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System Overload. Dialysis and Transplantation. 37(4): 118-122. April 2008.

This article reports on recent evidence that heavy patient loads for dialysis nurses have a direct impact on nurse well-being, patient safety, and adverse events. The study on which this information is based consisted of a survey of 422 registered nurses working in corporate or hospital-owned hemodialysis units across the United States. Those subjects are a subset of the total of 1,105 nurses who responded to the survey. This article briefly reviews the findings of the study and comments on the implications of those findings. Topics include the use of technicians in dialysis units, the lack of influence in policymaking, patient-to-nurse ratios, occupational burnout, the impact of burnout on patient safety, medication errors and polypharmacy, access-related events, and dialyzer errors. The author concludes by calling for more encouragement in nursing schools for nurses to specialize in nephrology and more involvement of nurses at the policy-making levels of health care management. 1 figure. 1 table. 6 references.

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Why is Peritoneal Dialysis Underutilized in the United States?. Dialysis and Transplantation. 37(3): 90, 111. March 2008.

This article considers the reasons why peritoneal dialysis (PD) is underused in the United States as a form of renal replacement therapy. The authors note that, in other parts of the world, PD is widely used and valued as an excellent form of renal replacement therapy. They consider multifactorial reasons for this lack of use, including the discrepancy in reimbursement for PD versus hemodialysis (HD) in the United States, the lack of training in PD by nephrology fellowship programs, and bias against PD based on inadequate and poorly designed studies comparing HD and PD survival. The authors mention that many physicians believe, mistakenly, that there is an increased risk of infection with PD, that dialysis is inadequate compared with HD, and that the HD population has survival benefits. This article considers and refutes each of these issues. There is a discussion of the role of intense patient education because PD is a patient-directed modality. 10 references.

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Why We Need A Health-Related Quality of Life CPM. Nephrology News & Issues. 22(3): 28-35. March 2008.

This article advocates for a health-related quality of life (HRQOL) clinical performance measure (CPM), a measure that would be used in addition to laboratory tests to assess the quality of dialysis care. The authors provide an overview of HRQOL and discuss how it is measured, why it makes sense to use HRQOL as a clinical performance measure, and the practical steps that need to be taken to implement HRQOL as a CPM. HRQOL is defined as the extent to which patients’ perceived physical and mental functioning are affected on a day-to-day basis by a chronic disease. Assessment tools have been developed that address physical functioning, physical and emotional role limitations, bodily pain, general health, vitality, social functioning, mental health, symptoms/problems, work status, sleep, and the burden of kidney disease. Readers are encouraged to consider the use of the KDQOL-36 assessment, available free of charge online at http://gim.med.ucla.edu/kdqol and in multiple languages. The authors briefly discuss the differences between staff members’ and patients’ perspectives on patient HRQOL. The authors conclude that the time for implementation of a standardized measurement of HRQOL has arrived. A sidebar lists four online quality-of-life resources. 1 figure. 18 references.

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“New Normal”: Life on Dialysis - The First 90 Days: Helpful Advice From People on Dialysis. New York, NY: National Kidney Foundation. 2007. 64 p.

This booklet is designed to help new dialysis patients get through the transition time of their first 90 days on dialysis therapy. Topics covered include adjusting to dialysis, the different types of dialysis available, hemodialysis, peritoneal dialysis, in-center hemodialysis, home dialysis, what to expect in the first few months, emotional and physical health while on dialysis, support systems, managing cardiovascular disease and other comorbid conditions, understanding laboratory test values, employment, travel, and daily living activities. A final section focuses on children who are on dialysis. The booklet is written in nontechnical language, with many supportive quotations from other patients sprinkled throughout the text. Detailed line drawings illustrate some of the sections, including the equipment and techniques used in the different types of dialysis. The booklet concludes with a section of suggested resources for more information, including the National Kidney Foundation (NKF), employment resources, financial and insurance resources, and general readings of encouragement. The booklet includes black-and-white photographs of a variety of kidney patients, as well as blank space for readers to make notes. 9 figures. 18 references.

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2007 Regulatory and Legislative Changes in Review. Dialysis and Transplantation. 36(11): 618-623. November 2007.

This article summarizes some of the recent legislative and regulatory issues that affect renal care. The author reports on several regulations that will have a dramatic impact on the dialysis industry and on hospital-based kidney transplant programs. Topics include anemia drug reimbursement; kidney transplant developments; extended immunosuppressive drug coverage; Stark III regulations, which provide regulatory guidance to the prohibitions against physician self-referrals; and proposed legislation. Tables summarize some of the changes, including to the single payment system, quality incentive payments, and miscellaneous State Children’s Health Insurance Program (SCHIP) provisions. The author concludes that, regardless of the ultimate fate of SCHIP, it is likely that the end-stage renal disease (ESRD) provisions described, or ones similar, will be reintroduced in future legislation. 3 tables.

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AAKP Advisory: Inadequate Hemodialysis Increases the Risk of Premature Death. Tampa, FL: American Association of Kidney Patients. 2007. 4 p.

This brochure, from the American Association of Kidney Patients (AAKP), explains a recently released special advisory on inadequate dialysis. Recent research has revealed that many hemodialysis (HD) patients may not be receiving enough dialysis to prevent uremic symptoms, serious medical complications, or even premature death. The AAKP posted a special advisory to advise and inform patients about the issues concerning the adequacy of dialysis. The brochure answers questions about how to determine what is enough dialysis, individualized doses of treatment, the components of dialysis treatment—time on dialysis, size of dialyzer, and amount of blood flow—urea reduction ratio (URR), how to calculate the URR, the use of a KT-to-V ratio instead of URR as a measure of adequacy, drawing blood samples for blood urea nitrogen (BUN) measurements, the role of proper nutrition, and maintaining adequate vascular access—fistula or graft. The brochure includes a list of questions for patients to ask of their own physician regarding their individual dialysis prescription and adequacy. The brochure includes a wallet-sized card that can be cut out, which lists contact information for the AAKP as well as the basic questions that patients should discuss with their health care providers.

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Affecting KT/V: An Analysis of Staff Interventions. Dialysis and Transplantation. 36(11): 584-600. November 2007.

This article examines current and past literature on the use of the Kt/V standard to determine dialysis adequacy, particularly the staff interventions that may influence this measurement of dialysis adequacy. The authors provide a brief history of how Kt/V was derived to measure dialysis adequacy and present a literature review of published articles on discrepancies in the measurement of dialysis adequacy. The data show that the interventions, complications, measurement, and compliance issues that dialysis staff members deal with daily affect the monthly blood urea nitrogen (BUN) measurements that form the basis for the Kt/V calculation. The author notes that when the dialysis staff begins to consistently work to improve each patient’s dialysis adequacy, dialyze to the patient’s prescription, and use the proper procedures for sampling pre-BUN and post-BUN measurements, the nephrologist will have a stable measure to judge adequacy. Accurately judging adequacy could subsequently result in less overprescribing, cost savings, and decreased morbidity and mortality in the patient population. The author concludes by stressing the importance of dialysis staff, especially nurses, taking a leading role in managing patient care to maximize Kt/V values, which are linked to morbidity and mortality. One section discusses barriers to dialysis adequacy. 5 figures. 15 references.

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Annual Buyers Guide 2007-2008. Dialysis and Transplantation. 36(7): 334-552. July 2007.

This special issue of Dialysis and Transplantation presents the annual buyers’ guide of information to the nephrology community. The buyers’ guide includes nine sections: companies, products, organ procurement organizations, renal transplant centers, associations in the fields of dialysis and renal transplantation, renal-related websites, a list of international dialysis centers that accept traveling patients, a multilingual communications guide, and a referral directory and listing of professional opportunities. The section on companies provides an alphabetical listing of company names, addresses, telephone and fax numbers, email and website addresses, key contact personnel, and brief descriptions of the companies. The products section lists the products and services offered by the companies listed in the earlier section. An advertisers’ index concludes the issue.

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Bon Appetit: Food Choices for Home Hemodialysis. At Home with AAKP. 1(1): 22-24. October 2007.

This article is from a new magazine about home dialysis for patients with kidney disease. In the article, the author offers suggestions for healthy, tasty foods that can be incorporated into the renal diet. The author notes that the home dialysis diet is sometimes less restrictive than the renal diet many patients must follow when on a traditional in-center dialysis schedule. The article begins with a chart that summarizes the different types of home dialysis, from conventional home hemodialysis and nocturnal home hemodialysis to ambulatory and cycling peritoneal dialysis. Some types of home hemodialysis regimens, such as nocturnal home hemodialysis, allow individuals to have a near-normal diet, whereas other regimens, such as conventional home hemodialysis, are much more restrictive. The author discusses the four main points to consider when planning meals each week: calories, protein, sodium, and fluid. The article concludes with two sample menu plans for a day’s meals, for individuals with and without potassium, phosphorus, or fluid restrictions. 3 figures.

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Catheter Climb. Dialysis and Transplantation. 36(9): 470, 472. September 2007.

This article reports on changing trends in the use of central venous catheters (CVCs) in dialysis patients in both the United States and Europe. The increasing use of CVCs means a reduction in the use of arteriovenous fistulas (AVFs), which have been shown to be particularly effective. The authors explore the reasons for the rise in CVC use, including an increase in fistula failures, the aging dialysis population, lack of expertise among surgeons and nephrologists for creating and maintaining AVFs, and changes in reporting practices that impact the statistics. They offer suggestions for ways to reverse this trend, including the use of skilled and experienced nursing, national coverage and reimbursement policies, a change in policies regarding initial catheterization, and, for patients who are poor fistula candidates, the use of grafts rather than catheters. The authors conclude that fistula placement and maintenance require skilled medical and nursing support and appropriate patient selection to minimize the risk of fistula failure and catheter use. 1 table. 1 reference.

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