HAEMODIALYSIS NURSING

6KNIN627
Level: 6
Credits: 15

Module leader: Roseline Elsie Agyekum

Tel: 020 7848 3538/020 3299 1564
Email: roseline.1.agyekum@kcl.ac.uk

Module deputy: Mary Malone

Tel: 020 7848 3014
Email: mary.malone@kcl.ac.uk

Academic support:
The Course Leader is the primary lecturer & provides academic support through both lectures and
tutorial support. She may also be approached for guidance at any time throughout the course.
Practice Development Nurses and clinical experts from practice undertake some of the lecturing in
specialist subject areas.

This handbook must be read in conjunction with module information provided on KEATS, the
King’s E-Learning And Teaching Service. You will be given access to KEATS on enrolment.
Important information relating to assessment and related regulations can be found in the
Postgraduate Programme Handbook, available on KEATS and via the Student Services Centre.

This handbook can also be provided in alternative formats (such as large print) upon
request to asc@kcl.ac.uk.

1
Contents
Module overview ............................................................................................................ 4
Module aims ............................................................................................................... 4
Learning outcomes ..................................................................................................... 4
Teaching arrangements .............................................................................................. 4
Submitting coursework/exam information................................................................ 5
The Assessment Portfolio ........................................................................................... 5
Entry 1: Formative assessment................................................................................... 5
Entry 2: Summative assessment ................................................................................ 6
Entry 3: Completed Practice Assessment Document (PAD) (Weighting: Pass/Fail) 8
Results and re-submissions for course work.............................................................. 8
Learning resources ......................................................................................................... 9
Week 1 taught sessions ................................................................................................... 9
Session 1: Introduction to the Course and e-learning, Portfolio & PAD .................... 9
Session 2: Renal Guidelines, Tariffs & Commissioning ........................................... 10
Session 3: Anaemia Management ............................................................................. 11
Session 4: Management of Diabetes in patients with CKD ....................................... 11
Session 5: Chronic Kidney Disease & Complications/ Cardiovascular disease in
CKD........................................................................................................................... 12
Week 1 Self-directed study and E-activities ................................................................. 13
E-activities 1: Renal Anatomy & Physiology............................................................. 13
E-activities 2: Cardiovascular disease ...................................................................... 13
E-activities 3: Renal Anaemia .................................................................................. 13
E-activities 4: Diabetes and CKD ............................................................................. 13
E-activities 5: Fluid & electrolytes ............................................................................ 13
E-activities 4: Fluid & electrolytes............................................................................ 14
E-activities 5: Renal Blood Tests Quiz...................................................................... 14
Week 2 Taught Sessions ................................................................................................15
Session 1: Haemodialysis machine ............................................................................15
Session 2: Haemodialysis prescriptions ....................................................................15
Session 3: Haemodialysis Assessment ..................................................................... 16
Session 3: Complications of Haemodialysis ............................................................. 16
Session 4: Dialysis Induced Hypotension .................................................................17
Week 2 Self-directed Study and e-activities................................................................. 19
E-activities 1: Principles of Haemodialysis/Haemodiafiltration Quiz ..................... 19
E-activities 2: Haemodialysis Machine Quiz ............................................................ 19
E-activities 3: Complications of Haemodialysis ....................................................... 19
Week 3 Taught Sessions ............................................................................................... 20
Session 1: Infection Control & Prevention ............................................................... 20
Session 2: Online Haemodialfiltration ..................................................................... 21
Session 3: Management of Haemodialysis Access ................................................... 21
Week 3 Self-directed Study and e-activities................................................................. 23
E-activities 1: Management of Haemodialysis Access .............................................. 23
E-activities 2: Dealing with Challenging Patients .................................................... 23
Week 4 Taught Sessions ............................................................................................... 24
Session 1: Acute Haemodialysis/1st Dialysis............................................................ 24
Session 2: Shared Care and Home Haemodialysis................................................... 24
Session 3: Haemodialysis Adequacy ........................................................................ 25
Session 4: Water Treatment ..................................................................................... 25
Week 4 Self-directed Study and E-activities ................................................................ 26
E-activities 1: Shared Care and Home Therapies ..................................................... 26
E-activities 2: Sustainable Haemodialysis ............................................................... 26
Week 5 Taught Sessions (with Nephrology) ................................................................ 27
Session 1: Psychological Implications of Kidney Disease......................................... 27
Session 3: Mineral Bone Disease .............................................................................. 28
Session 4: Nutrition Needs for Patients with Renal Diseases .................................. 28

2
 Assignment Workshop ............................................................................................. 29
Week 5 Self-directed study and E-activities ................................................................ 29
E-activities 1: Nutrition Quiz .................................................................................... 29
E-activities 2: How to Critique ................................................................................. 29
E-activities 3: Mineral Bone Disorder ...................................................................... 29
Week 5 self-directed study and e-activities.................................................................. 30
E-activities 1: Nutrition Quiz .................................................................................... 30
E-activities 2: How to Critique ................................................................................. 30
E-activities 3: Mineral Bone Disorder ...................................................................... 30
General indicative reading ........................................................................................... 31
Websites.................................................................................................................... 32
Module evaluation........................................................................................................ 33
Action from previous evaluations............................................................................. 33
Timetable...................................................................................................................... 34

3
Module overview

Module aims

This course aims to prepare practitioners working in Haemodialysis Units for their role within renal
health care. They will have the opportunity to develop and critically evaluate specialist
haemodialysis skills and knowledge in order to deliver high quality compassionate care to patients
undergoing haemodialysis treatment. There will be emphasis on the wider context of care such as
shared-decision making, social issues and the co-ordination of outside agencies.

Learning outcomes
At the end of the course students will be able to;
• Develop and critically review their own skills and competence in the holistic care of the
patient undergoing haemodialysis
• Enhance systematic assessment skills and professional experience to influence
haemodialysis patient outcomes
• Select and critically evaluate relevant research to promote evidence-based practice within
the haemodialysis setting including national and international guidelines
• Synthesise knowledge and create responses to problems that expand / redefine existing
practice to effect change within the haemodialysis setting
• Critically appraise and compare protocols and the management of care for haemodialysis
clients and families locally, nationally and internationally to achieve clinical effectiveness
• Critically evaluate and reflect on the professional role of the haemodialysis nurse within the
inter-disciplinary settings and other members of the multi-disciplinary team to gain a more
insightful perspective
• Critically discuss current resources in determining health care strategies for haemodialysis
clients

Teaching arrangements

This module incorporates a blended learning approach, with 50% taught session and 50% E-
learning. The educational approach is student centred and you will experience a wide variety of
teaching and learning strategies, including;
• Lectures and discussions E-learning activities
• Worksheets
• Directed reading and study including online reading list Case studies and discussion
• Reflective practice
• Personal and Group Tutorials Practice placements

4
Submitting coursework/exam information
Marking - All assignments are double marked, first by the module leader. A sample of the
essay is then reviewed and marked by the second marker prior to final agreement on marks.
Finally, a sample of the essay is submitted to an external examiner (Lecturer in another
University) who reviews and agrees with the marks

The Assessment Portfolio

The assessment is a portfolio made up of 3 entries aiming to assess your knowledge and
development. Your portfolio should demonstrate your achievement of the learning outcomes of
the course.

All three portfolio entries (self-directed study, essay and PAD) must be submitted
in order to pass the course.
Coursework submission/exam instructions are provided on the KEATS module page.
It is essential that you use your candidate number on all assignments/examinations. Your
candidate number will be available via Student Records on the King’s Intranet approximately
one month after you enrol.
Please note that work submitted late will constitute a fail grade. The exception to
this is if you submit Entry 2 in the window 24 hours after the submission date and
time. The maximum you can be awarded if you submit during this time is 40%.

Entry 1: Formative assessment

Pre-course workbook: Submission date: Thursday May 4 2017 by 09:00.
E-learning components: Submission date: Tuesday 8 August 2017 by
11:59m

5
 Entry 2: Summative assessment
Submission date: Tuesday 18 July 2017 by 11:59pm
Word limit: 2,500 (Weighting: 100% of the total course work). One copy of your assignment
must be submitted electronically via turnitin.

Title: Critically discuss the holistic assessment, intervention and proposed management of
ONE of the following clinical conditions

Question 1: Nursing Management of the deteriorating patient during

Haemodialysis
Felix is a 76-year-old male with chronic kidney disease secondary to type 1 diabetes who has
been transferred to you unit having had 3 HD sessions in Acute HDs. Past medical history
includes left ventricular hypertrophy and Left sided heart failure. He had Coronary Artery
Bypass Graft two years ago and currently has a pace maker in situ. His medications include
Bisoprolol prescribed for atrial flutter, Pregabalin and Amitriptyline for neuropathic pain His
HD prescription from acute are as follows:
• HD Duration- 2.5 hrs 3x weekly
• Dialyser size Polyflux 17L
• Vascular access: (LT) Brachiobasilic AVF)
• Anticoagulant: Heparin, 1.0 bolus and 1.0mL maintenance dose
• Blood flow and dialysate flow rate not stated.
On arrival for dialysis today his blood pressure is 108/68mmHg and he weighs 89 kg (dry not
stated). Previous blood results were as follows:
Poatssium-6.1, Calcium-1.70, Hb-7.8, random blood sugar 21.8, CRP 13.0

OR
Question 2: Nursing Management of a patient with challenging vascular access.
David is a 80 years old male diagnosed with CKD secondary to hypertension. He started dialysis
8 months ago, 4hr x 3 weekly, via tunnelled cuffed catheter however, he experiences poor blood
flow rate and subsequently his dialysis dose inadequate. He is malnourished and has lost 5% of
his flesh weight over the past 2 months. He routinely does not complete his dialysis sessions
early due to the frequent machine alarms and or asks to come off early. His CVC has been
revered consistently for the past two weeks. His additional dialysis prescription: Dialyser: 140H,
Anticoagulant: Clexane 40mg.
A trend review of his blood flow rate and patency record is as follows:
Date Blood flow Arterial Pressure Venus pressure Thrombolytic therapy
(Pre & Post) (Pre & Post) (Pre & Post)
04/05/17 250/230 -250/-270 250/230 -
02/05/17 200/180 -270/-270 200/150 25 000 units long dwell (30 mins)
29/04/17 220/200 -270/-270 230/180 -
27/04/17 250/230 -250/-270 250/240 -
25/04/17 200/180 -250/-270 200/250 25 000 units long dwell (30 mins)
22/04/17 240/220 -250/-250 210/250 -
20/04/17 230/250 -230/-220 250/240 25 000 units long dwell (30 mins)

6
OR
Question 3: Nursing Management of a patient with Renal Anaemia.
Sola is a 28-year-old female who has Stage 5 Chronic Kidney Disease (CKD) and she is dialysing
for 3.5 hrs x 3 weekly. She is morbidly obese, and has been treated for Catheter Related Blood
Stream Infection two weeks ago, with poor blood flows being recorded.
She is admitted to the Renal Ward for investigations into complaints of palpitations, lethargy
and occult blood stools. Her average dialysis adequacy is 61%. A blood test on admission
revealed the following results; Hb 85.0 g/dL Ferritin 180ug/L TSAT 15% % Hypochromic cells-
9%, Reticulocyte count- 70 , Total Iron Binding Capacity- 150 ug/dl, Vitamin B 12- 118 ng/l,
Folate- 6 ug/l, CRP- 15mg/dl.
She is currently on Eprex 3000IU twice weekly and Iron Sucrose 100mg fortnightly.

Essay Guidelines:
• Select any ONE of the above scenario or choose a patient within your clinical setting
with any ONE of the above clinical conditions; provide rationale for your choice
• Provide a brief explanation of underlying pathophysiology of your chosen condition
identifying actual and potential risk factors
• An overview of a holistic clinical assessment undertaken should be presented; and the
results/clinical observations should be compared with referenced norms i.e. explain
what the findings mean
• Critically discuss the psychological impact of your chosen clinical condition for patients
and their families

• Critically appraise two aspects of management and prevention of your chosen condition
in light of current research, and local, national and international guidelines (Please
select a maximum of two aspects of management and prevention for this
section)
• Make recommendations for future practice

Marking - All assignments are double marked, first by the module leader. A sample of the
essay is then reviewed and marked by the second marker prior to final agreement on marks.
Finally, a sample of the essay is submitted to an external examiner (Lecturer in another
University) who reviews and agrees with the marks.

Feedback - Feedback is provided via KEATS through the Turnitin submission portal.
Feedback is provided focusing on 3 key aspects
• The strengths of the work
• Areas in which this work could be developed
• General Comments

7
Entry 3: Completed Practice Assessment Document (PAD) (Weighting: Pass/Fail)

Submission date: Tuesday 1 August, 2017 by 11:59am.

You must submit your completed Practice Assessment Document. In order to pass you must
achieve the required standards stated within the document.

Results and re-submissions for course work

Students will receive a provisional (unratified) mark for their coursework 4 weeks following
submission. According to the method of submission as detailed on your KEATS site, if your
work was submitted online you will be able to download marked coursework from KEATS;
alternatively, if you completed a hard-copy submission you can collect your coursework and
feedback from the Student Services Centre.
To collect a hard copy assignment, you must provide your candidate number. Alternatively,
you may send a stamped addressed envelope to the Student Services Centre ensuring that this
is large enough to accommodate your assignments and that you have applied sufficient
postage. Hard copy assignments will be retained for four weeks; if you have not collected your
assignment by then, it will be destroyed.
Feedback will include the award of a numerical grade which remains provisional until ratified
by the examination boards. Ratified marks can be viewed via Student Records on the King’s
Intranet, following the relevant examination board.
If you are unsuccessful, it is recommended that you contact the module leader before
submitting your second attempt. This will enable the module lead to provide you with an
appropriate level of support as you prepare to re-submit your work.

Resubmission date: Tuesday 17 October 2017

8
Learning resources

Week 1 taught sessions

Session 1: Introduction to the Course and e-learning, Portfolio & PAD

By the end of the session students will be able to:

• Demonstrate an awareness of the Course content & assessment Explain what is expected
of them whilst on the course
• Understands the nature of the portfolio assessment
• Demonstrate an understanding of what is required for the portfolio
• Understand what is expected of them regarding their clinical competence
• Demonstrate understanding of how the competency document will improve clinical
practice
• Understand the assessment structure used within the document Access the FNSNM
website & KEATS renal site

Indicative reading
Benner P. (1983) From Novice to Expert: Excellence and Power in Clinical Nursing Practice.
Addison Wesley, Menlo-Park.
Bondy K. (1983) Criterion-Referenced Definitions for rating scales in clinical evaluation.
Journal of Nursing Education. 22(9), 376-82.
Course handbook
Post-qualification handbook
Practice Assessment Document
https://keats.kcl.ac.uk/login/index.php

9
Session 2: Renal Guidelines, Tariffs & Commissioning

By the end of the session students will be able to:

• Critically evaluate the Renal Association clinical practice guidelines and NICE guidelines
& how they influence practice
• Critically analyse the UK standards with Kidney Disease Outcomes Quality Initiative
• K/DOQI
• Have knowledge of the Renal Registry data and understand the relevance of this data
Demonstrate an understanding of renal tariffs and the implication they have on
• practice both nationally and locally
• Demonstrate an understanding of the implications of specialised commissioning
• Demonstrate an understanding of Quality, Innovation, Productivity and Prevention
(QIPP) within the Renal setting

Indicative reading
DH (2004) The National Service Framework for Renal Services. Part One: Dialysis and
Transplantation (available from www.doh.gov.uk)
DH (2005) The National Service Framework for Renal Services. Part Two: Chronic Kidney Disease,
Acute Renal Failure and End of Life Care (available from www.doh.gov.uk)
DH (2007) The National Service Framework for Renal Services. Second Progress Report.
(available from www.doh.gov.uk)
DH (2009) Achieving Excellence in Kidney Care; Delivering the National Service Framework for
Renal Services (available from www.doh.gov.uk)
DOQI guidelines available at www.kidney.org/professionals/kdoqi/guidelines.cfm
European Renal Association – European Dialysis and Transplantation Association (2007)
guidelines available at; http://www.ndt-educational.org/guidelines.asp
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGui
dance/DH_124356
http://www.dh.gov.uk/health/2012/02/confirmation-pbr-arrangements/
http://www.harmfreecare.org/wp-content/uploads/DH%20ST%20Guidance%2025%205%2012.pdf
http://www.health.org.uk/public/cms/75/76/1915/1522/Implementing_shared_decision_
making_in_the_UK2-1.pdf?realName=U39ZtQ.pdf
http://www.kidney.org.uk/reference/commissioning/Kidney-
Care_Commissioning_140512.pdf
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215049/d
h_133859.pdf
NICE guidance available at https://www.nice.org.uk/guidance/conditions-and-
diseases/kidney-conditions
Renal Association (2009) Clinical Practice Guidelines (5th edition) available at;
http://www.renal.org/guidelines/index.html
www.dopps.org
www.kdigo.org

10
Session 3: Anaemia Management

By the end of the session students will be able to:

• Identify normal and abnormal blood values related to renal anaemia.
• Critically evaluate the clinical evidence for anaemia treatment protocols.

Indicative reading:
Jenkins K. (2009) Guidance on managing anaemia in patients with chronic renal disease.
Journal of Renal Nursing 1(1), 13-17.
Jenkins K. (2011) Back to basics: anaemia of chronic kidney disease. Journal of Renal Nursing
3(1), 28-31.
KDIGO (2012) KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease.
Kidney International (suppl) 2(4); 1 -64 available at:
http://www.kdigo.org/clinical_practice_guidelines/pdf/KDIGO-Anemia%20GL.pdf
Tollitt J., Kalra P.A., & McIntyre H.N. (2012) Anaemia and the heart and kidneys. British
Journal of Cardiac Nursing 7(6), 276-281

Session 4: Management of Diabetes in patients with CKD

By the end of the session students will be able to:

• Critically evaluate the relationship between diabetes and the kidney
• Critically analyse the nursing care required by the patient with diabetes

Indicative reading:
Adler A., Stevens R.J., Manley S.E., Bilous R.W., Cull C.A. & Holman R.R. (2003) Development
and progression of nephropathy in type 2 diabetes: The United Kingdom Prospective Diabetes
Study (UKPDS 64). Kidney International 6, 225-32.
Burden M. (2003) Diabetes: signs, symptoms and making a diagnosis. Nursing Times 99(1),
30.
Cavanaugh K.L. (2007). Diabetes management issues for patients with chronic kidney disease.
Clinical Diabetes, 25(3), 90-97.
Fain J.A. (2009) Understanding Diabetes Mellitus and Kidney Disease. Nephrology Nursing
Journal 36(5), 465-9.
Jeffery A. & Voss L.D. (2007) Weighing in at school? The value of routine school based
measurement in the fight against obesity. Practical Diabetes International 24(7), 335-6.
Marchant K. (2008) Diabetes and chronic kidney disease: a complex combination. British
Journal of Nursing 17(6), 356- 61
Mehment S., Quan G., Thomas S., & Goldsmith D. (2001) Important causes of hypoglycaemia in
patients on peritoneal dialysis. Diabetic Medicine 18, 679-82.
Ravenscroft E.F. (2005) Diabetes and Kidney Failure: How Individuals with Diabetes
Experience Kidney Failure. Nephrology Nursing Journal 32(5), 502-510.
Russel T.A. (2006) Diabetic Nephropathy in Patients with Type 1 Diabetes Mellitus Nephrology
Nursing Journal 33(1), 15-30.
Williams G. & Pickup J.C. (1999) Handbook of Diabetes. Blackwell Science, Oxford.
Yee J. (2008) Diabetic Kidney Disease: Chronic kidney disease and diabetes. Diabetes
Spectrum 21(1), 8-10.

11
Session 5: Chronic Kidney Disease & Complications/ Cardiovascular disease in
CKD

By the end of the session students will be able to:

• Understand the D/OQI classification and how they relate to practice
• Analyse the psychological implications of the diagnosis of kidney disease Critically evaluate
the multidisciplinary care of kidney disease protocols
• Explore the interface between the primary and tertiary care of patients with CKD
Understand the systemic complications associated with CKD
• Explore the relationship of the heart, hypertension and kidney failure
• Explain the pathophysiology of the heart and hypertension and the kidney Identify
patients with Chronic Kidney Disease risk factors for developing
• Hypertension & Cardiovascular Disease
• Be able to discuss the pathophysiological mechanisms that contribute to increased
cardiovascular morbidity and mortality
• Critically evaluate the treatment options

Indicative reading:
Elliott K. & Bolton A. (2011) Managing the risk of cardiac arrhythmias in patients with
worsening renal function British Journal of Cardiac Nursing 6(8); 376-383
Holt S. & Goldsmith D. (2010) Cardiovascular Disease in CKD. Renal Association Guidelines
available at
http://www.renal.org/Clinical/GuidelinesSection/CardiovascularDiseaseInCKD.aspx
Levy J., Pusey C. & Singh A. (2006) Hypertension & diabetic nephropathy (Chapter 5) Fast
Facts: Renal Disorders. Health Press, Oxford.
MacGregor MS. & Taal MW. (2011) Detection, Monitoring and Care of Patients with CKD Renal
Assocation Guidelines available at http://www.renal.org/Clinical/GuidelinesSection/Detection-
Monitoring-and-Care-of-Patients-with-CKD.aspx
Murphy F. (2011) Chronic kidney disease in the primary care setting Practice Nursing 22(4),
184-89.
Murphy F. & Byrne G. (2009) Chronic kidney disease stages 1–3: Its relationship with CVD
British Journal of Cardiac Nursing 4(1), 7-12.
Murphy F. & Byrne G. (2009) Chronic kidney disease stages 4–5: Patient management.
British Journal of Cardiac Nursing 4(2), 59-66
NICE (2011) Chronic Kidney Disease Quality Standard available at:
http://www.nice.org.uk/guidance/qualitystandards/chronickidneydisease/ckdqualitystanda rd.jsp
NICE clinical guideline 182 (2014) Chronic kidney disease early identification and management
of chronic kidney disease in adults in primary and secondary care. Available online
http://www.nice.org.uk/guidance/cg182/resources/guidance-chronic-kidney-disease-pdf
O’Callaghan C. & Brenner B. (2009) Hypertension: causes and clinical evaluation (Chapter 34).
The Kidney at a Glance. Blackwell Science, Oxford.
Roderick P. (2010) An overview of recent advances in treating chronic kidney disease. Journal
of Renal Nursing 2(3), 110-15.
The Renal Association (2010) Clinical Practice Guidelines (5th Ed) Cardiovascular disease in
CKD available at http://www.renal.org/Clinical/GuidelinesSection/Guidelines.aspx Thomas N.
(2009) Identification and management of chronic kidney disease Journal of Renal Nursing
1(2), 62-66.
Upadhyay A., Earley A., Haynes S.M. & Uhlig K. (2011) Systematic Review: Blood Pressure
Target in Chronic Kidney Disease and Proteinuria as Effect Modifier. Annals of Internal
Medicine 154:541-48 http://www.renal.org/eGFR/eguide.htm

12
Week 1 Self-directed Study and E-activities

E-activities 1: Renal Anatomy & Physiology

By the end of the activity students will be able to:

• Explain the structure of the Kidney
• Explain the functions of the kidney
• Relate the normal functions of the kidney to dysfunction

Indicative reading:
Ludlow M. (2003) Renal Handling of Potassium. Nephrology Nursing Journal 30(5), 493–99.
Mirpuri N. & Patel P. (1998) Mosby’s Crash Course: Renal & Urinary Systems. Mosby, London.
O’Callaghan C. (2008) The Kidney at a Glance. Blackwell Science, Oxford.

E-activities 2: Cardiovascular disease

For objectives and indicative reading see week 3 taught sessions (above).

E-activities 3: Renal Anaemia

For objectives and indicative reading see week 1 taught session (above).

E-activities 4: Diabetes and CKD

For objectives and indicative reading see week 1 taught session (above).

E-activities 5: Fluid & electrolytes

By the end of the activity students will be able to:

• Understand the movement of fluid and solute between compartments within the body
• Understand the movement of fluid during dialysis.

Indicative reading
Nebelkopf Elagart H. (2004) Assessment of Fluids and Electrolytes AACN Clinical Issues 15(4),
607-21.

13
E-activities 4: Fluid & electrolytes

By the end of the activity students will be able to:

• Understand the movement of fluid and solute between compartments within the body
• Understand the movement of fluid during dialysis

Indicative reading
Nebelkopf Elagart H. (2004) Assessment of Fluids and Electrolytes AACN Clinical
Issues 15(4), 607-21.

Reilly R.F. (Jr) & Perazella M.A. (2005) Nephrology in 30 Days. McGraw-Hill Medical
Publishing Division, New York.

E-activities 5: Renal Blood Tests Quiz

By the end of the e-learning students will be able to:

• Identify the main blood tests undertaken in the management of renal diseases. State the
normal values of the common blood tests used with Nephrology.
• Explore the significance and potential implications of abnormal blood results.

Indicative reading:
Davies A. (2010) Back to basics: common renal blood tests. Journal of Renal Nursing 2(5),
236-39. Edren website; http://www.edren.org/pages/edreninfo.php
Levy J., Brown E., Daley C. & Lawrence A. (2001) The Oxford Handbook of Dialysis (Oxford
Medical Publications) Oxford University Press, Oxford.
Harris B. (2011) The role of albumin: creatinine ratio in detecting renal disease. Journal of
Renal Nursing 3(1), 16-19.
Mahon A. & Hattersley J. (2009) Investigations in Renal Failure (Chapter 6) In: Thomas N (Ed)
(3rd Edition) (2002) Renal Nursing. Bailliere Tindall, London.

14
Week 2 Taught Sessions

Session 1: Haemodialysis machine

By the end of this activity students will be able to:

• Identify all the safety features on a Haemodialysis machine
• Critically evaluate the importance & role of all technical aspects of the haemodialysis
machine

Session 2: Haemodialysis prescriptions

By the end of this session students will be able to:
• Explore the need for different haemodialysis prescriptions Discuss different
haemodialysis filter membranes and sizes
• Discuss and explore the rationale for different dialysate concentrations and flows and
when they may be required
• Identify high risk medications such as, IV anticoagulants, thrombolytics

Indicative reading
10D Hemostasis. Available online at https://www.youtube.com/watch?v=Zk2sW0ifwSU video
of coagulation
Activase t PA MOA Mechanism of Action Activase® Alteplase. Available online at
https://www.youtube.com/watch?v=dClu6nC2qNs
Ashley C. & Currie A. (2009) The Renal Drug Handbook. 3rd Revised edition, Radcliffe
Publishing Ltd, Oxford.
Barclay L. (2009) Guidelines for Drug Dosing Regimens in Chronic Kidney Disease (you are
required to register (free) to access this learning module. Available online at
http://www.medscape.org/viewarticle/557381
British Association of Paediatric Nephrology available at;
http://www.bapn.org/assets/clinical_standards/BAPN%20HD%20Standards%20and%20Guid
eli nes.pdf
Clot Formation and Clot Breakdown: 2D Medical Animation. Available online at
https://www.youtube.com/watch?v=fjjEiVeYRNg
Coagulation cascade. Available online at https://www.youtube.com/watch?v=xNZEERMSeyM
Daugirdas J.T. (2007) Chronic Hemodialysis Prescription: A Urea Kinetic Approach (Chapter
9) in Handbook of Dialysis (4th ed) Lippincott Williams & Wilkins, London.
http://www.medscape.org/viewarticle/557381
Kerr P. & Huang L. (2010) Review; Membranes for haemodialysis. Nephrology 15, 381-15.
Mactier R., Hoenich N. & Breen C. (2009) Renal Association Haemodialysis Guidelines 4.1 -
4.5
Toussaint N., Cooney P. & Kerr PG. (2006) Review of dialysate calcium concentration in
hemodialysis. Hemodialysis International 10, 326-37.

15
Session 3: Haemodialysis Assessment
By the end of the session students will be able to:
• Discuss the physiological mechanisms of both oedema formation and dehydration.
Critically evaluate how a fluid assessment is undertaken.
• Analyse the importance of fluid management in a patient with renal failure.
• Critically analyse the holistic assessment of patient prior to commencement of
haemodialysis and appropriate adjustment to the treatment plan.

Indicative reading:
Candela L. & Yucha C.B. (2004) Renal regulation of Extracellular Fluid Volume and Osmolarity.
Nephrology Nursing Journal 31(4), 397-406.
Challinor P. (2001) Principles of Haemodialysis In: Challinor & Sedgewick (2001) (editors)
Principles and practice of Renal Nursing. Cheltenham: Stanley Thorne.
Fisher L. (2004) Enhancing fluid management in haemodialysis patients. British Journal of
Renal Medicine 9(4), 21-23.
Kinton R. (2005) Discrepancies in performing target weight assessments in Haemodialysis
patients. EDTNA/ERCA 31(1), 15-17.
Mistiaan P. (2001) Thirst, Interdialytic Weight Gain and Thirst: Interventions in Hemodialysis
Patients: A Literature Review. Nephrology Nursing Journal 28(6), 601-13.
Mitchell S. (2002) Estimated Dry Weight (EDW): Aiming for Accuracy. Nephrology Nursing
Journal 29(5), 421-28.
Thomas N. (2002) Haemodialysis (Chapter 7) In: Thomas N (Ed). 2nd ed. (2002) Renal
Nursing. Bailliere Tindall, London.
Van Stone J. & Daugirdas J (2001) In: Daugirdas, J.T., Blake P.G., Todd S. (2001) (Editors). 3rd
ed. Handbook of Dialysis. Lippincott Williams, Philadelphia.
www.wilkes.med.ucla.edu/lungintro.htm

Session 3: Complications of Haemodialysis

By the end of the activity students will be able to:
• Understand the precipitating factors for the development of haemodialysis
complications Early detection and treatment of haemodialysis complications
• Ensure patent safety and to prevent further patient development of haemodialysis
complications

Indicative reading:
Ayoub A., Finlayson M. (2004) Effect of cool temperature dialysate on quality and patient's
perception of haemodialysis. Nephrology Dialysis & Transplantation 19, 190-194.
Benaroia M. & Iliescu E.A. (2008) Oral intake during hemodialysis: Is there an association with
intradialytic hypotension? Hemodialysis International, 12, 62–65.
Cruz D., Mahnensmith R., Brickel H. & Perazella M. (2002) Cool dialysate are effective
therapies for systemic intradialytic hypotension. American Journal Kidney Disease 39, 102-
107.
Daugirdas J.T., Blake P.G. & Ing S.T. (2006) Handbook of Dialysis. 4th ed. Lippincott Williams
and Wilkins, Philadelphia.
Davenport A. (2009) Can Advances in Hemodialysis Machine Technology Prevent Intradialytic
Hypotension? Seminars in Dialysis—Vol 22, No 3:2009 pp. 231–236.
Davenport A. Cox, C. & Thuraisingham R. (2008) Achieving Blood Pressure

16
Jaeger J.Q. & Mehta R.L. (1999) Assessment of dry weight in hemodialysis: an overview.
Journal of American Society of Nephrology. 10, 392–403.
Karnik I.A., Young B.S, Lew N.L, Herget M., Dubinsky C., Lazarus J.M. & Chertow G.M. (2001)
Cardiac arrest and sudden death in dialysis units. Kidney International. 60, 350–357
Kinton R. (2005) Discrepancies in performing target weight assessments in haemodialysis
patients. European Dialysis and Transplant Nurses Association /European renal Care
Association: Journal of Renal Care. 1, 15-18.
Sulowicz W. & Radziszewski A. (2006) Pathogenesis and treatment of dialysis hypotension.
International Society of Nephrology, 70, S36–S39.
Thomas N. (ed) (2007). Renal Nursing. 3rd ed. Bailliére Tindall, China.

Session 4: Dialysis Induced Hypotension

By the end of the session students will be able to:
• Define the pathogenesis of dialysis induced hypotension
• Identify haemodynamic changes during haemodialysis leading to hypotension using
non-invasive devices
• Classify patients in different risk categories, enabling specific therapy to be designed and
implemented
• Apply the most appropriate protective strategies for the hypotension prone patient on an
individual basis
• Analyse the care required for common intradialytic complications
• Discuss the effectiveness of different interventions for dialysis induced hypotension

Indicative reading:
Daugirdas, J.T. Blake, P.G.& Ing T.S. (2007) Handbook of Dialysis. 4th ed. Lippincott Williams
& Wilkins, Philadelphia.
Davenport A. (2009) Can Advances in Hemodialysis Machine Technology Prevent Intradialytic
Hypotension? Seminars in Dialysis—Vol 22, No 3:2009 pp. 231–236.
Davenport A., Cox C. & Thuraisingham R (2008) Achieving blood pressure targets during
dialysis improves control but increases intradialytic hypotension. Kidney Int 73, 759–764.
Dasselaar J.J., Huisman R.M., de Jong P.E. & Franssen C.F.M. (2005) Measurement of relative
blood volume changes during haemodialysis: merits and limitations. Nephrol Dial Transplant
20, 2043–2049.
Headley C.M. & Wall B.M. (2007) Flash Pulmonary Edema in Patients with Chronic Kidney
Disease and End Stage Renal Disease. Nephrology Nursing Journal 34(1), 15-28.
Hossli S.M. (2005) Clinical management of intradialytic hypotension: Survey of results.
Nephrology Nursing Journal 32(3), 287-291.
Ishibe S. & Peixoto JA. (2004) Methods of Assessment of Volume Status and
Intercompartmental Fluid Shifts in Hemodialysis Patients: Implications in Clinical Practice.
Seminars in Dialysis. Vol 17, No 1 pp. 37–43.
Kitamura H.R. & Saito A. (2001) Dialysis hypotension: a review of recent studies of causative
factors. Nephrology 6(3), 109–12.
K-DOQI work group (2005) K-DOQI clinical practice guidelines for cardiovascular disease in
dialysis patients. Am J Kidney Dis 45(Suppl 3):S1–S153.
Kooman J., Basci A., Pizzarelli F., Canaud B., Haage P., Fouque D., Konner K., Martin-Malo A.,
Pedrini L., Tattersall J., Tordoir J., Vennegoor M., Wanner C., Ter Wee P. & Vanholder R.
(2007) EBPG guideline on haemodynamic instability. Nephrol Dial Transplant 22(Suppl
2):ii22–ii44.

17
Levy J., Brown E., Daley C. & Lawrence A. (2009) Oxford handbook of Dialysis. 3rd ed. New
York: Oxford University Press.
Lopot F. (2007) Continuous blood volume based Biofeedback during Haemodialysis.
EDTNA/ERCA XXXIII(2), 52-8.
Marenzi G., Lauri G., Grazi M., Assanelli E., Campodonico J. & Agostoni P. (2001) Circulatory
response to fluid overload removal by extracorporeal ultrafiltration in refractory congestive
heart failure. Journal of American College of Cardiology. 38(4), 963-8.
Owen P.J., Prietman W.S., Sigrist M.K., Lambie S.H., John S.G., Chesterton L.J. & McIntyre
C.W. (2009) Myocardial contractile function and intradialytic hypotension. Hemodialysis
International. 13, 293–300.
Ronco C. (2001) The problem of hypotension in haemodialysis. Nephrology 6(3), 99–103.
Ronco C., Bellomo R. & Ricci Z.(2001) Hemodynamic Response to Fluid Withdrawal in
Overhydrated Patients Treated with Intermittent Ultrafiltration and Slow Continuous
Ultrafiltration: Role of Blood Volume Monitoring. Cardiology. 96, 196–201
Schroeder K.L., Sallustio J.E. & Ross E.A. (2004) Continuous haematocrit monitoring during
intradialytic hypotension: Precipitous decline in plasma refill rates. Nephrol Dial Transplant.
19(3), 652-656.
Shulman T., Heidenheim A.P., Kianfar C., Shulman S.M. & Lindsay R.M. (2001) Preserving
central blood volume changes in body fluid compartments during hemodialysis ASAIOJ 47(6),
615-8.
Mann H. & Stiller S. (2000) Sodium Modelling. Kidney International 58 (Supp 76), S79-88.
Terrill B. (2004) Renal Nursing – A Practical Approach. Melbourne Ausmed (Chapter 8).

18
Week 2 Self-directed Study and e-activities

E-activities 1: Principles of Haemodialysis/Haemodiafiltration Quiz

By the end of this activity students will be able to:
• Discuss the principles of the haemodialysis.
• Critically evaluate the effects of using different prescriptions on these principles

Indicative reading:
Challinor P. (2001) Principles of Haemodialysis In: Challinor & Sedgewick (2001) (editors)
Principles and practice of Renal Nursing. Stanley Thorne, Cheltenham.
Van Stone J. & Daugirdas J. (2001) In: Daugirdas J.T., Blake P.G. & Todd S. (2001) (Editors).
3rd ed. Handbook of Dialysis. Lippincott Williams and Wilkins, Philadelphia.

E-activities 2: Haemodialysis Machine Quiz

By the end of this activity students will be able to:

• Identify all the safety features on a Haemodialysis machine

• Critically evaluate the importance & role of all technical aspects of the haemodialysis
machine.

Indicative reading:
Graves G.D. (2001) Arterial & Venous Pressure Monitoring during Haemodialysis. Nephrology
Nursing Journal 28(1), 23-30.
Van Stone J. & Daugirdas J. (2001) Chronic Hemodialysis Prescription. In: Daugirdas, J.T.,
Blake P.G., Todd S. (2001) (Editors). 3rd ed. Handbook of Dialysis. Lippincott Williams and
Wilkins, Philadelphia.

E-activities 3: Complications of Haemodialysis

For learning outcomes and indicative reading see week 2 taught session, above.

19
Week 3 Taught Sessions

Session 1: Infection Control & Prevention

By the end of this session, students will be able to:

• Review strategies to prevent bloodstream infections in patients on dialysis Discuss

patient perspectives on prevention of bloodstream infections
• Relate the patients’ role in infection prevention
• Discuss risk factors, clinical manifestations, medical management, and methods to
prevent or reduce the transmission of common infections in haemodialysis patients
• Discuss risk factors, clinical manifestations, medical management, and methods to
prevent or reduce the transmission of Multi-Drug Resistant Organisms
• Analyse the importance of good infection control procedures / practices within renal
settings Identify how different blood borne viruses are transmitted

Indicative reading
Centers for Disease Control and Prevention (CDC). (2012). Guidance for control of carbapenem‐
resistant Enterobacteriaceae (CRE). Available online. Retrieved from
http://www.cdc.gov/hai/pdfs/cre/CRE‐guidance‐508.pdf
Centers for Disease Control and Prevention (CDC). (2013a). Threat report. Antibiotic resistance
threats in the United States. Retrieved from http://www.cdc.gov/drugresistance/threatreport
Centers for Disease Control and Prevention (CDC). (2013b).Vital signs: Carbapenem‐resistant
Enterobacteriaceae Morbidity and Mortality Report, 62(09), 165–70.
Loveday H.P., Wilson J.A., Pratt R.J., Golsorkhi M., Tingle A., Bak A., Browne J., Prieto J. &
Wilcox M. (2014) epic3: National Evidence-Based Guidelines for Preventing Healthcare-
Associated Infections in NHS Hospitals in England. Journal of Hospital Infection 86S1(2014)
S1–S70. Available online, retrieved from doi: 10.1016/S0195-6701(13)60012-2
Loveday H.P., Wilson J.A., Pratt R.J., Golsorkhi M., Tingle A., Bak A., Browne J., Prieto J.,
Wilcox M. & Ness S.M.(2013) Multidrug-Resistant Organisms. Nursing CEU, Available online
http://wildiris4.securesites.net/cms_prod/files/course/434/MDROs_WildIrisMedicalEducatio
n.pdf
Maki D.G., Ash S.R., Winger R.K. & Lavin P. (2011) AZEPTIC Trial Investigators. A novel
antimicrobial and antithrombotic lock solution for hemodialysis catheters: a multi-center,
controlled, randomized trial. Critical Care Medicine; 39, 613–620.
NHS Hospitals in England. Journal of Hospital Infection 86S1 (2014) S1–S70. Available online
http://www.his.org.uk/files/3113/8693/4808/epic3_National_Evidence-
Based_Guidelines_for_Preventing_HCAI_in_NHSE.pdf
See I., Shugart A., Lamb C., Kallen A.J., Patel P.R., Sinkowitz-Cochran R.L. (2014) Infection
Control and Bloodstream Infection Prevention: The Perspective Of Patients Receiving
Hemodialysis Nephrology Nursing Journal January-February 2014 Vol. 41, No. 1
Solomon L.R., Cheesbrough J.S., Ebah L., Al-Sayed T., Heap M., Millband N., Waterhouse D.,
Mitra S., Curry A., Saxena R., Bhat R., Schulz M., Diggle P. (2010) A randomized double-blind
controlled trial of taurolidine-citrate catheter locks for the prevention of bacteremia in patients
treated with hemodialysis. American Journal of Kidney Disease; 55, 1060–1068. doi:
10.1053/j.ajkd.2009.11.025
Venditto M., du Montcel S.T., Robert J., Trystam D., Dighiero J, Hue D., Bessette C., Deray G. &
Mercadal L.(2010) Effect of catheterlock solutions on catheter-related infection and

20
inflammatory syndrome in hemodialysis patients: heparin versus citrate 46% versus
heparin/gentamicin. Blood Purification; 29, 268–273. doi: 10.1159/000274461
Department of Health (2002) Good Practice Guidelines for Renal Dialysis / Transplantation
Units: Prevention & Control of Blood-borne Virus Infection. London; Department of Health.
Renal Association (2009) Clinical Practice Guidelines - Blood- Bourne Viruses (available at:
http://www.renal.org/Clinical/GuidelinesSection/Guidelines.aspx
Stragier A. & Jadoul M. (2003) Should dialysis machines be disinfected between patients’
shifts? EDTNA-ERCA Journal, 29, 73-76 http://onlinelibrary.wiley.com/doi/10.1111/j.1755-
6686.2003.tb00277.x/pdf
Kidney Disease: Improving Global Outcomes. KDIGO clinical practice guidelines for
the prevention, diagnosis, evaluation, and treatment of Hepatitis C in chronic kidney disease.
Kidney Int 2008;73:S1-S99 - http://www.renal.org/guidelines/modules/blood-borne-virus-
infection#sthash.x5aprMYK.dpuf
Valtuille R., Fernandez JL., Moretto H., del Pino N., Rendo P. & Lef L. (1998) Evidence of
Hepatitis C Virus passage across the Dialysis Membrane. Nephron 80, 194-6.

Session 2: Online Haemodialfiltration

By the end of the session students will be able to:

• Discuss the principles of this treatment option
• Identify the advantages and disadvantages of this treatment over haemodialysis.

Indicative Reading
Baldwin I.C. (1997) Training, management & credentialing for CRRT in the ICU. American
Journal of Kidney Disease (Suppl 4) 30(5), 112-6.
Davenport A. (2009) The techniques of haemofiltration and haemodiafiltration. Journal of
Renal Nursing 1(4), 191-5
Ledebo I. (1998) Principles & practice of Haemofiltration & Haemdiafiltration. Artificial
Organs 22(1), 20-5.
Vanholder, R.C.,Glorieux, G.L., & De Smet, R.V. (2003) Back to the Future: Middle Molecules,
High Flux Membranes & Optimal Dialysis. Hemodialysis International 7(1), 52-7.

Session 3: Management of Haemodialysis Access

By the end of the session students will be able to:
• Discuss ways of monitoring the function of access Analyse the effectiveness of fistula
assessments
• Critically discuss the advantages & disadvantages of different cannulation techniques
• Discuss ways of monitoring the function of CVC’s Discuss ways of monitoring the
function of CVC’s
• Explore the rationale for the care of required for CVC

Indicative reading:
Allon M. & Robbin M.L. (2009) Hemodialysis vascular access monitoring: Current concepts.
Hemodialysis International 13, 153-62
Ball L.K. (2006) The Buttonhole Technique for Arteriovenous Fistula Cannulation. 33(3), 299-
305.

21
Ball L.K. (2006) Improving Arteriovenous Fistula Cannulation Skills 32(6), 611-618
Brouwer D. (1995) Cannulation Camp: Basic Needle Cannulation training for Dialysis staff.
Dialysis & Transplantation 24(11), 606 –12.
DOQI guidelines available at www.kidney.org/professionals/kdoqi/guidelines.cfm
Malik J., Tuka V. & Tesar V. (2009) Local Hemodynamics of the vascular access for
hemodialysis. Kidney Blood Pressure Research 32, 59-66.
Menno A.M., Kooistra MP. & Van Jaarveld BC. (2007) Cannulating in hemodialysis rope ladder
or buttonhole technique. Nephrology Dialysis Transplantation 22, 2601-4.
Baskin J.L., Reiss U., Wilimas J.A., Metzger M.L., Ribeiro R.C., Ching-Hon Pui C.H. & Howard
S.C (2012) Thrombolytic therapy for central venous catheter occlusion. Haematologica 97, 641-
650. Available at doi:10.3324/haematol.2011.050492
Besarab A. & Pandey R. (2011) Catheter Management in Hemodialysis Patients: Delivering
Adequate Flow. Clinical Journal American Society of Nephrology 6, 227–234. Available online
at doi: 10.2215/CJN.04840610.
Hilleman D., & Campbell J. (2011) Efficacy, Safety, and Cost of Thrombolytic Agents for the
Management of Dysfunctional Hemodialysis Catheters: A Systematic Review.
Pharmacotherapy 31(10), 1031-1040. Available online at
http://www.medscape.com/viewarticle/751420 & http://dx.doi.org/10.1590/jvb.2014.013
McCann M. & Moore ZEH (2010). Interventions for preventing infectious complications in
haemodialysis patients with central venous catheters. Cochrane Database of Systematic.
Napalkov P., Felici D.M., Chu L.K., Jacobs J.R. & Begelman S.M. (2013) Incidence of catheter-
related complications in patients with central venous or hemodialysis catheters: a health care
claims database analysis. British Medical Council, Cardiovascular Disorders, 13, 86-96.
Available online at http://www.biomedcentral.com/1471-2261/13/86
Loveday H.P., Wilson J.A., Pratt R.J., Golsorkhi M., Tingle A., Bak A., Browne J., Prieto J. &
Wilcox M. (2013) epic3: National Evidence-Based Guidelines for Preventing Healthcare-
Associated Infections in NHS Hospitals in England Guidelines for preventing infections
associated with the use of central venous access devices. The Journal of Hospital Infection
65Supp; S33-S49. http://www.his.org.uk/files/3113/8693/4808/epic3_National_Evidence-
Based_Guidelines_for_Preventing_HCAI_in_NHSE.pdf
Reviews 2010, Issue 1. Art. No.: CD006894. DOI: 10.1002/14651858.CD006894.pub2.
available at:
http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD006894/frame.html
Skupien F.J., Gomes R.Z., Shimada E.H., Brandao R.I. & Skupien S.V. (2014) Transposition of
cephalic vein to rescue hemodialysis access arteriovenous fistula and treat symptomatic central
venous obstruction. Journal of Vascular, Brazil. 13(1), 63-66. Available online at
Waterhouse D. & Winterbottom J. (2010) How a central venous catheter surveillance tool was
developed for use with all ethnic groups. Nursing Times 106(6), 12-14

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Week 3 Self-directed Study and e-activities

E-activities 1: Management of Haemodialysis Access

For learning outcomes and indicative reading see week 3 taught session, above.
http://www.youtube.com/watch?v=HE5QhsPRaPU
https://www.youtube.com/watch?v=0IfjE0G9C_M or
https://www.youtube.com/watch?v=DGya15H_Jfw

E-activities 2: Dealing with Challenging Patients

By the end of the session students will be able to:

• Identify patients who may be challenging
• Explore strategies that staff can employ to deal with challenging patients Explore the
reasons why patients may present challenging behaviour
• Have knowledge of possible services available to assist patients

Indicative Reading
Burns T. & Smyth A. (2011) Reducing aggression in the haemodialysis unit by improving the
dialysis experience for patients. Renal Society of Australasia Journal, 7(2), 79-89.
Fisher P.A., Kropp D.J. & Fleming E.A. (2005) Impact on Living Kidney Donors: Quality of Life,
Self-Image and Family Dynamics. Nephrology Nursing Journal 32(5), 489-501.
Harwood L., Locking-Cusolito H., Spittal J., Wilson B., & White S. (2005) Preparing For
Hemodialysis: Patient Stressors and Responses. Nephrology Nursing Journal 32(3), 295-303.
Hashmi A., Alvin H. & Moss A.H. (2008) Treating difficult or disruptive dialysis patients:
practical strategies based on ethical principles Nature Clinical Practice: Nephrology 4(9), 515-
20.
Kugler C., Maeding I. & Russell C.L. (2011) Non-adherence in patients on chronic hemodialysis:
an international comparison study. Journal of Nephrology 24(3), 366-75.

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Week 4 Taught Sessions

Session 1: Acute Haemodialysis/1st Dialysis

By the end of the session students will be able to:
• Discuss the principles of performing a holistic assessment in a relation to both 1st
dialysis & dialysing an acutely ill patient
• Critically evaluate acute dialysis prescriptions.

Indicative reading:
Daugirdas J. (2000) Acute Haemodialysis (Chapter 5) In: Daugirdas, J.T., Ing T.S. & Blake P.G.
(2000) (Editors) Handbook of Dialysis. Lippincott Williams and Wilkins, Philadelphia.
Terrill B. (2002) Renal Nursing-A Practical Approach. Melbourne Ausmed (Section 2; chapter
7) http://www.renal.org/Clinical/GuidelinesSection/Guidelines.aspx

Session 2: Shared Care and Home Haemodialysis

By the end of the session students will be able to:
• Critically evaluate the concept of shared care
• Discuss barriers to shared care / home dialysis and how to overcome them Critically
analyse the patient selection criteria
• Critically analyse the NICE Home Haemodialysis guidelines
• Educate patients and assist with the decision making of patients regarding shared care /
home dialysis options.

Indicative reading
Glidewell L., Boocock S., Pine K., Campbell R., Hackett J., Gill S. & Wilkie M. 2013. Using
behavioural theories to optimise shared haemodialysis care: a qualitative intervention
development study of patient and professional experience. Implement Sci, 8, p.118.
Chow J. & Bennett L. (2001) Pre-training assessment tool (JPAT) a pilot study assessing
the suitability of candidates for home dialysis. EDTNA/ERCA Journal. 27(1), 37-41.
Collins K. (2003) Home or hospital – what is the place of home haemodialysis? British
Journal of Renal Medicine, 8(1), 20-22.
Sinclair P.M. (2009) Home haemodialysis: a literature review. Renal Society of Australasian
Journal 5(1); 9–15. (available at;
http://www.renalsociety.org/RSAJ/journal/mar09/sinclair.pdf
NICE (2002) Guidance on home compared with hospital haemodialysis for patients with end-
stage renal failure. Available at; https://www.nice.org.uk/guidance/ta48

24
Session 3: Haemodialysis Adequacy
By the end of the session students will be able to:
• Discuss the principles of adequacy measurements and the changes that maybe required
as a result.
• Critically analyse the clinical effectiveness of different adequacy tools
• http://www.kidney.org/professionals/kdoqi/guideline_uphd_pd_va/index.htm

Indicative reading:
Depner T.A. (2005) Hemodialysis adequacy: Basic essentials and practical points for the
nephrologist in training. Hemodialysis International 9, 241–254.
http://www.kidney.org/professionals/kdoqi/guideline_uphd_pd_va/index.htm
Ford E. (2005) Adequacy of Haemodialysis. EDTNA/ERCA 31(1), 4-9.
Ford L. (2001) Adequacy of dialysis In: Challinor & Sedgewick (2001) (editors) Principles and
practice of Renal Nursing. Stanley Thorne, Cheltenham.
Glidewell L., Stephen Boococ B., Pine K., Campbell R., Hackett J., Gill S. & Wilkie M. (2013)
Using behavioural theories to optimise shared haemodialysis care: a qualitative intervention
development study of patient and professional experience. Implementation Science, 8:118
http://www.implementationscience.com/content/pdf/1748-5908-8-118.pdf

Session 4: Water Treatment

By the end of the session students will be able to:

• Evaluate the importance of water purification in Haemodialysis
• Understand the complications of raw untreated water.

Indicative reading:
Amato R. (2001) Water Treatment for Haemodialysis, including the latest AAMI Standards.
Nephrology Nursing Journal 28(6), 619-29.
Levy J., Brown E., Daley C. & Lawrence A. (2009) The Oxford Handbook of Dialysis (Oxford
Medical Publications) Oxford University Press, Oxford.
Maul G. (2009) An overview of water treatment for haemodialysis patients. Journal of Renal
Nursing 1(3), 138-42.

25
Week 4 Self-directed Study and E-activities

E-activities 1: Shared Care and Home Therapies

For learning outcomes and indicative reading see week 4 taught session, above.

E-activities 2: Sustainable Haemodialysis

By the end of the session students will be able to:

• Discuss the importance and methods of improving the sustainability of haemodialysis

Indicative reading:
Agar J. W. M. (2013), It is time for “green dialysis”. Hemodialysis International, 17, 474–
478. doi: 10.1111/hdi.12063

26
Week 5 Taught Sessions (with Nephrology)

Session 1: Psychological Implications of Kidney Disease

By the end of the session students will be able to:

• Explore the signs and symptoms of psychological distress
• Identify different psychological presentations patients may display Explore different
coping strategies patients utilize
• Explore different strategies that healthcare professional can use to help patients to cope
with being on dialysis
• Analyse the potential reasons for psychological problems patients may present with.
Have knowledge of possible services available to assist patients.

Indicative reading
Afuwape S. (2010) Coping with established renal failure, transplantation and graft loss. Journal
of Renal Nursing 2(4), 162-65
Hagren B., Pettersen IM., Severinsson E., Lützén K., Clyne N. (2001) The haemodialysis
machine as a lifeline: experiences of suffering from end-stage renal disease. Journal of
Advanced Nursing 34, 196-202.
Major B. & Glass D. (2010) Common psychological problems experienced by the renal patients.
Journal of Renal Nursing 2(4), 172-77.
Shu-Chuan J.Y. & Hsueh-Chih C. (2007) Coping Strategies and Stressors in Patients With
Hemodialysis. Psychosomatic Medicine 69(2), 182-190.
Afuwape S. (2010) Coping with established renal failure, transplantation and graft loss. Journal
of Renal Nursing 2(4), 162-65.
Al-Arabi S. (2006) Quality of Life: Subjective Descriptions of Challenges to Patients With End
Stage Renal Disease. Nephrology Nursing Journal 33(3), 285-293.
Fisher P.A., Kropp D.J. & Fleming E.A. (2005) Impact on Living Kidney Donors: Quality of Life,
Self-Image and Family Dynamics. Nephrology Nursing Journal 32(5), 489-501.
Hagren B. et al (2001) The haemodialysis machine as a lifeline: experiences of suffering from
end-stage renal disease. Journal of Advanced Nursing 34,196-202.
Harwood L., Locking-Cusolito H., Spittal J., Wilson B. & White S. (2005) Preparing For
Hemodialysis: Patient Stressors and Responses. Nephrology Nursing Journal 32(3), 295-303.
Lindqvist R. et al (2000) Perceived consequences of being a renal failure patient. American
Nephrology Nurses’ Association Journal 27, 43-64.
Major B. and Glass D. (2010) Common psychological problems experienced by the renal
patients. Journal of Renal Nursing 2(4); 172-77
Ouellette A., Achille M.A., Vachen M. (2006) Psychological Impact of kidney failure and
implications for the psychological evaluation of Re-transplantation candidates. Dialysis and
Transplantation June: 1-5.

27
Session 3: Mineral Bone Disease

By the end of the session students will be able to:

• Identify the physiological processes that occur within the bones of patients with renal
failure.
• Analyse the complications of abnormal calcium, phosphate and PTH. Explain the
degenerative effects of the condition.
• Critically analyse the principles of the management of the disease.

Indicative reading:
Bro S. (2003) How Abnormal Calcium, Phosphate and Parathyroid Hormone Relate to
Cardiovascular Disease. Nephrology Nursing Journal 30(3), 275-83.
Espinosa O. (2006) Clinical challenges in treating renal osteodystrophy. British Journal of
Renal Medicine 11(1), 12-14
KDIGO (2009) Clinical Practice Guidelines Guideline for Chronic Kidney Disease -Mineral and
Bone Disorder (CKD-MBD) available at:
http://www.kdigo.org/clinical_practice_guidelines/kdigo_guideline_for_ckd-mbd.php
Part 10 in Levy J. et al (2001) The Oxford Handbook of Dialysis (Oxford Medical Publications)
Oxford University Press, Oxford.
Michael M. & Garcia D. (2004) Secondary Hyperparathyroidism in Chronic Kidney Disease: Clinical
Consequences and Challenges. Nephrology Nursing Journal 31(2), 185-95.
Renal Association (2010) (5thEd) CKD – Mineral and Bone Disorders (CKD – MBD) available
at: http://www.renal.org/docs/default-source/default-document-library/ra-ckd-mbd-final-
version-2015-v2870fa131181561659443ff000014d4d8.pdf?sfvrsn=0

Session 4: Nutrition Needs for Patients with Renal Diseases

By the end of the session students will be able to:
• Identify the key nutrients considered in the nutritional treatment of renal failure and
their main food sources in the diet
• List the health consequences of abnormal levels of these nutrients in the blood Identify the
incidence and causes of malnutrition in patients with chronic renal
• failure
• Select the appropriate nutritional tools available at ward level to undertake an accurate
nutritional assessment of a patient with chronic renal failure
• Identify the four methods of nutritional support used in malnourished patients with
chronic renal failure

Indicative reading:
Altmann, P. (2002) The Control of Calcium and Phosphate in Renal Failure. British Journal of
Renal Medicine 7(1);, 6-9.
Campbell H., James S., & O’Brien S. (2002) Nutrition in Renal Disease. Complete Nutrition
2(3), 9-12.
Engel B., & Griffiths A. (2001) Nutritional assessment and supplementation in patients with end
stage renal failure. British Journal of Renal Medicine 6(3), 21-4
Jackson, H. (2010) Nutritional assessment of a renal patient. Journal of Renal Nursing 2(1), 20
– 23
Unknown (2010) Diet in renal disease. Edren available at;
http://www.edren.org/pages/handbooks/unit-handbook/diet-in-renal-disease.php

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Assignment Workshop

Learning outcomes & indicative reading: see assessment criteria.

Week 5 Self-directed study and E-activities

E-activities 1: Nutrition Quiz

For learning outcomes and indicative reading see week 5 taught session, above.

E-activities 2: How to Critique

By the end of the session students will be able to:

• Critically review an article of their choice
• Discuss the merits and criticisms of the article

Indicative reading:
Ingham-Broomfield R. (2008) A nurses’ guide to the critical reading of research Australian
Journal of Advanced Nursing 26(1); 102-9 available at: http://www.ajan.com.au/Vol26/26-
1v2_Ingham-Broomfield.pdf
Lee P. (2006) Understanding & critiquing quantitative research papers Nursing Times 102(28),
28.
Lee P. (2006) Understanding and critiquing qualitative research papers Nursing Times
102(29), 30.
http://www.uis.edu/ctl/wp-
content/uploads/sites/76/2013/03/Howtocritiqueajournalarticle.pdf

E-activities 3: Mineral Bone Disorder

For objectives and indicative reading see week 5 taught sessions (above).

29
Week 5 self-directed study and e-activities
E-activities 1: Nutrition Quiz

For learning outcomes and indicative reading see week 5 taught session, above.

E-activities 2: How to Critique

By the end of the session students will be able to:
• Critically review an article of their choice
• Discuss the merits and criticisms of the article

Indicative reading:
Ingham-Broomfield R. (2008) A nurses’ guide to the critical reading of research Australian
Journal of Advanced Nursing 26(1): 102-9 available at: http://www.ajan.com.au/Vol26/26-
1v2_Ingham-Broomfield.pdf
Lee P. (2006) Understanding and critiquing quantitative research papers Nursing Times
102(28), 28.
Lee P. (2006) Understanding and critiquing qualitative research papers Nursing Times
102(29), 30.
http://www.uis.edu/ctl/wp-
content/uploads/sites/76/2013/03/Howtocritiqueajournalarticle.pdf

E-activities 3: Mineral Bone Disorder

For objectives and indicative reading see week 5 taught sessions (above).

30
General indicative reading
Baker L., Hurst M., Rudge C. & Sobeh M. (2000) Practical Procedures in Nephrology. Arnold,
LondoN.
Challinor P. & Sedgewick (2004) Principles & Practice of Renal Nursing. Stanley Thorne,
Cheltenham.
Clatworthy M. (2010) Nephrology: Clinical Cases Uncovered. Wiley-Blackwell, Oxford.
Daugirdas J.T., Blake P.G. & Ing T. S. (2006) (Editors) (4th Edition) Handbook of Dialysis.
Lippincott Williams and Wilkins, Philadelphia.
Goldsmith D., Jayawardene S. & Ackland P. (2007) ABC of Kidney Disease. BMJ Books.
Levy et al (2004) The Oxford Handbook of Dialysis (Oxford Medical Publications) Oxford
University Press, Oxford.
Levy J., Pusey C. & Singh Lote C.J. (2000) Principles of Renal Physiology. (3rd Edition) Croom
Helm, London.
Levy J., Pusey C. & Singh A. (2006) Fast Facts: Renal Disorders. Oxford: Health Press.
Malarkey L. & McMorrow M. (2000) Nurse’s Manual of Laboratory Tests and Diagnostic
Procedures. 2nd ed. W.B Saunders Company, Philadelphia.
McGee H.M. & Bradley C. (2000) Quality of Life Following Renal Failure: Psychosocial
Challenges Accompanying High Technology Medicine. Harwood Academic Publishers,
Victoria.
O’Callaghan C. (2009) The Kidney at a Glance. 3rd ed. Blackwell Science, Oxford.
Rennke H.G., Denker B.M. & Rose B.D. (2006) Renal Pathophysiology - The Essentials.
Williams and Wilkins, Baltimore.
Scott W.N. (2010) Fluids & Electrolytes Made Incredibly Easy. Lippincott Williams & Wilkins,
London.
Stein A., Wild J. & Cook P. (2007) Vital Nephrology: Your Essential Reference for the Most
Vital Points of Nephrology. Class Publishing, London.
Terrill B. (2003) Renal Nursing; A Guide to Practice. Radcliffe Medical Press, Abingdon.
Thomas N. (ed) (2008) Advanced Renal Care. Blackwell Publishing Ltd, Oxford.
Thomas N. (ed) (2008) Renal Nursing (3rd Edition). Bailliere Tindall, London.
Tortora J. & Grabowski S. (2005) Principles of Anatomy & Physiology. 10th ed. John Whiley,
Chichester.

31
Websites
www.advancesinpd.com
www.ajkdjouranl.org
www.anaemianurse.org
www.artery.org.uk
www.britishrenal.org
www.clinicalevidence.com
www.cochrane-renal.org/index.html
www.doh.gov.uk
www.dopps.org
www.edren.org
www.hdcn.com
www.hilo.nhs.uk
www.kidneycare.nhs.uk/
www.kdigo.org
www.kcl.ac.uk/nmvc/studyskills
www.kidney.org.uk
www.kidney.org/professionals/kdoqi/index.cfm
www.kidneypatientguide.org.uk
www.kidneywise.com
www.medscape.com www.ndt-
educational.org/default.asp
www.nephronline.org
www.nephron.com
www.annanurse.org/cgi-
bin/WebObjects/ANNANurse.woa/wa/viewSection?s_id=1073744615&ss_id=536873798&tNa
m e=articleList
www.nice.org.uk/
www.nkf.org.uk
www.renal.org/Clinical/GuidelinesSection/Guidelines.aspx
http://sonet.nottingham.ac.uk/resources/
www.videomd.com

32
Module evaluation

At the end of the module you are requested to complete the short online evaluation which will
be available on your module KEATS site. Student evaluations are very important to us and are
required by Health Education England and the regional London Local Education and Training
Boards.

Action from previous evaluations

1. Introduction of assignment workshop
2. Adjustment of assignment guidelines
3. Introduction of new topic

33
Timetable
Teaching Date Time Session Lecturer Room
Mode

09:00 – 09:30 Introduction to the courses & e- learning,

portfolio & PAD
09:30 –11:00 Renal Guidelines, Renal Tariffs & Roseline Agyekum
University
C i i i
based Study 4 May 2017 11:00-12:00 Anaemia Management FWB1.14
13:00 –14:30 Management of Diabetes in patients with CKD Ann Vanderpuye

14:30 – 16:00 Promoting holistic care in Renal Setting Roseline Agyekum

09:00 –10:30 Water Treatment Ian Morgan

University 10:30 – 12:00 Management of CVC & Infections in Roseline Agyekum

Haemodialysis Denmark Hill RM
based Study 25 May 2017
3

13:00 – 16:00 The management of AVF’s & Grafts Fatima Defiuredgo

09.00 – 09.45 The Haemodialysis machine Roseline Agyekum FWB 4.174

09:45 – 11.15 Haemodialysis prescriptions Roseline Agyekum FWB 4.174
University
(Dialysers & Dialysates, Anticoagulants
based Study 8 June 2017
11:15-12:00 Shared Care & Home HD Roseline Agyekum
13.00 – 1400 1st Acute Dialysis Samuel Asante FWB 4.174
14:00 – 16:00 HDx Assessment including Fluid Assessment Roseline Agyekum FWB 4.174

34
 09:00 – 10.30 Complications of Haemodialysis Nithyakala Devaraj

University 10.30 – 12.00 Online Haemodialfiltration

based Study 22 June Chantler Skills
2017 13.00 – 14.30 Haemodialysis Adequacy Centre 2.6
Viviene Caguicla
14.30 – 16.00 Dialysis induced hypotension

09:00 – 10.00 End of Life care disease & Symptom Roseline Agyekum
management

University 10.00 – 11.30 Psychological implications of kidney disease GSTT Palliative

6 July 2017 Team FWB 1.14
based Study
11:30-12:00 Assignment Workshop
13.00 – 14.30 Management of mineral bone disease Roseline Agyekum
14.30 – 16.00 Nutrition in CKD, PD, HD & AKI

FWB – Franklin-Wilkins Building; Waterloo Campus

Chantler Skills Centre 2.6: Guys Campus
WEC – Weston Education Centre, Denmark Hill Campus

35