This study evaluates the Comprehensive Conservative Kidney Care Clinic (CCKC), the first known U.S. nurse practitioner-led program for patients with advanced chronic kidney disease (CKD) choosing non-dialytic management in an urban safety-net setting. Retrospective analysis of 32 patients (mean age 74.6 years) over four years demonstrated the model's feasibility. While 81.3% remained on conservative management (CM), significant racial disparities emerged: 29.6% of Black patients transitioned to dialysis compared to 0.0% of White or Asian patients (p = 0.03). Furthermore, 70.8% of patients on CM utilized hospice, whereas none who initiated dialysis did. Qualitative findings suggest clinician framing strongly influenced patient choice. Despite the small sample size, the CCKC model effectively provides person-centered care, emphasizing the need for strategies addressing social determinants to ensure equitable access.
Chronic kidney disease (CKD) is a chronic illness linked to major metabolic abnormalities, including high levels of potassium and phosphorus. These abnormalities can lead to serious complications, such as bone and cardiovascular diseases. There are established dietary guidelines for the treatment of CKD, yet many patients still struggle with their effectiveness and adherence. The 2020 Kidney Disease Outcomes Quality Initiative (KDOQI) nutrition in CKD update and other renal dietary guidelines provide evidence-based suggestions for controlling these risks through medical nutrition therapy, protein and energy intake, nutritional evaluation, and electrolytes; however, effective implementation is still limited by provider knowledge gaps. This quality improvement project used an organized staff education program on renal nutrition to close that gap. Results of this project indicate that nephrology staff preparedness to reinforce nutritional education for patients with CKD may be enhanced by a systematic renal nutrition education intervention.
Licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) play a vital role in dialysis, yet many face obstacles in advancing their professional careers. ANNA's Administration Specialty Practice Network utilized focus groups to explore the experiences and perceptions of LPNs regarding barriers to professional growth. Thematic analysis revealed four primary barriers: role undervaluation by registered nurses, limited access to educational opportunities, lack of individual and organizational support, and lack of networking opportunities. These findings underscore the need for targeted interventions and enhanced support systems to foster career development among LPNs.
The transition from academic study to professional practice can be challenging for newly graduated nurses who have less than 12 months of experience. Newly graduated nephrology nurses need opportunities to build competence and confidence to provide quality and safe nephrology nursing care. A team of nursing educators and instructional designers integrated competency statements from the American Nephrology Nurses Association's Nephrology Nursing Scope and Standards of Practice (9th ed.) into a nurse residency program, which positively impacted competency obtainment, role confidence, and retention data for this population of nephrology nurses.
The study investigated the decision-making process of patients with end stage kidney disease in choosing a dialysis modality. It used a mixed-methods approach to assess individual characteristics impacting decision-making in shared decision-making. Data collection involved an online survey. The study revealed that participation in shared decision-making was notably higher when patients had provider support. Those opting for peritoneal dialysis experienced lower decisional conflict compared to those opting for conservative care, hemodialysis, and transplants. Findings indicated that active participation in shared decision-making is associated with decreased decisional conflict. Moreover, higher decision self-efficacy correlated with decreased decisional conflict and contributed to predicting satisfaction with the decision. A strong rapport between patients and clinicians and patients engaging in shared decision-making with their health care provider could enhance satisfaction with the decision.
Improving Continuous kidney replacement therapy (CKRT) Outcomes in Neonates and Infants Through Interdis ciplinary Collaboration (ICONIIC) is a multicenter quality improvement and research registry. We aimed to identify programmatic structures and educational practices for neonatal and infant CKRT. A survey focusing on care delivery and models, units offering therapy, staff-to-patient ratios, and education protocols was distributed to institutions in ICONIIC using the Carpediem machine. Of the 13 responding sites, 11 used the Carpediem machine in Pediatric Intensive Care Units (ICUs), 9 in Neonatal ICUs, and 8 in Cardiac ICUs. A collaborative care model was most common (69.2%). While education practices varied, all sites required nurse-specific training, and all but one mandated provider oversight during CKRT initiation. Understanding these practices may inform best practices for neonatal and infant CKRT.
Family caregivers of patients on hemodialysis (HD) experience significant burden that can impact their health and quality of life. Identifying effective strategies to reduce this burden is essential for improving outcomes for both patients and caregivers. This article highlights evidence-based strategies for addressing caregiver burden among family caregivers of patients receiving HD. A literature review was performed using EBSCOhost, ProQuest, and PubMed databases. Twenty-two related articles were identified, of which 12 met inclusion criteria. Five effective strategies were identified to reduce caregiver burden: the 5-A self-management model, stress management training, online peer mentoring programs, teach-back method based on the 'Timing it Right' framework, and peer support intervention. Nephrology nurses and health care professionals should work collaboratively to identify caregiver needs and offer appropriate tools to reduce burden.
Emergency preparedness is a critical component of patient safety in outpatient dialysis settings, where patients rely on life-sustaining treatments multiple times each week. Disruptions caused by natural disasters, infrastructure failures, or other emergencies can threaten the continuity of dialysis care and place this vulnerable population at significant risk. Tabletop exercises have emerged as an effective strategy for strengthening emergency readiness by allowing health care teams to rehearse response procedures in a structured, low-risk environment. These scenario-based simulations promote active engagement, interdisciplinary communication, and real-time problem-solving, while helping organizations identify operational gaps in existing emergency protocols. This article describes the creation and implementation of a tabletop exercise for a rapidly escalating emergency - a hurricane with a changing path and rapid intensification.
The pilot transition from outsourced to in-house hemodialy sis (HD) services at a 274-bed acute care hospital resulted in significant cost savings, operational improvements, and enhanced patient care. By adopting an advanced in-house HD model, the pilot hospital reduced per-treatment costs by 89.2%, eliminated outsourced vendor-imposed penalties, and achieved a 0% turnover rate among nephrology nurses. A structured, multidisciplinary strategy streamlined workflows and improved staff engagement. The pilot's success catalyzed system-wide expansion over four years across eight hospitals, demonstrating financial sustainability, scalability, and clinical benefits of an in-house HD model.
The purpose of this study was to assess the knowledge of individuals with or at risk for chronic kidney disease (CKD) and whether that knowledge differed as a function of race, socio-economic status, education level, and rural/urban living status. Knowledge about kidney disease is important to prevent or manage CKD. Data for this descriptive research were collected from 519 adults living in Alabama, reflecting diversity in age, gender, and race. Knowledge deficits were identified. Nephrology nurses have a role in preventing and promoting early diagnosis of CKD through education of individuals and communities to ensure people realize kidney health matters.
