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Caring For the Person on Home Dialysis. IN: Elements of Excellence: A Team Approach to Chronic Kidney Disease Care. New York, NY: National Kidney Foundation. 2008. pp 91-100.

This chapter about caring for the person on home dialysis is from a manual that was developed to support the distinctive specialty practice for chronic kidney disease (CKD) from a multidisciplinary perspective. Clinicians on the CKD team—including nurses, dietitians, dialysis technicians, and social workers—can use this resource as a foundation for education, orientation, and specialty training. This chapter is from the second section of the manual that focuses on practical, clinical applications of the concepts of care outlined in the first half of the manual. Care of the person who chooses home dialysis involves collaboration among the patient and family, primary teams for either peritoneal or hemodialysis, and adjunct teams, including pretransplant team, vascular access team, and, when needed, the palliative care team. The chapter begins with the essential aspects of care and the ideal patient outcomes to be achieved by each patient-centered team. The chapter goes on to discuss collaboration between teams, and the members and roles of the primary team, and of adjunct teams. Most of the information in the chapter is presented in bulleted lists. 9 references.

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Environmental Aspects of Infection Control in the Dialysis Clinic. Nephrology News & Issues. 22(3): 36-41. March 2008.

This article is the second in a three-part series that focuses on how dialysis clinics can improve their management of infectious disease. The author reviews the environmental aspects of infection control in the dialysis clinic. The author notes that the hemodialysis setting presents environmental challenges due to a variety of possible sources of contamination: water, dialysate, frequently touched surfaces, intrinsically contaminated products such as saline and antimicrobial soaps, and extrinsically contaminated products such as multidose vials, refillable soaps, and flushes. In addition, there are multiple patients and staff members following multiple shifts that make standard infection control strategies difficult to maintain. In each area of concern, the author offers specific suggestions for infection control, including the restriction of the use of common supplies, instruments, medication, and trays and carts, as well as proper cleaning and disinfection of surfaces and equipment. The author concludes that the key to preventing infection is adherence to infection control strategies, accomplished by patient and staff education, knowledge, surveillance, and compliance. 4 references.

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Home Hemodialysis in This Millennium: The Return of the King?. Nephrology News & Issues. 22(2): 41-43. February 2008.

In this commentary, the author explains his support of home hemodialysis (HD) as a vital option for patients who need renal replacement therapy. The author notes that, to increase dialysis dose in a practical manner, there need to be radical changes in how or where dialysis is provided. The vast majority of patients still receive in-center HD three times per week, and a decreasing number of patients do peritoneal dialysis (PD) at home. The author stresses that by removing the schedule limitations of traditional dialysis, therapy can be more like the naturally functioning kidney, improving patient well-being and quality of life. The author reviews the changes over the years in the numbers of patients using home dialysis; summarizes the advantages of more frequent dialysis, including blood pressure control, volume control, phosphorus management, quality of life, reduced hospitalization, and increased survival; and briefly considers the issues that need to be addressed before home hemodialysis can truly experience a resurgence, including increased simplicity and patient support, physician awareness, and reimbursement. 1 figure. 1 table. 6 references.

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Home Hemodialysis. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2008. 6 p.

A small but growing number of clinics offer home hemodialysis (HD) in addition to standard, in-clinic hemodialysis. Patients learn to treat themselves at the clinic, working with a dialysis nurse. Training can include a helper and often takes 3 to 8 weeks. Patients return to the clinic once a month to see the nephrologist, dialysis nurse, and dietitian. This fact sheet helps readers understand the option of home hemodialysis as a treatment for kidney failure. Topics include the usual schedule of in-clinic HD, how home HD works, the risks of complications with home HD, the advantages of home HD including flexible schedules, and some barriers to home HD. New, smaller dialysis machines are making HD more practical. People choosing home HD can choose between shorter daily treatments or longer nightly treatments. The fact sheet describes some of the research studies and programs currently underway in this area, including the End-stage Renal Disease program; the Frequent Hemodialysis Network (FHN); the U.S. Renal Data System (USRDS); and the Hemodialysis Vascular Access Clinical Trials Consortium. The fact sheet describes the availability of a patient education series titled the NIDDK Kidney Failure Series. The brochure concludes with the contact information for the National Kidney Foundation (www.kidney.org), the American Association of Kidney Patients (www.aakp.org), Home Dialysis Central (www.homedialysis.org), and a brief description of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 3 figures.

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Importance of Home Visits in Peritoneal Dialysis. Dialysis and Transplantation. 37(4): 132-136. April 2008.

This article reports on a study that assessed the training provided by a dialysis unit to patients who are performing peritoneal dialysis (PD) self-treatment at home. The study included 32 patients––13 women, 19 men; mean age 44.3 years, plus or minus 15.3 years––who answered a training assessment form comprising 31 questions during home visits. The patients’ average number of correct answers was 81 percent. Questions related to feeding, constipation, changing room, peritonitis, infections, medication, and material were those most often incorrectly answered. Infection is one of the primary reasons that patients must return to in-center dialysis or switch to hemodialysis; infectious complications are responsible for up to 6 percent of patient deaths. The authors conclude that lack of information about food to be avoided points to the importance of including a dietitian on the patient care team. Patients focused only on peritonitis as the infectious complication to watch; they had incomplete knowledge about the symptoms of and how to prevent place-of-exit and tunnel infections. The authors stress that patient training, in the home, should be repeated and tested at predetermined intervals. A chart reprints the training evaluation form used in the study. 1 table. 12 references.

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Infections in Dialysis Patients. Nephrology News & Issues. 22(2):48-59. February 2008.

This article reviews the problem of infections in dialysis patients, focusing on the causes of these infections and strategies to counter their negative effects. The authors remind readers that maintenance dialysis patients are at increased risk for infection due to well-defined immune deficits that are caused by the uremic state. These immune deficits in turn lead to increased rates of bacterial infections, particularly bloodstream infections and pneumonia. The authors discuss bloodborne pathogens of particular concern to patients on hemodialysis, notably hepatitis B, hepatitis C, and hepatitis D; HIV and AIDS; bacterial and fungal infections, particularly methicillin-resistant Staphylococcus aureus (MRSA); vascular access-related infections; and infections associated with water, dialysate, reuse, and dialysis machines. For each, the authors review transmission, host susceptibility, prevention, and infection control strategies. The article concludes with a list of 12 specific strategies that all dialysis facilities should consider implementing: vaccinate staff and patients; use catheters only when necessary, prefer fistulas or grafts; optimize access care; target the pathogen; access the experts; use local data; be wary of vancomycin use; treat infection, not contamination or colonization; stop antimicrobial therapy as soon as possible; follow infection control precautions; practice hand hygiene; and incorporate patients into access care and infection control measures. 21 references.

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Pregnancy and Successful Full-Term Delivery in a Patient on Peritoneal Dialysis: One Center’s Experience and Review of the Literature. Dialysis and Transplantation. 36(8):438-444. August 2007.

This article presents the case of pregnancy and successful full-term delivery of a 32-year-old woman on peritoneal dialysis due to chronic tubulointerstitial nephritis secondary to vesicoureteral reflux. The patient already had a functioning arteriovenous fistula (AVF), which was created before she was started on continuous ambulatory peritoneal dialysis (CAPD). The patient’s pregnancy was discovered when she was 10 weeks pregnant; the patient, her partner, and physicians agreed that the pregnancy would continue with the patient on CAPD for as long as possible under close supervision and would change to hemodialysis (HD) if the need arose. The authors describe the patient’s care throughout the pregnancy, including the monitoring while hospitalized in the nephrology ward from the 28th week to the end of her pregnancy. Topics include the patient’s weight changes, erythropoietin requirements, medications, delivery, postdelivery management, and care of the newborn. The authors conclude with a discussion of this case and a review of the related literature. They stress that this article was not written to encourage patients with end-stage renal disease (ESRD) to become pregnant, which is still a risky undertaking; rather, to emphasize that if the parents very strongly desire a child or if the pregnancy is accidental but the patient wants to continue to term, a pregnancy can be managed effectively. 4 figures. 45 references.

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Prevention of Sudden Cardiac Death in Dialysis Patients: A Nephrologist’s Perspective. Dialysis and Transplantation. 37(4): 124-129. April 2008.

This article presents the nephrologist’s perspective on the prevention of sudden cardiac death in dialysis patients, an unfortunately common event in the dialysis population. The author stresses that prevention of sudden death can be accomplished in this group by proper management of cardiac disease and attention to dialysis treatment. The proper usage of medications such as ACE inhibitors and beta blockers is likely to decrease the risk of sudden death, yet these medications are underused in the dialysis population. The author discusses dialysis treatment as a cardiac stress, the appropriate management of dialysate potassium, and volume shifts occurring during dialysis. The author calls for the development in each dialysis center of a systematic method to identify risk factors for sudden death, institute appropriate treatment, and monitor outcomes. Most of the systems currently in place concentrate on the dialysis procedure, with most time in dialysis rounds covering dialysis adequacy, calcium phosphate metabolism, anemia, and adjustment of dry weight. The evaluation of cardiac risk factors must be incorporated into this system of patient care. 29 references.

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Renal Resource and Buyers Guide 2008. Nephrology News & Issues. 22(5): 4-62. 2008.

This special issue of Nephrology News & Issues offers the annual renal resources and buyers’ guide, a comprehensive directory of products and services available for the renal care community. The guide has two sections: a products-and-services listing, arranged alphabetically by category, with company contact information provided; and the company directory, an alphabetical listing of the companies included. The company directory lists the name and address of the company, its website address, and a brief description of the products or services offered. The products-and-services categories include blood analysis devices, blood lines, blood pressure monitors, business support services, CAPD equipment, catheters, CCPD equipment, chairs, clothing, concentrate, dialysis machines, dialyzers, diet and nutrition, disinfectants, dry mouth products, equipment maintenance and repair, facility planning, fistula needles, hemodialysis supplies, hemofiltration supplies, heparin, home hemodialysis, immunosuppressives, implantable infusion devices, insulin, medical waste disposal, monitoring devices, needlestick protection, patient education, office supplies, peritoneal dialysis, pharmaceuticals, plasmapheresis, rehabilitation and exercise, reprocessing, scales, shunts, software, training, sterilants, syringes, ultrasound, vascular access, and water testing and treatment. The guide includes a list of nephrology conferences for 2007, a handy list of websites for renal associations, and an information page on how to use the journal’s website, www.nephronline.com.

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Starting Dialysis: What You Need to Know. Kidney Beginnings. 7(6): 10-14. May 2008.

This article reviews the basic information that patients just beginning dialysis need to know. The author reviews the five stages of chronic kidney disease (CKD), which are based on a common measure of kidney function called the estimated glomerular filtration rate (GFR). The article advises patients with stage 4 CKD to meet regularly with a nephrologist and health care team for monitoring and treatment of complications of CKD, such as anemia, bone disease, malnutrition, acidosis, and decreased sense of well-being; patients at this stage must follow diet, medications, blood pressure control, and lifestyle recommendations. The article lists and describes the types of kidney replacement therapy available for patients with stage 5 CKD, including home or in-center hemodialysis, peritoneal dialysis, kidney transplantation, or choosing nontreatment. Other topics include the time needed for each type of kidney replacement therapy, the different types of vascular access used for hemodialysis, the types of peritoneal dialysis (PD), preparation for PD, and understanding the option of declining dialysis. Charts summarize the advantages and disadvantages of each type of kidney replacement therapy. The article concludes with a brief description of some additional instructional materials available from the American Association of Kidney Patients (AAKP) website (www.aakp.org). 4 figures. 4 tables. 5 references.

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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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Changing the Course of PD: The Provincial Peritoneal Dialysis Joint Initiative. Nephrology News & Issues. 22(2): 36-40. December 2007.

This article describes the Provincial Peritoneal Dialysis Joint Initiative, a Canadian program designed to support the use of peritoneal dialysis (PD) in patients needing dialysis. The initiative calls for increasing the use of PD in Ontario from 17 percent to 30 percent of the dialysis population by 2010 and promoting integrated delivery of PD services throughout Ontario. The initiative has two primary goals: to remove the barriers to increased PD use in the province within a coordinated, quality, and cost-efficient accessible chronic kidney disease (CKD) system that covers the continuum of services for patients; and to provide the necessary tools and techniques to support and guide the standardizing of PD processes and patient care. The author outlines the three-phase implementation plan, summarizes the key core service components that need enhancements or monitoring, and explains why he does not support the conclusions and approach the coordinating committee advocates. The author focuses on the problem of emphasizing PD to the detriment of efforts to increase daily home hemodialysis, as well as the unrealistic goals of achieving 30-percent coverage in such as short period of time. 16 references.

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Classes Help Patients Manage Depression. In Control. 4(2): S2. June 2007.

This brief newsletter article provides information about depression in patients who are undergoing dialysis treatments and how it can be managed with group classes. The author describes a 6-week pilot program of classes used in the dialysis clinic at the University of South Florida, in Tampa. The article reports on patient enrollment, the program itself, and the positive results experienced by the patients who completed the series of classes. The class content focused on education about the biological components of depression, psychotropic medications, and cognitive-behavioral techniques. A comparison of patients’ self-reports before and after the series of classes showed a significant decrease in depression; a control group that did not attend the classes showed an increase in depression scores over the 6-week period. 1 figure 2 references.

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Clinical Indicators and Preventive Health. American Journal of Kidney Diseases. 49(1): s111-s128. January 2007.

End-stage renal disease (ESRD) patient complexity poses many challenges for providers, public health officials, and policy makers. This chapter on clinical indicators and preventive health in this patient population is from a special supplemental issue of the American Journal of Kidney Diseases that presents excerpts from the 18th annual report from the U.S. Renal Data System on the ESRD program in the United States; data through 2004 is included. The Annual Data Report (ADR) also presents information on patients with chronic kidney disease (CKD) and assesses care of at-risk populations and international comparisons of ESRD. This chapter examines progress toward guidelines set by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (K-DOQI) and toward other targets for clinical care. The authors look at trends in vascular access use and in access events and complications, at diabetes care, and at patient adherence to prescription drug therapy. The chapter includes figures on anemia treatment and EPO resistance, and anemia management. The chapter concludes with data on the use of preventive care—glycosylated hemoglobin testing, lipid testing, and vaccinations—in the ESRD population as a whole. 57 figures.

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Comorbid Diseases in Patients on Dialysis: The Impact on Anemia. Nephrology Nursing Journal. 34(01): 72-75. January-February, 2007.

This continuing education article considers the impact of comorbid diseases on anemia in patients on dialysis. The author notes that patients who are on dialysis frequently present with a multitude of comorbid diseases. These diseases include hypertension, coronary artery disease, congestive heart failure, diabetes mellitus, cardiomegaly, left ventricular hypertrophy, peripheral vascular disease, peptic ulcer disease, cellulitis or gangrene, gastrointestinal bleed, and cancer. Many of these conditions can either directly aggravate pre-existing anemia, or lead to acute or chronic inflammatory or infectious conditions that can lower hemoglobin levels. Awareness of these conditions and their compounding effect on anemia can help nurses when interpreting the results of longitudinal trends in hemoglobin. The author concludes that management of these patients requires an individualized approach to assess for the presence of multiple conditions that may be affecting hemoglobin levels and to adjust therapies, as appropriate, to minimize the impact on anemia-related outcomes. 3 tables. 12 references.

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Cost Associated With Home Dialysis. At Home with AAKP. 1(1): 12-13. October 2007.

This article is from a new magazine about home dialysis for patients with kidney disease. In the article, the author considers the costs involved in home dialysis, noting that both in-center and home dialysis options are covered by Medicare, Medicaid, and many private insurers. Basic supplies, including dialyzers, lines, needles, tape, gauze pads, dialysate, home scale, and laboratory supplies for home dialysis are covered by insurance, just as they are in a dialysis clinic. However, some out-of-pocket expenses may be incurred, notably water system revisions and electrical connections. Other costs may include storage area, shelving, increased waste disposal due to used lines and equipment, a reclining chair, telephone costs, and assistance from a home helper. A brief section notes that for home peritoneal dialysis, few additional expenses are incurred.

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Costs of CKD and ESRD. American Journal of Kidney Diseases. 49(1): s205-s222. January 2007.

This chapter on costs is from a special supplemental issue of the American Journal of Kidney Diseases that presents excerpts from the 18th annual report from the U.S. Renal Data System on the ESRD program in the United States; data through 2004 is included. The Annual Data Report (ADR) also presents information on patients with chronic kidney disease (CKD) and assesses care of at-risk populations and international comparisons of ESRD. This chapter addresses the economics of caring for patients with ESRD and CKD. Figures of overall costs are followed by actuarial tables and related figures on components of Medicare Part A and Part B costs, and by a summary of ESRD program expenditures. The authors update the annual data on per person per year costs, present comprehensive data on components of care, and show costs for vascular access procedures. The chapter concludes with data on Medicare risk (Medicare Advantage, Part C) patients. 53 figures. 3 tables.

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Depression and Dialysis. In Control. 4(2): S1, S4. June 2007.

This newsletter article provides information about depression in patients who are undergoing dialysis treatments. The author considers the different rates of depression reported in people with dialysis, focusing on four factors that may result in varying estimates of prevalence: different screening tools, different medical professionals, different cultural values, and different timing. The article goes on to recommend that health care providers and patients focus on the level of depressive symptoms and their impact on health, mortality, and quality of life, rather than on diagnosing clinical depression. A final section discusses the importance of identifying and treating depressive symptoms, as they have a negative impact on patient outcomes and quality of life. The author notes that screening tools are useful to identify patients who might benefit from help, such as medications that can improve symptoms. 11 references.

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Depression and Kidney Disease. In Control. 4(2): P1, P4. June 2007.

This article provides information about depression in patients who have kidney disease, particularly those who being treated with dialysis. The author outlines common symptoms of depression, encouraging readers who experience these symptoms for longer than 2 weeks to consult with their health care provider for help. The article goes on to stress that depression can be treated successfully, usually with medications or counseling, or both. The author suggests that patients consider using a home form of dialysis to help ease depression and experience a better quality of life. A final section offers ideas for contacting support groups and visiting websites for more information. A five-question quiz is included for readers to test their knowledge about depression and diabetes; the answers are provided elsewhere in the newsletter issue. 3 references.

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Dialysis and PKD Patients: An Analysis. Nephrology News & Issues. 21(9): 36, 37. August 2007.

This article focuses on the treatment of patients with polycystic kidney disease (PKD) before the need for renal replacement therapy and during chronic dialysis. The authors discuss the complications of PKD, including renal pain, hematuria, and renal infection; the extrarenal manifestations of PKD, including gastrointestinal involvement, hepatic synthetic dysfunction, cardiac valve abnormalities, hypertension, and brain aneurysms in patients with a strong family or personal history of same; the use of heparin in these patients; the use of dietary sodium restriction, diuretics, and antihypertensive medications used to control volume and blood pressure; the role of remaining kidney function, even in patients who require dialysis to maintain health; patient candidacy for dialysis; the decision between home dialysis versus in-center care; the choice between hemodialysis and peritoneal dialysis; and the importance of adequate nutrition to decrease hospitalizations, improve survival, increase independence, and improve sense of well-being. The authors note that PKD patients are generally good candidates for survival and have a survival advantage compared with patients with end-stage renal disease (ESRD) from other causes.

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Dialysis Care Clinical Handbook. New York, NY: National Kidney Foundation. 2007. 156 p.

This clinical handbook summarizes the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines and recommendations from the 2006 updates regarding hemodialysis adequacy, peritoneal dialysis adequacy, vascular access, anemia in chronic kidney disease (CKD), and cardiovascular disease in adult dialysis patients. The handbook provides a practical strategy for applying the statements and recommendations from the KDOQI in a real-world setting. Specific topics covered include planning for dialysis, initiating dialysis, monitoring dialysis adequacy, quality assurance, patient education, measuring peritoneal membrane function and ultrafiltration volume, preserving residual kidney function, maintaining euvolemia, family and caregiver education, preparation for permanent hemodialysis vascular access, treatment of vascular access complications, identifying patients with anemia in CKD, cardiovascular disease evaluation at initiation of dialysis, vascular heart disease, cardiomyopathy, dysrhythmia, peripheral vascular disease, the management of cardiovascular disease in patients on dialysis, the role of external defibrillation, and the management of cardiovascular risk factors, including smoking, dyslipidemia, and physical activity. The guidelines and recommendations in each section are organized according to the way a patient presents and thus do not follow the numerical sequence of the guidelines. All guideline and recommendation statements, tables, graphs, and figures in each section are identified by the guideline or recommendation number for easy cross-referencing. Clinicians are referred to the full guidelines and recommendations for more detailed analysis of the available data. Readers are referred to the KDOQI website at www.kdogi.org for references. 12 figures. 41 tables.

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Dialysis Patients’ Need for Protein. In Control. 4 (1): S1,S4. March 2007.

This newsletter article focuses on the importance of protein in the diet of patients who are on dialysis. The author notes that protein-energy malnutrition (PEM) is a common problem in people on dialysis and may be due to loss of appetite, protein catabolism caused by dialysis, chronic inflammation, and other reasons. Dialysis patients need more protein than the average healthy adult because they lose protein during dialysis and because kidney disease alters the body’s ability to use and process amino acids, the building blocks for muscles and healthy cells, organs, and bones. The article briefly reviews the most recent version of the KDOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure and discusses the realities of meeting these goals in the real world. Comprehensive nutritional counseling remains the intervention most recommended to help improve nutritional status. Individualized sessions with a dietitian can help identify the many factors that may be interfering with the patient eating enough protein. These factors may include nondialysis-related issues such as dental problems, depression, low-protein ethnic food preferences, or lack of funds. A final section considers the role of increased dialysis treatments to improve nutritional status. 9 references.

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Directory of ESRD Network Organizations 2007. Midlothian, VA: Forum of ESRD Networks. 2007. 54 p.

This 2007 Directory lists all the end stage renal disease (ESRD) network organizations, as well as the executive directors, chairs, review board chairs, and ESRD-related staff for Medicare and Medicaid services. The document lists Network office and staff information, including names, contact information, and email addresses for the 18 Networks: ESRD Network of New England, Inc.; IPRO: CKD Network for New York, Inc.; TransAtlantic Renal Council; ESRD Network 4, Inc.; Mid-Atlantic Renal Coalition; Southeastern Kidney Council, Inc.; FMQAI: The Florida ESRD Network; Network 8, Inc.; The Renal Network, Inc.; Renal Network of the Upper Midwest, Inc.; Heartland Kidney Network; ESRD Network Organization No. 13; ESRD Network of Texas, Inc.; Intermountain ESRD Network, Inc.; Northwest Renal Network; Western Pacific Renal Network, LLC; and Southern California Renal Disease Council, Inc. The document also includes sections on special projects, dialysis organizations, renal-related organizations, and the ESRD Forum Board of Directors. The volume is spiral-bound for ease of use.

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Double-Digit Growth in '07 Seen in Midsized Chains. Nephrology News & Issues. 21(8): 42-44, 46, 48, 50. July 2007.

This article reports on the growth of the renal care provider industry. The author briefly reports on some general trends, noting that growth has been minimal among the largest dialysis chains and most of the growth has come from the midsized dialysis chains, those with 3,500 patients or less. While all the dialysis chains in the survey, with the exception of one, showed some growth in 2006–2007, most are showing that growth in the hemodialysis market. Only one provider, Satellite Healthcare, had a peritoneal dialysis patient population in the double digits (17.7 percent). The author reports data from a ranking of the 10 largest dialysis chains in the United States. The bulk of the article consists of profiles of these 10 dialysis chains. For each entry, the author provides the name, address, contact information, number of clinics, number of patients, a map of the chain’s coverage area, and a brief description as provided by the chain. The 10 chains included are: Fresenius Medical Care North American, DaVita Inc., Dialysis Clinic Inc., Renal Advantage Inc., DSI Renal Inc., American Renal Associates Inc., Liberty Dialysis LLC, Satellite Healthcare Inc., U.S. Renal Care Inc., and Dialysis Corporation of America.

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End Stage Renal Disease Briefing Book For State And Federal Policymakers: A Guide to Kidney Disease Awareness And Education. Revised ed. Pitman, NJ: American Nephrology Nurses Association. 2007. 19 p.

This booklet provides basic information about end-stage renal disease (ESRD) for state and federal policymakers, offering an overview of kidney disease awareness and education. The booklet includes 14 chapters: chronic kidney disease (CKD) and ESRD, diabetes and CKD, hypertension and kidney disease, anemia and CKD, bone disease from CKD, current modalities for treating CKD, kidney transplantation, vascular access for dialysis, a blueprint of a typical dialysis facility, a typical day in the life of a nephrology nurse, the advanced practice nurse, Medicare payment policies, CKD resource websites, and the American Nephrology Nurses’ Association (ANNA). Readers are referred to the ANNA website for position statements, health policy agendas, resources and tools, and ESRD activities (www.annanurse.org). 10 figures. 1 table. 15 references.

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ESRD Providers. American Journal of Kidney Diseases. 49(1): s191-s204. January 2007.

The growing numbers of end-stage renal disease (ESRD) patients and dialysis units has been associated with a dramatic expansion of free-standing, for-profit providers, and approximately 70 percent of units are now for-profit. This chapter on ESRD providers is from a special supplemental issue of the American Journal of Kidney Diseases that presents excerpts from the 18th annual report from the U.S. Renal Data System on the ESRD program in the United States; data through 2004 is included. The Annual Data Report (ADR) also presents information on patients with chronic kidney disease (CKD) and assesses care of at-risk populations and international comparisons of ESRD. This chapter focuses on ESRD providers and the provider community. Figures describe provider growth, provider compliance with care guidelines, and differences in the provision of preventive care. Additional analyses look at anemia management by unit type and affiliation. The authors also present data on Bayesian hospitalization and mortality ratios, looking at how these ratios differ by unit affiliation. 40 figures.

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Evaluating Patients Perceptions of End-Stage Renal Disease. Nephrology News & Issues. 21(6): 44-49. May 2007.

This article reports on a study undertaken to evaluate patients’ perceptions of end-stage renal disease (ESRD). The authors note that the problem of noncompliance to hemodialysis is a pervasive problem in the renal community and is characterized by missed and shortened treatments. They approach this problem by considering ways to identify the patients’ unique needs and to then incorporate those needs into the delivery of dialysis care, in hopes of increasing patient adherence to treatment. The social workers at the University of South Florida Dialysis Center created and implemented a questionnaire that was designed to find out patients’ confidence in and perception of success levels of specific aspects of treatment. The participants were 54 patients (n = 27 males), ranging in age from 22 to 86, with a mean age of 51. The majority of patients, 70 percent, were African-American, followed by 13 percent Caucasian and 11 percent Hispanic. Medication, diet, fluid restrictions, and treatment were addressed separately. Diet represented the prescribed treatment regimen that patients felt the least successful with; fluid was the next area of treatment that patients where felt minimal success. The authors conclude that the implications of this survey are that patients’ perceptions do not coincide with their perceived self-efficacy. Although patients’ responses indicate that they are aware of the importance of adhering to treatment and possess the self-confidence to successfully carry out treatment regimens, success may be limited due to their degree of noncompliance. The authors conclude with a brief discussion of the study limitations and the implications of the results for interdisciplinary health teams who are working to improve patient adherence to treatment regimens. 5 figures. 3 tables. 8 references.

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Expecting the Worst: How Disaster Management is Taking the Kidney Community by Storm. Nephrology News & Issues. 21(10): 44, 46, 50. September 2007.

This article reviews increased attention to disaster management in the kidney community. Partially stimulated by the experiences after Hurricane Katrina, disaster preparedness protocols are being established and reviewed by dialysis centers and other providers of medical care. The author notes that without power and clean water, the basic requirements for dialysis are not possible. The author shares the disaster management protocol used at the Fresenius Medical Care centers, nearly 100 of which were affected by Hurricanes Katrina and Rita. Their protocol includes contracts with generator companies, water companies, and gasoline companies, and the use of a patient disaster preparedness hotline. The article briefly describes the work of the Kidney Community Emergency Response (KCER) Coalition, a group working to minimize disruption to dialysis and transplant services in emergencies. KCER’s website is at www.KCERCoalition.com. The author concludes by reminding readers of the importance of individual patient preparation for emergencies. One sidebar considers whether non-clinic-based dialysis would be a better option in disaster-prone areas. 3 figures.

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Experience and Evidence: Is There Enough to Support Funding Daily In-Center Dialysis?. Nephrology News & Issues. 21(12): 42-47. November 2007.

Recent evidence has demonstrated the health benefits of short daily hemodialysis (sDHD) sessions at home. This article considers whether there is enough evidence to support the funding of in-center dialysis undertaken on a daily basis, rather than the traditional schedule of three times weekly. The authors describe the Humber River Regional Hospital in Toronto, Ontario, Canada, which has an in-center daily dialysis program that offers services to 31 patients. They discuss the experiences of patients, the challenges for the health care team, and funding issues. Although the increased obligation of traveling daily to the dialysis center seems overwhelming, patients report there is a net gain in hours of productivity and well-being. sDHD has been shown to result in improvements in blood pressure and cardiac function. The authors conclude that although daily hemodialysis at home has a better financial and social benefit profile, daily in-center dialysis appears to be a good option for older and frailer patients. Renal providers are encouraged to advocate for funding for this modality that could eventually provide for the best outcomes with the lowest overall expenditures of public dollars. 11 references.

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Feasibility of Using a Personal Digital Assistant to Self-Monitor Diet and Fluid Intake: A Pilot Study. Nephrology Nursing Journal. 34(1): 43-48. January-February, 2007.

This continuing education article considers the feasibility of using a personal digital assistant (PDA) to self-monitor diet and fluid intake in people on hemodialysis therapy. The authors note that patients are often provided with lists of foods to avoid, alternative cooking strategies, or suggestions on how to improve food flavor, but the day-to-day implementation of the complex diet is challenging for patients. The authors conducted a pilot study with three patients on hemodialysis who self-monitored diet and fluid intake for 12 weeks with a PDA. The intervention was delivered as intended and the pilot study demonstrated that patients on hemodialysis can successfully learn to use a PDA to self-monitor their diet and fluid intake. However, the existing market product chosen for the study had several problems related to usability that would have to be addressed for this chronically ill population before proceeding to a formal test of effectiveness. A posttest with which readers can qualify for continuing education credits is appended to the article. 4 tables. 19 references.

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Home Dialysis Was Right For Me! At Home with AAKP. 1(1): 10-11. October 2007.

This article is from a new magazine about the use of home dialysis for patients with kidney disease. In the article, the author shares the experience of one patient who chose home dialysis for his kidney disease, which occurred secondary to diabetes. As a registered nurse, the patient, Keith Sloan, knew that hypertension and diabetes were leading causes of kidney disease. Despite support from his family and workplace, Keith found that the combination or working and doing in-center dialysis were too difficult to maintain. He and his wife, also a nurse, learned about home hemodialysis and implemented it as the standard of his treatment. He describes the adjustments to his new schedule, the benefits of home hemodialysis in terms of energy level and lifestyle, and his eventual treatment with a kidney transplant. A final section describes how Keith and his wife are speaking to kidney patient groups about home dialysis and its benefits. The article is illustrated with full-color photographs of Keith and his wife on a sailboat. 1 figure.

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Home Dialysis: A Fresh Look at Reimbursement Methods. Nephrology News & Issues. 21(3): 43-47, 52. February 2007.

Recently renewed interest in home dialysis as a method of kidney replacement therapy has also increased the confusion of clinic administrators who have to report for reimbursement for home dialysis under Method I and Method II. This article looks at which patients are affected, what home dialysis Method selection means, and how some dialysis programs use Method selection to improve the bottom line of the home program. Methods I/II apply only to home dialysis patients who have Medicare. Methods I/II refer to how a home dialysis patient gets supplies and equipment and also refers to who will be billing Medicare. Under Method I, the dialysis program provides dialysis equipment and all the supplies needed for dialysis, whether hemodialysis or peritoneal dialysis. Nursing, dietary, and social work support are included, just as they are for an in-center hemodialysis patient. Phone calls and periodic home visits are also included. Under Method II, a separate supplier provides dialysis equipment and all the supplies needed for dialysis. The supplier maintains the equipment and arranges for and pays for antibiotics taken at home for peritonitis or catheter infection. Nursing, dietary, and social work support are still provided by the dialysis unit under Method II. The author walks readers through the process that can be used to determine which Method will help control costs to the dialysis facility. Readers are referred to the Cardiovascular Risk, Blood Pressure, and Kidney Damaged-stage renal disease calculator on the Centers for Medicare and Medicaid Services website to help calculate the patient-specific rates (www.cms.hhs.gov). 3 figures. 7 references.

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Home Hemodialysis Fact Sheet. Pitman, NJ: American Nephrology Nurses Association. 2007. 4 p.

This fact sheet from the American Nephrology Nurses' Association (ANNA) provides information about patients who are undergoing home hemodialysis (HD) as treatment for end-stage renal disease (ESRD). Home HD is a renal replacement modality that allows patients to perform treatments in their own home. The fact sheet outlines the different types of home HD available, the benefits of this treatment option, challenges patients may encounter, patient selection and their care partner, training program considerations, and ongoing patient management, including the role of the visiting nephrology nurse. The fact sheet emphasizes that performing treatment in the home environment allows the patient to change or increase frequency of therapy to improve their overall health status and quality of life. Readers are referred to the ANNA website at www.annanurse.org for more information. 1 table.

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In a Bundling Era, Finding a Fair Price for ESRD Services. Nephrology News & Issues. 21: 37-40. March 2007.

This article considers the impact of the Medicare Modernization Act of 2003 (MMA) and the subsequent development of a bundled reimbursement rate that is applied to everyone, from large dialysis organizations with thousands of patients, to mid-sized and small-sized providers. The prospective payment for bundled services would be divided into two components: the dialysis composite rate, which serves as the base for payment, with adjustments for case-mix; and a second payment to cover an extended bundle of services, also influenced by case-mix. The bundled payment system was supposed to be released in a demonstration format in January 2006; the demonstration was delayed because of the Centers for Medicare and Medicaid Services’ (CMS) concerns about developing a fair case-mix model to integrate with the bundled payment. The author reviews the history of reimbursement for end-stage renal disease (ESRD) services and then explores how the bundled services plan was developed. The author also explains the financial modeling used to predict facility Earnings Before Interest Taxes Depreciation Amortization (EBITDA) breakeven. 2 figures.

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In Control With In-Center Self- Care. In Control. 4(3): P1, P4. September 2007.

This newsletter article describes in-center self-care, a method of dialysis delivery in which the dialysis patient shares responsibility with the clinic staff for running their dialysis treatments. The amount of responsibility the patient takes can vary depending on their interest and skill level, but many self-care patients do virtually all their own care, from set-up, through dialysis, recordkeeping, and preparing the station for the next patient. Staff members teach patients how to do much of their own treatment, and they are available to assist patients who have questions or encounter problems. Topics include self-cannulation, the benefits of self care, and ways to incorporate self-care aspects into regular dialysis care. The article includes a five-item quiz about in-center dialysis self-care; the answers are elsewhere in the newsletter.

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In-Center Self-Care: New Interest in an Old Idea. In Control. 4(3): S1, S4. September 2007.

This newsletter article describes in-center self-care, a method of dialysis delivery in which the dialysis patient shares responsibility with the clinic staff for running their dialysis treatments. The amount of responsibility the patient takes can vary depending on their interest and skill level, but many self-care patients do virtually all their own care, from set-up, through dialysis, recordkeeping, and preparing the station for the next patient. The author reports on the success stories of a number of clinics in implementing in-center self-care and the research studies that provide the evidence base for this success. Another section considers the use of in-center self-care as a bridge to eventual home care for these patients; patients build confidence by completing their own care in a monitored setting and become more willing to implement home dialysis. A final section reports on the potential benefits for the dialysis clinics and staff. 10 references.

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Increasing Self-Care Dialysis Adoption: The Role of Patient Education and Identification. At Home with AAKP. 1(1): 15-18. October 2007.

This article is from a new magazine about home dialysis for patients with kidney disease. In the article, the authors consider the role of patient education and identification as strategies to increase self-care home dialysis. The authors note there is still a widely held belief that self-care dialysis options, including home hemodialysis and home peritoneal dialysis, are significantly underutilized. Estimates show that approximately 9 percent of dialysis patients in the United States are using home dialysis. The authors review the benefits of self-care dialysis, which range from improved medical status to broad quality of life benefits. Self-care therapies have the ability to realize the potential of dialysis as an enabling therapy for patients, as it was originally intended, allowing them to continue to live productive lives, including the flexibility to remain employed. The authors explore the reasons why home dialysis is underutilized and offer suggestions for patient selection for home dialysis. The role of predialysis patient education is considered. The authors conclude that patients must be educated on the therapy options available, prior to their need for dialysis. Predialysis patient education can help patients with chronic kidney disease (CKD) stabilize and maintain their health while delaying the need for dialysis. The article is illustrated with full-color photographs of kidney patients and home care settings.

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Integrated Care: Planning for Change. InControl. 4(4): S1, S4. December 2007.

This newsletter article helps readers understand the steps that might need to be taken for a patient who changes from one type of kidney replacement therapy to a different type; for example, a patient may change from peritoneal dialysis to in-center hemodialysis, or to one of various home hemodialysis options, or vice-versa. The author describes an “integrated care” approach in which patients may be helped to anticipate transfer from one option to another over time, instead of seeing changes as “failures.” Topics include the importance of patient preferences, the medical benefits of different treatments, reduced costs, and the role of a multidisciplinary care team to help implement integrated care. The article concludes that recent growth in home hemodialysis options and expanded access to daily and nocturnal hemodialysis have prompted a renewed interest in integrated care. 8 references.

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International Comparisons. American Journal of Kidney Diseases. 49(1): s223-s235. January 2007.

This chapter of international comparisons is from a special supplemental issue of the American Journal of Kidney Diseases that presents excerpts from the 18th annual report from the U.S. Renal Data System on the ESRD program in the United States; data through 2004 is included. The Annual Data Report (ADR) also presents information on patients with chronic kidney disease (CKD) and assesses care of at-risk populations and international comparisons of ESRD. This chapter presents data from 37 regions and countries, offering a worldwide perspective on ESRD and the ways in which practitioners choose to treat it. Data is provided on incidence, prevalence, ESRD caused by diabetes, dialysis, and transplantation. The highest reported incident rates of ESRD are found in Taiwan, Mexico, the United States, and Japan; figures are based on patients on dialysis. The lowest rates are reported in the Philippines, Iceland, Finland, Norway, and Russia. The authors focus on concerns about the worldwide rise in rates of diabetes. 11 figures. 6 tables.

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Introduction. American Journal of Kidney Diseases. 49(1): s10-s16. January 2007.

This introductory chapter is from a special supplemental issue of the American Journal of Kidney Diseases that presents excerpts from the 18th annual report from the U.S. Renal Data System (USRDS) on the end-stage renal disease (ESRD) program in the United States; data through 2004 is included. This Annual Data Report (ADR) also presents information on patients with chronic kidney disease (CKD) and assesses care of at-risk populations and international comparisons of ESRD. The introduction describes the sections in the report: an overview, the healthy people 2010 goals, CKD, the incidence and prevalence of ERD, patient characteristics, treatment modalities, clinical indicators and preventive health, morbidity and mortality, transplantation, pediatric ESRD, cardiovascular special studies, ESRD providers, the costs of CKD and ESRD, and international comparisons. This introductory chapter also explains how readers can get more information on the USRDS website at www.usrds.org. The website outlines the administrative oversight responsible for this project and describes how to read and understand the disease mapping used for the ADR. 9 figures.

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Kidney Failure: Choosing a Treatment That’s Right for You. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2007. 36 p.

This booklet helps readers recently diagnosed with kidney disease to understand their options for treatment. The author reviews the basics of how the kidneys work and what happens when they fail. The booklet reviews each of four treatment options: hemodialysis, peritoneal dialysis, kidney transplantation, and refusing or withdrawing from treatment. The choices made can have an impact on the patient’s diet, ability to work, and other lifestyle issues. The author discusses paying for treatment of kidney failure, noting that Medicare and Medicaid pay much of the cost of treatment for kidney failure. Readers are encouraged to work closely with their health care providers; a list of suggested questions for them to ask is provided. The booklet concludes with a list of organizations through which readers can get more information, a brief description of the goals and activities of the National Kidney and Urologic Diseases Information Clearinghouse (NIKUDIC), and a list of publications in the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Kidney Failure Series. 6 figures. 1 table. 5 references.

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Management of Dialysis Patients with Celiac Disease. Practical Gastroenterology. 31(6): 70-72, 77-80, 82. July 2007.

This article considers the management of dialysis patients who also have celiac disease, a condition of gluten intolerance. The author notes that these two diseases are not often reported in the same patient, but celiac disease is sometimes listed as one of the associated diseases of IgA nephropathy. There are no written guidelines for managing these combined diseases, because of the rarity of their co-occurrence, or perhaps because they are underdiagnosed. Celiac disease is characterized by inflammation of the small intestine and malabsorption after the ingestion of gluten; thus, celiac disease is managed by life-long avoidance of gluten in the diet. Kidney disease is manifested by fluid and electrolyte imbalance, which also involves life-long dietary restrictions. This article reviews the renal dietary guidelines and provides suggestions on how to combine those guidelines with the required changes to manage celiac disease. Specific topics include malnutrition, potassium, fluid and sodium, renal bone osteodystrophy, phosphorus, common medications of dialysis patients, and socioeconomic considerations. One table provides a renal and gluten-free diet in a chart format. 4 tables. 9 references.

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MATCH-D: A Roadmap to Home Dialysis Therapy. Nephrology News & Issues. 21(11): 41, 43-44. October 2007.

This article reviews the benefits of home dialysis therapy and encourages health care providers to tell patients about options beyond standard, in-center hemodialysis that may allow them more normal lifestyles. The author discusses the lack of guidelines for identifying patients who might be candidates for peritoneal dialysis (PD) or home hemodialysis (HD) and describes the development of the Method to Assess Treatment Choices for Home Dialysis (MATCH-D). The MATCH-D is a home dialysis appropriateness assessment tool that is best used as the basis of a discussion among the patient, family, and care team as they move to choose a treatment that best suits the patient’s lifestyle and capabilities. Topics include patient characteristics, the benefits of home dialysis, strategies to assess and eliminate barriers to home HD or PD, and patient and partner training needs. The author concludes that offering the lifestyle benefits of home treatment to more patients will not only help patients and their families but will also reduce the staffing burden on dialysis facilities, increase facility revenues if patients maintain jobs with employer group health plans, and alleviate some of the financial burden on Medicare and Social Security disability programs. 17 references.

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Medicare Coverage of Kidney Dialysis And Kidney Transplant Services. Revised ed. Baltimore, MD: Centers for Medicare and Medicaid Services. 2007. 55 p.

This booklet helps people with end-stage renal disease (ESRD) or permanent kidney failure understand Medicare coverage for kidney dialysis and kidney transplant services. The booklet describes how to get Medicare coverage, how Medicare helps pay for kidney dialysis and kidney transplants, and where to get more information and help. Specific topics include a description of dialysis, how to find a dialysis facility, home dialysis treatment options, dialysis adequacy, patient education, dialysis and travel, transportation to dialysis facilities, where to get a kidney transplant, donor’s services, how Medicare pays for blood, how to have blood replaced, appeals and grievances, and other kinds of health insurance. The booklet provides information about combined kidney and pancreas transplants. The booklet includes contact information for special kidney organizations, ESRD Networks, State Health Insurance Assistance Programs (SHIP), and other Medicare booklets that are available. The booklet is illustrated with black-and-white photographs and concludes with a glossary of terms and a subject index. The booklet is also available in Spanish. 10 figures. 5 tables.

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Multidimensional Characteristics of Symptoms Reported by Patients on Hemodialysis. Nephrology Nursing Journal. 34(1): 29-37. January-February, 2007.

This continuing education article describes the multidimensional characteristics of symptoms reported by patients who are on hemodialysis. The author explored the intensity, frequency and duration, distress, and concurrence of symptoms in this patient population. The author created a multidimensional profile for each of the symptoms, which demonstrated that those rated as the most severe were not necessarily the most frequently occurring, longest lasting, or most distressing to patients. Symptoms also tended to occur in groups. Patients reported individual symptoms as increasingly troublesome and their quality of life progressively lower as they experienced more of the symptoms in a grouping. The author concludes that health care providers need to view patients’ symptom experiences more broadly. Symptom assessment should include the full complement of symptoms patients experience and should move beyond the current practice of using the assessment of severity alone to include all symptom dimensions. A posttest with which readers can qualify for continuing education credits is appended to the article. 5 tables. 29 references.

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New CPM Report Shows Slight Improvements in Hemoglobin Levels. Nephrology News & Issues. 21(11): 50-52, 54. October 2007.

This article reviews the 2006 Clinical Performance Measures (CPM) report, an annual data survey of hemodialysis (HD) and peritoneal dialysis (PD) patients. The author focuses on HD adequacy, vascular access, and anemia management CPMs, presenting data primarily from in-center HD settings. In the area of dialysis adequacy, the report showed that 82 percent of patients had monthly adequacy measurements performed; 76 percent of patients had their dialysis delivery calculated using either UKM or the Daugirdas II formula; and 94 percent of patients on dialysis for 6 months or more and dialyzing three times a week had a mean delivered adequacy dose of spKt/V greater than 1.2, calculated using the Daugirdas II formula. Data for vascular access showed that 54 percent of new patients were dialyzed using an arteriovenous (AV) fistula; 44 percent of prevalent patients were dialyzed using an AV fistula; and 21 percent of prevalent patients were dialyzed with a chronic catheter continuously for 90 days or longer. In the area of anemia management, 35 percent of targeted patients prescribed epoetin had a mean hemoglobin of 11 to 12 grams per deciliter (g/dL); and 81 percent of patients who met the inclusion criteria were prescribed intravenous iron in at least 1 month during the study period. A table summarizes data on the end-stage renal disease (ESRD) CPM trends from 1998 through 2005. Readers are referred to www.cms.hhs.gov/CPMProject for the complete 2006 end stage renal disease (ESRD) clinical performance measures annual report and reliability report. 3 figures. 1 table.

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Open Operative Management of Dialysis-Dependent Ischemic Nephropathy. Dialysis and Transplantation. 36(4): 192-204. April 2007.

This article reports the results of a retrospective review that examined the use of open operative management of dialysis-dependent ischemic nephropathy among adults with hypertension. The study included 820 patients who underwent open operative repair of 1,220 kidneys between February 1987 and July 2005. A subgroup consisting of 45 hypertensive patients (19 women, 26 men; mean age 68 years) considered permanently dialysis-dependent prior to renal artery (RA) repair forms the basis of this report. RA repairs to 73 kidneys included RA bypass (44 repairs: 22 saphenous vein repairs and 22 prosthetic grafts), RA endarterectomy (25 repairs; 13 transrenal and 12 transaortic), and RA reimplantation (four repairs). Thirty-five patients had bilateral procedure, including four procedures to solitary kidneys. Of 28 RA occlusions, 25 were repaired. Three nephrectomies were performed for unreconstructable RA to a nonfunctioning kidney. After RA repair, two patients (4.4 percent) died within 30 days of operation or in-hospital. Twenty-nine of the 43 (67 percent) surgical survivors stopped being dialysis dependent. Four patients initially removed from dialysis progressed to eventual dialysis-dependence on follow-up. The authors conclude that open operative management of dialysis-dependent ischemic nephropathy can remove selected patients from dialysis. Patients who showed beneficial renal function response were those who experienced a rapid decline in preoperative renal function. 4 figures. 3 tables. 24 references.

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Peritonitis Caused by Neisseria Sicca in a Child on Chronic Peritoneal Dialysis. Dialysis and Transplantation. 36(8): 457, 463. August 2007.

This article reports a case of peritonitis caused by Neisseria sicca in a child on chronic peritoneal dialysis (PD). Peritonitis is an serious complication of PD and has an incidence of about one episode per year in children on PD. The case report is a 6-year-old African American boy, diagnosed in utero with hydronephrosis, who received a Tenckhoff catheter for chronic outpatient PD at home just after his 6th birthday. Two months after beginning PD, the boy was admitted to the hospital for Pseudomonas aeruginosa urinary tract infection (UTI); 2 weeks later, after a mishap, the catheter connector was replaced in the outpatient nephrology clinic under sterile conditions. One week after this episode, the boy was admitted to the hospital with a diagnosis of peritonitis. On the third day, the boy’s cultures showed N. sicca, which is sensitive to penicillin. Although the patient recovered uneventfully, an elective kidney transplant from a living related donor had to be postponed several months because of this infection. The authors discuss this case and conclude by reiterating the importance of physicians to continually reinforce the understanding of parents and patients of the vital necessity of proper PD catheter care and must stress extremely close supervision of a child on chronic PD. 9 references.

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Planning for Changing Dialysis Needs. InControl. 4(4): P1, P4. December 2007.

This newsletter article helps patients understand the steps that might need to be taken for a patient who changes from one type of kidney replacement therapy to a different type; for example, a patient may change from peritoneal dialysis to in-center hemodialysis, or to one of various home hemodialysis options, or vice-versa. The author stresses that the patient’s first choice does not have to be permanent. Most people who have kidney failure for a long time will end up using more than one type of treatment. Readers are encouraged to make healthy choices in the months or years before they have to start dialysis, including learning about the different options for dialysis before it becomes necessary. Topics include the role of preemptive transplant, the importance of patient preferences, and the use of peritoneal dialysis as a good first dialysis option. Readers are referred to a website for information about all five home dialysis treatments (www.homedialysis.org/learn/types/). The article concludes with a five-item quiz for readers to check their understanding of the material covered in the article.

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Precis: Background on the US ESRD Program. American Journal of Kidney Diseases. 49(1): s17-s32. January 2007.

This Precis chapter is from a special supplemental issue of the American Journal of Kidney Diseases that presents excerpts from the 18th annual report from the U.S. Renal Data System on the end-stage renal disease (ESRD) program in the United States; data through 2004 is included. This Annual Data Report (ADR) also presents information on patients with chronic kidney disease (CKD) and assesses care of at-risk populations and international comparisons of ESRD. In this Precis, the authors provide an overview of the ESRD program itself, beginning with statistics on patient counts and rates, modalities, and costs. This chapter also covers modality use over time and across the country; the transplant waiting list; indicators of quality of care, such as vascular access use, dialysis adequacy, anemia treatment, diabetes preventive care, and prescription drug therapy; and trends in hospitalization and mortality rates. A final section examines expenditures related to ESRD, as well as expenditures for patients in the Medicare and employer group health plan (EGHP) populations who have chronic kidney disease. 38 figures. 2 tables.

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Protein: An Important Part of Your Dialysis Diet. In Control. 4 (1): P1, P4. March 2007.

This patient education newsletter article focuses on the importance of protein in the diet of patients who are on dialysis. Dialysis patients need more protein than the average healthy adult because they lose protein during dialysis and because kidney disease alters the body’s ability to use and process amino acids, the building blocks for muscles and healthy cells, organs, and bones. The article briefly reviews the types of protein found in common foods, concerns about foods that also have potassium or phosphorus, the use of serum albumin testing to measure blood levels of protein, the symptoms of low serum albumin levels, and how appropriate levels of dialysis can improve the patient’s appetite. Readers are encouraged to visit a website for more information on this topic––www.kidneyschool.org. The article is published in large print and concludes with a brief true/false quiz on protein and dialysis; the answers are elsewhere in the newsletter issue.

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Public Reporting of Patient Survival (Mortality) Data on the Dialysis Facility Compare Web Site. Dialysis and Transplantation. 36(9):486, 491-499. September 2007.

This article reports on a study that the authors conducted on Medicare’s Dialysis Facility Compare (DFC) website, which publicly reports patient survival statistics––mortality data. The authors conducted a qualitative study to evaluate how well patients and family members understand the patient survival data as it is currently explained and presented on the DFC website. The study investigated the users’ view of the value of the website. The researchers tested potential improvements to the website that used alternative language and display formats. The results showed that, overall, participants responded positively to the patient survival data, leading the authors to conclude that publicly reporting this type of information has value to patients and their families. The authors found that participants could easily identify facilities with better performance from the website as it is currently set up, but they had difficulty understanding the statistical differences between patient survival ratings. The authors’ discussion focuses on the goals of publicly reporting mortality data, including the ultimate goal of improving quality of care for patients. 3 tables. 14 references.

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Renal Resource and Buyers Guide 2007. Nephrology News & Issues. 21(2): 14-64. 2007.

This special issue of Nephrology News & Issues offers the annual renal resources and buyers’ guide, a comprehensive directory of products and services available for the renal care community. The guide is separated into two sections: a products–and-services section, arranged alphabetically by category, with company contact information provided; and the company director, an alphabetical listing of the companies included. The products-and-services section categories include blood analysis devices, blood lines, blood pressure monitors, business support services, CAPD equipment, catheters, CCPD equipment, chairs, clothing, concentrate, dialysis machines, dialyzers, diet and nutrition, disinfectants, dry mouth products, equipment maintenance and repair, facility planning, fistula needles, hemodialysis supplies, hemofiltration supplies, heparin, home hemodialysis, immunosuppressives, implantable infusion devices, insulin, medical waste disposal, monitoring devices, needlestick protection, patient education, office supplies, peritoneal dialysis, pharmaceuticals, plasmapheresis, rehabilitation and exercise, reprocessing, scales, shunts, software, training, sterilants, syringes, ultrasound, vascular access, and water testing and treatment. The guide includes a list of nephrology conferences for 2007, a handy list of websites for renal associations, and an information page on how to use the journal’s website, www.nephronline.com.

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Self-Care Agency in Dialyzed Patients. Dialysis and Transplantation. 36 (2): 57-70. February 2007.

Advances in hemodialysis technologies and developments in peritoneal dialysis permit patients the benefits of receiving treatment in their own homes. This article reports on a study undertaken to evaluate the factors affecting patients undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) as a self-care situation. The cross-sectional study was based in the Turkish city of Edirne and included 77 patients on maintenance HD and 15 patients on maintenance CAPD. The study used the Kearney and Fleischer scale, which has a maximum score—indicating the highest degree of self care—of 140. The results of this study showed a mean score of 113 (range 48-137) and no significant differences were found between the HD and CAPD groups. Variables such as gender, health perception, no complications during dialysis therapy, and maintaining a suitable diet were significantly related to self-care. Male patients had a higher overall self-care mean score than women. The authors conclude by recommending compliance programs to help patients and families cope with dialysis-related problems and support for patients who are handling their own dialysis. 3 tables. 42 references.

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Self-Care Improves Outcomes and Outlook. In Control. 4(3): S2. September 2007.

This brief newsletter article describes how the use of in-center self-care, a method of dialysis delivery in which the dialysis patient shares responsibility with the clinic staff for running their dialysis treatments, can improve patient outcomes and outlook. The article reports on patients of Dr. Edward Jones, medical director of the Mt. Airy Self-Care Dialysis Facility in Philadelphia. Dr. Jones reports on his comparisons of 50 self-care patients and those who are dialyzed in a traditional, staff-assisted facility. The article reports on the benefits of in-center self-care, which include less morbidity and mortality, more patient empowerment, and benefits for the dialysis clinic as well as the patients. The article briefly describes the training process that is available to patients who choose in-center self-care and reports on the strategies that have resulted in the most success, including keeping self-care patients and traditional-care patients in different units.

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Should the Medicare ESRD Program Fund Daily and Nocturnal Hemodialysis?. Nephrology News & Issues. 21(12): 48-57. November 2007.

This article addresses the issue of Medicare end-stage renal disease (ESRD) funding for short daily hemodialysis (sDHD) and nightly nocturnal hemodialysis (NNHD) at home. The author reports on a recent paper that concludes that funding for conventional hemodialysis (HD) should be maintained and that the newer methods of sDHD and NNHD should not be covered under Medicare until they undergo rigorous testing through the use of a randomized control trial (RCT). The author comments on the paradox of requiring RCT testing of these newer modalities, when conventional HD has not been vetted in this manner. Indeed, the use of an RCT itself may be unethical and impossible when the treatments under study are widely disparate lifestyle-impacting modalities. The author reviews some of the positive health outcomes and cost-efficiencies of sDHD and NHHD, concluding that available data is adequate to develop funding models for these treatments. 24 references.

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Supplement Program Improves Serum Albumin. In Control. 4 (1): S2. March 2007.

This brief patient education newsletter article focuses on the use of a nutritional supplement to improve serum albumin levels in patients who are on dialysis. The author reports on a program in which the National Kidney Foundation of South Carolina began providing free nutritional supplements to needy dialysis patients several years ago. A 3-month supply of nutritional supplements––either two cans of liquid supplement or six scoops of powdered protein per day––was delivered directly to the clinic of each patient who qualified for the supplement program (n = 130). Average patient age was 62.3 years––99 patients were on hemodialysis, 31 on peritoneal dialysis. Patients were enrolled because of low albumin levels (n = 116), in appropriate weight loss (n = 43), or both (n = 29). Data collected after 3 months of supplement use showed a statistically significant increase in serum albumin levels, a finding that was particularly strong in patients with original albumin levels less than 3.0 milligrams per deciliter. 1 figure. 1 reference.

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Surviving Change: Can the ESRD Provisions in the SCHIP Create A Level Playing Field? Nephrology News & Issues. 21(10): 52-54, 56. September 2007.

This article reviews the key provisions that are incorporated into the Children’s Health and Medicare Protection Act of 2007, including the creation of an end-stage renal disease (ESRD) bundled payment system, elimination of the hospital differential for treatment payments, creation of quality outcome incentive payments and performance standards, and extension of the Medicare Secondary Payer (MSP) provision. The proposed bill includes two provisions from the Kidney Care Quality and Education Act: establishing a demonstration project on education for chronic kidney disease (CKD) patients and requiring technical certification. However, the bill fails to include an inflationary update. The author encourages readers, regardless of which dialysis provider they work for, to work for the passage of this legislation. The author stresses that any rearrangement of payments called for by legislation should be budget neutral so as not to take any dollars from the ESRD program as a whole.

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Treatment Modalities. American Journal of Kidney Diseases. 49(1): s99-s110. January 2007.

The two major therapies for end-stage renal disease (ESRD) are dialysis and transplantation. This chapter on ESRD treatment modalities is from a special supplemental issue of the American Journal of Kidney Diseases that presents excerpts from the 18th annual report from the U.S. Renal Data System on the ESRD program in the United States; data through 2004 is included. The Annual Data Report (ADR) also presents information on patients with chronic kidney disease (CKD) and assesses care of at-risk populations and international comparisons of ESRD. This chapter provides data on modalities and the types of patients using each kind of therapy. Tables present data on incident and prevalent counts and rates, while graphs show patient distribution by insurance coverage, and maps illustrate regional variations in rates over time. The chapter also includes updated data on the probability of death or a change in modality during the first 5 years of therapy, as well as information on patient distribution by provider. 16 figures. 6 tables.

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Underutilizing PD: Looking for Answers. What is Needed to Make Peritoneal Dialysis a Success?. Nephrology News & Issues. 21(8): 29-31. July 2007.

This article reviews some of the reasons why peritoneal dialysis (PD), particularly continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD), are underutilized. These factors include lack of professional training, which tends to focus on hemodialysis; a lack of support for PD as a viable choice from national organizations, board examiners, and fellowship reviewers; a lack of support for chronic kidney disease (CKD) patient education; financial disincentives from a physician perspective; a slow regulatory process for new technology; physician bias and problems with the outcomes of the therapy; and the impact of home hemodialysis. The author reminds readers that the benefits of PD over in-center hemodialysis therapy include greater freedom, better patient control over treatment times, a more liberal diet, and use of an implantable catheter to avoid needlesticks. One sidebar describes a chosen Internet resource for the home dialysis patient, Nocturnal Dialysis (www.nocturnaldialysis.org), an Australian-based web site that promotes awareness of the benefits of nocturnal home hemodialysis. 3 figures.

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US Renal Data System: Excerpts from the USRDS 2006 Annual Data Report. Special Issue. American Journal of Kidney Diseases. 49(1 Suppl 1): 1-296. January 2007.

This special supplemental issue of the American Journal of Kidney Diseases presents excerpts from the 18th annual report from the U.S. Renal Data System (USRDS) on the end-stage renal disease (ESRD) program in the United States; data through 2004 is included. This Annual Data Report (ADR) also presents information on patients with chronic kidney disease (CKD) and assesses care of at-risk populations and international comparisons of ESRD. Sections include: an overview, the healthy people 2010 goals, CKD, the incidence and prevalence of ERD, patient characteristics, treatment modalities, clinical indicators and preventive health, morbidity and mortality, transplantation, pediatric ESRD, cardiovascular special studies, ESRD providers, the costs of CKD and ESRD, and international comparisons. Most of the information is presented in tabular and graph format. Detailed appendices cover the chapter topics as well as data sources, data management and preparation, ESRD networks, database definitions, vascular access, census populations, statistical methods, USRDS services, data requests, a glossary of terms, forms, and a subject index.

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Work-Related Stress, Burnout, and Job Satisfaction of Dialysis Nurses in Association with Perceived Relations with Professional Contacts. Dialysis and Transplantation. 36 (4): 182-191. April 2007.

This article reports on a study undertaken to determine levels of job-related stress, burnout, and job satisfaction in dialysis nurses and their association with nurses’ perceptions regarding relations with coworkers and coworker opinions on the nursing profession. The participants in the study were employed in dialysis units (n = 31), intensive care units (ICUs, n = 100), and in the most preferred wards, such as cardiology, general surgery, and orthopedics (n = 49), of three different hospitals in Turkey. Data was gathered by means of a questionnaire about sociodemographics, work places, and opinions, as well as the Work-Related Strain Inventory (WRSI), the Maslach Burnout Inventory (MBI), and the Minnesota Work Satisfaction Questionnaire (MWSQ). The results showed that, when compared with ICU and ward unit nurses, dialysis nurses had evidence of decreased job stress and burnout as well as increased job satisfaction, accompanied by decreased intention to leave the profession and higher levels of positive views concerning their relationships with physician coworkers and the opinions of their professional contacts toward the nursing profession. This study confirmed some established predictors of job satisfaction, work-related stress, and burnout and provided data on an unexplored area. The authors conclude that dialysis nurses appear to be at a decreased risk for job stress, burnout and premature retirement from nursing, with higher levels of job satisfaction. In addition, the quality of relationships with physician coworkers and the opinions of professional contacts regarding the nursing profession as perceived by nurses may be related to job stress, burnout, and work satisfaction. 2 tables. 30 references.

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You Can Live: Your Guide for Living with Kidney Failure. Revised ed. Baltimore, MD: Centers for Medicare and Medicaid Services. 2007. 46 p.

This booklet helps people with kidney disease make informed choices about the treatment of kidney failure. Designed for people who are about to begin dialysis or prepare for transplantation, the booklet covers the emotional impact of end-stage renal disease (ESRD), paying for treatment or transplant, the different types of dialysis, and the importance of working closely with the health care team. The booklet includes a section of tips for making treatment better, covering changes in mental health, physical changes, changes in sexual desire, communicating with health care providers, taking medications accurately, alternative treatments, vaccinations, diet and fluid intake, exercise, going back to work, and travel. Two final sections provide information on how to contact and file a complaint with the ESRD Network and the state survey agency in each location. Patient rights and responsibilities are spelled out. For telephone number information and other resources, readers are advised to visit the Helpful Contacts section of the Medicare website at www.medicare.gov. The booklet is illustrated with black-and-white photographs and line drawings of some of the concepts being discussed. The booklet is also available in Spanish. 20 figures. 1 table.

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You Have Options!. At Home with AAKP. 1(1): 5-8. October 2007.

This article is from a new magazine about the use of home dialysis for patients with kidney disease. In the article, the author introduces the concept of home dialysis as one option for treating end-stage renal disease (ESRD). The author explores the advantages of home dialysis––which can include either hemodialysis or peritoneal dialysis––which allows patients to learn more about their disease and have more control over when they get their treatments. Home dialysis allows patients to take a leadership role in their own health care team. This leadership role empowers patients to maintain their independence and influence their own quality of life. The article reviews the four options for home dialysis: conventional home hemodialysis, daily home hemodialysis, nocturnal hemodialysis, and peritoneal dialysis. For each type of home dialysis, the article covers who would be most appropriate for that type, the equipment and supplies necessary, complications that might be encountered, and the advantages and disadvantages. A sidebar summarizes the advantages of home dialysis, which include improved survival rate, better quality of life, greater opportunity to return to work or school, better blood pressure control, fewer hospital stays, increased dietary flexibility, fewer problems with fistulas, and reduced need for medications. The article is illustrated with full-color photographs of patients and dialysis procedures. 4 figures.

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2006 Updates Clinical Practice Guidelines and Recommendations. New York, NY: National Kidney Foundation. 2006. 411 p.

This clinical handbook provides the 2006 updates to the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines and recommendations regarding hemodialysis adequacy, peritoneal dialysis adequacy, and vascular access. The first section starts with clinical practice guidelines and recommendations for hemodialysis adequacy, covering initiation of dialysis, methods for measuring and expressing the hemodialysis dose, methods for postdialysis blood sampling, minimally adequate hemodialysis, control of volume and blood pressure, preservation of residual kidney function, quality improvement programs, and pediatric hemodialysis prescription and adequacy. The guidelines and recommendations outlined in the second section, on peritoneal dialysis adequacy, cover initiation of dialysis, peritoneal dialysis solute clearance targets and measurements, preservation of residual kidney function, maintenance of euvolemia, quality improvement programs, and pediatric peritoneal dialysis. The last section, on vascular access, offers clinical practice guidelines and recommendations covering patient preparation for permanent hemodialysis access, selection and placement of hemodialysis access, cannulation of fistulae and grafts, accession of hemodialysis catheters and port catheter systems, detection of access dysfunction through monitoring, surveillance, and diagnostic testing, treatment of fistula complications, treatment of arteriovenous graft complications, prevention and treatment of catheter and port complications, vascular access in pediatric patients, and clinical outcome goals. Each section includes research recommendations, a list of work group members and their biographies, a list of acronyms and abbreviations, and tables and figures. A list of references concludes each section. Readers are referred to the KDOQI website at www.kdogi.org for more information. 17 figures. 63 tables. 1275 references.

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Chronic Renal Failure and Dialysis Options. IN: Hogg, R., ed. Kidney Disorders in Children and Adolescents: A Global Perspective of Clinical Practice. New York, NY: Informa Healthcare USA. 2006. pp 193-202.

This chapter about chronic renal failure and dialysis options is from a textbook that presents a global perspective of clinical practice regarding kidney disorders in children and adolescents. The authors cover incidence, etiology, pathophysiology, and the role of nutrition in chronic renal failure (CRF); pathophysiology and treatment of renal osteodystrophy; renal anemia; hypertension; the impact of CRF in childhood on growth and development; the prognosis for children with CRF; and dialysis and renal transplantation as treatment options. The authors conclude by recommending a comprehensive, multidisciplinary approach to patient treatment plans for children with CRF. 1 table. 7 references.

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Developing Effective Kidney Patient Education Materials. Nephrology News & Issues. 20(9): 53, 55. August 2006.

The key to empowering people with any chronic disease is patient education. So contends the author of this article about developing effective kidney patient education materials. The author then presents the six principles of adult learning, as developed by Malcolm Knowles: autonomy and self-directedness, foundation of life experiences, goal-orientation, relevance, practicality, and respect. These principles must be kept in mind when developing educational materials that support the patient’s ability to self-manage their condition. Other topics covered include the use of learning assessments, appropriate reading levels, the visual elements of effective materials, and the role of humor. The author concludes that patient education is cost effective and an essential tool to improve patient outcomes. Patient education can and should be provided through all stages of kidney disease. 9 references.

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Dialysis. IN: Nilsson, K.R.; Piccini, J.P., eds. Osler Medical Handbook. Philadelphia, PA: Saunders. 2006. pp. 756-761.

This chapter on dialysis is from a handbook that provides the essentials of diagnosis and treatment, as well as the latest in evidence-based medicine, for residents working bedside, in-patient care. The chapter begins with a presentation of essential Fast Facts and concludes with Pearls and Pitfalls useful to the practicing internist. The body of the chapter is divided into sections: Epidemiology, Clinical Presentation, Diagnosis, and Management. Specific topics covered in this chapter include the indications for renal replacement therapy in patients with chronic kidney disease; the different types of dialysis, including hemodialysis, peritoneal dialysis, and continuous filtration; common conditions in which hemodialysis is used, including drug overdose, uremia, hyperkalemia, volume overload, and metabolic acidosis (that is refractory to conservative treatment); and the benefits of native arteriovenous fistulas for vascular access in patients undergoing long-term hemodialysis. The chapter concludes with a list of references, each labeled with a 'strength of evidence' grade to help readers determine the type of research available in that reference source. 10 references.

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Finding Your Way: Any Trip is Possible for Dialysis Patients with the Right Planning. Nephrology News & Issues. 20(3): 53-54. March 2006.

This article encourages readers on dialysis to include travel in their recreation plans. The author, himself a patient on dialysis, shares some of his experiences in travel, describing how embracing travel helps him to embrace life more fully. The authors offer some advice about finding travel information on the Internet, particularly sites that are geared to facilitate dialysis travel. Readers are also encouraged to use Internet discussion boards and message forums to find more specific information about particular travel adventures. Numerous website addresses are provided; readers are counseled to start at www.globaldialysis.com.

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Forum of ESRD Networks 2006 Directory. Midlothian, VA: Forum of End Stage Renal Disease Networks. 2006. 60 p.

This directory offers complete information about the Forum of End Stage Renal Disease (ESRD) Networks, a forum in which assistance, advice, information, ideas and policy proposals are exchanged among the Networks and the Centers for Medicare and Medicaid Services and its agencies, and other renal care organizations. The first section of the Directory includes the Forum Board of Directors, the administrative office personnel, ESRD Network Directors, Forum Representatives, ESRD Network Chairs, ESRD Medical Review Board Chairs. Contact information is provided for all of the personnel listed. The Directory then offers a one-page overview of each of the 18 Network offices. The overview sheet lists the Network office name, executive director, address, phone, toll-free telephone number for patients, FAX number, email contact, website address, listing of staff, the Forum representative, the Network chair, the MRB chair, and the Patient Advisory Committee chair. The remainder of the Directory covers the FistulaFirst Breakthrough Initiative, the central and regional office staff of the Centers for Medicare and Medicaid, the Crown project, the ESRD CPM QI committee members, a list of dialysis organizations, a list of renal-related organizations, and the bylaws of the Forum of ESRD Networks. The Directory is spiral-bound for ease of use.

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I Have CKD and My Doctor Said I May Need Dialysis and When Should a Patient Initiate It?. Kidney Beginnings. 5(3): 19-20, 24, 29. October-November 2006.

Dialysis is the procedure for artificially replacing many functions performed by normal kidneys. This article, from a series called Ask The Doctor, reviews the basics of dialysis and when it may be initiated to treat kidney disease. The first section describes the two common types of dialysis (peritoneal and hemodialysis) and the equipment and supplies used for each type. The author encourages readers to educate themselves about the advantages and disadvantages of each type of dialysis so they can select the one that best fits their individual lifestyle. The next section discusses how to know when dialysis is appropriate and planning for dialysis (including predialysis care). The author recommends using an objective, numerical measure of kidney dysfunction severity to determine when to begin dialysis, rather than waiting for symptoms and complications of kidney disease to occur. Readers are encouraged to bring a family member or friend as an advocate and a “second pair of ears” when visiting the health care provider to learn about kidney replacement therapy.

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Matching Dialysis Modality to Patient Lifestyle. In Control. 3(1): S1-S2, S8. March 2006.

There are many different dialysis modalities available for kidney disease patients, including manual and automated peritoneal dialysis as well as short daily and long nocturnal hemodialysis (done at home or in-center). This article considers the importance of matching dialysis modality to patient lifestyle. The author notes that most of the present options are underused, however, the author describes the reasons that the dialysis community has focused on modality options besides standard in-center hemodialysis, including quality of life, patient satisfaction, employment, and patient preference. The barriers to change modality options may play a part in the current delivery of dialysis care. The author concludes by encouraging health care providers to provide thorough, unbiased education about treatment options, to welcome patient participation in modality choice, and to make a full menu of modalities available in more clinics. One sidebar briefly describes the full array of seven dialysis options. 12 references.

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Mortality Difference by Dialysis Modaility Among New ESRD Patients with and Without Diabetes Mellitus. Dialysis and Transplantation. 35(4): 234-244. April 2006.

This article reports on a study that investigated mortality difference by dialysis modality (hemodialysis versus peritoneal dialysis) among new end stage renal disease (ESRD) patients with and without diabetes mellitus. The authors completed a retrospective analysis of data obtained from the China Medical University Hospital in Taiwan on all new ESRD patients undergoing hemodialysis (HD, n = 219) or peritoneal dialysis (PD, n = 226) for more than 3 months between January 2000 and December 2003. Of these patients, 102 HD patients and 96 PD patients also had diabetes. Their average age was 60 years (plus or minus 13 years) for the HD group and 57 years (plus or minus 16 years) for the PD patient group. Among these 445 patients, PD patients were associated with a significantly lower risk of death compared with the HD patients. Older age, diabetes mellitus as the cause of ESRD, co-morbidity of ischemic heart disease, congestive heart failure, cerebral vascular accident (CVA, stroke), peripheral artery occlusive disease, or liver cirrhosis, and HbA1c levels greater than 8 percent were associated with a significantly high risk of mortality. 4 figures. 4 tables. 20 references.

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Peritoneal Dialysis Dose and Adequacy. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2006. 4 p.

This fact sheet describes the need to determine the adequacy of peritoneal dialysis (PD) used to treat chronic kidney failure, also known as end-stage renal disease (ESRD). In PD, a soft tube or catheter is used to fill the abdomen with dialysis solution, made up of dextrose, salt, and other minerals dissolved in water; the lining of the abdomen serves as a membrane to allow waste products and extra fluid to pass from the blood into the dialysis solution. These wastes and fluid then leave the person’s body when the dialysis solution is drained. Many factors affect how much waste and extra fluid are removed from the blood, including the person’s capacity for dialysis solution and the permeability of the person’s abdominal lining, also called the peritoneum. Controllable factors include the number of daily exchanges and the dwell time, which is how long the fluid stays in the abdomen. The fact sheet describes the three types of PD and the tests that are used to determine if the exchanges are removing enough wastes and fluid. The PD prescription usually also considers the amount of residual kidney function the person has. Patients sometimes do not perform all of the exchanges recommended by their medical team; this lack of compliance can increase the risk of hospitalization and death. The fact sheet concludes with a description of current research efforts in this area and a summary of activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) that provides information about diseases of the kidneys and urologic system to patients and their families, the general public, and health care professionals. Readers are referred to the Centers for Medicare and Medicaid Services at www.cms.hhs.gov or 1–877–267–2323 and to the National Kidney Foundation at www.kidney.org or 1–800–622–9010 for more information. 1 figure.

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Starting and Managing an Intradialytic Exercise Program. Nephrology News & Issues. 20(9): 47-49. August 2006.

Despite many recent studies showing the benefits of exercise for patients on dialysis, most dialysis clinics have not incorporated exercise programs for their patients into their regular regimen of care. This article addresses this problem, offering advice for starting and managing an intradialytic exercise program. The author hypothesizes that perhaps clinic administrators are not able to access information about getting a program started. The author describes how the University of Virginia Renal Services facility added an exercise program. The greatest obstacle to such a program is the lack of federal and local reimbursement for such programs. However, funds can be raised through hospital or medical center grants, patient memorial funds, patient donations, and community events to pay for exercise equipment such as floor pedalers, hand or leg weights, treadmills, and other equipment. To keep the program going, the dialysis staff members must be consistent and diligent in encouraging the patients to exercise. The author concludes that, with proper commitment from the administration and staff, an exercise program for ESRD patients can become a reality and a standard treatment of care for dialysis patients. 14 references.

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Summary Report of the End Stage Renal Disease (ESRD) Networks' Annual Reports, 2005. Midlothian, VA: Forum of ESRD Networks. 2006. 110 p.

The Medicare End Stage Renal Disease (ESRD) Program, established in 1972, is a national health insurance program for people with irreversible kidney failure. There are 18 ESRD Networks that support the Federal Government in assuring appropriate care for patients who receive treatment through dialysis facilities and kidney transplant centers certified by Medicare. The Networks' responsibilities include: quality monitoring and improving the care ESRD patients receive, collecting data to administer the national Medicare ESRD program, providing technical assistance to patients who have ESRD and providers, and addressing patient grievances. This report provides a summary of the ESRD Networks' Annual Reports. Much of the data is presented in charts and tables, including some full-color graphs. Approximately half of the Summary Report is in the appendices which provide statistical information on incident and prevalent patients by network, age and network, dialysis prevalence patients by age, race and network, a list of the primary causes of end stage renal disease, patients by primary diagnosis and network, dialysis patients by gender and network, in-center dialysis patients by modality and network, and home dialysis patients by modality and network. Other appendices list acronyms used in the Summary Report as well as a list of renal organization web addresses. 3 figures. 20 tables.

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Treatment Methods for Kidney Failure in Children. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2006. 12 p.

The kidneys play an important role in a child’s growth and health, including removing wastes and extra water from the blood, regulating blood pressure, balancing chemicals like sodium and potassium, making a hormone that signals bone marrow to make red blood cells, and making a hormone to help bones grow and keep them strong. This fact sheet reviews treatment methods for kidney failure in children. A successful kidney transplant can give a child with chronic kidney disease (CKD) the best chance to grow normally and lead a full, active life. Dialysis can help a child survive an acute episode of kidney failure or stay healthy until a donated kidney becomes available. Families are encouraged to work closely with their team of health care providers. Topics include problems specific to children with kidney failure, treatment details, deceased donor kidneys, living donor kidneys, preemptive transplantation, keeping a transplanted kidney healthy, peritoneal dialysis, continuous ambulatory peritoneal dialysis (CAPD), continuous cycling peritoneal dialysis (CCPD), hemodialysis, the various members of the health care team and the duties of each one, anemia, bone problems, growth failure, and financial help for treatment of kidney failure. The fact sheet concludes with a list of resource organizations, websites, and publications for readers wanting additional information. Also included is a brief summary of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) that provides information about diseases of the kidneys and urologic system to patients and their families, the general public, and health care professionals. 4 figures.

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Treatment Methods for Kidney Failure: Peritoneal Dialysis. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2006. 28 p.

This booklet describes the option of peritoneal dialysis (PD) as a treatment for people with advanced and permanent kidney failure, also called end-stage renal disease (ESRD). Healthy kidneys clean the blood by removing excess fluid, minerals, and wastes. They also make hormones to keep the bones strong and the blood healthy. In kidney failure, medical treatments must be used to perform these functions of the kidneys. This booklet describes how PD works, getting ready for PD, the different types of PD, customizing PD to the individual, preventing problems, equipment and supplies for PD, testing the effectiveness of the dialysis, conditions related to kidney failure and their treatments, and the psychosocial adjustments that occur as one learns to cope with kidney failure. In PD, a soft tube, or catheter, is used to fill the abdomen with dialysis solution; the lining of the abdomen serves as a membrane to allow waste products and extra fluid to pass from the blood into the dialysis solution. These wastes and fluid then leave the person’s body when the dialysis solution is drained. The most common form of PD, continuous ambulatory peritoneal dialysis (CAPD), does not require a machine; other forms use a cycler to perform the exchanges. Infection is the most common problem for people on PD, but equipment advances and strict adherence to infection control measures can reduce this complication. Monitoring tests include those performed on the used solution, urine tests, and blood tests, all of which are done to determine whether the dialysis is adequate. Conditions related to kidney failure and their treatments include anemia; renal osteodystrophy, which is bone disease associated with kidney failure; itching, also called pruritus; sleep disorders; and dialysis-related amyloidosis. The booklet concludes with a description of current research efforts devoted to improving treatment for people with progressive kidney disease and permanent kidney failure. The booklet also includes a list of resources—organizations and instructional materials—and a summary of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) that provides information about diseases of the kidneys and urologic system to patients and their families, the general public, and health care professionals. 6 figures.

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Why Exercise Can Make a Difference. Nephrology News & Issues. 20(9): 50-52. August 2006.

Despite many recent studies showing the benefits of exercise for patients on dialysis, most dialysis clinics have not incorporated exercise programs for their patients into their regular regimen of care. This article reminds readers of the benefits that can be attained from an intradialytic exercise program. The author notes that the recently published Kidney Disease Outcome Quality Initiative clinical practice guidelines on management of cardiovascular disease mandate that all dialysis patients should be counseled and regularly encouraged by nephrology and dialysis staff to increase their levels of physical activity. This article also serves as an introduction to another article in this same journal that describes an ongoing dialysis exercise program at the University of Virginia. The author calls for more research to demonstrate exactly how to assess functioning and encourage physical activity within the routine care of end-stage renal disease (ESRD) patients. 1 figure. 8 references.

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You Decide! Choosing a Treatment that Fits Your Life. In Control. 3(1): S3, S6. March 2006.

There are many different dialysis modalities available for kidney disease patients, including manual and automated peritoneal dialysis as well as short daily and long nocturnal hemodialysis (done at home or in-center). This article helps patients consider the importance of matching dialysis modality to patient lifestyle. The author outlines the different types of treatment options for kidney failure, including transplant, peritoneal dialysis (CCPD and CAPD), home hemodialysis (including short daily home hemodialysis, conventional home hemodialysis, or nocturnal home hemodialysis), and in-center hemodialysis (conventional or nocturnal). The author then discusses some of the factors that might make patients reluctant to change from dialysis center-based therapy. Readers are advised to check two websites for more information about kidney treatment options: www.kidneyschool.org and www.homedialysis.org.

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Acid-Base Homeostasis in Dialysis Patients. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 553-576.

Many of the enzymes that constitute the body’s metabolic system depend on a stable pH within the body. Because acid is continually added to the body as a result of normal metabolic processes, a sophisticated system of checks and balances is required to prevent the pH from drifting outside the desired range. This chapter on acid-base homeostasis is from a textbook on the clinical management of patients on dialysis. The authors begin with a discussion of how acidosis contributes to severe chronic kidney disease, through protein catabolism, and its role in bone disease. The authors continue to discuss sources of acid, the magnitude of the daily acid burden, disposition of the acid burden, requirements of dialysis, base repletion by dialysis, hypoxemia, vascular and nervous system stability, highly efficient dialysis, selection of a dialysate base concentration, supplemental base, base repletion in peritoneal dialysis, biocompatibility, and base repletion in hemofiltration. The authors conclude by noting that the question of adequacy of base repletion remains unresolved. Use of bicarbonate results in a greater transfer of base to the patient than was obtained with acetate. They caution that high-flux and high-efficiency dialysis greatly exaggerate solute fluxes, thereby stressing all the systems involved in acetate metabolism and consequent bicarbonate generation. All new dialysis equipment is capable of delivering bicarbonate-containing dialysate and essentially all patients are now treated with this type of dialysate. 3 figures. 2 tables. 262 references.

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Assessing Health Status and Health Care Utilization in Adolescents With Chronic Kidney Disease. Journal of the American Society of Nephrology. 16(5): 1427-1432. May 2005.

Few validated health status measures have been assessed in children with chronic kidney disease (CKD). This article reports on a study undertaken to assess the validity of a generic health status measure, the Child Health and Illness Profile-Adolescent Edition (CHIP-AE), in adolescents with CKD. The case-control study was performed to assess scores on the CHIP-AE in adolescents with CKD compared with two control groups of age-, socioeconomic-, and gender-matched peers and to compare health of patients who had chronic renal insufficiency (CRI), were on dialysis, and were posttransplantation. Seven pediatric nephrology centers recruited the 113 patients (mean age, 14 years; 39 CRI, 21 dialysis, 53 posttransplantation). Compared with 226 control subjects, patients with CKD had lower overall satisfaction with health and more restriction in activity. Positively, patients with CKD had more family involvement, better home safety and health practices, and better social problem-solving skills and were less likely to participate in risky social behaviors or to socialize with peers who engaged in risky behavior. Patients who received dialysis were less physically active and experienced more physical discomfort and limitations in activities than did transplant or CRI patients. The authors conclude that patients with CKD have poorer functional health status than age-matched peers. Among CKD patients, dialysis patients have the poorest functional health status. The medical and surgical status of adolescents with CKD clearly has an impact on their level of social role functioning and the resources that they have available to meet the challenges of living with CKD and becoming well-functioning adults. 5 tables. 23 references.

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Cardiac Disease in Dialysis Patients. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 741-754.

This chapter on cardiac disease in dialysis patients is from a comprehensive textbook on the clinical management of patients on dialysis. The author first reviews animal models of uremia and the cardiovascular system, then considers diagnostic tests for coronary artery disease and for cardiac morphology and function. Additional sections cover prevalence, incidence, prognosis, risk factors (including smoking, poor glycemic control, hypertension, lipid abnormalities, anemia, uremia, inflammation, dialysis access problems, bacteremia, and oxidative stress), and research studies on patient management for cardiac patients on dialysis. The author concludes that risk factor management in dialysis patients is dependent on their enormous cardiovascular risk. Although the chapter includes therapy targets advocated by the major professional associations, the author emphasizes the need for safety over guideline attainment. 1 figure. 1 table. 165 references.

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Caregiving by Families and Friends of Adults Receiving Dialysis. Nephrology Nursing Journal. 32(6): 621-631. November-December 2005.

Individuals with kidney failure requiring dialysis often require the support of family and friends to manage their illness and treatment at home. This article reports on a study of the activities of caregivers of adults on dialysis and how the behaviors evolved over time. The authors conducted interviews with 37 caregivers and found that caregivers had a wealth of caregiving abilities and activities that were often supported by a strong knowledge base. Caregiving activities were categorized into five interdependent dimensions: appraising, advocating, juggling, routinizing, and coaching. Caregivers also described specific caregiving tasks, including dialysis-related activities; management of diet, medications, and symptoms; and personal care. The authors conclude that particularly in light of the trend toward self-care and home care and the reality that many caregivers combine caregiving responsibilities with other family and employment responsibilities, it is imperative that nurses and other health providers understand the care provided by caregivers so they can support the development of caregiving abilities and performance of caregiving activities. 3 tables. 34 references.

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Chronic Dialysis and Access-Related Morbidities in Children. Dialysis and Transplantation. 34(5): 278-282. May 2005.

This article reports on a study of the scope of morbidity facing children with end stage renal disease (ESRD). Morbidity data were collected prospectively during three separate periods from October 2001 through April 2003 from all children (aged 1 to 18 years) maintained on either chronic hemodialysis (HD) or peritoneal dialysis (PD) within the ESRD Network of New England. Data were obtained on 26 HD patients and 33 PD patients. The results showed that despite the use of recombinant human erythropoietin (EPO), anemia was often noted (48.9 percent of PD patients; 33.3 percent of HD patients). A low serum albumin was seen commonly in PD patients (53.2 percent) versus that in HD patients (11.9 percent). Growth failure occurred in 36 percent of the patients and correlated directly with years of renal failure. Dialysis access malfunction, dialysis access-related infection, and hypertension accounted for most of the patient morbidity and nearly all of the hospitalizations. HD access failures were twice as common with central venous catheters and arteriovenous grafts as they were with arteriovenous fistulas. Approximately one-third of HD and PD patients experienced an access-related infection. Hospitalization was necessary in 75 percent of the cases of access failures, 85 percent of the cases of dialysis access-related infections, and 40 percent of the cases of hypertension. 3 figures. 32 references.

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Clinical Dialysis. 4th ed. New York: McGraw-Hill. 2005. 1167 p.

This textbook offers a comprehensive overview of the care of patients who are undergoing dialysis therapy. Forty-seven chapters cover a wealth of topics, including the history of the development of hemodialysis (HD) and peritoneal dialysis (PD), vascular access, technological aspects, hollow-fiber dialyzers, biocompatibility, anticoagulation, kinetic modeling, optimizing dialysis in pediatric patients, complications during HD, dialyzer reuse, HD in children, peritoneal access devices, the physiology of PD, the clinical use of PD, infections in PD, infection and host defense, PD in pediatric patients, acid-base homeostasis, nutrition, growth and growth hormone treatment, liver disease in dialysis patients, gastrointestinal diseases in dialysis patients, hematologic aspects of chronic kidney disease, cardiac disease in dialysis patients, hypertension in HD, lipoprotein metabolism and dyslipidemia, endocrine dysfunction in chronic kidney disease, neurologic aspects of dialysis, diabetes and dialysis, drug usage in dialysis patients, the psychosocial adaptation of dialysis patients, psychosocial care of children on dialysis, high-flux renal replacement therapies, quality and accountability in dialysis, sorbent dialysis, continuous renal replacement therapy, pediatric hemofiltration, preemptive kidney transplantation in infancy, quotidian dialysis, HD access in children, surgical issues in pediatric PD, renal osteodystrophy, and the management of anemia. Each chapter concludes with a lengthy list of references; a detailed subject index concludes the volume.

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Clinical Implications of Larger Molecules. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 223-236.

Dialysis can correct many of the derangements associated with uremia, but some clinical symptoms usually persist despite adequate removal of low-molecular-weight solutes. This residual syndrome experienced by most dialysis patients includes anorexia, muscle wasting, neuropathy, pruritus, increased susceptibility to infection, prolonged recovery from infection, and poor wound healing. This chapter on the clinical implications of larger molecules is from a textbook on the clinical management of dialysis patients. The authors discuss morbidity, mortality, and larger retained solutes; the identification, characterization, and bioactivity of larger uremic toxins; beta2 microglobulin and dialysis-related amyloidosis (DRA); granulocyte-inhibiting proteins; parathyroid hormone; protein-bound uremic toxins; anemia and larger retained solutes; elimination of beta2 microglobulin by dialysis, hemofiltration, and adsorption; peritoneal dialysis; daily and nocturnal hemodialysis; and the treatment and prevention of DRA. 3 tables. 125 references.

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Clinical Use of Peritoneal Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 421-490.

This chapter on the clinical use of peritoneal dialysis (PD) is from a comprehensive textbook on the clinical management of dialysis patients. The author first explores the history, evolution, and current status of PD, then outlines the different modalities of PD, including continuous ambulatory PD, automated PD, and continuous cyclic PD. The next section addresses the selection of therapy, primarily selection between hemodialysis (HD) and PD and the impact of patient choice, the influence of residual renal function, comorbidity, survival, the incidence of fewer viral infections on PD, quality of life, and cost of therapy. Other topics covered in the chapter include PD solutions, biocompatibility, techniques to assess peritoneal function, techniques to assess peritoneal anatomy, the adequacy of PD, the PD prescription, clinical outcomes obtained with PD, complications, and PD in the treatment of specific medical conditions, including acute renal failure, diabetes mellitus, edema, hyperkalemia, hypercalcemia, metabolic acidosis, pancreatitis, hypothermia, and drug overdose. The author notes that the quest for the optimal prescription and dose of dialysis remains an important subject of investigation. 20 figures. 11 tables. 860 references.

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Continuous Renal Replacement Therapy. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 991-1012.

Continuous renal replacement therapy (CRRT) is a group of related therapies designed to provide uninterrupted renal support to critically ill patients over a period of days. This chapter on CRRT is from a comprehensive textbook on the clinical management of patients on dialysis. The author discusses the history of CRRT, the nomenclature in present use, mechanisms of solute transport in CRRT, determinants of solute clearance, vascular access, arteriovenous access, the extracorporeal circuit, other equipment used, dialysate and replacement fluids, dosing of CRRT, selection of modality, and drug dosing during CRRT. The author concludes that the advantages of CRRT over conventional dialysis include more stable control of fluid, electrolyte, and solute balance; improved cardiovascular stability; and greater ability to maintain fluid balance despite the administration of large volumes of hyperalimentation solution and other obligatory fluids. 9 figures. 4 tables. 134 references.

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Development of Hemodialysis and Peritoneal Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 1-26.

This chapter, from a textbook on the clinical care of dialysis patients, reviews the history of the development of hemodialysis and peritoneal dialysis. The author tells the story of those who had the vision and courage to risk everything in search of effective treatment for renal failure. The author offers a critical-path analysis of how the various components of renal care were brought together and evolved into the treatment techniques used today. The author discusses the first investigators, the first dialyzer, other membrane researchers, vividiffusion, the high-flow dialyzer, other membrane research, the first plate dialyzer, the first clinical dialysis, the emergence of manufactured membranes, the Kolff era, the first dialysis in the United States, development of the Kolff-Brigham kidney, other developers of artificial kidneys, the use of artificial kidneys in Korea in 1952, the Skeggs-Leonards dialyzer in Norway, the Seattle artificial kidney program, development of dialyzing fluids, prophylactic dialysis, the beginning of chronic dialysis, the hollow-fiber kidney, the development and coming of age of peritoneal dialysis, dialysis for the patient with diabetes, and the growth of home care. The chapter is illustrated with black-and-white photographs of some of the medical equipment discussed. 16 figures. 75 references.

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Diabetes and Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 877-890.

Diabetes-associated kidney disease (diabetic nephropathy) is the leading cause of end stage renal disease (ESRD) in the United States and much of the rest of the world. This chapter on diabetes and dialysis is from a comprehensive textbook on the clinical management of patients on dialysis. The authors of this chapter discuss the progression of renal disease and choice of uremia therapy in patients with diabetes, extrarenal disease, hemodialysis, continuous ambulatory peritoneal dialysis (CAPD), transplantation, and rehabilitation. In the section on hemodialysis, the authors discuss mortality and comorbid conditions, vascular access, blood glucose, hyperlipidemia, oxidative stress, inflammation, control of intravascular volume, retinopathy, and vasculopathy. The authors emphasize that, as renal failure progresses, concomitant evaluation of medical problems, physical abilities, lifestyle, and social support, together with patient education, must be undertaken in an attempt to slow the progression of renal failure and make good decisions about the choice of uremia therapy. 3 tables. 100 references.

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Dialyzer Reuse. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 273-292.

Dialyzer reuse is highly prevalent in the United States, with 80 percent of all U.S. dialysis units reprocessing hemodialyzers. This chapter on dialyzer reuse is from a textbook on the clinical management of patients on dialysis. The authors review patterns of dialyzer reuse, methods of dialyzer reprocessing, and the effects of hemodialyzer reprocessing on biocompatibility, solute clearance, and clinical outcomes. Specific topics covered include the effects of reuse on hospitalization and survival, infection risk, the toxicity of germicide exposure, and the issue of informed consent. The authors conclude that economic motivations remain the major reason for widespread dialyzer reuse, but the economic benefits of reuse deserve ongoing re-evaluation as the price of newer membranes decreases and as other aspects of dialysis care and the market forces that influence dialysis providers continue to evolve. Regarding adequacy of delivery dialysis, urea clearance appears to be substantially preserved after multiple uses with reprocessed membranes. However, the possible risks associated with chronic exposure of patients and health care workers to germicides in the modern reuse setting have yet to be fully characterized. 1 table. 124 references.

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Disaster Preparedness for Dialysis Facilities. Nephrology Nursing Journal. 32(6): 676-677. November-December 2005.

This article outlines disaster preparedness basics for dialysis facilities. The author first outlines the different types of disasters and emergencies with which a dialysis clinic may have to cope, then focuses on the need for planning and coordination in order to achieve the best outcome possible. The author emphasizes the importance of forming a multidisciplinary group that includes community utility representatives, American Red Cross workers, and the state Emergency Management Agency. Both the community representatives and the facility need to be aware of each others needs and strengths before any disaster occurs. The author refers readers to some publications available from the National Kidney Foundation and to the website of the Centers for Medicare and Medicaid Services. The author also discusses the potential impact of any disaster to the surrounding geographic area which although undamaged by the disastrous event itself, may still have to accommodate a large influx of dialysis patients needing care. One side bar lists the website addresses of eight resource organizations that can provide disaster preparedness-related information. 4 references.

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Drug Usage in Dialysis Patients. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 891-926.

Patients with compromised renal function are particularly vulnerable to drug accumulation and toxicity. While the exact burden of drug toxicity in patients with renal failure can be difficult to estimate, observational analysis indicates a higher incidence of adverse drug reactions in this population. In addition to drug excretion, drug metabolism and biotransformation can be altered by uremia. This chapter on drug usage in dialysis patients is from a comprehensive textbook on the clinical management of patients on dialysis. In this chapter, the authors address the principles behind rational drug therapy in patients with chronic kidney disease (CKD) and those on dialysis. Topics include bioavailability, drug distribution, metabolism and biotransformation, elimination and excretion, the assessment of renal function, determining the need for dosage adjustment, loading doses of drugs, maintenance doses, drug concentrations, drug dialyzability, and hemofiltration. The authors conclude that a knowledge of pharmacokinetics and pharmacodynamic variability in renal failure is essential for health care providers, who must make appropriate dosage adjustments to avoid serious adverse drug reactions. Extensive tables that summarize commonly used drugs and their indications in patients with ESRD are included. 14 tables. 39 references.

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Effective and Safe IV Iron and Anemia Management During Home Hemodialysis: A Dialysis Facility's Experience. Nephrology Nursing Journal. 32(6): 659-665. November-December 2005.

Iron therapy, in conjunction with erythropoietin, is essential in managing anemia in patients on hemodialysis. This article reports on a study undertaken to determine the safety of intravenous (IV) iron therapy self-administered during home hemodialysis. The author stresses that nurses should be aware of how to administer this therapy and be knowledgeable of possible allergic-type reactions that have been associated with its clinical use. The author first discusses the importance of IV iron in effective anemia management, then compares the safety profiles of the various IV iron products. The article reports the experiences of five hemodialysis patients who used self-administered IV iron therapy. A total of 223 doses of sodium ferric gluconate were self-administered at home during a 2-year period without any serious reactions occurring due to drug therapy. The findings of this small study are consistent with results from large clinical studies in patients receiving in-center hemodialysis. The article concludes with a section on the role of the nephrology nurse, including addressing patient concerns, selecting appropriate candidates, and providing patient education and training. Allergic-type reactions have been associated with the clinical use of IV iron therapy, with the majority of episodes occurring with IV iron dextran. Of the available IV iron therapies, sodium ferric gluconate and iron sucrose have the most favorable safety profiles. The author also briefly reports the benefits of fostering a safe home hemodialysis program. 2 figures. 3 tables. 45 references.

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Endocrine Dysfunction in Chronic Kidney Disease. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 795-830.

Patients with advanced chronic kidney disease (CKD) may display a wide range of hormonal and metabolic disturbances. There may be abnormalities in both the secretion and metabolism of the endocrine hormones as well as target-organ sensitivity to these hormones. This chapter on endocrine dysfunction in CKD is from a comprehensive textbook on the clinical management of patients on dialysis. The authors focus on the abnormalities of pancreatic, thyroid, adrenal, and gonadal hormones (derangements in parathyroid hormone, vitamin D, and erythropoietin metabolism are discussed in other chapters). Topics include carbohydrate and insulin metabolism; the problem of hypoglycemia (low blood glucose); insulin requirements in patients on dialysis; carbohydrate intolerance after kidney transplantation; thyroid hormone and iodide metabolism; normal thyroid hormone physiology; the management of patients with uremia who do not have hypothalamic, pituitary, or thyroid diseases; the management of patients with uremia who have goiter, thyroid nodules, thyroid cancer, hypothyroidism, or hyperthyroidism; the role of cortisol; aldosterone secretion in CKD, including that in patients on dialysis and posttransplantation; and the hypothalamic-pituitary-gonadal axis, including sexual dysfunction in prepubertal boys and men with CKD, sexual dysfunction in girls and adult women with CKD, the effect of dialysis therapy, and the effect of kidney transplantation. 12 figures. 7 tables. 307 references.

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Extracorporeal Blood Purification: Applications in the Renal Transplant Patient. In: Medical Management of Kidney Transplantation. Philadelphia, PA: Lippincott Williams and Wilkins. 2005. pp. 113-126.

Several different extracorporeal blood purification methodologies, including hemodialysis, peritoneal dialysis, plasma exchange, and immunoadsorption, have been employed in the perioperative setting in an effort to improve transplant outcomes. This chapter is from a textbook that provides a compendium of the latest advances and understandings regarding the complex medical problems seen in kidney transplant patients. The author of this chapter discusses extracorporeal blood purification and its applications in the renal transplant patient, including pre- and posttransplantation settings. The author covers hemodialysis and peritoneal dialysis in the pretransplantation period; modified hemodialysis and apheresis, including plasma exchange and immunoadsorption; delayed graft function and acute allograft rejection in the immediate posttransplantation period; and chronic allograft nephropathy, recurrent focal segmental glomerulosclerosis, and thrombotic microangiopathy in the longer posttransplantation period. The author concludes that extracorporeal blood purification remains a cornerstone of therapy in the perioperative renal transplantation setting. Information is accumulating regarding the ideal dialysis prescription both preoperatively and in those patients who develop delayed graft function (DGF). 9 figures. 2 tables. 116 references.

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Facts About Kidney Disease. Rockville, MD: American Kidney Fund. 2005. 8 p.

This brochure provides basic information about kidney disease. Topics include the anatomy and physiology of kidneys, common kidney diseases, risks for kidney disease, the symptoms of kidney disease, diagnostic tests used to confirm kidney disease, treatments for kidney failure, and prevention of kidney disease. Kidney diseases discussed include chronic kidney disease (CKD), which can occur from many different causes, kidney stones, polycystic kidney disease (PKD), kidney infections (pyelonephritis), simple kidney cysts, kidney cancer, and the nephritic syndrome. Diagnostic tests described include glomerular filtration rate (GFR), urine tests, blood pressure monitoring, blood glucose testing, kidney biopsy, and imaging tests (CT, MRI). Treatment options include hemodialysis, peritoneal dialysis, and kidney transplantation. Readers are encouraged to contact the American Kidney Fund (AKF) HelpLine (800–638–8299 or HelpLine@kidneyfund.org). The brochure is illustrated with black-and-white photographs. 5 figures.

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Gastrointestinal Diseases in Patients with Chronic Kidney Disease. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 677-690.

Gastrointestinal (GI) disorders are common in patients with chronic kidney disease (CKD) and encompass the full spectrum of diseases that affect the general population. This chapter on GI disease in patients with CKD is from a comprehensive textbook on the clinical management of patients on dialysis. The authors review common GI complaints that are often referred to gastroenterologists for further evaluation. These diseases merit special consideration in the patient with ESRD due to their increased incidence and severity. The authors organize their discussion based on clinical presentation and symptom complex, including nausea, vomiting, diarrhea, GI bleeding, and abdominal pain. Disorders discussed include metabolic imbalance, motility disorders, peptic ulcer disease, infection, and side effects of medications. Specific topics covered are gastroparesis, peptic ulcer disease, infection, bowel obstruction and infarction, acute and chronic diarrhea, diabetic enteropathy, upper and lower gastrointestinal bleeding, ischemic colitis, diverticular bleeding, small bowel bleeding, and abdominal pain. The authors conclude that diagnostic tests and treatment strategies are best formulated in conjunction with the radiologist, gastroenterologist, and surgeon. 6 figures. 5 tables. 106 references.

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Growth and Growth Hormone Treatment in Children with Chronic Renal Insufficiency. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 611-652.

As the treatment of children with end stage renal disease (ESRD) has advanced and many children’s lives have consequently been prolonged by dialysis and kidney transplantation, the impact of growth retardation on those with renal insufficiency has emerged. This chapter on growth and growth hormone treatment in children with chronic renal insufficiency (CRI) is from a comprehensive textbook on the clinical management of dialysis patients. The authors note that optimizing nutritional support and medical care with vitamin D and mineral supplements does not uniformly improve growth in children with chronic renal failure (CRF). The authors discuss the pathomechanism of growth failure, growth patterns in children with CRF, and treatment strategies. They conclude that growth hormone therapy has been shown to stimulate growth significantly in prepubertal children with renal failure and ESRD, and does not appear to exhaust growth potential. Therapy should be instituted when the patient falls below the third percentile for height and does not show spontaneous catch-up growth after other factors contributing to uremic growth failure have been adequately stabilized. Therapy is continued until final height is reached or a well-functioning renal transplant is achieved. 29 figures. 286 references.

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Hematologic Aspects of Chronic Kidney Disease. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 691-740.

The most characteristic hematologic abnormality in chronic kidney disease (CKD) is anemia, which results primarily from the failure of the kidneys’ endocrine function. Anemia can persist as a significant problem, even in patients receiving adequate dialysis. This chapter on the hematologic aspects of CKD is from a comprehensive textbook on the clinical management of patients on dialysis. The authors review the pathogenesis of the anemia associated with CKD, discuss the diagnosis and therapy of this anemia in patients with CKD, and outline selected aspects of granulocyte and platelet function in patients with CKD. Other topics covered include the paradoxical absence of anemia, treatment with epoetin (erythropoietin alfa), transfusion avoidance, quality of life issues, exercise tolerance and rehabilitation, the positive effects of the correction of anemia, special considerations for patients with congestive heart failure (CHF), target hemoglobin levels, newer epoetins, the role of ACE inhibitors, intercurrent illness or surgery, granulocyte number and function in uremic patients, and abnormalities of hemostasis in uremia. The authors include a discussion of treatment issues, particularly the challenges faced by primary care physicians in identifying, treating, and referring patients with CKD and CKD-related complications and comorbidity. 7 figures. 596 references.

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Hemodialysis in Children. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 293-308.

While most children with chronic kidney failure will eventually be treated with renal transplantation, nearly half of these children will be placed on hemodialysis while awaiting their transplants. In addition to the children with chronic dialysis needs, there is a population of children with acute renal insufficiency who may require a period of hemodialysis during acute illness and recuperation. This chapter on hemodialysis (HD) in children is from a textbook on the clinical management of dialysis patients. The authors caution that, with children, the whole task of providing care becomes even more daunting as the physical and psychosocial effects of HD and especially chronic HD therapy may adversely affect important aspects of normal childhood growth and development. The authors discuss epidemiology, the physiology of HD in children, the dialysis prescription, vascular access, the acute HD setting, HD in chronic renal failure, anemia, osteodystrophy, growth, the cognitive effects of HD, complications of HD, and the adequacy of HD. The authors note that there is preliminary evidence that optimizing caloric intake and diet and intensifying dialysis to achieve higher-than-normal measures of dialysis adequacy improves growth and pubertal development in children. 3 figures. 1 table. 66 references.

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Hemodialysis in Children: General and Practical Guidelines. Pediatric Nephrology. 20(8): 1054-1066. August 2005.

Over the past 20 years children have benefited from major improvements in both the technology and clinical management of dialysis. This article offers general practical guidelines for hemodialysis (HD) in children. The authors note that morbidity during dialysis sessions has decreased with seizures being exceptional and hypotensive episodes rare. Pain and discomfort have both been reduced with the use of chronic internal jugular venous catheters and anesthetic creams for fistula puncture. The authors offer specific guidelines in the areas of the dialysis unit, water quality, the dialysis machine, blood lines; principles of blood purification, extracorpeal blood access and circulation, dialyzer membranes, the dialysate, post-dialytic dry weight assessment and adjustment, assessments (of urea dialytic kinetic, dialysis dose, and protein intake), dialysis dose and outcome, and dialysis adequacy and monitoring. Although the optimum dialysis dose requirement for children remains uncertain, reports of longer duration or daily dialysis show they are more effective for phosphate control than conventional HD. In children, HD has to be individualized and viewed as an integrated therapy considering their long-term exposure to chronic renal failure treatment. The authors stress that dialysis is usually seen only as a temporary measure for children compared with renal transplantation because the latter enables the best chance of rehabilitation in terms of education and psychosocial functioning. 1 figure. 6 tables. 83 references.

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Hidden Phosphorus in Popular Beverages. Nephrology Nursing Journal. 32(4): 443-448. July-August 2005.

In order to maintain normal blood phosphorus levels in patients on dialysis, patient education has emphasized adherence to prescription phosphate binder drugs and maintenance of a low phosphorus diet. In addition to the standard advice to avoid dairy products and legumes, education also focused on lower phosphorus protein foods and beverages. However, current food-processing practices have stepped-up the use of phosphorus additives the ensure the quality and flavor of their products. This article considers the hidden phosphorus content of many popular beverages. The problem with phosphorus additives may be unique to the renal community because these phosphorus additives are highly absorbable. In a typical mixed diet of grains, meat, and dairy, only 60 percent of the dietary phosphorus is absorbed, whereas phosphoric acid and various polyphosphates and pyrophosphates are almost 100 percent absorbed. The author discusses how to identify these new, higher phosphorus foods and the importance of reading food and beverage labels. The article includes a chart that lists the sodium, potassium, and phosphorus content of many popular beverages. 1 table. 10 references.

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High-Flux Renal Replacement Therapies. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 949-962.

Conventional hemodialysis (HD), consisting of three sessions per week lasting 3 to 4 hours each, remains the major modality of life-supporting therapy in patients with chronic kidney disease (CKD). By enhancing the various components of solute clearance (diffusion, convection, and adsorption), high-flux HD improves overall solute removal capacity and enlarges the spectrum of removable substances. Diffusive clearance enhances small solute removal, convective clearance favors medium- and high-molecular-weight solute removal, and adsorptive clearance facilitates removal of reactive solutes according to their electrostatic or chemical reactivity. This chapter on high-flux renal replacement therapy is from a comprehensive textbook on the clinical management of patients on dialysis. The chapter covers the technical prerequisites for high-flux therapies, high-flux hemodialysis (HF-HD), hemofiltration, hemodiafiltration (HDF), unconventional methods, clinical results, and the risks and hazards of high-flux therapies. The authors conclude that high-flux modalities offer the most effective renal replacement therapy (RRT) for the patient with end stage renal disease (ESRD). By combining the use of ultrapure dialysis fluid and synthetic hemocompatible membranes, these high-flux modalities considerably improve the hemocompatibility model profile of the HD system. 8 figures. 2 tables. 61 references.

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Hollow-Fiber Dialyzers: Technical and Clinical Considerations. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 85-100.

Dialyzers containing hollow-fiber membranes are now used almost exclusively for hemodialysis (HD) therapy. This chapter on the technical and clinical considerations of hollow-fiber dialyzers is from a textbook on the clinical care of dialysis patients. Hollow-fiber dialyzers display relatively low blood-compartment resistance, which results in high blood-flow rates at acceptable axial (arterial-to-venous) pressure drops. In the first part of the chapter, hollow-fiber membranes are discussed specifically, including the chemical composition and physical characteristics of commonly used membranes. The author also reviews the membrane characteristics that determine solute and water permeability. The remainder of the chapter deals with properties of the dialyzer itself, with emphasis on the major determinants of performance characteristics. 5 figures. 84 references.

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Infection Control for Peritoneal Dialysis (PD) Patients. Atlanta, GA: Centers for Disease Control and Prevention. 2005. 4 p.

Peritoneal dialysis (PD) is a practical and commonly used treatment for kidney failure. Because a soft tube (catheter) is present in the abdominal cavity for this treatment, special care must be taken by PD patients and their medical providers to prevent infection, especially following natural disasters when flooding may be present, access to medical supplies may be limited, or PD patients may be living in temporary housing. This fact sheet, from the Centers for Disease Control and Prevention, reviews disaster safety and prevention strategies for PD patients. Topics covered include exit site infection; peritonitis; preventing exit site infections; general exit site care; exit site care with vinegar for wet, red or sore sites; and other infection control considerations. The fact sheet offers practical, specific suggestions for infection control steps and patient care management. 13 references.

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Infections in Peritoneal Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 491-514.

Peritonitis and peritoneal catheter infections cause significant morbidity in peritoneal dialysis (PD) patients, accounting for the majority of catheters lost and for transfer to hemodialysis, either temporarily or permanently. This chapter on infections in PD is from a comprehensive textbook on the clinical management of patients on dialysis. The first section covers catheter infections, including definitions and diagnosis, organisms causing catheter infections, and prevention strategies. The latter section discusses peritonitis, including epidemiology, risk factors, etiology, presentation and diagnosis, treatment strategies, and prevention. The authors conclude that, in order to achieve low rates of peritonitis, the PD program must offer constant surveillance. Root-cause analysis should be carried out for every episode of peritonitis to determine the etiology, so that future preventive measures can be implemented. Experienced and dedicated PD nurses are important in maintaining a PD program with low infection rates. 8 figures. 8 tables. 287 references.

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Invasive and Innovative Nephrology. Renal Failure. 27(3): 255-258. 2005.

This article explores the role of interventional nephrology in the current and future practice of modern nephrologists. The authors describe the interventional procedures available at the Overton Brooks Veterans Affairs Medical Center (OBVAMC), the first federal health care provider in the nation offering such services. The authors report their early experience in successfully providing complete care to veterans with renal failure. The OBVAMC is an acute care facility providing nephrology support to hospitalized veterans; the facility also handles access-related issues for eligible chronic dialysis patients. The authors analyzed all procedures performed between June 2000 and September 2003. The procedures were performed in the cardiac catheterization laboratory or in the surgical operating rooms. A total of 366 procedures were performed: 110 tunneled cuffed catheter (TCC) placements, 157 temporary dual lumen catheters, 36 TCC removals, 30 fistulograms, 24 thrombectomy-angioplasty, 1 stent placement, 3 Tenckhoff catheter placements, 3 central venograms, and 2 accessory vein ligations. The authors conclude that the interventional nephrology experience at OBVAMC has been successful and that interventional nephrology programs can be developed in any tertiary care hospital. 1 table. 12 references.

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Kidney Dialysis. IN: Physician's Guide to Medicare Coverage of Kidney Dialysis and Kidney Transplant Services. Baltimore, MD: Centers for Medicare and Medicaid Services. May 2005. pp. 15-21.

This chapter on kidney dialysis is from a booklet that provides information on Medicare for physicians who have patients with permanent kidney failure. The booklet explains how these patients can qualify for Medicare, how Medicare helps pay for kidney dialysis and kidney transplants, and where to get more information and assistance. This chapter reviews the treatment options for end-stage renal disease (ESRD), including peritoneal dialysis, hemodialysis, and home dialysis. Other topics include how dialysis adequacy is determined, deciding which payment option to choose for home dialysis, home dialysis drugs covered by Medicare, treatments and equipment that are not covered by Medicare, and what Medicare patients pay for dialysis in a dialysis facility, dialysis in a hospital, doctors' services, dialysis when traveling, and for transportation to dialysis facilities. Sidebars provide specific examples and important bullet points. Tables summarize some of the information presented. 3 tables.

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Kinetic Modeling in Hemodialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 153-202.

This chapter on kinetic modeling in hemodialysis is from a textbook on the clinical management of dialysis patients. The authors note that the clinical goals of modeling in dialysis therapy are to improve clinical understanding of control of the uremic syndrome by dialysis and to prescribe and deliver adequate, reproducible, and quantified doses of dialysis for a variety of solutes. The uremic syndrome is only partly responsive to adequate dialysis therapy, and there is variable ongoing morbidity, such as reduced taste and appetite, mild sensory neuropathy, renal osteodystrophy, and other clinical problems, even in well-dialyzed patients. The authors describe the development of several modeling techniques used for a variety of solutes for clinical application. Topics include an overview of urea kinetic modeling, applied single-pool urea kinetic modeling, applied double-pool kinetic modeling, modeling for inorganic phosphate (iP), kinetic continuous and intermittent clearances, and the pharmacodynamics of erythropoietin therapy. The chapter concludes with a glossary of kinetic modeling terms. 58 figures. 2 tables. 110 references.

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Kinetic Modeling in Peritoneal Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 385-420.

This chapter on kinetic modeling in peritoneal dialysis (PD) is from a textbook on the clinical management of dialysis patients. The authors note that the clinical goals of modeling in dialysis therapy are to reliably predict water and solute removal with various PD regimens, to quantify the dose of delivered dialysis, and to guide prescription of adequate dialysis. All forms of PD in clinical use are basically batch dialysis systems with intraperitoneal dialysate infusion followed by variable dwell time and subsequent drainage. Topics include ultrafiltration in PD, automated PD (APD), creatinine-to-urea clearances in PD, urea kinetic modeling, equivalent doses of dialysis in PD and hemodialysis (HD), quantification of the dose of intermittent HD combined with residual renal urea clearance, modeling the dose of PD, and the peritoneal function test. The authors stress that in order to prescribe specified levels of fluid and solute control removal for individual patients, the time course of ultrafiltration and clearance with varying infusion volumes and exchange times must be reliably predicted. 34 figures. 2 tables. 80 references.

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Lipoprotein Metabolism and Dyslipidemia. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 777-794.

Death from cardiovascular disease remains a major cause of mortality among patients on dialysis. The development of cardiovascular disease has many causes, including hyperlipidemia, hypertension, inadequate dialysis, vascular calcification, and subclinical inflammation. This chapter on lipoprotein metabolism and dyslipidemia in dialysis patients is from a comprehensive textbook on the clinical management of patients on dialysis. The authors first review the basics of lipoprotein metabolism, then explore lipoprotein abnormalities in uremia and dialysis. The remainder of the chapter focuses on treatment of lipid abnormalities in dialysis patients, including the role of lifestyle and diet, and the use of drug therapy, including fibrates, statins, drugs that inhibit lipid absorption, probucol, nicotinic acid and its derivatives, carnitine, and fish oil. 1 figure. 3 tables. 251 references.

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Liver Disease in Dialysis Patients. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 653-676.

This chapter, from a comprehensive textbook on the management of patients on dialysis, describes the clinical course, diagnosis, and management of liver diseases in this population. The authors note that liver disease typically is not a frequent management issue in patients on chronic dialysis, although viral hepatitis (both types B and C) remains a concern. The authors discuss the interpretation of dialysis tests, hepatitis B epidemiology in dialysis past and present, control practices to prevent the transmission of bloodborne pathogens in hemodialysis, the symptoms and treatment of hepatitis B virus (HBV) infection, hepatitis D (delta), hepatitis C virus (HCV) infection in this population, the epidemiology of HCV in dialysis centers, modes of nosocomial transmission of HCV in hemodialysis, the natural history of HCV infection (including mortality), the symptoms and treatment of HCV infection, and the role of nonviral agents in liver dysfunction in dialysis patients. The authors conclude that controlling the spread of HBV infection in dialysis centers has been a major triumph in the management of end stage renal disease (ESRD), but the diffusion of HCV within hemodialysis units remains high all over the world. 5 tables. 401 references.

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Medicare Basics. IN: Physician's Guide to Medicare Coverage of Kidney Dialysis and Kidney Transplant Services. Baltimore, MD: Centers for Medicare and Medicaid Services. May 2005. pp. 4-7.

This chapter on Medicare basics is from a booklet that provides information for physicians who have patients with permanent kidney failure. The booklet explains how these patients can qualify for Medicare, how Medicare helps pay for kidney dialysis and kidney transplants, and where to get more information and assistance. This chapter introduces physicians to Medicare coverage for kidney diseases, including who is eligible, how to sign up for Medicare, when Medicare coverage begins, how to get Medicare coverage sooner than normal, when Medicare coverage ends, and Medicare preventive benefits. Sidebars provide specific examples and important bullet points. One table summarizes the preventive services covered by Medicare.

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Medicare Legislation. IN: Physician's Guide to Medicare Coverage of Kidney Dialysis and Kidney Transplant Services. Baltimore, MD: Centers for Medicare and Medicaid Services. May 2005. pp. 10-13.

This chapter on Medicare legislation is from a booklet that provides information for physicians who have patients with permanent kidney failure. The booklet explains how these patients can qualify for Medicare, how Medicare helps pay for kidney dialysis and kidney transplants, and where to get more information and assistance. This chapter introduces physicians to the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA), including new benefits for Medicare beneficiaries, new protection for individuals with high drug costs, additional assistance for beneficiaries of limited means and with low incomes, savings for state government and employers, new preventive benefits available through the MMA, other key provisions of the legislation, and end-stage renal disease (ESRD) composite rate system.

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NAPRTCS Dialysis Registry Status Report. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 1021-1030.

The North American Pediatric Renal Transplant Cooperative Study Group (NAPRTCS) was founded in 1987 with the purpose of studying kidney transplantation in children and adolescents in North America. This chapter, which provides a status report on the NAPRTCS Dialysis Registry, is from a comprehensive textbook on the clinical management of patients on dialysis. The authors first outline the history of the NAPRTCS, then provide information on patient demographics and nephrologic history, modality initiation and termination, peritoneal dialysis, hemodialysis, dialysis dose, and temporal trends. In the sections on peritoneal dialysis and hemodialysis, the authors report on means of access, the first year of dialysis, complications (notably peritonitis, in the case of peritoneal dialysis), and differences between the two modalities. 2 figures. 14 tables. 1 reference.

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Natriuretic Peptides in ESRD. American Journal of Kidney Diseases. 46(1): 1-10. July 2005.

Natriuretic peptides are hormones that are involved in the regulation of volume homeostasis and effect the removal of sodium in the urine. Their levels generally are increased in the setting of volume expansion and act on multiple effector systems to cause vasodilation and natriuresis in an effort to return volume status back to normal. This article discusses the role of natriuretic peptides in people with end-stage renal disease (ESRD). The authors first describe the role and physiology of natriuretic peptides in patients with normal kidney function, then discuss patients with ESRD, in whom the natriuretic capabilities of these peptides are limited. However, there has been much interest in the potential applicability of measurement of these peptides as a surrogate marker of volume status and in the determination of dry weight. Furthermore, atrial natriuretic peptide and brain natriuretic peptide can serve as markers of left ventricular dysfunction and may have utility in determining cardiac prognosis in patients on long-term dialysis therapy. A final section discusses the role of natriuretic peptides in patients on peritoneal dialysis (PD). 1 figure. 2 tables. 81 references.

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Neurologic Aspects of Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 855-876.

This chapter on neurologic aspects of dialysis is from a comprehensive textbook on the clinical management of patients on dialysis. The author summarizes the current status of uremic encephalopathy: its pathophysiology, its possible management, and approaches for the future. The author focuses on two major clinical neurologic syndromes that can be observed in uremic patients: uremic encephalopathy (UE), which is closely linked to the progression of kidney disease; and dialysis encephalopathy (DE), resulting from the dialysis treatment itself. The author reviews each type, then discusses methods of assessing brain function in uremic patients, the pathogenesis of each type, and treatment approaches. Additional neurologic abnormalities are covered in a separate section and include central nervous system infection and hemorrhage, malnutrition and encephalopathy, the neurobiology of aging and dementia, aging collagen, schizophrenia, thiamine deficiency, high homocysteine levels, and erythropoietin encephalopathy. The author concludes that, for DE, malnutrition, anemia, hypertension, atherosclerosis, amino acid imbalance, hormonal disorders, drugs, trace elements, and the unphysiology of dialysis treatments are all factors possibly playing an important role. It may be possible to prevent UE by means of simple treatment approaches: better control of nutritional status, chronic supplementation of hydrosoluble vitamins, aerobic exercise training, and proper dialysis adequacy. 13 tables. 150 references.

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Nutrition in Patients With Chronic Kidney Disease and Patients on Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 577-594.

Nutritional factors play an important role in the management of patients with end stage renal disease (ESRD) as well as those with chronic kidney disease (CKD) not yet on dialysis. Nutritional status affects the morbidity and mortality of patients on dialysis, as well as their quality of life and ultimate rehabilitative potential. This chapter on nutrition is from a comprehensive textbook on the clinical management of dialysis patients. The authors discuss nutritional status in patients with ESRD, the causes of malnutrition in kidney failure, the effects of uremia and dialysis on nutritional status, inflammation and malnutrition, assessment of nutritional status in patients with kidney failure, the dietary management of patients with ESRD, and the nutritional management of patients treated with hemodialysis (HD) or peritoneal dialysis (PD). The authors contend that morbidity and mortality in this patient population might be reduced if patients were well nourished. In addition, the ability to recover from catabolic illness and the occurrence of infectious complications might be improved with better nutritional status. The role of oral or parenteral nutritional supplementation still remains unclear. Once the patient begins dialysis therapy, careful attention to nutritional factors is required to correct malnutrition that may have developed during the predialysis period or to maintain nutrition in the patient who suffers intercurrent catabolic illness. 6 tables. 170 references.

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Nutritional Management of Pediatric Patients on Chronic Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 595-610.

Nutritional factors play an important role in the management of patients with end stage renal disease (ESRD) as well as those with chronic kidney disease (CKD) not yet on dialysis; in pediatric patients, nutrition is an even more crucial factor. Protein and calorie malnutrition is a common complication of ESRD in children and has been linked to a wide range of complications, including growth retardation and death. This chapter on the nutritional management of pediatric patients is from a comprehensive textbook on the clinical management of dialysis patients. The authors discuss the assessment of nutritional status, the prevention and treatment of malnutrition, and the role of the optimization of dialysis. The authors stress that the treatment of malnutrition in children must be multidisciplinary and based on a series of steps: accurate and periodic monitoring of nutritional status, the provision of adequate calorie and protein intake, the optimization of dialysis treatment, drug prescriptions that are specific for each patient, and continuous psychosocial support for the patient and family. 3 figures. 1 table. 115 references.

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Optimizing Dialysis in Pediatric Patients. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 203-222.

This chapter on optimizing dialysis in pediatric patients is from a textbook on the clinical management of patients on dialysis. The author reviews the current information available on the optimal approach to the prescription and quantification of peritoneal dialysis (PD), the predominant mode of dialysis therapy for children through early adolescence. The author presents data on the kinetics of PD, the basis for the peritoneal equilibration test (PET), and the role of this information in the dialysis prescription. A final section covers the prescription of hemodialysis (HD), with specific emphasis on issues of importance to the pediatric population. Specific topics include peritoneal membrane function in children, scaling factor for kinetic studies, the peritoneum as a dialyzing membrane, mass transfer area coefficient, ultrafiltration and convection, peritoneal fluid and lymphatic absorption, principles of the peritoneal equilibration test, pediatric PET procedure, solute equilibration in children, and the adequacy of peritoneal dialysis. The author concludes that in both HD and PD, optimization in children can be achieved only if the dialysis prescription is individualized and based on the patient’s clinical status and some measure of dialysis delivery. 7 figures. 2 tables. 138 references.

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Options for Patients with Kidney Failure. IN: Danovitch, G.M. Handbook of Kidney Transplantation. Philadelphia, PA: Lippincott Williams and Wilkins. 2005. pp. 1-22.

This chapter, from a handbook that offers a practical guide for health care providers who manage kidney transplant patients, outlines the current treatment options for patients with kidney failure. The authors stress that for most patients with kidney failure, kidney transplantation has the greatest potential for restoring a healthy, productive life. However, virtually all transplant recipients have been exposed, at least to some extent, to the adverse consequences of chronic kidney disease (CKD). This must be taken into consideration when planning for renal replacement therapy. The authors review the stages of CKD, demographics of the end-stage renal disease (ESRD) population, hemodialysis, peritoneal dialysis, long-term complications of dialysis (anemia, renal osteodystrophy, uremic neuropathy, amyloidosis, acquired cystic disease, cancer of the kidney and urinary tract, dialysis access failure), transplantation considerations including patient survival, and choosing an appropriate renal replacement therapy. 6 figures. 3 tables. 16 references.

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Oxidative Stress in Chronic Kidney Disease. Nephrology Nursing Journal. 32(6): 683-685. November-December 2005.

Oxidative stress is physiological stress on the body that is caused by the cumulative damage done from free radicals inadequately neutralized by antioxidants. Oxidative stress is commonly associated with the process of aging, but also appears to be increased in persons with chronic kidney disease (CKD) as well as in other chronic diseases, including cancer, heart disease, Parkinson's disease, and depression. This article reviews the problem of oxidative stress in CKD, which is considered a major risk factor, particularly for patients on dialysis. The authors focus on the causes, including nutritional factors, the complications of, and treatment options for oxidative stress. Treatment of oxidative stress includes antioxidant therapy, consisting primarily of vitamin E and vitamin C. These therapies remain controversial and there have been few studies that investigate their use in the CKD population. However, the authors conclude that there is no doubt that correcting the oxidant-antioxidant imbalance in patients with CKD is an important approach to consider for reducing their risk of developing cardiovascular problems. 29 references.

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Parathyroid Hormone, Vitamin D, and Metabolic Bone Disease in Dialysis Patients. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 831-854.

Chronic kidney disease (CKD) leads to disturbances in the homeostatic balance and abnormalities in the parathyroid hormone (PTH) and vitamin D systems; these can result in a spectrum of bone disorders called renal osteodystrophy. This chapter on metabolic bone disease in dialysis patients is from a comprehensive textbook on the clinical management of patients on dialysis. The authors review the advances of the past decade that have led to changes in clinical practice guidelines for the prevention and treatment of renal osteodystrophy. Topics include the epidemiology and pathogenesis of renal osteodystrophy, including abnormalities of phosphorus metabolism, abnormalities of vitamin D metabolism, abnormalities of parathyroid gland function, and abnormal skeletal response to parathyroid hormone; adynamic bone disease and osteomalacia (low-bone-turnover renal osteodystrophy); other factors contributing to metabolic bone disease, including metabolic acidosis, corticosteroids, and growth factors and cytokines; the clinical manifestations of renal osteodystrophy, including musculoskeletal symptoms, metastatic and extraskeletal calcifications, and dialysis-related amyloidosis; the diagnosis and assessment of renal osteodystrophy; and clinical management strategies. Efforts for optimum treatment of patients on dialysis include avoiding the oversuppression of PTH, adjusting dialysate calcium, treating any existing acidosis, and using serial evaluations of bone mineral density. 4 figures. 287 references.

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Pediatric ESRD Peritoneal Dialysis Fact Sheet. Pitman, NJ: American Nephrology Nurses Association. 2005. 4 p.

This fact sheet from the American Nephrology Nurses' Association (ANNA) provides information for classroom teachers, school nurses, and other caregivers about children who are undergoing peritoneal dialysis (PD) as treatment for end-stage renal disease (ESRD). The fact sheet introduces ESRD and its treatments and outlines the different types of PD and their indications. Specific topics include continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD), care of the peritoneal dialysis catheter, blood pressure control, and common medications used in children on dialysis. The fact sheet includes space to individualize the information about a specific child who may be in the classroom. Readers are referred to the ANNA website at www.annanurse.org for more information.

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Pediatric Hemofiltration. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 1013-1020.

This chapter on pediatric hemofiltration (HF) is from a comprehensive textbook on the clinical management of patients on dialysis. The authors begin with a discussion of the three modes of dialysis (hemodialysis, peritoneal dialysis, and hemofiltration) and the choices to be made for pediatric patients in the acute care setting. The authors then discuss continuous renal replacement therapy (CRRT), continuous venovenous hemofiltration (CVVH), continuous venovenous hemofiltration with dialysis (CVVHD), ultrafiltration, equipment, membranes for HF, tubing, access, dialysate solutions, anticoagulation therapy, nutrition in CRRT, drug clearance, the complications of HF, and expected outcomes in acute renal failure (ARF). The authors conclude that CRRT is effective for the treatment of fluid and solute management in ARF and multi-organ system failure (MOSF). Early intervention with CRRT characterized by aggressive replacement and dialysis fluid parameters as well as the use of citrate anticoagulation results in superior patient outcomes. 2 tables. 26 references.

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Peritoneal Access Devices: Design, Function, and Placement Techniques. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 309-356.

A successful peritoneal access device must transfer large volumes of dialysate into and out of the peritoneal cavity in a minimal amount of time while maintaining normal anatomy, histology, bacteriology, and physiology of the surrounding tissues. This chapter on the design, function, and placement techniques of peritoneal access devices is from a textbook on the clinical management of dialysis patients. The authors discuss fluid flow in peritoneal catheters, the hydraulic function and biocompatibility of catheters, the history and chronology of peritoneal dialysis (PD) catheters, the current design of PD catheters, complications related to PD catheters, the placement of catheters for chronic PD (preoperative care and surgical techniques), postoperative catheter care, the effects of placement techniques on the success of catheters for chronic PD, new placement techniques, management of catheter complications, and removing peritoneal catheters. Complications discussed include exit site infection, cuff extrusion, tunnel tract infection, relapsing peritonitis, mechanical flow dysfunction, and abdominal wall hernias and leaks. 21 figures. 2 tables. 229 references.

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Peritoneal Dialysis in Pediatric Patients. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 514-552.

This chapter on peritoneal dialysis (PD) in pediatric patients is from a comprehensive textbook on the clinical management of patients on dialysis. The author notes that patient selection plays an important part in determining whether a child is placed on PD. If PD is an option for the treatment of chronic renal failure, the psychosocial determinants of the child and his or her family are important. Age, maturation, distance from the dialysis center, and other family characteristics influence the balance of choice between PD and HD. The author explains the components of a typical PD system and the dialysate used, then discusses the different types of PD, the PD prescription, and complications of this therapy. The ultimate goal of dialysis in pediatric patients is renal transplantation, and children on PD are as good candidates for transplantation as those on HD. New dialysis fluids are being developed, and bicarbonate-buffered solutions as well as solutions containing isodextrin are of benefit to patients. Attention to the adequacy of dialysis has led to intensification of the dialysis prescription schedules. 1 figure. 1 table. 151 references.

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Physician's Guide to Medicare Coverage of Kidney Dialysis and Kidney Transplant Services. Baltimore, MD: Centers for Medicare and Medicaid Services. May 2005. 49 p.

This booklet provides information for physicians who have patients with permanent kidney failure. The booklet explains how these patients can qualify for Medicare, how Medicare helps pay for kidney dialysis and kidney transplants, and where to get more information and assistance. The booklet explains how Medicare helps pay for kidney dialysis and kidney transplant services in the Original Medicare Plan, also known as fee-for-service. If the patients are in a Medicare Advantage Plan—the new name for Medicare plus Choice—which includes Medicare Managed Care Plans, Medicare Private Fee-for-Service Plans, and Medicare Preferred Provider Organization Plans, their plan must give them at least the same coverage as the Original Medicare Plan, but it may have different rules. The booklet includes 11 sections: Medicare basics, Medicare legislation, kidney dialysis, kidney transplants, how Medicare pays for blood, appeals and grievances, other kinds of health insurance, where to get more information, Medicare coverage charts, key definitions—a glossary of terms—and a subject index. The booklet also includes extensive charts and tables that present the information in summarized form.

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Physiology of Peritoneal Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 357-384.

This chapter on the physiology of peritoneal dialysis (PD) is from a textbook on the clinical management of dialysis patients. The author discusses the anatomy of the peritoneum, the primary functions of the peritoneum, the peritoneum as a dialysis system, resistance of the peritoneum to solute and water transport, ultrafiltration, solute transport by convection, measurements of peritoneal functions, and peritoneal function after long-term exposure to PD solutions. The author notes that long-term PD is associated with progressive loss of ultrafiltration capability. This may be due to the toxicity of glucose. Replacing glucose with other osmotic agents, changing the sterilization process, replacing the lactate buffer with bicarbonate, and blocking the formation of glucose degradation products (GPDs) may improve membrane preservation during long-term PD management. 12 figures. 3 tables. 227 references.

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Psychosocial Adaptation of Dialysis Patients. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 927-936.

The residual uremic symptoms and the burden of the treatment itself prevent dialysis patients from attaining a state of full health. The perception of a continuous chronic illness combined with the intrusive nature of the dialysis treatments can interfere with many aspects of the patient’s life. The degree to which an individual patient can adapt to these medical and psychosocial stresses will determine quality of life. This chapter on the psychosocial adaptation of dialysis patients is from a comprehensive textbook on the clinical management of patients on dialysis. The author discusses measurement issues, the assessment of overall quality of life, disease-specific quality of life, neuropsychological function, social functioning, functional status, vocational rehabilitation, and patient compliance. The author provides a brief review of related recent research in each of these areas. 1 table. 79 references.

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Psychosocial Care of Children on Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 937-948.

This chapter on the psychosocial care of children on dialysis is from a comprehensive textbook on the clinical management of patients on dialysis. After reviewing what is known about the epidemiology of psychosocial problems in children and adolescents with kidney disease and those on dialysis in particular, the authors discuss general issues of concern in the psychosocial domain with respect to child nephrology and dialysis patients. Topics include psychosomatic relationships, renal failure as a risk factor for psychiatric disorder in children, coping behaviors and psychological defenses in children, care of the dying child, the burden of dialysis treatment and care, the complexity of syndromes associated with chronic renal failure (CRF), nonadherence and patient compliance issues, the early detection of mental health problems, and specific disorders, including adjustment disorders, depression, eating disorders, posttraumatic stress disorders, confusional states, fear of procedures, separation anxiety, and short stature. The authors also introduce and describe a proposed model of psychosocial care. The authors stress that all members of the nephrology clinical team have a role in psychosocial care of these children and their families. A functional psychosocial team should be able to recognize when children have significant mental health problems, seek appropriate advice, and make appropriate referrals for specialist mental health assessment and intervention. 22 references.

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Quality, Safety, and Accountability in Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 963-980.

This chapter on quality, safety, and accountability in dialysis is from a comprehensive textbook on the clinical management of patients on dialysis. The author begins by introducing some of the problems found in end stage renal disease (ESRD) facilities and current goals to address those problems. Patient safety, which is a subset of health care quality, is defined as freedom from accidental injury stemming from the processes of health care. Medical errors are a subset of safety, but patient safety also includes the establishment of an environment that is designed to minimize adverse events that may be unrelated to medical errors. Quality is seen as a subset of a larger universe of health care delivery attributes. The author reviews various models of quality improvement, recommendations for improving patient safety, and accountability issues. The author concludes that, given the complexity of health care delivery in general and the variability and unpredictability of patient outcomes in particular, it is unrealistic for payers and oversight agencies to set rigid standards of performance by providers, especially when no clear unanimity exists regarding many processes of care. A system of public accountability must include case mix adjustment strategies to minimize patient selection bias and to encourage facilities to accept high-risk patients without fear that their adverse outcomes may have a negative impact on the facility’s profile. 2 figures. 13 tables. 62 references.

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Quotidian Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 1055-1072.

Daily (quotidian) hemodialysis is practiced on average six times a week. The short daily form lasts for an average of 2 to 2.5 hours at maximal blood and dialysate flow rates and is practiced in dialysis centers or at home. The long nightly version is practiced mainly at home for an average of 8 hours using lower blood and dialysate flows. This chapter on quotidian hemodialysis is from a comprehensive textbook on the clinical management of patients on dialysis. The authors first review the different types of hemodialysis, then describe the history, method, patient selection and training, and solute removal associated with daily hemodialysis. The authors also consider outcome factors, including health economics and quality of life; cardiovascular outcomes, such as blood pressure, left ventricular geometry, and other cardiovascular changes; mechanistic analyses; erythropoietin dose and anemia control; the role of nutrition; and related factors including mineral metabolism, sleep disorders, patient survival, daily hemofiltration, and a comparison of the modalities. The authors conclude that quotidian hemodialysis in both short and long forms provides improvement in quality of life, blood pressure control, phosphate control, and anemia control, as well as in improved nutrition. The increasing use of these methods, along with other nightlong hemodialysis modalities, will provide revitalization of home hemodialysis, bringing the benefits of increased patient independence and social and vocational rehabilitation to more patients while also providing a solution to the nursing shortage. 1 figure. 2 tables. 127 references.

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Suicide in the United States End-Stage Renal Disease Program. Journal of the American Society of Nephrology. 16(3): 774-781. March 2005.

Although depression and dialysis withdrawal are relatively common among individuals with end-stage renal disease (ESRD), there have been few systematic studies of suicide in this population. This article reports on a study that compared the incidence of suicide in patients in the United States ESRD program with national rates of individuals not in the program. All individuals who were aged 15 years and older and who initiated dialysis between April 1995 and November 2000 were in the cohort. Patients were monitored at the time of death, transplantation, or October 31, 2001. Death as a result of suicide in the ESRD population and the general United States population was ascertained from the Death Notification Form and the Centers for Disease Control and Prevention, respectively. Of the 465,563 patients included in the analysis, 44,465 (9.6 percent) withdrew from dialysis before death and 264 (0.005 percent) died from suicide. The crude suicide rate from 1995 to 2001 was 24.2 suicides per 100,000 patient-years, and the overall standardized incidence ratio for suicide was 1.84. In analyses, age older than 75 years, male gender, white or Asian race, geographic region, alcohol or drug dependence, and recent hospitalization with mental illness were significant independent predictors of death as a result of suicide. Persons with ESRD are significantly more likely to commit suicide than persons in the general population. The authors conclude that risk assessment could be used to identify patients for whom counseling and other interventions might be beneficial. 4 tables. 31 references.

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Support for Acute Renal Failure. Care of the Critically Ill. 21(4): 105-112. August 2005.

This article addresses the definitions, diagnosis, and care of acute renal failure (ARF). The authors note that although critical care physicians can all recognize ARF, there is no agreed-upon definition, nor is there consensus on successful management end points. Patient premorbid states vary significantly, causes of kidney dysfunction are heterogeneous, and renal recovery rates are influenced by whether the primary pathophysiological cause has been controlled. The author briefly reviews the anatomy and physiology of the kidney, then discusses ARF and its measurement, diagnostic and laboratory testing approaches, the causes of renal dysfunction, the principles of RRT (convection, diffusion, adsorption), the choice of renal replacement therapy (RRT, usually dialysis), hemodialysis versus peritoneal dialysis, continuous RRT, dialysis dose, membrane choice, the need for anticoagulation of the extracorporeal circuit, buffer solutions, and how RRT affects mortality. The section on the causes of renal dysfunction covers shock, nephrotoxic drugs, chronic or intrinsic renal disease, and problems with contrast media. 1 figure. 3 tables. 22 references.

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Surgical Issues in Pediatric Peritoneal Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 1081-1090.

Although peritoneal dialysis is the predominant modality for children with end stage renal disease (ESRD), there must be adequate peritoneal access for this method to be successful. This chapter on surgical issues in pediatric peritoneal dialysis is from a comprehensive textbook on the clinical management of patients on dialysis. The author reviews different catheter and surgical insertion techniques as well as lessons to be learned from the literature of this field. Topics covered include access types, preoperative evaluation and preparation, omentectomy, fibrin sealant, the choice of surgical technique, open technique, laparascopic technique, postimplantation care, the timing of catheter use, mechanical complications, exit-site infection, tunnel infection, peritonitis, the timing of catheter removal after kidney transplantation, and complications associated with peritoneal dialysis catheter removal. In each area, the author briefly summarizes the related research literature. 9 figures. 39 references.

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Survival Advantage of Hispanic Patients Initiating Dialysis in the United States Is Modified by Race. Journal of the American Society of Nephrology. 16(3): 782-790. March 2005.

Differences in survival have been reported among ethnic groups in the general population. This article reports on a study of the survival of Hispanic and non-Hispanic patients initiating dialysis in the United States. The overall survival of new end-stage renal disease (ESRD) patients of Hispanic ethnicity is substantially greater than that of non-Hispanics, with a 17 percent lower adjusted mortality risk among those without diabetes and a 30 percent lower adjusted mortality risk among those with diabetes. However, this survival advantage is not consistent across all Hispanic subgroups, with Hispanic whites and Hispanic blacks experiencing the lowest and Hispanic others experiencing the highest mortality rates. These differences in mortality outcomes cannot be explained easily by differences in baseline comorbidity profiles among groups, or by differences in transplantation rates during follow-up. The authors conclude that the survival advantage of Hispanic over non-Hispanic patients who receive chronic dialysis treatment in the United States is not consistent across subgroups and is modified by race. The authors hypothesize that cultural and genetic differences as well as variation in the access and delivery of care before and while on dialysis may account for these differences. 2 figures. 5 tables. 38 references.

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Technologic Aspects of Hemodialysis and Peritoneal Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 47-84.

This chapter on the technologic aspects of hemodialysis (HD) and peritoneal dialysis (PD) is from a textbook on the clinical care of dialysis patients. The author focuses on technical aspects related to the delivery of dialysis as well as to the measurement of effects resulting from the perturbations caused by the treatment. There is great need to measure treatment and patient variables to identify the state of the patient, so the extracorporeal blood circulation and the management of dialysate are described in some detail. The author also considers the important question of whether the prescribed dose of dialysis is indeed delivered with every treatment; success in this area will help to reduce treatment variability and system failure and will help improve patient and staff compliance. Specific topics covered include blood flow, pressure, thermal energy flow, the dialysate and its delivery, clearance and dialysis quantification, modes of delivery, feedback control, and peritoneal dialysis, including automated peritoneal dialysis (APD) and the role of telemedicine in PD. 12 figures. 1 table. 165 references.

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Understanding Your Peritoneal Dialysis Options. Tampa, FL: American Association of Kidney Patients, 2005. 16 p.

Peritoneal dialysis (PD) is one of the available treatment options to remove waste products and excess fluid from the blood when the kidneys are no longer functioning properly. This booklet, from the American Association of Kidney Patients (AAKP), reviews the option of PD as a treatment for advanced kidney disease. The booklet first briefly reviews the physiology and function of the kidneys, then explains how PD works by using the patient's own peritoneum as the filter for dialysis. The author explains how access is established to the peritoneal cavity and what to expect during the learning process. The booklet then outlines the two different types of PD: continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD). The booklet guides readers through the decision-making process for each type of PD, considering issues such as responsibility for patient care, body image, fluid overload, discomfort, and peritonitis. The booklet concludes with a glossary of related terms, a list of questions to help patients decide if PD is the right choice for them, blank space for notes, and a form for joining AAKP. 4 figures. 2 tables.

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