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Dear Colleague,

The Anemia Wall of Experts: a focus on iron deficiency in CKD provides expert answers to 7 selected key questions on this topic. This program, accredited by the Canadian Society of Nephrology (learning activity for Royal College MOC credits), assembled a faculty of 6 experts to provide answers to these selected questions:
  1. How does one diagnose iron-deficiency anemia in CKD and how do you differentiate between absolute and functional iron deficiency?
  2. How do you select and adjust the dose for iron therapy?
  3. When should you initiate iron therapy and what methods do you use to guide iron repletion decisions?
  4. What impact does iron repletion have on ESA use?
  5. What are the key differences between IV and oral iron?
  6. What are the key differences between the IV irons with respect to composition, molecular weights and monitoring?
  7. What are the key differences between the IV irons with respect to adverse-event profiles and safety data?
View the content:



PEOPLE TO PEOPLE NEPHROLOGY DELEGATION TO SOUTH AFRICA – 11-20 APRIL 2011

INTRODUCTION
People to People Citizen Ambassador Programs provides a unique opportunity for professionals to network, learn, and serve other countries through humanitarian efforts. A delegation of professionals specialising in Nephrology Nursing visited South Africa during April and had discussions with different health care institutions, universities and organisations. The RCSSA, SARS and the Cape Kidney Association were honoured to spend Tuesday 19th April with the delegation, not only sharing the status and challenges of Nephrology Nursing in the USA and South Africa, but also visiting different renal and transplant units in Cape Town.

DELEGATION DETAILS
Leslie Dinwiddie (MSN, RN, FNP, CNN):
Delegation leader:
Senior Vice President
ICEER
Cary, North Carolina, USA

Ms. Dinwiddie currently works as a Nephrology Nurse Consultant for Vascular Access for Haemodialysis: Education and Research and is the Senior Vice President for the Institute for Clinical Excellence, Education and Research (ICEER). She was a consultant to MARC, Network 5, for Fistula First QAPI in 2009-2010 and was a Delegation Leader for a Professional Nephrology Nursing People to People experience in October 2008 and November 2009.

She received the Outstanding Contribution to ANNA Award in 2010, the ANNA Clinical Practice Award in 1998; a Citation in the Congressional Record of 2006 by Representative David Price; and was the recipient of the North Carolina Great 100 Award in 2001.

MS. OLIMPIA M. ANTONIE
Registered Nurse, Henry Ford Health System, Belleville, Michigan, USA
Olimpia Antonie has been a Registered Nurse for the last 6 years, working as a nephrology nurse with primary clinical special interest in acute care, transplantation, chronic kidney disease, haemodialysis and peritoneal dialysis.

MS. RHONDA L. CHAPIN, RN
Wood Ranch, California, USA


MRS. LOIS G. FOXEN, RN, CNNE
Retired, Orange, California, USA
Mrs. Foxen was the first overseas guest speaker the RCSSA invited to South Africa in 1978. She was the President of ANNA during 1978 and 1979 and was instrumental in assisting the RCSSA to become part of the Associations to organise the World Congress of Nephrology Nursing and Technology.

MS. NANCY LUISA RUTH
RN, Retired, Bruceton Mills, West Virginia, USA
Nancy Ruth is a retired charge nurse in an acute care university hospital setting. She has been a 15 year ANNA member. Ms. Ruth was a Certified Nephrology Nurse for 13 years and received the 2008 Clinical Practice Award.

MS. EDWINA A. SAMSON
Registered Nurse, Irving, Texas, USA
MS. JENNY SUE STEED RN, CNN, TC
RN, CNN, TC, Sentara, Norfolk, Virginia, USA

MS. WANDA Y. WILLIS
Forestville, Maryland, USA
Wanda Willis is currently employed part time as a Renal Nurse Practitioner for two nephrologists. She also works part time as an acute (home) nephrology nurse between 3 Maryland hospitals. She’s been in nephrology for seventeen years and conducts weekly dialysis rounds in free standing dialysis units, 2 nursing homes and conducts the patient education workshop.

PROGRAMME 19TH APRIL 2011
Venue: Southern Sun Cape Sun

Presentation by Cape Kidney Association:
Ms. Molly Fabe, fund raising coordinator/manager gave an overview of CKA as a grassroots non-profit organisation that raises funds to assist with the needs of patients and families suffering from chronic kidney disease. The Delegation gave input on similar organisations in the USA and congratulated CKA with their work and outreach programmes.

Presentation by SARS: Dr. Julian Jacobs: Current Nephrology car in SA
Dr. Jacobs highlighted the following aspects:

  • Population statistics in South Africa as well as the GDP stance of SA in the world and a health review
  • Milestones in Nephrology care in SA
  • Renal services per province
  • Criteria for dialysis and transplantation
  • New developments with transplantation of HIV positive patients
Presentation by Dr. Heilie Uys : History and development of Nephrology Nursing of South Africa
This presentation included the following:
  • Founding of RCSSA and the start of national and international networking
  • Inter-continental outreach
  • Profile of RCSSA membership
  • RCSSA projects
  • Training of Nephrology Nurses
  • Statistical analysis of nursing in SA in comparison with the rest of the world
  • Nephrology Nursing challenges
Presentation by Mrs. Esme De Beer: Challenges facing Nephrology Nursing specific and nursing in SA in general
Mrs. De Beer Linked onto the previous presentation but elaborate on national challenges as discussed during the recent National Nursing Summit. It was surprising how the same challenges facing SA, are also the challenges facing nursing in the USA. She highlighted the following:
  • Lack of caring attitude of nurses
  • The standards of nursing and the influence of moonlighting on service delivery
  • Socio cultural influence on health care
  • Government-Private partnerships
Visiting renal and transplant units Francis Jacobs arranged for the Delegation to visit renal and transplant units at Groote Schuur Hospital and the Goodwood NRC renal unit

SUMMARY
It is with great appreciation that we thank the People to People Nephrology Nursing delegation not only for their visit but also for sharing their expertise, knowledge and friendship. It is opportunities like this that we realise how important international contact is in order to face the challenges in Nephrology in South Africa.

Heilie Uys
(RN, CNN, PhD)
28 April 2011




PERSPECTIVE ON KIDNEYS

THE NEED vs. THE REALITY

“End stage kidney disease is increasing amongst South Africans. Dialysis is the first form of intervention to patients affected by kidney failure. If patients do not get kidney donors they can wait for a long time on dialysis and that places a heavy burden on national resources.”

It is estimated that 10% of people worldwide have chronic kidney disease. In South Africa the annual incidence of end stage renal failure is roughly estimated to be 200 and 400 patients per 1 million of the population. This translates to 2 to 4 people out of 100 of the population that will go into kidney failure every year. These are the people that would need dialysis with the hope of finding a suitable donor for a kidney transplant.

The reality is that there are only about 4,000 patients on dialysis in SA. This is the number of kidneys needed for imminent transplantation. There was however only 290 kidneys transplanted in 2009. In addition there were 21 kidneys transplanted together with other organs.

WHAT DO OUR KIDNEYS DO?

Our kidneys are filters which support the various functions of all our organs other than the brain. Kidneys manufacture essential chemicals, they break down (metabolize) unnecessary or dangerous substances, they retain necessary substances and they eliminate toxic waste.

In everyday life, our kidneys filter about 150 litres of fluid but keep back (reabsorb) about 148 litres of fluid and useful substances like protein while the waste is excreted in about 2 litres of urine per day.

Problems with our kidneys can be caused by:
  • high blood pressure (putting more stress on the blood vessels throughout the body, including the kidneys)
  • diabetes mellitus (where there is a deposition of substance that causes the kidney filters to be gummed up)
  • inflammation of the kidney (glomerulonephritis)
  • blockage (may be caused by kidney stones that are formed by crystallisation of chemicals in the urine)
  • hereditary aspects (may cause the development of cysts or a predisposition to cancer of the kidneys)
  • trauma to the kidneys (accidents and injury caused by medication, drugs, poisons and radiation)


OTHER CONDITIONS THAT CAN CAUSE KIDNEY FAILURE

There is great concern internationally about the incidence of high blood pressure and diabetes that is on the rise. These conditions put unnecessary strain on the kidneys and it is estimated that more than 50% of people with diabetes will develop kidney problems while high blood pressure is known as the most common cause of kidney problems, especially in SA.

WHAT CAN YOU DO TO PREVENT KIDNEY DISEASE AND KIDNEY FAILURE?
In order to prevent the occurrence of kidney disease it is important that the following principles must be promoted:
  • QUIT SMOKING
    People who smoke are three times more likely to have reduced kidney function.
  • LIMIT ALCOHOL
    Excessive alcohol intake can lead to heart disease and high blood pressure, increasing the risk of kidney disease.
  • EXERCISE
    The benefits of regular exercise can help to reduce the risk of developing heart disease and diabetes which are risk factors for kidney disease. It is suggested that you exercise for 30 minutes on at least 5 days a week.
  • NUTRITION
    People with kidney disease may need to make some dietary changes to help manage their condition. It is very important that these changes must be discussed with the treating physician to create an individual diet plan.
For the prevention of kidney disease and for healthy living even if there is no or limited risk of kidney disease it is important that the following guidelines should be adhered to:

Dietary tips:
  • Limit salt in the diet to the absolute minimum. (Processed foods, spices and condiments, pre-prepared foods and take-aways normally have high salt content and should be avoided.)
  • Avoid saturated fats such as chicken skin, fat on meat and dairy fat.
  • Be aware of the sugar content in food and drinks and avoid excessive intake of sugar.
Tips for drinking:
  • Make water the tipple of choice. Water assists in transporting nutrients around the body, as well as helping to eliminate waste.
  • Limit the intake of caffeine and cola. These can irritate the bladder and can act as a diuretic.
CONSULT WITH YOUR HEALTH CARE WORKER / DOCTOR
Kidney problems can easily be detected by doing a urine dipstick test, taking a blood pressure and a few further investigative tests if anything abnormal is found. These examinations should de done at least once a year, especially if there is a family history of hypertension or diabetes or if there is a high risk because of smoking, obesity or stress.

Prevention is always better than cure but if there are no alternative a kidney transplant is one of the safest and most successful procedures in the field of organ transplantation. The NKFSA collaborates with the Organ Donor Foundation (ODF) in this regard and they will be able to supply the necessary information to register as a donor. The ODF can be contacted on 0800 22 66 11 or by visiting their website at www.odf.org.za

For more information contact THE NATIONAL KIDNEY FOUNDATION by e-mail: nkfsa@mweb.co.za or on telephone number 011 447 2531.

Please forward information about your planned events during Kidney Awareness week to the Secretary, Karlien van Jaarsveld at kvanjaarsveld@tiscali.co.za for placement in the next Newsletter