Caring together

43rd EDTNA/ERCAInternational Conference

September 6–9, 2014The Conference and Event Centre

Radisson Blu Hotel Latvija, Riga, Latvia

Conference Theme: Patient-centred renal care –A Multidisciplinary Approach to Holistic Healthwww.edtnaerca.org

EDTNA2014_inzA4.indd 1 8.11.13 8:46

43rd EDTNA/ERCAInternational ConferenceSeptember 6-9, 2014The Conference and Event CentreRadisson Blu Hotel Latvija, Riga, Latvia

Conference Theme: Patient-centred renal care – A Multidisciplinary Approach to Holistic Health

Preliminary Programme & Call for Abstracts

Maria Saraiva

Maria Saraiva

European Dialysis and Transplant Nurses Association/ European Renal Care Association

News43rd EDTNA/ERCA, International Conference, Riga, Latvia

Angela Henson

D.L.

: M-9

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| Spring Edition | 2014

Jitka Pancirova

EditorMaria Cruz Casal - Spain

Co-Editors

CROATIAMarjelka Trkulja

CzEChJitka Pancirova

DuTChSusan Rogers – The NetherlandsChrista Nagel Theodor Vogels Ronald VisserKrijntje Kruimel

FRENChMichel Roden Michel Lambotte

GERmANThomas Fernsebner – Germany

GREEkMarianna EleftheroudiIrini KokkinidiMaria Tachmazoglou Theodora KampouroglouEfi Kotzamanidou

hEbREwEvgenia Golland

ITAlIANRoberta Mereu – Italy

lIThuANIANIrmina Vaicekauskyte – Lithuania

POlIshAnna Klis

PORTuGuEsEMaria Saraiva – Portugal

RussIAN Edita Nourisiene - Lithuania Irina Cecenikova

sERbIANBožica Stupar – Serbia

slOvENIANSonja Pecolar – Slovenia

sPANIshCarlota Hidalgo - Spain

TuRkIsh Mukadder Mollaoğlu - Turkey

English ReviewersAngela Henson – Australia/ New ZealandMarissa Dainton – United Kingdom Emer Kenny - Ireland

Dr. Helen Noble

Dr. Karen Pugh-Clarke

lesley bennettkaren Jenkins

1

Karen Jenkins IDA Advanced Level August 2013

European Dialysis and Transplant Nurses Association/ European Renal Care Association

Understanding Iron Deficiency Anaemia in Chronic Kidney DiseaseInformation at Advanced Level. Karen Jenkins RN, PGDip HE, MSc

Learning outcomes1. Understand markers used to define iron deficiency

anaemia in chronic kidney disease2. Understand types of iron deficiency and when to treat3. Gain knowledge and understanding of the medicines available to treat iron deficiency in chronic kidney dis-ease

4. Understand how guidelines can be used in practice

Introduction

Iron deficiency is a public health problem and the most com-mon and widespread nutritional disorder in the world1. A defi-ciency of iron leads to a reduction of the normal physiological function of tissues in the blood, brain, and muscles. This can be detected by the symptoms of iron deficiency anaemia such as fatigue, breathlessness, deterioration in concentration and reduced exercise tolerance. The onset is often insidious and the symptoms can are similar to those experienced in chronic kidney disease (CKD) itself, diabetes and heart disease.Iron deficiency anaemia (IDA) is common in people with

CKD, particularly those with stage 3B, 4 and 5 CKD2 and in patients with both diabetes and CKD3. Reduced iron levels in CKD can be caused by:

• Bleeding (Patients with CKD have a tendency to bleed due to platelet dysfunction)• The inability to absorb iron from food• The demand made on iron stores by the use of eryth-

ropoiesis stimulating agents. • Haemodialysis blood loss

The causes of IDA which apply to the general population can also apply to people with CKD and should not be excluded when investigating IDA. These include:

• Dietary iron deficiency• Gastrointestinal disorders• Infectious diseases e.g. malaria, tuberculosis• Acquired immunodeficiency syndrome (HIV/AIDS)

• Haematological disorders e.g. thalassaemia• Blood loss

As iron has an essential role in the process of myoglobin and haemoglobin synthesis and lack of iron leads to a reduc-tion in the function of tissue in the brain, muscles and blood4. There are five stages of IDA

• Normal iron status (normal iron indices)• Latent iron deficiency ( reduction of iron stores)• Iron depletion (no iron stores)• Iron deficient erythropoiesis ( reduced iron transpor-tation)

• Iron deficiency anaemia (microcytic, hypochromic anaemia)

Adequate iron stores are required to support the process of erythropoiesis. As red cell production increases, iron stores decrease and therefore need to be maintained. (150mg iron is required to raise haemoglobin by 1g/dl). 65% of iron stored in the body is used to form haemoglobin. If there are inadequate iron stores red cell survival is reduced. In people without CKD normal red cell survival is 120 days, in CKD it is ~ 90days.

Markers used to define Iron deficiency in CKDThere is ongoing debate as to the most accurate test to use

to measure iron status. WHO1 recognise that prevalence of iron deficiency has been derived from the prevalence of anae-mia related to haemoglobin measurements. It is important to note that not all people with anaemia are iron deficient and that iron deficiency can occur without anaemia5.

A variety of tests can be used to diagnose IDA:• Full blood count; • red cell indices• mean corpuscular volume (MCV)• mean corpuscular Hb Concentration (MCHC)• mean corpuscular haemoglobin (MCH)• Serum ferritin

• Serum % transferrin saturation

Advanced Level

1

Helen Hurst et al, EPS; February 2014

European Dialysis and Transplant Nurses Association/

European Renal Care Association

Encapsulating Peritoneal Sclerosis (EPS)

Information at Expert Level. Dr Helen Hurst, Dr Angela Summers, Mr Titus Augustine; Dr Anand Vardhan, Mr David Van Dellen

Manchester Royal Infirmary, Central Manchester and Manchester Children’s NHS Foundation Trust (CMFT), Manchester

Institute of Nephrology and Transplantation (MINT), UK

Contact: Helen.hurst@cmft.nhs.ukThe aim of this paper is to provide an overview of EPS and

relate it to clinical practice.• To help health care professionals (HCPs) understand

the pathophysiology of EPS• To identify early signs and symptoms and patients at

risk• To examine the clinical features of EPS• To guide HCPs when it is appropriate to refer patients

to a specialist centre for interventions. Introduction

EPS is a rare but serious complication of peritoneal dialysis

(PD) and can be fatal. In the last ten years there have been

several publications on incidence and research in the field of

EPS, yet many aspects of EPS are still not fully understood.

Various terms have previously been used for the condition, but

encapsulating peritoneal sclerosis best describes the morpho-

logical process, in which acute inflammation or peritonitis may

be absent during later stages of the condition1.Patients diagnosed with EPS face a potentially life threat-

ening condition and the prospect of major surgery, with often

prolonged periods in hospital and lengthy recovery time. This

can affect their quality of life and cause immense distress to

them, their families and carers. With increased awareness and

continued research the patient experience can only be en-

hanced as HCPs endeavour to provide better treatments to

patients. The rarity of the condition however makes this task

difficult.

Diagnosis

The diagnosis of EPS remains a contentious issue as gold

standard criteria cannot be simply applied. Patients who ex-

perience EPS may have had symptoms for several months,

in many cases undetected. The criteria initially recommended

by the International Society of Peritoneal Dialysis (ISPD) have

been updated to include four stages to EPS 2. An ISPD posi-

tion paper also describes the diagnostic criteria 3. Another re-

view suggests a structure for reporting EPS and includes his-

tological and macroscopic appearances 4. Table one combines

these reports but does not include all the features.

Table 1 Diagnosing EPSDiagnostic Criteria FeaturesClinical Features and Symptoms Gastrointestinal :• Initially mild, occasional nausea, vomiting, indigestion

• Progressively worsening, anorexia, weight loss, pain, vomiting and alteration of bowel habitus• Obstructive symptoms then

occur requiring interventionInflammatory:• Raised CRP, hypoalbuminaemia• Prolonged sterile peritonitisMembrane Function/PD:• Change in peritoneal transport status• Ultra filtration failureHaemoperitoneumRadiological Features Computerised tomography (CT)

will only show evidence of later stages but include:• Peritoneal calcification• Bowel thickening• Bowel tethering• Bowel dilatationLoculation

Surgical Features• Sclerosis or tanning of small

bowel• Encapsulation• Calcification

Macroscopic• Sticky fibrin coating the peritoneal membrane • Classical cocooning with a sclerotic capsule

HistologicalNot yet described well in detail to be used as specific for diagnosis but includes:• Vasculopathy• Acute inflammation• Chronic inflammation

Expert Level

AGM Call for Motion

AGM

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