Authors: Georgios Aperis MD, PhD, Christos Paliouras MD,  Angelos Zervos MD, Antonios Arvanitis MD, Polichronis Alivanis MD, PhD.

Summary: We evaluated the effect of pregabalin in the treatment of uraemic pruritus not due to secondary hyperparathyroidism. Sixteen haemodialysis patients suffering from uraemic pruritus resistant to conventional treatment started on pregabalin 25 mg/d orally. The parameters recorded were age, time on haemodialysis, haematocrit, Ca, PO4, CaxPO4 product, PTH, spKt/V, eosinophil counts and IgE. The effectiveness of pregabalin on uraemic pruritus was evaluated by using Visual Analogue Scale before and after one month of treatment. Visual Analogue Scale consisted of a 10 cm horizontal line scored from 0 (no itch) to 10 (worst imaginable itch). Four patients discontinued treatment due to side effects and therefore were excluded from the study. The mean age of the remaining 12 patients was 61.2±12.8 years and the time on haemodialysis was 38±39.1 months. The haematological and biochemical profile of the patients remained without significant change at the end of the observation period. There was a statistically significant difference between Visual Analogue Scale values before and after the one month treatment period (7.44±2.01 and 1.7±1.31 respectively), p<0.00001. Uraemic pruritus is a common and distressing symptom in patients undergoing haemodialysis. Pregabalin appears to be an effective alternative treatment.

Key words: Haemodialysis, pregabalin, uraemic pruritus

Authors: Sima Noohi, M.D., Mahyar Azar,M.D., Ashkan Heshmatzade Behzadi, M.D. Mohammad Esmaeil Barbati, M.D. Arezoo Haghshenas, M.D. Behzad Amoozgar, M.D. Mehdi Karami, M.D.

Summary: The aim of this study is to compare the sexual function of kidney transplant recipients and ESRD patients receiving haemodialysis in female patients. In the sample population of this study, there were 72 women in the transplant group and 40 women in the haemodialysis group. To test the differences in the quantitative variables between these two groups, an independent sample Student’s t-test was performed. Sexual relationship, sexual function, sexual frequency, and sexual fear in the renal transplant patients are significantly better than haemodialysis patients. Sexual intercourse satisfaction was apparently higher in the kidney recipients than that in the haemodialysis patients. 21 patients in transplanted group described number was 6 (15%) (p=0.03). This study indicated that female kidney transplant recipients experienced a significantly better sexual relationship compared with the ESRD patients receiving haemodialysis.

Key words: Female, End stage Renal Disease, Transplantation, Haemodialysis, sexual function

Authors: Scott Hurton MD. John M. Embil MD. Andrew Reda BA. Susan Smallwood RN. Cathy Wall BPT. Lily Thomson RN.,James Zacharias MD. Mario Dascal MD. Elly Trepman MD. Joshua Koulack MD.

Summary: Limited data are available about disability associated with upper extremity complications in patients who receive haemodialysis for end stage renal disease.  In this study of 123 patients receiving haemodialysis, the mean Disabilities of the Arm, Shoulder and Hand (DASH) score was 31 ± 22 points, indicating markedly greater disability than in a normal population.  Dupuytren’s contracture was the most frequent deformity.  Brachial, radial, and ulnar pulses were present in most upper limbs, but 14 (14%) of 102 patients had poor arterial perfusion pressures.  Diabetic patients had residual or complete loss of protective sensation more frequently than non-diabetic patients.  Motor testing with the index finger abduction and fifth finger flexion tests showed a significantly greater frequency of weakness in diabetic than non-diabetic patients.  In summary, upper extremity disability was noted in haemodialysis patients, including loss of protective sensation and motor strength, both in diabetic and non-diabetic subjects.

Key words: Kidney, hand, disability, neuropathy, weakness, vascular.

Authors: Bronwyn Hayes RN, MHlthSci.  Ann Bonner RN, BAppSc (Nursing), MA, PhD, MCRNA

Summary Job dissatisfaction, stress and burnout are linked to high rates of nurses leaving the profession, poor morale and poor patient outcomes. Haemodialysis (HD) nursing is uniquely characterised by the intense prolonged interaction with patients who require complex, technological care. A review of nine articles found that factors affecting job satisfaction were aspects of nursing care, organisational factors and length of time that a nurse has been working in nephrology nursing. Factors affecting job stress and burnout were due to interpersonal relationships with physicians, patient care activities, violence and abuse from patients, organisational factors and a lack of access to ongoing education.

Key words: Haemodialysis, job burnout, job satisfaction, job stress.

Authors: Muhammad Javaid, Manivarma Kamalanathan, Sui Phin Kon

Summary: Polymyalgia rheumatica (PMR) is a common chronic inflammatory disorder affecting patients over the age of 50. Renal involvement in PMR is extremely rare and very few cases of AA amyloidosis secondary to PMR have been described in literature. We present a case of a patient with history PMR who developed nephrotic range proteinuria and rapidly deteriorating renal function secondary to AA amyloidosis within 18 months of the onset of symptoms of PMR. This case reinforces the association of PMR with secondary AA amyloidosis and highlights the importance of monitoring renal function in patients with PMR.

Key words: Chronic Kidney Disease, Immune System Dysregulation, Infection Control, Standard Precautions

Authors: Karen Pugh-Clarke MSc, BSc (Hons). RN, PhD(c) Nephrology, Sheila Donlon RGN, HDip Infection Prevention and Control, Margaret McCann MSc. BNS (Hons). FFNMRCSI. RGN. RNT, PhD(c).

Summary: This first article, in a three-part CE series on the prevention of infection in patients with chronic kidney disease, focuses on infection susceptibility in this patient population and the application of infection control principles to the renal care environment. The second and third articles in this series will focus on specific aspects of infection control including the prevention and management of blood borne virus and other healthcare-associated infections.

Key Words: Short daily, Haemodialysis, Quality of life

Authors: Rumeyza Kazancioglu MD, Gulbahar Kirikci RN, Muserref Albaz RN, Rukiye Dolgun RN, Serpil Ekiz RN

Summary: The present study evaluates the clinical findings and treatment of continuous ambulatory peritoneal dialysis (CAPD) patients with fungal peritonitis in Istanbul from 2000 to 2010. The clinical records of 15 patients with fungal peritonitis among the total 795 patients were reviewed for the clinical and laboratory data. The mean duration of dialysis from the initiation of treatment until the development of fungal peritonitis was 41.14 months. Fungal peritonitis was the primary episode of infection in 8 patients. In 5 other patients previous intensive antibiotherapy was documented. The isolated mircoboes were Candida albicans in 6, non-Candida albicans in 8 and Aspergillus fumigatus in 1 patient. Tenckoff catheters were removed in all cases and antifungal treatment was given for a minimum of 3 weeks. Two patients died in the hospital due to the fungal infection–while others were transferred to haemodialysis.  This study highlights the importance of removing the catheter and initiating antifungal therapy as soon as possible in cases of fungal peritonitis because it is responsible for high morbidity and mortality.

Key words list: Fungal peritonitis, CAPD, mortality, morbidity, Candida species

Authors: John Sedgewick MSc, MSc (Research), BSc (Hons), RN, RMN, Renal Cert, Cert. ED, RNT, PhD(c) Nephrology; Helen Noble PhD, RN; Tai Mooi Ho RN, RM; Theodora Kafkia MSc. RN. PhD(c); Jean-Pierre Van Waeleghem RN.

Summary: Patients with advanced chronic kidney disease (Stage 5 CKD) have palliative care needs similar to patients with cancer. The decision not to commence dialysis or to withdraw from active treatment can have a profound impact upon all those closely involved in the patient’s care. It is essential that every effort is made to minimise the physical and psycho-social symptoms experienced by patients who require palliative care. Effective team work across professional boundaries and specialities will ensure that patients and their families are provided with maximum comfort during their final days. All members of the healthcare team must strive to ensure patient and family are actively encouraged in the decision-making process surrounding palliative care needs.

Keywords: Chronic Kidney Disease, Palliative Care, Dying, Symptoms, End of life