Developing and sustaining a renal supportive care service

for people with end-stage kidney disease

Elizabeth Josland, Frank Brennan, Anastasia Anastasiou & Mark A Brown

 Josland, E., Brennan, F., Anastasiou, A., & Brown, MA. (2012). Developing and sustaining a renal supportive care service for people

with end-stage kidney disease. Renal Society of Australasia Journal, 8 (1), 12-18

Abstract

 Background The poor, self-reported quality of life, high symptom burden and complex care needs of dialysis patients prompted the development of a renal supportive care service at St George Hospital.

 Aim To report the development of a renal supportive care service at St George Hospital and methods used to sustain its growth.

 Method Supportive care consists of outpatient and inpatient services with four specific groups of patients identified as the primary clientele. These groups are those on a conservative (non-dialysis) pathway, end-stage kidney disease (ESKD) patients with a symptom burden requiring specialised management, patients on dialysis considering dialysis withdrawal and ESKD patients with cancer. Services consist of complex symptom management, end-of-life (EOL) care and coordination of services to assist the patient to stay at home as long as they are able.

Conclusion The future of the supportive care service looks promising; therefore, it is important to incorporate this as part of routine patient care in ESKD. There is a need to pass on renal supportive care knowledge to the renal care teams to assist ESKD patients to live as well and as comfortably as possible, whether they choose a dialysis pathway or not, and to engage in clear conversations with patients and carers throughout the disease trajectory.

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Monitoring of the efficacy of Hepatitis B vaccination and infection in renal disease and transplantation patients

Sanaa Ghazi AlAttas

Journal of Nephrology and Renal Transplantation, Vol 4, No 1 (2012)

Abstract

Background: Reports show that patients with end stage renal failure and transplants present with reduced immunity to infections especially with Hepatitis B Virus. This may make the patients respond poorly to hepatitis B vaccine with resultant poor seroconversion rate. This study examines the efficacy of hepatitis B vaccine, in chronic renal failure (CRF), Post Kidney Transplantation (PKT), and renal patients as compared to controls healthy.

Methods: A total of 303 subjects participated: One hundred and thirty-three immunocompetent and immunocomprised individuals and 170 controls were enrolled in this study. They were categorized into four groups. Group I: Comprised 54 Chronic Renal Failure, Group II: Comprised 21 End Stage Renal Disease patients, Group III:Comprised 38 Post Kidney Transplant patients, Group IV: Control group comprised 170 vaccinated blood donors and hospital staff. Detection of serological markers - HB_sAg, Anti-HBs, HB_eAg, Anti-HBe, HB_cI_gG, and HB_cI_gM were performed by enzyme immune assays (EIA). The vaccination schedule comprised recombinant hepatitis B vaccine (Engerix B) 40 μg intramuscularly at 0, 1, and 6 months.

Results: Our results have documented successful vaccination in only group I, and III, with primary seroconversion 20.4% and 15.8% respectively while none in group II, seroconvert and 100% of group lV demonstrated successful vaccination. The remaining patients were HBV infected.

Conclusions: It was concluded that controlling HBV infection in end stage of renal disease still pose a great deal of challenges. Based upon this study results, we highly recommend stating vaccination strategy at an earlier stage of chronic renal disease. Furthermore, regular serological testing and booster injections are necessary for hypo-responders. 

Wishing All Mothers

A 

Happy Mother's Day

Thank you Mothers

 for all your love and care

Best Wishes and Warmest Regards

Malaysian KidneySPA

Effect of duration on hemodialysis on prevalence of Helicobacter pylori infection

Yousef Rasmi1, Saman Farshid1, Khadijeh Makhdomi2

¹ Department of Biochemistry, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran

² Department of Nephrology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Ira

Abstract

Digestive tract complications are common in hemodialysis (HD) patients, and Helicobacter pylori (H. pylori) is thought to play an important role in the pathogenesis of gastrointestinal mucosal lesions in these patients. Also, reports indicate that cytotoxin-associated gene A (CagA) is the major factor involved in the pathogenesis of H. pylori disease. However, many issues regarding H. pylori infection in HD patients are still unclear. In this cross-sectional study, we investigated the effect of duration on HD on the prevalence of H. pylori infection and its virulent CagA(+) strain. One-hundred and fifty-one HD patients who were referred to our university HD center were included in the study. There were 78 males and 73 females, with a mean age of 54.2 ± 14.6 years (range: 19-87 years). They were tested for serum anti-H. pylori IgG antibody by the enzyme-linked immunosorbent assay method. Also, anti-CagA IgG antibody was tested in H. pylori-infected patients. The study patients were categorized into two groups: short-term HD duration (STHD: ≤3 years) and long-term HD duration (LTHD: >3 years). The overall prevalence of antibodies to H. pylori and CagA were 65.6% (99/151) and 25.3% (25/99), respectively. The prevalence of H. pylori infection among the STHD and LTHD patients were 49/89 (55.10%) and 49/62 (79.0%), respectively; P <0.05. The prevalence of anti-CagA antibody in infected STHD and LTHD patients was 24.5% (12/49) and 26.5% (13/49), respectively; P >0.05. Our study suggests that the prevalence of H. pylori infection is higher in patients on LTHD. More investigations are needed regarding the clinical consequences of H. pylori infection in HD patients.

Wishing all

Buddhist Brothers and Sisters

A Happy and Blessed

Wesak

Best wishes and warmest regards

MalaysianKidneySPA

Antimicrobial Locks in HD Catheters May Have a Down Side

Jody A. Charnow April 20, 2012

Renal & Urology News

http://www.renalandurologynews.com/antimicrobial-locks-in-hd-catheters-may-have-a-down-side/article/237233/

Antimicrobial locks (AML) decrease the incidence of catheter-related bloodstream infections in hemodialysis (HD) patients, but they may result in the emergence of problematic pathogens, according to British investigators.

In a retrospective study, John J. Dixon, MD, and colleagues at St. Helier Hospital in Carshalton, Surrey, found that AML containing vancomycin and gentamicin significantly decreased the incidence of catheter-related bloodstream infections from 8.50 to 3.80/1,000 catheter-days. However, the proportion of Gram-positive bacteria, notably Staphylococcus aureus, increased significantly with AML use, although the proportion of methicillin-resistant S. aureus and vancomycin resistance did not, the researchers reported online ahead of print in Nephrology Dialysis Transplantation.

The study also found that AML use was associated with increased gentamicin and ciprofloxacin resistance among Enterobacter species, but not among Pseudomonas species or Escherichia coli.

Dr. Dixon's team noted that catheter-related bloodstream infections caused by S. aureus are highly pathogenic, with studies showing that it associated with 22% in-hospital mortality, rising to 32% at 90 days. Enterobacterbacteremia has a mortality rate of 5%-20%, increasing to 44% in patients who develop endocarditis. “It seems logical that resistant Enterobacter will be harder to treat with consequent higher mortality,” the authors stated.

“Given the prevalence of S. aureus and resistant Enterobacter, there is a need for a trial directly comparing the effectiveness of AML with non-antibiotic locks (e.g. citrate) in reducing CR-BSI,” they wrote. Non-antibiotic locks do not promote antimicrobial resistance and may be more cost-effective, they noted.

The study included 927 hemodialysis patients, of whom 662 received vancomycin and gentamicin systemically as well as in an AML. The other 265 patients received only systemic vancomycin and gentamicin and served as a control group.

The proportion of S. aureus cultures was 37.7% in the AML group compared with only 28.6% of the control arm. In the AML group, 29.4% of Enterobacter isolates were resistant to gentamicin, 23.5% were resistant to ciprofloxacin, and 15.7% were resistant to both drugs. In the control group, none of the Enterobacter isolates were resistant to gentamicin and 2.9% were resistant to ciprofloxacin. None of the isolates was resistant to both drugs.