Background The management of chronic kidney disease (CKD) is challenging, particularly for people with low health literacy. There is a paucity of literature evaluating the multifaceted dimensions of health literacy in CKD populations. The aim of this study was to examine the health literacy of people with end-stage kidney disease (ESKD) attending renal services in a single local health district in Sydney, New South Wales, Australia.

Method A cross-sectional analysis of health literacy in a mixed ESKD population. Health literacy was measured using the validated Health Literacy Questionnaire (HLQ) that explored nine domains of health literacy.

Results A total of 102 people with ESKD were surveyed. Domains with the highest levels of adequate health literacy included feeling understood and supported by healthcare professionals (88%) and having social support for health (80%). Over 50% of participants were classified as having inadequate health literacy related to the ability to find good health information and understanding health information well enough to know what to do. Factors associated with higher levels of health literacy included attending a multi-disciplinary clinic, living alone, being born in Australia, having English as a first language, not having an emergency admission in the past 12 months, and being able to complete the survey alone.

Conclusion There are high rates of poor health literacy in ESKD. Future evaluation of novel factors, such as the potential impact of multi-disciplinary teams on health literacy, should be investigated. Future research should evaluate the impact of interventions targeting aspects of health literacy.

The review intends to look into the benefits, impacting factors, preserving strategies especially haemodialysis (HD)-related factors and strategies as well as clinical practice implications of residual renal function (RRF) among patients on HD. Databases of Medline (Ovid), CINAHL Plus with full text (EBESCO), Embase (Ovid) and Pubmed (from January 2000 to December 2018) were searched for relevant study reports and reviews and 78 full articles were included. RRF confers a wide range of benefits for people on HD. It brings a strong survival advantage for HD populations. It provides continuous water and sodium excretion and clears middle molecular weight and protein bound uraemic toxins more efficiently. RRF also brings better management of anaemia, mineral and bone disorder, and leads to lower risk of arteriosclerosis, better nutrition and better quality of life (QOL). Intradialytic hypotension (IDH), inflammation, volume derangement, dialyser bio-incompatibility are important HD-related factors accelerating RRF decline after the initiation of HD. Studies also elucidate that incremental HD, haemodiafiltration (HDF) and peritoneal dialysis (PD) or a combination of PD and HD modality may better preserve RRF. Based on the available evidence, nephrology nurses can improve clinical practice to assist in preserving RRF among HD patients. These clinical practice implications include preventing IDH, improving dry weight assessment and volume control, advocating for incremental HD, promoting HDF, PD modality or the combination of PD and HD, improving infection control to decrease systemic inflammation, using a dialyser with further improved biocompatibility as well as promoting diuretic agents’ adherence.

Background There is substantial variation in peritonitis rates across peritoneal dialysis (PD) units globally. This may, in part, be related to the wide variability in patient selection and pre-dialysis assessment prior to commencement of home training.

Aims This study aimed to evaluate whether performing a pre-dialysis assessment using a well validated assessment tool, JPAT (Jo-Pre-training Assessment Tool), before the patient commenced PD affected patient outcomes positively, and subsequently reduced PD-related complications.

Study design This is a retrospective file audit of all incident patients who commenced PD at home from 1 July 2014 to 30 June 2016 in a metropolitan PD Unit in Sydney. Data collected included demographics, pre-dialysis assessment, JPAT score, peritonitis episodes and commencement date of PD. Local Ethics Committee approval was sought prior to commencing the study. Outcome measures included time to first peritonitis episode and length of time on PD.

Results The medical records of 155 patients who commenced PD were collected. The results showed that there was no significant statistical difference (p=0.494 >0.05) for the onset of peritonitis between patients who received pre-dialysis education or had a JPAT attended and those that did not.

Conclusion The use of a validated tool to assess patient suitability for PD to enhance patient outcomes has not been demonstrated in this study. The timing the JPAT was attended may have impacted on the outcome of the study as patient issues may have developed following assessment and prior to the commencement of dialysis.

Background Uraemic pruritus is a common symptom in end-stage kidney disease (ESKD) with a documented poor response to standard medical treatment. Patients seeking relief may self-medicate using complementary and alternative medicine (CAM), often without medical supervision. Healthcare professionals seeking to alleviate discomfort may be reluctant to promote CAM usage due to scant evidence on efficacy and effectiveness.

Aim To systematically review the use of CAM for pruritus management in patients with ESKD.

Method MEDLINE, CINAHL EMBASE, Cochrane databases, grey literature and hand searches occurred using specific MeSH terms. Studies using CAM in the treatment of symptoms for ESKD patients experiencing pruritus were considered relevant. Articles available in English, written from 2000 and later were appraised using the Joanna Briggs Institute (JBI) critical appraisal tools.

Results 193 studies were screened as per the inclusion criteria. 21 studies were identified – 11 randomised controlled trials (RCTs), seven quasi-experimental, two case studies, and one cross-sectional. Interventions studied included acupressure, acupuncture, aromatherapy, homeopathy, music therapy, oral supplements, thermal therapy and topical application. Studies claiming consistent benefits were acupressure, acupuncture and aromatherapy.

Conclusion CAM encompasses multiple interventions with very few studies consistent in design and measurement, resulting in a gap in evidence on safety and effectiveness. Further research is needed incorporating standardised validated tools to establish best practice. CAM use should be discussed with patients and integrated into the health assessment process so that interventions can be safely monitored.

Background Aboriginal people requiring haemodialysis experience high cardiovascular mortality. Dietary interventions have uncertain effects on mortality and cardiovascular events in people with end-stage kidney disease (ESKD).

Aim To determine if a dietary intervention of fish and fruit would decrease all-cause and cardiovascular mortality in Aboriginal people requiring haemodialysis.

Methods A randomised dietary intervention of 300gm fish and five portions of fruit spaced over three dialysis treatments per week versus usual renal diet. Blood concentrations of omega-3 and omega-6 polyunsaturated fatty acids (n-3 PUFA and n-6 PUFA respectively) were recorded over a 12-month period.

Results The mean age of the 151 randomised patients was 53 years; 42% were males, 94% of Aboriginal people and 74% with diabetes. There was no significant difference in n-3 PUFA concentration over the follow-up. The cardiovascular mortality rate was not different between the intervention and control group assessed at 2.1 years follow-up (3.7 v 4.3%, p=0.92), or at 5.0 years follow-up (19.7% v 21.8%, p=0.93).

Conclusions The 12-month diet intervention including fish and fruit meal supplementation did not provide a survival advantage in patients with very low baseline n-3:n-6 PUFA ratio.