Kidney Health Australia ‐ Caring for Australasians with Renal Impairment guideline recommendations for infection control for haemodialysis units

Abstract

Aim There is no national consensus on infection control in haemodialysis units in Australia and New Zealand. The primary aim of this guideline was to provide recommendations on screening for blood‐borne viruses and multi‐resistant organisms for dialysis units based on the available evidence. Methods The Kidney Health Australia Caring for Australasians with Renal Impairment guidelines, overall approach to guideline development follows the GRADE framework. A facilitated workshop was conducted to ensure that patient and caregiver concerns were considered. The evidence from relevant medical databases on the impact of screening on detection and transmission rates, hospitalization, mortality and psychosocial care, was reviewed and critically appraised. The guideline group made recommendations from the evidence available. Results The main guideline recommendations are: Dialysis units adopt a comprehensive approach that encompasses standard infection control precautions. Conduct routine surveillance for key blood‐borne viruses and methicillin‐resistant Staphylococcus aureus. Conduct routine surveillance of individual levels of protection against hepatitis B for patients on haemodialysis. Use dedicated dialysis machines for HBV‐infected patients. The evidence in totality was not found to support routine surveillance of vancomycin‐resistant Enterococci . Enhanced surveillance in light of the local risk of transmittable infectious agents should be considered by dialysis units. Very few studies have reported on the potential adverse effects of screening and associated practices. Conclusions Future research should focus on the potential benefits and adverse effects of screening and associated practices on clinical outcomes including infections prevented and health service delivery, and psychosocial domains for patients. Given the results of trials in the critical setting, the effectiveness of methicillin‐resistant Staphylococcus aureus decolonization in people receiving dialysis therapy warrants further research.

Obesity in work-up of kidney transplant candidates – review of clinical practice guidelines.

“…Three CPGs recommended that obesity should be routinely assessed at each pre-transplant consultation [10][11][12]. The included measurements should be as follows: patients height, weight, calculation of BMI.…”

“…Additionally, waist circumference should be assessed when weight and physical appearance suggest obesity, but calculated BMI is < 35 kg/m 2 [10]. The definition of obesity in adults includes waist circumference ≥ 102 cm in men and ≥ 88 cm in women [11]. Two guidelines recommended weight reduction before transplantation if BMI exceeds 30 kg/m 2 [12][13].…”

“…These therapies were considered safe in ESKD population but they were related only to a short-term weight reduction [10]. Only one study clearly stated that overweight kidney transplant recipients should have an individually-planned diet with a moderate energy restriction of about 30% of energy expenditure, with dietician follow-up [11]. It recommended also to create a caloric deficit of 500-1000 kcal/day along with increased physical activity [11].…”

“…The analyzed CPGs briefly discussed the role and the risk of novel pharmacological weight reduction therapies [10][11]. There were no trials examining the safety of those interventions in this specific population.…”

“…There were no trials examining the safety of those interventions in this specific population. Two medications (orlistat and sibutramine) were mentioned in recommendations [10][11]. Orlistat is related to decreased absorption of fat-soluble vitamins and may also interfere with the absorption of immunosuppressive medications and may be associated with higher risk in ESKD patients [10].…”