Contemporary Nephrology Nursing: Principles and Practice, Second

Contemporary
Nephrology Nursing:
Principles and Practice
Second Edition
Anita E. Molzahn, PhD, RN
Editor
Evelyn Butera, MS, RN, CNN
Assistant Editor
Copyright © 2006
American Nephrology Nurses’ Association
Publication Management by
Anthony J. Jannetti, Inc.; East Holly Avenue/Box 56; Pitman, New Jersey 08071-0056
ISBN No. 0-9768125-4-1
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopy, recording, or any information storage and retrieval system
without the written permission of the American Nephrology Nurses’ Association.

Preface
Janel Parker left a wonderful legacy with the publication of the first edition of
Contemporary Nephrology Nursing. Evelyn and I were looking forward to working
with her as Associate Editors on this second edition, but Janel’s unexpected and
tragic death in 2003 left a huge vacuum. I have often reflected on how we would
have enjoyed working with her on this publication (she was such fun to work with),
but we know that Janel would have wanted us to continue on and build on the
strong foundation of the first edition.
This edition of Contemporary Nephrology Nursing: Principles and Practice is
directed to a North American audience of front-line nephrology nurses. We recognize
that there are many practice patterns and cultural perspectives that will be different
in other regions of the world. Nevertheless, there has been interest in the
book from many areas of the world and from other health professionals working in
nephrology settings. We hope that graduate and undergraduate students in nursing
also find it to be a useful reference book.
Knowledge in nephrology nursing continues to grow at a rapid rate. We have
integrated current research findings and best current practices into the various chapters
of this text. As ANNA continues to strive towards the goal of research-based
practice, we expect that this book will move us forward in attaining that goal.
In this edition, there is a new opportunity for nurses to earn CE credits for each
chapter that they read. Not only can you increase your knowledge base, but now
you can also obtain CE credit!
This is an exciting and dynamic specialty in nursing. It blends rich opportunities
to come to know individuals and their families with opportunities to integrate complex
knowledge and skills in a wide range of care settings. There are few more
rewarding or challenging opportunities in nursing. We hope that this book will
prove to be a valuable resource to you as you deal with the many challenges in
nephrology nursing practice.
Knowledge in our specialty will continue to grow, as will nursing knowledge
and medical knowledge. Please offer your suggestions of areas that you would like
to see addressed in future editions, by contacting either of the editors or ANNA, the
publisher.
Anita Molzahn, PhD, RN
Editor
Evelyn Butera, MS, RN, CNN
Assistant Editor
II
Contemporary Nephrology Nursing: Principles and Practice, Second Edition © —— American Nephrology Nurses’ Association 2006

Foreword
A decade, a century and a millennium have all passed since the first edition of
Contemporary Nephrology Nursing was published in 1998. In the past 8 years,
many events have transformed the healthcare landscape of our country and the
world. Many of these have influenced the manner in which professional nurses
deliver care to patients with kidney disease. With policy focus on value-based reimbursement;
concern for the exponential increase in chronic conditions such as diabetes,
hypertension, and obesity; the demands of a mobile, aging population; the
emphasis on quality of life and end of life options; and the decrease in the number
of nurses available to provide care, our nursing specialty has many opportunities to
become preoccupied. However, the second edition of the Contemporary
Nephrology Nursing: Principles and Practice Textbook brings nephrology nursing
back to the basics of our practice regardless of the setting and supports ANNA’s mission
to advance nephrology nursing practice and positively influence outcomes for
patients with kidney or other disease processes requiring replacement therapies
through advocacy, scholarship, and excellence.
The new edition builds upon the foundation set forth in the first edition as
nephrology nurses faced a new millennium. The ANNA Board of Directors and I are
grateful to Editor Dr. Anita Molzahn and Assistant Editor Evelyn Butera for assembling
expert contributors and reviewers to deliver a publication that I would recommend
be available for frequent reference in resource libraries of individuals as well
as educational and work settings. Few can comprehend the time, dedication and
commitment that a project of this magnitude involves, but all who benefit will
appreciate the product.
Finally, it is fitting to remember Janel Parker, Editor of the first edition of
Contemporary Nephrology Nursing, whose untimely death in 2003 brought great
sadness to many whose personal and professional lives were touched by the contributions
she made to nephrology nursing. Few nephrology nurses have played such
a significant role in the professional growth and development of nephrology nursing
as Janel. She would be proud of the second edition of this textbook if she were here
today!
Suzann VanBuskirk, BSN, RN, CNN
ANNA President, 2005-2006
Contemporary Nephrology Nursing: Principles and Practice, Second Edition © — American Nephrology Nurses’ Association 2006 III

Dedication to Janel Parker
On August 26, 2003, nephrology nursing and the American Nephrology Nurses’
Association (ANNA) lost one of our best and brightest colleagues when Janel Parker
passed away following injuries sustained in an automobile accident in Philadelphia.
Janel, who had served as the first Editor of Contemporary Nephrology Nursing in 1998,
had just been appointed Editor for the second
edition of this publication at the time of her
sudden and unexpected death.
Not only did Janel leave behind her wonderful
family – daughter Ellen, son J.D., and husband
David – but she left behind a professional
legacy that was brilliant and lengthy to say the
least. Where do we begin when speaking of
Janel’s many professional accomplishments?
During her career, she:
• Served as President of ANNA in
1986-87;
Janel Parker (2nd from L), with her son J.D., husband
David, and daughter Ellen, was a dedicated
mother and wife as well as a devoted colleague and
friend to nephrology nurses around the country.
• Helped to form the Nephrology Nursing Certification Board (NNCB) and develop
the first Nephrology Nursing Certification Examination;
• Served as Charter President of NNCB, now known as the Nephrology Nursing
Certification Commission (NNCC);
• Served as NNCC’s first full-time Executive Director;
• Served as the first Editor of the Contemporary Nephrology Nursing textbook; and
• Helped to organize the American Board of Nursing Specialties (ABNS), serving a
term as its first President.
Janel was honored for her many accomplishments in 1992 when she was awarded the
Outstanding Contribution to ANNA Award, the association’s highest honor! She received
additional honors as well from other organizations for her ongoing role in patient advocacy.
Those of us who were close to her, of course, knew Janel for her bright, caring, and
energizing personality! She took many of her colleagues and friends under her wing, and
helped all of us fulfill accomplishments and goals we thought beyond our reach.
Ironically, it was primarily Janel’s outgoing and caring personality that have led us to
bestow upon her one more honor. The Editors, staff, and members of the ANNA Board of
Directors would like to dedicate this Second Edition of Contemporary Nephrology
Nursing: Principles and Practice to Janel Parker, for whom this project was close to her
heart.
Thank you Janel for your wonderful legacy. We have missed you!
Anita E. Molzahn, PhD, RN
Editor
Evelyn Butera, MSN, RN, CNN
Assistant Editor
IV
Contemporary Nephrology Nursing: Principles and Practice, Second Edition © — American Nephrology Nurses’ Association 2006

Table of Contents
Contemporary Nephrology Nursing: Principles and Practice
Second Edition
Table of Contents and Contributors
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . II
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . III
Dedication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IV
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
Reviewers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XII
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XIII
Sponsorships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XIII
Unit One
Nature and Scope of Nephrology Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chapter 1 Professional Nephrology Nursing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Beth Tamplet Ulrich, EdD, RN, CHE
Chapter 2 The Evolution of Nephrology and Nephrology Nursing . . . . . . . . . . . . . . . . . . . 27
Caroline S. Counts, MSN, RN, CNN
Chapter 3 Chronic Illness Management and Outcomes: A Theory-Based Approach . . . . . . 53
Charlotte Thomas-Hawkins, PhD, RN
Unit Two
The Kidney. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Chapter 4 Renal Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Christine Chmielewski, MS, CRNP, CNN, CS
Mary Jo Holechek, MS, CRNP, CNN
Marlys Ludlow, MS, RN
Carolyn B. Yucha, PhD, RN, FAAN
David Guthrie, MN, ARNP
Lori Candela, EdD, RN, APRN, BC, FNP
Chapter 5 Alterations in Fluid, Electrolyte, and Acid-Base Balance . . . . . . . . . . . . . . . . . 121
Kathy P. Parker, PhD, RN, FAAN
Chapter 6 Diseases of the Kidney . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
LaVonne M. Burrows, M-SCNS, BC, RN, CNN
Contemporary Nephrology Nursing: Principles and Practice, Second Edition © — American Nephrology Nurses’ Association 2006 V

Table of Contents
Chapter 7 Genetics and Kidney Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Ann Cashion, PhD, RN
Carolyn J. Driscoll, MSN, RN, FNP-C
Chapter 8 Assessment of the Renal System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Kathy P. Parker, PhD, RN, FAAN
Chapter 9 Acute Renal Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Christy Price Rabetoy, NP
Unit Three
Chronic Kidney Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Chapter 10 Diagnosis, Classification and Management of Chronic Kidney Disease . . . . . . 243
Patricia Bargo McCarley, MSN, RN, ACNPc, CNN
Chapter 11 Symptom Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Janet L. Welch, DNS, RN, CNS
Chapter 12
Diabetes and Kidney Disease: A Challenge in Chronic
Disease Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Janice A. Neil, PhD, RN
Chapter 13 End Stage Renal Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
Lori Candela, EdD, RN, APRN, BC, FNP
Kathy P. Parker, PhD, RN, FAAN
Chapter 14
Client and Family Decision Making about Treatment Modalities for
End Stage Renal Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Maryse Pelletier Hibbert, MN, RN
Isabelle Toupin, MN, RN
Cynthia Baker, PhD, MN, RN
Chapter 15 Quality of Life and Chronic Kidney Disease: Living Long and Living Well. . . . 343
Anita E. Molzahn, PhD, RN
Chapter 16 End-of-Life Care in the Chronic Kidney Disease Population . . . . . . . . . . . . . . 359
Lesley C. Dinwiddie, MSN, RN, FNP, CNN
Elaine R. Colvin, BSN, RN, MEPD
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Table of Contents
Unit 4
Clinical Management of the Renal Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
Chapter 17 Nutrition and Chronic Kidney Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
Jordi Goldstein-Fuchs, DSc, RD
Megan A. Tichy, RD, CDE
Chapter 18 Pharmacology of Renal Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
Kristine Schonder, PharmD
Chapter 19 Infections in the Hemodialysis Unit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419
Eileen Peacock, MSN, RN, CNN, CIC, CPHQ
Unit Five
Renal Disease Across the Lifespan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455
Chapter 20 The Child with Kidney Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457
Cyrena Gilman, MN, RN, CNN
Annette Frauman, PhD, RN, FAAN
Chapter 21 The Young and Middle Aged Adult with Chronic Kidney Disease. . . . . . . . . . . 485
Leanne Dekker, MBA, MN, RN
Chapter 22 The Older Adult with Chronic Kidney Disease. . . . . . . . . . . . . . . . . . . . . . . . . 501
Terran Mathers, DNS, RN
Unit Six
Hemodialysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 527
Chapter 23 Hemodialysis Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529
Carolyn E. Latham, MSN, MBA, RN, CNN
Based on previous edition by Patricia Baltz Salai, MSN, RN, CNN, CRNP
Chapter 24 Vascular Access for Hemodialysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 559
Randee Breiterman White, MS, RN, CNN
Chapter 25 Hemodialysis: Prevention and Management of Treatment Complications . . . . 581
Karen C. Robbins, MS, RN, CNN
Based on previous edition by Patricia Baltz Salai, MSN, RN, CNN, CRNP
Chapter 26 Home Dialysis Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 605
Lori Harwood, MSc, RN, CNeph(C)
Rosemary Leitch, RN, CNeph(C)
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Table of Contents
Unit Seven
Peritoneal Dialysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 629
Chapter 27 Technical Aspects of Peritoneal Dialysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 631
Elizabeth Kelman, MEd, RN, CNeph(C)
Diane Watson, MSc, RN, CNeph(C)
Chapter 28 Peritoneal Dialysis Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 661
Barbara F. Prowant, MS, RN, CNN
Chapter 29 Preventing and Managing Complications of Peritoneal Dialysis. . . . . . . . . . . . 687
Elizabeth Kelman, MEd, RN, CNeph(C)
Diane Watson, MSc, RN, CNeph(C)
Unit Eight
Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 711
Chapter 30 Organ Donation: The Supply and the Issues . . . . . . . . . . . . . . . . . . . . . . . . . . 713
Marilyn Bartucci, MSN, RN, CS, CCTC
Chapter 31 Transplantation: The Procedure and Implications . . . . . . . . . . . . . . . . . . . . . . 731
Christine Mudge, RN, MS, PNPc/CNS, CNN, FAAN
Laurie Carlson, RN, MSN
Patricia Brennan, RN, MSN
Chapter 32 Pharmacotherapy of Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 769
David Quan, PharmD
Unit Nine
Ethical, Legal, Public Policy and Legislative Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 793
Chapter 33 Ethical Challenges in Nephrology Nursing. . . . . . . . . . . . . . . . . . . . . . . . . . . . 795
Rosalie Starzomski, PhD, RN
Chapter 34 Medical Information and Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 817
Mary Rau-Foster, MBA, BS, JD, RN
Chapter 35 Public Policy Issues and Legislative Process . . . . . . . . . . . . . . . . . . . . . . . . . . . 833
Kathleen Smith, BS, RN, CNN
Chapter 36 The Federal End Stage Renal Disease (ESRD) Program. . . . . . . . . . . . . . . . . . . 851
Janel Parker, MSN, RN, CNN
Gail S. Wick, BSN, RN, CNN
Chapter 37 Nephrology Nursing: A Global Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . 869
Nicola Thomas, MA, BSc (Hons), RN
VIII
Contemporary Nephrology Nursing: Principles and Practice, Second Edition © — American Nephrology Nurses’ Association 2006

Table of Contents
Unit 10
Communication and Collaboration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 883
Chapter 38 Relating to Teaching and Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 885
Janice McCormick, PhD, RN
Chapter 39 Informatics and the Electronic Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 903
Francis Lau, PhD
Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 923
Appendix A
Appendix B
Appendix C
Nursing Management of the Person with Kidney Disease:
Alterations in Fluid Electrolyte and Acid Base Balance . . . . . . . . . . . . . . . . . . 925
Nursing Management of the Person with Kidney Disease:
Metabolic and Endocrine Disturbances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 931
Nursing Management of the Person with Kidney Disease:
Uremic Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 933
Appendix D ANNA Health Policy Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 939
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 943
Corporate Sponsorships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 969
Contemporary Nephrology Nursing: Principles and Practice, Second Edition © — American Nephrology Nurses’ Association 2006 IX

Contributors
Editor
Anita E. Molzahn, PhD, RN
University of Victoria
Vancouver, British Columbia, Canada
Assistant Editor
Evelyn Butera, MS, RN, CNN
Mills-Peninsula Health Services
A Sutter Health Affiliate
Burlingame, CA
Contributors
Cynthia Baker, PhD, MN, RN
University of New Brunswick
Fredericton, New Brunswick, Canada
Marilyn Bartucci, MSN, RN, CS,
CCTC
Fujisawa Healthcare, Inc.
Euclid, OH
Patricia Brennan, MSN, RN
Fresenius Medical Care
Lexington, MA
LaVonne M. Burrows, M-SCNS, BC,
RN, CNN
Springfield Nephrology Associates
Springfield, MO
Lori Candela, EdD, RN, APRN, BC,
FNP
University of Nevada, Las Vegas
Las Vegas, NV
Laurie Carlson, RN, MSN
UCSF Transplant Service
San Francisco, CA
Ann Cashion, PhD, RN
University of Tennessee Health
Science Center
Memphis, TN
Christine Chmielewski, MS, CRNP,
CNN, CS
Edward Filippone MD, PC
Philadelphia, PA
Elaine R. Colvin, BSN, RN, MEPD
Gundersen Lutheran
La Crosse, WI
Caroline S. Counts, MSN, RN, CNN
Medical University of South Carolina
Charleston, SC
Leanne Dekker, MBA, MN, RN
University of Alberta Hospitals
Edmonton, Alberta, Canada
Lesley C. Dinwiddie, MSN, RN, FNP,
CNN
Nephrology Nurse Consultant
Cary, NC
Carolyn J. Driscoll, MSN, RN, FNP-C
University of Tennessee Health
Sciences Center
Memphis, TN
Annette Frauman, PhD, RN, FAAN
Atlanta, GA
Cyrena Gilman, MN, RN, CNN
Riley Hospital for Children
Indianapolis, IN
Jordi Goldstein-Fuchs, DSc, RD
DaVita, Inc.
Sparks Dialysis
Sparks, NV
David Guthrie, MN, ARNP
University of Florida
Gainesville, FL
Lori Harwood, MSc, RN, CNeph(C)
London Health Science Centre
London, Ontario, Canada
Maryse Pelletier Hibbert, MN, RN
University of New Brunswick
Fredericton, Canada
Mary Jo Holechek, MS, CRNP, CNN
Johns Hopkins Hospital
Baltimore, MD
Elizabeth Kelman, MEd, RN,
CNeph(C)
University Health Network/Toronto
GH
Toronto, Ontario, Canada
Carolyn E. Latham, MSN, MBA, RN,
CNN
Renal Care Group
Nashville, TN
Francis Lau, PhD
University of Victoria
Victoria, British Columbia, Canada
Rosemary Leitch, RN, CNeph(C)
London Health Science Centre
London, Ontario, Canada
Marlys Ludlow, MS, RN
Stanford University Hospital
Palo Alto, CA
Terran Mathers, DNS, RN
Spring Hill College
Mobile, AL
Patricia McCarley, MSN, RN,
ACNPc, CNN
Diablo Nephrology Group
Walnut Creek, CA
Janice McCormick, PhD, RN
University of Victoria
Lower Mainland Campus
Vancouver, British Columbia, Canada
Anita E. Molzahn, PhD, RN
University of Victoria
Vancouver, British Columbia, Canada
Christine Mudge, RN, MS,
PNPc/CNS, CNN, FAAN
University of California
San Francisco, CA
Janice A. Neil, PhD, RN
East Carolina University
Greenville, NC
Kathy P. Parker, PhD, RN, FAAN
Emory University
Atlanta, GA
Eileen J. Peacock, MSN, RN, CNN,
CIC, CPHQ
DaVita, Inc.
Berwyn, PA
Barbara F. Prowant, MS, RN, CNN
University of Missouri
Columbia, MO
David Quan, PharmD
UCSF
San Francisco, CA
Christy Price Rabetoy, NP
Nephrology Associates, Inc.
Salt Lake City, UT
Mary Rau-Foster, MBA, BS, JD, RN
Foster Seminars and Communication
Brentwood, TN
Karen C. Robbins, MS, RN, CNN
Hartford Hospital
Hartford, CT
Patricia Baltz Salai, MSN, RN, CNN,
CRNP
VA Pittsburgh Healthcare System
Pittsburgh, PA
X
Contemporary Nephrology Nursing: Principles and Practice, Second Edition © — American Nephrology Nurses’ Association 2006

Contributors
Kristine Schonder, PharmD
University of Pittsburgh School of
Pharmacy
Pittsburgh, PA
Kathleen Smith, BS, RN, CNN
Fresenius Medical Care
Washington, DC
Rosalie Starzomski, PhD, RN
University of Victoria
Vancouver, British Columbia, Canada
Nicola Thomas, MA, BSc (Hons), RN
St. Helier Hospital
Carshalton, Surrey, England
Charlotte Thomas-Hawkins, PhD, RN
Rutgers University
Newark, NJ
Isabelle Toupin, MN, RN
University of Laval
Laval, Quebec, Canada
Beth Tamplet Ulrich, EdD, RN, CHE
Nephrology Nursing Journal
Pearland, TX
Diane M. Watson, RN, MSc,
CNeph(C)
Toronto General Hospital, University
Health Network
Toronto, Ontario, Canada
Janet L. Welch, DNS, RN, CNS
Indiana University
Indianapolis, IN
Randee Breiterman White, MS, RN,
CNN
Vanderbilt Medical Center
Nashville, FL
Gail S. Wick, BSN, RN, CNN
Consultant
Atlanta, GA
Carolyn B. Yucha, PhD, RN, FAAN
University of Nevada
Las Vegas, NV
ANNA National Office Staff
Gus A. Ostrum
Managing Editor
Michael Cunningham
Executive Director
Katie Brownlow
Editorial Coordinator
Lauren McClintock
Editorial Coordinator
Carol M. Ford
Copy Editor
Maryanne Hatfield
Proofreader
Jack M. Bryant
Art Director
Darin Peters
Graphic Artist
Melody Edwards
Creative Designer
Reviewers
The Editors of Contemporary Nephrology Nursing wish to thank the following professionals,
who reviewed and commented on the content of the chapters in this publication.
Kim M. Alleman, MS, RN, FNP, CNN
Hartford Hospital
Hartford, CT
Joan Arslanian, MSN, RN, CNN, FNP, CS
New York Hospital Medical Center of
Queens
Fresh Meadows, NY
Lynda Ball, BS, BSN, RN, CNN
Northwest Renal Network
Seattle, WA
Donna Bednarski, MSN, APRN, BC, CNN,
CNP
Harper University Hospital
Detroit, MI
Judy Bernardini, BSN, RN
University of Pittsburgh
Pittsburgh, PA
Geri Biddle, RN, CNN, CPHQ
Nephrology Nurse Consultants
Loudonville, NY
Joan Brookhyser, RD, CSR, CD
St. Joseph Medical Center
Tacoma, WA
Laura Broome, RN, CPN
Children’s Hospital of Alabama
Birmingham, AL
Deborah J. Brouwer, RN, CNN
Renal Solutions, Inc.
Warrendale, PA
Gillian Brunier, MScN, RN
Sunnybrook & Womens Hospitals
Toronto, Canada
Sally Burrows-Hudson, MS, RN, CNN
Nephrology Management Group, Inc.
Sunnyvale, CA
Anita Catlin, DNSc, FNP, FAAN
Sonoma State University
Rohnert Park, CA
Christine M. Ceccerelli, MS, MBA, RN, CNN
Hartford Hospital
Hartford, CT
Christine Chmielewski, MS, CRNP, CNN, CS
Edward J. Filippone, MD, PC
Philadelphia, PA
Jean Colaneri, MS, RN, CNN
Albany Medical Center Hospital
Albany, NY
Caroline S. Counts, MSN, RN, CNN
Medical University of South Carolina
Charleston, SC
Nancy Fleming Courts, PhD, RN, NCC
University of North Carolina
Greensboro, NC
Patricia A. Cowan, PhD, RN
University of Tennessee Health Science
Center
Memphis, TN
Kennith Culp, PhD, RN
University of Iowa
Iowa City, IA
Roberta Braun Curtin, PhD
Medical Education Institute
Madison, WI
Peggy Devney, RN, CNS, ACNP
University of California
San Francisco, CA
Sheila J. Doss, RN, CNN
Satellite Healthcare, Inc.
Mountain View, CA
Claudia M. Douglas, MA, RN, CNN
Hackensack University Medical Center
Hackensack, NJ
Andrea Easom, MA, MNSc, APN, BC, CNN
University of Arkansas for Medical Science
Kidney Center
Little Rock, AR
Contemporary Nephrology Nursing: Principles and Practice, Second Edition © — American Nephrology Nurses’ Association 2006 XI

Reviewers
The Editors of Contemporary Nephrology Nursing wish to thank the following professionals,
who reviewed and commented on the content of the chapters in this publication.
Pamela R. Frederick, MSB
Centers for Medicare & Medicaid
Baltimore, MD
Nancy M. Gallagher, BSN, RN, CNN
St. Joseph Medical Center
Tacoma, WA
Karen K. Guiliano, MSN, CCRN, NP
Phillips Medical Systems
Andover, MA
Nancy Hoffart, PhD, RN
Northeastern University
Boston, MA
Mary Jo Holchek, MS, CRNP, CNN
Johns Hopkins Hospital
Baltimore, MD
Dawn T. Holcombe, MSN, RN, CDE
Eli Lilly & Company
Indianapolis, IN
Jean A. Jacko, PhD, RN
Capital University
Columbus, OH
Tamara M. Kear, MSN, RN, CNN
Physicians Dialysis, Inc.
Philadelphia, PA
Karen Kelley, BSN, RN, CNN
Baxter Healthcare Corporation, Renal
Division
McGaw Park, IL
Maria Luongo, MSN, BA, RN
Massachusetts General Hospital
Boston, MA
Jean A. S. MacMullen, RN, CNA
Health Care Consultant
Inverness, FL
Harold Manley, PharmD, BCPS, FASN
Albany College of Pharmacy
Albany, NY
Judith C. Meraw, BHScN, RN, CNeph(C)
London Health Sciences Centre
London, Ontario, Canada
Sheila G. Mitchell, MSN, ACNP, CNN
Network 8, Inc.
Jackson, MS
Amy Barton Pai, PharmD, BCPS, FASN
University of New Mexico Health Sciences
Center
College of Pharmacy
Albuquerque, NM
Eileen J. Peacock, MSN, RN, CNN, CIC,
CPHQ
DaVita, Inc.
Berwyn, PA
Daisy Perry, BScN, RN
Retired, University of Alberta Hospitals
Edmonton, Alberta, Canada
Marcia Phillips, DNSc, RN
St. Luke’s Medical Center
Chicago, IL
Mary A. Pipkin, BA, RN, CNN
Lynchburg Nephrology, Inc.
Lynchburg, VA
Linda M. Plush, MSN, RN, CNS/FNP, CNN
Plush Systems, Inc.
Palmdale, CA
Christy A. Price Rabetoy, NP
Nephrology Associates, Inc.
Salt Lake City, UT
Fannie Rankin-Vinci, RN, CDE
Mills-Peninsula Health Services
Burlingame, CA
Kitty Richardson
Falls Church, VA
Sue Dickey Roberts
Abbott Laboratories
Oakland, CA
Joan H. Ruppert, MSN, RN, CNN
St. Louis Community College
Kirkwood, MO
Patricia Baltz Salai, MSN, RN, CNN, CRNP
VA Pittsburgh Healthcare System
Pittsburgh, PA
Mary Scott, PhD, RN
UCSF Department of Psychological Nursing
San Francisco, CA
Nancy J. Sharp, MSN, RN, FAAN
Sharp & Associates
Bethesda, MD
Rosalie C. Starzomski, PhD, RN
University of Victoria
Vancouver, British Columbia, Canada
Donna J. Swartzendruber, MSN, RN, CNN
DaVita, Inc.
Denver, CO
Charlotte Szromba, MSN, APRN, NP, CNN
University of Chicago
Chicago, IL
Charlotte Thomas-Hawkins, PhD, RN
Rutgers University
Newark, NJ
Annie W. Tu, MSN, ARNP, CNN, RN
University of Washington Medical Center
Seattle, WA
Diane M. Watson, MSc, RN, CNeph(C)
Toronto General Hospital, University Health
Network
Toronto, Ontario, Canada
Patricia D. Weiskittel, MSN, RN, APRN, BC,
CNN
VA Hospital Medical Center
Cincinnati, OH
Joan K. Werner, BSN, CNN, MBA
Fresenius Medical Care
Lexington, MA
Beth Witten, MSW
Medical Education Institute
Madison, WI
Gail S. Wick, BSN, RN, CNN
Consultant
Atlanta, GA
Barbara Wilson, MScN, RN, CNeph(C)
London Health Sciences Centre
London, Ontario, Canada
Rebecca P. Winsett, PhD
University of Tennessee
Memphis, TN
Karen C. Wiseman, MSN, RN, CNN
Renal America, Inc.
Brentwood, TN
Cynthia Yam, BScN, RN
University of Alberta Hospital
Edmonton, Alberta, Canada
XII
Contemporary Nephrology Nursing: Principles and Practice, Second Edition © — American Nephrology Nurses’ Association 2006

Acknowledgments
There are many people who contribute to the publication of a comprehensive textbook like
Contemporary Nephrology Nursing: Principles and Practice. We would like to express our sincere gratitude
to the many people who made this book possible. In particular, we would like to extend our
appreciation to:
Gus Ostrum, for his wonderful organizational ability, expert advice, good judgment, and invaluable
support,
Mike Cunningham and the Board of Directors of ANNA, for their confidence in our abilities and ongoing
support of the project,
Katie Brownlow and Lauren McClintock, for their administrative, organizational, and editorial skills,
To the authors, for their creativity, persistence and cooperation in meeting deadlines, despite many
personal and family responsibilities and challenges.
Anita Molzahn, PhD, RN
Editor
Evelyn Butera, MS, RN, CNN
Assistant Editor
Contemporary Nephrology Nursing: Principles and Practice, Second Edition © — American Nephrology Nurses’ Association 2006 XIII