community for six
     months. Potential work streams included: increasing patient and public
     involvement, improving primary care management of CKD, in proving care
     within kidney units, increasing transplant listing, advising on appropriate
     arrangements for specialist commissioning networks.
      The National Screening Committee was examining the potential role of
      including screening for CKD as part of a proposed screening for vascular risk
      An “End of Life” consensus workshop was being held in April and would lead
      to the generation of action plan to realise the vision.

      b) 18 Week Pathway

      The clock stops and starts were being defined

      c) HD capacity

      Ongoing work about appropriate modelling for HD capacity was required.
      There was now a national acceptance of the need for HD capacity to increase
      year on year. This was felt to be a useful and positive commitment from the

      d) PbR

      The work streams for PbR for RRT were nearing completion and would help
      inform more accurate indicated tariff and in due course the tariff for RRT.
      Further work needed to be done on “the year before dialysis” and end of life

      e) Darzi

      The need to continue engagement of the kidney community with this process
      was noted.

      f) Draft renal failure symptom control guidelines

      The appropriate changes had been made. It was agreed the RA would
      endorse this document and that it would be circulated to CDs by MR.

9.       Other issues for consideration
      a) Draft Report from PD working party (Paper F)

      Not formally discussed, but CAB members encouraged to feed any responses
      directly to MW.

      b) Changing face of Renal Medicine (Paper G)

      Not formally discussed. Action: PK asked to consider the report, and provide
      CAB with recommendations on any further action that may be required.

10.      Any other business


11.      Date and Venue for next CAB meeting

2nd July 2008
Norvartis Foundation, London
1:00 pm start

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