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Annual Buyers Guide 2008-2009. Dialysis and Transplantation. 37(7): 220-302, L1-L130. July 2008.

This special issue of Dialysis and Transplantation presents the annual buyers’ guide of information to the nephrology community. The buyers’ guide includes eight 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, and a multilingual communications guide. The section about 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. The websites section lists websites alphabetically by title and includes the URL and a brief summary of the site’s content and purpose. An advertisers’ index concludes the issue.

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Artificial Kidneys: Hype or Hope?. Dialysis and Transplantation. 37(1): 6, 7. January 2008.

This article explores current research efforts into an artificial organ that can perform the complex functions of a biological kidney. The article’s first section discusses whether dialysis could be considered an artificial organ and the difficulties of replicating such a complex organ. The next section considers new types of less intrusive, longer lasting portable dialysis systems that allow patients to maintain relatively normal lives. Another section describes the peritoneal automated wearable artificial kidney (AWAK), which involves no extracorporeal circulation and regenerates and reuses the dialysate. The last solution discussed is called a renal assist device (RAD) that more closely approximates the functions of a healthy kidney. However, it still requires patients to be hooked up at the bedside as in conventional dialysis. The author concludes that it will be more than 2 years before any of the devices are ready for clinical trials. 3 references.

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Bundling and its Potential Impact on Dialysis Service Providers. Nephrology News & Issues. 22(11): 12-17. October 2008.

This article describes the concept of bundling treatment costs for health care services, particularly as it applies to costs for end-stage renal disease (ESRD) care, notably dialysis treatments. The author describes federal legislation passed in July 2008 that calls for a bundled payment system in place for ESRD by 2011. The legislation is called Medicare Improvements for Patients and Providers Act of 2008. The author discusses how this reimbursement policy shift is likely to be one of the most significant in the ESRD program’s history. Topics include the rationale for the change; incentives to provide quality care; the issue of erythropoietin (Epogen) treatments and national erythropoietin dosing standards; the costs of erythropoietin; the changes in Medicare expenditure for diabetes and other chronic health conditions; the lack of enough donated organs for transplantation, which contributes to the ever-increasing need for dialysis; economies of scale; how larger dialysis chains can deal with changes in reimbursement structures; the expansion of other dialysis options such as home dialysis and vascular access services; problems associated with a reduction in the number of dialysis clinics; the impact of this legislation on small- and medium-sized providers of dialysis; measuring quality amid patient noncompliance; and the impacts of these changes on staffing of dialysis care. The author concludes by noting that the impact of this legislation depends on what the bundled rate will ultimately be for each size provider and the influence of geographic location. Fallout and changes in the existing industry can be estimated based on current conditions if the reimbursement is below the cost of providing the current level of care to patients.

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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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False Hyperglycemies in Diabetic Patients Using Icodextrin in Peritoneal Dialysis. Dialysis and Transplantation. 37(8): 323-327. August 2008.

This article reports on the potential problem of false readings of hyperglycemia in patients with diabetes who are on peritoneal dialysis (PD) and who use icodextrin. The authors note that several systems of blood glucose meters are available, but most are based on three enzymatic reactions. The two used most often are glucose oxidase (GOD) and glucose dehydrogenase using pyrroloquinolinequinone cofactor (GDH/PQQ). Icodextrin (Extraneal) is an isosmotic PD solution that contains glucose polymers. Accumulation in the systemic circulation of icodextrin metabolites may lead to a disparity between finger-stick and formal blood glucose measurement. The authors analyzed the possible interference of icodextrin metabolites with various glucose assays in nine diabetes patients who were undergoing PD using icodextrin. They found that this patient population is at risk of having erroneous blood glucose measurements using GDH/PQQ-based glucometers. They conclude that careful attention must be paid to checking that the glucose devices used in these patients are based instead on GOD, GDH with a different PQQ cofactor, or hexokinase methods to minimize the risk of hypoglycemia due to an overdose of insulin. 2 figures. 2 tables. 11 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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How Understanding Motivation Can Improve Dialysis Practices. Nephrology News & Issues. 22(10): 32-36. September 2008.

This article considers the role of patient motivation in improving dialysis practices and health care outcomes. The authors emphasize that motivation can help explain why some patients become good self-managers who follow their treatment plans and thrive, whereas others skip dialysis sessions, overload on fluids, and sabotage their chances for success. The authors describe self-determination theory and three critical psychological needs that are related to intrinsic motivation for health behavior changes: autonomy, competence, and relatedness. The article concludes by applying these concepts to practice strategies for clinical practice in the areas of patient education, modality choice, self-care, caregiver and family support, patient care setting, and sharing power with patients. Health care teams can help patients build competence by encouraging participation in self-care tasks, by providing appropriate challenges and celebrating successes, by offering positive performance feedback, and by avoiding demeaning evaluations of performance. The article includes an essay by Dr. Geoffrey C. Williams on the importance of self-determination in chronic kidney disease (CKD). 14 references.

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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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