bluuebunny/crossref_metadata_2025 huggingface dataset:
THE EFFECT OF PROFILING DIALYSATE SODIUM AND ULTRAFILTRATION ON PATIENT COMFORT AND CARDIOVASCULAR STABILITY DURING HAEMODIALYSIS
Authors: Gerrish M. , Little J.
Published: July 2012

The aim of this study was to investigate what affect profiling dialysate sodium and ultrafiltration rate had on cardiovascular stability during haemodialysis, and if there was any effect on patients' fluid balance, thirst, serum sodium levels, blood pressure, or comfort and tolerance.

The past decade has seen major advances in haemodialysis machine technology. Parallel developments have included profiling dialysate sodium levels and fluid removal during dialysis. However, some dialysis centres do not use profiling due to fears of long‐term detrimental effects, especially with regard to hypertension and fluid control. Within my own workplace, approximately 30% of haemodialysis treatments utilise either sodium or ultrafiltration profiling, or a combination of both. Anecdotally, we have seen an increase in cardiovascular stability and haemodialysis tolerance. The aim of this study was to identify the effects of profiling haemodialysis, to ensure that the treatment we offer patients is safe and effective.
SHOULD DIALYSIS MACHINES BE DISINFECTED BETWEEN PATIENTS' SHIFTS?
Authors: Stragier A. , Jadoul M.
Published: July 2012

The disinfection of dialysis machines is performed after each session in some units but only at the end of the day in other ones. In a multicentre study, in 15 units (five with and ten without disinfection after each session), the incidence of sero‐conversion for HCV was reduced to zero, after reinforcement of general hygiene precautions only, without changing the above‐mentioned machine disinfection policies. Recently reported episodes of blood contamination of dialysis machines beyond pressure transducers demonstrate that pressure isolator inspection and care should be added to the general hygiene precautions. In a second investigation, no difference was found in dialysate bacterial and endotoxin characteristics between dialysis machines, disinfected after each dialysis (n = 2) and those disinfected at the end of the day only (n = 2). In conclusion, the systematic disinfection of all dialysis machines after each session does not appear to help prevent HCV infection nor to have a detectable impact on optimal dialysate bacterial and endotoxin characteristics.
CAMPUS AND EDUCATION: AN EXPERIENCE WITH PD PATIENTS
Authors: Zuccherato N. , Bordin G. , Evangelista F. , Oliva S. , Susin E.
Published: July 2012

Every day patients on peritoneal dialysis (PD) must focus on their dialysis schedules and on nutritional and therapeutic prescriptions. Unfortunately, over time all these actions may not follow the initial protocol. In order to evaluate patient's knowledge and approach to dialysis, an alternative educational tool to hospital or home was investigated. The campus was utilised as a place for re‐training and detecting and correcting discrepancies in knowledge and the management of techniques.

A continuous educational programme involves some re‐training of PD patients and this approach helps us to identify whether the treatment management at home is in accordance with the information given at the start of the dialysis, but there was a need to improve on this and to improve patient understanding and compliance. The campus was chosen as an alternative educational process with the aim of involving the patients themselves and their families to achieve additional benefits and long‐term success of the therapy (7–9).

This initiative, outside the hospital and in collaboration with professional figures not affiliated with the dialysis unit, hoped to offer patients new knowledge about: dialysis technique and procedures, prevention of infectious complications, nutrition and physical activity.
HUMAN RIGHTS: IMPLICATIONS FOR PATIENTS AND STAFF
Authors: Dreezen I. , Nys H.
Published: July 2012

Originating from wider declarations of fundamental human rights, individual human rights in the field of health care, also called patients' rights, have been elaborated, developed and implemented by most international organisations, including the European Union and the World Health Organisation. The Council of Europe is however, particularly prominent in its work in the field of human rights, having drawn up a number of vital international treaties, among them and most importantly the Convention on Human Rights and Biomedicine, which strengthens internationally the legal position of the patient and the research subject in setting a minimum level of protection in respect of individual human rights and health and is binding upon the member states that have ratified it. Nonetheless, it needs to be examined to see if the European Union would be a better alternative to regulate these patients' rights.
MONITORING PARAMETERS OF DIALYSIS DOSE
Authors: Kesziová A. , Kinská H. , Pilbauerová K. , Švárová B. , Nejedlý B. , Lopot F.
Published: July 2012

In order to deliver a specific dialysis dose (Kt/V) to all patients, their product Kt (urea clearance K multiplied by dialysis time t) should be individually adjusted according to total body water (V) of each patient. With dialysis time being fixed in most centres for organisational reasons, such individualisation can be accomplished by individually set blood flow (QB). For a given t, the value of QB also defines the magnitude of the cumulative blood volume (VB=QB*t), i.e. the volume of blood perfused through the dialyser during the whole dialysis time. VB is displayed by every contemporary dialysis machine but not used. The aim of this work was to derive an easy to use approach to QB individualisation based on patient's body weight and dialysis time to obtain a desired Kt/V value which would also be easy to check after dialysis by looking at the obtained VB value.

Statistically significant correlation was found between the QB‐based Kt/V estimation and Kt/V determined by the other two methods demonstrating practical feasibility of the novel approach. Kt/V values obtained with the QB prescribed according to patient's body weight tended to be better in females and patients with higher body mass index.
THOUGHTS ABOUT BIOFILM IN DIALYSIS WATER SYSTEMS
Authors: Nystrand Rolf
Published: July 2012

What is a biofilm? Basically, a biofilm is formed when a structure or a surface has a growth on it. The growth consists of a community of micro‐organisms, which is active. Growth means that there are metabolic processes taking place.

The amount of organisms can be low, and at the beginning there is always just a few, in principle, just one.

The surface area covered can also be very small. This will change over time due to the nutritional situation.

In this paper the phenomena of surface growth (biofilm) will be reviewed and commented on.
EUROPEAN GUIDELINES FOR VASCULAR ACCESS: CLINICAL ALGORITHMS ON VASCULAR ACCESS FOR HAEMODIALYSIS
Authors: Tordoir Jan HM , Mickley Volker
Published: July 2012

Vascular access remains the Achilles heel of end‐stage renal disease patients, receiving haemodialysis. The increase in the number of elderly dialysis patients with additional cardiovascular co‐morbidities and diabetes mellitus makes the creation and maintenance of functioning vascular access, more difficult and cumbersome. Therefore, the development of guidelines for vascular access management seems logical.

A team of multidisciplinary vascular access experts created a set of algorithms covering the whole spectrum from pre‐operative vessel assessment, peri‐operative access management and post‐operative follow up and surveillance. Additionally, a range of various access complications with their diagnosis and treatment options were included in these algorithms.

The new European guidelines for vascular access augment the knowledge of vascular access problems and their management. Additionally, the use of algorithms facilitates the decision‐making when treating complications by all physicians dedicated to this field of healthcare.
VALIDATION OF PHYSICAL ACTIVITY MEASUREMENT FOR PEOPLE ON DIALYSIS TREATMENT
Authors: Wellard S.
Published: July 2012

Chronic illness frequently contributes to diminished levels of activity, a consequent increased dependence on health related support services and reduced quality of life. Surprisingly few studies have described activity among people with end‐stage renal disease (ESRD). The current study examined the utility and validity of the Human Activity Profile (HAP) for describing activity in a sample of Australians with ESRD. A descriptive design supported the primary objective of validating the use of HAP for an Australian renal population. Data was collected from 65 adults with ESRD under the care of one regional and one metropolitan renal unit in Victoria. The HAP measures physical activity across a range of activities of daily living, including a dyspnoea scale. The Sickness Impact Profile (SIP) describes activities associated with daily living in the areas of physical, psychological and independence. The HAP, SIP and a questionnaire summarising demographic and diagnostic details were administered while each person was undergoing dialysis and the results subsequently compared. This study demonstrates that HAP is a valid measure of activity levels for people with ESRD undergoing maintenance haemodialysis. Additionally, scores on SIP and HAP indicate that this group have low levels of daily activity. These findings support the use of HAP in research to understand the activity levels of ESRD patients and the factors associated with decline.
ADVANCED GLYCATION IN URAEMIC TOXICITY
Authors: de Strihou C. van Ypersele
Published: July 2012

The Maillard reaction involves the non enzymatic combination of carbohydrates such as glucose with protein aminogroups to yield schiff bases and Amadori protein adducts evolving into irreversible advanced glycation end products (AGEs). This phenomenon, part of normal ageing, is accelerated in diabetes, as a result of hyperglycaemia, and in renal failure, as a consequence of the accumulation of reactive carbonyl compounds (RCOs).

AGEs and RCOs are implicated in uraemic toxicity both at the biochemical and the clinical level (dialysis amyloidosis, atherosclerosis, alterations of peritoneal membrane permeability). Reduction of plasma AGEs and RCOs is an interesting avenue to reduce uraemic toxicity. Therapeutic strategies involve dialysis technique (haemodialysis membranes, daily haemodialysis, ultrapure dialysate, RCO free peritoneal dialysate) as well as drugs inhibiting AGE formation (aminoguanidine and the less toxic angiotensin converting enzyme inhibitors or angiotensin receptor blockers).
DEPRESSION IN DIALYSIS PATIENTS
Authors: Yucedal C. , Olmez N. , Gezen G. , Celik F. , Altindag A. , Yilmaz ME. , Kara IH.
Published: July 2012

Many psychiatric disorders can be seen in patients with chronic renal failure (CRF). Haemodialysis (HD), which is a renal replacement treatment, causes various psychiatric and psychosocial problems. Patients are dependent on treatment and the illness causes various problems. In addition, strict diet and continuous treatment are other stress factors (1,2).

Various studies have been published in different regions and countries about the prevalence of depression and the relation between sociodemographic factors and depression in patients treated by continuous ambulatory peritoneal dialysis (CAPD), which has gradually become common in Turkey. However studies, which reflect the authors' region, have become necessary (2,3).
INTRAVENOUS ADMINISTRATION OF EPOETIN IN HAEMODIALYSIS PATIENTS
Authors: De Vos Jean‐Yves , Upsing Louise
Published: July 2012

Recombinant human erythropoietin (epoetin, rHuEPO) can be administered to haemodialysis patients intravenously or subcutaneously. Although the intravenous route is the originally approved and used route of administration, subcutaneous administration has been quite common throughout Europe since the introduction of prefilled syringes. The intravenous route has been shown to be as effective as the subcutaneous route, but patients should have adequate iron stores. In addition, intravenous administration is patient‐friendly and results in fewer injections, less pain and bruising, and a minimised risk of immunogenicity. Furthermore, intravenous administration of epoetin is convenient for the nurse and is commonly used in Germany, Belgium and the USA.

The purpose of this paper is to illustrate the very easy, practical ways of administering epoetin in prefilled syringes during dialysis at machine level, based on the authors' experiences in Belgium and Germany.
USING AND DEVELOPING YOUR EDTNA/ERCA PROFESSIONAL PORTFOLIO
Authors: Thomas N.
Published: July 2012

A portfolio is an instrument for continuing professional development, which can be used by all members of the multidisciplinary team. This paper describes the development of the EDTNA/ERCA Professional Portfolio and discusses how health care professionals are able to complete and utilise the Portfolio in everyday practice. A discussion on reflective practice is presented and a short example of reflective writing is given. The paper concludes with an evaluation of possible Portfolio use in teaching and management and discusses plans for future development.
A UNIVERSITY ACCREDITED RENAL NURSING COURSE DELIVERED BY DISTANCE LEARNING
Authors: Hurst J.
Published: July 2012

Continuous professional development (CPD) is limited in some regions of the UK and within Europe generally. This is compounded for all by limited resources for course fees and the lack of study leave granted away from the clinical area for full‐time courses. This is set against recommendations from national and European governments and renal clinical guidelines concerning expectations of CPD and competency levels of renal nurses (1,2). In the past renal nurses have been trained in all areas of the speciality by local Schools of Nursing linked to renal units. However, since the formation of Trusts in 1990 education delivery has been ring‐fenced and separated from the control of local hospitals by Schools of Nursing being incorporated into Institutes of Higher Education. That has led in some instances to a rationalising of post registration education delivery for some geographical areas. This paper will discuss the development and implementation of a distance learning renal care course taking into consideration the clinical, academic and educational requirements necessary for effective education and training at the post basic level.
EDUCATION TO REDUCE POTASSIUM LEVELS IN ADOLESCENT, HAEMODIALYSIS PATIENTS
Authors: Daǧdeviren A. , Savaşer S.
Published: July 2012

A semi‐experimental survey was carried out. The aims included assessing how knowledgeable adolescents undergoing haemodialysis treatment were regarding hyperkalaemia, and determining how effective an education programme in preventing hyperkalaemia would be. 31 volunteers (twelve girls and nineteen boys), who had two or three haemodialysis treatments a week, were included in the study. Data were obtained through a questionnaire, the answers to which were written down for each participant separately by the researcher. A manual was prepared with the aim of educating children in hyperkalaemia, the participants were taught lessons in groups of two to three at a time. The education programme was completed in eight sessions. At the end of the programme each participant was given a copy of the manual. A month after the education programme, participants were asked to refill the section of the aforesaid questionnaire. The scores in this section had increased, and blood potassium levels had significantly decreased (p=0.02).
A CASE STUDY ‐ INITIATION OF HAEMODIALYSIS
Authors: Gerogianni G.
Published: July 2012

End‐stage renal disease (ESRD) is a chronic failure of normal kidney function, which is precipitated by a number of factors, such as diabetes, pyelonephritis, hypertension, and polycystic kidney disease (1). The loss of kidney function is gradual, and many patients do not have any symptoms until the end‐stage of the disease. Killingworth and Van Den Akker (2) point out that people undergoing haemodialysis have to comply with a wide range of medications and restrictions, which affect both their physiological and psychological status.

This paper presents a case study of a woman with ESRD, requiring initiation of haemodialysis. An assessment of the patient's health needs is addressed, followed by the implementation and evaluation of the nursing process. Finally, the analysis of the overall plan used in the case study is presented.
TIME DISTRIBUTION FACTORS OF HOSPITAL AND HOME CARE AMONG CHRONIC HAEMODIALYSIS PATIENTS
Authors: Ziegert K. , Högstedt B. , Fridlund B. , Lidell E.
Published: July 2012

Today, many studies are available that focus on haemodialysis; however studies on the time distribution factor involved are lacking. It is therefore important to study the distribution of time, taking into account outpatient care, inpatient care and home care. The aim of the study was to chart over a five‐year period, the time distribution factors of hospital care and home care among chronic haemodialysis patients. The design of the study was descriptive, and the data material was drawn from a patient register (N=61). The data analysis was performed by means of both descriptive and inferential statistics.
PREVENTING CROSS INFECTION OF BLOOD BORNE VIRUSES ON HAEMODIALYSIS
Authors: Nilsson K.
Published: July 2012

A chronic haemodialysis patient acquired hepatitis C. It was thought certain that this had occurred while dialysing in a satellite dialysis unit. The incident initiated a review of current measures in place to prevent the transmission of blood‐borne viruses (BBV) on haemodialysis, with an analysis of current literature on the topic.

It was found that the author's unit and several additional local units had no written protocols on prevention of BBV during haemodialysis, and methods of prevention were largely verbally communicated. A review of the literature gave conflicting opinions on the effectiveness of different measures to prevent cross‐infection. Following the assessments and literature review, the appropriateness of certain preventative measures was looked at in more detail. A local protocol was subsequently developed and implemented at the author's Trust, which will significantly change practice in the haemodialysis unit.
EVALUATION OF RELATIONSHIPS BETWEEN HAEMODIALYSIS UNIT PROFESSIONALS
Authors: Rivares A.V. , Navarrete I.G. , Pueyo C.G. , Torrent A.M. , Durán M.M. , Gatius J.R. , Mussol L.R. , Solano M.
Published: July 2012

This paper focuses on the dynamics of a workgroup in a nephrology and haemodialysis unit. Teamwork is indispensable in nephrology units, as it provides support and help to professionals but working closely together may also cause conflict and great strain. This study describes how much and in what way the anxiety and the relationship between these professionals influences their work, depending on skills and personal preferences among the staff. A questionnaire was used to analyse the following issues: stress, changes, routine, confrontation, comparisons, preferences, support, valuation, assertiveness, self‐evaluation, technical competence, affiliation, motivation, work atmosphere and training.
THE RESEARCH BOARD OF THE EUROPEAN DIALYSIS AND TRANSPLANTATION NURSES ASSOCIATION/EUROPEAN RENAL CARE ASSOCIATION (EDTNA/ERCA)
Authors: Zampieron Alessandra , Harrington Maurice , Elseviers Monique , Lindley Elizabeth , De Vos Jean‐Yves , Visser Ronald
Published: July 2012

The Research Board (RB) of EDTNA/ERCA is a multidisciplinary group, established by the participation of renal care centres all around Europe. The RB also works with the association's Special Interest Groups (SIGs) on developing guidelines for implementing safe renal clinical practice. It is composed of six permanent members, with co‐opted experts from specific fields. This article describes how the RB works and the projects implemented since 1996.
MANAGEMENT OF RENAL ANAEMIA: COMPARISON OF PRACTICE IN THE CZECH REPUBLIC AND NORTHERN ENGLAND
Authors:   EDTNA/ERCA Collaborative Research Programme, Lindley Elizabeth , Pancírová Jitka , Kraciková Jindra , Lopot František , Green Diane , Harrington Maurice , De Vos Jean‐Yves , Elseviers Monique
Published: July 2012

The EDTNA/ERCA European Practice Database (EPD) questionnaire was piloted in the Czech Republic (CZ), Northern Italy and Northern England (N‐ENG) in early 2003. The questionnaire used in the CZ and N‐ENG featured additional questions on the use of erythropoetin (EPO) and intravenous (IV) iron.

There were significant differences in the policies for anaemia management in the CZ and N‐ENG, reflecting the higher level of funding available to centres in the UK. There was also a wide variation in practice between the CZ centres, but not those in N‐ENG, possibly due to the adoption of guidelines that are currently unrealistic. Some centres, particularly those in the CZ, could improve outcomes or reduce overall costs by adopting a more aggressive policy for the use of intravenous iron.
OVERVIEW OF CURRENT THERAPY IN DIABETES MELLITUS
Authors: Kroker M.
Published: July 2012

Diabetes mellitus can be found world wide and is a disease effecting carbohydrate metabolism. An increase in the number of diabetic patients from 189 billion today to 324 billion worldwide in 2025 is predicted. More than ninety percent suffer from type 2 diabetes. Similar numbers are mentioned for the pre‐diabetic stage of impaired glucose tolerance (IGT) and metabolic syndrome. It is an important task for the future to use adequate diagnosis‐finding methods and therapies to discern and treat the disturbance of carbohydrate metabolism as early as possible and perhaps slow down further progress in the case of IGT or metabolic syndrome. This should minimize the risk of cardiovascular or organic damage.

In contrast to the treatment of type 1 diabetes with intensive insulin regimens, therapy for type 2 diabetes has changed noticeably in the last years. All treatment forms have to account for the results of recent studies which show evidence that long‐ and short‐dated elevation of blood glucose, mostly postprandial appearing peaks can lead to vascular damage with all consequences. The main goal should be to adapt treatment individually, estimating the stage of the disease, the risk of developing or progression of micro‐ or/and macrovascular complications, present risk factors, age and abilities. Non‐pharmacologic and pharmacologic approaches are available.
BLOOD PRESSURE AND CARDIOVASCULAR COMPLICATIONS IN DIABETIC DIALYSIS PATIENTS
Authors: Gutiérrez Vilaplana Josep Ma
Published: July 2012

Diabetic nephropathy is one of the most frequent causes of renal failure. Diabetes increases the cardiovascular risk by 2–4 times that of the general population; hypertension increases this risk. Diabetes is a factor that shortens the survival of renal patients. Appropriate hospital care and attention can diminish complications in these patients and improve quality of life.
COPING AND LIVING WELL WITH DIABETES AND NEPHROPATHY
Authors: Kieboom J.
Published: July 2012

Coping and living with diabetes and nephropathy is not easy. The illness may affect quality of life and can influence the person physically, psychologically and socially. Once on dialysis unfortunately, quality of life is influenced even more. In addition, health professionals demand a great deal of self‐discipline in the care and management of the person's illness. To support the person with these demands it is important to provide good education, treatment and care with the aid of the multi‐disciplinary team‐approach involving a nephrologist/diabetologist, nurse‐educator, dietician, exercise specialist and a social worker/counsellor. With a treatment plan in each discipline and regular aftercare appointments it is hoped that the person will be able to master his illness.
WHEN TO START DIALYSIS IN DIABETIC PATIENTS?
Authors: De Alvaro Fernando
Published: July 2012

Diabetic nephropathy and diabetes related nephropathies represents one of the most common causes of end‐stage renal disease (ESRD), and diabetic patients with chronic renal failure represent the most important high risk cohort of uraemic patients requiring renal replacement therapy. Interventions to slow progression of kidney disease and measures to reduce the risk of cardiovascular disease are highly effective in early renal damage and should be the main task of nephrologists, but diabetic patients are more frequently referred late to the nephrologist. Factors involved in the rate of mortality of diabetic patients with ESRD are multiple, including nutritional status, comorbidity, age, etc, but the duration and quality of pre‐dialysis nephrological care constitute a key for improving outcomes of diabetic patients with ESRD.
VASCULAR ACCESS FOR DIALYSIS IN DIABETIC PATIENTS
Authors: Konner K.
Published: July 2012

There is consent that arteriovenous fistulae as introduced by Brescia et al. (1) are the preferred choice in the field of vascular access for maintenance haemodialysis therapy.

Worldwide, a rapidly growing population of older patients suffering from diabetes mellitus, mainly type 2, is observed. The pre‐existing damage to the arterial and/or venous vascular anatomy and the high cardiovascular comorbidity makes it more difficult to construct and to maintain a well functioning arteriovenous fistula (AVF). Problems arise from specific complications of AVF in diabetic patients. Alternative types of vascular access are needed in case arteriovenous access fails completely or cannot be created. It is concluded that old and new techniques in creating, maintaining and revising vascular accesses should be critically revisited for the benefit of the diabetic patient. A new, particularly demanding field in nephrology asks for urgent answers.
FOOT CARE EDUCATION IN RENAL PATIENTS WITH DIABETES
Authors: Lawrence A.
Published: July 2012

Foot complications are said to be the primary cause of hospitalization for patients with diabetes, resulting in enormous personal and financial costs. It is reported that end‐stage renal disease (ESRD) diabetic patients with peripheral vascular disease have a much higher incidence of foot complications and increased risk for amputation. However, despite the serious financial burden caused by diabetic foot ulcers and their complications, the importance of diabetic foot care is still not fully recognised or supported.

There is increasing evidence to suggest that education on foot care is essential for patients with diabetes. Studies have shown that simple techniques such as identifying those at risk of developing foot ulcers, educating patients about foot care that is tailored to meet the requirements of individual patient needs, educational background and learning ability can be of obvious benefit to people with diabetes and is cost‐effective.
TRANSPLANT STRATEGIES FOR DIABETIC RENAL PATIENTS
Authors: Belmonte Amado Andrés
Published: July 2012

The strict control of glycaemia in the diabetic patient prevents severe long‐term complications of diabetes. The most effective physiological method to control glycaemia in the type 1 diabetes patient is pancreas or pancreatic islet transplant. However, these types of transplants require chronic immunosuppressant treatment that leads to short and long term complications and are reserved for type 1 diabetic patients with life threatening complications (frequent unexplained ketoacidosis or hypoglycaemias). With regards to type 1 diabetics with end‐stage nephropathy, simultaneous pancreas‐kidney transplant has excellent results and makes it possible for the patient to be insulin and dialysis free. If vascular complications, especially coronary disease, make it impossible to perform a simultaneous pancreas‐kidney transplant, kidney transplant alone will be indicated and, in the future, the patient may have access to the transplant of pancreatic islets when the technique is perfected. Type 1 diabetic patients who receive a living or cadaver kidney transplant, and later a pancreatic transplant show excellent results. Type 2 diabetics, in whom pancreas transplant is not indicated, as they do not have a total deficit of insulin, can have access to a kidney transplant if they reach end‐stage nephropathy in spite of their more advanced age, as long as their vascular disease allows it. Transplant of cadaver islets is beginning to provide good results, thanks to new immunosuppressant protocols. This procedure does not require surgery, the islets being implanted into the liver by infusion through the vena porta. Obtaining islets from embryonic or adult tissue stem cells, although in an experimental phase, could be a reality in the near future.
DIABETIC NEPHROPATHY ‐ WHO CARES?
Authors: Wilde C.
Published: July 2012

Diabetic nephropathy has become the most common single cause of Established Renal Failure (ERF) in the United States of America (USA) and Europe. In the United Kingdom (UK) diabetic nephropathy is seen in 18% of new patients requiring dialysis (1). In the USA 7.3% of all adults and 17.8% of those over 65 years have diabetes mellitus (2). Furthermore diabetic nephropathy is the cause of ERF in up to 45% of patients on dialysis (3). Recently compiled data by the World Health Organisation (WHO) shows that approximately 150 million people worldwide have diabetes and predict that this number may well have doubled to 300 million by 2025 (4). These figures are clearly daunting and renal units must prepare themselves for the rising number of patients with diabetes needing renal replacement therapy (RRT) in the future.

Renal specialist nurses do not always have a major role to play in the prevention of diabetic nephropathy. Their remit must be to try and delay the progression to ERF and perhaps more importantly to concentrate their efforts on their ERF patient population with diabetes that have co‐existing diabetes related pathologies. This article will attempt to discuss how renal nurses can best expand/extend their skills and knowledge to provide effective care for this patient group, and explore whether developing new and innovative roles or just new ways of working is the way forward.
THE DEVELOPING ROLE OF THE RENAL DIABETES NURSE
Authors: Youngman S.
Published: July 2012

Diabetes as a chronic disease is often complicated in its management, particularly when combined with chronic and end‐stage renal failure. Patients, carers and health care professionals are unfortunately often confused by either too little or conflicting advice provided by the two specialist teams. Within this context, the Renal Diabetes Nurse (RDN) role serves to bridge the gap by ensuring effective links and communication.

Currently, renal referrals are made from surrounding secondary care settings and primary care GP practices. The expansion of renal outreach clinics, the appointment of new consultant nephrologists and the emergence of nurse‐led clinics, reflects our continuous growth to meet the demand for renal services.

The number of patients with renal failure and diabetes is set to increase as the acceptance criteria are clarified and referral routes made explicit. An ageing population (1) with 21–62% of the renal population over the age of 65 (depending on the location of the renal unit), coupled with an increase in the Asian and African‐Caribbean population all contribute to increased patient numbers (2). It is now well recognised that these patients often experience associated generalised atheroma and vascular calcification from inadequately managed hypertension and diabetes over a number of years. Consequently, this group of patients are often “high maintenance” requiring input from the multidisciplinary team on a continuing basis.
THE CHALLENGE OF KIDNEY TRANSPLANTATION AMONG MINORITY ETHNIC GROUPS IN THE UK
Authors: Randhawa G.
Published: July 2012

The increased rate of renal failure secondary to diabetes among minority ethnic groups compared to Caucasians in the UK has been well documented. However, the impact of this phenomenon on kidney transplant services has been relatively unexplored. The Government has recently published its ‘Tackling Health Inequalities: A Programme for Action’ report which emphasises the importance of reducing health inequalities at all levels of the health service. This article provides a timely review of the UK's national transplant database examining the provision of kidney transplant services to minority ethnic groups in the United Kingdom. It seeks to explore the demographics of the database by focusing upon waiting list data, donor data, and recipient data. Inequalities do currently exist in transplant services and the solutions to rectifying this situation are complex. However, the financial and human burden of not addressing these inequalities encourages some immediate action.
PUBLIC AWARENESS AND ACCEPTANCE OF TISSUE AND ORGAN DONATION
Authors: Ozdag Nurten
Published: July 2012

Organ donation is a worldwide problem especially in developing countries due to lack of knowledge about brain death and organ transplantation as well as traditional values and beliefs. Limited data are available concerning public knowledge and awareness of organ donation and transplantation in Turkey.

A prospective study was carried out and data (n=774) were gathered from a structured questionnaire. The results indicated that 96.6% of participants had heard of organ donation and transplantation, 91.8 % approved donation, and 59.2% would consider donating organs of their own. 62.6% were unaware of the donation law.

As 81.7% of participants were interested in having more information on the issue, information booklets covering brain death, donation law and the organ donation process may increase donation of organs.
AN INVESTIGATION INTO STRESS LEVELS AMONGST RENAL NURSES
Authors: Murphy F.
Published: July 2012

A qualitative study was designed to explore renal nurses' perception of stress within their unit. This study collected information from ten staff nurses through semi structured taped interviews. Using content analysis, interviews were coded and categories and themes were identified.

Findings indicate that stress was derived from the following categories: job content, resource issues, professional concerns, professional working relationships, extrinsic factors, and coping mechanisms. The actual words of the nurses were included to provide depth and substance to the categories and themes.

A discussion was held regarding the relationship of these findings to theory. These findings have implications for nursing practice, administration and education. Recommendations are also made for future studies.
OUR DILEMMA: THE SELF‐MARGINAL PEOPLE
Authors: Ho TM. , Cordovilla L.
Published: July 2012

Cultural diversity is nowadays a common phenomenon in most developed countries. Its impact is felt in daily life, as well as in health care settings.

Hospital del Mar, due to its geographical location, receives some of the 34.7% of immigrants from a varied cultural background. Endeavours are made to promote cultural awareness among staff and to facilitate communication.

However, a Spanish Gypsy group, albeit not immigrants, are by large the problematic cultural group.

A questionnaire study was conducted to validate the difficulty in treating these Gypsies versus migrant patients. The questionnaire was distributed to different health care professionals in the hospital. The result is not surprising. The problems encountered with the migrant patients are mainly due to language barrier. Concerning these Gypsies who speak fluent Spanish, the problems are by far more extensive. These are often generated by their abiding cultural values, distinctive lifestyle, low educational level and rejection of the shared norms of the majority. Any attempt to encourage adherence to hospital rules are often futile as a result of the gypsies' negative attitudes. Staff have expressed occasional feelings of weariness when dealing with such situations.
PERCEPTIONS AND EXPERIENCES OF PRE‐DIALYSIS PATIENTS
Authors: Iles‐Smith H.
Published: July 2012

The literature shows that many complications including psychosocial, sexual and economic are associated with dialysis. However few studies have been conducted from the patients' perspective or have examined the pre‐dialysis phase of established renal failure. The aim of this qualitative study was to explore the perceptions and experiences of pre‐dialysis patients.

Ten patients were interviewed, on one occasion, prior to starting dialysis. The interviews were conducted in a semi‐structured manner in accordance with pre‐defined interview topics. The findings of the study highlighted that participants had no clear expectations of dialysis treatment and generally expressed a sense of fatalism and lack of knowledge. This was highlighted by the main emergent theme, response to information. It became clear that most of the patients had received information, but had either misinterpreted, or been unable to absorb it. A number of specific issues including provision, quantity, interpretation and the timing of information appeared to be linked to the participants' inability to gain knowledge.

These study findings highlight the importance of a patient centred, flexible education programme to enable patients to absorb and accurately interpret information.
ON‐LINE CLEARANCE MONITORING FOR BLOOD ACCESS MANAGEMENT
Authors: Mehmedović N.
Published: July 2012

On‐line Clearance Monitoring (OCM) provides frequent and precise information about urea clearance values during haemodialysis. In the case of blood access recirculation, it is presumed that urea clearance values on OCM would be lower and suspect to blood access malfunction.

In order to check the relation between significantly lower urea clearance values and blood access recirculation, the Kt value (Clearance × time/min) for fifteen patients on OCM, including the patients with a low Kt/V in spite of their small urea distribution volume (V) was observed.

Average urea clearance was calculated indirectly using Kt value (Kt/time in minutes = average clearance ml/min) and blood access recirculation tests performed using slow/stop flow two‐needle, three samples method (urea method). After comparison of the recirculation percentage to clearance value, positive correlation between high recirculation and clearance reduction was noted. OCM alongside detection of haemodialysis inefficiency is also a practical instrument for blood access management between regular monitoring. Lower OCM urea clearance values demonstrate a possible blood access problem that can be confirmed with another method. When an OCM urea clearance reading is decreased by more than 25%, undiscovered access recirculation can be suspected.
ANAEMIA AS AN EARLY PREDICTOR FOR DIABETIC RENAL DISEASE? A REVIEW OF THE LITERATURE
Authors: Balshaw‐Greer A. , Davies J. , Casey J.
Published: July 2012

Diabetes is the leading cause of end‐stage renal disease in the western world and significant proportions of patients with diabetes mellitus develop renal complications. Anaemia is a key indicator of renal disease, and potentially may contribute to the pathogenesis of diabetes complications. Early correction of anaemia therefore has the potential to prevent or reverse other complications This review of the literature will examine anaemia in diabetic patients and seek to determine whether it is exclusive to diabetic nephropathy.
EVALUATING STAFF AND STUDENT EXPERIENCES OF MULTIDISCIPLINARY CONTINUOUS PROFESSIONAL DEVELOPMENT VIA DISTANCE‐LEARNING
Authors: Hurst J.
Published: July 2012

Continuous professional development (CPD) in caring for people with kidney disease is limited in some regions of the UK and within Europe generally. This is compounded for all by limited resources for course fees and the lack of study leave granted away from the clinical area for full‐time courses. This is set against recommendations from National and European governments, and renal clinical guidelines concerning expectations of CPD and clinical competency levels of renal nurses (1–4). In the past renal practitioners have been trained in all areas of the renal speciality by Schools of Nursing linked to renal units based in large teaching hospitals. However, more recent changes in the structure of Health Care provision have led in some instances to a rationalising of post registration education delivery.
LIVING WITH A HAEMODIALYSIS MACHINE
Authors: Sadala M.L.A. , Lorençon M.
Published: July 2012

The aim of the present study was to describe the experience of patients undergoing haemodialysis starting from their own perception. A qualitative perspective using Merleau Ponty's Existential Phenomenology was considered to be the most appropriate methodology for this study. Fifteen patients were interviewed in a haemodialysis unit at a Brazilian teaching hospital. Interviews were based on the question ‘What does the experience of living with a haemodialysis machine mean?’ Convergences in speeches were grouped into three categories: the machine, improvement in quality of life, reflection on patients' experience. These findings show the existential reality patients experience. A haemodialysis machine dictates their lives: they have to accept strict rules controlled by a team of healthcare providers. They realize it has to be so and there is no way out. It is the only way to get some relief from the symptoms of the disease. The feeling is mostly acceptance of the condition. Healthcare providers' dedication is recognized. Some participants complain about painful procedures, others deny them, others fantasize the reality. An essential piece of information is the lack of future perspectives; few patients mentioned the possibility of a transplant or the possibility of carrying out their own care. The study may contribute in outlining new perspectives for nurses to understand the needs of patients undergoing haemodialysis. An approach accepting patients' views will probably bring awareness to patients as to the possibilities of helping with their own treatment.
A CLINIC TO PREVENT THE DETERIORATION OF RENAL INSUFFICIENCY
Authors: Brousseau A.
Published: July 2012

Prevention in nephrology is only possible with the cooperation of patients and their families. The nurse plays a considerable role in working with patients and is a major player in the team, responsible for follow‐up of the patient, where the earliest interventions can help delay and sometimes avoid dialysis. The hypertension clinic is the beginning of a continuum until dialysis. This paper describes three clinics that are managed in the renal service and indicates how they contribute to offering optimal care to a renal population.
NUTRITIONAL STATUS AND HANDGRIP STRENGTH IN PRE‐DIALYSIS PATIENTS
Authors: Pagels A. , Heiwe S. , Hylander B.
Published: July 2012

Introduction and aim — Protein‐energy malnutrition (PEM) is a well‐known problem in the care of persons with chronic kidney disease (CKD). Continuous assessment of nutritional status (NS) is therefore recommended in dialysis care as well as in the care of pre dialysis patients. Subjective Global Assessment (SGA) is a multifactor, subjective method for assessment of a patients' NS. Reduced handgrip strength (HGS) is associated with PEM and considered to be a reliable nutritional parameter that reflects loss of muscle mass. The aim of this retrospective study was to analyse NS in pre dialysis patients with a focus on the significance of HGS.

Patients and study design — In this retrospective study HGS and NS assessed by SGA in 112 pre dialytic individuals were analysed. The patients' mean Glomerular Filtration Rate (GFR) was 14 (±4) ml/min. and their mean age was 63 (±15) years. The patients were assessed consecutively from November 2001 to November 2003. Sixty‐three percent of these patients were assigned a protein‐restricted diet (PRD) 0,6–0,8g/kg/day.

Results and conclusions — Relatively few patients (13%) were classified as malnourished according to SGA but many reported fatigue, loss of appetite and reduced levels of physical activity. Few patients (6%) were underweight (BMI >20), whereas 58% were overweight (BMI >25). Patients on a PRD did not have impaired NS, compared to patients not on a PRD. Patients who had some degree of malnutrition tended to have reduced HGS. Among male patients, those with a lower level of physical activity tended to have lower HGS. Among the female patients, those who experienced loss of appetite and/or feeling of fatigue tended to have lower HGS. The pre dialysis patients had lower HGS compared to predicted norm for healthy subjects.
RECRUITMENT AND RETENTION AUDIT: TRAINING DOES MAKE A DIFFERENCE
Authors: King J.
Published: July 2012

The aim of this study was to find out if offering specialist renal training courses enhanced staff recruitment and retention. An audit of staff with specialist renal skills acquired through training was completed. Analysis of the records available in this Trust since 2003, reporting on staff retention and increased nurse satisfaction following renal course attendance, were used in this study. The research used semi‐structured interviews gaining qualitative data. The participants were all staff who had undertaken renal courses provided by this Trust. The results showed that when the interviews were thematically analysed, key themes emerged, which displayed enhanced insight, confidence and increased skill base. The quantitative data concerning staff retention, staff movement and staff sickness, helped to identify that not only do staff actually stay longer but also appear to develop advanced skills and knowledge as well as more positive attitudes. In summary, it was shown that by offering specialist training there is an increased number of skilled renal nurses presenting for employment attracted by the opportunity of undertaking specialist renal courses. They in return, benefit from the advanced renal programme, which enables them to deliver better quality of care with increased job satisfaction.
PATIENT EDUCATION IN PRE‐DIALYSIS — PATIENT LED FORUMS
Authors: Heatley S.A.
Published: July 2012

In order for patients to make an informed choice about renal replacement therapies, it is important that they are given sufficient and appropriate information, which must include explanations about their condition and likely outcomes with or without treatment. Furthermore information regarding the reality of living with dialysis, its strict regimes and patient's commitment to self care are imperative to enable patients to adapt to a life changing, ongoing, often relentless treatment. Encouraging patients to take control of their chronic illness through the provision of education support and choice is fundamental to the successful outcomes of the patient's journey through the pre‐dialysis phase of their illness.

This paper describes the implementation of Patient‐led Forums designed to offer an education programme for pre‐dialysis patients and the benefits gained by those who have attended.