首页 > 最新文献

Canadian Journal of Kidney Health and Disease最新文献

英文 中文
Characteristics and Practices of High-Performing Centers in Organ Donor Identification and Referral: A Qualitative Study. 高绩效中心在器官捐献者识别和转介方面的特点和做法:定性研究。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-09-21 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241276362
Leahora Rotteau, Samuel Vaillancourt, Mercedes Magaz, Lisha Lo, Brian M Wong, Jehan Lalani, Sam D Shemie, Samara Zavalkoff
<p><strong>Background: </strong>The identification and referral (ID&R) of potential organ donors to provincial organ donation organizations (ODOs) is a critical first step in the organ donation process. However, even in provinces with mandatory referral legislation, there remains variability in ID&R rates across critical care units, with some units demonstrating high performance despite experiencing similar constraints associated with existing structures, policies, and practices.</p><p><strong>Objective: </strong>We sought to identify the enablers and specific strategies that high-performing critical care units leveraged to achieve their exceptional performance.</p><p><strong>Design: </strong>We conducted a descriptive qualitative study to inform ID&R improvement efforts as part of a positive deviance initiative.</p><p><strong>Setting: </strong>We identified three high-performing critical care units as study sites.</p><p><strong>Participants: </strong>Clinicians working in identified critical care units.</p><p><strong>Methods: </strong>At each site, we interviewed clinical team members about their perceptions and experiences of ID&R. Data analysis followed a thematic analysis approach.</p><p><strong>Results: </strong>We outline three themes describing how the high-performing hospitals achieve strong ID&R practices. First, all units demonstrated a high degree of integration between the concepts of high-quality end-of-life care and organ donation. Team members were consistently notified of successful transplants stemming from their unit, and all missed ID&Rs were tracked and discussed. Second, participants described a team approach with strong medical leadership, where all team members embrace their role in ensuring that no potential donor is missed. Finally, the units adopted strategies to support and simplify ID&R such as collectively simplifying triggers for referral, developing strong working relationships with provincial donor coordinators, and creating informal avenues of communication between clinicians and donor coordinators.</p><p><strong>Limitations: </strong>The lack of comparable data for potential organ donor referral rates across Canada impacted our ability to identify high-performing hospitals based on data. Instead, we contacted the ODOs directly to identify high-performing units that met our criteria. Second, our study sample was limited to three hospital sites from three different provinces and the three hospitals perform organ recovery and transplant on-site.</p><p><strong>Conclusion: </strong>Critical care units can adopt strategies and implement interventions to support ID&R improvement efforts. We provide examples informed by this study. We also highlight considerations that require attention when engaging in this work such as ensuring that all team members are aware of changes in care plans and physicians consistently engage in discussions about organ donation. Local medical leadership is critical to supporting these changes.
背景:向省级器官捐献组织(ODOs)鉴定和转介(ID&R)潜在的器官捐献者是器官捐献过程中至关重要的第一步。然而,即使在制定了强制性转介立法的省份,各重症监护病房的 ID&R 率仍存在差异,一些病房尽管受到与现有结构、政策和实践相关的类似限制,但仍表现出很高的绩效:我们试图找出高绩效重症监护病房实现其卓越绩效的推动因素和具体策略:设计:我们进行了一项描述性定性研究,为作为积极偏差倡议一部分的 ID&R 改进工作提供信息:我们确定了三个表现优异的重症监护病房作为研究地点:方法:在每个研究地点,我们都采访了临床团队成员:在每个研究地点,我们采访了临床团队成员,了解他们对 ID&R 的看法和经验。数据分析采用主题分析法:结果:我们概述了三个主题,描述了高绩效医院如何实现强大的 ID&R 实践。首先,所有单位都展示了高质量临终关怀与器官捐献理念的高度融合。团队成员会持续收到来自本单位的成功移植通知,所有遗漏的ID&R都会被追踪和讨论。其次,与会者描述了一种具有强大医疗领导力的团队方法,在这种方法下,所有团队成员都能发挥自己的作用,确保不遗漏任何潜在的捐献者。最后,这些单位采取了支持和简化 ID&R 的策略,如集体简化转诊的触发因素、与省级捐献协调员建立牢固的工作关系,以及在临床医生和捐献协调员之间建立非正式的沟通渠道:由于缺乏加拿大全国潜在器官捐献者转介率的可比数据,我们无法根据数据确定表现优异的医院。相反,我们直接联系了ODOs,以确定符合我们标准的高绩效单位。其次,我们的研究样本仅限于三个不同省份的三家医院,而且这三家医院都在现场进行器官回收和移植:结论:重症监护病房可以采取策略并实施干预措施,以支持 ID&R 的改进工作。我们根据本研究提供了一些实例。我们还强调了在开展这项工作时需要注意的事项,如确保所有团队成员都了解护理计划的变更,以及医生持续参与有关器官捐献的讨论。地方医疗领导对于支持这些变革至关重要。
{"title":"Characteristics and Practices of High-Performing Centers in Organ Donor Identification and Referral: A Qualitative Study.","authors":"Leahora Rotteau, Samuel Vaillancourt, Mercedes Magaz, Lisha Lo, Brian M Wong, Jehan Lalani, Sam D Shemie, Samara Zavalkoff","doi":"10.1177/20543581241276362","DOIUrl":"10.1177/20543581241276362","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The identification and referral (ID&R) of potential organ donors to provincial organ donation organizations (ODOs) is a critical first step in the organ donation process. However, even in provinces with mandatory referral legislation, there remains variability in ID&R rates across critical care units, with some units demonstrating high performance despite experiencing similar constraints associated with existing structures, policies, and practices.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We sought to identify the enablers and specific strategies that high-performing critical care units leveraged to achieve their exceptional performance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;We conducted a descriptive qualitative study to inform ID&R improvement efforts as part of a positive deviance initiative.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;We identified three high-performing critical care units as study sites.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Clinicians working in identified critical care units.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;At each site, we interviewed clinical team members about their perceptions and experiences of ID&R. Data analysis followed a thematic analysis approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We outline three themes describing how the high-performing hospitals achieve strong ID&R practices. First, all units demonstrated a high degree of integration between the concepts of high-quality end-of-life care and organ donation. Team members were consistently notified of successful transplants stemming from their unit, and all missed ID&Rs were tracked and discussed. Second, participants described a team approach with strong medical leadership, where all team members embrace their role in ensuring that no potential donor is missed. Finally, the units adopted strategies to support and simplify ID&R such as collectively simplifying triggers for referral, developing strong working relationships with provincial donor coordinators, and creating informal avenues of communication between clinicians and donor coordinators.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The lack of comparable data for potential organ donor referral rates across Canada impacted our ability to identify high-performing hospitals based on data. Instead, we contacted the ODOs directly to identify high-performing units that met our criteria. Second, our study sample was limited to three hospital sites from three different provinces and the three hospitals perform organ recovery and transplant on-site.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Critical care units can adopt strategies and implement interventions to support ID&R improvement efforts. We provide examples informed by this study. We also highlight considerations that require attention when engaging in this work such as ensuring that all team members are aware of changes in care plans and physicians consistently engage in discussions about organ donation. Local medical leadership is critical to supporting these changes.","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241276362"},"PeriodicalIF":1.6,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Use of Sucroferric Oxyhydroxide Prior to Sigmoidoscopy in Patients With End-Stage Kidney Disease: A Case Report. 在终末期肾病患者进行乙状结肠镜检查前使用蔗糖铁氧氢氧化物:病例报告。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-09-12 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241273998
Jennifer Horwitz, Katelyn Roberts, Stephanie Canning, Douglas Mcintosh, Deborah Zimmerman

Rationale: Sucroferric oxyhydroxide is an iron-based phosphate-binding medication that has been approved for the treatment of hyperphosphatemia in patients with end-stage kidney disease. Given the low overall iron release from the polynuclear iron(III)-oxyhydroxide molecule, recommendations regarding its use prior to colonoscopy/sigmoidoscopy have not been developed.

Presenting concerns of the patient: A 51-year-old male with a known history of end-stage renal disease treated with hemodialysis was referred to Gastroenterology for consideration of colonoscopy to rule out malignancy because of a history of rectal bleeding. This was to be completed prior to proceeding with a living-donor kidney transplant.

Diagnoses: Flexible sigmoidoscopy done after non-diagnostic colonoscopy demonstrated diffuse "charcoal-like" material that prevented adequate visualization of the bowel despite standard bowel preparation. The findings were believed to be secondary to the use of sucroferric oxyhydroxide prescribed for hyperphosphatemia.

Interventions: The patient was subsequently instructed to discontinue sucroferric oxyhydroxide for 2 weeks prior to his repeat sigmoidoscopy procedure.

Outcomes: The patient's repeat sigmoidoscopy after discontinuing sucroferric oxyhydroxide allowed for adequate bowel visualization that revealed only a benign lipoma.

Teaching points: This case demonstrates the potential for sucroferric oxyhydroxide use to result in poor bowel preparation and resulting inadequate visualization on lower gastrointestinal endoscopy. It serves to highlight the clinical implications leading to the need for repeated procedures, which contributes to resource waste and unnecessary costs to the healthcare system, as well as delays in diagnostic evaluation required for transplantation; patient frustration was evident.

理由:蔗糖铁氧氢氧化物是一种铁基磷酸盐结合药物,已被批准用于治疗终末期肾病患者的高磷酸盐血症。鉴于多核氢氧化铁(III)分子的总体铁释放量较低,因此尚未制定在结肠镜/乙状结肠镜检查前使用该药物的建议:一名 51 岁的男性患者,已知其有接受血液透析治疗的终末期肾病病史,因有直肠出血病史,转诊至消化内科考虑进行结肠镜检查以排除恶性肿瘤。在进行活体供肾移植之前,必须完成结肠镜检查:诊断:在结肠镜检查未确诊后进行的柔性乙状结肠镜检查显示,尽管进行了标准的肠道准备,但弥漫的 "木炭样 "物质仍阻碍了肠道的充分观察。该结果被认为是继发于使用蔗糖铁氧氢氧化物治疗高磷血症:干预措施:随后指导患者在再次接受乙状结肠镜检查前停用蔗糖铁氧氢氧化物两周:结果:患者在停用蔗糖铁氧氢氧化物后再次接受乙状结肠镜检查,肠道得到充分显影,仅发现一个良性脂肪瘤:本病例表明,使用蔗糖铁氧氢氧化物可能会导致肠道准备不良,从而导致下消化道内窥镜检查视野不足。本病例强调了导致需要重复手术的临床影响,这造成了资源浪费,给医疗系统带来了不必要的成本,并延误了移植所需的诊断评估;患者的沮丧情绪显而易见。
{"title":"The Use of Sucroferric Oxyhydroxide Prior to Sigmoidoscopy in Patients With End-Stage Kidney Disease: A Case Report.","authors":"Jennifer Horwitz, Katelyn Roberts, Stephanie Canning, Douglas Mcintosh, Deborah Zimmerman","doi":"10.1177/20543581241273998","DOIUrl":"https://doi.org/10.1177/20543581241273998","url":null,"abstract":"<p><strong>Rationale: </strong>Sucroferric oxyhydroxide is an iron-based phosphate-binding medication that has been approved for the treatment of hyperphosphatemia in patients with end-stage kidney disease. Given the low overall iron release from the polynuclear iron(III)-oxyhydroxide molecule, recommendations regarding its use prior to colonoscopy/sigmoidoscopy have not been developed.</p><p><strong>Presenting concerns of the patient: </strong>A 51-year-old male with a known history of end-stage renal disease treated with hemodialysis was referred to Gastroenterology for consideration of colonoscopy to rule out malignancy because of a history of rectal bleeding. This was to be completed prior to proceeding with a living-donor kidney transplant.</p><p><strong>Diagnoses: </strong>Flexible sigmoidoscopy done after non-diagnostic colonoscopy demonstrated diffuse \"charcoal-like\" material that prevented adequate visualization of the bowel despite standard bowel preparation. The findings were believed to be secondary to the use of sucroferric oxyhydroxide prescribed for hyperphosphatemia.</p><p><strong>Interventions: </strong>The patient was subsequently instructed to discontinue sucroferric oxyhydroxide for 2 weeks prior to his repeat sigmoidoscopy procedure.</p><p><strong>Outcomes: </strong>The patient's repeat sigmoidoscopy after discontinuing sucroferric oxyhydroxide allowed for adequate bowel visualization that revealed only a benign lipoma.</p><p><strong>Teaching points: </strong>This case demonstrates the potential for sucroferric oxyhydroxide use to result in poor bowel preparation and resulting inadequate visualization on lower gastrointestinal endoscopy. It serves to highlight the clinical implications leading to the need for repeated procedures, which contributes to resource waste and unnecessary costs to the healthcare system, as well as delays in diagnostic evaluation required for transplantation; patient frustration was evident.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241273998"},"PeriodicalIF":1.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11406624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Letter to the Editor in Response to the Article "Clinical Outcomes With Medium Cut-Off Versus High-Flux Hemodialysis Membranes: A Systematic Review and Meta-Analysis". 致编辑的信,回应文章 "中截流与高通量血液透析膜的临床结果:系统回顾与元分析"。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-09-10 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241278843
Mehmet Riza Altiparmak, Serkan Feyyaz Yalin
{"title":"Letter to the Editor in Response to the Article \"Clinical Outcomes With Medium Cut-Off Versus High-Flux Hemodialysis Membranes: A Systematic Review and Meta-Analysis\".","authors":"Mehmet Riza Altiparmak, Serkan Feyyaz Yalin","doi":"10.1177/20543581241278843","DOIUrl":"https://doi.org/10.1177/20543581241278843","url":null,"abstract":"","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241278843"},"PeriodicalIF":1.6,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11388295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Optimizing Subsequent CARdiovascular Medication Reintroduction in the Intensive Care Unit. 优化重症监护病房的后续 CARdiovascular 药物再引入。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-09-05 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241276361
Hadjer Dahel, Najla Tabbara, Lisa Burry, Gabrielle Hornstein, David Williamson, Han Ting Wang

Importance: Hospital admission for a critical illness episode creates communication breakpoints and can lead to medication discrepancies during hospital stays. Due to the patient's underlying condition and the care setting, chronic medications such as cardiovascular medication are often held, discontinued, or changed to alternative administration routes. Unfortunately, data on the optimal timing of cardiovascular drug reinitiation among intensive care unit (ICU) survivors are lacking.

Objective: The primary objective of this study was to describe the prevalence of chronic cardiovascular medication taken before hospital admission and discontinued at ICU discharge and hospital discharge for critically ill patients. A secondary objective was to assess factors associated with medication discontinuation.

Design setting and participants: We conducted a multicentered retrospective cohort study at 2 tertiary academic hospitals in Canada. All adult patients taking cardiovascular medication before ICU admission and surviving to hospital discharge between April 1, 2016, and April 1, 2017, were eligible.

Main outcomes and measures: The main outcome of the study was the discontinuation of cardiovascular medication prescribed before ICU admission. The outcome was assessed through participants' chart review.

Results: We included 352 patients with a median age of 71.0 years. A total of 155 patients (44.03%) had at least 1 cardiovascular medication discontinued during their stay. Our adjusted model uncovered 3 factors associated with cardiovascular medication discontinuation: male sex (odds ratio [OR] = 0.564, 95% confidence interval [CI] = 0.346-0.919), number of cardiovascular medications taken preadmission (OR = 1.669, 95% CI = 1.003-2.777 for 2 medications and OR = 3.170, 95% CI = 1.325-7.583), and the use of vasopressors (OR = 1.770, 95% CI = 1.045-2.997).

Conclusion: Our study uncovered that cardiovascular medication discontinuation for ICU patients is frequent, especially for renin-angiotensin system (RAS) blockers. Data from our study could be used to reinforce site-specific protocols of medication reconciliation and optimization, as well as inform future protocols aimed at RAS blocker reinitiation follow-up.

重要性:因危重病入院会造成沟通中断,并可能导致住院期间的用药差异。由于患者的基本病情和护理环境,心血管药物等慢性药物通常会被搁置、停用或改用其他给药途径。遗憾的是,有关重症监护室(ICU)幸存者重新开始使用心血管药物的最佳时机的数据还很缺乏:本研究的主要目的是描述重症患者入院前服用的慢性心血管药物在重症监护室出院和出院时停药的情况。次要目标是评估与停药相关的因素:我们在加拿大的两家三级学术医院开展了一项多中心回顾性队列研究。所有在入住 ICU 前服用心血管药物并在 2016 年 4 月 1 日至 2017 年 4 月 1 日期间存活至出院的成年患者均符合条件:研究的主要结果是在入住ICU前停用心血管药物。该结果通过参与者的病历回顾进行评估:我们共纳入了 352 名患者,中位年龄为 71.0 岁。共有 155 名患者(44.03%)在住院期间至少停用了一种心血管药物。我们的调整模型发现了 3 个与心血管药物停用相关的因素:男性(几率比 [OR] = 0.564,95% 置信区间 [CI] = 0.346-0.919)、入院前服用的心血管药物数量(2种药物的OR = 1.669,95% CI = 1.003-2.777;OR = 3.170,95% CI = 1.325-7.583)以及使用血管加压药(OR = 1.770,95% CI = 1.045-2.997):我们的研究发现,重症监护室患者心血管药物的停用很频繁,尤其是肾素-血管紧张素系统(RAS)阻断剂。我们的研究数据可用于加强特定场所的用药调节和优化方案,并为今后旨在重新启用 RAS 阻滞剂的后续方案提供参考。
{"title":"Optimizing Subsequent CARdiovascular Medication Reintroduction in the Intensive Care Unit.","authors":"Hadjer Dahel, Najla Tabbara, Lisa Burry, Gabrielle Hornstein, David Williamson, Han Ting Wang","doi":"10.1177/20543581241276361","DOIUrl":"10.1177/20543581241276361","url":null,"abstract":"<p><strong>Importance: </strong>Hospital admission for a critical illness episode creates communication breakpoints and can lead to medication discrepancies during hospital stays. Due to the patient's underlying condition and the care setting, chronic medications such as cardiovascular medication are often held, discontinued, or changed to alternative administration routes. Unfortunately, data on the optimal timing of cardiovascular drug reinitiation among intensive care unit (ICU) survivors are lacking.</p><p><strong>Objective: </strong>The primary objective of this study was to describe the prevalence of chronic cardiovascular medication taken before hospital admission and discontinued at ICU discharge and hospital discharge for critically ill patients. A secondary objective was to assess factors associated with medication discontinuation.</p><p><strong>Design setting and participants: </strong>We conducted a multicentered retrospective cohort study at 2 tertiary academic hospitals in Canada. All adult patients taking cardiovascular medication before ICU admission and surviving to hospital discharge between April 1, 2016, and April 1, 2017, were eligible.</p><p><strong>Main outcomes and measures: </strong>The main outcome of the study was the discontinuation of cardiovascular medication prescribed before ICU admission. The outcome was assessed through participants' chart review.</p><p><strong>Results: </strong>We included 352 patients with a median age of 71.0 years. A total of 155 patients (44.03%) had at least 1 cardiovascular medication discontinued during their stay. Our adjusted model uncovered 3 factors associated with cardiovascular medication discontinuation: male sex (odds ratio [OR] = 0.564, 95% confidence interval [CI] = 0.346-0.919), number of cardiovascular medications taken preadmission (OR = 1.669, 95% CI = 1.003-2.777 for 2 medications and OR = 3.170, 95% CI = 1.325-7.583), and the use of vasopressors (OR = 1.770, 95% CI = 1.045-2.997).</p><p><strong>Conclusion: </strong>Our study uncovered that cardiovascular medication discontinuation for ICU patients is frequent, especially for renin-angiotensin system (RAS) blockers. Data from our study could be used to reinforce site-specific protocols of medication reconciliation and optimization, as well as inform future protocols aimed at RAS blocker reinitiation follow-up.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241276361"},"PeriodicalIF":1.6,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11378200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Five Things to Know About Depression in Hemodialysis. 血液透析患者抑郁的五大注意事项。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-08-27 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241264465
Peter Smylie, Bhanu Prasad
{"title":"Five Things to Know About Depression in Hemodialysis.","authors":"Peter Smylie, Bhanu Prasad","doi":"10.1177/20543581241264465","DOIUrl":"https://doi.org/10.1177/20543581241264465","url":null,"abstract":"","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241264465"},"PeriodicalIF":1.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11350542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
An Environmental Scan of Canadian Kidney Transplant Programs for the Management of Patients With Graft Failure: A Research Letter. 加拿大肾移植项目管理移植失败患者的环境扫描:研究报告。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-08-23 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241274006
Anita Slominska, Kathleen Gaudio, M Khaled Shamseddin, Ngan N Lam, Julie Ho, Amanda Vinson, Rahul Mainra, Stephanie Hoar, Marie-Chantal Fortin, S Joseph Kim, Sacha DeSerres, G V Ramesh Prasad, Matthew A Weir, Marcelo Cantarovich, Shaifali Sandal
<p><strong>Background: </strong>Kidney transplant recipients with graft failure (KTR-GF) and those with a failing graft are an increasingly prevalent group of patients. Their clinical management is complex, and outcomes are worse than transplant naïve patients on dialysis. In 2023, the Kidney Disease: Improving Global Outcomes (KDIGO) organization reported findings from a controversies conference and identified several clinical practice priorities for KTR-GF.</p><p><strong>Objective: </strong>As an exercise in needs assessment, we aimed to collate and summarize current practices in adult Canadian kidney transplant programs around these KDIGO-identified clinical practice priorities.</p><p><strong>Design: </strong>Environmental scan followed by content analysis.</p><p><strong>Setting: </strong>Canadian adult kidney transplant programs.</p><p><strong>Measurements: </strong>We categorized the themes of our content analysis around 7 clinical practice priorities: (1) determining prognosis and kidney failure trajectory; (2) immunosuppression management; (3) management of medical complications; (4) preparing for return to dialysis; (5) evaluation and listing for re-transplantation; (6) management of psychological effects; and (7) transition to supportive care.</p><p><strong>Methods: </strong>We solicited documents that identified each program's current care practices for KTR-GF or patients with a failing graft, including policies, procedures, pathways, and protocols. A content analysis of documents and informal correspondence (email or telephone conversations) was done to extract information surrounding the 7 practice priorities.</p><p><strong>Results: </strong>Of the 18 programs contacted, 12 transplant programs participated in this study and a document from a provincial organization (where 2 non-responding programs are located) was procured and included in this analysis. Overall, practice gaps and discrepancies were noted. Many participants highlighted the lack of evidence or consensus to guide the management of KTR-GF as the key reason. Immunosuppression management was the most frequently addressed priority. Six programs and the provincial document recommended a nuanced approach to immunosuppressant management based on clinical factors and re-transplant candidacy. Two programs used the Kidney Failure Risk Equation and eGFR to determine referral trajectories and prepare patients for return to dialysis. Exact processes outlining medical management during the transition were not found except for nephrectomy indications and in 1 program that has a specific transition clinic for KTR-GF. All programs have a formal or informal policy that KTR-GF should be assessed for re-transplantation. Referrals for psychological support and transition to supportive care were made on a case-by-case basis.</p><p><strong>Limitations: </strong>Our environmental scan was at risk of non-response bias and restricted to transplant programs. Kidney clinics and dialysis units may h
背景:移植失败的肾移植受者(KTR-GF)和移植失败的患者越来越多。他们的临床管理非常复杂,治疗效果比接受透析治疗的移植新患者更差。2023 年,肾脏病:改善全球结果(KDIGO)组织报告了一次争议会议的结果,并确定了 KTR-GF 的几个临床实践重点:作为一项需求评估工作,我们旨在围绕 KDIGO 确定的这些临床实践重点,整理和总结加拿大成人肾移植项目的当前实践:设计:环境扫描,然后进行内容分析:环境:加拿大成人肾移植项目:我们围绕7个临床实践重点对内容分析的主题进行了分类:(1)确定预后和肾衰竭轨迹;(2)免疫抑制管理;(3)医疗并发症管理;(4)为恢复透析做准备;(5)再次移植的评估和列表;(6)心理影响管理;(7)向支持性护理过渡:我们征集了一些文件,以确定每个项目目前对 KTR-GF 或移植失败患者的护理措施,包括政策、程序、路径和协议。我们对文件和非正式通信(电子邮件或电话交谈)进行了内容分析,以提取与 7 项优先实践相关的信息:在所联系的 18 个项目中,有 12 个移植项目参与了本研究,另外还从一个省级机构(其中有 2 个项目未做出回应)获得了一份文件,并将其纳入了本分析。总体而言,我们注意到了实践中存在的差距和差异。许多参与者强调,缺乏指导 KTR-GF 管理的证据或共识是主要原因。免疫抑制管理是最常见的优先事项。六项计划和省级文件建议根据临床因素和再移植候选资格对免疫抑制剂管理采取细致入微的方法。两项计划使用肾衰竭风险方程和 eGFR 来确定转诊轨迹,并为患者重返透析治疗做好准备。除了肾切除术适应症和 1 个为 KTR-GF 设立了专门过渡诊所的项目外,没有发现概述过渡期间医疗管理的确切流程。所有项目都有一项正式或非正式的政策,规定应评估 KTR-GF 的再移植情况。心理支持和过渡到支持性护理的转诊是根据具体情况决定的:我们的环境扫描存在无响应偏差的风险,且仅限于移植项目。肾脏诊所和透析室可能有相关的政策和程序,但没有进行检查:我们的环境扫描结果表明了护理方面的不足和潜在的质量改进领域,包括缺乏多学科护理、结构化透析准备和心理支持。此外,还需要优先开展研究,以获得指导 KTR-GF 管理的证据,并为制定临床实践指南的目标做出贡献。
{"title":"An Environmental Scan of Canadian Kidney Transplant Programs for the Management of Patients With Graft Failure: A Research Letter.","authors":"Anita Slominska, Kathleen Gaudio, M Khaled Shamseddin, Ngan N Lam, Julie Ho, Amanda Vinson, Rahul Mainra, Stephanie Hoar, Marie-Chantal Fortin, S Joseph Kim, Sacha DeSerres, G V Ramesh Prasad, Matthew A Weir, Marcelo Cantarovich, Shaifali Sandal","doi":"10.1177/20543581241274006","DOIUrl":"10.1177/20543581241274006","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Kidney transplant recipients with graft failure (KTR-GF) and those with a failing graft are an increasingly prevalent group of patients. Their clinical management is complex, and outcomes are worse than transplant naïve patients on dialysis. In 2023, the Kidney Disease: Improving Global Outcomes (KDIGO) organization reported findings from a controversies conference and identified several clinical practice priorities for KTR-GF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;As an exercise in needs assessment, we aimed to collate and summarize current practices in adult Canadian kidney transplant programs around these KDIGO-identified clinical practice priorities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Environmental scan followed by content analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Canadian adult kidney transplant programs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;We categorized the themes of our content analysis around 7 clinical practice priorities: (1) determining prognosis and kidney failure trajectory; (2) immunosuppression management; (3) management of medical complications; (4) preparing for return to dialysis; (5) evaluation and listing for re-transplantation; (6) management of psychological effects; and (7) transition to supportive care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We solicited documents that identified each program's current care practices for KTR-GF or patients with a failing graft, including policies, procedures, pathways, and protocols. A content analysis of documents and informal correspondence (email or telephone conversations) was done to extract information surrounding the 7 practice priorities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 18 programs contacted, 12 transplant programs participated in this study and a document from a provincial organization (where 2 non-responding programs are located) was procured and included in this analysis. Overall, practice gaps and discrepancies were noted. Many participants highlighted the lack of evidence or consensus to guide the management of KTR-GF as the key reason. Immunosuppression management was the most frequently addressed priority. Six programs and the provincial document recommended a nuanced approach to immunosuppressant management based on clinical factors and re-transplant candidacy. Two programs used the Kidney Failure Risk Equation and eGFR to determine referral trajectories and prepare patients for return to dialysis. Exact processes outlining medical management during the transition were not found except for nephrectomy indications and in 1 program that has a specific transition clinic for KTR-GF. All programs have a formal or informal policy that KTR-GF should be assessed for re-transplantation. Referrals for psychological support and transition to supportive care were made on a case-by-case basis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Our environmental scan was at risk of non-response bias and restricted to transplant programs. Kidney clinics and dialysis units may h","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241274006"},"PeriodicalIF":1.6,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Feasibility and Effects of Self-Acupressure on Symptom Burden and Quality of Life in Hemodialysis Patients: A Pilot RCT. 自我压迫对血液透析患者症状负担和生活质量的可行性及影响:试验性 RCT。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-08-06 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241267164
Kristen Parker, Shauna Raugust, Becky Vink, Kuljit Parmar, Allan Fradsham, Marni Armstrong

Background: Symptom burden among long-term hemodialysis (HD) patients is high, and addressing symptoms has been identified as a key research priority by patients. Acupressure has shown some effectiveness in management of symptoms in patients with HD.

Objective: The purpose of this study was to explore the feasibility and the effect of implementing a self-administered acupressure intervention on symptom burden and quality of life for in-center HD patients.

Design: A pilot randomized controlled study.

Setting: Two outpatient community HD clinics between in Calgary, Alberta, Canada.

Patients or sample or participants: Patients on HD for at least 3 months and with at least one symptom score rated greater than moderate were eligible for the study.

Methods: Participants were randomized into either the (1) self-acupressure + usual care or (2) usual care alone group. Participants in the acupressure group were given a wooden acupressure tool and taught how to self-administer protocol on 6 acupressure sites for the 4-weeek study duration. Feasibility outcomes were assessed through satisfaction surveys and attrition. Other outcomes included quality of life and symptom scores by validated questionnaires (EQ-5D-5L and Integrated Palliative Outcome Score-Renal [IPOS-Renal]).

Results: Thirty-two participants were successfully enrolled in the study; acceptability was high with study completion at 98% in the intervention group and 82% adherence rate to the 4-week protocol. Participants in the intervention group reported an improved change score in quality of life (EQ-5D-5L Index Score change = +0.053; EQ-5D-5L visual analog scale score change = +6.7). Participants in the intervention group also reported improved symptom scores (IPOS-Renal overall change = -2.8).

Limitations: Small sample size and intervention duration are limitations of this pilot study.

Conclusions: The results from this study suggest that self-acupressure was acceptable and feasible in this sample of HD patients. Self-acupressure may have a role for supporting the management of symptoms in HD patients. These pilot results can be used to inform larger more definitive investigations.

背景:长期血液透析(HD)患者的症状负担很重,解决症状问题已被患者确定为研究的重点。穴位按摩在控制血液透析患者的症状方面有一定的效果:本研究旨在探讨对中心内的 HD 患者实施自我管理的穴位按摩干预对症状负担和生活质量的可行性和影响:设计:试验性随机对照研究:患者或样本或参与者:患者或样本或参与者:接受 HD 治疗至少 3 个月且至少有一项症状评分超过中度的患者有资格参与研究:参与者被随机分为(1)自我穴位按摩+常规护理组或(2)单纯常规护理组。穴位按摩组的参与者将获得一个木制穴位按摩工具,并在为期 4 周的研究期间学习如何在 6 个穴位按摩部位进行自我按摩。可行性结果通过满意度调查和自然减员进行评估。其他结果包括通过有效问卷(EQ-5D-5L 和综合姑息治疗结果评分-肾脏 [IPOS-Renal])得出的生活质量和症状评分:32名参与者成功加入了研究;干预组的研究完成率为98%,4周方案的坚持率为82%,接受度很高。干预组参与者的生活质量得分有所提高(EQ-5D-5L 指数得分变化 = +0.053;EQ-5D-5L 视觉模拟量表得分变化 = +6.7)。干预组参与者的症状评分也有所改善(IPOS-Renal 总体变化 = -2.8):局限性:样本量小和干预持续时间长是这项试点研究的局限性:本研究的结果表明,自我按压在这一 HD 患者样本中是可接受和可行的。自我按压疗法可能有助于缓解 HD 患者的症状。这些试点结果可为更大规模、更明确的调查提供依据。
{"title":"The Feasibility and Effects of Self-Acupressure on Symptom Burden and Quality of Life in Hemodialysis Patients: A Pilot RCT.","authors":"Kristen Parker, Shauna Raugust, Becky Vink, Kuljit Parmar, Allan Fradsham, Marni Armstrong","doi":"10.1177/20543581241267164","DOIUrl":"10.1177/20543581241267164","url":null,"abstract":"<p><strong>Background: </strong>Symptom burden among long-term hemodialysis (HD) patients is high, and addressing symptoms has been identified as a key research priority by patients. Acupressure has shown some effectiveness in management of symptoms in patients with HD.</p><p><strong>Objective: </strong>The purpose of this study was to explore the feasibility and the effect of implementing a self-administered acupressure intervention on symptom burden and quality of life for in-center HD patients.</p><p><strong>Design: </strong>A pilot randomized controlled study.</p><p><strong>Setting: </strong>Two outpatient community HD clinics between in Calgary, Alberta, Canada.</p><p><strong>Patients or sample or participants: </strong>Patients on HD for at least 3 months and with at least one symptom score rated greater than moderate were eligible for the study.</p><p><strong>Methods: </strong>Participants were randomized into either the (1) self-acupressure + usual care or (2) usual care alone group. Participants in the acupressure group were given a wooden acupressure tool and taught how to self-administer protocol on 6 acupressure sites for the 4-weeek study duration. Feasibility outcomes were assessed through satisfaction surveys and attrition. Other outcomes included quality of life and symptom scores by validated questionnaires (EQ-5D-5L and Integrated Palliative Outcome Score-Renal [IPOS-Renal]).</p><p><strong>Results: </strong>Thirty-two participants were successfully enrolled in the study; acceptability was high with study completion at 98% in the intervention group and 82% adherence rate to the 4-week protocol. Participants in the intervention group reported an improved change score in quality of life (EQ-5D-5L Index Score change = +0.053; EQ-5D-5L visual analog scale score change = +6.7). Participants in the intervention group also reported improved symptom scores (IPOS-Renal overall change = -2.8).</p><p><strong>Limitations: </strong>Small sample size and intervention duration are limitations of this pilot study.</p><p><strong>Conclusions: </strong>The results from this study suggest that self-acupressure was acceptable and feasible in this sample of HD patients. Self-acupressure may have a role for supporting the management of symptoms in HD patients. These pilot results can be used to inform larger more definitive investigations.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241267164"},"PeriodicalIF":1.6,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Assessment of the Correlation Between Serum Phosphate Level and Muscle Strength as Measured by Handgrip Strength in Patients Treated With Hemodialysis. 评估血液透析患者血清磷酸盐水平与用手握力测量的肌肉力量之间的相关性
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-08-06 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241267163
Dror Ben-Noach, Dina Levy, Michal Raz, Ronit Anbar, Doron Schwartz, Orit Kliuk-Ben Bassat

Background: Sarcopenia, commonly observed in patients treated with hemodialysis, correlates with low serum phosphate levels. Although normophosphatemia is desired, dietary phosphate restriction is difficult to achieve and may result in undesirable protein restriction.

Objective: We aimed to evaluate whether hyperphosphatemia is associated with higher muscle strength in patients receiving hemodialysis treatment.

Design: A single-center prospective observational study.

Setting: Ambulatory prevalent patients undergoing hemodialysis treatments in a dialysis unit of a tertiary hospital.

Patients: Participants included prevalent patients treated with hemodialysis. All patients were above 18 years. Only patients with residual kidney function below 200 mL/24 hours were included to avoid bias.

Measurements: Muscle strength was measured by handgrip strength (HGS). Each patient repeated 3 measurements, and the highest value was recorded. Handgrip strength cutoffs for low muscle strength were defined as <27 kg in men and <16 kg in women. Biochemical parameters, including serum phosphate level, were driven from routine monthly blood tests. Hyperphosphatemia was defined as serum phosphate above 4.5 mg/dL.

Methods: Handgrip strength results were compared to nutritional, anthropometric, and biochemical parameters-in particular phosphate level. Long-term mortality was recorded.

Results: Seventy-four patients were included in the final analysis. Handgrip strength was abnormally low in 33 patients (44.5%). Patients with abnormal HGS were older and more likely to have diabetes mellitus and lower albumin and creatinine levels. There was no correlation between HGS and phosphate level (r = 0.008, P = .945). On multivariable analysis, predictors of higher HGS were body mass index and creatinine. Diabetes mellitus and female sex predicted lower HGS. Hyperphosphatemia correlated with protein catabolic rate, blood urea nitrogen, and creatinine. On multivariable analysis, predictors of hyperphosphatemia were higher creatinine level, normal albumin level, and heart failure. During mean follow-up time of 7.66 ± 3.9 months, 11 patients died. Mortality was significantly higher in patients with abnormally low HGS compared with normal HGS (odds ratio = 9.32, P = .02).

Limitations: A single-center study. All measurements were performed at one time point without repeated assessments. Direct dietary intake, degree of physical activity, and medication compliance were not assessed.

Conclusion: Hyperphosphatemia correlated with increased protein intake as assessed by protein catabolic rate in patients treated with hemodialysis; however, neither correlated with higher muscle strength as measured by HGS.Trial registration: MOH 202125213.

背景:接受血液透析治疗的患者通常会出现肌肉疏松症,这与血清磷酸盐水平过低有关。虽然正常磷酸盐血症是人们所期望的,但限制饮食中的磷酸盐含量却很难实现,而且可能会导致不良的蛋白质限制:我们旨在评估高磷血症是否与接受血液透析治疗的患者肌肉力量增加有关:设计:单中心前瞻性观察研究:背景:在一家三级医院的透析室接受血液透析治疗的门诊患者:参与者包括接受血液透析治疗的患者。所有患者均在 18 岁以上。为避免偏差,仅纳入剩余肾功能低于 200 mL/24 小时的患者:肌肉力量通过手握力(HGS)进行测量。每位患者重复测量 3 次,记录最高值。方法:将手握力结果与营养、人体测量和生化指标(尤其是磷酸盐水平)进行比较。记录长期死亡率:结果:74 名患者被纳入最终分析。33名患者(44.5%)的手握力异常低下。HGS 异常的患者年龄较大,更有可能患有糖尿病,白蛋白和肌酐水平较低。HGS 与磷酸盐水平之间没有相关性(r = 0.008,P = 0.945)。多变量分析显示,体重指数和肌酐是预测 HGS 较高的因素。糖尿病和女性则预示着较低的 HGS。高磷血症与蛋白质分解代谢率、血尿素氮和肌酐相关。通过多变量分析,预测高磷酸盐血症的因素包括较高的肌酐水平、正常的白蛋白水平和心力衰竭。在平均 7.66 ± 3.9 个月的随访期间,有 11 名患者死亡。与正常 HGS 相比,异常低 HGS 患者的死亡率明显更高(几率比 = 9.32,P = .02):局限性:单中心研究。所有测量均在一个时间点进行,无重复评估。未对直接饮食摄入量、体力活动程度和药物依从性进行评估:结论:血液透析患者的高磷血症与蛋白质分解代谢率评估的蛋白质摄入量增加有关;但两者都与HGS测量的肌肉力量增加无关:MOH 202125213。
{"title":"Assessment of the Correlation Between Serum Phosphate Level and Muscle Strength as Measured by Handgrip Strength in Patients Treated With Hemodialysis.","authors":"Dror Ben-Noach, Dina Levy, Michal Raz, Ronit Anbar, Doron Schwartz, Orit Kliuk-Ben Bassat","doi":"10.1177/20543581241267163","DOIUrl":"10.1177/20543581241267163","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia, commonly observed in patients treated with hemodialysis, correlates with low serum phosphate levels. Although normophosphatemia is desired, dietary phosphate restriction is difficult to achieve and may result in undesirable protein restriction.</p><p><strong>Objective: </strong>We aimed to evaluate whether hyperphosphatemia is associated with higher muscle strength in patients receiving hemodialysis treatment.</p><p><strong>Design: </strong>A single-center prospective observational study.</p><p><strong>Setting: </strong>Ambulatory prevalent patients undergoing hemodialysis treatments in a dialysis unit of a tertiary hospital.</p><p><strong>Patients: </strong>Participants included prevalent patients treated with hemodialysis. All patients were above 18 years. Only patients with residual kidney function below 200 mL/24 hours were included to avoid bias.</p><p><strong>Measurements: </strong>Muscle strength was measured by handgrip strength (HGS). Each patient repeated 3 measurements, and the highest value was recorded. Handgrip strength cutoffs for low muscle strength were defined as <27 kg in men and <16 kg in women. Biochemical parameters, including serum phosphate level, were driven from routine monthly blood tests. Hyperphosphatemia was defined as serum phosphate above 4.5 mg/dL.</p><p><strong>Methods: </strong>Handgrip strength results were compared to nutritional, anthropometric, and biochemical parameters-in particular phosphate level. Long-term mortality was recorded.</p><p><strong>Results: </strong>Seventy-four patients were included in the final analysis. Handgrip strength was abnormally low in 33 patients (44.5%). Patients with abnormal HGS were older and more likely to have diabetes mellitus and lower albumin and creatinine levels. There was no correlation between HGS and phosphate level (<i>r</i> = 0.008, <i>P</i> = .945). On multivariable analysis, predictors of higher HGS were body mass index and creatinine. Diabetes mellitus and female sex predicted lower HGS. Hyperphosphatemia correlated with protein catabolic rate, blood urea nitrogen, and creatinine. On multivariable analysis, predictors of hyperphosphatemia were higher creatinine level, normal albumin level, and heart failure. During mean follow-up time of 7.66 ± 3.9 months, 11 patients died. Mortality was significantly higher in patients with abnormally low HGS compared with normal HGS (odds ratio = 9.32, <i>P</i> = .02).</p><p><strong>Limitations: </strong>A single-center study. All measurements were performed at one time point without repeated assessments. Direct dietary intake, degree of physical activity, and medication compliance were not assessed.</p><p><strong>Conclusion: </strong>Hyperphosphatemia correlated with increased protein intake as assessed by protein catabolic rate in patients treated with hemodialysis; however, neither correlated with higher muscle strength as measured by HGS.Trial registration: MOH 202125213.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241267163"},"PeriodicalIF":1.6,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Use of Kidneys With Lower Longevity From Deceased Donors to Improve Access to Preemptive Renal Transplantation for Elderly Patients: A Qualitative Study. 使用已故捐献者寿命较短的肾脏来改善老年患者获得先期肾移植的机会:定性研究。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-30 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241267165
Carina Sancho, Aliya Affdal, Fabián-Andrés Ballesteros Gallego, Marie-Françoise Malo, Savannah-Lou Cochran-Mavrikakis, Héloise Cardinal, John S Gill, Marie-Chantal Fortin

Background: There is a gap between the number of patients waiting for a transplant and the number of kidneys available. Some deceased donor kidneys are currently nonutilized, as medical teams fear that they will experience suboptimal graft survival. However, these organs could provide an acceptable therapeutic option if they were allocated for preemptive kidney transplantation in elderly candidates.

Objective: This project aims to gather patients' perspectives on the allocation of kidneys with lower longevity for preemptive kidney transplantation in elderly patients.

Design: Individual interviews.

Setting: The Center hospitalier de l'Université de Montréal (CHUM) chronic kidney disease (CKD) clinic.

Participants: Patients aged between 64 and 75 years with CKD G4-5 ND, followed at the CHUM and who have not initiated dialysis yet.

Methods: Between March and July 2023, we conducted 14 individual interviews with patients aged between 64 and 75 years who had CKD G4-5 ND and were followed at the CHUM. The interviews were digitally recorded and transcribed. Thematic analysis was conducted.

Results: Most participants were in favor of using kidneys with lower longevity to increase their access to transplantation, improve their quality of life, enable accelerated transplantation, and avoid dialysis. Patients also wanted to be engaged in the decision-making process, underlining the importance of informed consent. Although the use of kidneys with lower longevity offers the hope of returning to "normal" life, some patients were concerned about the risk of reduced graft survival and the need for a subsequent kidney transplant. In these cases, patients were interested in using mitigation strategies, such as prioritization for kidney transplantation from standard donors in case of early graft loss associated with receiving kidneys with lower longevity. They also recommended the development of a separate waiting list for patients consenting to preemptive transplantation with kidneys with lower longevity.

Limitations: This study was conducted in only 1 nephrology clinic in the province of Quebec with French-speaking patients. Consequently, the results may not be generalizable to other populations, including ethnic minorities.

Conclusion: The use of kidneys with lower longevity for preemptive kidney transplantation appears to be an interesting option for elderly kidney transplant candidates. However, patient information and participation in the decision-making process are essential. Moreover, organ donation organizations and transplant programs should develop a separate waitlist for transplant candidates who have preconsented to receive organ offers of deceased donor kidneys with lower longevity.

Trial registration: Not registered.

背景:等待移植的患者人数与可用肾脏数量之间存在差距。目前,一些已故捐献者的肾脏未得到利用,因为医疗团队担心这些肾脏的移植存活率不理想。然而,如果将这些器官分配给老年患者进行先期肾移植,则可提供一种可接受的治疗选择:本项目旨在收集患者对将寿命较短的肾脏分配给老年患者进行先期肾移植的看法:设计:个人访谈:地点:蒙特利尔大学医院中心(CHUM)慢性肾脏病(CKD)门诊:方法:2023 年 3 月至 7 月期间,在蒙特利尔大学中心医院(CHUM)慢性肾脏病(CKD)门诊对年龄在 64 岁至 75 岁之间、CKD G4-5 ND、尚未开始透析的患者进行访谈:在 2023 年 3 月至 7 月期间,我们对年龄在 64 岁至 75 岁之间、患有 CKD G4-5 ND 并在中国医科大学接受随访的患者进行了 14 次个别访谈。对访谈进行了数字录音和转录。结果:大多数参与者赞成使用寿命较短的肾脏,以增加移植机会、改善生活质量、加快移植速度并避免透析。患者还希望参与决策过程,这强调了知情同意的重要性。虽然使用寿命较短的肾脏为恢复 "正常 "生活带来了希望,但一些患者担心移植物存活率降低的风险以及后续肾移植的需要。在这种情况下,患者希望采用缓解策略,例如在接受寿命较短的肾脏导致早期移植物损失的情况下,优先从标准供体进行肾脏移植。他们还建议为同意预先接受寿命较短肾脏移植的患者制定单独的候选名单:本研究仅在魁北克省的一家肾脏病诊所进行,研究对象为讲法语的患者。因此,研究结果可能无法推广到其他人群,包括少数民族:结论:使用寿命较短的肾脏进行先期肾移植似乎是老年肾移植候选者的一个有趣选择。然而,患者必须了解相关信息并参与决策过程。此外,器官捐献组织和移植项目应为预先同意接受器官捐献的寿命较短的已故捐献者肾脏的移植候选者制定一份单独的候选名单:未注册。
{"title":"The Use of Kidneys With Lower Longevity From Deceased Donors to Improve Access to Preemptive Renal Transplantation for Elderly Patients: A Qualitative Study.","authors":"Carina Sancho, Aliya Affdal, Fabián-Andrés Ballesteros Gallego, Marie-Françoise Malo, Savannah-Lou Cochran-Mavrikakis, Héloise Cardinal, John S Gill, Marie-Chantal Fortin","doi":"10.1177/20543581241267165","DOIUrl":"10.1177/20543581241267165","url":null,"abstract":"<p><strong>Background: </strong>There is a gap between the number of patients waiting for a transplant and the number of kidneys available. Some deceased donor kidneys are currently nonutilized, as medical teams fear that they will experience suboptimal graft survival. However, these organs could provide an acceptable therapeutic option if they were allocated for preemptive kidney transplantation in elderly candidates.</p><p><strong>Objective: </strong>This project aims to gather patients' perspectives on the allocation of kidneys with lower longevity for preemptive kidney transplantation in elderly patients.</p><p><strong>Design: </strong>Individual interviews.</p><p><strong>Setting: </strong>The Center hospitalier de l'Université de Montréal (CHUM) chronic kidney disease (CKD) clinic.</p><p><strong>Participants: </strong>Patients aged between 64 and 75 years with CKD G4-5 ND, followed at the CHUM and who have not initiated dialysis yet.</p><p><strong>Methods: </strong>Between March and July 2023, we conducted 14 individual interviews with patients aged between 64 and 75 years who had CKD G4-5 ND and were followed at the CHUM. The interviews were digitally recorded and transcribed. Thematic analysis was conducted.</p><p><strong>Results: </strong>Most participants were in favor of using kidneys with lower longevity to increase their access to transplantation, improve their quality of life, enable accelerated transplantation, and avoid dialysis. Patients also wanted to be engaged in the decision-making process, underlining the importance of informed consent. Although the use of kidneys with lower longevity offers the hope of returning to \"normal\" life, some patients were concerned about the risk of reduced graft survival and the need for a subsequent kidney transplant. In these cases, patients were interested in using mitigation strategies, such as prioritization for kidney transplantation from standard donors in case of early graft loss associated with receiving kidneys with lower longevity. They also recommended the development of a separate waiting list for patients consenting to preemptive transplantation with kidneys with lower longevity.</p><p><strong>Limitations: </strong>This study was conducted in only 1 nephrology clinic in the province of Quebec with French-speaking patients. Consequently, the results may not be generalizable to other populations, including ethnic minorities.</p><p><strong>Conclusion: </strong>The use of kidneys with lower longevity for preemptive kidney transplantation appears to be an interesting option for elderly kidney transplant candidates. However, patient information and participation in the decision-making process are essential. Moreover, organ donation organizations and transplant programs should develop a separate waitlist for transplant candidates who have preconsented to receive organ offers of deceased donor kidneys with lower longevity.</p><p><strong>Trial registration: </strong>Not registered.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241267165"},"PeriodicalIF":1.6,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11292676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Characterizing Interventions Used to Promote Life Participation in Adults on Peritoneal Dialysis Therapy: A Scoping Review. 描述用于促进腹膜透析治疗成人参与生活的干预措施:范围综述。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-30 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241263168
Alexia Kateb, Kaleigh McCarthy, Janine Farragher

Background: Living with kidney failure can interfere with life participation (ie, participation in valued life activities). Life participation has recently been identified as a top-priority health outcome of people on peritoneal dialysis therapy, but it is a relatively unexplored topic in peritoneal dialysis.

Objective: The objective is to describe the interventions that have been used to promote life participation in the peritoneal dialysis population and highlight research gaps warranting further investigation.

Design: A scoping review was conducted according to the Joanna Briggs Institute methodology.

Setting: Six electronic databases (MEDLINE [OVID], EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL Plus, SCOPUS) were searched.

Patients: Adults aged 18+ years on peritoneal dialysis therapy.

Measurements: Any dedicated scale or subscale that measured life participation as an isolated outcome.

Methods: Title/abstract screening was completed independently after adequate inter-rater reliability (kappa > 0.8) was achieved among reviewers. Full-text review and data extraction were conducted in duplicate. Extracted data were analyzed using counts, percentages, and narrative synthesis to describe patterns in the literature.

Results: After identifying 13 874 results, 17 studies met eligibility criteria. Eight studies were conducted within the past 5 years, with China as the most common study location. Only 2 studies investigated life participation as a primary study outcome. Eight studies targeted personal-physical barriers to life participation, 8 targeted multiple barriers, and 1 targeted an environmental-institutional barrier. Life participation was assessed within a subdomain of a broader quality of life assessment (The Kidney Disease Quality of Life [KDQOL]-36 or the 36-Item Short-Form Health Survey [SF-36]) in 11 studies. The majority of assessments captured life participation in all major domains of participation (self-care, work, and leisure).

Limitations: Eligibility screening at title/abstract stage was not performed in duplicate; articles not available in English were excluded.

Conclusions: Life participation has infrequently been prioritized as a health outcome in peritoneal dialysis (PD). Interventions have been narrow in focus given the range of challenges faced by people on PD and the holistic approaches used in other clinical populations. Future research should prioritize life participation as a key health outcome in PD and investigate the impact of interventions that address cognitive, affective, and environmental barriers to participation.

背景:肾衰竭患者的生活会影响生活参与度(即参与有价值的生活活动)。最近,生活参与已被确定为腹膜透析治疗患者最优先考虑的健康结果,但这在腹膜透析中是一个相对未被探索的课题:目的:描述用于促进腹膜透析患者参与生活的干预措施,并强调需要进一步调查的研究缺口:设计:根据乔安娜-布里格斯研究所(Joanna Briggs Institute)的方法进行了范围界定综述:检索六个电子数据库(MEDLINE [OVID]、EMBASE、PsycINFO、Cochrane Central Register of Controlled Trials、CINAHL Plus、SCOPUS):患者:18 岁以上接受腹膜透析治疗的成年人:任何将生活参与度作为单独结果进行测量的专用量表或分量表:在审稿人之间达到充分的互评可靠性(kappa > 0.8)后,独立完成标题/摘要筛选。全文审阅和数据提取一式两份。采用计数、百分比和叙事综合法对提取的数据进行分析,以描述文献中的模式:在确定了 13 874 项结果后,有 17 项研究符合资格标准。其中 8 项研究是在过去 5 年内进行的,中国是最常见的研究地点。只有 2 项研究将生活参与度作为主要研究结果。8 项研究针对生活参与的个人-物理障碍,8 项研究针对多重障碍,1 项研究针对环境-制度障碍。11项研究在更广泛的生活质量评估(肾病生活质量[KDQOL]-36或36项短式健康调查[SF-36])的一个子域中对生活参与度进行了评估。大多数评估都涵盖了所有主要参与领域(自理、工作和休闲)的生活参与情况:限制因素:标题/摘要阶段的资格筛选未重复进行;未提供英文版的文章被排除在外:参与生活作为腹膜透析(PD)患者的一项健康结果,很少被优先考虑。考虑到腹膜透析患者所面临的各种挑战,以及其他临床人群所采用的整体方法,干预措施的重点一直很狭窄。未来的研究应将参与生活作为腹膜透析患者的一项重要健康成果,并调查针对参与生活的认知、情感和环境障碍的干预措施的影响。
{"title":"Characterizing Interventions Used to Promote Life Participation in Adults on Peritoneal Dialysis Therapy: A Scoping Review.","authors":"Alexia Kateb, Kaleigh McCarthy, Janine Farragher","doi":"10.1177/20543581241263168","DOIUrl":"10.1177/20543581241263168","url":null,"abstract":"<p><strong>Background: </strong>Living with kidney failure can interfere with life participation (ie, participation in valued life activities). Life participation has recently been identified as a top-priority health outcome of people on peritoneal dialysis therapy, but it is a relatively unexplored topic in peritoneal dialysis.</p><p><strong>Objective: </strong>The objective is to describe the interventions that have been used to promote life participation in the peritoneal dialysis population and highlight research gaps warranting further investigation.</p><p><strong>Design: </strong>A scoping review was conducted according to the Joanna Briggs Institute methodology.</p><p><strong>Setting: </strong>Six electronic databases (MEDLINE [OVID], EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL Plus, SCOPUS) were searched.</p><p><strong>Patients: </strong>Adults aged 18+ years on peritoneal dialysis therapy.</p><p><strong>Measurements: </strong>Any dedicated scale or subscale that measured life participation as an isolated outcome.</p><p><strong>Methods: </strong>Title/abstract screening was completed independently after adequate inter-rater reliability (kappa > 0.8) was achieved among reviewers. Full-text review and data extraction were conducted in duplicate. Extracted data were analyzed using counts, percentages, and narrative synthesis to describe patterns in the literature.</p><p><strong>Results: </strong>After identifying 13 874 results, 17 studies met eligibility criteria. Eight studies were conducted within the past 5 years, with China as the most common study location. Only 2 studies investigated life participation as a primary study outcome. Eight studies targeted personal-physical barriers to life participation, 8 targeted multiple barriers, and 1 targeted an environmental-institutional barrier. Life participation was assessed within a subdomain of a broader quality of life assessment (The Kidney Disease Quality of Life [KDQOL]-36 or the 36-Item Short-Form Health Survey [SF-36]) in 11 studies. The majority of assessments captured life participation in all major domains of participation (self-care, work, and leisure).</p><p><strong>Limitations: </strong>Eligibility screening at title/abstract stage was not performed in duplicate; articles not available in English were excluded.</p><p><strong>Conclusions: </strong>Life participation has infrequently been prioritized as a health outcome in peritoneal dialysis (PD). Interventions have been narrow in focus given the range of challenges faced by people on PD and the holistic approaches used in other clinical populations. Future research should prioritize life participation as a key health outcome in PD and investigate the impact of interventions that address cognitive, affective, and environmental barriers to participation.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241263168"},"PeriodicalIF":1.6,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11292723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Canadian Journal of Kidney Health and Disease
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1