ESRD Reflection
1. What parts of the resource were most useful in working with the "client" and why?
The pathophysiology section gave a comprehensive overview of End Stage Renal Disease
(ESRD), which helped me to understand exactly what was involved with the client’s disease.
Further, I liked that the resource integrated multiple links to external sources. This allowed
for further investigate into various areas relating to the disease. The identification of
exercise limitations and risk factors was well summarised and very useful to know before
seeing a patient with ESRD. All the statistics on the prevalence of ESRD was from current
Australian data. This made it applicable to our client base and interesting to learn how
prevalent this disease is amongst the Australian population.
2. Can you suggest improvements to the practical use of the resource? Rationalise
any improvements and provide examples where possible.
The inclusion of exercise prescription summaries and recommendations from the research
would have been helpful rather than annotations from each reviewed journal. The exercise
information was there but as the reader I had to sift through all the information to identify
the general exercise recommendations. Further, the inclusion of external links to patient
fact sheets, patient experiences and help groups for people with ESRD would be a useful
tool to have as a practitioner. The National Kidney Foundation offers fact sheets, these
could help answer and explain various questions about kidney disease and its link with other
comorbidities. Further, the Kidney Care Partners offer patent experiences on their website
and the Canberra Region Kidney Support Group provides support and information for
people living with or affected by renal conditions.
3. Was the resource factually accurate? Use references to support your response.
A review article by Cheema (2008) referenced 108 journal articles and provided empirical
evidence to support the finding of the wiki in regards to exercise reducing the risk factors for
early mortality in ESRD patients. My current textbook by Ehrman, Gordon, Visich & Keteyian
(2009) support the pathophysiological listings in the wiki. Further, the exercise guidelines
recommended by the wiki cohere to the K/DOQI recommended guidelines and a position
paper by Johansen (2007) supports the use and benefits of the various modalities of
exercise reviewed by this wiki.
All sources used for the wiki were published post 2000 except the exercise training section
which used some older papers. This demonstrates that that majority of the information
presented in the wiki is up to date and still relevant.
4. What are your thoughts on the layout of the resource? Describe what changes you
might make to improve ease of understanding of the resource. If you are aware of
anything that may improve the resource (e.g. a video, reference to further reading
etc) include them here.
The layout of the wiki was user friendly with clear titles for easy navigation to the various
sections. There were plenty of pictures, videos and graphs which complemented the
written content. I would potentially increase the size of the subheadings so they are easier
to identify. Further, the inclusion of summaries after each reviewed section for exercise
prescription would make the resource more user-friendly and helpful when deciding how to
treat a patient with ESRD.
5. Describe any personal experiences you have had, or anticipate, in professional life
and how such a resource might be used in practice.
I have previously worked at a physiotherapy clinic seeing a variety of clients each day. My
role was to prescribe exercises that would address their medical problems and improve
their health conditions. Sometimes I would see a client for a particular injury but they
would have other underlying conditions (diabetes, hypertension, etc) that I would need to
understand and consider when prescribing exercise. To have an easily accessible resource
like a wiki which can give an overview of various conditions and summarise the research
related to exercise prescription and the associated precautions/limitations is very helpful.
With so many different diseases being treated with exercise, it is hard to memorise all the
exact risk factors and special considerations for each. Thus, it is extremely useful to have a
resource that allows for a quick or detailed overview of the various diseases and their
recommended exercise modalities.
In conclusion, this wiki is well written with plenty of up to date and useful information. The
inclusion of exercise prescription summaries and additional patient specific information
(fact sheets, support groups, etc) would add to the accessibility of information for
practitioners but overall a good recourse.
References
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Cheema, B. (2008) Review article: Tackling the survival issue in end-stage renal
disease: Time to get physical on haemodialysis. Nephrology, 13, 560–569.
Ehrman, J. K., Gordon, P. M., Visich, P. S., & Keteyian, S. J. (2009). Clinical Exercise
Physiology. Human Kinetics.
Johansen, K.L. (2007). Exercise in the end-stage renal disease population. Journal of
the American Society of Nephrology, 18(6): p. 1845.
National Kidney Foundation: K/DOQI clinical practice guidelines for cardiovascular
disease in dialysis patients. Am J Kidney Dis 45[Suppl 3]: S1–S154, 2005