bluuebunny/crossref_metadata_2025_split huggingface dataset:
MULTIDISCIPLINARY APPROACH FOR PRESCRIPTIVE MANAGEMENT OF MINERAL AND BONE METABOLISM IN CHRONIC KIDNEY DISEASE: DEVELOPMENT OF A DIETETIC LED PROTOCOL
Authors: Casey J. , Li Chui Han , Johnson V. , Sluman C. , McClelland P. 
Published: July 2012

ABSTRACTBackground — A number of mineral metabolism abnormalities occur as kidney function declines, these include hyperphosphatemia, hyperparathyroidism and altered vitamin D metabolism. These derangements are associated with increased morbidity and mortality amongst the chronic kidney disease patient group. Treatment requires a multidisciplinary team approach in which the dietitian plays a pivotal role.Objectives — The development of protocols to aid implementation of various international, national and local treatment strategies is described. Audit the protocol to evaluate their clinical effectiveness.Results — A prescriptive Protocol for the management of mineral and bone metabolism abnormalities in chronic kidney disease was developed and implemented. Initial audit findings suggest the protocol has had a positive effect on the control of phosphate, corrected calcium and parathyroid (PTH) levels.Conclusion — The development and implementation of a dietetic‐led prescriptive therapy protocol allows dietitians and clinicians to adopt an integrated approach for the diagnosis and timely management of these complicated conditions.
DIETARY STRATEGIES TO HALT THE PROGRESSION OF CHRONIC KIDNEY DISEASE
Authors: Clements L. , Ashurst I. 
Published: July 2012

ABSTRACTChronic kidney disease is fast becoming a worldwide epidemic. There is an estimated annual increase of 8% with an associated economical and clinical burden. Recent research into lifestyle factors has confirmed different dietary attributes play a part in slowing the progression of chronic nephropathies. This has important implications and a potentially cost‐saving way, to help reduce the progression of the disease. The roles of obesity, lipids, protein, diabetes and blood pressure are discussed to show how the current literature reflects how to modify the dietary aspects of these. The mechanisms behind these are not fully understood, but the message remains the same that there is an increased need for dietary advice in the pre‐dialysis population.
RE‐TRAINING AND SWITCHING OF PD SYSTEM TO REDUCE RECURRENT GRAM‐POSITIVE PD PERITONITIS
Authors: Cox S.D. , Steddon S. , Mallinder S. , Fan S.L.‐S. , Punzalan S. 
Published: July 2012

ABSTRACTIntensive training and re‐education of peritoneal dialysis (PD) exchange technique has been advocated to minimize peritonitis rate. However, re‐education of patients that are established on PD for some years can be difficult and a minority of patients on PD remain susceptible to repeated episodes of peritonitis. The UV Flash Compact system (Baxter Healthcare) automates patient connection and disconnection during the PD exchange procedure and uses bactericidal UV irradiation to minimise the effects of touch contamination. We have explored the efficacy of retraining patients using this system for reducing peritonitis rates in a cohort of 10 patients in who repeated episodes of peritonitis due to gram +ve organisms suggest irrevocable breaches in sterile technique. These patients were converted from their existing PD system (6 Staysafe [Fresenius Medical Care], 4 Mini‐solo [Baxter]). Mean follow up post‐conversion was 10 months. There was a striking reduction in peritonitis caused by gram +ve pathogens from 1 in 8.5 to 1 in 50.5 months. Although it is not possible in this study to differentiate the impact of the UV Flash Compact as opposed to the effect of re‐training, we advocate that patients with a high peritonitis burden from gram +ve organisms should be considered for conversion to the UV Compact system.
MANAGING PERITONEAL DIALYSIS (PD) — FACTORS THAT INFLUENCE PATIENTS' MODIFICATION OF THEIR RECOMMENDED DIALYSIS REGIMEN. A EUROPEAN STUDY OF 376 PATIENTS
Authors: Hollis J.L , Harman W. , Goovearts T. , Paris V. , Chivers G. , Hooper J.M. , Begg S. , Curtis L. 
Published: July 2012

ABSTRACTObjectives — The purpose of the study was to assess the prevalence and extent of missed peritoneal dialysis (PD) exchanges and to identify possible predictors for regimen modification.Design — The study was a cross sectional postal survey of PD patients. Patients were asked to complete a single questionnaire looking at factors that influenced their management of the prescribed regimen.Patients − 551 patients were invited to participate in the study from 17 centres across three European countries; 10 centres from Belgium, 5 from Italy and 2 from the UK. Patients on continuous ambulatory peritoneal dialysis (CAPD), CAPD and Quantum, or automated peritoneal dialysis (APD) for more than three months and at least 18 years old were included in the study. 376 out of 551 questionnaires were completed; a response rate of 68%. Results − 20% (n=67) of those who responded to the questionnaire admitted to modifying their treatment in the previous month. Those who were more likely to modify their treatment were younger, employed, had greater contact with the PD team, were on APD 10 hours or longer and were less satisfied with their APD treatment.Conclusion — Many of the patients self‐reported modifying their dialysis regimen and possible predictors were highlighted from this study. By trying to identifying individual patients who do modify treatment healthcare professionals can target information that can support the patient in making safer treatment modification choices.
PLASMAPHERESIS IN THE TREATMENT OF ACUTE VASCULAR REJECTION: AN EXPERIENCE ON A DIALYSIS UNIT
Authors: White B. 
Published: July 2012

ABSTRACTDespite numerous the advances made in transplantation, acute rejection remains a major complication. Recent studies have shown that the use of plasmapheresis in the treatment of acute vascular rejection improves the chances of graft survival. In 1997 the plasmapheresis was transferred to the management of the renal unit, because we could offer a 24‐hour service for all acute cases in our hospital. The number of cases has steadily increased, incorporating not only plasmapheresis, but also stemcellpheresis and red blood cell exchanges. Since July 2003, we have started using plasmapheresis in the treatment of acute vascular rejection in renal transplants.When a biopsy shows acute vascular rejection (A.V.R), combined with a decreased urine production, the patient commences therapy. Treatment consists of consecutive sessions, alternating between two sessions using saline/albumin followed by one session using fresh frozen plasma. Depending on the lymphocyte count, therapy is carried out in conjunction with a course of Antithymocyte globulin (A.T.G.) between July 2003 and October 2004, 124 transplants were carried out, 15 suffered from acute rejection. Six were diagnosed with A.V.R, of these six; five were successfully treated with plasmapheresis and A.T.G. One patient only needed plasmapheresis to ensure a reversal of acute vascular rejection. We encountered no problem with the technique itself and although plasmapheresis seems to improve the outcome of graft survival, we need to ask ourselves, as demand increases: “Do we have the capacity to treat these patients on our unit in the future and is it our domain?”
PRE‐DIALYSIS EDUCATION AND PATIENT CHOICE: Summary of the EDTNA|ERCA Journal Club discussion spring 2006
Authors: Lindley Elizabeth J. , Thomas Nicki , Hanna Linda , Walker Diane , Milo Elisheva , Koupatsiari Thomy , De Vos Jean‐Yves , Sedgewick John , Pugh‐Clarke Karen , O'Kane Frankie , Treloar Gillian , Pegoraro Marisa , Marti Anna , Muroma‐Karttunen Riitta , Murcutt Gareth , Shaldon Stanley , Hoenich Nic , Brooks Don , Pilley Ken , Küntzle Waltraud , Goovaerts Tony 
Published: July 2012

ABSTRACTThe discussion was initiated by a paper on the influence of a pre‐dialysis education programme on the mode of renal replacement therapy by Goovaerts et al (NDT 2005). Barriers to the uptake of self‐care treatment modalities, including late referral, limited availability of treatment options, reimbursement, support from staff and families, the requirement for a helper and the length of the training programmes for home haemodialysis (HD) were discussed by 21 participants from 12 countries.The ‘take‐home’ messages from the discussion were that to optimise the uptake of self‐care modalities, renal units should try to ensure the all patients who are able to choose are fully informed before starting dialysis, even if they are referred to the unit very late. Offering a wide range of treatment options to new patients, and allowing (or encouraging) home HD without a helper, may also increase the number of patients who start and stay on a self‐care modality. It should be possible to provide an acceptable level of training, without compromising on safety, within 3 weeks if the patient is confident with needling.
MONITORING OF DIALYSIS WATER SYSTEMS — IS THERE A NEED FOR INCREASED SAMPLING?
Authors: James R. 
Published: July 2012

ABSTRACTWater quality is one of the most important aspects of ensuring a safe and effective delivery of haemodialysis. An extensive microbiological survey of several water systems highlighted a contamination problem which routine sampling had failed to detect.Current guidelines suggest that samples for microbiological and endotoxin analysis should be taken from the outlet of water treatment plant and points expected to have the highest bacterial load, normally the end of the distribution loop and connections to the dialysis machines, where the flow is at its lowest. The survey extended sampling to include a large number of machine connection points.Four systems were investigated. The samples from routine test points generally returned results within our operational limits (<10 CFU/ml and <0.06 IU/ml). However, results from several machine connection points exceeded these limits by a large margin. Several disinfection cycles were required in order to achieve results in keeping with our operational limits.The conclusion is that sample results from the end of the distribution loop may give a false sense of security by not indicating a contamination problem at the machine connection points. Increasing the number and frequency of machine connection points tested should provide greater security in detecting contamination and allow for remedial action at an earlier stage.
THE EFFECT OF PROGRESSIVE MUSCLE RELAXATION TRAINING ON ANXIETY LEVELS AND QUALITY OF LIFE IN DIALYSIS PATIENTS
Authors: Yildirim Y.K , Fadiloglu C. 
Published: July 2012

SUMMARYAim — To determine the effect of progressive muscle relaxation training (PMRT) on anxiety levels and quality of life (QoL) in dialysis patients.Methods — A total of 46 patients who had been treated with dialysis in the Dialysis Center of Ege University Medical Faculty Hospital were recruited. Data were collected by means of a questionnaire. Patients' Recognition Form (PRF), State and Trait Anxiety Inventory (STAI), and QoL‐index for dialysis patients (QoLI‐dialysis) were used to collect the necessary data. All three forms were utilised prior to PMRT and 6 weeks after completion of PMRT.Results — The mean state‐anxiety score before and after PMRT was found as 43.4±4.3 and 28.9±2.8, respectively (P<0.001). Similarly, the mean trait‐anxiety scores before and after PMRT were found as 43.6±9.5 and 31.1±6.5, respectively (P<0.001). When the QoLI‐dialysis score was examined it was 28.7±3.2 before PMRT and 29.6±2.3 after PMRT (P<0.01).Conclusion — The results of the study demonstrate that PMRT for dialysis patients helps decrease state‐ and trait‐anxiety levels and has a positive impact on QoL.
SYMPTOM MANAGEMENT IN PATIENTS WITH ESTABLISHED RENAL FAILURE MANAGED WITHOUT DIALYSIS
Authors: Murtagh F.E.M. , Addington‐Hall J.M. , Donohoe P. , Higginson I.J. 
Published: July 2012

ABSTRACTIncreasing numbers of patients with chronic kidney disease Stage 5 (GFR <15ml/minute) are being managed without dialysis, either through their own preference or because dialysis is unlikely to benefit them. This growing group of patients has extensive health care needs. Their overall symptom burden is high, and symptom prevalence matches or exceeds that in other end of life populations, both with cancer and other non‐cancer diagnoses. These symptoms may often go unrecognised and under‐treated. Regular symptom assessment is necessary, together with pro‐active management of identified symptoms.Pain can be managed using the principles of the World Health Organisation analgesic ladder. Not all opioid medications are recommended for these patients. Paracetamol, tramadol, and fentanyl are the most appropriate medications for steps 1, 2 and 3 respectively. There is limited evidence on the use of buprenorphine, oxycodone and hydromorphone. Methadone is safe but should only be prescribed by a clinician experienced in its use. Morphine and diamorphine are not recommended because of metabolite accumulation.Pruritus is also challenging to manage. The evidence for pharmacological interventions to alleviate pruritus is summarized, and a pragmatic approach to management suggested. Emollients, capsaisin cream, antihistamines, thalidomide and ondansetron may be helpful, according to the extent and pattern of pruritus. Symptoms may frequently be due to co‐morbid conditions, not renal disease itself, and managing them is difficult because of the constraints on the use of medication which kidney failure imposes. Collaboration between renal and palliative specialists can help identify ways to achieve best care for these patients.
RENAL SPECIFIC SECONDARY HYPERTENSION
Authors: Kalra P.A. 
Published: July 2012

SUMMARYChronic kidney disease (CKD) is now understood to affect over 5% of all adult patients and it conveys a risk of reduced survival in those affected. At least 80% of those patients with stages 3–5 CKD (i.e. GFR <60 ml/min) suffer with hypertension, and in most the major cause is due to pertubation of an important renal endocrine system, the renin‐angiotensin‐aldosterone (RAA) axis. In this article the epidemiology of renal‐related hypertension and its importance in pre‐disposing to the increased cardiovascular risk in renal disease are discussed. Hypertension is known to be a major cause of progressive loss of renal function in CKD, particularly because of activation of the RAA, and hence the case for blockade of this system with ACE inhibitors and Angiotensin receptor blockers is highlighted.
EDUCATION OF TRANSPLANTED WOMEN FOR PREVENTION OF UNPLANNED PREGNANCY FOLLOWING KIDNEY TRANSPLANTATION
Authors: Calic M. , Grego K. , Kersnic B. , Jovanovic E. , Svetlin M. , Kandus A. 
Published: July 2012

ABSTRACTReproductive function in female patients (pts) with advanced kidney disease is decreased and characterised by diminished libido, ovulation and infertility. The underlying cause is hypothalamic‐hypophysis‐gonadal axis dysfunction in women with chronic kidney disease which usually results in high levels of prolactin and.ammenorrhea In women with end stage kidney disease requiring replacement therapy in fertile period conception is very rare. Even in case of conception successful pregnancy and delivery are not likely, on most occasions spontaneous abortion occurs. Should a newly pregnant woman on haemodialysis wish to deliver the baby, intensive dialysis is required, everyday until childbirth. In the haemodialysis center in University Clinical Center in Ljubljana, only one woman in the chronic dialysis programme gave birth, in 1996.
DIALYSIS NURSES FOR PALLIATIVE CARE
Authors: Madar H. , Gilad G. , Elenhoren E. , Schwarz L. 
Published: July 2012

SUMMARYThe palliative approach offers significant and practical care throughout the treatment of the dialysis patient until death. Varied aspects of quality of life for patients can be improved. It is possible to relieve symptoms such as sleep disorders, pain, constipation and pruritus, which, according to the present survey, are common symptoms. The treatment of dying dialysis patients or the possibility and legitimization of discontinuing treatment are complex, controversial issues with ethical and legal implications. But these issues have not yet been adequately dealt with by the nephrological community. The nurses who encounter patients daily, who constantly deal with great suffering and who lack tools to help, can lead the practice in this field within the framework of inter‐disciplinary team work. In light of the obvious need for progress in this area, appropriate training courses should be considered. The implementation of the palliative approach in dialysis units could be a challenge for all of us in the coming years.
THE NEED FOR CARE CO‐ORDINATION IN AN AGEING DIALYSIS POPULATION
Authors: Witkowski E. , Vanstraelen E. , De Moor B. , Hardy F. 
Published: July 2012

SUMMARYOver the past ten year period, there has been a sharp increase in the age distribution of dialysis patients. The mean age of patients entering dialysis therapy in 1995 was 69 years, rising to 75 years by 2005 (Figure 1). Of this group of patients, there is a 20% mortality rate within 6 months of commencing dialysis (Figure 2). Renal replacement therapy (RRT) is considered a bridge to transplantation. However, what if the patient is not eligible for transplantation because of age, co‐morbidity or refusal?
MICROBIOLOGICAL MONITORING OF DIALYSIS WATER SYSTEMS — WHICH CULTURE METHOD?
Authors: James Ray 
Published: July 2012

ABSTRACTProblem — Assurance of adequate water quality is one of the most important aspects of ensuring a safe and effective delivery of haemodialysis. There are several different culture methods recommended in the various guidelines on the microbiological testing of water for dialysis.Aims — The aim was to investigate whether or not there was a significant difference in the microbiological results obtained using the various recommended culture methods.Methods — Current guidelines suggest that samples for microbiological analysis should be cultured using a low nutrient media such as Reasoner's 2A but vary in recommending temperature and time. Over a six month period, samples were sent to an independent laboratory and cultured using three different times and temperatures. Samples were cultured at 22°C for 7 days (ERA‐ERCA, EDTNA‐ERCA), 37°C for 2 days (AAMI and ISO) and 30°C for 5 days (ISO, EP).Results — The bacterial culture method used was R2A media at the incubation temperatures and times indicated. During an extensive microbiological survey of several water systems, the results from the laboratory gave conflicting results for the three methods. Results showed that several of sample sets returned results with a difference in recovery by a factor of between 10 and 1000.Conclusions — Culturing using the stated temperature and times produces large variations in reported levels of contamination. Culturing at the different temperatures and incubation times can produce results which may give a false sense of security by not indicating a contamination problem. Standardising on a single method is desirable in order to produce consistently valid results.
KIDNEY FAILURE STABILIZES AFTER AN INCREASE OVER 2 DECADES
Authors: Cravedi Paolo , Ruggenenti Piero , Remuzzi Giuseppe 
Published: July 2012

SUMMARYThe level of proteinuria is one of the most important predictors for progressive renal function loss in kidney disease. Reduction of urinary protein levels by renin‐angiotensin‐system (RAS) inhibitors limits renal function decline in patients with non‐diabetic and diabetic nephropathies to the point that remission of the disease and regression of renal lesions have been reported. The increasing use of these drugs is possibly at the basis of the stabilization of rates of new cases of kidney failure reported to the US Renal Data System after a 2‐decade period of progressive increases.RAS inhibition, however, may not be effective to the same degree in all patients. For those patients who do not reach a complete remission of proteinuria, treatment procedures to implement renoprotection should include strict blood pressure control (and metabolic control in diabetics), lowering of blood lipids, and lifestyle modifications. Early intervention may be important to maximize renoprotection, especially in diabetics.
HYDROXYETHYLSTARCH SOLUTIONS VERSUS SALINE FOR THE TREATMENT OF INTRADIALYTIC HYPOTENSION
Authors: Konings Magda , Wolters Evelien , Betjes Michiel GH 
Published: July 2012

ABSTRACTBackground — It is unknown whether the colloid solutions hydroxyethylstarch (HES) 6% and 10% are equally effective as compared to saline alone for the treatment of intradialytic hypotension.Methods − 44 stable patients treated with chronic intermittent haemodialysis were divided in two equally sized groups (Group I and Group II). When symptomatic hypotension occurred, patients received 100 ml 0,9% NaCl in Group I and 100 ml HES 6% in Group II. In the second month of the study, patients in Group I received HES 6% and saline was given in Group II. In the third and fourth month this treatment schedule was repeated, but now HES10% instead of HES6% was given.Results and conclusion — HES solutions of 6% and 10% and saline were equally effective for the reversal of the intradialytic hypotension, but patients receiving HES10% had a significant lower incidence of recurrent hypotension.
THE CHALLENGES ENCOUNTERED DURING A COLLABORATIVE RESEARCH PROJECT
Authors: McCann Ms. Margaret 
Published: July 2012

ABSTRACTCollaborative research in the clinical environment ensures that research questions are valued and relevant to health care professionals who are based in the clinical setting. This form of research is not without its difficulties and can present numerous challenges and conflicts. For successful collaboration, research teams need to invest a considerable amount of commitment and energy into team functioning and relationships. In addition, the team needs to work together through the pooling of resources, interests and talents. This includes the sharing of tasks that are time consuming and work intensive. Using the experiences gained from the pilot phase of a collaborative study this paper will offer solutions to a number of challenges that emerged from this study.
CHANGING EUROPEAN CKD TRENDS: A CALL TO ACTION
Authors: Bennett Lesley 
Published: July 2012

SUMMARYIncreasing numbers of patients with chronic kidney disease (CKD) who require renal replacement therapy threaten to overwhelm nephrologists, nephrology nurses, and haemodialysis units in many European countries. Health care costs are increasing more rapidly than corresponding budgets. These changing trends mandate new policies to provide continued quality care for more patients at international, national, and local levels. Although individual countries have different requirements regarding health care systems, approaches must be taken that improve structure, process, and outcome. Common issues include improving professional education, increasing collaboration among health care providers and specialists, and the acquisition and allocation of funds. Solutions identified by some countries provide examples of model programs that could be adapted for others. The impending crisis that more and older patients with serious comorbidities and CKD will impose on health care delivery must be addressed now in a proactive manner by the nephrology health care community.