腹膜透析置管患者出院准备度现状及影响因素分析

目的调查腹膜透析置管患者出院准备度现状并分析其影响因素,以指导出院准备服务。方法采用一般情况调查表、出院准备度量表对62例腹膜透析置管患者出院前进行问卷调查。结果腹膜透析置管患者出院准备度总分(155.05±21.36)分,条目均分为(7.05±1.26)分,各维度得分从高到低依次为出院后应对能力、可获得的社会支持、自身状况、疾病知识;多元线性回归分析显示,性别、教育程度、居住方式、疾病知识知晓程度是患者出院准备度的重要影响因素(均P0.05)。结论患者出院准备度处于中等水平。医护人员应高度关注腹膜透析置管患者出院准备度水平及其影响因素,根据具体情况给予针对性的干预措施,确保患者出院后的安全。     

腹膜透析患者照顾者的生存质量及相关影响因素分析

目的:探讨腹膜透析患者及其照顾者的社会人口学资料、照顾者负担情况及心理状态与照顾者生存质量的相关性。方法:采用横断面调查方法,纳入2020年09月—2021年08月在中山大学附属第一医院随访的腹膜透析患者的照顾者。收集腹膜透析患者及照顾者的社会人口学资料和病情资料、照顾情况、以及照顾者负担情况、抑郁和焦虑状态、生存质量情况。采用多元线性回归分析腹膜透析患者照顾者生存质量的影响因素。结果:本研究共纳入腹膜透析患者照顾者273例。入组照顾者平均年龄(43.5±12.4)岁,男44.3%,患慢性疾病占11.4%,中位每日照顾患者时长1.0(0.5～2.3)小时,中位照顾患者总年限12.0(2.1～48.8)个月。照顾者中位负担得分10.0(4.0～19.0)分,中位抑郁得分2.0(0.0～6.0)分,中位焦虑得分1.0(0.0～4.0)分,平均生存质量总分(79.5±15.8)分。多元线性回归分析结果显示,照顾者接受九年及以上教育与较高的照顾者生存质量总分独立相关;而照顾者患慢性疾病、较长的每日照顾患者时长、较高的抑郁得分及焦虑得分与较低的照顾者生存质量总分独立相关(均P<0.05)。...     

维持性血液透析患者照顾者心理脱离现状分析

目的探讨维持性血液透析患者照顾者心理脱离现状及影响因素。方法采用心理脱离量表、照顾负担量表、沃里克-爱丁堡积极心理健康量表,对205例维持性血液透析患者照顾者进行问卷调查。结果维持性血液透析患者照顾者心理脱离总分为12.01±3.57。照顾者照顾时间、性格类型、照顾负担、积极心理健康和患者透析年限、透析并发症种类是照顾者心理脱离的主要影响因素(P0.05,P0.01)。结论维持性血液透析患者照顾者心理脱离处于中等水平,受照顾时间、自述性格类型、照顾负担、积极心理健康和患者透析年限、透析并发症种类的影响。医护人员应关注照顾者的心理脱离情况,采取积极措施提高心理脱离水平,促进其身心健康。     

居家腹膜透析患者自我护理能力及影响因素分析

目的:了解上海市松江区居家腹膜透析患者自我护理能力情况,分析其影响因素,为提高患者的自我护理能力提供依据。方法:对松江地区在本市三级医院术后出院和本院入院置管的患者进行问卷调查,调查内容包括腹膜透析知识认知和实际操作过程治疗依从性情况。结果:至2014年10月31日,全区共纳入102例居家腹透患者,患者的腹膜透析认知得分最低为10分,最高得分18分,得分平均值为(16.11±0.23)分;实际操作过程治疗依从性方面的最低得分7分,最高得分16分,得分平均值为(11.75±1.52)分。患者的腹膜透析相关知识认知情况较好而实际操作过程依从性普遍欠佳。多因素Logistic回归分析结果显示,性别、年龄、婚姻状况都是影响患者腹膜透析认知和实际操作过程依从性的主要因素。结论:患者相关知识掌握程度欠佳、家庭腹透操作过程依从性不容乐观,特别是操作前规范洗手和戴口罩最差,对无菌操作的重视程度不够。机构可结合本地区现有条件和患者分布情况,建立医院-社区-家庭全程护理服务模式,更好地解决患者自我护理问题,减少患者的并发症发生率。     

改良24 h腹透液标本留取法在腹膜透析充分性评估中的应用

腹膜透析( peritoneal dialysis,PD)是利用人体自身腹膜作为透析膜的一种透析方式,通过不断更新腹透液,达到肾脏替代或支持治疗的目的[1] ,具有血流动力学影响小、可居家操作等优点[2] ,是治疗终末期肾病( end-stage renal disease,ESRD)的主要肾脏替代疗法之一.既往研究显...     

基于信息平台的1型糖尿病患儿照顾者居家管理体验的定性研究

目的了解1型糖尿病患儿照顾者居家疾病管理的真实经验与体会,为医护人员理解、认识其健康需求,帮助照顾者更好地进行居家管理提供参考。方法建立1型糖尿病患儿居家照顾者微信群,提取95条照顾者分享的居家管理经验和体会,采用内容分析法归纳主题。结果共归纳为5个方面的主题:胰岛素调节、饮食、运动、药物使用及照顾负担。结论 1型糖尿病患儿照顾者居家疾病管理期间存在多方面的困惑和心理压力,需加强针对性个体化的指导,以提高其居家疾病管理能力,缓解心理压力。     

腹膜超滤衰竭机制新进展

腹膜透析（腹透）是终末期肾脏疾病（end—stagerenaldisease,ESRD）患者替代治疗的主要方法之一,目前在全球的透析患者中,约有15％采用腹透。腹透通过腹膜清除溶质和多余的水分来达到治疗的目的。随着腹透治疗时间的延长,腹膜的结构和转运功能会出现显著的变化,最终引起腹膜超滤衰竭导致腹透治疗失败。因而研究腹膜超滤衰竭的机制并进而寻找预防其发生的干预措施一直是近年来透析学界的重点和热点。     

腹膜透析在老年ESRD患者中的应用

过去几十年间,终末期肾病(ESRD)患病率逐年升高,随着社会人口老龄化,老年ESRD人数迅速增加,给社会和医保造成了巨大的负担。老年ESRD的治疗方式主要包括腹膜透析(腹透)和血液透析(血透)、肾移植。由于老年患者接受移植的比例较低,透析仍然是老年ESRD患者的主要治疗方式。对于老年ESRD患者的最佳透析方式,目前尚缺乏普遍共识,本文就腹透在老年ESRD患者中的应用展开综述。     

规律腹膜透析患者血PTH与血脂代谢水平关系的研究

腹膜透析以其简便、有效、居家可透等特点已经成为一种成熟的肾脏替代治疗手段,然而随着腹透时间的延长,腹膜透析的患者常合并心脑血管事件和代谢综合征等并发症,其原因与脂质代谢紊乱、甲状旁腺功能亢进、高血压以及感染等有关,     

腹膜透析相关性腹膜炎的临床分析

<正>腹膜炎是终末期肾衰竭(ESRD)患者居家进行持续性不卧床腹膜透析(CAPD)治疗中最常见的并发症,最终可导致患者退出CAPD。我们通过对本腹透中心近5年来所发生的腹膜透析相关性腹膜炎进行回顾分析,探讨腹膜透析相关性腹膜炎发生的相关因素,为腹膜炎的防治提供临床指导。     

Health-related quality of life, psychosocial strains, and coping in parents of children with chronic renal failure

Health-related quality of life (HRQOL) in parents of children suffering from renal disease is often diminished by the illness burden experienced in daily life and by unfavorable ways of coping. Our aim was to examine the relationship between psychosocial strains perceived by parents, their ways of coping, and HRQOL. In an anonymous cross-sectional study, parents completed a questionnaire concerning psychosocial strains, coping strategies, and HRQOL, as well as sociodemographic and illness parameters. Study participants were recruited in two outpatient dialysis centers. Participating in the study were 195 parents (105 mothers, 90 fathers; age 43?±?8 years; representing 108 families) of children suffering from renal disease (age 12?±?5 years). Parents of children with chronic renal failure reported moderate HRQOL with parents of children undergoing dialysis experiencing more limitations in quality of life than parents of children living with a kidney graft and parents of children undergoing conservative treatment. Mothers experienced lower HRQOL and higher psychosocial strains than fathers. HRQOL was predicted by the coping strategies “focusing on child” (β?=?–0.25), “improving marital relationship” (β?=?0.24), “seeking social support” (β?=?–0.22) and “self-acceptation and growth” (β?=0?.19) as well as parents′ perceived limitation by illness in daily life (β?=?–0.15; explained variance 57%). In the comprehensive care for families with a child suffering from a renal disease, screening for psychosocial strains and ways of coping, along with applying interventions to strengthen adaptive coping strategies, may be a preventative means of improving parents′ quality of life.     

Strategies to support families of children with end-stage renal failure

The burden of care for families looking after children with end-stage renal failure can be considerable, especially when it involves home peritoneal dialysis and supplementary feeding. Good communication with the family and between team members delivering the multidisciplinary care is essential. Stress may be partly reduced by meeting the information needs and supplementing the spoken word with booklets, videos, tape-recorded interviews and play preparation for children. Families greatly appreciate a continuum of care between the hospital and community which is enhanced by team members visiting the home, nursery/school and primary care physician to impart and update knowledge. Respite care is essential for home dialysis patients. It can be enhanced by an evening baby-sitting service and the involvement of a home care renal nurse, as well as a holiday support strategy. Participation of the families in a regular parents support group provides not only an opportunity to integrate families into the unit, but also allows direct feedback on issues affecting the quality of care.     

Group Meetings Benefit Families of Burned Children

Recognition must be given to the continuing burden carried by parents of children who have been discharged from a burns hospital. Weekly parents' meetings under the direction of social workers are offered during clinic hours in an effort to maintain support and offer guidance. Unlike other therapeutic groups, these parents are not screened by interests, background or age. Their only common denominator is that of having a severely burned child. Also, unlike other groups, the participants change each week, depending on the clinic schedule. However, despite the lack of continuity in participaton, the parents have come to know that by returning to the group at any time, they can find help and understanding and often receive renewed strength for coping. It is interesting to note that the same problems recur in the meetings' content: 1) Adjustment of the home schedule immediately following discharge in order to deal with the demands of the children and the time required for skin care, 2) parents' tendency to project their guilt by over-protecting the children, 3) adolescent problems stemming from burn scars affecting body image and self-esteem, 4) changes in marital relationships. Often, parents of children who are still in the acute stage attend these meetings and take their first cautious steps toward facing the future supported by “those who have been there”. All learn that this is an hour when they may freely question, share feelings, and leave knowing they are supported and not alone.     

Psychosocial adjustment and adherence to dialysis treatment regimes

Sixty children and adolescents in end-stage renal failure who were undergoing either haemodialysis or continuous ambulatory peritoneal dialysis at one of five United Kingdom dialysis centres were assessed on psychosocial adjustment and adherence to their fluid intake, diet and medication regimes. Parental adjustment was also measured and data on sociodemographic and treatment history variables collected. A structured family interview and standardised questionnaire measures of anxiety, depression and behavioural disturbance were used. Multiple measures of treatment adherence were obtained, utilising children's and parents' self-reports, weight gain between dialysis, blood pressure, serum potassium level, blood urea level, dietitians' surveys and consultants' ratings. Correlational analyses showed that low treatment adherence was associated with poor adjustment to diagnosis and dialysis by children and parents (P<0.01), self-ratings of anxiety and depression in children and parents (P<0.001), age (adolescents tended to show poorer adherence than younger children,P<0.001), duration of dialysis (P<0.05), low family socioeconomic status (P<0.05) and family structure (P<0.01). These findings demonstrate the importance of psychosocial care in the treatment of this group of children. Future research should develop and evaluate psychosocial interventions aimed at improving treatment adherence.     

Factors related to psychosocial adjustment in children with end-stage renal failure

Psychological functioning and adjustment to dialysis were assessed in the families of 60 children and adolescents undergoing chronic dialysis. Sociodemographic factors, treatment variables, health status and satisfaction with health care provision were also measured. Correlation analyses identified a number of important factors associated with poor adjustment to dialysis and/or anxiety and depression in children and parents. Particularly at risk are parents in lower socioeconomic status households, parents with large families, parents with limited support and parents of young children. Children were more at risk where there was greater functional impairment caused by illness. Received: 10 December 1997 / Revised: 8 March 1999 / Accepted: 16 March 1999     

Psychosocial aspects of children and families of children treated with automated peritoneal dialysis

Background

The aim of this study was to analyze psychosocial aspects of chronic kidney disease (CKD) in children treated with automated peritoneal dialysis (APD).

Methods

The study assessed 41 children > 2  (range 2.1–18) years of age and their parents. Data concerning the illness and sociodemographic parameters were collected. Patients completed the Paediatric Quality of Life Inventory (PedsQL) and their parents the PedsQL-proxy version, General Health Questionnaire (GHQ-12), Berlin Social Support Scales (BSSS), and Caregiver’s Burden Scale (CBS).

Results

Parents rated their children’s overall health-related quality of life (QoL) as well as their physical and emotional functioning lower than the patients themselves. The majority of primary caregivers had a medium level of the total burden index in the CBS and higher values in the scales need for support and perceived available support than in the received support (BSSS). In the GHQ-12, 51.2 % of primary caregivers had scores >2 points, which indicated the possible occurrence of abnormal mental functioning.

Conclusions

Financial support for patients’ families is necessary. Parents who provide primary care to children on PD require, above all, emotional support and assistance in self-fulfilment. More than half of them may have impaired mental function. There is the strong need to provide continuous psychological care for caregivers. Differences in perception of the children’s activity in varied areas by the patients themselves and their caregivers may contribute to further problems within families.     

Assisted peritoneal dialysis

Elderly patients are the largest and fastest growing group of patients with chronic kidney disease maintained on dialysis in the world. Because of advanced age and a heavy burden of comorbidities, the elderly are usually not candidates for kidney transplantation and are less likely to be offered peritoneal dialysis (PD). There is, however, growing evidence that the use of community nurses to assist with PD and the introduction of programs for assisted peritoneal dialysis (aPD) targeting these frail, elderly patients may enable more elderly patients to have their PD treatment at home. Suitable candidates for aPD are incident end-stage kidney disease patients preferring PD but unable to perform their own treatment because of comorbidities, physical disabilities, or psychosocial problems; prevalent, previous autonomous PD patients who have lost their independence because of advanced age or an increased burden of comorbidities; or prevalent hemodialysis (HD) patients switched from HD to aPD because of their own preference, failure of vascular access for HD, or an inability to tolerate HD. We believe that aPD in the future will prove to be a safe and feasible complementary alternative to in-center HD for the growing group of frail, elderly patients with end-stage kidney disease.     

Pediatric dialysis and renal transplantation in Kuwait over the past 11 years

Data on end-stage renal disease (ESRD) patients and their renal replacement therapy (RRT) were collected retrospectively from the three dialysis centers, the pediatric urology unit, and the organ transplant center of Kuwait. The study period was from 1 January 1986 to 31 December 1996. A total of 61 children, 50 of whom were Kuwaiti nationals, required RRT for ESRD during those 11 years. This gave an average annual incidence rate of 18 per million Kuwaiti children. Glomerulonephritis was the most-frequent underlying disease and accounted for 44% of total cases, while pyelonephritis (including urinary tract anomalies and dysplastic kidneys) was responsible for 30%. Multisystem disease was responsible for ESRD in 7 patients (14%), 2 of whom had lupus nephritis, 2 vasculitis, 2 Henoch-Schönlein purpura, and 1 hemolytic uremic syndrome. Continuous ambulatory peritoneal dialysis and home intermittent peritoneal dialysis, using cycler machines, were not favored dialysis techniques by most parents, especially for those <6 years old. The actuarial survival on dialysis was 75%±7% at 12 months. Of the 8 patients who died, 7 were <6 years old. Thirty-eight patients received 46 kidney transplants, 13 of which were performed on a pre-emptive basis. The actuarial patient survivals at 12 months for those receiving first live and cadaveric kidney transplants were 90%±5% and 85%±2%, respectively, while those for grafts were 76%±8% and 66%±2%, respectively. This is the first nationwide long-term study of the incidence and etiology of pediatric ESRD in our area and the RRT in a country with adequate treatment facilities.     

How Australian nephrologists view home dialysis: results of a national survey

Aim: Australia's commitment to home dialysis therapies has been significant. However, there is marked regional variation in the uptake of home haemodialysis (HD) and peritoneal dialysis (PD) suggesting further scope for the expansion of these modalities. Methods: Between 1 April and 5 August 2009, Australian nephrologists were invited to complete an online survey. Seventy‐six questions were asked covering characteristics of the dialysis units, responders' experience, adequacy of facilities and support structures, attitudes to the use of home HD and PD and issues impeding the increased uptake of home dialysis. Results: Completed surveys were received and analysed from 71 respondents; 27 from Heads of Units (35% response rate) and 44 (16%) from other nephrologists. There was strong agreement that HD with long hours was advantageous and that this was most easily accomplished in the home. PD was not considered to be an inferior therapy. A ‘PD first’ policy existed in 34% of Renal Units. The most commonly reported impediments to expanding home dialysis services were financial disadvantage for home HD patients, and lack of physical infrastructure for training, support and education. Areas of concern for expanding home dialysis programmes included psychiatry support, access to respite care and home visits, and lack of support from medical administration and government. The majority of nephrologists would recommend home dialysis to more patients if these impediments could be overcome. Conclusion: This survey identified support from nephrologists for the expansion of home dialysis in Australia and highlighted important barriers to improving access to these therapies.