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.

Planning for a good death: a neglected but essential part of ESRD care.

Planning a "good death" is a neglected, but essential, part of the care of patients with end stage renal disease and their families. Many of these patients do not have advance directives and few utilize palliative care. Guidelines from medical and specialty nursing organizations regarding end-of-life (EOL) issues and palliative care have been developed, but they are not consistently used by the nephrology community. Nephrology nurses are frequently positioned to begin EOL discussions with patients and families, and advanced practice nurses are in a unique position to coordinate and facilitate a patient's transition from chronic to terminal illness and to increase the likelihood that the patient and family experience a "good death". This article reviews the need for practice improvement in EOL care and a review of the current literature.