Nephrology Nursing Journal最新文献

Citrate anticoagulation offers a targeted and effective method for preventing clotting in extracorporeal blood circuits during dialysis. This article reviews the mechanisms, benefits, risks, and best practices associated with citrate anticoagulation, emphasizing its growing role within critical care and dialysis.

Patients in need of a kidney transplant have the option of receiving a kidney from a living donor or a deceased donor. Patients in the United States who do not have an available living donor typically wait on the deceased donor waiting list for an average of three to five years, although some patients may wait longer. The waiting list is very complex and intended to allocate kidneys in a fair and equitable manner. The deceased donor waiting list is currently managed by the United Network for Organ Sharing, but a recent change will soon distribute its current functions to multiple different organizations with a goal to improve transplantation rates. This article discusses how to help patients navigate the complexity of the kidney transplant waitlist.

Intradialytic hypotension (IDH) is a common occurrence in hemodialysis. IDH occurs when there is a drop in blood pressure along with hypotensive symptoms. There are various causes of IDH, and it is important to consider proper management of this condition. One strategy is to administer vasoconstrictor medication before the hemodialysis session to decrease the risk of IDH. A vasoconstrictor medication used for IDH is midodrine. Midodrine is an oral alpha-1 adrenergic receptor agonist. Evidence on its long-term efficacy and safety data is lacking. This article describes important information on midodrine for nephrology practitioners.

Whether pediatric dialysis is morally obligatory is an ethical issue. The study's aim was to understand neonatal and pediatric intensive care unit (ICU) nurses' beliefs regarding the ethical use of pediatric dialysis. A single center study was conducted using theoretical and case-based surveys. Sixty-three (63) registered nurses completed at least part of the survey. The most important factors influencing nurses' beliefs on the appropriateness of dialysis were patient quality of life, prognosis, and severity of comorbidities. Nurses with experience vs. nurses without experience caring for patients on dialysis ranked family wishes as more important (p < 0.05) and were more likely to express their beliefs when they disagreed with the decision (p < 0.005). The data suggest that beliefs of nurses vary based on demographic and situational factors. Consideration of these factors may improve care team communication.

Patients with acute kidney injury often require dialysis (AKI-D) in the outpatient setting following hospitalization. Management of the patient with AKI-D should focus on preventing further insult to the damaged kidney and recovery of kidney function. Clinical attention should include continuity of care, education, infection control, medication management, and fluid management.

More and more nursing homes are admitting residents receiving dialysis. In 2023, the Centers for Medicare and Medicare Services released guidance addressing the qualifications of those caring for these residents and further clarified the survey process. The American Nephrology Nurses Association Board of Directors created the Home Dialysis for Nursing Home Residents Task Force to review the revised guidance, investigate strategies and opportunities for nephrology registered nurses in home dialysis therapy in this setting, and consider the potential implications related to alternative home dialysis settings. This article discusses their process, findings, and outcomes.

Nurse well-being is critical for safe and efficient health care delivery, particularly in complex and demanding specialties like nephrology. However, levels of burnout are rising and may relate to a largely unexplored phenomenon: loneliness. This study investigated the phenomenon of nurse loneliness as a potential factor in burnout. A mixed-methods approach was used to investigate burnout and loneliness in a national sample of nephrology nurses. Together with workforce demographics, burnout and loneliness were measured, prevalence was estimated, and correlations were examined. Interpretive descriptive inquiry and analysis was used to develop a richer understanding of nurse loneliness in the context of burnout. In the study population (n = 217), rates of burnout were low, but positively correlated with loneliness. Qualitative interviews reveal that organizational and systemic pressures, recognition and peer support, work environment and demands, and physical and emotional well-being are components of the experience of current nephrology nurses related to loneliness and burnout.

Value-based care (VBC) aims to improve patient health outcomes relative to the cost of care by shifting from traditional fee-for-service models to patient-centered, outcome-driven approaches. This framework is particularly important in nephrology, where high costs associated with chronic kidney disease (CKD) and end stage kidney disease have prompted the adoption of new care models. Key programs such as the Comprehensive End-Stage Renal Disease Care Model and the Kidney Care Choices program have introduced multidisciplinary teams and early-stage CKD interventions to improve patient outcomes and reduce costs. This article highlights the essential role of interdisciplinary collaboration in VBC, with registered nurses, nurse practitioners, pharmacists, social workers, dietitians, and physicians coordinating care to address clinical and non-clinical needs. Case studies demonstrate the effectiveness of coordinated efforts in medication management, patient education, and addressing social determinants of health. These examples underscore the potential for VBC to significantly improve patient outcomes in kidney care while addressing health care inequities and reducing overall costs. Findings emphasize the importance of early interventions, interdisciplinary teamwork, and targeted support for patients with CKD in achieving VBC outcomes.