By Lesley Bennett

Increasing 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.. 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. 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.

By Paul Bennett

This study explored whether an exercise programme for haemodialysis patients, including the use of a purpose built dialysis exercise machine, would improve quality of life (QoL), nutrition, physical function and biochemical indices.  QoL, and biochemical indices were measured at 6 months and nutrition was measured at 12 months. Physical function was measured at 4, 8 and 12 months. Results showed improvement in physical function tests a decrease in serum phosphate. The QoL health and physical functioning domain improved also.  Conclusions  The development of a structured exercise programme can improve quality of life, physical functioning, PO4 levels and urea clearances of dialysis patients.

By Giorgos Sakkas

Sleep apnoea disorders affect a large proportion of patients with renal failure. However, it is unknown whether body composition and visceral adiposity predispose haemodialysis patients to sleep apnoea disorders.

Forty-one dialysis patients were divided in two groups according to the BMI score.  Sleep disturbances were assessed by a full polysomnography (PSG), visceral adipose tissue (VAT), calculated by computed tomography, the quality of life, assessed by the SF-36, and the body composition, measured by DEXA.  Results showed no PSG parameters were different between the two groups. Only visceral adiposity was correlated significantly with sleep apnoea disorders. Conclusions – BMI and percent of total body fat do not seem to predispose for sleep apnoea disorders. It is the increased fat deposition in abdominal area that plays the pivotal role.

By Gabriella Bordin

This observational study describes the characteristics of the education programmes used in Italian PD-centres, evaluating a possible relationship between education programmes and peritonitis rates. The data were collected by a questionnaire and evaluated with SPSS software. The SPSS programme was used for analyses. 120 dialysis centres took part in the survey. Training occurs in all the centres, while pre-dialysis education, home visits and re-training take place in 38.3%, 50% and 44.2% respectively. Lower peritonitis rates proved to be correlated to these activities rather than to the presence of specialised personnel, to ratio nurses-patients or training time.

By Debbie Sutton

Constipation is an important cause of technique failure and poor dialysis efficiency in Peritoneal Dialysis (PD) patients. A review of patient notes on our unit revealed 43% reported difficulties associated with constipation. 46 patients reported using laxatives. All respondents using laxatives were invited to use a soluble dietary fibre supplement for 4 weeks, followed by dietary advice to see if they could achieve the same effect using high fibre foods.

23 patients entered the intervention stage of the study. 17 succeeded in replacing prescribed laxatives with the fibre supplement. 16 tried to increase their intake of high fibre foods, with 8 of these succeeding in improving their dietary intake of fibre; however only 2 were able to reduce their intake of fibre supplement. The results of the study suggest that a fibre supplement can be as effective as current laxative treatment in preventing constipation, as well as being the preferred choice of patients.

By Alessandra Zamperion

Severe thirst distress is frequent in haemodialysis (HD) patients.  Some studies have noted a positive relationship between thirst and an increased interdialytic weight gain (IDWG). The goal of this explorative study was to describe the perception of thirst and correlated symptoms in HD patients, and verify the correlation between thirst intensity and the IDWG. Data were collected using a questionnaire containing a demographic and a clinical part, the Thirst Distress Scale, and a Visual Analogue Scale (VAS) 0-10 about thirst intensity.  Fluid restriction causes severe physical discomfort and xerostomy. 66% of the respondents declared a thirst level of more than 7 on the VAS scale. The average IDWG was 2,47 kg. The 2 tests did not show a significant difference when correlated with thirst intensity.

By Jane Macdonald

Nephrology nurses play a central and wide-ranging role in renal care. However, they have inadequate time tomanage their responsibilities as patient volume increases due to earlier diagnosis and improved survival, and patient care becomes more complex. The challenge to achieve and maintain target haemoglobin levels with current agents compounds nursing workload.

Early recognition and treatment of anaemia, a multidisciplinary approach and patient management algorithms can improve outcomes and nursing time utilisation. Innovative erythropoietic agents produce stable haemoglobin levels at extended administration intervals, offering time-savings. Such initiatives may allow nurses more time to focus on other aspects of patient care.

By Tami Chayu

The study examinined the need for support groups in nephrology nurses (NN) in Israel. A questionnaire with questions and demographic background information was administered to nephrology nurses in different parts of the country. The findings showed that there is a need for support groups among NN in Israel. Conclusions – It is necessary to organise support groups for nurses in every dialysis unit.

Chaired by Gareth Murcutt

The paper discussed during spring 2007 was a case study report entitled “Hemolysis: A Hidden Danger” published in The Nephrology Nursing Journal. The authors, Elisabeth Harman and Paula Dutka, agreed to follow the discussion and respond to points raised. Sixteen contributors from ten different countries provided insights into the potential causes, symptoms and effects of both acute and hidden haemolysis during dialysis, as well as discussing some of the safety systems that can be used to try and minimise occurrences. The use of blood volume monitoring as a potential method of ‘seeing’ hidden haemolysis was explored as well as some reporting mechanisms and organizational safeguards that are used to manage the risks.