Intended for healthcare professionals

Rapid response to:

Practice Guidelines

Renal replacement therapy: summary of NICE guidance

BMJ 2018; 363 doi: (Published 19 October 2018) Cite this as: BMJ 2018;363:k4303

Rapid Response:

Re: Renal replacement therapy: summary of NICE guidance

It's striking that the UK has half the incidence of end-stage renal disease than the US. I'm also impressed that the majority of the UK's ESRD patients are transplanted which I agree is the best treatment for ESRD. Prevention, of course, would be even better. What the article failed to reference is that 90% of dialysis has been preventable since 2002 (1). If that were known (2), there would be no waiting list at all for a cadaver kidney transplant in either the UK or the US. There would be no need for living donors, and both countries could be dialysis-free within 5 years.
In acute renal therapy, it's also possible to avoid renal replacement therapy (RRT) (3).
1. Paper #1 at (abstract at PubMed ID: 12396747)
2. Paper #9 at

Competing interests: I am the Founder, CEO, and majority shareholder of GenoMed, Inc, a NextGen Disease Management company that uses genomics to solve diseases. We use knowledge of disease-causing genes to improve prediction and treatment of common diseases like kidney failure. We repurpose already existing drugs whenever possible.

20 October 2018
David W. Moskowitz
GenoMed, Inc.
Hollywood, Florida, USA