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Introduction: Nursing care is an essential part of the management of patients undergoing home peritoneal dialysis. The institution of an educational pathway facilitates ease and safety of self-management of peritoneal dialysis (PD) procedures., Aim of the Study: The aim of this study was to evaluate the relevance of a nurse-guided training programme for PD patients., Patients and Methods: A questionnaire regarding quality of life was administered to patients undergoing PD at the Cardinal Massaia Hospital in Asti, Italy. The EQ-5D questionnaire was used with the adjunct of some study- specific questions. Prior research of relevant Pubmed references had also been performed., Results and Discussion: Our data confirm other works in the literature emphasising the central role of nurses during educational processes involving PD patients. The quality of life of these patients improved notably when compared to controls who had not followed an education programme. In fact, a higher average quality of life was reported by patients enrolled in our study when compared to that found in other studies. Nurses involved in our PD educational programme follow international guideline sources., Conclusion: Patient education is a fundamental and on-going part of the process of nursing care and contributes to the well-being, safety, independence and compliance of patients undergoing PD at home.

Background: Mixed diffusive-convective dialysis therapies offer greater removal capabilities than conventional dialysis. The aim of this study was to compare two different on-line, post-dilution hemodiafiltration (HDF) treatments with regard to achieved convective volume and middle-molecule dialysis efficiency: standard volume control (sOL-HDF) and automated control of the transmembrane pressure (TMP) (UC-HDF)., Methods: We enrolled 30 ESRD patients (55.9 ± 14.0 years, 20/10 M/F) in a randomized, prospective, cross-over study. The patients received a 3-month period of sOL-HDF followed by UC-HDF for a further 3 months, or vice versa, using the same dialysis machine. In sOL-HDF, fixed exchange volumes were set according to a filtration fraction greater than or equal to 25%. In UC-HDF therapy, the exchanged volume was driven by a biofeedback system controlling the TMP and its set point in a double loop. Patients maintained their treatment time, dialyzer, blood flow rate, and anticoagulant regimen unchanged throughout the study., Results: Greater convective volumes were achieved in UC-HDF than in sOL-HDF (23.8 ± 3.9 vs.19.8 ± 4.8 L; p<0.001) with high pre-dialysis Ht value (sOL-HDF 34.0 ± 4.5% and UC-HDF 34.0 ± 4.4%; p = 0.91). The average clearance values of ß2m and P were higher in UC-HDF than in sOL-HDF (respectively 123 ± 24 vs. 111 ± 22 ml/min, p<0.002 and 158 ± 26 vs. 152 ± 25 ml/min, p<0.05). Moreover, the UC-HDF mode led to a significantly increased rate of call-free sessions from 88% to 97% (p<0.0001)., Conclusions: This study showed that the biofeedback module, applied to the automatic control of TMP in on-line HDF, results in higher convective volumes and correspondingly higher ß2m and P clearances. By making the HDF treatment more automated and less complex to perform, it significantly reduced the staff workload.

In 2009, 90% of nephrology centers in Lombardy declared to have a ''predialysis'' outpatient department, without, however, specifying its meaning. Research carried out in 2008 among nephrology centers in Piemonte showed how ambiguous this term was. According to the 2007 EDTA-ERA Registry, about 68% of European nephrology centers stated that they had an outpatient department for stage 4-5 CKD patients, but no information was available about the role of patients in the choice of dialysis. It is known that when the predialysis phase is poorly managed, the patient's rehabilitation will be more difficult. Dissatisfaction with dialysis often leads to withdrawal from dialysis, as several registries have shown. For this reason, we created a predialysis course at our center, involving a nephrologist, a nurse, and a dietician. The nephrologist helps the patient choose the most suitable therapeutic strategy, which means that doctor and patient share the responsibility for the treatment choice. The offered options are hemodialysis, peritoneal dialysis, preemptive kidney transplant, and a conservative dietary-pharmacological program. The nurse plans at least 4 meetings: 1) to talk with the patient in order to get to know him or her and his/her family; 2) to provide information about the dialysis procedure and establish the patient's preferences; 3) to clear any doubts about the treatment and deliver a booklet with information about the chosen dialysis procedure; 4) to explain the chosen dialysis procedure; 5) to meet the patient after their preparation for dialysis (vascular access or peritoneal catheter). The dietician manages the dietary programs both for patients who are close to starting dialysis and those on a longlasting conservative program. The predialysis course includes a meeting among all those involved with the patient (nephrologists, nurses, dieticians) to exchange information with the purpose of shared evaluation and decision-making.

Many studies reveal the presence of sleep disturbances in patients with end-stage renal disease (ESRD) undergoing haemodialysis. The objective of this study was to identify the incidence of sleep disturbances in a sample of 112 patients, being treated by a dialysis centre. Patients who fulfilled the inclusion criteria, were interviewed by means of a questionnaire. The average age was 63.97, 79 male (70.5%) and 33 female (29.4%). The principal pathology underlying subjects' ESRD was hypertension (27.6%) and cardiovascular pathologies were the accompanying pathologies most suffered (75.8%). Sleep disturbances were noted in 54 patients (48.2%). These findings confirm the results of the literature, but less daytime sleepiness and nighttime waking occurred with this study group.