Nephrology Nursing Journal最新文献

Patients with chronic kidney disease (CKD) often prioritize their quality of life (QOL) over life extension, especially in advanced stages. Although shared decision-making (SDM) positively influences QOL, evidence on this topic remains limited. To address this gap, we conducted a systematic review and synthesized evidence from 12 quantitative studies examining the relationship between SDM and QOL in adults with CKD. We found that SDM enhances QOL by promoting patient autonomy and treatment satisfaction, particularly in conservative management. However, QOL benefits for patients on dialysis were inconsistent due to restrictive treatment pathways. Further, barriers such as insufficient provider training and lack of standardized frameworks, hindered the impact of SDM. Overcoming these challenges with tailored strategies, standardized QOL tools, and longitudinal research could improve outcomes for patients with CKD.

Patients in outpatient dialysis settings, including InCenter and Home Therapies, have the potential to experience hypersensitivity reactions from multiple sources, such as dialyzer membranes, other products unique to dialysis, and new medications. Awareness of co-factors, frequently present in the end stage kidney disease population, is crucial in managing reactions effectively. Dialysis staff must act quickly to identify anaphylaxis. This article provides clinicians with the critical information required to prevent and mitigate life-threatening emergencies, including symptom identification and prompt treatment.

As hemodiafiltration (HDF) is introduced in the United States and becomes more common, it is even more important for every person who has any responsibility for hemodialysis (HD) or HDF to know and understand the critical importance of safe dialysis water and dialysate. With HDF, the patient's bloodstream is directly infused with purified dialysate, making it even more critical to ensure the water used in these treatments is safe. Today, few HD programs have full-time technical staff to operate and test the water treatment and dialysate preparation systems, relying on nurses and other direct care staff for the day-to-day operation and testing of these systems. It is critical for the entire care team to work together to keep patients safe. This article details reasons safe water and dialysate are critical for individuals who rely on HD or HDF, and reviews components of water treatment systems, dialysate concentrate preparation, integrated HD systems, and the monitoring and testing necessary to assure that both water and dialysate are safe for patient use.

Nurse presence is intimately tied to quality patient care and outcomes. The purpose of this study was to explore the relationship between the perceptions of patients on outpatient hemodialysis of nurse presence and on satisfaction with care. A descriptive, correlational design assessed perceptions of nurse presence and satisfaction with care in 15 male adult outpatient patients on hemodialysis. Subjects had high, positive perceptions of nurse presence and satisfaction with care. There was a significant, positive relationship between perceptions of nurse presence and satisfaction with care (r = 0.53, p = 0.04). Many factors influence this relationship, including the physical environmental setting.

Tenapanor is a first-in-class, minimally absorbed, smallmolecule phosphate absorption inhibitor that targets the primary paracellular pathway of phosphate absorption in the gastrointestinal tract. In BLOCK and PHREEDOM (phase 3 studies), tenapanor demonstrated acceptable safety in patients on maintenance hemodialysis and peritoneal dialysis. Diarrhea was the most common adverse event, reported in about 50% of patients. We examined the impact of patient education on tenapanor tolerability/ adherence during the OPTIMIZE study. After receiving diarrhea reduction education, patients took tenapanor 30 mg (twice daily, 10 weeks). In the BLOCK and PHREEDOM studies, patients received tenapanor for 8 and 26 weeks, respectively, without education. During the up-to- 10-week analysis period, diarrhea incidence was 39.3% in OPTIMIZE (N = 333) versus BLOCK (N = 71; 47.9%) and PHREEDOM (N = 419; 47.7%). In all studies, most diarrhea episodes (88.7% to 91.9%) were mild/moderate; the majority (75.7% to 79.6%) occurred within weeks 1 and 2. Patient education may help improve tenapanor adherence and reduce the incidence of bothersome loose stools.

Social determinants of health (SDOH) significantly influence the risk of chronic kidney disease (CKD), particularly in underserved populations. The Designing Equitable Care for Kidneys (DECK) study examined the relationship between CKD risk and unmet SDOH in Richmond, Virginia's East End, a historically redlined area with high social vulnerability. Among 61 participants, CKD awareness was moderate (mean score = 71%), and 36% recognized the disease as preventable. Substantial unmet social needs were reported in financial and social domains. Stratified analysis revealed nuanced associations between social needs and CKD risk: participants with mild social needs were most frequently categorized as having moderate CKD risk (19.7%), while those with moderate needs exhibited the highest prevalence of moderate (24.6%) and high (9.8%) CKD risk. These findings underscore the need for integrated interventions targeting clinical and social factors to address kidney health disparities in vulnerable populations.

As staffing shortages and ongoing cost-containment measures continue to challenge organizations, the use of assistive personnel (AP) for patient care activities increases. Emphasis on safe and effective care delivery remains crucial when RNs delegate certain tasks and aspects of patient care. The principles of delegation according to American Nurses Association and the National Council of State Boards of Nursing include the responsibility and accountability of the registered nurse (RN) for patient care outcomes. Authority for delegation of clinical tasks in the chronic hemodialysis setting and home dialysis therapies varies greatly by state. The responsibility remains with the RN to oversee complex tasks despite the staff skill mix. While specific information from several states, although limited, was interpreted by this team as delegation, it remains the responsibility of each RN to know their individual state Nurse Practice Acts. This article provides an updated review of the states' current available positions on delegation of clinical tasks in hemodialysis with the addition of information on dialysis technicians or licensed practical nurses/licensed vocational nurses in home therapy when available.