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This paper will discuss why nephrology teams should collaborate with primary care teams in delaying the progression of chronic kidney disease (CKD), and explain how they can collaborate to improve the outcomes for patients who eventually need dialysis. The paper will describe the staging of CKD and will discuss evidence-based guidelines for the management of CKD in the community. Practical examples of how a specialist renal nurse can improve communication with primary care and can improve the outcome of patients with early kidney disease will be described. [ABSTRACT FROM AUTHOR]

The discussion was initiated by a paper on the influence of a pre-dialysis education programme on the mode of renal replacement therapy by Goovaerts et al (NDT 2005). Barriers to the uptake of self-care treatment modalities, including late referral, limited availability of treatment options, reimbursement, support from staff and families, the requirement for a helper and the length of the training programmes for home haemodialysis (HD) were discussed by 21 participants from 12 countries. The ‘take-home’ messages from the discussion were that to optimise the uptake of self-care modalities, renal units should try to ensure the all patients who are able to choose are fully informed before starting dialysis, even if they are referred to the unit very late. Offering a wide range of treatment options to new patients, and allowing (or encouraging) home HD without a helper, may also increase the number of patients who start and stay on a self-care modality. It should be possible to provide an acceptable level of training, without compromising on safety, within 3 weeks if the patient is confident with needling. [ABSTRACT FROM AUTHOR]

It is well documented that sexual problems often accompany chronic health conditions, for example: chronic renal failure, hypertension and diabetes mellitus. One of the responsibilities of a nurse is to provide patients with information concerning their health and treatment to achieve optimum outcomes, thus enhancing patients' quality of life. However, the authors observed that the nursing clinical pathways in their practice seldom reflect the attention given to patient's sexuality. This paper aims to confirm the hypothesis that health professionals do not give sufficient care to patient's sexual health and to define the causes. A descriptive study consisted of close-ended questionnaire was employed. The medical and nursing staff of a Nephrology Department were included in the study (92.6% response rate). Professionals' opinions on the importance of patient's sexual health, difficulty in addressing this issue and attitude were explored. Staff's opinion on the importance of patient's sexual health is moderately high. However, 86% admit that they do not give sufficient attention and 92% never initiate to address sexual issues to patients. The results reveal the impediment being in relation to awkwardness and deficient sex education in dealing with this subject. Some staff have expressed other deterring factors. This study confirms that professionals do not render sufficient care to patient's sexual health due to their conservative attitude and lack of skill in addressing sexuality. The authors therefore suggest some ways in helping to bridge this gap. [ABSTRACT FROM AUTHOR]

Prevention in nephrology is only possible with the cooperation of patients and their families. The nurse plays a considerable role in working with patients and is a major player in the team, responsible for follow-up of the patient, where the earliest interventions can help delay and sometimes avoid dialysis. The hypertension clinic is the beginning of a continuum until dialysis. This paper describes three clinics that are managed in the renal service and indicates how they contribute to offering optimal care to a renal population. [ABSTRACT FROM AUTHOR]

Unfortunately, there is still a high mortality rate among patients with end-stage renal disease (ESRD). If the decision is made to activate non-dialytic management of the patient with ESRD, it should be made jointly by the patient and responsible consultant nephrologist after consultation with relatives, the family doctor and other relevant members of the caring team. This paper discusses the establishment of a new renal supportive care service for patients opting not to have dialysis and focuses on the results of a 'death audit' carried out on this patient population. Recommendations for practice resulting from analysis of the audit results include, the use of advance directives, identification and prompt treatment of symptoms, increased staff education, timely referral to the palliative care team and expansion and further integration of the renal supportive care team. [ABSTRACT FROM AUTHOR]

The European Practice Database (EPD) project, developed by the EDTNA/ERCA Research Board, collects data on renal practice at centre level in different European countries. Results presented in this paper focus on the European Practice in Haemodialysis centres from 8 European countries or regions following data collection from 2002 to 2004. These results will enable international comparison in practice and will stimulate further research and the development of new practice recommendations. [ABSTRACT FROM AUTHOR]

This paper focuses on the development of a portal in the World Wide Web (WWW), which captures and locates quality information for patients with chronic kidney disease (CKD). It examines the problems patients face when accessing and understanding information gleaned from Web sites and describes an idea from a Research Board Member to facilitate patient access to quality information. The idea germinated into the development of a patient specific Web site, providing one stop access and links to appropriate CKD information, assessed by patients and health professionals. Collaboration between the EDTNA/ERCA Research Board and CEAPIR the European Federation of Kidney Patients has enhanced the project. [ABSTRACT FROM AUTHOR]

The Paediatric Access Care (PAC) project, organised by the Research Board of EDTNA/ERCA, aimed to study the organisation of paediatric renal care in Europe and to investigate the practice of access care for both haemodialysis (HD) and peritoneal dialysis (PD) paediatric patients. This paper reports on the organisation of paediatric renal care. The majority of paediatric renal care units were located in specific paediatric units of university hospitals. Most of the centres had offered HD, PD and transplantation (Tx) for more than 20 years. Half of nursing staff had qualifications in paediatric and renal nursing. Most of the centres offered an extended multidisciplinary team approach with the family actively involved in the care of the patient. PD and HD were equally used. Automatic Peritoneal Dialysis (APD) was offered as the standard PD treatment in 2 out of 3 centres. The HD schedule mostly utilised was 3 × 4 hours a week. Half of the patients were on the Tx waiting list and one third of registered patients were transplanted in 2004. [ABSTRACT FROM AUTHOR]

This paper reports part of the findings from a larger study reported earlier, the European study on epidemiology and the management of HCV in the haemodialysis population (1). Centres recruited to the larger study were monitored for a further one year observation period to measure and generate a deeper understanding of HCV sero-conversion. From 4724 patients who were studied at the baseline, in 68 centres, only 13 patients were found to have sero-converted. These sero-conversions occurred in 7 hospitals within 5 different countries. Possible routes of transmission and risk factors are described with respect to the individual centres and good practice recommendations based on current evidence presented. [ABSTRACT FROM AUTHOR]

This paper reports the findings from the European Practice Database project (1) providing an overview of transplant practice in Europe and patient selection. From the 276 centres surveyed 25 recorded performing patient transplants across eight different countries. The overall figures indicate that the waiting list for transplants is made up of 38% women and 9% of patients above the age of 65 years. All countries offered pre-transplant counselling and screening and post-transplant follow-up, but the extent to which these activities occurred varied. The waiting/transplant ratio ranged from one in Norway to eight in Slovakia. Differences still exist as a result of country specific policies and legislation regarding transplantation. [ABSTRACT FROM AUTHOR]

The European Practice Database (EPD) project, developed by the EDTNA/ERCA Research Board, collects data on renal practice at centre level in different European countries. Results presented in this paper focus on infection control practice in haemodialysis centres from 8 different European countries or regions following data collection from 2002 up to 2004. The prevalence of hepatitis B (HBV), hepatitis C (HCV), human immune deficiency (HIV) and methicillin-resistant staphylococcus Aureus (MRSA) was studied as well as the use of screening and preventive actions. These results will enable international comparison in practice and will stimulate further research and the development of new practice recommendations. [ABSTRACT FROM AUTHOR]

This paper reports the findings from the European Practice Database project providing an overview of the technical aspects of haemodialysis treatment, comparing practice in Scotland and Belgium. Findings identified that in Scotland almost all centres (95%) employed renal technicians compared to 67% of centres in Belgium. There was also a higher level of technical duties performed by technicians in Scotland compared with Belgium, and marked differences in the disinfection protocols of dialysis machines between the two countries. The study highlights the need for further investigation to discover why technical practice varies so much between the two countries. [ABSTRACT FROM AUTHOR]

This paper describes a study to capture the key roles and activities of nephrology nurses across different countries in Europe. The concept of the study and the need to clarify the activities of the nephrology nurse arose as part of a larger study to develop the European Practice Database (EPD) (1). The Research Board (EDTNA/ERCA) needed to identify key questions that would detect significant differences in the role and responsibilities of nephrology nurses in different countries and monitor the evolution over time of nephrology nursing practice in Europe. It was therefore appropriate to devise a separate small study to generate evidence based questions for the EPD and confirm the reliability and usefulness of the information captured. [ABSTRACT FROM AUTHOR]

This paper describes some of the issues currently influencing thoughts and practice in expanding the use of living kidney donors. One of the challenges facing kidney transplantation is the increasing number of patients with Established Renal Failure (ERF) waiting for a kidney, and the ethical concerns raised as a result of meeting these challenges by the use of living donors. Nephrology professionals play an important role in the education of patients and potential living kidney donors and should be familiar with current issued related to this field. [ABSTRACT FROM AUTHOR]

Chronic dialysis and renal transplantation have been developed over the last three decades of the 20th century. These two forms of renal replacement therapy have revolutionized the fate of children in established renal failure. Yet, chronic dialysis is a serious burden to both the patient and the family and long-term results of renal transplantation are far from excellent. Moreover, both forms of treatment have serious complications, some of them fatal. It is therefore important to highlight what has been achieved in terms of conservative treatment of chronic renal failure. This paper describes in detail the progress made in this field with special emphasis on the great opportunity to slow down progression from chronic renal disease to end-stage renal failure. Renal replacement therapy can wait in many children and should be postponed as long as possible, ideally until they have reached adulthood. [ABSTRACT FROM AUTHOR]

Vascular access recirculation (R) is a well-known cause of decreased dialysis dose. In this paper a new easy protocol for R detection in pre-dialysis derived from the classic Glucose infusion Test (GIT) is introduced. The pre-dialysis GIT (GIT-pre) is based on the glucose (5%, 10 ml) bolus injection directly into the venous needle and on a simultaneous withdrawal from the arterial needle. If the glucose value increases during the glucose bolus, R is present. This new protocol was validated on 29 chronic haemodialysis patients (20 AVFs, 7 CVCs, 2 PTFE grafts), comparing the glucose increase with the classic GIT during dialysis. Only one CVC had R with the blood lines in the normal position (Δglu = 465 mg/dl with GIT-pre and a Δ glu = 186 mg/dl, R = 9.3% with classic GIT) while in the reverse blood line position, all CVCs showed a significant glucose increase (mean GIT-pre Δglu = 195 mg/dl; mean GIT Δ = 140 mg/dl corresponding to a R = 8%). There were 5 AVFs with true R (correct blood lines position) clearly identified by both methods (mean values Δglu = 316 mg/dl with GIT-pre and a Δglu = 390 mg/dl, R = 19.5% with classic GIT). Preliminary results show good reliability of the new protocol in identifying VA R caused either by failing VA with stenosis or by reverse blood lines position. The GIT-pre is a simpler application of the classic GIT useful for testing new VA, new needle positions or CVC performance before starting dialysis. A simpler R test could increase the frequency of the measurements and consequently the power of R in early detection of VA problems. [ABSTRACT FROM AUTHOR]

The quality of dialysis fluids has become increasingly important in the treatment of HD patients. Purified water represents over 95% of its volume. Bacterial and endotoxin content of Reverse Osmosis (RO) water is usually kept under control by bacterial filters, inserted in the distribution departure loop, and by monthly disinfection of the distribution circuit; the simpler the circuit, the better. This paper reports 12 years experience during which Ultraviolet Irradiation (UV) has replaced bacterial filters. To keep the bacterial growth under control in a complex RO water circuit (including a tank and multiple loops) a simple UV lamp was inserted in the departure line. It proved sufficient to keep bacterial count within AAMI norms. Failure of the UV lamp was associated with a rise of up to 500 cfu/ml in the last (fourth week) before routine disinfection. Normal levels were again obtained after replacement of the UV lamp. Six years later, a second UV lamp was added on the return loop. Bacterial counts and endotoxin levels in RO water promptly fell to <1 cfu/ml and <0.125 EU, till today. It is concluded that UV lamps should be favoured over bacterial filters in systems that are not disinfected daily, such as the RO water circuit. The principle of UV irradiation is explained and its advantage over bacterial filters is discussed. Future possible applications of UV are presented. [ABSTRACT FROM AUTHOR]

The management of anaemia of Chronic Kidney Disease (CKD) has progressed significantly during the last decade. Research studies show that effective treatment of anaemia in adult patients with CKD can reduce cardiovascular complications (1,2) slow progression of renal failure (3), and improve quality of life (4). To ensure adult patients receive optimum care, evidence-based practice and recognised guidelines and management strategies are needed to help reduce variations in clinical practice. In 1999 a working party of European Nephrologists developed the European Best Practice Guidelines (EBPG) for Management of Anaemia in Patients with Chronic Renal Failure to address this issue (5). Since the publication of the guidelines in 1999, over 3,000 papers relating to anaemia in CKD, have been published, many of which have significant implications for the practice of anaemia management. To ensure that the most up to date scientific evidence is available to those who manage anaemia in CKD the guidelines were revised in 2004 (6). These guidelines, look at the anaemia management of adults with CKD and do not include guidelines for children. [ABSTRACT FROM AUTHOR]