A structured literature review of pain assessment and management of patients with chronic kidney disease

Aims and objectives. This paper reviews the literature concerning nurses’ assessment and management of pain in adult patients with chronic kidney disease, and proposes implications for clinical practice to support the control of pain in these patients. Background. Chronic kidney disease is a worldwide public health concern with increasing incidence and prevalence, poor patient outcomes and high cost. Patients with kidney disease often experience pain. Optimal pain assessment and management are key clinical activities; however, inadequate pain control by health professionals persists. Renal failure compounds this problem because of the small margin between pain relief and toxicity, and the patient's concomitant health problems. Conclusions. The literature review uses 93 articles that were published in medical‐ and other health‐related journals, including 12 medical and pharmaceutical studies specifically relating to pain control in adults with kidney disease. Very little research has been conducted on pain in patients with kidney disease prior to requiring dialysis or kidney transplantation for survival. However, past research showed pain is common and analgesics are underprescribed in patients on dialysis in end‐stage kidney disease. The review indicates that an interest in nephrotoxicity and analgesic‐induced morbidity dominates over an interest in pain relief in patients with kidney disease. Most analgesics are excreted renally or by the liver, and the use of simple analgesics such as paracetamol is cautioned. Relevance to clinical practice. Findings from the literature review highlight specific difficulties relating to effective pain control in patients with chronic kidney disease. Research is required to identify and overcome barriers to effective pain management, including the development of specific tools to facilitate interventions that optimize analgesic outcomes in patients with chronic kidney disease.     

多囊肾保留原肾行肾移植术病人的术后观察及护理

[目的]总结多囊肾保留原肾行肾移植术病人的术后观察及护理措施。[方法]对49例多囊肾病人行保留原肾肾移植术,同时加强术后观察及护理。[结果]49例病人均未切除原肾脏,术后移植肾功能3 d~24 d恢复正常,术后较长时间后病人腰部胀痛及腹胀均有所减轻,34例术后1个月内原肿大肾脏体积减少15%~30%;术后均未发生早期急性排斥反应。[结论]加强多囊肾保留原肾行肾移植术病人的术后观察及护理是手术成功的保证。     

肾移植患者待肾期间的应对方式调查

背景：对肾移植患者待肾期间的心理学征象进行量化评估,分析该人群应对方式,对其进行相对应的个性化临床心理干预,有利于患者积极面对现实和疾病。目的：通过对等待肾移植患者的心理应激状态进行调查,分析不同社会因素对患者应对方式的影响,探讨相应的临床心理干预对策。方法：随机抽取2009年2月至2010年8月在解放军第309医院器官移植中心泌尿二科等待肾移植患者58例及非等待肾移植患者60例进行调查,采用目前通用的医学应对问卷的形式要求患者填写心理调查问卷表,应用多因素Logistic回归方法分析不同社会因素对患者应对方式及其心理应激状态的影响。结果与结论：调查结果显示等待肾移植患者的“回避”和“屈服”量表得分明显高于非等待肾移植患者(P <0.05);但两组的“面对”量表得分差异无显著性意义(P>0.05)。说明等待肾移植患者较非等待肾移植患者所承受的心理压力大,可能与等待肾移植患者病程长、花费大、担心移植后排斥等因素有关。多因素 Logistic回归分析发现患者的性别、文化程度、收入、费用支付方式和年龄均可影响等待肾移植患者的“面对”(斗争)、“回避”和“屈服”(接受)量表得分,其中文化程度在大专以上的患者“面对”量表得分高;年收入6万元以下的患者“回避”和“屈服”量表得分高。可见等待肾移植患者的收入与文化程度是影响其应对方式和心理应激状态的主要因素,对患者进行合理的临床个体化护理干预,有利于患者积极面对疾病,可减少移植对患者的心理损害。     

拉萨维持性血液透析患者肾移植意愿调查研究

目的了解拉萨地区维持性血液透析患者的肾移植意愿及其影响因素。 方法选择2019年4月5日至2019年4月12日期间在西藏自治区人民医院血液净化中心进行维持性血液透析的患者102例参加的横断面调查。所使用的问卷是根据之前发表的文献进行编制,使用多元Logistic回归分析确定肾移植意愿的影响因素。 结果入选患者98例了解肾移植（96.1%）,35例维持性透析患者有肾移植意愿（34.3%）。调整了混杂因素后,潜在受者的年龄的增长（比值比为0.9,95%CI：0.8~0.9,P<0.001）、已婚状态（比值比为0.1,95%CI：0~0.5,P=0.010）、糖尿病肾病（比值比为0,95%CI：0~0.2,P=0.001）均是肾移植意愿的负面影响因素,并发现41岁是肾移植意愿降低的一个关键转折点。较高的受教育程度（比值比为8.2,95%CI：2.9~22.7,P<0.001）是促进选择肾移植的因素。在职状态（比值比为3.1,95%CI：0.9~10.9,P=0.085,交互作用检验P=0.0133）可能是促进选择肾移植的因素。与肾小球肾炎患者相比,多囊肾患者（比值比为6.0,95%CI：1.0~35.9,P=0.050,交互作用检验P=0.0007）与肾病综合征患者（比值比为1.8,95%CI：0.4~8.4,P=0.485,交互作用检验P=0.0007）可能更愿意选择接受肾移植。 结论在拉萨地区的维持性血液透析患者中,除年龄的增长外,潜在受者对肾移植预后较为落后和偏差的认知是不愿意选择肾移植的重要原因。我们建议开发基于多学科和新媒体的标准化、患者可理解、和基于循证的CKD患者肾脏替代治疗信息系统,以促进西藏CKD患者获得正确的各种肾脏替代治疗预后的信息,以便促进患者能够做出获益更大的治疗决定。     

多囊肾保留原肾行肾移植术病人的术后观察及护理

[目的]总结多囊肾保留原肾行肾移植术病人的术后观察及护理措施.[方法]对49例多囊肾病人行保留原肾肾移植术,同时加强术后观察及护理.[结果] 49例病人均未切除原肾脏,术后移植肾功能3 d～24 d恢复正常,术后较长时间后病人腰部胀痛及腹胀均有所减轻,34例术后1个月内原肿大肾脏体积减少15%～30%;术后均未发生早期急性排斥反应.[结论]加强多囊肾保留原肾行肾移植术病人的术后观察及护理是手术成功的保证.     

广西15个透析中心维持性血液透析患者治疗现况调查

目的掌握广西城市维持性血液透析患者的透析现状。方法对广西9城市15家医院透析中心进行维持性血液透析患者调查,调查年龄、性别、原发疾病、透析时限、透析频率、透析方式、主要并发症和付费方式。结果调查维持性血液透析患者586例,男性337例,女性249例,平均年龄52.03岁;前5位原发病因：慢性肾小球肾炎263例（44.88%）,糖尿病肾病108例（18.43%）,高血压肾病87例（14.85%）,梗阻性肾病36例（6.14%）,间质性肾炎33例（5.63%）。81.91%患者透析年限〈5年;60.92%单纯血液透析,血液透析加间断血液透析滤过182例（31.06%）,血液透析加间歇血液灌流47例（8.02%）;52.84%每周透析2次,37.77%每周透析次数少于2次,9.39%每周3次;约90%患者有高血压,而66.59%高血压未控制。超过一半患者出现过心力衰竭;51.53%出现骨痛;93.45%存在贫血。结论广西城市血液透析患者透析方式主要为血液透析,透析频率多为2次/周,主要并发症为高血压、心力衰竭、贫血和骨痛等,需要加强对并发症的防治。     

Hyperhomocysteinaemia and vascular access thrombosis among chronic hemodialysis patients in Taiwan: a retrospective study

Vascular access thrombosis (VAT) is an important cause of morbidity for chronic haemodialysis (HD) patients. Some risk factors for VAT have been well-defined for chronic HD patients from western countries. However, only a few such factors have been confirmed for Taiwanese patients. This study attempted to determine the association between hyperhomocysteinaemia and the incidence of VAT for chronic HD patients in Taiwan. We retrospectively enrolled a total of 196 patients into this study during 2003. The patients were separated into VAT (n = 142) and control (n = 54) group. The participants of the VAT group were identified as those having one or more VAT, and the participants of the control group were those with no VAT in the past. The mean follow-up period was 48 months. The mean serum homocysteine levels were 29.5 +/- 9.6 and 29.1 +/- 9.5 micromol/l for the VAT (n = 142) and the control (n = 54) group, respectively. There was no significant difference in the level of homocysteine between the VAT and the control group (p = 0.70). Female chronic HD patients had significantly greater mean total homocysteine levels than male (30.89 micromol/l, 95% CI 28.84-32.94 vs. 28.06 micromol/l, 95% CI 26.32-29.82, respectively, p = 0.038). That synthetic graft was a significant risk factor for VAT was determined using multivariate logistic regression analysis. There was no association between serum total homocysteine levels and the incidence of VAT in chronic HD patients in Taiwan.     

Specialist palliative care: patients' experiences

BACKGROUND: Nursing research generally, and palliative care research in particular, has been criticized for generating numerous small scale, often qualitative and/or evaluative studies, from which it is difficult to draw generalizations. AIMS: Our aim in this study was to conduct a synthesis of three evaluative studies of palliative care services in the United Kingdom (UK), to ascertain patients' reported expectations and experiences of specialist care. We also demonstrate how secondary data analysis and synthesis can identify commonalities and differences between services. METHODS: Secondary qualitative data analysis was conducted on interview data gathered from 37 patients during three evaluation studies of specialist palliative care services. All studies used formative evaluation methodology. FINDINGS: Four themes were identified: (1) knowledge and information about services, (2) meeting practical and psychosocial needs, (3) lack of control, and (4) family atmosphere. Data are presented to illustrate the presence or absence of these themes in patients' accounts of their expectations and experiences of each service. STUDY LIMITATIONS: Data were collected at different times between 1998 and 2000, and interviews were conducted by different researchers. CONCLUSIONS: Synthesizing findings from small scale qualitative studies offers the possibility of demonstrating their applicability beyond local and specific contexts. It is imperative to listen to the experiences of patients and carers as a basis for developing interventions and guidelines for services. The methods proposed in this paper offer the potential for these voices of experience to be heard more widely.     

肝肾联合移植术后使用免疫抑制剂的观察及护理

[目的]观察肝肾联合移植术后常用免疫抑制剂的不良反应及并发症,并提出相关护理对策。[方法]对16例肝肾移植病人使用免疫抑制剂后的护理措施进行回顾性分析。[结果]16例病人有1例出现肝功能异常,4例出现肾功能异常,12例出现高血糖,6例出现高血压,1例出现精神症状,调整免疫抑制剂的使用,采取对症治疗后均好转。[结论]肝肾联合移植术后病人使用免疫抑制剂后应重视用药史、用药健康教育、免疫抑制剂的血药浓度监测,注意对肝肾功能、高血糖、高血压、精神症状等药物不良反应的病情观察及护理。     

Development of a wearable bioartificial kidney using the Bioartificial Renal Epithelial Cell System (BRECS)

Cell therapy for the treatment of renal failure in the acute setting has proved successful, with therapeutic impact, yet development of a sustainable, portable bioartificial kidney for treatment of chronic renal failure has yet to be realized. Challenges in maintaining an anticoagulated blood circuit, the typical platform for solute clearance and support of the biological components, have posed a major hurdle in advancement of this technology. This group has developed a Bioartificial Renal Epithelial Cell System (BRECS) capable of differentiated renal cell function while sustained by body fluids other than blood. To evaluate this device for potential use in end‐stage renal disease, a large animal model was established that exploits peritoneal dialysis fluid for support of the biological device and delivery of cell therapy while providing uraemic control. Anephric sheep received a continuous flow peritoneal dialysis (CFPD) circuit that included a BRECS. Sheep were treated with BRECS containing 1 × 10⁸ renal epithelial cells or acellular sham devices for up to 7 days. The BRECS cell viability and activity were maintained with extracorporeal peritoneal fluid circulation. A systemic immunological effect of BRECS therapy was observed as cell‐treated sheep retained neutrophil oxidative activity better than sham‐treated animals. This model demonstrates that use of the BRECS within a CFPD circuit embodies a feasible approach to a sustainable and effective wearable bioartificial kidney. Copyright © 2016 John Wiley & Sons, Ltd.     

应用彩色流速流量定量技术评价肾移植和血液透析患者颈动脉僵硬度

目的 探讨肾移植与血液透析患者颈动脉僵硬度的差别.方法 132例研究对象分为肾移植组(60例)、血液透析组(42例)及正常对照组(30例).二维超声测量颈动脉内中膜厚度,彩色流速流量定量技术测量颈动脉收缩期及舒张期内径,计算颈动脉僵硬度.比较僵硬度的组间及不同时限间的差异.所有受试者血压均低于140/90mmHg(1 mmHg=0.133 kPa).结果 肾移植时间在>6～24个月的肾移植患者颈动脉僵硬度明显低于相同透析时间的透析患者103.8±42.7 vs 262.9±113.0(P<0.01).透析时间<24个月的血液透析患者与正常对照组相比,动脉僵硬度明显增加,其中≤6个月433.3±194.6 vs 125.7±48.6,>6～24个月262.9±113.0 vs 130.7±47.6(P<0.05或<0.01).结论 血液透析较肾移植患者和正常受试者的动脉僵硬度增高.     

肾移植患者口腔粘膜炎的护理

目的 通过探讨肾移植术后口腔粘膜发生、发展规律、为临床护理提供 依据。方法 对22例口腔粘膜炎进行周密细致的评估、观察、记录、分析。结果 肾移植术后口腔粘膜炎的发生与长期透析、大剂量应用免疫抑制剂、WBC下降、营养不良有关；发生部位：颊部8例，舌部6例，齿龈6例，腭部2例；以病毒感染多见；发生程度Ⅰ、Ⅱ级。结论本组口腔粘膜炎发生率22．9％，虽然发生率较高，但通过行之有效的护理降低了口腔粘膜发生程度。