Psycho-educational strategies to promote fluid adherence in adult hemodialysis patients: a review of intervention studies

BACKGROUND: We reviewed psycho-educational intervention studies that were designed to reduce interdialytic weight gain (IDWG) in adult hemodialysis patients. Our goals were to critique research methods, describe the effectiveness of tested interventions, and make recommendations for future research. METHODS: Medline, PsychInfo, and the Cumulative Index to Nursing and Applied Health (CINAHL) databases were searched to identify empirical work. Each study was evaluated in terms of sample, design, theoretical framework, intervention delivery, and outcome. RESULTS: Nine studies were reviewed. Self-monitoring appears to be a promising strategy to be considered to reduce IDWG. Theory was not usually used to guide interventions, designs generally had control groups, interventions were delivered individually, more than one intervention was delivered at a time, the duration of the intervention varied greatly, there was no long-term follow-up, IDWG was the only outcome, and IDWG was operationalized in different ways. CONCLUSIONS: Theoretical models and methodological rigor are needed to guide future research. Specific recommendations on design, measurement, and conceptual issues are offered to enhance the effectiveness of future research.     

Acquired Cystic Disease of the Kidney in Patients with End-Stage Chronic Renal Failure: A Study of Prevalence and Aetiology

Renal ultrasound scanning was performed in 100 patients withend-stage renal failure treated by both haemodialysis and continuousambulatory peritoneal dialysis (CAPD). Each kidney was assessedfor the presence of acquired cystic disease and solid lesions.The appearances were divided into five grades from grade 0 (nocysts detected) to grade 4 (>15 cysts per kidney). Otherintra-abdominal organs were also scanned for the presence ofcysts. The findings were then correlated with possible aetiologicalfactors, including the type of dialysis used. Sixty-three percent of all the patients had acquired cysticdisease of the kidney (ACDK). No solid lesions were found andno cysts were detectable in other organs. The presence and gradeof ACDK did not correlate with the age or sex of the patient,the nature of the underlying renal disease, or the durationof chronic renal failure. There was a significant correlationbetween the grade of ACDK and the duration of both haemodialysis(P<0.001) and CAPD (P<0.01). The presence of residualrenal function did not influence the development of cysts. ACDKhad no effect on haemoglobin or other laboratory parametersmeasured.     

Kinetics of erythropoiesis in dialysis patients receiving recombinant erythropoietin treatment

In eleven patients with uraemia on intermittent haemodialysis treatment, recombinant human erythropoietin (rHuEpo) was used at a dosage schedule of 100 IU/kg bodyweight thrice weekly. Erythrokinetic studies (blood volume, RBC survival and iron kinetics) were performed in nine cases before and after 6 months of treatment. The remaining two patients had only RBC and plasma volume determinations before and after treatment. Although total blood volume remained unchanged, RBC volume was increased in all cases. Red cell loss was not modified, and quantitative improvement of RBC production was noted in all cases. No qualitative defect of erythroid maturation or release was observed in the treated patients. In conclusion, rHuEpo treatment improves the anaemia of haemodialysis patients by normalising circulating RBC volume only through an increase in red cell production.     

Quality assessment in nephrology nursing

In order to evaluate the quality of nephrology nursing in Flanders, three quality indicators (anaemia, dialysis dose and patient satisfaction) were studied in 11 Flemish dialysis centres, including 521 haemodialysis patients. Median haematocrit (Hct) was 33.7 with 42% of patients not reaching the target level of 33. Median percentage removal of urea (PRU) was 64.8 with 52% of patients showing values below the target level of 65. PRU levels were significantly influenced by needle technique, type of vascular access, sex, duration of dialysis and diabetes The patient satisfaction questionnaire showed that most patients particularly appreciated the professional skills of the health care workers. On completing this study, we ex perienced that the regular use of well‐established indicators to assess the quality of nephrology nursing, is mandatory.     

高纯度透析浓缩液对血液透析患者血清白细胞介素6、肿瘤坏死因子α和白蛋白水平的影响

目的比较高纯度透析浓缩液和普通透析浓缩液对长期透析患者血清促炎症因子白细胞介素(6IL鄄6)、肿瘤坏死因子α(TNF鄄α)和血清白蛋白的影响。方法采用前瞻性临床对照研究,将85例维持性血液透析患者随机分为两组,分别采用普通透析浓缩液(常规组,例)和42高纯度透析浓缩液(高纯度组,例)进行常规低通量血液透析治疗并随访4312个。月比较常规组与高纯度组患者在血清IL鄄6、TNF鄄α、血清白蛋白、干体重、体重指数(BMI)、上臂中肌肉周径(MAC)、血红蛋白、红细胞压积、白细胞计数、中性粒细胞计数以及红细胞生成素应用剂量上的差异。结果高纯度组43例,常规组42例,两组患者间年龄、性别比例、透析龄、BMI、Kt/V值和血清IL鄄6、TNF鄄α水平差异无统计学意义。与基础水平比较,随访结束时高纯度组患者血清IL鄄6[(6.91±5.13)pg/ml比(3.06±2.42)pg/ml]和TNF鄄α水平[(14.78±4.61)pg/ml比(13.60±4.24)pg/ml]显著下降;血清白蛋白[(35.9±3.7)g/L比(37.6±3.4)g/L]、血红蛋白[(82.4±24.7)g/L比(88.2±22.9)g/L]及红细胞压积(0.25±0.07比0.28±0.05)均显著上升。与常规组比较,随访结束时高纯度组血清IL鄄6[(3.06±2.42)pg/ml比(4.22±3.99)pg/ml]和TNF鄄α水平[(13.60±4.24)pg/ml比(15.79±6.38)pg/ml均显著下降     

Glycosylated haemoglobin in uraemia

Glycosylated haemoglobin (GHb) was measured in 71 patients with stable chronic renal failure by the thiobarbituric acid (TBA) reaction and by agar gel electrophoresis. Nineteen patients were diabetic. Of the non-diabetics, 22 were treated conservatively (including 8 children), 15 by maintenance haemodialysis, and 15 by continuous ambulatory peritoneal dialysis. GHb measured by both methods correlated with postprandial blood glucose levels. There was a significant discrepancy between the two methods only in patients with serum urea concentrations greater than 30 mmol/l, mean +/- SD, (6.8 +/- 2.6% vs 8.2 +/- 2.5% for TBA and electrophoresis, respectively). This difference, delta GHb, correlated with serum urea, serum creatinine, and serum bicarbonate, but after logistic regression of results from all 71 patients only serum urea was associated with delta GHb. Lower haemoglobin and GHb and high fetal haemoglobin concentrations in the haemodialysis group suggested increased haemolysis in these patients. Measurement of GHb by the TBA method and by agar gel electrophoresis remain useful indicators of hyperglycaemia in patients with mild, stable chronic renal failure.     

A Simple In Vitro Test to Evaluate Biocompatibility of Dialysis Membranes

As arachidonic acid metabolites are implicated in hypersensitivityreactions, we measured arachidonic acid metabolites of dialysedpatient's granulocytes, preincubated with different dialysismembranes. Results indicate that cuprophan and cellulose acetatemembranes partially inhibit in vitro production of 15-HETE and5-HETE, whereas polyacrylonitrile membrane does not. This suggeststhat polyacrylonitrile is a more biocompatible membrane.     

临时性血液透析中心静脉留置导管的感染并发症分析

目的探讨临时性血液透析中心静脉留置导管感染并发症的发生率、危险因素以及防治措施.方法回顾性研究95例患者103例次中心静脉留置导管的特征,感染并发症情况,用多因素分析方法分析感染并发症的危险因素.结果11例留置导管者发生导管相关性感染（出口感染3例,导管相关性血流感染8例）,占10.7%,导管相关性感染的发生率为4.5次/1 000导管日.病原菌以葡萄球菌属为主.随着导管留置时间的增加,发生导管感染的危险性呈线性增加趋势.未发现年龄、性别、糖尿病、置管部位、白蛋白水平、免疫抑制剂使用与感染相关.结论临时性血液透析导管感染的发生率高.发生导管感染的危险性随导管留置时间呈线性增加趋势.需早期发现感染并积极正规治疗.