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