Cover
List of Contributors
Foreword
Preface
CHAPTER 1: The History of Dialysis and Transplantation
1. Introduction
2. Haemodialysis
3. Peritoneal Dialysis
4. Transplantation
5. Conclusion
6. References
CHAPTER 2: Applied Anatomy and Physiology and the Renal Disease Process
1. Introduction
2. Structure and Functions of the Kidney
3. Basic Renal Processes
4. Conditions Causing Chronic and Advanced Kidney Disease
5. References
6. Resources
CHAPTER 3: Patient and Carer Involvement in Renal Nursing Care, Education, and Research
1. Introduction
2. Patient Involvement in Care
3. Patient‐Reported Experience Measures
4. Reflection
5. Patient Involvement Using Social Media: The Renal Patient Support Group, Facebook, Twitter, BlogSpot, and Instagram
6. The Renal Patient Support Group on Facebook
7. Patient and Carer Involvement in Renal Nursing Education
8. Patient and Carer Involvement in Renal Research
9. Kidney Patient Involvement Network
10. INVOLVE
11. Measuring the Impact of Patient and Public Involvement
12. Conclusion
13. References
14. Resources
CHAPTER 4: Psychological Perspectives
1. Introduction
2. Psychonephrology
3. Chronic Kidney Disease
4. Patient Choice
5. Depression
6. Sexuality
7. Patient Education
8. Self‐Care
9. Conservative Kidney Management (Nondialytic Options)
10. Transplantation
11. Conclusion
12. References
CHAPTER 5: Acute Kidney Injury
1. Introduction
2. Identifying The Cause(s) of Acute Kidney Injury
3. Management of Acute Kidney Injury
4. The Clinical Course of Acute Kidney Injury
5. Renal Replacement Therapy (RRT) in Acute Kidney Injury
6. Conclusion
7. References
8. Further Reading
9. Useful Web Sites
CHAPTER 6: Chronic Kidney Disease
1. Introduction
2. Chronic Kidney Disease
3. Innovation in Managing Mild to Moderate Kidney Disease in Primary Care
4. Care and Management of Mild to Moderate Kidney Disease (Stages 3a–3b)
5. Diabetes Mellitus
6. Care and Management of Moderate to Severely Decreased Kidney Function (Stage 4)
7. Education in the Predialysis Phase
8. When Should Dialysis Commence?
9. Conclusion
10. References
11. Resources
CHAPTER 7: Investigations in Kidney Disease
1. Introduction
2. Phlebotomy
3. Biochemical Blood Tests
4. Kidney Function Tests
5. Kidney Biopsy
6. Radiographic Investigations
7. Conclusion
8. References
CHAPTER 8: Haemodialysis
1. Introduction
2. What Is Haemodialysis?
3. How Does Haemodialysis Work?
4. Mortality and Haemodialysis
5. Haemodialysis Prescription
6. Anticoagulation
7. Vascular Access for Haemodialysis
8. Assessment and Monitoring During Haemodialysis
9. Less Common Complications of Haemodialysis
10. Patient's Perspective of Haemodialysis
11. Conclusion
12. References
CHAPTER 9: Peritoneal Dialysis
1. Introduction
2. Physiology of Peritoneal Dialysis
3. Peritoneal Dialysis Access and Exit Site Care
4. Peritoneal Dialysis Therapy Options
5. Patient Selection
6. Peritoneal Dialysis for Those with Diabetes
7. Solution Formulation
8. Assessing Peritoneal Dialysis Adequacy
9. Longitudinal Changes to the Peritoneal Membrane
10. Fluid Management in Peritoneal Dialysis
11. Problem Solving in Peritoneal Dialysis
12. Infectious Complications of Peritoneal Dialysis
13. Education and Training for Those on Peritoneal Dialysis
14. Conclusion
15. References
16. Additional Resources
CHAPTER 10: Renal Transplantation
1. Introduction
2. Contraindications to Renal Transplantation
3. Evaluation for Transplantation
4. Pretransplantation Preparation
5. Specific Pretransplant Anxieties and Fears
6. Transplant Waiting List
7. Donor and Recipient Matching
8. Deceased Donation
9. Living Relation Donation
10. Increasing Donor Organ Supply
11. Preoperative Management for a Recipient of a Renal Transplant
12. Surgical Technique for Renal Transplantation
13. 10.13 Immunosuppression
14. Renal Transplant Rejection
15. Postoperative Care and Complications for the Recipient of a Renal Transplant
16. Discharge of the Recipient from Hospital and Continuing Care
17. Pancreas‐Kidney Transplantation
18. Conclusion
19. References
CHAPTER 11: Nondialytic Options and the Role of Palliative Care
1. Introduction
2. Numbers of Patients
3. The Importance of Nondialytic (Conservative) Care
4. The Palliative Approach
5. Recent Government and Other Initiatives
6. Communication, Decision‐Making, and Planning
7. Care of Patients Managed Without Dialysis
8. Symptoms Towards the End of Life
9. Psychological and Social Issues
10. Spiritual Care
11. Conclusion
12. References
CHAPTER 12: Renal Care in Infancy, Childhood, and Early Adulthood
1. Introduction
2. Physiology in Childhood – Impact on Renal Care
3. Chronic Kidney Disease
4. Conservative management
5. Nephrotic Syndrome
6. Renal Replacement Therapy
7. Dialysis
8. Acute Kidney Injury
9. Haemolytic Uraemic Syndrome
10. Transition to Adult Services
11. Conclusion
12. References
CHAPTER 13: Renal Nutrition
1. Introduction
2. Historical Review of Dietary Management
3. Current Concepts of Predialysis Dietary Intervention
4. Hypertension
5. Cardiovascular Risk and Hyperlipidaemia
6. Interventions in Patients with Diabetes
7. Calcium, Phosphate, and Vitamin D Metabolism
8. Hyperkalaemia
9. Anaemia
10. Acidosis
11. Malnutrition
12. Nephrotic Syndrome
13. Dietary Management: Dialysis
14. Malnutrition
15. Techniques to Assess Body Composition
16. Transplantation
17. Dietary Management in Paediatrics
18. Conclusion
19. References
20. 13.A: Calculation of Body Mass Index and Ideal Body Weight
21. 13.B: Seven‐Point Subjective Global Assessment
22. 13.C: Foods with a High and Low Sodium (Salt) Content
23. 13.D: Foods with High and Low Phosphorus Content
24. 13.E: Foods with High, Medium, and Lower Potassium Content
CHAPTER 14: Quality Improvement in Kidney Care
1. Introduction
2. Quality Improvement
3. Patient Safety
4. Best Practice Guidelines from International and National Renal Associations
5. Other Guidelines
6. Evaluation of Guidelines
7. Audit
8. Quality and Service Improvement Methods
9. Conclusion
10. References
Index
End User License Agreement

List of Tables

Chapter 2
1. Table 2.1 Normal fluid inputs and outputs.
Chapter 3
1. Table 3.1 Membership of the Renal Patient Support Group (RPSG) January–March 201...
Chapter 4
1. Table 4.1 Male and female physical and psychosocial sexual concerns living with ...
Chapter 5
1. Table 5.1 Acute kidney injury (AKI): major causes and aetiology (Rennke and Denk...
2. Table 5.2 Effects of therapeutic agents on the kidney.
3. Table 5.3 RIFLE classification of AKI.
4. Table 5.4 AKIN classification of AKI.
5. Table 5.5 KDIGO classification of AKI.
6. Table 5.6 Types of urine output.
Chapter 6
1. Table 6.1 Classification of CKD using GFR and ACR categories (NICE 2014).
Chapter 7
1. Table 7.1 Analysis of a normal blood sample.
2. Table 7.2 Normal values – haematological tests.
3. Table 7.3 Normal volumes of urine.
Chapter 9
1. Table 9.1 Classification of membrane type.
2. Table 9.2 Patients who are most suited to continuous ambulatory peritoneal dialy...
3. Table 9.3 Patients who could be unsuitable for continuous ambulatory peritoneal ...
4. Table 9.4 Comparison of dialysis fluid containing ionised calcium (a) with origi...
5. Table 9.5 The electrolyte formulation of intraperitoneal amino acid (IPAA) solut...
Chapter 10
1. Table 10.1 The ABO blood group system.
2. Table 10.2 Actual deceased organ donors across Europe in 2016.
Chapter 12
1. Table 12.1 Biochemistry reference ranges for children.
2. Table 12.2 Common causes of ERD in children.
Chapter 13
1. Table 13.1 Suggested protein and energy requirements versus degree of renal func...
2. Table 13.2 Management of nephrotic syndrome (NS).
3. Table 13.3 Dietary recommendations for patients on renal replacement therapy (RR...
4. Table 13.4 Suggested daily dosage of vitamins for patients with ERF (EBPG and UK...
Chapter 14
1. Table 14.1 The patient safety conversation.
2. Table 14.2 Renal‐specific NICE guidance (since 2010).
3. Table 14.3 Renal Association clinical practice guidelines.

List of Illustrations

Chapter 1
1. Figure 1.1 Artificial kidney machine (Kolff–Brigham), France, 1955.
2. Figure 1.2 Patient and nurse with dialysis machine and Kiil dialyser, 1968....
3. Figure 1.3 Renal replacement therapy modality in the UK at 31/12/16.The ...
Chapter 2
1. Figure 2.1 Structure of the kidney.
2. Figure 2.2 Relative position of the kidneys in the body.
3. Figure 2.3 The parts of a nephron, collecting duct, and associated blood ves...
4. Figure 2.4 The position of the nephrons in the kidney.
5. Figure 2.5 Structure of the glomerulus and Bowman's capsule.
6. Figure 2.6 The formation of filtrate in the glomerulus.
7. Figure 2.7 Histological features of the renal tubule and collecting duct....
8. Figure 2.8 Negative‐feedback loop for antidiuretic hormone (ADH) release and...
9. Figure 2.9 The renin–angiotensin–aldosterone pathway.
10. Figure 2.10 The actions of sunlight, vitamin D and parathyroid hormone (PTH)...
11. Figure 2.11 Negative‐feedback loop for parathyroid hormone (PTH) release and...
12. Figure 2.12 Bicarbonate reabsorption in the kidney tubules.
13. Figure 2.13 Conventional angiogram showing a normal right renal artery. Cont...
14. Figure 2.14 Computed tomography scan showing left renal artery stenosis. The...
15. Figure 2.15 Digital subtraction angiogram of the same patient shown in Figur...
16. Figure 2.16 Causes of the nephrotic syndrome.
17. Figure 2.17 Oedema formation in the nephrotic syndrome.
18. Figure 2.18 Ultrasound of a normal right kidney.
19. Figure 2.19 Ultrasound of a polycystic kidney showing how the normal tissue ...
20. Figure 2.20 Computed tomography scan showing a polycystic left kidney; the c...
Chapter 5
1. Figure 5.1 AKI – selected symptoms (O'Callaghan et al. 2004).
2. Figure 5.2 Prerenal failure progression (Steddon et al. 2014).
3. Figure 5.3 Continuous venovenous haemofiltration (HF).
4. Figure 5.4 Continuous venovenous haemodiafiltration (HDF).
5. Figure 5.5 Continuous haemodialysis (HD).
6. Figure 5.6 Plasma exchange.
Chapter 7
1. Figure 7.1 Veins of the arm.
Chapter 8
1. Figure 8.1 Image of a dialyser.
2. Figure 8.2 How the dialyser works.
3. Figure 8.3 Image of an extracorporeal circuit and haemodialysis machine.
4. Figure 8.4 Diffusion.
5. Figure 8.5 Diagram of convection.
6. Figure 8.6 Creation of ultrafiltration (UF) in the dialysate circuit.
7. Figure 8.7 Peak and trough effect of haemodialysis.
8. Figure 8.8 Composition of the dialysate fluid.
9. Figure 8.9 Dialysate use in haemodiafiltration (HDF).
10. Figure 8.10 Indicators that dry weight requires adjustment.
11. Figure 8.11 Fluid distribution in the body.
12. Figure 8.12 Refilling during haemodialysis.
13. Figure 8.13 What happens when the refilling rate is lower than the ultrafilt...
14. Figure 8.14 Unfractionated heparin v. LMWH.
15. Figure 8.15 Arteriovenous fistula.
16. Figure 8.16 Arteriovenous graft.
17. Figure 8.17 Complications of the three vascular access types.
18. Figure 8.18 ACCESS for assessment and surveillance of AVF/AVG.
19. Figure 8.19 Multi‐faceted approach to promote AVF/AVG use.
20. Figure 8.20 Cannulation techniques, as described by Kronung (1984).
21. Figure 8.21 Buttonhole site.
22. Figure 8.22 Site rotation in rope ladder.
23. Figure 8.23 The rare complications of haemodialysis.
Chapter 9
1. Figure 9.1 Location of the peritoneal cavity.
2. Figure 9.2 (a) The three layers of the peritoneal membrane. (b) Diagrammatic...
3. Figure 9.3 Osmotic ultrafiltration across the peritoneal membrane with a glu...
4. Figure 9.4 The peritoneum acts as a semipermeable membrane, allowing small s...
5. Figure 9.5 Functional parts of the peritoneal catheter.
6. Figure 9.6 Straight Tenckhoff catheter.
7. Figure 9.7 Curled Tenckhoff catheter.
8. Figure 9.8 Swan‐neck catheter.
9. Figure 9.9 Toronto Western catheter.
10. Figure 9.10 The position of a peritoneal dialysis catheter in the abdomen.
11. Figure 9.11 Continuous ambulatory peritoneal dialysis (CAPD).
12. Figure 9.12 Continuous cycling peritoneal dialysis (CCPD).
13. Figure 9.13 Tidal peritoneal dialysis (TPD).
14. Figure 9.14 Optimised cycling peritoneal dialysis (OCPD).
15. Figure 9.15 Baxter Healthcare Ltd. HomeChoice Pro automated peritoneal dialy...
16. Figure 9.16 Kt/V worksheet.
17. Figure 9.17 Initial clinical and laboratory assessment of a patient for peri...
Chapter 10
1. Figure 10.1 Deceased donor kidney programme in the United Kingdom, 1 April 2...
2. Figure 10.2 Influence of human leukocyte antigen (HLA) matching on renal all...
3. Figure 10.3 Perfusion catheters in situ for deceased donor nephrectomy.
4. Figure 10.4 Number of deceased and living donors in UK, 1 April 2007–31 Marc...
5. Figure 10.5 An example of tissue‐type inheritance.
6. Figure 10.6 Position of the transplanted kidney.
7. Figure 10.7 The surgical technique for renal transplantation.
8. Figure 10.8 Histopathology of hyperacute rejection.
9. Figure 10.9 Histopathology of acute rejection.
10. Figure 10.10 Deceased pancreas and islet programme in the United Kingdom, 1 ...
Chapter 13
1. Figure 13.1 Flow chart for dietary treatment of chronic kidney disease (CKD)...
Chapter 14
1. Figure 14.1 The model for improvement.

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Edition History [4e, 2014]

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Library of Congress Cataloging‐in‐Publication Data

Names: Thomas, Nicola, editor.
Title: Renal nursing : care and management of people with kidney disease / edited by Nicola Thomas.
Description: Fifth edition. | Hoboken, NJ : Wiley‐Blackwell, 2019. | Includes bibliographical references and index. |
Identifiers: LCCN 2018060334 (print) | LCCN 2018061627 (ebook) | ISBN 9781119413165 (Adobe PDF) | ISBN 9781119413158 (ePub) | ISBN 9781119413141 (pbk.)
Subjects: | MESH: Kidney Diseases–nursing | Nephrology Nursing
Classification: LCC RC918.R4 (ebook) | LCC RC918.R4 (print) | NLM WY 164 | DDC 616.6/140231–dc23
LC record available at https://lccn.loc.gov/2018060334

Cover Design: Wiley
Cover Image: © ALFRED PASIEKA/SCIENCE PHOTO LIBRARY/Getty Images

Foreword

Kidney disease is common, harmful, often treatable and preventable. Although much progress has been made in identifying chronic kidney disease earlier and delaying the need for dialysis and transplantation, the number of people affected by kidney disease continues to grow each year. Chronic Kidney Disease is a global health burden and has become a major public health issue.

Over 2 million people worldwide currently receive treatment with dialysis or a kidney transplant to stay alive, yet this number may only represent 10% of people who actually need the treatment to live. Acute Kidney Injury accounts for 8–16% of hospital admissions, with >1% of health service expenditure being attributed to AKI in the UK. The International Society of Nephrology has an ambitious aim to prevent all avoidable death from AKI worldwide by 2025. Nurses play a key role in the early recognition and treatment of AKI and renal nurses are no exception and have a crucial role in adding quality to care.

People with Chronic Kidney Disease have a wide range of physical and emotional needs. These include encouragement to achieve behavioural change goals they have set themselves, support with decision making, education about their condition, traditional basic care needs individually delivered with compassion and an understanding of the complexity of kidney disease along with other co‐morbidities. The skills and competencies required to address these needs are the foundation of high‐quality care delivered by both registered and non‐registered nurses. Caring for people with kidney disease is a ‘hands‐on’ job requiring an understanding of psychology – the person, the carers and the families and your own; knowledge of the biology and pathophysiology of the kidney; expertise in the nursing of the acutely unwell and the management of complex long‐term conditions; as well as emotional resilience.

Renal nurses recognise the patients they care for have a common disease, but each individual’s experience is unique, requiring support and encouragement appropriate to his/her age, cultural background and degree of health literacy. As such, nurses specialising in kidney care are pivotal to the multi‐professional team. Not only do they bring their understanding of kidney disease and experience of managing others in a similar situation, they are also the advocate for holistic care, and act as a catalyst for shared decision‐making. To achieve such high standard of care the appropriate education and training is needed to develop this vast knowledge base and practical skills.

Nurses’ access specialist knowledge in a variety of formats be it e‐learning, text books such as this or even social media. Since the dissolution of national renal courses there is a lack of educational standardisation for renal nursing, something which the newly formed Association of Renal Nurses UK (ANN‐UK) is keen to address. By bringing the renal nursing community together under one national organisation we have the opportunity to create an educational framework for all nurses working in kidney care. The future will include access to a national curriculum via e‐learning.

As part of the educational framework, this 5^th edition of Renal Nursing will provide you with the information you need to understand the fundamentals of kidney care. Use this textbook in conjunction with gaining practical hands‐on experience in dialysis units, inpatient wards, outpatient settings and home therapies and you will have the knowledge and skills to make a vast difference to many people with kidney disease.

Karen Jenkins
President of the Association of Nephrology Nurses, UK

Preface

I have very much enjoyed editing the fifth edition of this successful book for nurses and allied health care professionals working in nephrology, dialysis and transplantation, along with colleagues who are all experts. The past five years have again seen tremendous changes in renal care in the UK, particularly in the area of patient and public involvement. The Kidney Patient Involvement Network (KPIN), launched in 2018, is a network of kidney organisations, charities and individuals committed to quality patient, public involvement and engagement (PPIE), who are willing to work collaboratively on initiatives to improve standards in PPIE and develop patient leaders of the future. It is so important that people with experience of kidney disease contribute to renal nursing education, both in the classroom and also in writing. Chapter Three of this textbook was very warmly received last time as it is provided a patient and carer perspective on care, and encouraged us to think in the ‘patient’s shoes’.

This book is mostly for those who are new to the renal specialty. Nurses who are studying on preregistration courses and practitioners who are commencing a post‐registration course in renal nursing will find it particularly helpful. It also serves as a good foundation for nurses who wish to refresh their knowledge in a part of the renal field in which they are currently not practising, or for other members of the multi‐professional team who are commencing a career in nephrology. This new edition is again written in a style that promotes kidney care for what it is: a dynamic, varied and rewarding specialty.

Each chapter has been written by an expert in his or her field. Recognition must go to those authors who wrote chapters for the previous edition but were unable to contribute to this edition. They are Annette Davies, Paul Challinor, Claire Main and Fliss Murtagh.

Renal nurses in the 21st century face a constant challenge to keep abreast of developments in care and management. What does not change is the constant physical and psychosocial challenges that patients and their families have to face. This must always be in our minds. In my thirty‐five years of practice as a renal nurse the repeated request from patients is that we should emphasise what can be done rather than what cannot. The word ‘restriction’ should not be part of a renal nurse’s vocabulary: why not fluid or dietary allowance? As in the fourth edition, I have endeavoured to use a language in this book which puts patients at the centre of care.

I am delighted that the Association of Nephrology Nurses, UK (ANN‐UK), launched in 2018, might reintroduce a framework for renal nursing education in the near future. I hope that this latest edition will complement that vision and will continue to encourage renal nurses to care for their patients with compassion, sensitivity and understanding.

Professor Nicola Thomas
Professor of Kidney Care, London South Bank University, London, UK

Care and Management of People with Kidney Disease