COVID-19 is a new crown virus of the beta coronavirus genus that originated in bats. The virus first emerged in China in December 2019 and has since spread rapidly to other areas of the world; in Italy the region most affected was Lombardy.

The infection caused by the virus manifests itself in most cases as an infection of the lower respiratory tract that leads to fever, cough and dyspnoea, while more serious cases can lead to respiratory failure and/or multi-organ failure.

Patients undergoing renal replacement therapy have a fragility related to the overlap of multiple pathologies, and the sharing of the same microclimate during dialysis sessions significantly increases the risk of transmission and spread of the infection among patients and among healthcare professionals. The frequency of exposure of dialysis patients to infectious diseases also increases the risk of poor nutrition in a vicious circle of malnutrition–infection–malnutrition. Therefore, prevention, protection, screening and isolation measures can minimise the risk of transmission for patients and for healthcare professionals.

Working together on the further development of tools such as telemedicine, robotics, video communications, international protocols and best practice sharing can improve the efficiency and maybe the weapons the world needs to combat coronavirus.

Clinical renal physiologists (formerly known as dialysis technicians) have been performing renal replacement therapies and associated procedures in Australia since the 1960s. In the context of increasing patient numbers and a forecasted nursing shortage, clinical renal physiologists are a viable complementary workforce option that is seen globally. However, this highly competent and experienced workforce was potentially vulnerable in terms of numbers and sustainability, largely due to ambiguities around scope of practice and external governance. This prompted investigation into more robust and transparent regulation, with New Zealand identified as having a workforce similar to our own in Australia. Development and implementation of a trans-Tasman governing body provides increased confidence to employers and consumers by mandating regulatory processes including qualifications, education and training requirements, scope of practice, competency standards, continuing professional development, as well as registration, certification and recertification requirements.

Objectives Rhabdomyolysis is defined as a clinical syndrome due to skeletal muscle injury resulting in the release of muscular cell constituents into the circulation. There is a varied spectrum of severity of rhabdomyolysis. The purpose of this study was to analyse the incidence, aetiologies, biochemical variables and complications in patients with rhabdomyolysis at a regional tertiary hospital over a 10-year period.

Methods A retrospective review of patients from May 2006 to May 2016 with a diagnosis of rhabdomyolysis was undertaken. An episode of rhabdomyolysis was defined as acute elevation of serum creatine kinase (CK) value greater than five times the upper limit of normal (>1000U/L). Data extracted included: patient demographics, aetiology of rhabdomyolysis, peak serum CK, renal function, use of kidney replacement therapy (KRT) and death.

Results Of the 631 patients identified, 248 were excluded based on: a diagnosis of myocardial or cerebral infarction; serum CK levels not meeting the criteria for rhabdomyolysis; and duplicated or inadequate data from medical records. A total of 383 patients, 220 males and 163 females, of median age 71 years, were analysed. The leading cause of rhabdomyolysis was prolonged immobility (71.5%). 194 patients (50.7%) developed an acute kidney injury (AKI), 9.9% required KRT, and 7.6% died.

Conclusion In this 10-year review of 383 cases of rhabdomyolysis, the most common cause was prolonged immobility, rhabdomyolysis was more common among males, and half of the patients developed an AKI.

Background With the increasing age and complex comorbidities of dialysis patients globally, there has been increased attention to planning for end of life care (EoLC) and advanced care directives.

Objectives We sought to understand the thoughts and experiences of dialysis patients in relation to EoLC planning.

Methods An eight-question closed-ended survey at two time points 12 months apart through our Renal Supportive Care Program. All people undergoing dialysis in the service were invited to participate.

Results There were good response rates to the survey at both time points (T) (T1 n=224 T2 n=247) and, for the majority, planning for EoLC was considered to be very important (80%). However, only 23% reported having a conversation with their healthcare provider regarding advanced care directives and only 30% had documented their future care goals. At T2 there was an increased awareness of planning in this population which resulted in an improvement in advanced care directives (40%). This study suggests that there is a subgroup of patients who are aware of advanced care directives but do not have any in place.

Conclusion There is an ongoing reluctance in dialysis units by patients to have a conversation with their healthcare providers regarding advance care directives despite this population being at heightened risk of deterioration. This is likely impacting on the delivery of complex and possibly unnecessary and unwanted invasive care in the last year/s of life.