CANNT Journal

Background: Accreditation Canada recognizes medication reconciliation as a key required organizational practice (ROP) to enhance patient safety. Patients with chronic kidney disease (CKD) carry a high risk for adverse drug events due to multiple co-morbidities, using many medications, and being cared for by many practitioners. Data evaluating the benefits of ambulatory medication reconciliation (AmbMR) in patients with advanced CKD is limited. Methods: We retrospectively evaluated types and rates of medication discrepancies and their potential index for patient harm using the Cornish classification system in a cohort of consecutive non-dialysis-dependent CKD stage 5 patients who received AmbMR...

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The mental health of patients living with end-stage kidney disease (ESKD) is an important aspect of their care. According to national survey data, depressive disorders affect about 9% of the North American population (Kessler, Chiu, Demler, Merikangas, & Walters, 2005). A review of psychological distress and depression across the spectrum of chronic kidney disease indicates that the prevalence of depression in ESKD is reported to be about four times that of the general population and it is associated with adverse outcomes including low quality-of-life ratings, graft failure, and death after renal transplantation (Zalai, Szeifert, & Novak, 2012)...

No abstract text is available yet for this article.

A major decision for patients with stage 5 chronic kidney disease (CKD) relates to vascular access (VA) for treatment. Patients who receive pre-dialysis care often defer making a decision, which results in initiation of hemodialysis (HD) with a central venous catheter (CVC) in an urgent or emergent situation. Little is known about how individuals make decisions around VA. In this context, a mixed-methods study was undertaken to explore uncertainty related to changing their VA from an existing CVC to a graft or fistula...

Chronic fatigue--an overwhelming subjective feeling of mental or physical exhaustion--impacts patients' everyday functioning and quality of life, delays recovery after hemodialysis, and increases mortality. There are a number of factors that may perpetuate clinically significant fatigue among individuals with chronic kidney disease, including sleep disorders, depression, sedentary lifestyle, anemia, and chronic inflammation. Some of these factors (i.e., anemia and inflammation) are in the forefront of clinical attention, whereas the other contributing factors often remain unrecognized...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

As the number of Canadians living with end-stage kidney disease (ESKD) continues to grow, even higher numbers are living with advanced chronic kidney disease (CKD). Many of these people will eventually require renal replacement therapy (RRT), either dialysis or transplantation. More than 50% of patients starting RRT today are aged 65 or older, with the fastest growing group being patients 75 years and older. Despite advances to dialysis technology and dialysis care, the mortality rates remain high and dialysis patients' end-of-life care may not align with their preferences or values...

No abstract text is available yet for this article.

The Kidney Transplant Program (KTP) at the Toronto General Hospital has taken great strides in preparing to meet the needs of patients and health care providers, as the number of end-stage renal disease patients in Ontario increases. The KTP has begun the process of increasing engagement and collaboration with various stakeholders from the pre- to the post-transplant phase through (1) the development of innovative programs to increase the number of live kidney donations, (2) the development and maintenance of information technology solutions that work simultaneously to provide data to manage and treat patients, and conduct research, and (3) the development, implementation, and delivery of educational presentations and tools to various stakeholders both at the referring centres and the transplant program...

No abstract text is available yet for this article.

You are a charge nurse in a large hemodialysis unit in Ontario.One of the clerical staff has approached you today to assist withan update to her statistics on new and existing patients in yourunit. You are asked to clarify the cause of death for one patientand to clarify the date of transfer to the home dialysis programfor peritoneal dialysis on another patient. Finally, you are asked toremind the nurse practitioner (NP) to complete a registration formfor another patient who has just started chronic hemodialysis inyour unit...

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"Get the camera!" I yelled. As my young son came running towards me with the camera, I pointed up to the sky. Therethey were, four magnificent gleaming rainbows. The cloudssurrounding were a moody bluish black and the sun swiftly andgracefully beamed through them. The shimmering and glistening rainbows in that brief moment of sunshine pierced throughmy own darkness. In the last few months in my First Nationscommunity, we had experienced many deaths. Some of thesedeaths were relatives and friends. Years later, I would gaze atthe picture taken through hot tears, Nagweyaab geebawug orrainbow spirits I thought--these are the ancestors, those whohave passed reminding us to never give up...

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Chronic kidney disease affects 10 per cent of the general population. A number of studies over the last decade have established that there is a higher prevalence of depression amongst those with chronic kidney disease (CKD). Biological, psychological and socio-economic factors influence the higher prevalence of depression in this population. The complex interplay between bio-psycho-social factors helps explain the bidirectional relationship between progress of CKD and depression. We summarize the prevalence and etiology of depression in those suffering from CKD and describe in brief the impact of depression in CKD on outcomes such as mortality and morbidity, as well as the different management options that are available...

The past five decades have shown a tremendous growth, world wide, in the number of patients with advanced chronic kidney disease (CKD). Patients with advanced CKD today are notably older, have significant comorbidity, substantial symptom burden and, ultimately, have high mortality. Subsequently, there is an increased global awareness of the need to integrate palliative care into routine kidney care to enhance the quality of life and death for patients with advanced CKD. This article outlines a conceptual framework for kidney palliative care for patients with advanced CKD and discusses issues such as symptom burden, illness trajectories, advance care planning, and complex decision-making, including decisions around the appropriate initiation, withholding and withdrawal of dialysis, and the potential palliative care roles and responsibilities for nursing staff within kidney care programs...

No abstract text is available yet for this article.

This project assessed unmet psychosocial needs of kidney transplant recipients and the feasibility of a support group located at an urban Canadian hospital to meet those needs. A survey assessed transplant recipient concerns about psychosocial issues related to transplantation, interest in a support group, desired group composition, facilitation, leadership, barriers and alternative forms of support. Most respondents were more than two years since transplant and were more concerned about medical complications, returning to normalcy, and had a greater desire to talk to other transplant recipients...