Authors: Maria Kastrouni RN, Eleni Sarantopoulou RN, Georgios Aperis MD, PhD, Polichronis Alivanis, MD, PhD

Summary: An evaluation of the quality of life of patients with end stage kidney disease undergoing haemodialysis in the Greek population was conducted to understand whether this quality could be improved. Comparisons were made with a similar study conducted in USA in regards to the effects of kidney disease in daily life, burden of kidney disease, work status, cognitive function, quality of social interaction, sexual function, social support, physical functioning, role physical on daily routine, pain, general health perceptions, role emotional, emotional well-being, social function and energy/fatigue. Any differences are discussed and analysed. Sexual problems were found to be more prominent in this study, but the emotional status has greater influence in quality of life in the US study. The results were more positive in Greece with respect to dialysis staff encouragement, patient satisfaction, as well as acceptance and the under-standing of illness. The results from our study reflect the differences of the healthcare systems in various countries as well as population-related beliefs and values.

Key Words: Chronic Kidney Disease, Haemodialysis, Quality of Life , SF-36 Questionnaire

Authors: Koosha Kamali MD, Mohammad Amin Abbasi MD, Ashkan Heshmatzade Behzadi MD, Ahmad Mortazavi MD, Bahar Bastani MD

Summary: Background: This study was designed to evaluate the incidence and risk factors of Transplant Renal Artery Stenosis (TRAS) among living donor un-related kidney recipients.
Patients and methods: 360 kidney consecutive transplant recipients were included in this retrospective cohort study. Informed written consent was obtained, only TRAS occurring 3 months after transplantation were considered. After 5 year follow up, TRAS was established in 6.6% (24 patients) of patients.

Results: Mean±SD age of recipients was 39.8±14.9 years old (range 16 to 77). Upon multivariate analysis recipient age>50 (RR=2.9, CI95%: 1.33;2.93, p=0.008), recipient BMI>30(kg/m2) (RR:7.97, CI95%: 3.44;18.46 , p<0.001), re-transplantation (RR=4.88, CI95%: 2.21; 10.77, p<0.001), cytomegalovirus (CMV) infection and Delayed Graft Function (DGF) (RR:4.29, CI95%: 3.12;13.79, P=0.01) appeared to be independently associated with TRAS. Positive CMV-antibody was more frequent in recipients with TRAS (95.83% vs 70.8%, P=0.04) but all of them were HCV-antibody negative. Other variables as discussed were similar between two groups.
Conclusion: High recipient age, BMI>30, hyper trigelyceridaemia, previous transplantation, CMV infection and DGF are shown to be risk factors for TRAS.

Key words: Transplant Renal Artery Stenosis, cytomegalovirus infection, Delayed Graft Function.

Authors: Andrew Connor MRCP, Frances Mortimer MRCP

Summary: The impact of unmitigated climate change upon global health is predicted to be disastrous. However, the very provision of healthcare itself has a significant environmental impact, and the contribution of kidney care to the carbon footprint of the NHS is likely to be disproportionately high. Furthermore, the current economic climate will ensure that healthcare systems face unprecedented reductions in resources (or, at the very least, diminished expansion in the face of ongoing increases in demand). Improvements in the way that renal services use resources will address both issues. This survey was designed to identify a baseline for sustainability in kidney care, to support a clinical transformation to lower carbon kidney care by identifying fruitful areas for attention, and to act as an educational tool.
The survey identified measures for improvement across the different areas of the provision of kidney care, including building energy use, patient and staff transport, water use and the consumption and procurement of resources. The results of the survey, which was completed by 58 adult and paediatric renal units across England, Scotland and Wales, are reported here and potential changes are discussed.

Key words: Environment, Haemodialysis, research, workforce

Author: Ray James. BSc MSc

Summary: The environment and ‘green’ issues are currently being promoted in the healthcare sector through recently launched initiatives. This paper considers aspects of healthcare waste management, with particular reference to waste generated in dialysis units. With dialysis being dependent upon large amounts of disposables, it generates considerable volumes of waste. This paper focuses upon a typical haemodialysis unit, evaluating and quantifying the volumes and categories of waste generated. Each haemodialysis patient on thrice weekly dialysis generates some 323 kg/yr of waste, of which 271 kg is classified as clinical. This equates to 1626 kg of (solid) clinical waste per dialysis bed, which is around 3 times the volume of clinical waste generated per general hospital bed.
Waste disposal routes are considered and this suggests that present healthcare waste paradigms are outmoded. They do not allow for flexible approaches to solving what is a dynamic problem, and there is a need for new thinking models in terms of managing the unsustainable situation of disposal in constantly growing landfills.
Healthcare waste management must be considered not only in terms of the environmental impact and potential long-term health effects, but also in terms of society’s future energy requirements.

Key words: Healthcare waste; haemodialysis; incineration; landfill.

Authors: Magnus Lindberg, RN, MSc. Manuel Matos Fernandes, RN, PhD

Summary: Self-efficacy is a temporary and influence-able characteristic, related to situations and tasks, mediating health-promoting behaviours. This study aimed to evaluate psychometric properties of a Portuguese version of the Fluid Intake Appraisal Inventory, and to describe self-efficacy in relation to limited fluid intake among Portuguese haemodialysis patients. Respondents were recruited from three dialysis units, and 113 of 155 eligible patients gave their informed consent. The translated scale was distributed and collected by the head nurses. Interdialytic weight gain was calculated as percentage of dry weight. Satisfactory psychometric properties were estimated in the Portuguese context. The participants’ self-efficacy in relation to low fluid intake was asymmetrically distributed; the majority had moderately to high self-efficacy while some patients had very low self-efficacy to limited fluid intake. There was a significant difference in self-efficacy to fluid restrictions; patients with a weight gain of 3.5% or less presented higher self-efficacy scores than did patients exceeding the cut-off point.

Keywords: self-efficacy, reliability/validity, fluid intake appraisal inventory, fluid restriction

Authors: Glenda Rayment MSc Nursing (Renal), RMN, RN. Josephine Chow MBA, PhD, Grad Cert Edu, BAppSci

Summary: Studies have shown that patients converted to short daily haemodialysis (SDHD) have reported many clinical benefits, decreased complications during dialysis and a better quality of life. A six month prospective cohort study was conducted to examine the efficacy of short daily haemodialysis to patients previously receiving three times per week haemodialysis therapy. Following informed consent, participants received haemodialysis daily, Monday to Saturday, between 2 and 2.5 hours for each treatment and followed up for a six month period. The participants continued to experience hypotension, cramping and headache and were non compliant with fluid intake. There was a gradual reduction in blood pressure, cessation of antihypertensives and reduction of erythropoietin therapy (ERT). There were no hospital admissions or reports of access complications. The nursing staff reported an increase in activity levels and nursing interventions with the participants following conversion to SDHD. However the participants reported a better quality of life.

Key Words: Short daily, Haemodialysis, Quality of life

Author: Duncan Thomas MD

Summary: This account is of the pathway to a renal transplant. It is my feelings and conception of the journey acknowledging the psychological impact along the way. The workload before transplantation and my unappreciated desire to delay the operation are discussed. The search for the donor was difficult as I had to come to terms with being the person responsible for giving my mother pain and suffering. The outcome is good and my desire to thank my mother is overwhelming.

Authors: Maria Sarrias RN, Ester Diaz RN, Rosa Escofet RN.

Summary: Cardiovascular disease is the major cause of mortality in Chronic Kidney Disease (CKD). Arterial stiffening is recognised as a critical precursor of cardiovascular disease. Available evidence indicates that lifestyle modifications are therapeutic interventions for preventing and treating arterial stiffening.
Objective: To evaluate the influence of lifestyle modifications on the arterial vessel compliance in CKD patients not receiving renal replacement therapy (RRT).
We measured the arterial vessel compliance in 50 CKD patients not receiving RRT, (30 post transplant, 20 pre RRT). Non-invasive pulse wave analysis of radial artery was used to estimate large artery (C1) and small artery elasticity (C2) and was corrected for patients’ age. Renal transplant (RT) patients were younger than CKD patients. Renal Transplant patients C1 normal in 13%. C2 lower than normal in 77% of cases and not associated with evaluated variables, but worse large artery compliance was observed.
In CKD patients C1 was normal in 55%. C1 was strongly associated with aerobic exercise. For CKD patients exercise normalises large artery compliance. C2 was lower than normal in 90%. Small artery compliance was affected in majority of patients.

Key words: Chronic Kidney disease, transplantation, cardiovascular, education