The American Nephrology Nurses Association (ANNA) held its 2018 National Symposium in Las Vegas, Nevada, April 15-18, 2018. The meeting included posters and presentations on topics such as hemodialysis, chronic kidney disease, acute kidney disease, use of telemedicine in pediatric nephrology care, and treatment with direct-acting antiviral therapy for patients with hepatitis C on dialysis.
Jami S. Brown, DHEA, RN, CNN, presented a poster titled Strategies to Prevent Acute Kidney Injury (AKI) and Dialysis-Requiring Acute Kidney Injury (AKI-D) in Patients with HIV. The poster described a 43-year-old patient with a history of HIV, hypertension, myocardial infarction, and type 2 diabetes mellitus. The patient reported a decrease in urination one week after a heart catherization. “It is important for nurses to translate the knowledge of nephrology into practice and think critically when providing care to patients with HIV in order to minimize the risk of AKI and prevent complications associated with AKI-D,” the poster noted.
In a poster titled Telemedicine Use in the Pediatric Renal Transplant Population, Cindy Richards, BSN, RN, CNN, Children’s Hospital of Alabama, described a telemedicine program designed to provide care to pediatric kidney transplant recipients in rural areas. A nephrology and transplant center is working in cooperation with the state health department and a hospital with an existing telemedicine program. The center has a dedicated office to be utilized for telemedicine visits and local health department nursing staff have been trained to use equipment that will allow the physician to auscultate lung and heart sounds. “The hope for the program is to decrease the number of no-show clinic visits, and improve our patients’ outcomes and lengthen the life of the allograft for these patients,” Ms. Richards said.
Suzanne Joynt, nurse unit manager, Renal and Gastroenterology Services, Auckland District Health Board, New Zealand, presented a poster titled Dialysis Fatigue–How Can We Best Assess Our Patients and Help Them to Manage This? Ms. Joynt conducted a literature search to identify assessment tools to aid in objective measurement of fatigue in patients on maintenance dialysis. Of the 24 tools studied, the Fatigue Severity Scale (FSS) and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) will be tested at the author’s center due to ease of use and the information gathered that will enable healthcare providers to formulate plans of care. “While managing fatigue in hemodialysis patients can be a challenge, nurses have the ability to influence their patients on how to best manage their fatigue,” Ms. Joynt said.
Peritoneal dialysis in older patients with end-stage renal disease (ESRD) was the topic of a presentation from Nida Quirong-Jones of the Einstein Medical Center in Philadelphia, Pennsylvania. In her presentation, Peritoneal Dialysis in Octogenarians, she notes that peritoneal dialysis is “underutilized in the very old population, especially those over the age of 80 years.” The author describes the experience with elderly peritoneal patients with an average age of 83 years and finds that “octogenarian ESRD patients can successfully do peritoneal dialysis at home with the help of their care partners and comprehensive training…The peritoneal dialysis training nurse must be patient, resourceful, and supportive in the elderly patient’s desire to successfully perform peritoneal dialysis at home,” she said.
In a poster titled Depression and Medication Adherence in Patients on Hemodialysis, Zorica Kauric-Klein, APRN-BC, PhD, reported that approximately 80% of a cohort of 118 patients on chronic hemodialysis were found to have moderate depression. The analysis also demonstrated that depression was a significant predictor of nonadherence to blood pressure medication therapy in that patient population. “Depression is a modifiable risk factor, and interventions that address depression in conjunction with adherence to blood pressure regimens need to be tested in the hemodialysis population,” the author said.
Rebecca J. Bartlett, PhD, RN, and colleagues reported on the Feasibility of an Intervention to Slow Progression of Chronic Kidney Disease [CKD]. The presentation included a description of a pilot study to assess the feasibility and acceptability of delivering ISTOP-CKD (Intervention Strategies to Overcome Progression of CKD), an intervention designed for patients with CKD stage 3 and comorbid diabetes and hypertension. The study included 15 patients randomized to ISTOP-CKD and 15 to attention control groups. Knowledge significantly increased in the ISTOP-CKD group compared with the control group (P<.05). “Recruiting stage 3 CKD patients is challenging; this study highlights the importance of increasing patients’ awareness of CKD in stage 3 to increase patient activation, self-management, and slow CKD progression,” the authors said.
Improving patients’ experience with hemodialysis was the subject of a presentation by Erica Kang, BsN, RN. She described an innovation developed at a community-based hospital in Toronto, Canada, that included the utilization of home design hemodialysis machines for in-hospital patients. In a poster titled Utilizing a New Model of Care to Improve Patients Experience on Hemodialysis, Ms. Kang reviewed a pilot project that evaluated the efficacy of a care model for patients who were unable to tolerate conventional three times weekly hemodialysis. Upon completion of the trial run, patients in the new model group had fewer visits to the emergency department and fewer hospital admissions compared with a control group. “The pilot project was successful and led to an expansion of the unit in January 2017, accommodating 14 patients including those with congestive heart failure,” Ms. Kang said.
Joni-Jill Tobrocke, RN, CNN, and Wanda Flynn, BS, CNN, CEN, presented a poster titled Honor Thy Nurse: Establishing a Nursing Honor Guard, that described a program designed to “recognize men and women who have dedicated their professional lives to nursing, and to pay respect to fellow nurses (retired or active NP, RN, or LPN), at the end of life’s journey, for the devotion and commitment they demonstrated in caring for the vulnerable.” Since its founding 4 years ago, the Honor Guard has been called upon for 18 services. The presence of the Honor Guard provides recognition of the nurse who has died, and “the nurses who are members of the Honor Guard consider it both an honor and a privilege to participate in final services for their fellow nurses,” the authors said.
Patients with chronic kidney disease have altered taste function, and are at higher risk of hyperkalemia that may require chronic use of patiromer. In a study sponsored by Relypsa, a Vifor Pharma Group Company, Jeanene Fogli and colleagues conducted a study to examine the compatibility of patiromer with apple and cranberry juices, as alternatives to water. Results were reported in a poster titled In Vitro Total Potassium-Binding Capacity of Patiromer When Mixed with Apple or Cranberry Juice. The mean total potassium-binding capacity of patiromer suspended in apple juice was 8.8 mEq/L at both high and low dilutions. For cranberry juice cocktail, the values were 8.6 mEq/L for high dilutions and 8.6 mEq/L for low dilutions. The mean result for water was 9.1 mEq/L. The differences were not considered clinically relevant. “There was no adverse impact on the in vitro total potassium-binding capacity when patiromer was mixed with apple juice or cranberry juice cocktail,” the authors said.
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Fresenius Medical Care North American Provides Funding for Scholarships
At the ANNA National Symposium, Fresenius Medical Care North America announced the names of five recipients of educational scholarships. The five scholarship recipients were selected from 32 applicants; each will receive $4000 ahead of the fall 2018 academic term. The scholarships are made possible through a $20,000 grant from Fresenius Medical Care North America.
The five scholarship recipients are Genna Hirsch, RN, CDN, who is pursuing her bachelor’s degree in nursing at Fort Hays State University, Hays, Kansas; Sonya Jeevanandam, BSN, CND. RN, who is a candidate for a master’s degree in nursing; Stacey Meier, BS, RN, pursuing a master’s in education; Amber Paulus, BSN, RN, CPHQ, a second-year PhD candidate at Virginia Commonwealth University, Richmond; and James Thomas, RN, CDN, who is a candidate for a master’s degree in nursing with a focus on leadership and management.
“As a leader in renal care, we are committed to recognizing the passion and dedication of nephrology nurses across the country,” said Ron Rodgers, executive vice president, Fresenius Medical Care North America and president, Fresenius Kidney Care. “Congratulations to the scholarship recipients and thank you for the incredible work you do for people living with kidney disease.”