Principles of Nursing in Kidney Care: Under the Auspices of EDTNAERCA and EKPF

Foreword
Preface
Acknowledgments
Contents
About the Editors
Introduction to Kidney Functions and Pathophysiology
	1	 Introduction
	2	 Basic Anatomy of the Kidney
	3	 Nephron Structure and Functions
	4	 Blood Supply
	5	 Fluid Regulation
	6	 Acid Base Balance
	7	 Blood Pressure Regulation (Renin–Angiotensin Aldosterone System—RAAS)
	8	 Calcium Phosphate Regulation
	9	 Excretion of Waste Products
	10	 Regulation of Electrolytes
	11	 Erythropoietin Production
	12	 Drugs and the Kidney
	13	 Kidney Pathophysiology and Links to Kidney Disease
	References
Management of Chronic Kidney Disease
	1	 Introduction
		1.1	Chronic Kidney Disease Definition
		1.2	Chronic Kidney Disease Classification
		1.3	 Prevalence of Chronic Kidney Disease
		1.4	 Outcomes in Chronic Kidney Disease
		1.5	 Costs in Chronic Kidney Disease
	2	 Management
		2.1	 Hyperfiltration
			2.1.1	 Renin–Angiotensin–Aldosterone System Inhibitors (RAASi)
				Hyperkalemia
			2.1.2	 Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2i)
		2.2	 Hypertension
			2.2.1	 Therapeutic Target
			2.2.2	 Blood Pressure Measurement
			2.2.3	 Treatment of Hypertension
		2.3	 Diabetes
			2.3.1	 Diagnosis of Diabetes
			2.3.2	 Therapeutic Target
			2.3.3	 Lifestyle Recommendations for Chronic Kidney Disease Individuals and Family
			2.3.4	 Pharmacological Treatment of Diabetes
		2.4	 Dyslipidemia
			2.4.1	 Pharmacological Treatment of Dyslipidemia
				Hypercholesterolemia
				Hypertriglyceridemia
		2.5	 Obesity
			2.5.1	 Management of Obesity
				Lifestyle Recommendations in the Management of Obesity
				Pharmacological Treatment of Obesity
				Surgical Treatment in Obesity
		2.6	 Hyperuricemia
		2.7	 Acidosis
		2.8	 Chronic Kidney Disease-Mineral Bone Disorder (CKD-MBD)
		2.9	 Anemia
			2.9.1	 Definition of Anemia
			2.9.2	 Recommended Periodicity for Hemoglobin Determinations
			2.9.3	 Pharmacological Treatment of Anemia
	3	 Conclusions
	References
Oral Care for Adults with CKD
	1	 Introduction
	2	 Importance of Good Oral Hygiene
	3	 Oral Health and CKD
	4	 Oral Manifestations of CKD
	5	 Oral Cavity Assessment
	6	 Toothbrushing
	7	 Denture Care
	8	 Recommended Oral Care and Advice for Oral Health Problems
	9	 Dental Checkup
	10	 Case Studies
		10.1	 Case Study A
		10.2	 Case Study B
		10.3	 Case Study C
		10.4	 Case Study D
	11	 Conclusions
	12	 Implications for Nursing Practice
	References
Pharmacological Management of CKD
	1	 Introduction
	2	 Hypertension
	3	 Proteinuria
	4	 Anemia in CKD
	5	 Cardiovascular Disease in CKD
	6	 Acute Kidney Injury in CKD
	7	 Prescribing in CKD
	8	 Self-Management Strategies and Improving Adherence in CKD
	9	 Case Vignettes
	10	 Conclusion
	References
Nutrition and Chronic Kidney Disease
	1	 Introduction
	2	 Nutritional Assessment: Anthropometry and Other Indexes
	3	 Protein Energy Wasting (PEW)
	4	 Nutritional Scores and Assessment of Dietary Intake
	5	 Laboratory Tests Used in Nutritional Assessment
	6	 Nutritional Management of People with CKD Stage 1–3
	7	 Nutritional Management of People with CKD Stage 3–5, Before Dialysis
		7.1	 Sodium and Fluid Intake
		7.2	 Potassium Intake
		7.3	 Phosphorus
	8	 Nutritional Management of Peoples on Hemodialysis
		8.1	 Energy Intake
		8.2	 Protein Intake
		8.3	 Sodium and Fluids
		8.4	 Potassium
		8.5	 Phosphate
		8.6	 Vitamins
	9	 Nutrition for People on Peritoneal Dialysis
		9.1	 Protein Intake
		9.2	 Energy Intake
		9.3	 Sodium and Fluids
		9.4	 Potassium
		9.5	 Phosphate
	10	 Nutritional Management of People with Kidney Transplantation
		10.1	 Nutritional Approach to the Patient Preoperatively
		10.2	 Nutritional Approach to the Patient in the Acute and Chronic Postoperative Period
		10.3	 Protein and Energy
		10.4	 Sodium and Fluids
		10.5	 Potassium
		10.6	 Phosphate and Magnesium
		10.7	 Nutritional Approach in the Chronic Post-Transplant Period
	References
Acute Kidney Injury
	1	 Introduction
	2	 Definition of AKI
	3	 Staging of AKI
	4	 Background and Epidemiology of AKI
	5	 Acute Kidney Disease (AKD)
	6	 Etiology, Pathophysiology, and Classifications of AKI
		6.1	 Pre-kidney AKI
		6.2	 Intrinsic AKI
		6.3	 Post-kidney AKI
	7	 Clinical Sequence of AKI
	8	 Clinical Presentation of AKI
	9	Diagnosis of AKI
	10	 Initial Management of AKI
	11	 Ongoing Management of AKI
		11.1	 Volume Status
		11.2	 Medication Review
		11.3	 Pharmacological Management
		11.4	 Nutritional Support
	12	 Management of Complications of AKI
		12.1	 Hyperkalemia
		12.2	 Metabolic Acidosis (pH <7.25)
		12.3	 Pulmonary Edema
		12.4	 Indications for Kidney Replacement Therapy
	13	 COVID-19 Associated Acute Kidney Injury (C19-AKI)
	14	 Sepsis-Associated AKI
	15	 Contrast-Induced AKI
	16	 Education for Individuals with AKI
	17	 Emotional Support for Individuals with AKI
	18	 Education for Nurses
	19	 Prevention of AKI
	20	 Conclusion
	21	 Reflective Questions
	References
Kidney Replacement Therapies: Hemodialysis
	1	 Hemodialysis
		1.1	 Principles of Hemodialysis, Dialyzer, and the Hemodialysis Machine
		1.2	 Hemodialysis Fluid and Dialysate
	2	 Hemodialysis Modalities
		2.1	 Conventional Hemodialysis
		2.2	Hemodiafiltration
		2.3	 Home Hemodialysis
		2.4	 Nocturnal Hemodialysis
	3	 Hemodialysis Vascular Access
		3.1	 Buttonhole Technique
		3.2	 Rope Ladder Technique
	4	 Hemodialysis Adequacy
	5	 Hemodialysis Potential Complications
		5.1	 Cardiovascular Complications
		5.2	 Neuromuscular
		5.3	 Hematological Complications
		5.4	 Pulmonary Complications
		5.5	 Technical Malfunction Complications
		5.6	 Dialysis Reaction
		5.7	 Vascular Access Complications
		5.8	 Miscellaneous Complications
	6	 Fluid Managements
	7	 Anticoagulation
	8	 Implications for Nursing Practice in HD Individuals
	9	 Conclusions
	References
Dialysis Fluid for Hemodialysis and Associated Treatments
	1	 Introduction
	2	 Water Treatment
	3	 Dialysate Components
	4	 Bicarbonate: The Currently Most Widely Used Buffer
	5	 The Weak Acid
	6	 Sodium
	7	 Potassium
	8	 Magnesium
	9	 Calcium
	10	 Phosphate
	11	 Glucose
	12	 Conclusions
	References
Vascular Access Management and Care: Arteriovenous Fistula (AVF)
	1	 Definitions
	2	 Creation and Maturation Phase of AVF
	3	 Pre-Cannulation Care
	4	 Home Care
	5	 Main Principles to Prevent Complication and Failure
	6	 Do’s
	7	 Don’ts
	References
Vascular Access Management and Care: Arterio-Venous Grafts (AVG)
	1	 Introduction
	2	 Types of AVG
		2.1	 Pre-cannulation Care
	3	 AVG Cannulation
	4	 Needle Removal and Hemostasis Care
	5	 Home Care When Having an AVG
	6	 Main Principles to Prevent Complications and Failure
	7	 Actions to Maintain a Healthy Vascular Access
	References
Vascular Access Management and Care: CVC
	1	 Definition
	2	 Implantation Care
	3	 Connection Procedure to HD Therapy with CVC
		3.1	 Materials Needed for the Connection Procedure with CVC
		3.2	 Disconnection Procedure to HD Therapy with CVC Vascular Access
		3.3	 Materials Needed While Disconnecting from CVC
		3.4	 Step-by-Step Process When Disconnecting from HD Therapy with CVC
	4	 CVC Exit Site Care
		4.1	 Actions When Caring for the CVC Site
		4.2	 Materials Used When Caring for the CVC Site
		4.3	 Dressing Replacement in 30 Steps
	5	 CVC Exit Side Home Care
	6	 Main Principles to Prevent Complications and Failures
		6.1	 Dos and Don’ts When Having a CVC
	References
Use of the Ultrasound in Hemodialysis
	1	 Introduction
	2	 The Use of Ultrasound in Hemodialysis
	3	 Postsurgical AVFs Maturation Monitoring
	4	 Site Choice for Cannulations
	5	 Assessment After Extravasation
	6	 Training in the Use of US
	7	 Cannulation
		7.1	 US-Guided Cannulation
		7.2	 US-Guided Cannulation in Practice
	8	 Needle Insertion Procedure
	9	 Conclusions
	References
Kidney Replacement Therapies: Peritoneal Dialysis
	1	 Introduction
	2	 The Anatomy, Physiology, and Solute Transportation of the Peritoneum
	3	 Principles of Peritoneal Dialysis
	4	 Catheter Care in PD
		4.1	 Introduction
	5	 PD Modalities for Adults
		5.1	 Continuous Ambulatory Peritoneal Dialysis (CAPD)
		5.2	 Automated Peritoneal Dialysis (APD)
		5.3	 Continuous Cyclic Peritoneal Dialysis (CCPD)
		5.4	 Intermittent Peritoneal Dialysis (IPD)
		5.5	 The PD Plus Prescription
		5.6	 Tidal PD (TPD)
		5.7	 Adapted Automated Peritoneal Dialysis (Adapted APD)
		5.8	 Assisted Peritoneal Dialysis (aPD)
	6	 The Management of PD Complications
		6.1	 Abdominal Pain During Outflow or Inflow
		6.2	 Bloody PD Outflow Solution
		6.3	 Catheter Malfunction
		6.4	 Fracture of PD Catheter or Accidental Contamination
		6.5	 Fluid (PD Outflow Solution) Leakage
		6.6	 Hernia
		6.7	 Encapsulating Peritoneal Sclerosis (EPS)
	7	 Infection Complications
		7.1	 Catheter Related Infections
			7.1.1	 Exit-Site Infection (ESI)
		7.2	 Peritonitis
	8	 Education and Training for Individuals on PD [1]
	9	 Nursing Perspectives in PD
	References
Infection Prevention and Control: The Importance of Hygiene in Dialysis Care
	1	 Hygiene and Infection Prevention as a Global Priority
	2	 The Importance of Infection Control for Dialysis Patients
	3	 Infection Control in the Dialysis Setting
	4	 Hand Hygiene
	5	 Additional Components of Standard Precautions and Infection Prevention
	6	 Personal Protective Equipment (PPE)
	7	 Respiratory Etiquette
	8	 Medication and Sharps Safety in the Dialysis Setting
	9	 Cleaning and Disinfection of Environmental Surfaces in the Dialysis Unit
	10	 Screening and Routine Serological Testing
	11	 Immunization
	12	 Disinfection of Internal Machine Pathways
	13	 Water Treatment and Testing
	14	 Minimizing Risk of Infection in Vascular Access
	15	 Infection Prevention of the AV Fistula
	16	 Infection Prevention and Care of the AV Graft
	17	 Infection Prevention and Care of the Central Venous Catheter
	18	 Nursing Care and Assessment of CVC Catheter
	19	 Accessing the Dialysis Catheter
	20	 Conclusions
	References
General Vaccination Scheme for Patients with CKD: Management of Kidney Care During the COVID-19 Pandemia-Vaccination for COVID-19
	1	 General Vaccination Scheme for Patients with CKD
	2	 Introduction to CKD and ESKD Population and Vaccinations
	3	 Vaccinations in the CKD Population
	4	 Importance of Vaccination in CKD Population
	5	 Hepatitis B Vaccine (HBV)
	6	 Pneumococcal Vaccine
	7	 Influenza Vaccine
	8	 Tetanus, Diphtheria, and Pertussis Vaccine
	9	 Reflection Question
	10	 Management of Kidney Care During the COVID-19 Pandemia- Vaccination for COVID-19
		10.1	 COVID-19
	References
		Further Reading
Management of Conservative and Palliative Care in CKD
	1	 Conservative Management
		1.1	 Conservative Kidney Management Pathway
			1.1.1	 Making the Decision
			1.1.2	 Initiate Care Planning
			1.1.3	 Clinical Assessments: Symptom Management
			1.1.4	 Clinical Assessments: Kidney Disease Management
			1.1.5	 Advanced Care Planning
			1.1.6	 Establish Community Support and Referrals
			1.1.7	 Crisis Management Plan
			1.1.8	 End-of-Life Plan
				eGFR: 10–15 (mL/min), Last 0–5 Years of Life
				eGFR: 5–10 (mL/min), Last 0–3 Years of Life
				eGFR: 0–5 (mL/min), Last 0–2 Months of Life
			1.1.9	 Grief and Loss
				Anticipatory Grief [21]
		1.2	 Palliative Approach to People Receiving Dialysis
			1.2.1	 Withdrawal from Dialysis
		1.3	 Conclusion
	References
Kidney Transplantation
	1	 Introduction
	2	 The Benefits of Kidney Transplantation
		2.1	 Clinical Benefits for Kidney Transplant
		2.2	 Quality of Life Benefits of Kidney Transplant
	3	 Barriers to Transplantation
		3.1	 Organ Availability
	4	 Recipient Assessment
		4.1	 KDIGO 2020
		4.2	 Tissue Typing and Blood Group Compatibility
	5	 Living Donation
	6	 Kidney Sharing Scheme
	7	 Surgery and Complications
	8	 Follow-Up and Immunosuppression
	9	 Living Donor Follow-Up
	References
Management of the Elderly Patient with Kidney Disease
	1	 Prevalence of ESKD in Elderly Patients
	2	 Factors Increasing the Frequency of ESKD in the Elderly Patients
	3	 Comorbidity
	4	 Assessment of Kidney Function in the Elderly
	5	 Structural and Functional Alterations in the Aging Kidney
	6	 The Elderly Patient on HD
	7	 Vascular Access
	8	 HD or Peritoneal Dialysis?
	9	 Kidney Transplantation
	10	 Functionality
	11	 Falls
	12	 Palliative Care in Elderly Patients with CKD
	13	 Health-Related Quality of Life in the Elderly
	14	 Case Study
	15	 Analysis
	References
Psychosocial Approach in People with CKD: Psychosocial Implications
	1	 Introduction
	2	 Psychosocial Reaction When Receiving the Diagnosis of CKD
	3	 Coping Strategies When Suffering from CKD
	4	 Nurse’s Role in People Suffering CKD: Psychosocial Approach
	5	 Behavioral Change When Suffering from CKD
	6	 Nurse’s Role in Facilitating Behavioral Change
	7	 The Importance and Value of Providing Psychosocial Care to Patients with CKD
	References
Quality of Life in People Receiving Kidney Replacement Therapy
	1	 Introduction
	2	 Quality of Life in HD Patients
		2.1	 Pain, Anxiety, and Depression as a Quality of Life Factor in Patients on HD
		2.2	 Emotional Intelligence as a Protective Factor for Quality of Life in Patients on HD
		2.3	 Implications for Nursing Practice when Caring for People on Chronic HD Therapy: Psychosocial Approach
	3	 Quality of Life in Peritoneal Dialysis Patients
		3.1	 Introduction
		3.2	 Quality of Life and Peritoneal Dialysis
		3.3	 Therapeutic Adherence and PD
	References
Sexual Health and Kidney Failure
	1	 Introduction
	2	 Causes of Sexual Dysfunction in Individuals Living with Kidney Failure
	3	 Treatment and Management of Sexual Dysfunction in Kidney Failure
	4	 Impact on Partners
	5	 Conclusion
	References
CKD Care for Pediatric and Adolescent Patients
	1	 Introduction
	2	 Caregivers for Pediatric and Adolescent Patients with CKD
	3	 CKD-Bone Mineral Disease
	4	 Diet in Children with CKD
		4.1	 Nutritional Assessment
		4.2	 Nutritional Needs
			4.2.1	 Energy
			4.2.2	 Protein
			4.2.3	 Sodium
			4.2.4	 Potassium
			4.2.5	 Phosphorus and Calcium
	5	 Adolescent Patient Education
	6	 The Transition to Adult CKD Care
	7	 The Consensus Statement
	8	 Conclusion
	References
Patient Education in Kidney Care
	1	 Clinical Cases
	2	 The Learning Process
		2.1	 The Learner
		2.2	 Learning Styles
		2.3	 Reflective Question
		2.4	 The Learning Situation
		2.5	 Learning by Using Examples
		2.6	 Learning by Doing
		2.7	 Learning Together
		2.8	 Learning at the Right Time
		2.9	 Learning Through Instruction, Counseling, Supervision, or Coaching
		2.10	 Learning Through Leaflets
		2.11	 The Content of the Learning Situation
		2.12	 Learning Activity
		2.13	 To Apply What Has Been Learned
		2.14	 The Application Situation
		2.15	 The Relatives
		2.16	 People with Chronic Kidney Disease Both as an In-Patient or an Out-Patient
		2.17	 Feedback
		2.18	 Conflicting Goals
	References
Patient Partnership in Kidney Care
	1	 Involving Patients in Development and Research in Kidney Care
		1.1	 A Reflective Question
	2	 Involving Patients in Their Own Kidney Care
	3	 Involving Patient in the Decision-Making Process Regarding Kidney Care
		3.1	 A Reflective Question
	4	 Involving Patients in Their Own Kidney Care and Treatment
		4.1	 A Learning Activity
	5	 Involving the Perspective of the Patient in Providing Kidney Care
	6	 A Patient Case
		6.1	 A Learning Activity
	7	 Involving Patients in Other Patient’s Kidney Care
	8	 Involving Relatives in the Patient’s Kidney Care
	References
Multidisciplinary Approach of Care and Management of Kidney Disease. Evidence-Based Nursing Practice and Different Nursing Roles in the Management of Kidney Care
	1	 Introduction
	2	 Multidisciplinary Kidney Care
		2.1	 Case Study
		2.2	 Transdisciplinary Care
		2.3	 Reflective Questions
	3	 Kidney Care Nursing Practice
		3.1	 Professional Regulation
		3.2	 Practice
		3.3	 Education
		3.4	 Research
		3.5	 Leadership
	4	 Kidney Care Nursing Roles
		4.1	 Kidney Care Advanced Practice Nurse
		4.2	 Case Study
			4.2.1	 Medical History
			4.2.2	 Social History
			4.2.3	 Family History
		4.3	 Medications
		4.4	 Investigations
		4.5	 Reflective Questions
	5	Chapters Summary
	References