Journal of renal care最新文献

Background: Patients awaiting kidney transplantation need to be prepared ahead of the upcoming transplantation by developing targeted pre- and post-transplant knowledge. On this background, we designed a new health literacy intervention, including a film and a counselling session, based on motivational interviewing for dialysis patients provided by dialysis nurses.

Aim: To explore patients' and nurses' experiences of the feasibility and acceptability of the intervention, focusing on the patient as a prepared knowledge actor.

Design: An explorative qualitative study.

Participants and methods: Data included in-depth interviews with nine patients and three nurses who participated in the intervention. The interviews were audiotaped and analysed following Kvale and Brinkmann's method for thematic data analysis.

Findings: Three main themes were identified: a different kind of health intervention stimulating new insight; a challenging kind of health conversation and changed relationships and increased security.

Conclusions: Both the patients and the nurses had an overall positive attitude toward the intervention, providing a kind of dialogue to prepare dialysis patients going through kidney transplantation. The nurses found the MI methodology to be challenging. When introducing a comprehensive communication method like MI, potential training and supervision needs for the nurses must be addressed.

Background: The palliative care phenomenon is increasingly invested in all medicine and nursing fields, as care for people with kidney disease who do not wish to embark on dialysis: it encompasses a palliative approach to shared decision-making. To deliver patient-centred optimal care, nephrology healthcare staff should be knowledgeable about palliative care and the appropriate conservative management approach.

Objective: This paper aimed to explore, using a Delphi survey, the barriers and facilitators to palliative care in patients with kidney disease.

Design: An e-Delphi technique with three questionnaire rounds was performed; statements were generated using Likert scales.

Participants and measurements: A list of 80 statements related to palliative care in patients with kidney disease was divided into facilitators and barriers. Questionnaires were administered to 13 nephrology nurse experts in some European countries.

Results: Seven items were removed from the list of 80 statements after the first round of the Delphi study; eight items achieved a significant change of the mean between round two and three, whereas internal stability emerged in all the remaining items.

Conclusions: Specific training and education in palliative care emerged as a facilitator, as well as the role of spiritual and beliefs and the role of family and caregiver. The main barriers were represented by the differences in cultures, beliefs, and practices and by the lack of experience in the role of the staff in palliative care. These statements provide a platform for future research to improve palliative care practice in patients with kidney disease.

Background: Young adults with long-term conditions can struggle to accept their diagnosis and can become overwhelmed with managing their condition. Suboptimal transfer from paediatric to adult services with a resultant disengagement with the service can result in less involvement in care and decision-making. Shared decision-making can improve involvement in health decisions and increase satisfaction with treatment/therapy and care.

Objectives: An integrative literature review was conducted to explore and understand young adults' experiences of decision-making in health care.

Design: An integrative literature review.

Data sources: CINAHL, EMCARE, PsycINFO, HMIC, EMBASE, Web of Science, PubMed, MEDLINE, EBSCOHOST and COCHRANE databases were searched for relevant literature published between January 1999 and January 2020.

Findings: Thirteen primary research papers met the inclusion criteria. Four main themes were identified: (1) Information delivery and communication; (2) participation in decision-making; (3) social factors influencing decision-making and (4) emotional impact of decision-making.

Conclusions: Young adults with long-term conditions have specific decision-making needs which can impact their emotional health. Research with a specific focus on young adults' experiences of decision-making in health care is needed.

Background: Successful arteriovenous fistula cannulation ensures maximum patient benefit in the haemodialysis procedure.

Objective: The aim of this study was to determine the effect of various cannulation methods used for arteriovenous fistulas on dialysis adequacy.

Design: It is a descriptive, cross-sectional and multicenter study.

Participants: A total of 164 dialysis patients from four dialysis centers were included.

Measurements: Data were collected by determining patients' characteristics and the arteriovenous fistula cannulation method used, in addition to recording the Kt/V and urea reduction ratio values to evaluate dialysis adequacy. The mean Kt/V and urea reduction ratio values over 3 months after dialysis initiation were used. This trial is registered with ClinicalTrials.gov, NCT04270292.

Results: Cannulation with the puncture method was used in 53% of the patients; the fistula needles were inserted in the antegrade direction in 43.9% of the patients; the arterial needle was rotated after fistula needle placement in 63.4% of the patients; and the arterial and venous needles were on the same vascular line in 15.2% of the patients. Placement of the fistula needle in the antegrade direction increased the Kt/V value 0.164 times (95% confidence interval: 0.002-0.212, p = .047).

Conclusion: Antegrade placement could be a factor influencing dialysis adequacy. We suggest antegrade interventions to the fistula to maximize the patient benefit from the haemodialysis treatment.

Background: Nutritional status and protein energy wasting (PEW) is prevalent in patients with nondialysis-dependent chronic kidney disease (CKD). The relationship between PEW and long-term development of clinically important outcomes remains to be examined.

Objectives: To investigate the relationships between PEW, as measured by Subjective Global Assessment (SGA 1-7), and progression to important clinical outcomes: mortality and/or kidney failure.

Design: Prospective cohort design.

Participants: One hundred and thirty-nine participants were well-nourished and 37 moderately malnourished patients with CKD 3-5.

Measurements: The outcomes were 2, 5, and 10-year progression to kidney failure (dialysis or transplant) or mortality, kidney failure alone, and mortality alone. SGA was determined by a registered renal dietitian. Food frequency questionnaires were used to assess dietary intake. Clinical and laboratory baseline characteristics were collected. Multivariable regression models and Cox models were created to examine the relationship between SGA and outcomes.

Results: PEW was associated with the combined outcome of kidney failure or mortality at 2 (p = 0.003), 5 (p = 0.004), but not at 10 (p = 0.73) years. This relationship was primarily driven by the relationship between PEW and kidney failure. In Cox models, the relationship between PEW and kidney failure remained after adjusting for Kidney Failure Risk Equation scores. The multivariable modeling revealed that PEW remained a statistically significant predictor of the combined outcome and ESKD after adjustment for age, estimated glomerular filtration rate (eGFR), sex, albumin-to-creatinine ratio, diabetes, albumin, and protein intake.

Conclusions: PEW, determined by the SGA 1-7, is an important prognostic tool. Further research looking at clinically important outcomes are needed to implement nutritional interventions for nondialysis-dependent CKD patients.