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After consideration of risks and benefits, some patients with kidney failure choose conservative management. Conservative management of kidney failure (CM-KF) does not include dialysis or transplant and utilizes primarily pharmacologic strategies for symptom management, which can be challenging due to the number and complexity of symptoms. Additionally, there are safety concerns regarding altered pharmacokinetics and the adverse effects induced by some of the therapies that may be selected to treat symptoms. This review describes common kidney failure symptoms and provides recommendations for pharmacologic management in CM-KF. Selection of medication should be individualized to the patient and comorbidities, drug interactions, cost, and adverse effects should be carefully considered. Additional studies specifically focused on CM-KF are needed. [ABSTRACT FROM AUTHOR]

Autosomal dominant polycystic kidney disease (ADPKD) is incurable and occurs once in every 1,000 births. Confirmation of AKPKD is made through imaging and a positive family history. Symptoms typically appear in midlife and include kidney, side, and/or back pain related to the rupture of kidney cysts, renal stones, infection, pressure of cysts against other organs, and stretching of the renal capsule. In addition to end stage renal disease, cerebral aneurysm may also be a threat to individuals with this diagnosis. Recent clinical trials have shown that tolvaptan, a vasopressin-2 receptor antagonist, produced a moderate to significant reduction in total kidney volume and improved function, leading to its recent approval by the U.S. Federal Drug Administration for treatment of patients with ADPKD. This article provides a comprehensive look at the pathophysiology of ADPKD, pharmacokinetics and pharmacodynamics of tolvaptan, and tolvaptan's clinical implications, effects, and contraindications. In addition, we present a case study discussing tolvaptan's clinical usefulness and address patient concerns in an adult presenting with rapidly progressing ADPKD. [ABSTRACT FROM AUTHOR]

Patients living with end stage renal disease (ESRD) who are undergoing hemodialysis experience frequent hospitalizations associated with complications of care and exacerbations of illness. Efforts to reduce hospitalizations have had limited success. The purpose of this study was to explore why hospitalizations occur from the perspectives of patients undergoing hemodialysis treatment, their caregivers, and health care providers. Semi-structured interviews and focus groups were conducted with 21 patients living with ESRD, 10 caregivers, and three focus groups with health care professionals. Findings are discussed under four main themes: Graft site/Catheter/Access issues, "My resistance is low," "I could not breathe," and "The perfect storm." Results highlight the complexity of care and vulnerability of patients with ESRD. Further interprofessional research is needed to improve transitional care and care delivery for patient populations receiving hemodialysis. [ABSTRACT FROM AUTHOR]

Effective methodologies for teaching nursing students how to care for pediatric patients with end stage renal disease (ESRD) are not well described. Two teaching methodologies were compared using a mixed-methods approach: an at-home simulation group (three days simulating having ESRD: taking medications, eating a renal diet, nightly peritoneal dialysis), and a video group (children with ESRD and their families sharing their experiences). Data were collected via an anonymous online survey at course completion. Knowledge acquisition was assessed using psychometrically reliable multiplechoice questions; no statistically significant differences between the two groups were found, indicating both learned the material. Qualitative analysis found that both groups valued the assigned teaching method and that it deepened their learning. Students identified challenges that children with ESRD and their families are known to experience. Combining both teaching methods may ultimately be the most effective approach. [ABSTRACT FROM AUTHOR]

Globally, home dialysis prevalence has been declining relative to the increase in end stage renal disease and renal replacement therapy. The goal of this study was to identify international perceptions and practices. A web-based questionnaire was disseminated to nephrology nurses in 30 home dialysis-prevalent nations. Global telehealth use was low (23%), contrasting with 83% respondents agreeing telehealth would improve care. Only 31% of all programs enabled patient training outside of normal working hours (e.g., nights and weekends), and 31% of all program patients had some cost reimbursement, with a significant difference between U.S. and non-U.S. programs (U.S. 11%, non-U.S. 59%, 2 = 93.6, p < 0.0001). Significant differences in the need for monthly clinic visits (U.S. 72%, non-US 44%, 2 = 83.7, p < 0.0001) were also found. Telehealth provision and patient training flexibility is limited, and patient cost reimbursement is low. Increased telehealth, patient cost reimbursement, and flexible training models may promote home dialysis growth. [ABSTRACT FROM AUTHOR]

Fatigue is a subjective overwhelming feeling of tiredness at rest, exhaustion with activity, lack of energy that impedes daily tasks, lack of endurance, or a loss of vigor. Individuals with end stage renal disease (ESRD) experience a high rate and severity of fatigue. Symptom management of fatigue in this population is critical, since fatigue has been linked with lower quality of life and higher mortality rates. In this article, we present a definition and overview of fatigue, a review of factors contributing to fatigue, and ways to manage fatigue in individuals with ESRD. [ABSTRACT FROM AUTHOR]

The article discusses pain management in the older adult population with end-stage renal disease (ESRD) receiving in-center hemodialysis. Topics covered include definition of palliative care by the World Health Organization, reasons for pain in older adults with ESRD receiving hemodialysis, and barriers to effective pain management.

Adult patients on hemodialysis experience a high prevalence of poor oral health and periodontitis. The chronic inflammation associated with poor periodontal health can increase the risk of cardiovascular disease and mortality among patients on hemodialysis. A systematic review of research articles published from 2012-2018 was conducted to synthesize current literature on the subject. Forty-three articles were identified. Findings were summarized into two categories: clinical measurements and lifestyle/quality of life. We suggest the development, implementation, and evaluation of oral health nursing interventions and periodontal treatments among patients on hemodialysis. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the level of engagement with medication among kidney transplant recipients in South Africa. A descriptive cross-sectional study design with random sampling was used. Data were collected through structured face-to-face interviews. Total engagement with medication scores among kidney transplant recipients ranged from 60% to 100%, with a mean score of 80%. Although over half of the participants (55%) scored above the mean, only 19% had high levels of engagement with medication. Engagement with medication was significantly associated with race (Chi-square value = 66.225, df=42, P=0.010) and years post-kidney transplantation (Chi-square value = 415.423, df=364, P=0.032). [ABSTRACT FROM AUTHOR]

Fluid restriction is a major lifestyle change for patients with end stage renal disease who are on hemodialysis. Educating patients about fluid management supports self-management of their prescribed fluid restrictions. Using a pre-test/post-test design, this project aimed to educate 17 patients on chronic hemodialysis about the management of fluid restrictions for improved renal fluid adherence. Post-intervention assessments revealed increased knowledge of hemodialysis treatment and improved renal fluid adherence. Findings suggest that educational interventions help patients improve knowledge of dietary and fluid management, thereby aiding in adherence to fluid restrictions. [ABSTRACT FROM AUTHOR]

End stage renal disease (ESRD) affects African Americans more than any other ethnic group. Adherence is a challenge. Patients with ESRD must adhere to medication, diet, fluid restrictions, and dialysis treatment schedules if they do not receive a kidney transplant. The purpose of this exploratory, descriptive study was to assess adherence in 120 African Americans with ESRD undergoing hemodialysis (HD). Participants completed a demographic questionnaire and the ESRD Adherence Questionnaire (ESRD-AQ). Biomarkers were collected from medical records. Few participants (24%) adhered to dietary restrictions; however, fluid restriction was reported as the most difficult to manage, which was consistent with the interdialytic weight gain biomarker. Older participants were more adherent. Participants were adherent with HD attendance and medication. Participants reported frequent communication with the healthcare team, but a more formal process needs to be implemented with follow up to ensure understanding and reinforce adherence. [ABSTRACT FROM AUTHOR]

Caregiver burden has negative consequences on the perceived health and quality of life of caregivers. There is limited research on the positive aspects of caregiving. A descriptive convenience sample of 89 caregivers of patients on hemodialysis responded to an online survey distributed on the National Kidney Foundation's email list. Participants completed the Self- Assessed Health Measure (SAH), Positive Aspects of Caregiving (PAC), and the Caregiving Stress Appraisal (CAS) survey instruments. Caregivers with higher self-assessed levels of health, who view their caregiver role positively, experienced lesser degrees of burden (Pearson r=-0.537, p=0.000; and r=-0.335, p=<0.001, respectfully). Healthcare providers must take into consideration the health, wellness, and needs of unpaid caregivers. [ABSTRACT FROM AUTHOR]

Controlled fluid intake is an important aspect of living with end stage renal disease (ESRD), and is complicated by depression, the most common mental health issue affecting individuals with ESRD. Factors that mitigate the deleterious effects of depression are underexplored. This study sought to identify potential mediators between depression and fluid adherence in 107 individuals with ESRD aged 50 years and older by comparing four logistic regression models. Age was associated with an increase in fluid adherence (adjusted odds ratio [AOR]=1.08, 95% confidence interval [CI]=1.02-1.14), whereas depression was associated with a decrease in fluid adherence (AOR=0.82, 95% CI=0.67-0.99), but when self-efficacy was entered into the model, the association between depression and fluid adherence weakened. Findings suggest that self-efficacy and age are important factors in fluid adherence, and self-efficacy can potentially mediate the negative effects of depression in older adults with ESRD. [ABSTRACT FROM AUTHOR]

Hospital readmissions are responsible for considerable health care costs. About 35% of patients with end stage renal disease (ESRD) who are hospitalized are readmitted within 30 days of discharge (United States Renal Data System, 2017). Studies point to the considerable percentage of readmissions that are preventable through effective discharge planning and patient follow-up after discharge (Mistiaen & Poot, 2006). Telephone follow up is a high-quality, low-cost method of providing discharge follow up. This project examined the effectiveness of an evidence-based quality improvement process in providing post-discharge telephone follow up to adult patients on hemodialysis by experienced nephrology nurses through standardized unit workflow and leveraging of the electronic medical record (EMR). Results indicated a lower percentage of admissions from the emergency department (59.9% pre- vs. 55.4% post-intervention) and a lower percentage of 30-day readmissions (28.4% pre- vs. 24.6% post-intervention). [ABSTRACT FROM AUTHOR]

Patients receiving care for the management of end stage renal disease require transport to nephrology practice settings and treatment centers for hemodialysis and peritoneal dialysis. This type of transportation, defined as non-emergency medical transportation, has long presented a challenge for patients, families, and healthcare providers. This article explores the current and projected statistics and trends for chronic kidney disease, transportation challenges faced by patients and nephrology healthcare providers, and examples of successful transportation services and programs. Implications for practice with a focus placed on the importance of an interprofessional approach are described. [ABSTRACT FROM AUTHOR]

This study measured the prevalence of depression in 39 patients on hemodialysis and peritoneal dialysis in two urban outpatient facilities in the southeastern United States. Additionally, it evaluated the number of patients who sought and scheduled a mental health evaluation after screening and education. The prevalence of mild to severely depressed individuals among participants in this study was 36%, affirming previous findings of depressive symptoms in the ESRD population. Results suggest that patients with ESRD are at a higher risk for depression than the general population. The effects of depression may exacerbate ESRD symptoms, affect treatment adherence, and increase hospitalizations and morbidity. It is likely that screening, diagnosing, and treating depression will be associated with improvement in quality and quantity of life. The practicality of using the screening procedure may improve the detection of depression in this population. However, only a fraction of identified patients in this study pursued further mental health evaluation within the 45-day period. Continued research is needed to identify barriers to seeking mental health consultation and treatment in this community. [ABSTRACT FROM AUTHOR]

The HIV Organ Policy Equity Act, or HOPE Act, requires the Secretary of Health and Human Services to develop guidelines for research on the transplantation of kidneys and livers from individuals infected with the human immunodeficiency virus (HIV) into patients with end stage organ failure who are also infected with HIV. Although signed into law in 2013, the guidelines were not finalized until November 2015. Currently, 18 transplant centers that wish to participate in this research have received Institutional Review Board approval. The HOPE Act is expected to expand the donor pool by approximately 500 to 600per year in the United States and reduce wait times for HIV-infected patients as well as those not infected with the virus. South Africa, a country that began HIV+ to HIV+ transplants several years ago, has demonstrated encouraging patient and graft survival rates. The extent to which these results will be replicated in the United States is unknown. The outcomes experienced by patients and transplant centers that participate in the HOPE Act research will determine if the practice of transplanting HIV-infected organs will one day be considered for more widespread use in the United States. [ABSTRACT FROM AUTHOR]

The article discusses the role of advanced practice nurses (APNs) in palliative care for patients with chronic kidney disease. Topics covered include the drop in the number of physicians who have specialized training in hospice and palliative medicine, the pillars of the collaborative model for nurse practitioners (NP) and the sustainability of an NP-based model of specialist palliative care in patients' homes.

This study explored experiences associated with burden, depressive symptoms, and perceived health in six male caregivers of persons with end stage renal disease (ESRD) using qualitative interviews. Analysis employed open coding and analysis to generate codes and categories. Eighty-three percent of the participants reported significant subjective and objective burden. Linkages occurred between sociodemographic characteristics, care recipient attributes, and caregiver-care recipient relationship, and caregivers' experience of burden and depressive symptoms. Findings suggest the need for intervention trials targeting new coping strategies to help improve the well-being of this population. [ABSTRACT FROM AUTHOR]

Effective management of end stage renal disease for individuals undergoing hemodialysis (HD) requires the acquisition of self-care abilities, which have been shown to improve outcomes. Studies have indicated that educational interventions improve self-care abilities in patients with chronic kidney failure. A self-care coaching intervention was designed to bridge this gap. To evaluate, we utilized a pre-test/post-test quasi-experimental design using the Self Care for Adults on Dialysis (SCAD) tool. This was administered prior to, four months, and one year after the intervention. Results demonstrated improvement in self-care related to vascular access and fluid management, both significant aspects of being HD-dependent. [ABSTRACT FROM AUTHOR]

Patients with end stage renal disease (ESRD) experience a high symptom burden and poor quality of life as part of their advanced illness. Latinos experience a higher prevalence of ESRD compared to non-Latino whites; however, they are underrepresented in existing ESRD literature. We conducted a systematic review of qualitative studies that include Latino patients with ESRD and their caregivers in the United States. Of 694 citations published through August 2014, six met inclusion criteria. Four major themes emerged: 1) Losses, 2) Heightened awareness of death, 3) Barriers to quality communication and care, and 4) Mediating Latino traditions and values. A thematic schema was developed. [ABSTRACT FROM AUTHOR]

Home dialysis offers many advantages over in-center dialysis, but peritoneal dialysis and home hemodialysis are infrequently used. To better understand why, a survey of dialysis healthcare professionals (N = 273) in the United States was conducted to assess their knowledge, perceptions, and beliefs about home dialysis modalities. Most survey respondents demonstrated a lack of knowledge about home dialysis and perceived many barriers to home therapy, which may affect patient modality choice; however, 90% of respondents stated they would choose home dialysis for themselves if they required dialysis. Additional staff education may help reduce misperceptions, address knowledge gaps, and subsequently, increase use of home modalities. [ABSTRACT FROM AUTHOR]

Pediatric patients with end stage renal disease (ESRD) are not as prevalent as adults with ESRD, but the numbers are increasing each year. Medical management is the same for pediatric patients as it is with adults with ESRD: hemodialysis, peritoneal dialysis, no therapy, or transplantation. Among most pediatric nephrology centers, the goal for patients is to achieve transplantation. [ABSTRACT FROM AUTHOR]

Children with end stage renal disease (ESRD) frequently miss great amounts of school due to hospitalizations and three-times-a week hemodialysis (if that is their modality); thus, they miss opportunities to be with their peers and learn normal social interactions with other students. Because of this lack of normal socialization, many children with ESRD are behind in development in contrast to their peers and need opportunities to enhance their growth and development. One way this can occur for children with ESRD is by providing them opportunities to attend age-appropriate and disease-appropriate camps. [ABSTRACT FROM AUTHOR]

The incidence of end stage renal disease is more than three times higher in African Americans. Treatment regimens contribute to gastrointestinal (GI) complaints. This study's purpose was to examine the incidence of GI symptoms in African-American patients undergoing hemodialysis. Younger participants were more likely to report mild indigestion, while older participants reported severe indigestion or none at all. Females were more likely to report gastrointestinal symptoms. Commonly reported co-morbidities included hypertension, diabetes, and heart disease. Time on hemodialysis ranged from 1 to 279 months. Those who had been on hemodialysis the longest were more likely to report acid reflux, stomach rumbling, and mild diarrhea. This study provides a foundation for early identification of GI symptoms in African-Americans patients undergoing hemodialysis. [ABSTRACT FROM AUTHOR]

When encountering unusually appearing dialysate effluent from a patient doing peritoneal dialysis, it is important to review the patient's recent exposures. In the case of "black"-appearing dialysate effluent, consideration needs to be given to the possibility of someone having undergone a colonoscopy and having tattooing with India ink. Nephrology nurses are frequently the first to be notified when there has been a change in the character of a patient's peritoneal dialysis dialysate effluent. This article describes a case of "black"-appearing dialysate and includes some of the potential differentials that were considered in the evaluation process. Even though "black"-appearing dialysate is a rare occurrence, nephrology nurses need to be aware of some of the potential etiologies, including exposure to India ink. [ABSTRACT FROM AUTHOR]

Poor sleep among the general population is understudied, unrecognized, and often not assessed. This is especially true for patients receiving hemodialysis. This study used a case study design to examine the impact of hemodialysis treatments on the sleep of two patients as measured by actigraphy and self-reported sleep logs. Patient 1 experienced an average sleep efficiency of 82.3% on non-hemodialysis days compared to 75.0% on dialysis days, which resulted in a 7.3 percentage point change and 9.7% better sleep efficiency on non-hemodialysis days. Patient 2 reported sleep efficiency 76.6% on non-hemodialysis days compared to 70.5% dialysis on days, resulting in a 6.1 percentage point change and 8.7% better sleep efficiency on non-hemodialysis days. Actigraphy sleep patterns provided an initial move toward best practice for sleep evaluation in this population. [ABSTRACT FROM AUTHOR]

Patients with chronic kidney disease (CKD) are often referred to a nephrologist late. Contributing factors include primary care providers' lack of awareness of practice guidelines for treating kidney disease and their uncertainty of timing for referral to a nephrologist. The purpose of this quasi-experimental study was to determine if advanced practice nurses working in primary care are knowledgeable about the National Kidney Foundations Kidney Disease Outcomes Quality Initiative Guidelines, if a CKD education program increases knowledge, and if knowledge is retained. Fourteen advanced practice nurses participated in the study. The knowledge outcome was measured using a CKD knowledge-based survey. The results showed a significant increase in knowledge post-intervention; moreover, knowledge gained was retained at the one-month follow-up interval. This evidence-based practice project was developed to promote timely referral to a nephrologist, which may then slow the progression of kidney disease, decrease morbidity and mortality, and reduce healthcare cost. [ABSTRACT FROM AUTHOR]

The article describes the case of 84 year old female Paula who was told she had chronic kidney disease (CKD) State 3 that was irreversible. The kidney disease was diagnosed based on serum creatinine 1.2mg/dL with estimated glomerular filtration rate of 43mL/min/1.73 sq meter, urinalysis dipstick negative for protein and blood and kidney ultrasound. It cites the importance for nephrology nurse to understand how to interpret estimated glomular filtration rate (eGFR) estimating equations.

Cardiovascular disease (CVD) is the leading cause of death in patients undergoing dialy sis. This article summarizes identified CVD risk factors, elaborates on how risk factors impact patients, and discusses the implications to the nephrology community based on the current evidence-based practice. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the occurrence of chronic kidney disease (CKD) in a Alaskan Native/American Indian healthcare network using two diagnostic methods: single measure and repeat measures according to current guidelines. This descriptive study of laboratory data (n = 15,515) found that the diagnosis of CKD was overstated when single measures (9.6%) were used compared to multiple measures (5.0%). Occurrence rates of CKD varied significantly depending on the method used for diagnosis. [ABSTRACT FROM AUTHOR]

Nephrology nurse shortages have historically been viewed as a subset of the overall nursing supply in the United States. Not-here-to-fore considered as a contributing factor are the effects of word-of-mouth and Internet-based word-of-mouth communications from nurses who have had disappointing work experiences in hemodialysis clinics. This article discusses the potential effects of word-of-mouse communications and posits that negative word-of-mouse communications may discourage new and experienced nurses from considering the specialty of nephrology nursing, thus contributing to a nephrology nursing shortage. [ABSTRACT FROM AUTHOR]

The article discusses research done on safety issues in home dialysis. It references the study "Safety Issues in Home Dialysis" by A. Peters published in the 2014 issue. It cites the factors that nephrology nurses must consider when initiating a home dialysis therapy. It mentions the important role of an early home visit in the success of home dialysis therapy. The unique aspects of home therapy for patients are also discussed.

Dialysis disequilibrium syndrome is a potentially fatal complication of hemodialysis that is often undetected and under-reported. Early recognition and intervention are essential to prevent the potential deadly effects of this disorder and improve outcomes for patients with end stage renal disease (ESRD) on hemodialysis. Using a case study, this article discusses the pathophysiology, clinical manifestations, prevention, and management of dialysis disequilibrium syndrome. [ABSTRACT FROM AUTHOR]

Vitamin D is well known for its skeletal and extraskeletal benefits. Chronic kidney disease (CKD), even in the early stages, may predispose patients to vitamin D deficiency, which may result in deleterious effects. Understanding the prevalence of vitamin D deficiency in the CKD population living in southern areas of the United States may help in early identification and implementation of preventative strategies. [ABSTRACT FROM AUTHOR]

Over the last century, remarkable advances have been made in the care of patients with end stage renal disease (ESRD), resulting in improved prognosis. However, for decades after the advent of dialysis, anemia-associated symptoms continued to adversely affect patients' daily lives. The identification, isolation, and eventual cloning of erythropoietin and its receptor led to development of erythropoiesis stimulating agents, revolutionizing anemia management. Continued advancements have paved the way for the discovery of novel erythropoiesis stimulating agents with enhanced properties. This article charts the history of anemia management in patients with ESRD, including the discovery of erythropoietin, and briefly reviews the development, mechanism of action, and select attributes of erythropoiesis-stimulating agents. [ABSTRACT FROM AUTHOR]

Venous needle dislodgement is a potential serious complication of hemodialysis therapy. In 2012, the American Nephrology Nurses' Association (ANNA) created a collaborative special project workgroup to review venous needle dislodgement occurrence, consequences, and recommended practices, and to develop strategies and resources on venous needle dislodgement to be used by nephrology nurses and other healthcare professionals, as well as by patients and their families. The ANNA Venous Needle Dislodgement Special Project Workgroup conducted a literature review and also surveyed nephrology nurses about their experiences with venous needle dislodgement and their recommendations for needed resources. This article discusses the results of the literature review and survey, and provides resources on venous needle dislodgement, including a venous needle dislodgement risk assessment tool, education materials, and practice recommendations. [ABSTRACT FROM AUTHOR]

End stage renal disease is a major health issue in the United States. Dialysis, the major form of renal replacement therapy, has physical and psychological implications that can have a major impact on both men's and women's sexuality and sexual performance. Nurses are in a key position to assist men and women on dialysis to develop healthy and realistic approaches to their sexuality. This article reviews the literature on dialysis and sexuality, and recommends nursing interventions that can assist persons on dialysis achieve the level of sexual intimacy and satisfaction they desire. [ABSTRACT FROM AUTHOR]

The article presents the case study of 56-year-old female with type 2 diabetes and end stage renal disease (ESRD). The patient had a 3-month history of increasingly painful, firm, red to brown nodules bilaterally in her distal extremities, increasing in size and number. Various tests confirmed the diagnosis of calcific uremic arteriolopathy (CUA). The patient was with IP sodium thiosulfate. The article also discusses several review studies dealing with treatment and diagnosis of CUA.

Despite the use of epoetin alfa, over one-third of patients with end stage renal disease have persistent anemia. The nephrology literature cites various erythropoietin adjuvants that may have the potential to improve the efficiency of anemia management, and one option is ascorbic acid. This article reviews the published data on the effectiveness of intravenous ascorbic acid in increasing the hemoglobin levels of patients with hyporesponse to epoetin alfa, as well as adverse effects of the administration of intravenous ascorbic acid specifically in relation to hyperoxalemia. [ABSTRACT FROM AUTHOR]

Patients with end stage renal disease on hemodialysis are at risk for cardiovascular events and increased mortality. Hypertension contributes to these risks and can be difficult to assess due to unreliable blood pressure (BP) measurements at dialysis centers. A clinical practice grant from the American Nephrology Nurses' Association allowed for the purchase of 35 home BP monitors to study the use of these monitors to provide additional information for BP management. Findings indicated that home BP monitoring can be an effective tool in hypertension management. [ABSTRACT FROM AUTHOR]

This study examined whether racial/ethnic differences in illness perceptions exist among patients on maintenance hemodialysis. One hundred sixty-one patients with end stage renal disease (ESRD) undergoing maintenance hemodialysis (20% African Americans, 44% Hispanics, 9% Filipinos, and 27% Koreans) completed the Revised Illness Perception Questionnaire. Korean participants had higher emotional disturbance than their counterparts, whereas African-American participants had higher negative perceptions of personal intervention or medical treatment controlling their disease. This study indicates that patients from different racial/ethnic backgrounds undergoing maintenance hemodialysis may perceive their disease differently. This phenomenon could affect clinical outcomes and may require different therapeutic approaches. [ABSTRACT FROM AUTHOR]

The article describes a case study of an older adult patient with end stage renal disease (ESRD) who is managed by a family nurse practitioner (FNP) and a nephrologist. Topics discussed include challenges for the elderly patient on dialysis, how a FNP primary care provider (PCP) provides primary care in collaboration with a nephrologist and renal care team, and how FNP PCP can educate patients during a dialysis modality change.

The article provides an answer to a question about improving fall prevention strategies in an outpatient hemodialysis setting.

The article argues against the use of the term "stable" in patients with chronic kidney disease (CKD). Topics covered include the explanation that CKD is a progressive disease, uncertainty about the intensity of care required, mortality rates and cardiovascular disease progression in CKD patients and the suggestion nephrology professionals to avoid the use of the word stable in describing CKD patients given the multiple complications of the disease.