Tornay E. Madrid, Spain

This article outlines the methods used to provide, via the use of a manual, information to the parents and kidney-transplanted children. The guide offers information to kidney-transplanted children and their caregivers, with clear instructions, simple vocabularies and attractive drawings or illustrations. With this guide, children and youngsters learn measurements of self-care, know the details of diet, recognize their physical limits and are informed about their necessary medication in order that the medication can be taken with minimal side effects.

José Luis Cobo Sánchez¹, Ana Rosa Alconero Camarero²,María Casaus Pérez³, Mª Ángeles Maza Sota⁴, Carmen Higuera Roldán¹, Raquel Menezo Viadero¹, Rosa Alonso Nates¹.

¹Hemodialysis Unit, Hospital Universitario Marqués de Valdecilla, Santander (Spain); ²Titular Teacher of Surgical-Medicine. Nursing Deparment. Universidad de Cantabria. Santander (Spain); ³Hospitalization Unit. Hospital Universitario Marqués de Valdecilla, Santander (Spain); ⁴Nephrology Laboratory. Hospital Universitario Marqués de Valdecilla, Santander (Spain).

This paper considers a descriptive, cross-sectional and prospective study in hospital haemodialysis (HD) patients, evaluating electrocardiographic changes related to potassium. Pre- and post-HD serum potassium and other electrolyte concentrations were measured, and a simultaneous 12-lead electrocardiogram (ECG) was obtained at the first session of the week. 39 patients were included in the study, 58.9% were women and 41.1% men. The results indicate that the ECG continues being a good tool for early hyperkalaemia detection, and contributing to the estimation of severity.

R. James, The Royal London Hospital, London, UK.

This study considers and compares the environmental aspects arising from the provision of haemodialysis (HD) in the hospital and home setting. Resource items were measured at unit and individual patient level, with unit level items equated with patient level items that could be attributable to individuals. The data was measured in standard units such as hours and number of treatments or apportioned appropriately. With equivalent emissions calculated as CO2 annually per patient for standard HD, the findings indicate that HD in the home offers a net reduction in CO2 emissions per patient annually compared to hospital based HD.

Magda Konings, Evelien Wolters, Michiel GH Betjes. Department of Internal Medicine, Division of Nephrology, Rotterdam, The Netherlands

This paper examines whether the colloid solutions hydroxyethylstarch (HES) 6% and 10% are equally effective as compared to saline alone for the treatment of intradialytic hypotension. Patients being treated with chronic intermittent haemodialysis were divided in two equally sized groups (Group I and Group II). When symptomatic hypotension occurred, patients received either 0,9% NaCl or HES 6%, with the order reversed in month 2. This treatment schedule was repeated in months 3 and 4, but with HES10%. HES solutions and saline were equally effective for the reversal of the intradialytic hypotension, but patients receiving HES10% had a significant lower incidence of recurrent hypotension.

A. Mahon¹ and L. Bennett^2
1Barts and the London NHS Trust, London, UK; ²Oxford Kidney Unit, Oxford, UK

The global burden of chronic kidney disease (CKD) and associated anaemia is substantial. With the increasing numbers of patients that are likely to be affected in the future, approaches are required to improve anaemia management without increasing the workload of renal units. Adopting a multidisciplinary approach, alongside nephrologists, diabetologists, cardiologists, social workers, nutritionists and pharmacists, may allow nurses to detect and treat anaemia earlier in patients with CKD. To reduce the burden on healthcare providers, anaemia management could be simplified by extending the administration interval of ESAs.

Jo Mason¹, Margaret Stone², Kamlesh Khunti², Azhar Farooqi³ & Sue Carr^1
1Department of Nephrology, University Hospitals of Leicester NHS Trust, Leicester, UK; ²Department of Health Sciences, University of Leicester, Leicester, UK; ³The East Leicester Medical Practice, Leicester, UK

Strict blood pressure control reduces the risk of adverse outcomes in chronic kidney disease but is difficult to achieve. To inform the design of an educational intervention for patients with chronic kidney disease and hypertension, focus groups were used to identify key patient issues. Framework methodology was used to analyse data and patient confusion emerged as the core concept. This was both an effect and, in some cases, a cause of the six key themes identified. In people with chronic kidney disease, confusion can lead to a lack of motivation and negative views that need to be addressed through appropriate education and support.

Margaret McCann, Dublin, Ireland.

Collaborative research in the clinical environment ensures that research questions are valued and relevant to health care professionals who are based in the clinical setting. For successful collaboration, research teams need to invest a considerable amount of commitment and energy into team functioning and relationships. 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.

Markus Riegersperger, Gere Sunder-Plassmann. Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Austria

Chronic kidney disease (CKD) and end stage renal disease (ESRD) are severe medical conditions, increasing threats to human health and socio-economic burdens in industrialized countries. The multi-factorial pathogenesis of CKD and ESRD offers various therapeutic interventions: treatment of the underlying disease, anti-hypertensive therapy, glycemic control and anti-diabetic therapy, anti-proteinuric therapy, renoprotection, and life style management.

Paolo Cravedi, MD, Piero Ruggenenti, MD, Giuseppe Remuzzi, MD, FRCP. Department of Medicine and Transplantation, Ospedali Riuniti di Bergamo - Mario Negri Institute for Pharmacological Research, Bergamo, Italy

The 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. Early intervention may be important to maximize renoprotection, especially in diabetics.