Outcome measurements in dialysis: the consensus and the conflicts

There are several published sources of guidelines and studies measuring dialysis parameters. The practical aspects of measuring and improving these parameters in a typical clinical setting are discussed in this paper and the paper concludes with recommendations for actions that can be taken at the current time.     

Future developments in renal care,the patient's perspective

This paper explores from a patients perspective, how collaboration between staff and patients enhances the quality of care for patients with ends stage renal disease. The role of patient associations and professional associations are discussed.     

Daily dialysis and survival rates of vascular access

A major cause of morbidity for haemodialysis patients is vascular access failure and/or occlusion. It is commonly believed that increased frequency of dialysis sessions, among other factors, might lead to higher rates of fistula complications. To evaluate if patients on daily haemodialysis carry a higher risk of vascular access occlusion, we examined the raw incidence rate of access occlusion and the survival function of native vascular access in patients undergoing daily dialysis (DD ‐ N. =24) as compared to patients on standard three times a week haemodialysis (TWD‐N. =198). The number of thrombotic events in the first group was 2 (8%) whereas in the second group we observed 76 (38%) access problems (8%) (p<0.008). The mean vascular access survival before occlusion was 1307 days in TWD and 1388 days in DD. Our data clearly shows that daily dialysis should not be considered a risk factor for access occlusion.     

透析后尿素反跳和残余肾功能对KT／V及PCR的影响

为了评价影响透析充分与否的因素，本文研究了６５例慢性血液透析患者，透析后尿素反跳和残余肾功能对尿素、ＫＴ／Ｖ－尿素和ＰＣＲ影响。结果表明，尿素和肌酐的反跳率取决于溶质的分子量，残余肾功能以及透析；血磷反跳与残余肾功能无关，在无残余肾功能的患者中，计算ＫＴ／Ｖ尿素和肌酐生成率必须考虑反跳因素。否则，４ｈ透析，ＫＴ／Ｖ尿素和肌酐生成率分别可能被过高评估为１５％、２０％，因此，适当调整影响因素，才能达到     

An adequacy improves adequacy of dialysis

The role of the Adequacy Nurse is concerned with the adequacy of dialysis and nutritional status in both haemodialysis and peritoneal dialysis patients. This relatively new and unique post incorporates diverse roles, including that of practitioner, educator, researcher and change agent. The purpose of this work is to educate both staff and patients about the importance of Urea Kinetic Modelling, to enable them to participate in the process, to ensure that standards set are research based and to act as a change agent when necessary. The creation of this post has resulted in improved communication amongst nurses and the multidisciplinary team and with this increased knowledge a higher standard of care has been observed.     

A decade review: Methods to improve adherence to the treatment regimen among haemodialysis patients

Haemodialysis patients are asked to adhere to a very difficult treatment regimen consisting of fluid and diet restrictions, many daily medications, and usually 3 or 4 hour haemodialysis sessions three times each week. Many haemodialysis patients fail to adhere to their prescribed treatment and although this regimen is difficult, it is necessary for patients to adhere for optimal health and well‐being. It is important for nephrology nurses to know what interventions help patients overcome the barriers that keep them from adhering to prescribed treatment The purpose of this paper is to review the literature to examine the research that has been published on methods to improve adherence among haemodialysis patients. Behavioural approaches, education, and primary nursing are interventions that have been researched More research has been reported on the demographics of noncompliant haemodialysis patients than on effective methods that help patients improve adherence to the treatment regimen. Demographic characteristics do not consistently predict compliance for individual patients. Each patient is unique. Research supports the idea that the nephrology nurse should spend time with the patient on a regular basis in order to understand the factors that hinder the individual patient from adhering to the treatment regimen. The nurse who knows the patient well is empowered to develop individualised interventions aimed at reducing barriers that interfere with the patient's ability to adhere to treatment.     

Communication as a teamwork tool in peritoneal dialysis

The growing complexity of the problems which have to be faced in providing a peritoneal dialysis service, such as giving assistance over a territory, consideration of the needs of the individual and the greater emphasis on the prevention of complications, makes multidisciplinary teamwork necessary, with the interaction of various skills. In order to succeed, teamwork requires the identification of clear objectives which are shared by all the members of the team. The various skills can best be exploited by defining roles and agreeing common aims and objectives so that the team can provide the patient with holistic treatment, which recognises the needs of the individual rather than the needs of the illness. Active cohesion between the various components is only possible through a defined communication strategy and an on-going transfer of knowledge.     

Caring for renal patients during loss and bereavement

Many of us are not prepared in assisting patients through the final phase of the life cycle. Recognising physical manifestations of stress, understanding why patients experience loss with kidney disease, and realising the supportive role that staff play for a patient undergoing this process, are key to assisting the patient to cope with loss and bereavement. The renal caregiver can assist the patient to view the ESRD life from another perspective as they journey through the life cycle to death. In so doing, the renal caregiver can recognise the needs of the family during this period, thus making them feel they fulfil a valuable role in the patient's final care. Being with a patient and family at the time of death is extremely rewarding as it helps the staff bring closure to the nurse patient relationship.     

Self‐monitoring of microbiological levels in dialysis fluids

Self monitoring of dialysis fluids is important. The dialysis technician has experience of the microbiological situation of the fluid systems and can make more tests for personnel safety. The tests are not expensive and are very easy to learn. It seems that the cells, which generate endotoxins, cannot be determined by the plate count system. No tanks or permanent water flow UV sterilisation in the pipeline to the dialysis machines can prevent the build up of biofilms and higher endotoxin amounts in water.     

A nursing view of future haemodialysis anticoagulation treatments

The purpose of prescribing anticoagulation therapy in haemodialysis treatments ‐ extracorporeal treatments in general ‐ is to avoid coagulation of blood within the extracorporeal circuit. I.e. catheter/needle(s), bloodlines, artificial kidney/haemofilter. In this paper we differentiate between chronic treatments and acute treatments. The methods of anticoagulation are quite similar in both groups, except for specific preferences and adapted dose.     

Perceptions of renal nursing

Recruitment and retention of nursing staff in general, but renal nurses in particular has become an increasing problem in Britain in recent years. This study set out to measure nurses' attitudes to and understanding of renal nursing and explore the image of renal nursing. The methodology used included focus group discussion and telephone interviews with both renal and non‐renal nurses. Strategies and factors, which may influence recruitment and retention of staff, are recommended.     

Treatment of water for dialysis ‐ A European survey

The EDTNA/ERCA survey of the treatment of water for dialysis was the third project organised through the Collaborative Research Programme (CRP). Data was collected from 69 haemodialysis facilities in 14 countries. Water quality in European dialysis units was mainly self‐regulated. The majority of centres aimed to meet the requirements of the European Pharmacopoeia, but only 50% carried out tests to check compliance. All facilities used reverse osmosis to treat water for dialysis, most also used softening and carbon adsorption. There was a wide variation in policies for the maintenance of carbon filters, and for the control and monitoring of contamination in the distribution system. Endotoxin tests carried out in 27 facilities showed that higher levels of contamination are associated with systems that are infrequently disinfected, and also with older system designs. The survey indicated that guidelines for water treatment are urgently needed. EDTNA/ERCA guidelines for microbiological monitoring are now being drafted, additional guidelines are under consideration.     

Pre-dialysis serum albumin is a poor indicator of nutritional status in stable chronic haemodialysis patients

The correlation between pre-dialysis serum albumin and mortality has been linked with malnutrition. We measured pre and post-dialysis albumin in 86 stable haemodialysis patients and compared them with anthropometric measurements and body mass index (BMI). On the basis of pre-dialysis albumin 13% of patients would be classified as high risk, whilst on the basis of post-dialysis albumin only 12% would be classified as high risk. Change in albumin could be predicted by fluid removal during haemodialysis. Pre-dialysis albumin correlated weakly with mid upper arm circumference (MUAC). Post dialysis albumin correlated with MUAC and triceps skin fold thickness (TSF). There was a weak negative correlation between age and post-dialysis albumin. TSF strongly correlated with MUAC and BMI. Pre-dialysis albumin appears to be a poor predictor of nutritional status and does not correlate well with other nutritional parameters. The excess risk of death associated with a low pre-dialysis albumin may be related to fluid overload rather than malnutrition.     

Comparison of sexual function in females receiving haemodialysis and after renal transplantation

The aim of this study is to compare the sexual function of kidney transplant recipients and end-stage renal disease (ESRD) patients receiving haemodialysis (HD) in female patients. In the sample population of this study, there were 72 women in the transplant group and 40 women in the HD group. To test the differences in the quantitative variables between these two groups, an independent sample Student's t-test was performed. Sexual relationship, sexual function, sexual frequency and sexual fear in the renal transplant patients are significantly better than HD patients. Sexual intercourse satisfaction was apparently higher in the kidney recipients than in the HD patients. Twenty-one patients in transplanted group described number was 6 (15%) (p = 0.03). This study indicated that female kidney transplant recipients experienced a significantly better sexual relationship compared with the ESRD patients receiving HD.     

Haemodialysis and H.I.V. infection ‐ therapeutic management

The prevalence of human immunodeficiency virus among haemodialysis patients is of interest and this article discusses the management of 25 patients between 1985 and 1998 in Paris.     

Blood recirculation in malfunctioning catheters for haemodialysis

Venous catheters are increasingly used for chronic haemodialysis, with dual lumen catheters being the most commonly used as blood recirculation (REC%) is relatively low. The aim of this study was therefore to evaluate blood recirculation in dual lumen catheters, both well-functioning and malfunctioning, with reversed lumens. In our study, blood recirculation in well-functioning catheters with standard lumens is similar to that found in previous studies. However, when lumens are reversed, blood recirculation increases significantly (6.7 ± 4 vs 19 ± 11 %, p<0.001). REC% in malfunctioning catheters (10.8 ± 2%) was higher than normal function (p<0.05) but lower than reversed flow in normal catheters (p<0.01) Therefore, inadvertent reversal of lumens in a well-functioning catheter increases REC% in a significant manner, thus worsening haemodialysis efficiency. We conclude that, in inflow failure catheters, lumens can be reversed because REC% is acceptable. However, inadvertent reversal of lumens in a well-functioning catheter increases REC% to a level which may compromise the adequacy of haemodialysis.