Philip A Kalra, MA MB Bchir FRCP MD

Corresponding Author
Philip A Kalra
Consultant Nephrologist and Honorary Senior Lecturer
Hope Hospital
Stott Lane
Salford M6 8HD
UK
Tel: 0044 161 206 5998
Fax:  0044 161 206 5342
Email: Philip.kalra@srht.nhs.uk

Keywords
Angiotensin receptor blockers; Cardiovascular risk; Chronic kidney disease; Diabetic nephropathy; Hypertension; Renovascular disease

Summary
Chronic 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.

ZIONI N. Pediatric Hemodialysis Unit, Shaare Zedek Medical Center, Jerusalem, Israel

Corresponding Author
Naomi Zioni
Head Nurse of Pediatric Hemodialysis Unit,
Shaare Zedek Medical Center.
Jerusalem,
Israel 2006
oritoosh@hotmail.com

Key words
Nutrition; Weight; Children; Growth

Summary
The growing number of infants receiving HD treatment has led to an increased awareness among the nursing staff of the unique and complex needs of children undergoing chronic treatment. As part of the overall treatment, nurses must broaden their knowledge of medical advancements in numerous areas: Increased knowledge in the area of child growth and development and unique formulas and “supplements”.

M. Calic, K. Grego, B. Kersnic, E. Jovanovic, M. Svetlin, A. Kandus, University Medical Center Ljubljana, Slovenia

Corresponding Author
Mirjana Calic
Centre for kidney transplantation
Clinical Centre Ljubljana
Zaloska 7
1000 Ljubljana
Slovenia
Tel: + 386 1 2318 871
Fax: + 396 1 522 22 25
mirjana.calic@kclj.si

Key Words
Kidney transplantation; pregnancy; education

Summary
Reproductive 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.

Polaschek N. DHB Funding and Performance Directorate
Ministry of Health, New Zealand

Corresponding Author
Nick Polaschek
Senior Project Manager/Team Leader
DHB Funding and Performance Directorate
Ministry of Health
DDI: 04 496 2452
Nick_Polaschek@Moh.govt.nz

Key Words
Home dialysis; Patient experience; Compliance; Negotiation 

Abstract
Background - There are many studies about the professional problem of renal patient non-compliance and a number describing the experience of living on dialysis. To date studies have not examined client attitudes toward their therapy.
Objectives - This paper reports a study seeking to describe characteristic attitudes towards their treatment regimen among a group living on home dialysis.
Methods - The study used a critical interpretive methodology, enabling a distinction between the professional viewpoint and the renal client perspective. Twenty home dialysis clients from one renal service in New Zealand were interviewed for an hour each in November 2004 and January 2005. Texts of the taped interviews were analysed to discover the client perspective towards their therapy in this group.
Results - During the initial period of adjustment to treatment many participants discovered their need for treatment by experimenting with the therapeutic prescription. They then used what they had learned about the therapy to alter their treatment regimen in order to maintain, as far as possible, their normal lifestyle. After modifying their therapeutic prescription to suit themselves, participants’ motivation to continue meeting the ongoing demands of the treatment regimen was influenced by their perception of their individual life situation, including their relationships, work and personal attitudes towards life.
Discussion - Health professionals have interpreted renal client behaviour in relation to their therapy in terms of compliance, because effectiveness of treatment depends on their cooperation. From a client perspective their attitudes are better understood in terms of negotiation. Renal clients do not simply follow professional advice but, through a process of negotiation, seek to integrate therapy into their pattern of regular activities to maintain their normal lifestyle. Renal clients’ motivation to meet the ongoing demands of treatment is not related solely to their health status, but is also affected by their general life situation. Understanding client attitudes towards therapy enables nurses to better support people living on dialysis.

Acknowledgements
This study has been fully reported in the Renal Society of Australasia Journal.

I. Tobita & C. Hyde, Graduate School of Medicine
Osaka University, 1-7 Yamadaoka Suita Osaka

Corresponding Author
Itoko Tobita
Doctoral Course in Allied Health Science
Department of Clinical Nursing
Graduate School of Medicine
Osaka University         
1-7 Yamadaoka Suita Osaka
565-0871 Japan
Tel: +81-75-465-4210
itoko0106@yahoo.co.jp

Key words
Quality of life; QLI-H; KDQOL™; Dialysis; End-stage renal disease

Abstract
Findings from quality of life research provide nurses with valuable information for planning care. However, the instrument for measuring quality of life has to be carefully selected to ensure that it assesses accurately the impact on the patients’ lives. The research tools reviewed in this article (QLI-H, and KDQOL™) are well-established instruments that have contributed significantly to understanding issues surrounding quality of life in the end-stage renal disease population. This understanding will lead to improved patient care in the field of nephrology nursing practice.

Duncan C. University Hospital Birmingham NHS Foundation Trust

Corresponding Author
Christopher Duncan
Professional Development/Project Nurse
Renal & Urology Services
University Hospital Birmingham NHS Foundation Trust
Edgbaston
Birmingham B15 2TH
Tel: 0121 472 1311
christopher.duncan@uhb.nhs.uk

Key Words
Hand hygiene; MRSA; Patient information; Patient involvement; Clean Your Hands Campaign

Summary
The purpose of this study was to explore patient opinion about asking healthcare professionals to wash their hands prior to a clinical procedure and to explore if MRSA status and access to patient information about infection control would influence anxiety about asking.
A descriptive survey was undertaken using a semi-structured questionnaire. The questionnaire was distributed to a randomised convenience sample of 185 in-patients across all departments of an acute NHS Trust hospital (response rate 59.4%).
Spearman’s rank order and Kendall Tau-b tests were used to analyse specific correlations.
Respondents were more confident than anxious to be involved in a campaign that asked patients to ask staff to wash their hands. Patients were more anxious to ask if previous admission episodes were fewer, if their knowledge of MRSA was high and if there was less information about infection control available. Less anxiety was associated with patients who had MRSA in the past and the suggestion that staff wore badges saying ‘It’s OK to ask’.

Hadassa Madar¹, Gila Gilad², Elenhoren Eti³, Lina Schwarz⁴

¹Hasharon Hospital, Rabin Medical Center, Petah-Tikva.
²Western Galilee Hospital, Nahariya
³Nephrology Department, Haemek Medical Center, Afula
⁴Nephrology Department, BGU Soroka Medical Center, Beer.

Contact Details
Hadassa Madar, RN, MSc
Department of Nephrology
Rabin Medical Center – Hasharon Campus
7 Keren Kayemet St.
Petah-Tikva 49372
Israel
Tel: +972-3-9372488
Fax: +972-3-9372311
ruthm2@clalit.org.il

Keywords
Common Symptom; Severity rate; Staff standpoints toward Palliative care; Palliative Care

Summary
The 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.

E Witkowski, E Vanstraelen, B De Moor, F Hardy,
Haemodialysis unit Virga Jesse, Stadsomvaart 11,3500 Hasselt, Belgium

Corresponding author
Hardy F.
Haemodialysis unit Virga Jesse
Stadsomvaart 11
3500 Hasselt
Belgium
freddy.hardy@virgajesse.be

Keywords
Palliative; Care plan; Care coordinator; Quality of life

Introduction
Over 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?
In our centre a patient commencing dialysis and not eligible for transplantation, is considered to be in need of palliation. Of course, a dialysis patient can survive many years when being dialysed and death is not always imminent. One cannot consider these patients as really palliative, but they require specialised management (1). This is why the team is not considered to be a palliative care team, but a group of care coordinators with a care plan as a tool to deliver better care (2,3).