Renal Caregivers - KDOQI EDUCATION (Survey)

KDOQI EDUCATION PUTTING GUIDELINES INTO PRACTICE Participate in our survey Dear Friend, The National Kidney Foundation's (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI™) is recognized throughout the world for providing evidence-based clinical practice guidelines and transforming the care of patients with kidney disease. KDOQI expanded its scope of work in 2009. In addition to guideline development and commentaries, KDOQI also supports targeted research, advocates public policy positions consistent with KDOQI guideline recommendations and develops implementation and education tools for KDOQI guidelines. In order to help better define future roles for KDOQI education, we would like to hear from you about our programs and how we can improve our resources. Please take a moment to complete our survey. Click here. Your thoughts will be a great asset to NKF and KDOQI. Warm Regards, Michael Choi, MD Vice Chair of KDOQI Education Michael Rocco, MD KDOQI Chair WWW.KDOQI.ORG

25 Facts About Organ Donation and Transplantation. NKF.

The success rates of transplant surgery have improved remarkably, but growing shortages exist in the supply of organs and tissues available for transplantation. Many Americans who need transplants cannot get them because of these shortages. The result: some of these people die while waiting for that "Gift of Life."
Each year, the National Kidney Foundation develops special public education programs aimed at increasing public awareness of the need for organ and tissue donation. Learning more about organ and tissue donation will help every American to make an informed decision about this important issue. Here are some facts everyone should know:

1. 104,748 U.S. patients are currently waiting for an organ transplant; more than 4,000 new patients are added to the waiting list each month.
2. Every day, 18 people die while waiting for a transplant of a vital organ, such as a heart, liver, kidney, pancreas, lung or bone marrow.
3. Because of the lack of available donors in this country, 4,573 kidney patients, 1,506 liver patients, 371 heart patients and 234 lung patients died in 2008 while waiting for life-saving organ transplants.
4. Nearly 10 percent of the patients currently waiting for heart transplants are young people under 18 years of age.
5. Acceptable organ donors can range in age from newborn to 65 years or more. People who are 65 years of age or older may be acceptable donors, particularly of corneas, skin, bone and for total body donation.
6. An estimated 12,000 people who die each year meet the criteria for organ donation, but less than half of that number become actual organ donors.
7. Donor organs are matched to waiting recipients by a national computer registry, called the National Organ Procurement and Transplantation Network (OPTN). This computer registry is operated by an organization known as the United Network for Organ Sharing (UNOS), which is located in Richmond, Virginia.
8. Currently there are 58 organ procurement organizations (OPOs) across the country, which provide organ procurement services to 250 transplant centers.
9. All hospitals are required by law to have a "Required Referral" system in place. Under this system, the hospital must notify the local Organ Procurement Organization (OPO) of all patient deaths. If the OPO determines that organ and/or tissue donation is appropriate in a particular case, they will have a representative contact the deceased patient’s family to offer them the option of donating their loved one’s organs and tissues.
10. By signing a Uniform Donor Card, an individual indicates his or her wish to be a donor. However, at the time of death, the person's next-of-kin will still be asked to sign a consent form for donation. It is important for people who wish to be organ and tissue donors to tell their family about this decision so that their wishes will be honored at the time of death.
11. All costs related to the donation of organs and tissues are paid for by the donor program. A family who receives a bill by mistake should contact the hospital or procurement agency immediately.
12. Tissue donation can enhance the lives of more than 50 people. Donated heart valves, bone, skin, corneas and connective tissues can be used in vital medical procedures such as heart valve replacements, limb reconstruction following tumor surgery, hip and knee joint reconstruction and in correcting curvature of the spine.
13. In 2008, a total of 14,208 organ donors were recovered in the U.S. Of these, 7,990 were cadaveric donors, which represented a decrease over the total of 8,019 in 2006. Living donors decreased from 6,732 in 2006 to 6,218 in 2008.
14. Donor organs and tissues are removed surgically, and the donor’s body is closed, as in any surgery. There are no outward signs of organ donation and open casket funerals are still possible.
15. Acceptable organ donors are those who are "brain dead" (whose brain function has ceased permanently) but whose heart and lungs continue to function with the use of ventilators. Brain dead is a legal definition of death.
16. Organ transplant recipients are selected on the basis of medical urgency, as well as compatibility of body size and blood chemistries, and not race, sex or creed.
17. Advances in surgical technique and organ preservation and the development of more effective drugs to prevent rejection have improved the success rates of all types of organ and tissue transplants.
18. About 94.4 percent of the kidneys transplanted from cadavers (persons who died recently) are still functioning well at one year after surgery.
19. The results are even better for kidneys transplanted from living donors. One year after surgery, 97.96 percent of these kidneys were still functioning well.
20. Following are one-year patient and organ graft survival rates:

Organ		Patient Survival Rate		Graft Survival Rate
Kidney (cadaveric) Kidney (live donor) Liver		94.4% 97.9% 90.1%		89.0% 95.1% 82.0%

21. Following is a comparison of the numbers of organ transplants done in 2008 and the numbers of individuals who are on the national waiting list as of November 2009.

Organ		Number of Transplants in 2008		Number of Patients on Waiting List* (of November 2009)
Kidney Kidney/Pancreas Pancreas Liver Heart Heart/lung Lung Intestine Total:		16,520 837 436 6,319 2,163 27 1,478 185 27,965		82,364 2,220 1,488 15,915 2,884 83 1,863 229 107,046

22. Of the 13,156 single kidney transplants performed in 2008, 5,968 were from living donors and the rest were from cadaveric donors. In addition, 837 kidneys were transplanted in combination with pancreas transplants.
23. Over 2,500 bone marrow transplants were performed in the U.S. in 2004. Marrow is collected from a pelvic bone using a special needle while the volunteer donor is under anesthesia. The majority of bone marrow transplants are done for leukemia.
24. In the United States fewer than 2.5% of patients with end-stage kidney disease undergo transplantation as their first treatment or therapy. The National Kidney Foundation is dedicated to educating kidney patients about the benefits of pre-emptive transplantation - when a person is able to go straight to transplant without dialysis they usually have good health outcomes.
25. 2008 was the first time in 20 years that there was a decline in the number of deceased donors used for transplants. Living donors in 2008 were at their lowest numbers since 2001.
26. Virtually all religious denominations approve of organ and tissue donation as representing the highest humanitarian ideals and the ultimate charitable act.

Shad Ireland Ever Inspiring

I have seen this presentation before and wanted to share it as this man is so motivating!

Spouses of Dialysis Patients Have Reduced Kidney Function

Spouses of Dialysis Patients Have Reduced Kidney Function

Married couples share a bed, a life, children, but chronic illness? A new study, reported in the May issue of American Journal of Kidney Diseases, suggests that a shared home environment and health habits can contribute to the development of chronic kidney disease (CKD) in the spouses of dialysis patients.

“We were surprised to find that the risk of developing chronic kidney disease for spouses of hemodialysis patients is just about as high as it is for blood relatives of these patients,” said study author Dr. Hung-Chun Chen of the Division of Nephrology at Kaohsiung Medical University Hospital in Taiwan.

To see how environmental factors might contribute to the development of CKD, researchers examined prevalence of chronic kidney disease in 95 spouses and 196 first- and second-degree relatives of 178 hemodialysis patients, who had been undergoing dialysis for between three months and 21 years.

The prevalence of CKD was found to be significantly higher in spouses and relatives of hemodialysis patients, than in a matched control group who were not related or married to patients. Both types of relatives were found to have a noticeably lower estimated glomerular filtration rate (eGFR), a measure of kidney function, and a high rate of albuminuria, or protein in the urine, an early sign of kidney disease.

The spouses had higher rates of habitual smoking, use of herbal medicines and analgesics and high blood pressure than their control group. Additionally, diabetes, which can be caused by obesity and poor health habits, was found to be a significant risk factor for CKD in spouses of dialysis patients.

“In light of these findings, it is critically important that spouses of dialysis patients receive careful screening for chronic kidney disease, in addition to first degree relatives,” said Dr. Kerry Willis, Senior Vice President for Scientific Activities, National Kidney Foundation. “Education about the role of environmental factors and health habits in increasing the risk of developing CKD is essential, as well.”

The National Kidney Foundation offers free screenings to those at risk of chronic kidney disease—anyone with high blood pressure, diabetes or a family history of chronic kidney disease, through its Kidney Early Evaluation Program.

'JumpStart' uses retired Rochester officer's story to highlight kidney disease

(CARLOS ORTIZ staff photographer)

Jon Hand • Staff writer • April 29, 2010  JHAND@DemocratandChronicle.com

The current story line of the comic strip JumpStart has been pulled from the real-life health problems of retired Rochester police Officer Greg Raggi, a dialysis patient who has been in line for a life-saving kidney transplant for 3 ½ years.
Artist Robb Armstrong's strip, which is printed daily in the Democrat and Chronicle, features the lives of a fictional police officer, Joe, and his wife, Marcy, a nurse.
Since April 12, the strip has focused on Joe's "cop lifestyle" of eating fast fatty foods, working long hours and dealing with high stress. In the past few days, Joe and Marcy have discussed how that lifestyle can lead to diabetes and renal failure. In a subplot of the comic, Joe's partner, Crunchy, has left the fictional world of JumpStart to give his brother, Stanley (also a police officer), a kidney because Stanley has diabetes.
Armstrong said he developed the story line after a phone call from Mike Mazzeo, a friend and longtime partner of Raggi's in the narcotics unit of the Rochester Police Department.
Mazzeo, who is also the president of the Locust Club, the city police officer's union, first met Armstrong last year during a dust-up over a strip by Armstrong depicting a police shooting. The strip ran about the same time two city officers were shot and some in the community criticized Armstrong and the newspaper for being insensitive.
Mazzeo disagreed and publicly came to Armstrong's defense.
A bond was formed and the next time Mazzeo talked to Armstrong, he was asking him to help his friend, Raggi, and bring awareness to a problem many officers are concerned about.
"It's something that has affected many of us," said Mazzeo, who spent many hours taking his own father to dialysis treatments.
At least one other retired Rochester officer, Stan Prewasnick, is on dialysis and a third, Lt. Lou Genovese, died this past year after spending a year on dialysis, Mazzeo said.
Armstrong said he loved the idea right away.
"I have people walking up to me all the time saying, 'This is so funny, you have to write about it in JumpStart,'" Armstrong said from his home in Pasadena, Calif. "Mike came up to me and told me about something that wasn't funny but was so important. I said: 'Wow, this isn't just good for JumpStart, this is perfect.'"
Dr. Carlos Marroquin, a transplant surgeon from Strong Memorial Hospital, said no studies have been done to calculate whether police officers have a higher incidence of renal failure compared to other professions. But it's clear, Marroquin said, poor diet and stress can be a harmful combination.
"Clearly it is an issue, given the lifestyle, the stress, the dietary habits of a police officer," said Marroquin, who, at Mazzeo's invitation, spoke to union members in March to discuss kidney health and the safety of becoming "live donors." Donna Dixon, education director for the local chapter of the National Kidney Foundation, also spoke to the officers.
For his part, Raggi acknowledges that many of his old habits as an officer likely "caught up with him."
"I'm sure, eating the way I did, sleeping the way I did, middle shifts, night shifts, waking up early for court, it all took a toll on me," he said. "I'm not complaining. I loved it. But I wish I'd known better."
He retired in 1993 after 20 years in the department, and was diagnosed with Type 2 diabetes in 1995. The symptoms became more prevalent following a heart attack in 2004 and he went on the donor list in 2006.
He began peritoneal dialysis about 18 months ago, which requires Raggi to attach a tube leading from a suitcase-sized machine to a permanent tube in his abdomen each night for about nine hours while he sleeps. The process takes the place of the natural function of Raggi's kidneys, to filter toxins from his blood.
"I feel OK. I have good days and bad days; my doctor tells me to hang in there," said Raggi.
Doctors told him to expect it to take four to five years to find a donor kidney from the date he was placed on the list.
That surgery would change his life, he said. He's been looking forward to one thing, in particular.
"We never travel anymore because of the dialysis," he said. "I'd like to take a trip with my wife."
JHAND@DemocratandChronicle.com 
http://www.democratandchronicle.com/article/20100429/NEWS01/4290339/1003/-JumpStart--uses-retired-Rochester-officer-s-story-to-highlight-kidney-disease

Nasal mupirocin prevents Staphylococcus aureus

If you are a Peritoneal Dialysis patient or a PD Nurse you may want to mention this study in your clinic and ask for the opinion of the professionals in the office. 
J Am Soc Nephrol. 1996 Nov;7(11):2403-8.

Nasal mupirocin prevents Staphylococcus aureus exit-site infection during peritoneal dialysis. Mupirocin Study Group.

[No authors listed]

Abstract

A total of 1144 patients receiving continuous ambulatory peritoneal dialysis in nine European centers was screened for nasal carriage of Staphylococcus aureus. Two hundred sixty-seven subjects were defined as carriers of S. aureus by having had at least two positive swab results from samples taken on separate occasions, and were randomly allocated to treatment or control groups. Members of each group used a nasal ointment twice daily for 5 consecutive days every 4 wk. The treatment group used calcium mupirocin 2% (Bactroban nasal; SmithKline Beecham, Welwyn Garden City, United Kingdom) and the control group used placebo ointment. Patients were followed-up for a maximum period of 18 months. There were 134 individuals in the mupirocin group, and 133 individuals acted as control subjects. There were no differences in demographic data, cause of renal failure, type of catheter, system used, or method of exit-site care between the groups. Similarly, there were no differences in patient outcome or incidence of adverse events between both groups. Nasal carriage fell to 10% in those subjects who received active treatment and 48% in those who used the placebo ointment. There were 55 exit-site infections in 1236 patient-months in the control group and 33 in 1390 patient-months in the treatment group (not significant). S. aureus caused 14 episodes of exit-site infection in the mupirocin group and 44 in the control group (P = 0.006, mixed effects Poisson regression model). There were no differences in the rate of tunnel infection or peritonitis. There was no evidence of a progressive increase in resistance to mupirocin with time. Regular use of nasal mupirocin in continuous ambulatory peritoneal dialysis patients who are nasal carriers of S. aureus significantly reduces the rate of exit-site infections that occurs because of this organism.

PMID: 8959632 [PubMed - indexed for MEDLINE]

The PD Option

When a person reaches the point where they have been categorized as ESRD(End Stage Renal Disease) and it has been determined that they must start Dialysis treatment to stay alive there are two treatment options. One is Hemodialysis(HD) usually where the Patient has a scheduled treatment time at an outpatient treatment center three times a week for most commonly 3 to 4 hours each treatment.


The other option is Peritoneal Dialysis(PD). In this treatment the blood stream is not accessed directly. A special tube(PD Catheter) is surgically placed in the Abdomen and via this tube Dialysate solutions are exchanged in and out of the Peritoneal Cavity. The Peritoneum is a membrane that encompasses our internal organs and this membrane is the natural filter that makes PD possible.


These treatments are done at home. The person does the treatment by themselves or with the assistance of a partner. Treatments can be preformed in two ways, Manual exchanges of Dialysis solution 4 to 5 times a day or automated with a PD Cycler mechanically doing the exchanges for you usually while you sleep.


With the Hemodialysis Option you have to comply to the outpatient treatment center schedule, there are more dietary restrictions and there can be more drastic physical reactions to the treatment such as extremes in blood pressures,nausea,electrolyte imbalances.
With Peritoneal Dialysis your treatment can be worked around your own schedule,you can travel more easily with PD. I think the single most important advantage to the PD option is that you are always being dialyzed like your kidneys it is a natural process occurring inside you.
One disadvantage is that in most cases patients are usually on PD for only a few to several years and then if not transplanted they have to move to Hemodialysis. This is usually because after some time the Peritoneum lessens in its ability to adequately preform the dialysis commonly because of infection(Peritonitis.


As a Nurse working in both PD & HD for 5 years, personally if I had to made the choice I would opt for the more natural treatment PD at first if I could. There are many more specifics to these options but I feel like I have covered the basics for now. Thanks, Joe Macomber RN