ORCID Profile
0000-0002-8660-0175
Current Organisation
Edith Cowan University
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Publisher: Oxford University Press (OUP)
Date: 09-02-2022
DOI: 10.1093/CKJ/SFAC039
Publisher: Wiley
Date: 30-03-2018
DOI: 10.1111/JOCN.14309
Abstract: To measure the prevalence of symptomatic (S-IDH) and asymptomatic intradialytic hypotension (A-IDH) or postdialysis overhydration in a satellite haemodialysis clinic in Western Australia. Intradialytic hypotension is one of the most common side effects of haemodialysis caused by ultrafiltration provoking a temporary volume depletion. The prevalence of asymptomatic hypotension during dialysis has been rarely reported, but is considered to have the same negative consequences as symptomatic hypotension on various end organs like the brain and the gastrointestinal tract. Observational study on a retrospective 3-month period of nursing recorded fluid-related adverse events. Data collection on the occurrence of S-IDH and A-IDH during a total of 2,357 haemodialysis treatments in 64 patients. Body weight of patients at the time of cessation of treatment was recorded, and patients, whose weight exceeded their ideal body weight by at least 0.5 kg, were classified as overhydrated. Data analysis was performed using spss version 24 software. Symptomatic intradialytic hypotension was the most common adverse event measured in this cohort, and occurred during 221 (9.4%) of all treatments, whereas asymptomatic intradialytic hypotension occurred in 88 (3.7%) of all treatments. The total occurrence of intradialytic hypotension was 13.1%, and symptomatic was observed in 30 patients, implying that nearly every second patient had at least one symptomatic episode within 3 months. Overhydration occurred in a total of 103 (4.4%) of all treatments, and involved 17 patients. Symptomatic and asymptomatic intradialytic hypotension were the most commonly observed adverse events in this cohort overhydration occurrence was considerably less common. The high occurrence of hypotension-related events demonstrates that ultrafiltration treatment goals in satellite dialysis clinics are sometimes overestimated, resulting in regular significant symptomatic episodes for the patient. Raising the awareness of the prevalence of IDH amongst renal nurses could be an essential initial step before collectively preventative strategies in haemodialysis satellite units are implemented.
Publisher: Wiley
Date: 28-02-2019
DOI: 10.1111/JOCN.14804
Abstract: To evaluate the accuracy of traditional clinical predialytic fluid assessment by renal nurses and the efficacy of 2 additional fluid assessment methods focussing on the potential preventative effect for intradialytic hypotension (IDH). Predialytic fluid assessment remains a daily challenge for renal nurses, when aiming for adverse event free haemodialysis treatments. Adding further objective parameters obtained through noninvasive methods into pre- and intradialytic fluid assessment could potentially improve health outcomes for haemodialysis patients. Comparative, observational study of three fluid assessment methods on their reliability on volume status and correlation to clinical outcomes. Clinical predialytic nursing fluid assessments in 30 haemodialysis patients were compared with additional initial bioimpedance spectroscopy (BIS) measurements, and 3 serial intradialytic ultrasound scans of the inferior vena cava (IVC-US) performed by a second renal nurse concurrently during the same session. A retrospective data analysis compared all measurements in each in idual for the predictive value for IDH. A STROBE checklist for observational cohort studies was used for the reporting of results. Seven subjects experienced episodes of symptomatic intradialytic hypotension (S-IDH), which would have been anticipated by IVC-US or by BIS in 5 patients (71%). Using an algorithm to predict IDH would have provided a sensitivity of 100% and specificity of 95%. Both additional fluid assessment methods would have provided critical information before and during each haemodialysis session. Therefore, we consider them as being potentially effective for the prevention of intradialytic hypotension, with IVC-US being similar to BIS. Traditional clinical nursing fluid assessment methods in haemodialysis patients do not provide sufficient information to prevent episodes of IDH. Additional objective fluid assessment methods are useful and likely to lead to improved health outcomes in HD patients when applied by renal nurses. A combination of IVC-US, MAP and BIS has potential to reduce the risk of IDH events in HD patients significantly.
Publisher: Frontiers Media SA
Date: 26-01-2022
DOI: 10.3389/FNEPH.2021.808909
Abstract: Haemodialysis is the most common treatment method in Australia for in iduals requiring renal replacement therapy. Although it is known that the residual renal function in these patients has many advantages for their overall health outcomes and that the residual urine volume production is also declining over time, it is unknown how fast this functional decline occurs when patients are embarking on their first year on haemodialysis. This scoping review sought to determine if the functional decline in renal residual function in the first year of haemodialysis has been previously investigated, documented or quantified. The scoping review was performed using variety of nursing and medical databases comprising MEDLINE, Embase, Web of Science and CINAHL Plus with Full Text. The decline of renal residual function in patients on Peritoneal dialysis over the first year of treatment has previously been described, but not in detail for patients receiving haemodialysis. There is a paucity of knowledge how fast residual urine production can decline in patients receiving haemodialysis during their first year of treatment. A PRISMA checklist has been used to validate the results of this scoping review. The extended preservation of renal residual function in patients on haemodialysis is crucial for their survival and may have a positive impact on their quality of life. An observational study is needed to examine how fast the functional decrease of the residual urine production function within patients receiving haemodialysis generally occurs. This information could prove to be useful in the context of treatment goals and could inform clinical practice.
Publisher: Wiley
Date: 11-10-2018
DOI: 10.1111/HDI.12606
Abstract: Ultrasound of the inferior vena cava (IVC-US) has been used to estimate intravascular volume status and fluid removal during a hemodialysis session. Usually, renal nurses rely on other, imprecise methods to determine ultrafiltration. To date, no study has examined whether renal nurses can reliably perform ultrasound for volume assessment and for potential prevention of intradialytic hypotension. This pilot study aimed to determine if a renal nurse could master the skill of performing and correctly interpreting Point of Care Ultrasound on patients receiving hemodialysis. After receiving theoretical training and performing 100 training scans, a renal nurse performed 60 ultrasound scans on 10 patients. These were categorized by the nurse into hypovolemic, euvolemic, or hypervolemic through measurement of the maximal diameter and degree of collapse of the IVC. Scans were subsequently assessed for adequacy and quality by two sonologists, who were blinded to each other's and the nurse's results. The interrater reliability of 60 scans was good, with intraclass correlation 0.79 (95% confidence interval (CI) =0.63-0.87) and with a good interrater agreement for the following estimation of intravascular volume (Cohen's weighted Kappa κ A renal nurse can reliably perform ultrasound of the IVC in hemodialysis patients, obtaining high quality scans for volume assessment of hemodialysis patients. This novel approach could be more routinely applied by other renal nurses to obtain objective measures of patient volume status in the dialysis setting.
Publisher: Elsevier BV
Date: 2015
DOI: 10.1053/J.AJKD.2014.06.020
Abstract: Erythropoiesis-stimulating agent (ESA)-hyporesponsive anemia is common in chronic kidney disease (CKD). Pentoxifylline shows promise as a treatment for ESA-hyporesponsive anemia, but has not been rigorously evaluated. Multicenter, double-blind, randomized, controlled trial. 53 adult patients with CKD stage 4 or 5 (including dialysis) and ESA-hyporesponsive anemia (hemoglobin≤120g/L and ESA resistance index [calculated as weight-adjusted weekly ESA dose in IU/kg/wk ided by hemoglobin concentration in g/L]≥1.0IU/kg/wk/g/L for erythropoietin-treated patients and ≥0.005μg/kg/wk/g/L for darbepoetin-treated patients). Pentoxifylline (400mg/d n=26) or matching placebo (control n=27) for 4 months. ESA resistance index at 4 months secondary outcomes: hemoglobin concentration, ESA dose, blood transfusion requirement, serum ferritin level and transferrin saturation, C-reactive protein level, adverse events, quality of life, and health economics. There was no statistically significant difference in ESA resistance index between the pentoxifylline and control groups (adjusted mean difference, -0.39 [95%CI, -0.89 to 0.10] IU/kg/wk/g/L P=0.1). Pentoxifylline significantly increased hemoglobin concentration relative to the control group (adjusted mean difference, 7.6 [95%CI, 1.7-13.5] g/L P=0.01). There was no difference in ESA dose between groups (-20.8 [95%CI, -67.2 to 25.7] IU/kg/wk P=0.4). No differences in blood transfusion requirements, adverse events, or quality of life were observed between groups. Pentoxifylline cost A$88.05 (US $82.94) per person over the trial and produced mean savings in ESA cost of A$1,332 (US $1,255). The overall economic impact over the trial period was a saving of A$1,244 (US $1,172) per person for the pentoxifylline group compared with controls. S le size smaller than planned due to slow recruitment. Pentoxifylline did not significantly modify ESA hyporesponsiveness, but increased hemoglobin concentration. Further studies are warranted to determine whether pentoxifylline therapy represents a safe strategy for increasing hemoglobin levels in patients with CKD with ESA-hyporesponsive anemia.
Publisher: SAGE Publications
Date: 2022
DOI: 10.1177/23333936221128240
Abstract: This study aimed to explore the lived experiences of patients receiving maintenance hemodialysis in Pakistan. Purposive s ling was used to recruit 24 patients and six healthcare professionals, each participated in a semi-structured interview. Interpretive Phenomenological Analysis was used to analyze interviews’ data. Two superordinate themes, “The experience of hemodialysis” and “The conceptualizations of hemodialysis” as well as six sub-themes were identified. The experience of hemodialysis was related to, the implications of HD procedure on everyday life, social, cognitive, emotional, financial, and occupational influences. While all participants recognized the importance of hemodialysis for their survival, their conceptualizations of the treatment varied. Despite facing multiple challenges, optimism and independence were observed among participants. Stigma related to hemodialysis, and role adaptation, which appear unique to the Pakistani context, highlight a need for tailored interventions designed to enhance and maintain the mental health of patients receiving hemodialysis in Pakistan.
Publisher: Elsevier BV
Date: 02-2022
Publisher: Cambridge Media
Date: 12-2021
Publisher: SAGE Publications
Date: 03-2015
Abstract: The ability of urinary biomarkers to predict residual renal function (RRF) decline in peritoneal dialysis (PD) patients has not been defined. The present study aimed to explore the utility of established biomarkers from kidney injury models for predicting loss of RRF in incident PD patients, and to evaluate the impact on RRF of using neutral-pH PD solution low in glucose degradation products. The study included 50 randomly selected participants from the balANZ trial who had completed 24 months of follow-up. A change in glomerular filtration rate (GFR) was used as the primary clinical outcome measure. In a mixed-effects general linear model, baseline measurements of 18 novel urinary biomarkers and albumin were used to predict GFR change. The model was further used to evaluate the impact of biocompatible PD solution on RRF, adjusted for each biomarker. Baseline albuminuria was not a useful predictor of change in RRF in PD patients ( p = 0.84). Only clusterin was a significant predictor of GFR decline in the whole population ( p = 0.04, adjusted for baseline GFR and albuminuria). However, the relationship was no longer apparent when albuminuria was removed from the model ( p = 0.31). When the effect of the administered PD solutions was examined using a model adjusted for PD solution type, baseline albuminuria, and GFR, higher baseline urinary concentrations of trefoil factor 3 (TFF3, p = 0.02), kidney injury molecule 1 (KIM-1, p = 0.04), and interferon γ–induced protein 10 (IP-10, p = 0.03) were associated with more rapid decline of RRF in patients receiving conventional PD solution compared with biocompatible PD solution. Higher urinary levels of kidney injury biomarkers (TFF3, KIM-1, IP-10) at baseline predicted significantly slower RRF decline in patients receiving bio-compatible PD solutions. Findings from the present investigation should help to guide future studies to validate the utility of urinary biomarkers as tools to predict RRF decline in PD patients.
Publisher: Springer Science and Business Media LLC
Date: 19-06-2023
DOI: 10.1186/S12909-023-04428-5
Abstract: Point-of-care ultrasound (POCUS) is increasingly used as a non-invasive vascular access assessment method by clinicians from multiple disciplines worldwide, prior and during vascular access cannulations. While POCUS is a relatively new method to establish a vascular access in patients with complex vascular conditions, it is also essential to train and educate in iduals who are novices in the techniques of cannulation so that they become proficient in performing this task subsequently on patients safely and successfully. A simulated environment may be a helpful tool to help healthcare providers establish skills in using POCUS safely and may also help them to successfully establish vascular access in patients. With this project, we sought to determine if participants of a simulated POCUS workshop for vascular access can use this technique successfully in their in idual clinical environment after their attendance of a half-day workshop. A mixed-methods longitudinal study design was chosen to evaluate a point-of-care ultrasound workshop for peripheral intravenous cannula insertion. The workshops used simulation models for cannulation in combination with multiple ultrasound devices from various manufacturers to expose participants to a broader variety of POCUS devices as they may also vary in different clinical areas. Participants self-assessed their cannulation skills using questionnaires on a 10-point rating scale prior to and directly after the workshop. A total of 85 In iduals participated in eleven half-day workshops through 2021 and 2022. Workshop participants claimed that attending the workshop had significantly enhanced their clinical skill of using ultrasound for the purpose of cannulating a venous vessel. The level of confidence in using this technique had increased in all participants directly after conclusion of the workshop. Globally, clinicians are increasingly using POCUS to establish vascular access in patients, and it is necessary that they receive sufficient and adequately structured and formal training to successfully apply this technique in their clinical practice. Offering a workshop which uses simulation models in combination with various POCUS devices to demonstrate this technique in a hands-on approach has proven to be useful to establish this newly learned skill in clinicians.
Publisher: Wiley
Date: 25-01-2017
DOI: 10.1111/JORC.12191
Abstract: In Western Australia (WA), most stable patients undergoing haemodialysis receive treatment in a satellite setting where no doctors are on-site during treatment hours, so nurses must make critical decisions about fluid removal. Some patients regularly experience adverse events during dialysis (intradialytic), often due to excessive ultrafiltration goals, with intradialytic hypotension being particularly challenging. Ultrasound of the inferior vena cava has been previously demonstrated being a rapid and non-invasive method for volume assessment on haemodialysis patients, thus could hold valuable information for the treating nurse. This paper examines the existing literature in regards to the use of ultrasound measurements of the inferior vena cava in patients on haemodialysis for objective assessment of their intravascular volume status by renal nurses. A systematic literature review was performed within medical and nursing databases including CINAHL Plus with Full Text, SCOPUS, Web of Science and MEDLINE. Renal nurses are conscious of the significance of intradialytic hypotension and have only limited options for its prevention. Ultrasound of the inferior vena cava could add another objective dimension for intravascular volume assessment and prevention of intradialytic hypotension, but to date renal nurses have not been using this technique. Ultrasound of the inferior vena cava has the potential to assist in defining the ultrafiltration goal for that particular dialysis session, thus reducing the risk of intradialytic hypotension. Additionally, it has potential to change current renal nursing practice when added to clinical nursing assessment methods. Further studies are required to validate this assessment tool carried out by a renal nurse compared with a skilled ultrasonographer.
Publisher: Wiley
Date: 25-04-2011
DOI: 10.1111/J.1440-1797.2010.01421.X
Abstract: Haemodialysis with regional citrate anticoagulation in patients with contraindications for heparin is increasingly performed in the USA and Europe. Most published protocols use trisodium citrate, which is not readily available nor is it licensed in Australia. We established a protocol for citrate-anticoagulation in haemodialysis using acid citrate dextrose solution A (ACDA), which is approved for apheresis procedures in Australia. The aim of the present study was to assess the safety and efficacy of this protocol for routine use in haemodialysis patients. Systemic and post-filter blood ionized calcium, serum sodium and bicarbonate and dialyzer clotting score were analyzed prospectively in 14 patients undergoing 150 consecutive haemodialysis treatments with citrate anticoagulation using calcium-free dialysate. A simple algorithm allowed the attending nurse to adjust citrate infusion (to maintain post-filter ionized calcium at 0.2-0.3 mmol/L) and i.v. calcium substitution. Scheduled dialysis time was 4 h, and point-of-care monitoring of blood ionized calcium during dialysis was done at 0, 15, 60, 120 and 240 min. ACDA infusion rates of 300 mL/h were used in the first 52 treatments, but resulted in high dialyzer clotting score and 6% of treatments were discontinued due to complete clotting. Thereafter, ACDA infusion rate was increased to 350 mL/h, with all 98 subsequent treatments completed successfully. Ionized calcium levels were stable during all procedures with post-dialysis serum sodium averaging 135 ± 3 mmol/L and bicarbonate 23.8 ± 2 mmol/L. Routine use of citrate anticoagulation in the setting of a long-term haemodialysis unit is safe and efficient. Point-of-care measurements of ionized calcium levels are critical to safely and successfully perform citrate anticoagulation.
Publisher: Dustri-Verlgag Dr. Karl Feistle
Date: 2007
DOI: 10.5414/PRP19035
Publisher: MDPI AG
Date: 13-01-2021
DOI: 10.3390/RS13020256
Abstract: Being the highest and largest land mass of the earth, the Tibetan Plateau has a strong impact on the Asian climate especially on the Asian monsoon. With high downward solar radiation, the Tibetan Plateau is a climate sensitive region and the main water source for many rivers in South and East Asia. Although many studies have analyzed energy fluxes in the Tibetan Plateau, a long-term detailed spatio-temporal variability of all energy budget parameters is not clear for understanding the dynamics of the regional climate change. In this paper, satellite remote sensing and reanalysis data are used to quantify spatio-temporal trends of energy budget parameters, net radiation, latent heat flux, and sensible heat flux over the Tibetan Plateau from 2001 to 2019. The validity of both data sources is analyzed from in situ ground measurements of the FluxNet micrometeorological tower network, which verifies that both datasets are valid and reliable. It is found that the trend of net radiation shows a slight increase. The latent heat flux increases continuously, while the sensible heat flux decreases continuously throughout the study period over the Tibetan Plateau. Varying energy fluxes in the Tibetan plateau will affect the regional hydrological cycle. Satellite LE product observation is limited to certain land covers. Thus, for larger spatial areas, reanalysis data is a more appropriate choice. Normalized difference vegetation index proves a useful indicator to explain the latent heat flux trend. Despite the reduction of sensible heat, the atmospheric temperature increases continuously resulting in the warming of the Tibetan Plateau. The opposite trend of sensible heat flux and air temperature is an interesting and explainable phenomenon. It is also concluded that the surface evaporative cooling is not the indicator of atmospheric cooling/warming. In the future, more work shall be done to explain the mechanism which involves the complete heat cycle in the Tibetan Plateau.
No related grants have been discovered for Ulrich Steinwandel.