European Society of Anaesthesiology.

There remains room for improvement in airway management strategies and resources in ICUs in the UK.

End-stage renal failure (ESRF) creates a considerable health burden in the UK. Despite the increasing number of kidney transplants and a plateau in the incidence of patients starting renal replacement therapy (RRT), the prevalence of patients undergoing dialysis has been steadily increasing, with over 56 000 individuals registered for RRT in 2013 (Fig. 1). 1 As the population ages and the survival of those on dialysis increases, it is likely that the requirement to provide anaesthesia for renal access will only increase.Chronic renal disease significantly increases mortality risk, 8 worsening as glomerular filtration rate (GFR) falls. For those aged 35-39 yr who require RRT, the relative risk of death is 16.2 times that of the general population. In addition to the independent risk of death conferred by RRT, many of the commonest causes of ESRF (see Table 1) are serious systemic diseases in their own right, affecting multiple other organ systems. Decision to offer dialysisChronic kidney disease (CKD) describes abnormal kidney function and/or structure, 2 and its classification has evolved, being most recently described by the updated 2015 NICE guidelines on CKD. 2 It had previously been defined as GFR <60 ml min À1 (1.73 m 2 ) À1 for 3 months or more, or abnormalities of kidney function or structure with implications for health, 3 but the NICE guidance now describes grades of CKD using both GFR and albumin:creatinine ratio (ACR) (Fig. 2).It is usual for patients with G5 CKD, or less severe but rapidly accelerative disease, to be offered dialysis. Types of RRT Peritoneal dialysisThe main advantage of peritoneal dialysis (PD) is that it can be done at home, and it therefore has less impact on daily living. Most patients are on continuous ambulatory PD where they do

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1 Koster A, Boergermann J, Zittermann A, Lueth U, Gillis-Januszewski T, Schirmer U. Moderate dosages of tranexamic acid during cardiac surgery with cardiopulmonary bypass and convulsive seizures: incidence and clinical outcome. Br J Anaesth 2013; 110: 34-40 2 Glynn RJ, Schneeweiss S, Stormer T. Indications for propensity scores and review of their use in pharmacoepidemiology.