EDTNA/ERCA European Dialysis and Transplant Nurses Association/
European Renal Care Association
EDTNA/ERCA Project Website Dresden 2015
Patient-centred Renal Care – A Multidisciplinary Approach to Holistic Health
Journal of Renal Care

EDTNA/ERCA Journal 3.2003

A screening test for vascular access recirculation?

Dear Editor,

Vascular access (VA) is an important tool in the haemodialysis session and is a frequent source of morbidity and hospitalisation.

Several factors affect vascular access recirculation (VAR): the screening test used, blood flow, the placement of needles and vascular access conditions.

There are several methods to calculate VA recirculation, but it can be expensive and requires special training We looked for a screening test which was simple and came up with the dilution method First, we performed the method with serum potassium but we found several problems. We then tried a dilution method with another molecule, urea.

We developed a dilution method with urea as a tracer molecule. This was more accurate than tests previously used and avoided problems with cardio-pulmonary recirculation.

This method does not require expensive specialised devices, which limit applicability. The method was applied three times over one year and compared to the classical urea tests.Address for correspondence

Juan L. Chaín de la Bastida
Avda. Alcaldesa Mª Regla Jiménez Jiménez,
120 Espartinas
España (C.P. 41807)
Tel.: 0034 652 955 280 (home)
0034 954 170 909 (work)
Email: juanchainbastida@hotmail.com.

Juan L. Chaín de la Bastida qualified as a nurse at the University of Seville in 1996. He has worked in renal nursing since that time. Juan has been a co-ordinator and instructor of a renal nursing course and a renal care assistant course. He has been a Quality Manager and Education and Formation Manager. Juan won an Amgen Scholarship for his Oral Poster presentation at the EDTNA/ERCA Conference at The Hague in 2002.

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Advanced glycation in uraemic toxicity

JC. van Ypersele de Strihou, University of Louvain Medical School, Cliniques Universitaires St. Luc, Brussels, Belgium.

Address for correspondence
C. van Ypersele de Strihou
Emeritus Professor of Nephrology,
University of Louvain Medical School,
Cliniques Universitaires St. Luc,
1200 Brussels,

Charles van Ypersele de Strihou, MD, PhD is Emeritus Nephrology Professor at the Catholic University of Louvain, UCL in Brussels. He contributed to the creation of EDTNA and was a guest speaker at our first Conference, 31 years ago. He is now an honorary member of EDTNA/ERCA.

Key words
Advanced glycation; Carbonyl stress; Uraemic toxicity

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).

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Awareness of anaemia in diabetes patients

K. Jenkins, Anaemia Nurse Specialist, Kent and Canterbury Hospital, UK
J-P Van Waeleghem, University Hospital Antwerp, Belgium

Address for correspondence
Karen Jenkins
Department of Renal Medicine
Kent & Canterbury Hospital
Ethelbert Road
Kent CT1 3NG, United Kingdom

Jean-Pierre Van Waeleghem
Department of Nephrology
University of Antwerp
Wilrijkstraat 10
B-2650 Edegem Antwerpen

Karen Jenkins is an Anaemia Nurse Specialist, at the Kent & Canterbury Hospital, Kent UK. She has been a nephrology nurse for 18 years and has been in her current position since 1997. She is President of the Anaemia Nurse Specialist Association (ANSA) and has presented and published numerous papers at national and international level.

Jean-Pierre Van Waeleghem is a nephrology nurse manger at the University Hospital Antwerp, Belgium. He has been working in dialysis for 37 years. He is a past president of the EDTNA/ERCA and ORPADT (Flemish nurses association). In 1994, he received the Lenin Tolstoy award for his work in Armenia. He has presented and published numerous papers at national and international level.

Key words
Anaemia; Diabetes; Renal Disease; Tiredness

Although the link between diabetes and anaemia has been firmly established in the renal world, patients with diabetes and healthcare workers in this field are clearly failing to recognise many of the common symptoms of anaemia, a key indicator for renal disease. By forging links and instigating an exchange of information, renal health care workers can work with their colleagues in diabetes to raise awareness of the important benefits arising from the early diagnosis and treatment of the anaemia, related to kidney disease.

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Bed-side blind insertion technique for peritoneal dialysis catheters

C. Dequidt, D. Vijt, N. Veys, W. Van Biesen, Renal department, UZ Ghent, Belgium

Key words
Peritoneal dialysis catheter; Catheter placement method; Blind insertion technique; Catheter complications; Catheter survival

Access to the peritoneal cavity is an essential factor for successful peritoneal dialysis. The technique of catheter insertion can influence technique success and patient satisfaction. As compared to conventional surgical laparotomy, a bedside blind insertion technique under local anaesthesia has logistical advantages for the patient, the hospital and the community. This study compares outcomes of both methods in a single centre.

A retrograde analysis of a prospectively collected database on all catheters implanted at the University hospital Ghent between 1/1/1998 and. 31/5/2002 was carried out. During this period, catheters were implanted either by conventional laparotomy (CL) or by a bedside blind insertion technique (BI) under local anaesthesia.

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Citrate Anticoagulation and Adverse Events

J-Y De Vos and R. Hombrouckx (MD), Dialysis Unit, Ronse, Belgium

Address for correspondence
J-Y De Vos and R. Hombrouckx (MD)
AZ Werken Glorieux,
Hogerlucht 6,
9600 Ronse,
E-mail: devosjy@skynet.be

Jean-Yves De Vos completed graduate general nursing studies in 1979 in Gent, Belgium. He has worked in the dialysis field for over twenty years and is presently part time head nurse and part time research nurse. He is a member of the EDTNA/ERCA Research Board and the Journal Club Manager. He has been voted President of the Flemish ORPADT (Flemish National Renal Care Association).

Key words

  • Citrate
  • Heparin intolerance
  • Alkalosis
  • Hypernatraemia
  • High aluminium level

Several patients with heparin intolerance were dialysed with tri-sodium citrate as anticoagulant without acute clinical problems (good tolerance). After some weeks however problems arose: in all patients an alkalosis developed: the pre dialysis bicarbonate level rose progressively from 27 mmol/l to 40 mmol/l. This could be tempered by lowering the dialysis fluid bicarbonate concentration from 37 mmol/l to 25 mmol/l.

A second problem was a progressive rise in pre dialysis sodium level from a mean of 136 mmol/l to 150 mmol/l. Adapting the dialysis fluid sodium concentration from 140 mmol/l towards 132 mmol/l could solve this.

The third problem was a progressive rise in serum aluminium level in patients from 3 microg/l to 38 microg/l. After excluding water, concentrate, dialysis fluid, drug intake, etc & as possible sources, we controlled the aluminium level in the glass bottle containing tri-sodium citrate. We noted the very high value of 35,300 microg/l.

After replacing the glass bottles by polyvinylchloride bags with negligible aluminium content, the serum aluminium levels returned back to normal.

It is known that citrate chelates the aluminium present in the glass of bottles or vials. Our warning is not to be careful when using citrate solutions out of glass containers.

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Depession in Dialysis Patients

*JC. Yucedal, *N. Olmez, *G. Gezen, *F. Celik, **A. Altindag, ***ME. Yilmaz, ****H. Kara

*HD Nurse, Haemodialysis Center of Medical Faculty, **Psychiatrist Dr., Resident, Department of Psychiatry, ***Assoc. Prof. Dr., Department of Nephrology, Dicle University, School of Medicine, ****Assoc. Prof. Dr., Department of Family Practice, Dicle University, School of Medicine, Diyarbakir, Turkey

Address for correspondence
Mehmet E. Yýlmaz.
Dicle Üniversitesi Týp Fakültesi,
Nefroloji BD.
21280 Diyarbakýr 
Call: +90 412 2488001/4320 (hospital)
Fax: +90 412 2488440
Email: memin@dicle.edu.tr

Key words

  • Depression
  • Dialysis
  • Somatic anxiety
  • Suicidal ideas

According to the results of studies in patients who undergo dialysis, especially HD, the most common psychiatric disorder, which causes morbidity and mortality, is depression. Suicide frequently accompanies depression (2,3). According to studies from various countries the prevalence of severe depression is 5-22% and mild to moderate depression is 17.7-25% in patients with CRF who undergo dialysis (2,4). It has been reported in recent studies in the authors' country that 22.9 % of these patients have at least one psychiatric disorder and the most common psychiatric disorder is depression in these patients (1-3).

The purpose of this study was to investigate sociodemographic factors and the prevalence of depression in patients with CRF treated with CAPD and HD in Dicle University Hospital, Turkey.

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).

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Thanks to modern Internet technology, I was able to prepare this message whilst attending to the 15th Conference of the Chilean Association of Nephrology Nursing (SENFERDIALT), which was celebrating its 25th anniversary.

The Conference organisers had asked me to prepare two contributions for the scientific programme, the first one related to the situation of Nephrology Nursing both in Spain and in Europe, and the second one on Quality Standards in Haemodialysis.

While preparing the first contribution I discovered with no surprise that the Chilean, EDTNA/ERCA and Spanish association, SEDEN, have a number of similarities. These include:

  • A long history of continuous development driven by a devoted group of volunteers.
  • The aim of contributing to professional development and renal care improvements.
  • A mature and independent relationship with other sister associations and governmental bodies.
  • A clear vision, which is member-service orientated.

I also discovered the appropriateness of this years EDTNA/ERCA Birmingham conference theme - One Renal World, Many Cultures , where as you know we will be discussing:

  • How different cultures affect the delivery of care and how care is received.
  • Varying treatments and how they are affected by the values of the family and community.
  • The future of our multi-disciplinary, multi-lingual, multi-cultural renal world.
  • Care of staff and open forum.

As we all know this richness and complexity is present in all our Renal Units and is even more important for us a multidisciplinary, multicultural, Association.

You will receive this issue the week before or during the 2003 Conference. This year EDTNA/ERCA is organising its International Conference in Birmingham, United Kingdom and I don' t want to finish this message without mentioning how important this country has been for our Association development.

EDTNA/ERCA was born in the UK. Its first President and Executive Treasurer were English and several Presidents including the first non-nurse President belonged to this country. One of the largest memberships per country is from the UK. This history plus the excellent scientific programme and the hard work of the local committee and Association Executive Committee and other volunteer groups will make the Birmingham Conference an unforgettable one.

Journal Editor.

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European guidelines for blood access

Jan HM Tordoir* and Volker Mickley**
*Department of Surgery, University Hospital Maastricht, the Netherlands and
**Department of Vascular Surgery, Stadtklinik Baden-Baden, Germany

Address for correspondence
Dr JHM Tordoir,
Department of Surgery,
University Hospital Maastricht,
P Debijelaan 25,
6202 AZ Maastricht,
the Netherlands
e-mail: mailto:j.tordoir@surgery.azm.nl

Key words
Vascular access; Guidelines; Haemodialysis; Algorithms

Background. Vascular access for haemodialysis remains the Achilles heel of end-stage renal disease patients, treated by 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.

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

Results. A total of 27 algorithms were developed on preoperative assessment (four including Algorithm sequence overview), four placement of vascular access, three postoperative control and routine management and 16 identification of AV fistula and graft problems and their management. In addition to each algorithm, a discussion on references from the literature has been made with special emphasis on evidence-based knowledge. At the end of each algorithm section, a summary of references was included.

Conclusions. 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 of treating complications by all physicians dedicated to this field of healthcare.

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Evidence Based Practice

JM. Sedgewick, University of Teesside, Cleveland, UK

Address for Correspondence
John Sedgewick,
Director Multi Professional Programmes & Principal Lecturer (Nephrology),
School of Health & Social Care,
University of Teesside,
Tees Valley,
TS1 3BA,

John Sedgewick has worked in renal nursing since 1995 in haemodialysis and transplantation. He is currently Director Multi-professional Programmes & Principal Lecturer Nephrology, University of Teesside. He currently teaches on a wide range of undergraduate and postgraduate programmes. Having gained BSc & MSc in Nursing Science he is currently a Doctoral candidate (Health Services Research) at the University of York. Author of the book Principles & Practice of Renal Nursing, he is currently a member of EDTNA/ERCA Education board involved with accreditation of Nephrology Nursing Programmes within Europe.

Key words
Evidenced Based Nephrology; Research; Systematic Reviews; Clinical Effectiveness

This paper highlights the importance of evidenced-based practice (EBP) and its implications to patient and health professionals working within nephrology. The need to ensure that practice is based upon best evidence should be a concern for all health care professionals. Confusion sometimes surrounds the concept of EBP and the potential impact this may have upon patient outcomes. It is the intention of this paper to firstly demystify the process of EBP highlighting the important factors to be considered in moving towards EBP in nephrology care. Secondly, the paper draws upon a number of well-conducted research studies, which have important implications for nephrology care. These selected examples of best evidence will highlight further where ongoing work could be focused. Whilst there is much published within current literature concerning research within nephrology it is essential that practitioners are encouraged to develop the skills to critically search literature, appraise and evaluate its usefulness in developing appropriate and meaningful evidence to enhance practice and patient care.

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Intravenous administration of epoetin in haemodialysis patients

Jean-Yves De Vos¹ and Luise Upsing²

¹Dialysis Unit, AZ Werken Glorieux, Ronse, Belgium. ²Klinik IV für Innere Medizin, Klinikum der Universität Köln, Cologne, Germany

Address for correspondence
Jean-Yves De Vos
Hogerlucht 6
9600 RONSE

Jean-Yves De Vos, haemodialysis/research nurse, has been working in dialysis since 1979. He has been the secretary of EDTNA/ERCA and is presently a member of the Research Board. He is at present the President of the Flemish National Renal Care Association ORPADT.

Luise Upsing, a nurse with special certification in nephrology, has been working in dialysis since 1983. In 1996, she joined the University Hospital of Cologne, where she became Head Nurse of the dialysis ward in 1997.

Key words
Erythropoietin/administration and dosage; Renal dialysis; Injections, intravenous; Education; Nurse

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.

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Management of vascular access in Europe: Part 2 - A multi centre of complications related to patient's and center's characteristics


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Monitoring parameters of dialysis dose

Kesziovà  A, Kinskà H, Svàrovà B, Nejedlýýy B, Lopot F. General University Hospital, Department of Medicine, Prague  Strahov, Czech Republic

Address for correspondence
Andrea Kesziovà
General University Hospital,
Department of medicine,
Sermirskà 5
169 00 Prague 6 Strahov,
Czech Republic
email akesziova@seznam.cz or f.lopot@vfn.cz

Andrea obtained her nursing qualification from the Nursing School in Ro&##382;nava, Slovakia in 1994. Currently she is a staff nurse in the dialysis unit of General University Hospital, Prague-Strahov, Czech Republic. With eight years of experience in dialysis Andrea successfully completed her post-basic specialisation in nehprology nursing in the Institute for post-graduate studies in health care, Brno, Czech Republic in 1999.

Key words

  • Haemodialysis dose
  • Individualisation
  • Blood flow
  • Cumulative blood volume
  • Kt/V

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.

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Psychological involvement of nurses in front of a terminally sick haemodialysis patient


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Thoughts about biofilm in dialysis water systems

Dr Rolf Nystrand, Bio-TeQ Nystrand Consulting, Malmö, Sweden

Address for correspondence
Dr Rolf Nystrand
Gullbackegatan 12
S-212 30 Malmö
Email: rolf.nystrand@swipnet.se
Mobile phone: +46-(0)70-6925047
Phone: +46-(0)40-499004
Fax: +46-(0)40-499120

Dr Rolf Nystrand holds a PhD in Microbiology and has worked in the medical device (dialysis) and pharmaceutical industry since 1974 in Research and Quality Assurance positions.
Since 1996 he has been a consultant to industry and hospitals regarding hygiene, microbiology, disinfection, sterilisation, education of staff and quality. He has worked with water in different aspects including the restoration of lakes to produce substitution fluid in haemodiafiltration /haemofiltration on line on site.

Key words
Water systems; Haemodialysis; Biofilm; Surface growth

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Validation of physical activity measurement for people on dialysis treatment

S. Wellard, Deakin University, Australia.

Address for correspondence
Sally Wellard, RN, PhD
Professor of Nursing
University of Ballarat
ph: 61 3 53279663
fax: 61 3 53279719

Sally Wellard is currently Director of the Chronic Illness Research Unit at Deakin University, Australia. Following a 20 year clinical nursing career with significant experience in renal care, she took up an academic career maintaining a commitment to developing rigorous nursing based research to support care and improve outcomes for people with ESRD. She has published widely, and serves on a number of scientific committees, editorial boards and advisory committees.

Key Words
Human activity; Validity; Haemodialysis

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.

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Journal of Renal Care
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