Patients have a Home Care team to rely on When dialysis patients are undergoing self-care, it’s important that they have access to the support they need. Gambro’s Home Care team is proud to be helping hospitals to ensure this support is available. The team’s relationship with patients usually starts by helping them make the transition to home treatment. This begins with coordinating the installation of equipment and the delivery of their first month’s worth of treatment supplies, with extra stocks for emergency use. Once the self-therapy has begun, the team calls patients each month to take orders for consumables. Patients know when deliveries will be made so they can plan to be at home, or ask that alternative arrangements are made if a scheduled delivery date is not convenient. Building relationships with patients and clinicians “This is an area of our service we take very seriously,” says Home Care Coordinator, Lynne Kemp. “It’s vital that patients always have the supplies they need and so we liaise closely with them. But we do much more than taking orders for consumables. We don’t see ourselves as a faceless call centre, but instead have the time to listen to patients whenever they need someone to talk to. Showing them empathy and giving them comfort is something we feel is important, especially given the difficult circumstances they are often in when they call.” A high ultrafiltration rate is associated with increased mortality risk A prospective observational study in 287 haemodialysis patients has found that patients who died during the five-year observation period differed in several respects from those who survived, including a greater intra-dialytic weight gain. In a Cox proportional hazard survival analysis, adjusting for several covariates, the body weight-adjusted UF rate appeared as an independent predictor of death (p<0.0001), while intra-dialytic weight gain did not. The authors conclude that longer or more frequent sessions should be considered in patients requiring high UF rates. [Movilli E et al, Nephrol Dial Transplant. 2007;22(12):3547-52] Clinical studies look at high-flux dialyzers Two clinical studies performed by a team from Louisville, USA, benchmarked the performance of high-flux dialyzers. Comparing the Gambro Polyflux H series to Fresenius Optiflux and Polyflux S to the F series, the Polyflux filters respectively showed some 140% and 75% greater clearance for beta-2-microglobulin. Other middle molecules were also better cleared by the Polyflux dialyzers, while urea and phosphate removals were similar. The paper emphasises that membranes made of apparently similar polymers may differ substantially in the removal of small protein uremic toxins. [Ouseph R et al; Nephrol Dial Transplant Advance Access Dec 21, 2007] Beta-2-microglobulin serum level is associated with infectious mortality in dialysis patients A recent analysis of data from 1813 chronic HD patients participating in the HEMO study found that for each 10 mg/l greater serum b2m level the risk for infectious death increased by 21%, which was statistically highly significant. The effect was not dependant on how long patients had been on dialysis. This data supports the use of high-flux dialyzers to increase the removal of middle molecules and the use of serum b2m level as marker of uremic toxicity. [Cheung AK et al, Clin J Am Soc Nephrol 2008;3:69-77] Investment in upgraded training facilities now ensures a better experience for delegates Technical training facilities upgraded Renovation work at our Huntingdon head office has created a custom built area for technical training. Perhaps the best feature is the newly-installed central water plant (CWP), but this is just one of the areas in which we have invested. Work on the CWP began in December with the local water company installing the necessary external infrastructure. Ian Proud, Gambro’s National Field Technician for water products, and Chris Matthews, Team Leader for National Specialists, then installed the CWP to provide clean water to four points in the training room. Kirsty James, Junior Product Manager for Technical Services, says: “As well as the new water points, the training room also has a new self draining resin floor, improved lighting and an interactive IT whiteboard. The refurbishment is one of the outcomes of an overall review of our training services. More changes will follow, all of which will make our technical training a more pleasurable experience for participants.” Contact Kirsty James 01480 444055 kirsty.james@gambro.com 6 clinical corner

Technical training dates With the upgrade of our facilities complete, there’s never been a better time to attend a course. Here’s what’s available over the next few months: Prismaflex Technical course 23-24 April and 24-25 June This two-day course is for technicians and engineers responsible for maintaining and servicing Prismaflex machines. It provides a firm understanding of the Prismaflex’s role in continuous renal replacement therapy and enables them to perform basic calibration, fault finding and simple maintenance. AK 95 S Extended course 13-16 May This four-day course is aimed at service engineers who have participated in the Basic course and then had at least six months’ practical experience with the AK 95 S. It provides engineers with a deeper knowledge of the system, enabling them to carry out advanced trouble shooting and maintenance. WRO 300 H course 22-23 May This two-day course gives service engineers a deeper knowledge of the WRO 300 H system, enabling them to perform advanced trouble shooting and maintenance. AK 200 S Basic course 2-5 June Any service engineer working with the AK 200 S should attend this four-day course as it provides a thorough grounding in relevant systems. After the course, engineers should be able to handle simple maintenance and trouble shooting. Prisma Technical course 8-9 July This two-day course is for technicians and engineers responsible for maintaining and servicing Prisma machines. It covers how the machine works, basic calibration, fault finding and simple maintenance. Prismaflex Study Days Monthly during April-July These provide further knowledge on the principles of CRRT therapies and give delegates a firm overall understanding of using and trouble shooting the Prismaflex machine more effectively. The schedule is: • 29 April - Manchester. • 13 May - Glasgow. • 17 June - London. • 16 July - Huntingdon. To book a place on a course, or for further information and a full list of all our training course dates, please contact Louise Young 01480 444033 louise.young@gambro.com Cardiovascular death rate is less in patients treated with on-line HDF A positive assessment of the effects of on-line HDF is an outcome of a prospective observational study of all chronic HD patients in the northwest part of the Tuscany region, Italy. During a 30-month follow-up, all patients on on-line HDF treatment (17% of all) were compared to those on HD (56%) or low-volume HDF with bagged reinfusion fluid (27%). Both HDF groups showed better survival rates than the regular HD group. Inflammatory markers (CRP, IL-6) also correlated significantly with mortality rates. Patients on on-line HDF showed significantly lower IL-6 levels than the other groups. [Panichi V et al, Nephrol Dial Transplant. 2008; Advance Access Feb 27, 2008] American researchers investigate allergic reactions in haemodialysis patients An outbreak of acute allergic-type reactions in US haemodialysis patients is being investigated by the US Centers for Disease Control and Prevention (CDC). In a report on their ongoing investigation, CDC states, 65 confirmed or probable cases from mid November 2007 to mid January 2008. The following signs and symptoms are reported: • Generalised or localised sensations of warmth, numbness or tingling of the extremities. • Difficulty in swallowing. • Shortness of breath/audible wheezing/chest tightness. • Low blood pressure/tachycardia. • Nausea/vomiting. One factor being investigated is receipt of a certain batch of heparin, but other exposures have not been ruled out as potential causes of the reactions. [Centers for Disease Control and Prevention (CDC), MMWR Morb Mortal Wkly Rep. 2008 Feb 8;57(5):124-5] 7 As Home Care Operations Coordinator David Lyons explains, the team’s responsibilities extend beyond liaison with patients: “Although the delivery of consumables to patients is an important aspect of our work, we are just as committed to clinical support. We make a point of keeping renal units fully informed about any issues that crop up. “Whenever we talk to a patient who raises anything about their treatment we tend to contact their renal unit. We understand the critical relationship that hospitals have with patients and we want to support clinical staff as much as possible.” Like other areas of service at Gambro, Home Care will see some specific new investment and service developments over the next year or so. We will keep you informed through future editions of Highlights and our other communication channels. Contact David Lyons 01480 444025 david.lyons@gambro.com Support for patients from members of the Home Care team including, from left, Lynne Kemp, David Lyons and Tina Hanibal, often means a friendly voice at the other end of the line There have been a number of interesting dialysis-related papers published recently. As always, our clinical specialists have been monitoring the publications and here is our summary of the papers we have found to be especially relevant.