Gender- and age-related benefit of renal replacement therapy on health-related quality of life

Objectives:  The aim of this study was to compare the health-related quality of life (HRQOL) of end-stage renal disease patients on renal replacement therapy with that of subjects of the same gender and similar age from the general population, in an attempt to determine patient subgroup that benefits more from the treatment.
Methods:  A cross-sectional study involving haemodialysis, peritoneal dialysis and renal transplant patients (n = 874) was conducted with subjects providing socio-demographic and disease-related data, and completing the validated Greek Short Form-36 (SF-36) Health Survey. Patient-specific z -scores were calculated using mean SF-36 scores and SD of age- and gender-matched subgroups from the Greek norms.
Results:  Males and younger patients generally reported better HRQOL. However, z -scores in these groups generally showed a larger health deficit, i.e. an increased divergence from the HRQOL of their age- and gender-matched counterparts of the general population, compared with the health deficit observed in female and younger patients.
Conclusions:  Health-related quality of life studies involving disease groups may sometimes be inconclusive if results are not compared with population norms, and particularly with subgroups matched for important demographic variables. Otherwise, as this study has shown, it is possible that important information may remain unrevealed.     

Cost-effectiveness analysis of the Spanish renal replacement therapy program

♦ Background: We undertook a cost-effectiveness analysis of the Spanish Renal Replacement Therapy (RRT) program for end-stage renal disease patients from a societal perspective. The current Spanish situation was compared with several hypothetical scenarios.♦ Methods: A Markov chain model was used as a foundation for simulations of the Spanish RRT program in three temporal horizons (5, 10, and 15 years). The current situation (scenario 1) was compared with three different scenarios: increased proportion of overall scheduled (planned) incident patients (scenario 2); constant proportion of overall scheduled incident patients, but increased proportion of scheduled incident patients on peritoneal dialysis (PD), resulting in a lower proportion of scheduled incident patients on hemodialysis (HD) (scenario 3); and increased overall proportion of scheduled incident patients together with increased scheduled incidence of patients on PD (scenario 4).♦ Results: The incremental cost-effectiveness ratios (ICERs) of scenarios 2, 3, and 4, when compared with scenario 1, were estimated to be, respectively, –€83 150, –€354 977, and –€235 886 per incremental quality-adjusted life year (ΔQALY), evidencing both moderate cost savings and slight effectiveness gains. The net health benefits that would accrue to society were estimated to be, respectively, 0.0045, 0.0211, and 0.0219 ΔQALYs considering a willingness-to-pay threshold of €35 000/ΔQALY.♦ Conclusions: Scenario 1, the current Spanish situation, was dominated by all the proposed scenarios. Interestingly, scenarios 3 and 4 showed the best results in terms of cost-effectiveness. From a cost-effectiveness perspective, an increase in the overall scheduled incidence of RRT, and particularly that of PD, should be promoted.     

应用无肝素连续肾脏替代治疗肝移植术后危重病人的护理

[目的]总结连续性肾脏替代治疗(CRRT)治疗肝移植术后危重病人的疗效,总结护理经验。[方法]30例肝移植术后危重病人行CRRT治疗,记录CRRT治疗前后生命体征、液体平衡、电解质及APACHEⅡ评分的变化;严密监测动脉压、静脉压、跨膜压的变化;严格执行无菌操作,预冲、管路浸泡、定时用生理盐水冲管,保持体外循环畅通,与病人有效沟通。[结果]30例病人经CRRT治疗24h后内环境平衡、APACHEⅡ评分逐渐下降。所有病人治疗过程中生命体征平稳,无肝素连续性肾替代治疗得以顺利进行。[结论]CRRT是提高肝移植术后危重病人近期存活率和抢救成功率的重要措施,有效的护理干预是治疗顺利进行的关键。     

连续性肾脏替代治疗急性肾衰的疗效及护理方法

目的探讨连续性肾脏替代治疗急性肾衰的临床疗效及护理体会。方法选取本院102例急性肾衰患者,均给予连续性肾脏替代治疗,根据随机数字法,将其分为对照组(常规护理)和观察组(护理干预),各51例,比较治疗前后2组肾功能、治疗效果及并发症发生情况。结果与对照组相比,观察组治疗后血肌酐、尿素氮水平显著降低,KT/V值显著增高(P0.05);与对照组相比,观察组治疗后APACHEⅡ评分及尿量恢复600 m L/d均显著降低(P0.05);与对照组相比,观察组低血压、心律失常等并发症发生率降低(P0.05)。结论连续性肾脏替代治疗急性肾衰期间,护理干预能够明显改善患者肾功能,提高治疗的临床疗效,降低并发症发生率。     

危重老年患者无肝素连续性肾脏替代治疗的护理配合

目的探讨危重老年患者开展无肝素连续性肾脏替代治疗(CRRT)的护理方法。方法对14例患者开展的总计88次床边无肝素CRRT积累的护理经验进行总结性回顾。结果除6例次外,其余均顺利平稳完成透析任务,患者CRRT过程中未出现体液失衡、漏血、大出血等严重并发症。结论准确的护理配合是保证CRRT顺利、安全、有效进行的关键。     

Quality of life and dialysis decisions in critically ill patients with acute renal failure

Objective To determine whether health-related quality of life (HRQL) in survivors of acute renal failure (ARF) occurring in intensive care is predictable from data available at the time of acute illness.Design and setting Prospective pilot study in academic intensive care units.Patients and methods Patients requiring renal replacement therapy for ARF while in intensive care over a 6-month enrollment period were included. The primary outcome measure was HRQL among survivors 6 months following hospital discharge, as assessed by the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and its association with Acute Physiology and Chronic Health Evaluation (APACHE) III score. We also asked survivors whether, in retrospect, they would choose to have dialysis again and what factors influenced this decision.Results Ninety-two percent (12/13) of participants surviving 6 months completed the follow-up interview. The mean mental and physical components of the SF-36 were comparable to and slightly lower than the age-matched general population, respectively. There was no correlation between APACHE III score at the time of dialysis initiation and SF-36 score at 6 months. Almost all patients, regardless of their HRQL, stated they would choose dialysis again.Conclusions HRQL may not be predictable from data available at the time of dialysis initiation in this population. In retrospect, surviving patients agree with the decision to accept dialysis, even when their HRQL is poor.This study was supported by a grant from the General Medicine Housestaff Research Fund of the Veteran's Administation Pittsburgh Healthcare System. Dr. Arnold was supported by the Project on Death in America Faculty Scholars Program, the Greenwall Foundation, Ladies Hospital Aid Society of Western Pennsylvania, the International Union Against Cancer Yamagiwa-Yoshida Memorial International Cancer Study Grant Fellowship, and the LAS Trust Foundation.     

Effects of an adaptation training programme for patients with end-stage renal disease

AIMS: This paper reports a study investigating the effectiveness of an adaptation training programme (ATP) to help patients with end-stage renal disease (ESRD) to cope with illness-related stresses and, thus, to alleviate depression and improve quality of life. BACKGROUND: Patients with ESRD who receive dialysis must confront the burdens of long-term illness and numerous treatment-associated stressors. The ability of these patients to cope with and adapt to these stresses, whether related to their medical regimen or to the demands of daily life, has an important influence on physical and psychological well-being. METHODS: The study was a randomized controlled trial using a convenience sample of 57 eligible, fully informed and consenting patients with ESRD who were assigned to experimental (ATP plus usual care) or control (usual care) groups. Participants in the ATP took part in weekly small group sessions over an 8-week period and monthly follow-up to help them to cope with stressors. A clinical nurse specialist and an experienced psychotherapist led them in three small groups (8-10 per group). Participants in the usual care group received routine care. Instruments comprised the Haemodialysis Stressor Scale, Beck Depression Inventory and Medical Outcomes Study SF-36. Data were collected at baseline and at three months following the intervention. RESULTS: The major stressors for these patients were limitations on time and place related to employment, limitations on fluid intake, transport difficulties, loss of bodily function, length of dialysis treatment, and limitation of physical activities. The ATP had a beneficial effect on perceived stress (P = 0.005), depression (P = 0.001) and quality of life (P = 0.02) 3 months after the intervention. CONCLUSIONS: This study supports the effectiveness of an ATP to decrease stress and depression levels, and to improve the quality of life of ATP patients receiving haemodialysis.     

Survival and quality of life of patients requiring acute renal replacement therapy

Objective To assess long-term survival and health-related quality of life in patients with acute renal failure.Design and setting Cross-sectional cohort study in the ten-bed medical-surgical intensive care unit and the three-bed acute dialysis unit in a tertiary care hospital.Patients 703 patients receiving renal replacement therapy for acute renal failure during 1998–2002.Measurements and results The mortality rate was 41% at 28 days, 57% at 1 year, and 70% at 5 years. SOFA score, age, and continuous renal replacement therapy were independent predictors of 1-year mortality. The median follow-up time was 3.9 years for mortality and 2.4 years for health-related quality of life. Of the 229 survivors in 2003, 153 (67%) responded to the health-related quality of life questionnaire. Health-related quality of life was evaluated with the EuroQol (EQ-5D) instrument including a visual analogue scale (VAS) score to evaluate the patients perceived health. The EQ-5D score was significantly lower in the study population than in the age- and gender-matched Finnish population (0.68 vs. 0.86). Median VAS scores were 69.5 and 70.0, respectively. Patients age and duration of follow-up had no significant effect on EQ-5D or VAS scores. Mortality and EQ-5D data were used to calculate quality-adjusted life years. Quality-adjusted survival was poor (15 quality-adjusted life years per 100 patients in the first year of follow-up).Conclusions The long-term survival of patients with acute renal failure is poor. Although survivors have a low health-related quality of life, they are as satisfied with their health as the general population.This article refers to the editorial available at     

重症患者连续性肾脏替代治疗中管路寿命影响因素的研究

目的探讨影响重症病患者连续性肾脏替代治疗(CRRT)中管路寿命的因素。方法将131个因为管路凝结而更换配套的滤器分成两组,寿命<48h的为A组(106个),≥48h的为B组(25个)。比较两组管路滤器应用时患者的血清白蛋白、红细胞压积、血小板计数、离子钙浓度、pH值、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、肝素剂量及体温的变化,并采用多因素线性回归对上述指标进行分析。结果 B组患者血清离子钙浓度、pH值及体温明显低于A组患者(P均<0.05)。血PH值及离子钙浓度是影响管路滤器寿命≥48h的相关因素。结论影响CRRT管路寿命≥48h的相关因素是血pH值和离子钙浓度。     

Acupoints massage in improving the quality of sleep and quality of life in patients with end-stage renal disease

BACKGROUND: Traditional Chinese acupressure is a noninvasive technique that employs pressure and massage to acupoints in order to stimulate the balance of life energy that promotes health and comfort. Sleep disturbance is common in patients with end-stage renal disease but no intervention studies have addressed this problem. Aim. The purpose of the present study was to test the effectiveness of acupoints massage for patients with end-stage renal disease and experiencing sleep disturbances and diminished quality of life. METHODS: The study was a randomized control trial. A total of 98 end-stage renal disease patients with sleep disturbances were randomly assigned into an acupressure group, a sham acupressure group, and a control group. Acupressure and sham acupressure group patients received acupoints or no acupoints massage three times a week during haemodialysis treatment for a total of 4 weeks. The measures included the Pittsburgh Sleep Quality Index, Sleep Log, and the Medical Outcome Study - Short Form 36. FINDINGS: The results indicated significant differences between the acupressure group and the control group in Pittsburgh Sleep Quality Index subscale scores of subjective sleep quality, sleep duration, habitual sleep efficiency, sleep sufficiency, and global Pittsburgh Sleep Quality Index scores. Sleep log data revealed that the acupressure group significantly decreased wake time and experienced an improved quality of sleep at night over the control group. Medical Outcome Study - Short Form 36 data also documented that acupressure group patients experienced significantly improved quality of life. CONCLUSION: This study supports the effectiveness of acupoints massage in improving the quality of sleep and life quality of end-stage renal disease patients, and offers a noninvasive therapy for sleep-disturbed patients.     

连续性肾脏替代疗法治疗危重症患者的护理

目的 探讨连续性肾脏替代疗法治疗危重症患者的应用及临床护理措施.方法 选取2009年10月至201 1年6月于本院进行治疗的l00例危重症患者为研究对象,对其实施护理措施,将连续性肾脏替代疗法治疗前后患者的生化指标进行比较分析.结果 连续性肾脏替代疗法治疗后患者的生化指标较治疗前均有明显改善.结论 在连续性肾脏替代疗法治疗危重症患者的过程中实施有效、全面的护理能够很大程度上改善患者的生命指标,提高重症患者的存活率,值得在临床开展应用.     

集束化护理干预对老年危重症患者行无肝素连续性肾脏替代治疗的影响

目的探讨集束化护理干预对老年危重症患者行无肝素连续性肾脏替代(CRRT)治疗的影响。方法选取本院收治的行CRRT治疗的老年危重症患者94例作为研究对象,将其随机分为观察组和对照组,各47例。其中对照组给予常规护理干预,观察组在对照组基础上给予集束化护理干预。观察2组并发症发生率、滤器使用情况以及患者依从性情况。结果观察组感染、低体温、体外循环凝血、酸碱度失衡、出血、低血压、水电解质失衡发生率低于对照组(P0.05);观察组每个滤器使用时间、滤器使用总时间以及24 h使用滤器个数低于对照组(P0.05);观察组依从率91.49%,高于对照组的76.60%(P0.05)。结论集束化护理干预可有效降低老年危重症患者行CRRT治疗的并发症,减少滤器更换,并提高患者治疗依从性。     

Quality of life after renal transplantation

End stage renal disease (ESRD) inevitably reduces the life-span of its victims. The treatment of choice for many patients is transplantation but this does not effect a cure. Its aim is to improve renal function and thus to enhance the patient's ability to enjoy as full a life as possible. However, surprisingly little research has been concerned with quality of life after transplantation. A small-scale, exploratory study employing a qualitative design was undertaken to compare stress and quality of life between five patients with ESRD awaiting transplantation and five patients who had received a graft within the previous 6 months. The desire to undergo transplantation was fuelled by patients' perceived need to 'get off dialysis' and to 'lead a normal life'. All patients had received abundant technical information about renal transplantation and pre-operative preparation but information concerning the negative effects of transplantation, including the side-effects of medication appeared lacking. It was not possible to determine whether this information had not been supplied or had been offered but forgotten or denied. For pre-transplantation patients the main sources of stress were the need to undergo dialysis, awaiting the summons to hospital and the social isolation imposed by having a chronic condition such as constant fatigue. Post-transplantation patients were remarkably free of anxiety considering the impositions placed upon them by frequent clinic attendance to monitor their condition. Quality of life improved dramatically after transplantation despite the persistence of renal symptoms and patients felt privileged to have been offered this treatment option.     

持续肾脏替代疗法治疗老年急性肾功能衰竭的疗效

目的探讨持续肾脏替代疗法治疗老年急性肾功能衰竭的疗效。方法对11例老年急性肾功能衰竭患者采用持续肾脏替代疗法,平均治疗时间24.8h,置换液以前稀释方式输入,流量2~4L/h,血流量150~250ml/min,采用普通肝素抗凝。结果11例患者中7例好转,3例死亡;所有患者治疗中血流动力学稳定,血尿素氮及肌酐均明显下降(P<0.01),未见明显副作用。结论持续肾脏替代疗法对老年急性肾功能衰竭患者有改善预后作用,不受年龄限制,患者耐受性好,是抢救老年急性肾功能衰竭的有效手段之一。     

肝植移术后急性肾功能衰竭患者连续性肾脏替代治疗的护理

采用连续性肾脏替代疗法治疗原位肝移植术后急性肾功能衰竭患4例。通过连续监测生命体征，准确记录每小时出入量，严格按配方配制透析液和置换液，预防感染，保持血管通路通畅等护理措施，保证了连续肾脏替代治疗顺利进行。     

连续肾脏替代疗法在感染性休克致急性肾损伤患者中的应用效果

目的探讨连续肾脏替代疗法在感染性休克致急性肾损伤患者中的应用效果。方法选取我院2017年5月至2019年4月收治的65例感染性休克致急性肾损伤患者,按照随机法将其分为对照组(32例)与研究组(33例)。对照组采用间歇性血液透析治疗,研究组采用连续肾脏替代疗法治疗。比较两组临床疗效。结果研究组尿量恢复时间、器官支持时间、ICU住院时间及总住院时间均短于对照组,差异具有统计学意义(P<0.05)。治疗前,两组APACHEⅡ、SOFA评分比较,差异无统计学意义(P>0.05);治疗后24、48 h,研究组APACHEⅡ、SOFA评分低于对照组,差异具有统计学意义(P<0.05)。结论对感染性休克致急性肾损伤患者行以连续肾脏替代疗法可促进尿量恢复,缩短器官支持时间、ICU住院时间及总住院时间,还可以改善患者健康状况及器官衰竭状况。     

连续性肾脏替代治疗对急性肾功能衰竭患者血浆细胞因子的影响

目的探讨连续性肾脏替代治疗(CRRT)对急性肾功能衰竭(ARF)患者血浆细胞因子的影响。方法对42例急性肾功能衰竭患者进行CRRT治疗,使用ELISA法检测治疗前和治疗后4、12、24、48 h血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、IL-6、IL-8的浓度,并与同期健康人群做比较。结果 ARF患者TNF-α、IL-1β、IL-6、IL-8血浆浓度均显著高于正常对照组(P<0.01),4种细胞因子在CRRT治疗4 h开始后显著下降,12 h时浓度降至最低,24～48 h有不同程度的回升,但仍低于治疗前水平。结论 CRRT能有效清除ARF患者血浆细胞因子,从而阻断炎症反应。     

连续性肾脏替代治疗过程中外周血细胞因子浓度的变化

目的 研究连续性肾脏替代治疗（ＣＲＲＴ）过程中外周血中肿瘤坏死因子（ＴＮＦ）。白细胞介素－８（ＩＬ－８）和内皮衍生血管舒张因子一氧化氮（ＮＯ）浓度的变化,方法：５例重症急性肾功能衰竭（肾衰）患者在明确诊断之后即开始地ＣＲＲＴ,每天持续１０－１２小时,血管通路采用动－静脉内瘘成颈内静脉留置导管,ＡＫ－１０血浆建立体外循环,血滤器采用ＦＨ６６Ｄ型（聚酰胺膜,０．６ｍ＾２）。治疗前和治疗１,２,３,６,