The new Cardiovascular Disease Modern Service Framework gives kidney disease a stronger place in national policy, recognising its central role in cardiovascular and metabolic health. However, significant unmet need remains, and a dedicated Kidney Disease Modern Service Framework is needed to turn recognition into better prevention, treatment and support for people living with kidney disease
Moral distress is an increasingly recognised challenge in kidney care, affecting clinicians, patients and services alike. Understanding its causes, recognising its impact and implementing practical strategies to address it are essential for supporting staff wellbeing, maintaining high-quality patient care and strengthening workforce resilience.
Understanding coping across psychological, social and healthcare contexts is essential to improving support for young people living with chronic kidney disease and other long-term conditions. A more integrated approach to coping research and practice may help shape future guidance, tools and healthcare services that better reflect young people's needs. Background: Coping is a complex, multi-faceted concept influenced by psychological and psychosocial factors. Understanding coping among young people living with chronic kidney disease requires consideration of multiple levels of experience. Aims: This review aims to explore coping strategies among young people living with chronic kidney disease and examine how integrated perspectives may improve understanding and support. Methods: A literature review was conducted to examine evidence on coping, stress and psychosocial experiences in young people living with chronic kidney disease. The review also explored Patient and Public Involvement initiatives, including the Renal Patient Support Group, the Kidney Disease and Renal Support Group for Kids, and The May Gardens Project. Findings: Young people living with chronic kidney disease use a range of positive and negative coping strategies. Coping is influenced by complex interactions between psychological, social, and health-related factors. Patient and Public Involvement initiatives provide opportunities for young people to share experiences and contribute to improving care. Conclusions: A multi-level understanding of coping can support the development of meaningful and supportive healthcare approaches for young people living with chronic kidney disease. Implication for practice: Healthcare professionals and researchers should recognise the broader factors influencing coping and involve young people in designing care that reflects their experiences and needs.
As home haemodialysis expands across UK kidney services, vascular access has become a defining factor in treatment success. This article explores how personalised access planning, integrated surveillance and proactive service design can improve safety, preserve access longevity and support sustainable home-based dialysis. Background: Home haemodialysis offers clinical and quality-of-life benefits for the patient, but depends on safe, durable vascular access. Aims: To review current evidence on vascular access selection, surveillance and management for home haemodialysis. Methods: A narrative review of contemporary literature, international guidelines and home haemodialysis-specific evidence. Findings: Guidance supports personalised vascular access planning within the patient's end-stage kidney disease life-plan. Although arteriovenous fistulas remain the preferred option for many patients, arteriovenous grafts and tunnelled haemodialysis lines have important roles for selected patients. Safe home haemodialysis also requires integrated surveillance, competency-based training, infection prevention and timely management of complications. Conclusions: Vascular access should be regarded as a continuous component of home haemodialysis care rather than a single procedural intervention. Implications for practice: Individualised access planning, structured surveillance and patient education can improve safety, preserve vascular access and support sustainable home haemodialysis programmes.
This article provides an overview of research ethics and governance within the NHS, exploring how the history of research ethics has shaped today's safeguards. It outlines the current approvals process and offers practical guidance for healthcare professionals planning and undertaking research.
