Palliative Care for Thai Older Adults with Chronic Kidney Disease: A Scoping Review.

Palliative care is an effective way to alleviate suffering and improve quality of life in older adults with end stage kidney disease (ESKD). The purpose of this scoping review was to identify gaps in available evidence about current and future needs for palliative care in community-residing older adults living in Thailand with advanced chronic kidney disease. Four essential elements (community, education, research, and nursing practice) were found related to older adults with ESKD, their families, and limited graduate palliative care education. Results support the need for graduate nursing education to meet the needs of a growing ESKD population in Thailand and other countries, including the United States.

Iron-Deficiency Anemia in CKD: A Narrative Review for the Kidney Care Team.

Anemia is a common complication of chronic kidney disease (CKD) and is associated with increased mortality and reduced health-related quality of life. Anemia is characterized by a decrease in hemoglobin, the iron-rich protein that the body uses for oxygen transport. Iron is required to produce hemoglobin, and disruptions in the iron homeostasis can lead to iron-deficiency anemia. Management of anemia in individuals with CKD is typically performed by a team of physicians, nurse practitioners, physician assistants, or registered nurses. Throughout the care continuum, the management can be enhanced by multidisciplinary care, and individuals with CKD can benefit from the involvement of other specialties, with dietitians/nutritionists playing an important role. However, a key area of unmet clinical need is how to assess and address iron-deficiency anemia. This review aims to provide an overview of iron-deficiency anemia in CKD and how this may be diagnosed and managed by the entire kidney care team, such as describing the mechanisms underlying iron homeostasis, the complications of iron-deficiency anemia, and the current challenges associated with its diagnosis and treatment in CKD. Opportunities for each multidisciplinary team member to add value to the care of individuals with CKD and iron-deficiency anemia are also described.

Detecting dementia among older, ethnically diverse residents of rural subsidized housing.

Rural, ethnically diverse residents face at least twice the risk of Alzheimer's disease than urban residents. Chronic diseases such as diabetes and hypertension which increase dementia risk are more prevalent in rural areas with less access to specialty providers. A home-based approach for increasing dementia detection and treatment rates was tested among rural residents of government-assisted independent living facilities (N = 139; 78% non-White, and 70% with health literacy below 5th grade). Of 28 residents identified at risk during cognitive screening, 25 agreed to further in-depth assessment by adult gerontological nurse practitioners (AGNP). Fifteen of 25 (60%) completing consequent primary provider referrals were diagnosed with dementia and receiving new care (statistically significant; [χ2(1) = 76.67, p < .001, Phi = 0.743]). Home-based dementia management through a community engagement approach can help to meet the Healthy People 2030 goals of earlier detection and treatment and reduce the length of costly institutionalizations.

Administration of Etelcalcetide for the Treatment of Secondary Hyperparathyroidism in Patients with CKD-MBD on Hemodialysis: A Nephrology Nursing Perspective.

The number, volume, and timing of oral medications prescribed to treat secondary hyperparathyroidism can add to the burden of disease management for both the patient and the nurse. Administering intravenous (IV) medication when possible has the potential of reducing the burden of medication management. Data on the use of IV calcimimetic etelcalcetide has shown improvement in blood calcium, phosphorus, and parathyroid hormone levels. IV administration of etelcalcetide at the end of each hemodialysis session may reduce the pill burden for patients and has the potential to help improve disease management within an environment that supports person-centered care.

IV Iron: To Give or to Hold in the Presence of Infection in Adults Undergoing Hemodialysis.

Intravenous (IV) iron is often given to treat iron deficiency anemia in adults undergoing hemodialysis. Evidence supports an association between IV iron and infection exits, which often create a clinical dilemma: whether to give or to hold in the presence of infection. This article presents the best available evidence regarding the risk of IV iron and infection along with nephrology nursing practice implications.

The perfect storm: older adults and acute kidney injury.

Older adults have a high risk for acute kidney injury (AKI), often necessitating critical care admission. The majority of older adults live with 1 or more chronic conditions requiring multiple medications, and when faced with acute illness increased vulnerability can lead to poor health outcomes. When combined with circumstances that exacerbate chronic conditions, clinicians may witness the perfect storm. Some factors that contribute to AKI risk include the aging kidney, sepsis, polypharmacy, and nephrotoxic medications and contrast media. This paper discusses specific risks and approaches to care for older adults with AKI who are in critical care.