Chronic kidney disease stressors influence choice of dialysis modality

harwood l., wilson b., sontrop j. & clark a.m. (2012)?Chronic kidney disease stressors influence choice of dialysis modality. Journal of Advanced Nursing68(11), 2454-2465. ABSTRACT: Aim. This article is a report of a study examining the relationships between chronic kidney disease stressors and coping strategies with dialysis modality. Background. People with chronic kidney disease are given information to enable dialysis modality choice. This education increases awareness and may alleviate concerns and stress. Disease-related stressors and coping may affect dialysis selection. Understanding the influence of stress and coping on dialysis choices will assist in providing responsive programmes. Reducing stress and encouraging coping may increase home dialysis which, despite economic and patient benefits, remains underused. Design. A prospective correlational design was used. Methods. Information was obtained from the Chronic Kidney Disease Stress Inventory and the Jalowiec Coping Scale in 223 individuals not on dialysis between the years 2005-2007. Data were recorded with respect to modality at dialysis initiation (n?=?76) from 2005-2010. The effects of stress, coping and patient parameters on modality selection were compared using bivariate and multivariate analyses. Results. Individuals on home dialysis vs. in-centre haemodialysis reported significantly fewer pre-dialysis stressors. Coping was not associated with dialysis modality. Individuals on in-centre haemodialysis had a lower serum creatinine, less advanced kidney disease and weighed more than those who started on a home therapy. Physiological stressors were most common and are amenable to interventions. Conclusion. Pre-dialysis stress levels predicted dialysis modality. Interventional studies are recommended to address chronic kidney disease stressors with the outcome of improving home-dialysis usage.     

Sleep-Disordered Breathing in 2 Pediatric Patients on Peritoneal Dialysis

Sleep-disordered breathing (SDB) is prevalent in children with chronic kidney disease (CKD), and has the potential to worsen vascular and neuro-cognitive health and quality of life. We present 2 children with CKD who experience central sleep apnea and nocturnal hypoventilation and discuss the possible underlying mechanisms in relation to CKD and dialysis.     

Africa and nephrology: the forgotten continent

Chronic kidney disease (CKD) is not a priority on the health agenda in Africa and it remains a 'forgotten condition'. Most people in Africa do not have access to dialysis or transplantation, if they develop end-stage renal disease. Cardiovascular disease (CVD) and HIV/AIDS enjoy a more prominent profile as a serious cause of morbidity and mortality, but despite the clear links of CVD and HIV with CKD, there has been a failure to highlight the link between chronic illnesses like diabetes, hypertension and HIV/AIDS and both CKD and CVD. Management of chronic illnesses requires a functioning public health system and good links between primary and specialist care. Despite calls to establish CKD prevention programs, there are very few in Africa and they have not been integrated into existing primary healthcare systems. This is aggravated by shortages of both financial and human resources and failure to strengthen health systems managing chronic diseases. The result is that very few people in Africa with CKD are managed early or receive dialysis or transplantation. This article investigates some of the issues impacting on the recognition of CKD as a public health issue, and will also consider some factors which could make CKD a more prominent chronic disease in Africa.     

Factors affecting peritoneal dialysis selection in Taiwanese patients with chronic kidney disease

LIANG C.‐H., YANG C.‐Y., LU K.‐C., CHU P., CHEN C.‐H., CHANG Y.‐S., O'BRIEN A.P., BLOOMER M. & CHOU K.‐R. (2011) Factors affecting peritoneal dialysis selection in Taiwanese patients with chronic kidney disease. International Nursing Review 58 , 463–469 Background: Taiwan has the highest incidence and prevalence of end‐stage renal disease (ESRD) in the world with 55 499 ESRD patients on long‐term dialysis. Nevertheless, 90.96% of these patients are managed on maintenance haemodialysis (HD), with only 9.03% enrolled in a peritoneal dialysis (PD) programme. Aim: The study aim was to identify the factors affecting Taiwanese patient's selection of PD in preference to HD for chronic kidney disease. Methods: A cross‐sectional research design was utilized with 130 chronic renal failure (CRF) patients purposively selected from outpatient nephrology clinics at four separate Taiwan hospitals. Logistic regression was used to identify the main factors affecting the patient's choice of dialysis type. Results: Single‐factor logistic regression found significant differences in opinion related to age, education level, occupation type, disease characteristics, lifestyle modifications, self‐care ability, know‐how of dialysis modality, security considerations and findings related to the decisions made by medical personnel (P < 0.05). Moreover, multinomial logistic regression after adjustment for interfering variables found that self‐care ability and dialysis modality know‐how were the two main factors affecting the person's selection of dialysis type. Conclusions: Self‐care ability and the person's knowledge of the different types of dialysis modality and how they function were the major determinants for selection of dialysis type in Taiwan based on the results from this study. The results indicate that the education of CRF patients about the types of dialysis available is essential to enable them to understand the benefits or limitations of both types of dialysis.     

Diagnosis and Treatment of Anemia of Chronic Kidney Disease in the Primary Care Setting: A Primer for Nurse Practitioners

Anemia of chronic kidney disease (CKD) is associated with increased cardiovascular morbidity, health care costs, and mortality. Both early CKD and its attendant anemia may be asymptomatic and thus often go undetected. Appropriate anemia treatment may improve cardiovascular prognosis, physical activity, and quality of life in CKD patients not requiring dialysis. Primary care nurse practitioners are ideally positioned to detect and treat CKD-related anemia. This review discusses the pathophysiology, consequences, and primary detection and management of anemia of CKD.     

慢性肾脏病患者疾病感知与疼痛感知的关系研究

目的探讨慢性肾脏病患者疼痛感知与疾病感知的相关性,并分析影响因素,为制订相关干预措施提供参考。方法采用一般资料调查表、简明疾病感知问卷、简明疼痛问卷——长版对259例慢性肾脏病患者进行问卷调查。结果 259例未透析慢性肾脏病患者疾病感知总分为(43.07±9.46)分、疼痛强度得分5.00分,疼痛影响各条目得分为2.00～3.00分。疾病感知总分与疼痛影响总分呈显著正相关(r=0.282,P<0.01)。多元线性回归分析结果显示,疾病感知的影响因素为性别、个人月收入、慢性肾脏病分期以及疼痛影响与他人关系(P<0.01或P<0.05)。结论女性、个人收入越低、肾脏病分期越晚、疼痛影响患者与个人关系越严重的未透析患者,其疾病感知可能越负面,临床专业人员可采取相应干预措施,治疗或缓解患者的疼痛症状,改变疾病感知水平,以期提高患者的身心健康。     

Extended dosing of darbepoetin alfa in patients with chronic kidney disease not on dialysis: a review of recent data.

Anemia is a common and serious complication of chronic kidney disease (CKD), which can be successfully and safely treated with erythropoiesis-stimulating proteins (ESPs). Darbepoetin alfa, a long-acting ESP, can be dosed less frequently than Epoetin alfa, thereby reducing the burden on patients and health care staff. This review summarizes recent clinical data supporting use of darbepoetin alfa at extended dosing intervals of once every 2 weeks and once monthly in patients with CKD not on dialysis.     

Evaluation of a nurse-led disease management programme for chronic kidney disease: A randomized controlled trial

Background

Patients with end stage renal failure require dialysis and strict adherence to treatment plans to sustain life. However, non-adherence is a common and serious problem among patients with chronic kidney disease. There is a scarcity of studies in examining the effects of disease management programmes on patients with chronic kidney disease.

Objectives

This paper examines whether the study group receiving the disease management programme have better improvement than the control group, comparing outcomes at baseline (O1), at 7 weeks at the completion of the programme (O2) and at 13 weeks (O3).

Methods

This is a randomized controlled trial. The outcome measures were non-adherence in diet, fluid, dialysis and medication, quality of life, satisfaction, symptom control, complication control and health service utilisation.

Results

There was no significant difference between the control and study group for the baseline measures, except for sleep. Significant differences (p < 0.05) were found between the control and study group at O2 in the outcome measures of diet degree non-adherence, sleep, symptom, staff encouragement, overall health and satisfaction. Sustained effects at O3 were noted in the outcome measures of continuous ambulatory peritoneal dialysis (CAPD) non-adherence degree, sleep, symptom, and effect of kidney disease.

Conclusions

Many studies exploring chronic disease management have neglected the group with end stage renal failure and this study fills this gap. This study has employed an innovative model of skill mix using specialist and general nurses and demonstrated patient improvement in diet non-adherence, CAPD non-adherence, aspects of quality of life and satisfaction with care. Redesigning chronic disease management programmes helps to optimize the use of different levels of skills and resources to bring about positive outcomes.     

Is “chronic kidney disease” a disease?

Several philosophers of medicine have attempted to answer the question “what is disease?” In current clinical practice, an umbrella term “chronic kidney disease” (CKD) encompasses a wide range of kidney health states from commonly prevalent subclinical, asymptomatic disease to rare end‐stage renal disease requiring transplant or dialysis to support life. Differences in severity are currently expressed using a “stage” system, whereby stage 1 is the least severe, and stage 5 the most. Early stage CKD in older patients is normal, of little concern, and does not require treatment. However, studies have shown that many patients find being informed of their CKD distressing, even in its early stages. Using existing analyses of disease in the philosophy literature, we argue that the most prevalent diagnoses of CKD are not, in fact, diseases. We conclude that, in many diagnosed cases of CKD, diagnosing a patient with a “disease” is not only redundant, but unhelpful.     

Dialysis and fatigue: implications for nurses--a case study analysis

Fatigue is one of the most common symptoms experienced by patients receiving dialysis. When patients with chronic kidney disease (CKD) and end-stage renal disease are admitted to acute care settings, they require management of their often profound fatigue. CKD, renal pathology, and renal fatigue are examined in relation to a case study.     

Clinical considerations and practical recommendations for the primary care practitioner in the management of anemia of chronic kidney disease

Anemia is prevalent in patients with chronic kidney disease (CKD) and is a risk factor for poor disease outcome. Anemia acts as a risk multiplier, significantly increasing the risk of death in anemic versus nonanemic CKD patients with similar comorbidities. Erythropoiesis-stimulating agents (ESA) are a mainstay for the treatment of anemia in renal patients on dialysis, but recent data suggests that earlier treatment of anemia in CKD may delay the onset of end-stage renal disease (ESRD) and decrease mortality. Nonetheless, anemia of CKD is under-recognized and undertreated during the period before initiation of dialysis, when anemia correction may have the greatest impact on disease outcome. This report describes anemia in CKD and its association with diabetes, cardiovascular disease, and poor disease outcome, and offers suggestions for the recognition and treatment of anemia of CKD in the primary care setting.     

慢性肾脏病合并妊娠管理的多学科协作

慢性肾脏病(chronickidneydisease,CKD)合并妊娠,是产科高危妊娠因素之一,非妊娠禁忌证。随着医 学水平的发展,肾脏透析的普及,产科高危妊娠管理规范化及早产儿救治水平的提高,CKD成功妊娠成为可能。但如 何顺利度过妊娠期,需要多学科协作共同管理,才能得到良好的妊娠结局。本文就CKD合并妊娠的临床多学科协作 管理进行综述。     

Background of measures against chronic kidney disease

The number of chronic kidney disease (CKD) in Japan is estimated to be 6-13 million. The actions against CKD are urgently requested, because 1) CKD is a strong risk factor for the development of chronic renal failure and cardio-vascular diseases, 2) the numbers of end stage renal failure and cardiovascular events are increasing, and 3) CKD is a treatable disease. To prevent the increase in patients on dialysis and cardio-vascular events, the establishment of the system to detect and treat CKD patients is essential. In addition, the advice regarding healthy lifestyle is also valuable to prevent the development and progression of CKD. Since CKD is harmful but treatable, nephrologists and family doctors should collaborate in the action against CKD.     

Patient and Technique Survival of Older Adults with ESRD Treated with Peritoneal Dialysis

The number of older adults worldwide is increasing as societies gain success in improving the health and lifespan of their citizens. As a result, increasing numbers of older adults are presenting to the medical community with advanced kidney failure. Historically, dialysis treatments were withheld from older adults particularly those with severe co-existing illnesses. This has changed in most parts of the world, and there is now an increasing emphasis on shared decision-making to determine whether dialysis is appropriate and to determine which modality meets the needs, expectations, and desire of patients. Evidence examining the difference in risk for death of older adults treated with hemodialysis (HD) or peritoneal dialysis (PD), and the probability of those treated with PD to transfer to HD among older compared to younger adults, is largely derived from prospective cohort studies or analyses of data from national registries. In such studies, it is difficult to distinguish whether differences in outcomes reflect the effect of dialysis modality or differences in health status of different groups of patients. Longevity and technique survival are important, albeit not the only or most important consideration in such decision-making. Given the risk for bias in observational studies and the profound effect of dialysis modality on patients'' lifestyle, the selection of dialysis modality should remain a decision made by the patient, caregivers, and his/her physician after thorough education and review of the available data.     

Supporting patient choice: an intervention to promote independent dialysis therapies

Independent dialysis therapies are as effective as in-center therapies but cost only about half as much. This project incorporated a patient focus group to better understand patient perceptions and possible barriers related to choosing independent dialysis therapies. Focus group findings included hardship related to loss of kidney function, the need for support from healthcare professionals, the need for educational materials and recruitment strategies focused on the benefits of independent dialysis, the need for peer support to encourage choice of independent dialysis modality, and support for technical issues. Themes identified by the focus group were used to create two new education tools and a nurse-delivered education program for patients with CKD. Future evaluation will determine whether these efforts lead to an increase in selection of independent dialysis therapies.     

慢性肾脏病高磷血症的治疗

高磷血症是导致慢性肾脏病(CKD)患者死亡的独立危险因素,有效控制高磷血症可改善CKD患者的预 后。目前控制血磷水平的措施主要有限制饮食中磷的摄入、口服降磷药物和透析清除等,其中口服肠道磷结合剂是目 前CKD患者降磷最简便有效的方法。     

The self-management experience of people with mild to moderate chronic kidney disease.

This qualitative, exploratory study examined the self-management experiences of people with mild to moderate chronic kidney disease (CKD, Stages 1-3) to elicit participants' perceptions of health, kidney disease, and supports needed for self-management. Findings revealed a process of renegotiating life with chronic kidney disease, which encompassed Discovering Kidney Disease and Learning To Live With Kidney Disease. A number of themes were identified including searching for evidence, realizing kidney disease is forever, managing the illness, taking care of the self and the need for disease-specific information. The findings indicate participants with early CKD want to self-manage their illness in collaboration with health care providers. As well, people with early CKD need guidance and support from health professionals to successfully self-manage. Nephrology nurses are uniquely positioned to provide this support while collaborating with other care providers to facilitate self-management.     

慢性肾脏病冠状动脉钙化发生率及预后评估

目的探讨慢性肾脏病（CKD）冠状动脉钙化发生率及其在预后评估中的应用。方法测定136例CKD患者及50例同期健康体检者血钙（Ca）、血磷（P）水平,并采用多层螺旋CT（MSCT）检测所有观察对象冠状动脉钙化积分情况。比较不同组间患者的冠状动脉钙化及主要心脏不良事件（MACE）发生情况。结果与对照组比较,三组不同CKD分期患者的冠状动脉钙化率、重度钙化率、血磷及钙磷乘积均明显升高（P〈0．05）;且随着CKD病情程度的增加,患者冠状动脉钙化率、重度钙化率、钙磷乘积均依次增加（P〈0．05）;随着透析治疗时间的延长,冠状动脉钙化率、重度钙化率均呈上升趋势（P〈0．05）;随访1年,钙化组MACE发生率为16．9％,显著高于非钙化组为5．6％（P〈0．05）。结论CKD患者冠状动脉钙化发生率较高,尤其是长期维持性透析患者,且冠状动脉钙化程度与CKD患者的预后有关。     

K/DOQI gets to the heart of managing dyslipidemias in patients with CKD.

There is a wealth of data in the general population regarding interventions to reduce cardiovascular risk. Unfortunately, most of these studies exclude patients with chronic kidney disease. As a result, the lack of CKD specific data has resulted in a lack of attention and intervention. With the epidemic levels of cardiovascular disease in patients on dialysis, the NKF has established these K/DOQI guidelines in an effort to get to the "heart" of dyslipidemias and ultimately to assist the health care team in their effort to improve CKD patient outcomes. In addition, the National Kidney Foundation currently has draft K/DOQI Clinical Practice Guidelines for Cardiovascular Disease in the public review process. These new guidelines will elaborate on areas not covered in the dyslipidemia guidelines.     

Risk factors associated with coronary artery calcification should be examined before kidney transplantation

The best treatment for end stage renal disease (ESRD) patients is kidney transplantation, but the renal transplant recipients still have a higher incidence of cardiovascular events compared with general population. Cardiovascular risk factors were imposed long before ESRD, as the majority of patients starting dialysis or kidney transplantation already have signs of advanced atherosclerosis. Artery calcification is an organized, regulated process similar to bone formation. Coronary artery calcification (CAC) is found frequently in advanced atherosclerotic lesions and could be a useful marker of them. We evaluated the prevalence of CAC in 49 stable renal transplant recipients and in 48 age- and gender-matched patients with chronic kidney disease (CKD) in stages 2-5 not requiring dialysis to assess risk factors associated with CAC. Computed tomography was used for CAC detection and quantification (CAC score). The prevalence of CAC was 43.8% in transplant recipients and 16.7% in CKD patients (p < 0.001). Transplant recipients with CAC were significantly older and had longer duration of CKD and/or dialysis than recipients without CAC. In contrast, the serum levels of fetuin A (an inhibitor of vascular calcification) and albumin were significantly lower in CKD patients with CAC than those without CAC. During the observation period (30 months), 30 patients, including 23 CKD patients, began dialysis, and 4 transplant recipients and 2 CKD patients died. Independent predictors of mortality were age, serum amyloid A and the CAC score. In conclusion, the examination and prevention of risk factors associated with atherosclerosis should be started at the beginning of renal failure.