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Nephrology Nursing Journal News Briefs
Case Report: Delivering a Full-Term Baby While on Hemodialysis is Possible
For women with chronic kidney disease (CKD), getting pregnant is very rare, and a successful pregnancy is even more uncommon, especially for women on dialysis.
In the July-August 2008 issue of Nephrology Nursing Journal, Mary Coyle and co-authors present a case report of a 35-year-old woman with Stage 5 CKD who successfully completed a 39-week pregnancy while on hemodialysis. The pregnancy was diagnosed at seven weeks, and five three-hour hemodialysis sessions per week were started right away, say the authors.
A care team was assigned to the patient and her family, which included a nephrologist, a dialysis center nurse practitioner, a nurse manager, a dietician, a social worker, and a core group of nurses who would dialyze her. This group, say the authors, was crucial in monitoring signs and symptoms and maintaining a continuum of care. The care team used recommendations in the available literature to manage blood urea nitrogen levels, fluid removal by ultrafiltration and other issues.
The nurse practitioner also shared status updates with the perinatologist and perinatal center nurse practitioner throughout the pregnancy. The perinatologist saw the patient every two weeks and with greater frequency when she reached 24 weeks.
The patients anemia worsened during the pregnancy, and she also developed hypertension, pre-eclampsia and polyhydramnios, all common among women on dialysis. Despite these complications, fetal heart rate testing and OB ultrasounds revealed an active, growing fetus. A scheduled cesarean section took place at 39 weeks, and the patient delivered a five-pound, seven-ounce daughter. Mother and baby were discharged after five days.
Coyle and co-authors say that they were fortunate their patient was highly motivated and committed to following treatment guidelines. While some limited data currently exists, they say more extensive research is needed to determine appropriate guidelines, better understanding of risks and clear indications of how medications and treatments affect the fetus. (A Successful 39-Week Pregnancy on Hemodialysis: A Case Report; Mary Coyle, MS, FNP; Elyn Sulger, BSN, RN, CNN, CAN-BC, CPHQ, LNC; Cindy Fletcher, MSW, LMSW; and Diane Rouse, MS, RD, CDN; Nephrology Nursing Journal; July-August 2008; www.annanurse.org/journal)
Smoking Cessation Reduces Cardiovascular Risks in CKD Patients
Nearly 47.5 million Americans currently smoke, and the habit is one that increases the risk and progression of chronic kidney disease (CKD). Patients with CKD also develop cardiovascular issues as the disease worsens, and researchers are calling for more studies that will help reduce cardiovascular mortality in this patient group.
Smoking cessation may decrease cardiovascular disease as well as slow the progression of CKD. In the July-August 2008 issue of Nephrology Nursing Journal, Harold J. Manley and Nicole M. Stack describe smoking cessation therapies for the CKD population, an area in which little guidance exists.
Because nicotine use is an addiction, Manley and Stack say it requires pharmacologic as well as behavioral interventions. They review a variety of drug therapies, including nicotine replacement therapies (NRT), which supplement the need for nicotine; buproprion, a non-nicotine-containing medication which reduces a patients craving; and varenicline, which targets tobacco dependence by reducing cravings and blocking the pleasurable sensations of nicotine. The authors say clinicians should use reduced doses of bupropion and varenicline and recommended doses of NRT.
Manley and Stack report only three studies to date have investigated the effects of smoking cessation on kidney function preservation, and say more research in this area is needed. They advise making concerted efforts to encourage CKD patients to stop smoking. (Smoking Cessation Therapy Considerations for Patients with Chronic Kidney Disease; Harold J. Manley, FASN, FCCP, BCPS; Nicole M. Stack, PharmD; Nephrology Nursing Journal; July-August 2008; www.annanurse.org/journal)
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Nephrology Nursing Journal is a refereed clinical and scientific resource that provides current information on a wide variety of subjects to facilitate the practice of professional nephrology nursing. Its purpose is to disseminate information on the latest advances in research, practice, and education to nephrology nurses to positively influence the quality of care they provide. For more information, visit www.annanurse.org/journal.