Renal Nursing: Care and Management of People with Kidney Disease

Cover
Title Page
Contents
List of Contributors
Foreword
Preface
Acknowledgements
Chapter 1 The History of Kidney Dialysis and Transplantation
	Introduction
	Haemodialysis
		The beginning
		Pre-1920
		The 1920s
		The 1930s
		The 1940s and 1950s
		The 1950s
		Development of the dialyser from 1950s onwards
		Emergence of home haemodialysis
		Vascular access for haemodialysis
		Further developments
	Peritoneal Dialysis
		The peritoneal dialysis catheter
		Peritoneal dialysis at home
		Beginning of continuous ambulatory peritoneal dialysis
		Advances in peritoneal dialysis 1970s–2000s
		Peritoneal dialysis: the present
	Transplantation
		In the beginning
		The first successes
	Immunosuppression
		The present
		The future
	Conclusion
	References
Chapter 2 Applied Anatomy and Physiology, the Kidney Disease Process, and Kidney Investigations
	Introduction
	Structure and Functions of the Kidney
		The nephron
		Versatility of urine
		Urinary volume
		Urinary concentration
		Urinary content
	Basic Renal Processes
		Glomerular filtration
		Selective reabsorption
		Secretion
		Excretion of drugs and drug metabolites
		Concentration and dilution of urine
		Regulation of body fluid volume and osmolality
		The renin–angiotensin–aldosterone pathway
		Aldosterone and the control of body potassium content
		Hypokalaemia and hyperkalaemia
		Regulation of calcium, phosphate, and magnesium
		Renal handling of calcium and phosphate – the roles of PTH, vitamin D, and calcitonin
		Acid–base control
		Bicarbonate buffering system
		Control of bicarbonate ion concentration by the kidney
		Correcting acid–base fluctuations in the healthy individual
		Erythropoietin production by the kidney
		Relationship between blood pressure and renal function
		Blood pressure control
	Conditions Causing Chronic and Advanced Kidney Disease
		Renal artery stenosis
		Nephrosclerosis
		Nephrotic syndrome or nephrosis
		Pathology of nephrotic syndrome
		Clinical features of nephrotic syndrome
		Diabetic kidney disease
		Glomerulonephritis
		Pyelonephritis
		Reflux nephropathy
		Polycystic kidney disease
		Multisystem diseases affecting the kidney
	Biochemical Blood Investigations in Kidney Disease
		Urea
		Creatinine
		Sodium
		Potassium
		Mineral and bone disorder tests
		Calcium
		Phosphate
		Parathyroid hormone
		Calcitrol (calcidol, 25(OH)D)
		Other biochemical blood tests
	Haematological Investigations for Renal Anaemia and Other Disorders
		Full blood count
		Haemoglobin
		Haematocrit
		Red cell count
		White blood cell count and differential
		Coagulation
	Further Investigations for Renal Anaemia
		Symptoms of anaemia
		Other anaemia investigations
		Other haemolysis investigations
	Urine Investigations
		Urinalysis
		Urine appearance
		Dipstick tests
		Osmolality
		Glucose
		Blood
		Protein
		Causes of proteinuria
		Microalbuminuria
		Albumin : creatinine ratio
		Myoglobin levels
		Urine microscopy and culture
		Casts
	Kidney Function Tests
	Estimated Glomerular Filtration Rate
		CKD-EPI equation
		eGFR Cystatin C
	Kidney Biopsy
		Kidney biopsy in the transplant recipient
	Radiographic Investigations
		Plain abdominal X-ray
		Bone density scan
		Skeletal X-rays
		Intravenous urogram
		Retrograde pyelogram
	Computed Axial Tomography or Computed Tomography (CAT/CT) Scan
	Nuclear Magnetic Resonance or Magnetic Resonance Imaging
	Ultrasound
		US in kidney transplantation
	Renal Doppler Studies
		Renograms
		Renal scans
		Renal angiogram
	References
Chapter 3 Patient and Carer Involvement in Kidney Care, Education, and Research
	Introduction
	Patient Involvement in Care
	Patient-Reported Experience Measures
		Reflections on the case studies
	Patient and Carer Involvement in Kidney Nursing Education
	Patient and Carer Involvement in Kidney Research
	Kidney Patient Involvement Network (KPIN)
	Measuring the Impact of Patient and Public Involvement
	Conclusion
	References
	Resources
Chapter 4 Emotional Well-being
	Introduction
	Covid-19 and Kd
	Health Inequalities in Kidney Disease
		Social deprivation
		Food and fuel banks
		Stable housing
		Health literacy
	CKD and Mental Illness
		CKD and severe mental illness
		Cognitive impairment
		Lesbian, gay, bisexual, transgender, and queer (lgbtq+) communities
		QOL and living well with kidney disease
		Life participation
	Patient Activation
		Individual symptom management
		Strengths-based approach
	Haemodialysis
		Home dialysis
		Home haemodialysis
		Peritoneal dialysis
	Kidney Transplantation
		Living kidney donors
		Post–kidney transplant
		Failing kidney transplant
	Conservative Kidney Management (Non-Dialytic Options)
	Depression
	Sexuality
	Caregivers’ Role
	Conclusion
	References
Chapter 5 Acute Kidney Injury
	Introduction
	Signs and Symptoms of AKI
	Mortality Following AKI
	Classification of Acute Kidney Injury
		Pre-renal failure
		Renal (intrinsic) failure
		Post-renal failure
	AKI Classification Systems
	Identifying the Cause(s) of Acute Kidney Injury
		Urinalysis
		Ultrasound
	Nutritional Issues in AKI
	Infection and Sepsis
	Clinical Course of Acute Kidney Injury
		Initiating stage
		Oliguric stage
		Diuretic stage
		Recovery stage
	Kidney Replacement Therapy (KRT) in Acute Kidney Injury
		Acute intermittent haemodialysis
		Intermittent haemodiafiltration
		Continuous kidney replacement therapy
		Continuous haemofiltration
		Continuous haemodiafiltration
		Continuous haemodialysis
		Acute peritoneal dialysis
		Plasma exchange
	Conclusion
	References
	Further reading
Chapter 6 Chronic Kidney Disease and Advanced Kidney Care
	Introduction
	Chronic Kidney Disease
		Rethinking CKD in the 2000s: The National Service Framework
		Kidney function and estimated glomerular filtration rate
		Staging of CKD
		Incentivisation for primary care to test for CKD
		The impact of clinical guidelines for managing CKD in primary care
	Innovation in Managing Mild to Moderate Kidney Disease in Primary Care
		Care and Management of Mild to Moderate Kidney Disease (Stages 3a–3b)
		Monitoring of CKD
		Medicines review
		Referral to secondary care
	Care and Management of Moderate to Severely Decreased Kidney Function (Stage 4)
		Diabetes Mellitus
		SGLT-2 inhibitors
		Optimal nutritional management
		Control of serum bicarbonate within normal levels
		Management of bone disease
		Control of anaemia
		Control of gastrointestinal disorders
		Treatment of dermatological disorders
		Control of volume disorders
		Control of potassium disorders
		Control of acid–base balance
		Disorders of the central nervous system
		Sexual dysfunction
	Education in Advanced Kidney Care
		Shared decision-making
		Advanced Kidney Care education: practical aspects
		When Should Dialysis Commence?
	Conclusion
	References
	Resources
Chapter 7 Haemodialysis
	Introduction
	What is Haemodialysis?
		What does haemodialysis do?
		What is needed to perform haemodialysis safely?
		Haemodialysis machinery
		Vascular access
	How Does Haemodialysis Work?
		Diffusion
		Convection
		Small, middle, and large molecules
		Ultrafiltration
		Summary of the principles of haemodialysis
	Mortality and Haemodialysis
	Haemodialysis Prescription
	Dialysis Modality
	Haemodiafiltration
	More Frequent and Longer Haemodialysis
	Nocturnal dialysis
	Home Haemodialysis
		The dialysate
		The dialyser
		Haemodialysis clearance
		Improving clearance
		Single-needle or double-needle dialysis
	Kidney Nurse’s Role in Maintaining an Optimal Haemodialysis Prescription
		Fluid removal
		Managing fluid loss
		Managing the UFR
		Managing refilling
		Dialysate temperature
		Blood-volume monitoring
		Summary of managing fluid removal during haemodialysis
	Anticoagulation
		Managing clotting within the extracorporeal circuit
		Heparin-induced thrombocytopenia (HIT)
	Vascular Access for Haemodialysis
		Achieving definitive access provision
	Care of AVF and AVG
		Post-operative care
		Cannulation of the AVF/AVG
		Cannulation techniques to preserve AVF/AVG function
		Good cannulation technique
		Planning cannulation
		Self-awareness of the cannulator
		Gentleness and sensitivity throughout the cannulation
		Correct placement of the needles
		Tourniquet use
		Experienced and well-trained nurses
	Tunnelled Central Venous Catheter Care
		Prevention of Infection in TCVC
		Prevention of flow problems
		Summary of vascular access
	Assessment and Monitoring During Haemodialysis
		Common complications during haemodialysis
	Less Common Complications of Haemodialysis
		Haemolysis
		Dialysis disequilibrium syndrome
		Air embolism
		Venous needle dislodgement (VND)
		Monitoring for complications during haemodialysis
		Management of diabetes in the context of haemodialysis
		Patient’s Perspective of Haemodialysis
	Conclusion
	References
Chapter 8 Peritoneal Dialysis
	Introduction
	Physiology of Peritoneal Dialysis
		Blood supply
		Lymphatic drainage
		Peritoneal membrane transport characteristics
		Osmosis
		Diffusion
		Convection
		Measurement of peritoneal permeability
		Performing a PET
	Peritoneal Dialysis Access and Exit Site Care
		Types of catheters
		Pre-insertion preparation of the patient
		Preoperative care of the patient
		Perioperative care of the patient
		Post-operative care of the patient
		Long-term care of the exit site
		Catheter immobilisation
		Swimming and bathing
		Indications for catheter removal
	Peritoneal Dialysis Therapy Options
		Continuous ambulatory peritoneal dialysis
		Automated peritoneal dialysis
		Continuous cycling peritoneal dialysis
		Tidal peritoneal dialysis
		Optimised cycling peritoneal dialysis
	Patient Selection
		Assisted Peritoneal Dialysis (asPD)
	Peritoneal Dialysis for Those with Diabetes
		Blood glucose control
		Administration of Insulin
	Solution Formulation
		Glucose-based solutions
		Icodextrin peritoneal dialysis solution
		Bicarbonate/lactate-based peritoneal dialysis solutions
		Amino acid based peritoneal dialysis solution
	Assessing Peritoneal Dialysis Adequacy
		Prescribing in PD
	Longitudinal Changes to the Peritoneal Membrane
	Encapsulating Peritoneal Sclerosis (EPS)
	Fluid Management in Peritoneal Dialysis
	Problem Solving in Peritoneal Dialysis
		Protein loss
		Raised intra-abdominal pressure problems
		Drainage problems
		Kinks in the tubing
		Constipation
		Fibrin formation
		Malpositioned catheter
		Shoulder pain
		Bloodstained effluent
	Infectious Complications of Peritoneal Dialysis
	Causes of peritonitis
		Intraluminal
		Periluminal
		Transmural
		Haematogenous
		Vaginal
	Prevention of PD-Related Peritonitis
		Diagnosis of peritonitis
		Obtaining a PD effluent specimen
		Permeability changes during peritonitis
		Culture-negative peritonitis
		Fungal peritonitis
		Relapsing peritonitis
		Exit-site and tunnel infection
	Education and Training for Those on Peritoneal Dialysis
		Barriers to learning
		The learning environment
		Recommendations for training within kidney units
		What to teach
	Conclusion
	References
Chapter 9 Kidney Transplantation
	Introduction
	Cost-Effective Care
	UK National Waiting-List Figures for Kidney Transplant
	Contraindications to Kidney Transplantation
		Malignancy
		Recurrent disease
		Hepatitis virus and human immunodeficiency virus
		Diabetes mellitus and cardiovascular disease
	Evaluation for Transplantation
		Age
		Polycystic kidney disease
		Urinary tract disease
		Cardiac disease
		Peptic ulceration
		Respiratory disease
		Obesity
		Oral hygiene
	Pre-transplantation Preparation
		Specific pre-transplant anxieties and fears
		Transplant waiting list
	Donor and Recipient Matching
		Immune system: overview
		Components of the immune system
		Requirements for donor and recipient matching
	Deceased Donation
		Causes of brainstem death
		Brainstem functions
		Absolute contraindications to organ donation
		Organ-specific contraindications for potential kidney donors
		Requesting donation
		Refusal to donate
		Clinical care of a potential organ donor
		Role of the specialist nurse for organ donation
		Organisation of the organ donation procedure and surgery
		Permission from the coroner
		Removal of kidneys from a multiorgan donor
		Surgical technique for deceased donor nephrectomy
		Organ preservation
		Donation after circulatory death
	Living Donation
		Ethical issues
		Physical well-being – doing good without doing harm
		Psychological well-being – doing good without doing harm
		Altruism
		Benefits for the transplant recipient
		Transplant rates
		Living unrelated donation (genetically unrelated – emotionally related)
		Buying and selling of organs
		National Living Donor Kidney Sharing Scheme
		The future for living kidney donation
		Donor and recipient matching
		Immunological aspects
		Assessment and preparation of donors
		Pre-operative care for the donor
		Surgical technique of nephrectomy
		Post-operative management: living donor
		Hydration: fluid and electrolyte balance
		Wound management
		Emotional support
		Discharge
	Increasing Donor Organ Supply
		Legislation
	Pre-operative Management for a Recipient of a Kidney Transplant
		The transplant call
		Nursing admission
		Medical assessment
		Pre-operative dialysis
		Information and emotional support
		Immediate pre-operative care
	Surgical Technique for Kidney Transplantation
	Immunosuppression Regimes
		Guidance from the National Institute for Health and Care Excellence
		Induction immunosuppression
	Maintenance Immunosuppression
		Calcineurin inhibitors
		Antiproliferative agents
		Corticosteroids
	Kidney Transplant Rejection
		Hyperacute rejection
		Acute rejection
		Transplant biopsy
		Chronic allograft injury
	Post-operative Care and Complications for the Recipient of a Kidney Transplant
		Aims of care
		Immediate post-operative care
		Cardiorespiratory status
		Pain management
		Hydration: fluid and electrolyte balance
		Urine output: catheter care
		Wound management
		Infection control
		Post-operative medications
		Continuing care
		Complications of KIDNEY transplantation
	Infections
		Bacterial infection
		Fungal infections
		Viral infections
	Discharge of the Recipient from Hospital and Continuing Care
		Ongoing care: information and support for transplant recipients
	Simultaneous Pancreas-Kidney Transplantation (SPK)
	Conclusion
	References
Chapter 10 Non-dialytic Options and a Palliative Conservative Kidney Management Approach
	Introduction
	Numbers of Patients
	The Importance of Conservative Kidney Management
	The Palliative Approach
	Recent Government and Other Initiatives
	Communication, Decision-Making, and Planning
		Patient communication
		Family communication
		Communication within the team
		Shared decision-making
	Advance Care Planning
	Care of Patients Managed Without Dialysis
	Symptoms Towards the End of Life
		Symptom assessment
		Symptom management
	Psychological and Social Issues
	Spiritual Care
	Conclusion
	References
Chapter 11 Kidney Care in Infancy, Childhood, and Early Adulthood
	Introduction
	Physiology in Childhood – Impact on Renal Care
		Growth
		Fluid balance
		Renal anatomy
	Chronic Kidney Disease
		Conservative management
		Blood pressure
		Anaemia
		Growth and bone health
	Nephrotic Syndrome
		Nursing care of children with nephrotic syndrome
		Congenital nephrotic syndrome (CNS)
	Renal Replacement Therapy
		Transplantation
		Living donor transplantation
		Pre-emptive transplantation
		Care of the child after kidney transplantation
		Immunosuppression
		Complications
		Preparation for dialysis and transplant
		Immunisation
	Dialysis
		Peritoneal dialysis
		Haemodialysis
		Vascular access
		Prescribing dialysis and adequacy
		Home haemodialysis
	Acute Kidney Injury
		Causes
		Treatment
	Haemolytic Uraemic Syndrome
	Transition to Adult Services
	Conclusion
	References
Chapter 12 Nutrition in Kidney Disease
	Introduction
	Historical Review of Dietary Management
		Pre-dialysis treatment (1960–2000)
	Current Concepts of Pre-dialysis Dietary Intervention
		Nutritional requirements
		Hypertension
	Cardiovascular Risk and Hyperlipidaemia
	Interventions in Patients with Diabetes
	Calcium, Phosphate, and Vitamin D Metabolism
		Calcium supplements
		‘Active’ vitamin D
		Dietary phosphate reduction
		Phosphate binders
	Hyperkalaemia
		Dietary management
		Potassium and high-fibre foods
		Potassium-reducing medication
	Anaemia
	Acidosis
	Malnutrition
		Nutritional assessment
		Body composition changes
		Conclusions regarding nutritional status
	Nephrotic Syndrome
		Protein reduction
		Hyperlipidaemia
	Dietary Management: Dialysis
		Historical review
		Current concepts of dietary management for people receiving dialysis
		Protein
		Energy requirements
		Sodium and fluid
		Potassium
		Phosphorus
		Vitamins and minerals
	Malnutrition
		Protein energy wasting
		Causes of malnutrition
		Detection of malnutrition
	Techniques to Assess Body Composition
		Biochemistry
		Subjective global assessment
		Patient History
		Physical examination
		Protein energy wasting
		Treatment of malnutrition
	Transplantation
		Post-operative transplant care
		Long-term post-transplant care
		Cardiovascular disease
		Bone disease
		Diabetes
		Summary of dietary advice for kidney transplant recipients
	Dietary Management in Paediatrics
	Conclusion
	References
	Appendices
		12.A: Calculation of Body Mass Index and Ideal Body Weight
		12.B: Seven-Point Subjective Global Assessment
		12.C: Foods with a High and Low Sodium (Salt) Content
		12.D: Foods with High and Low Phosphorus Content
		12.E: Foods with High, and Lower Potassium Content
		12.E.1: Potassium portions
Chapter 13 Quality Improvement and Nursing Research in Kidney Care
	Introduction
	Quality Improvement
	Patient Safety
	Getting It Right First Time (GIRFT)
	Clinical Practice Guidelines
		National Service Frameworks
		Kidney Quality Improvement Partnership
		National Institute for Health and Care Excellence (NICE)
		European Standards for Nephrology Nursing Practice
		Kidney Disease Outcome Quality Initiative/Kidney Disease Improving Global Outcomes
		UK Kidney Association
		Other Guidelines
	Evaluation of Guidelines
	Audit
	Kidney Nursing Research
	Association of Nephrology Nurses UK (ANN UK)
	Conclusion
	References
	Resources
Index
EULA