Nephrology Nursing: Early Intervention in Chronic Kidney Disease

The early diagnosis of a patient with chronic kidney failure presents enormous opportunities for the nephrology health care team. Current research has identified that appropriate and timely education and management during the early stages of kidney disease reduces health care risk to the patient and lowers associated cost.

This study explored the potential for extending the contribution nurses make in managing patients with chronic kidney disease as they progress to end stage kidney failure. In the context of a shortage of nephrologists and an escalating patient population suffering from kidney disease, the potential to include advanced nephrology nursing in early disease management was postulated. The literature was reviewed with regard to initiatives to reduce the progression of kidney failure and the prevention of associated complications. Local and international literature on advanced nursing practice and the nurse practitioner role was examined in relation to the management of chronic kidney disease.

The introduction of the nurse practitioner in New Zealand could provide an ideal framework for independent nephrology nursing. Well-established nursing practice in dialysis, transplantation and pre-dialysis provide distinct scopes of practice in these areas for independent nursing in the future. It seems likely that these sub-specialties in nephrology nursing will be the first to experience the value of the nurse practitioner.

The creation of early interventionalist nurse practitioners in nephrology health care would allow nurses to step outside these well-established sub-specialties, and provide new resources to help manage chronic kidney disease. A model of care was proposed that outlines how a nephrology nurse practitioner could work collaboratively with community health providers and the local nephrology health care team to manage the early stages of kidney disease.

It is evident that early intervention and ongoing management of patients with chronic kidney disease is currently suboptimal. The development of the nephrology nurse practitioner is an innovative way to reach the nephrology community and meet health needs in a cost-effective manner.