The Severity of Renal Disease Scale (SORDS) was developed to provide a single score reflecting disease severity of renal patients independent of confounding psychosocial influences. This study examined SORDS' reliability and validity and its relevance as a research tool assessing the psychological effect of illness severity. Data was collected from 127 renal patients (predialysis, HD, CAPD). SORDS was compared with the Endstage Renal Disease Severity Index (ESRD-SI), the SF-36, the Beck Depression Inventory - 2nd Edition and a subset of BDI-II items reflecting cognitive features only at differing stages of renal disease and time on dialysis. SORDS and ESRD-SI data from twenty-two CAPD patients was included in reliability analyses. SORDS reliability estimates were low suggesting that the use of SORDS with medical chart data at this time is problematic. SORDS should be used only by medical practitioners who are aware of patients' standing on SORDS variables. There was however strong support for SORDS' validity. Validity was demonstrated by correlations between SORDS and the ESRD-SI. Compared to the ESRD-SI, SORDS was better able to discriminate between dialysis and pre-dialysis patients. SORDS and ESRD-SI scores were related to self-perceptions of decreased health status on the SF-36 independent of dialysis duration and age. SORDS utility in psychosocial research with renal patients was demonstrated by a finding that disease severity differentially impacts levels of depression for HD versus CAPD patients independent of age or dialysis duration. At the lowest level of illness severity as assessed by SORDS, CAPD patients scored in the moderate range of depression and were significantly more depressed than HD patients. Using the same analyses but with the ESRD-SI, no differences in level of depression were detected. These results imply a relationship between adjustment to treatment and illness severity. It is concluded that SORDS is a valid index of renal disease severity and that illness severity as assessed by SORDS may have an important role as a moderator variable in psychosocial research with renal patients. These results may have important implications for treatment assignment and psychosocial assessment and intervention of renal patients and their families.

Visame pasaulyje daugėja pacientų, sergančių galutiniu inkstų nepakankamumu. Daugiau negu 1 mln. tokių pacientų yra taikoma pakaitinė inkstų terapija, kuri yra gyvybę gelbstintis gydymas. Gydymas hemodializėmis išlieka dažniausia pakaitinės inkstų terapijos rūšimi visuose pasaulio regionuose. Nežiūrint per paskutinius dešimtmečius įvykusios didelės medicinos pažangos ir pagerėjusios dializių techninės bazės, vis dar išlieka didelis hemodializėmis gydomų pacientų sergamumas bei mirtingumas ir gana prasta gyvenimo kokybė. Jų išgyvenimas nėra vienodas skirtingose šalyse, nes skiriasi valstybių geografiniai, socialiniai ir ekonominiai ypatumai bei sveikatos apsaugos politika. Todėl labai svarbu kiekvienoje valstybėje nagrinėti tokių pacientų išgyvenimą ir išskirti būtent tai šaliai būdingus išgyvenimą lemiančius veiksnius, kad iš esmės būtų galima pagerinti šios didėjančios pacientų populiacijos gyvenimo prognozę ir kokybę. Daugelyje pasaulio valstybių veikia inkstų ligų registrai, renkantys duomenis ir analizuojantys įvairių lėtinių inkstų ligų stadijų dažnį, gydymo būdus, pacientų mirtingumą bei jų išgyvenimą. Lietuvoje kol kas nėra oficialaus inkstų ligų registro, todėl ilgai buvo nežinomi net pagrindiniai demografiniai sergančiųjų galutiniu inkstų nepakankamumu rodikliai. Todėl mūsų tyrimo tikslas buvo nustatyti pacientų, sergančių galutiniu inkstų nepakankamumu ir gydomų hemodializėmis, išgyvenimą bei su juo susijusius veiksnius. Į tyrimą įtraukti visi Lietuvos pacientai... [toliau žr. visą tekstą] / End-stage renal disease is highly prevalent worldwide, with more than 1 million patients undergoing renal replacement therapies, which are a life-saving treatment for such patients. Haemodialysis remains the most common treatment modality in all regions of the world. Despite many technical advances in the medical care and in the delivery of dialysis over the past years, mortality and morbidity of dialysis patients remains persistently high and their quality of life is rather poor. Survival rates differ among countries and registries. International differences in the mortality of dialysis patients are probably related to differences in population demographics, renal disease, lifestyle and socioeconomic status. Therefore, it is extremely important to investigate survival of such patients in each country and to identify characteristic risk factors in order to improve outcomes. In most countries, renal registries are responsible for end-stage renal disease data collection, analysis and reporting. There is no renal registry in Lithuania and regular information about patients on dialysis in Lithuania is not available. The aim of our study was to estimate the survival of patients on chronic haemodialysis in Lithuania and to identify associated risk factors. All patients who started chronic haemodialysis in Lithuania between 1 January, 1998, and 31 December, 2005, were enrolled. For the first time in Lithuania, survival of patients on chronic haemodialysis and associated risk factors... [to full text]

End-stage renal disease is highly prevalent worldwide, with more than 1 million patients undergoing renal replacement therapies, which are a life-saving treatment for such patients. Haemodialysis remains the most common treatment modality in all regions of the world. Despite many technical advances in the medical care and in the delivery of dialysis over the past years, mortality and morbidity of dialysis patients remains persistently high and their quality of life is rather poor. Survival rates differ among countries and registries. International differences in the mortality of dialysis patients are probably related to differences in population demographics, renal disease, lifestyle and socioeconomic status. Therefore, it is extremely important to investigate survival of such patients in each country and to identify characteristic risk factors in order to improve outcomes. In most countries, renal registries are responsible for end-stage renal disease data collection, analysis and reporting. There is no renal registry in Lithuania and regular information about patients on dialysis in Lithuania is not available. The aim of our study was to estimate the survival of patients on chronic haemodialysis in Lithuania and to identify associated risk factors. All patients who started chronic haemodialysis in Lithuania between 1 January, 1998, and 31 December, 2005, were enrolled. For the first time in Lithuania, survival of patients on chronic haemodialysis and associated risk factors... [to full text] / Visame pasaulyje daugėja pacientų, sergančių galutiniu inkstų nepakankamumu. Daugiau negu 1 mln. tokių pacientų yra taikoma pakaitinė inkstų terapija, kuri yra gyvybę gelbstintis gydymas. Gydymas hemodializėmis išlieka dažniausia pakaitinės inkstų terapijos rūšimi visuose pasaulio regionuose. Nežiūrint per paskutinius dešimtmečius įvykusios didelės medicinos pažangos ir pagerėjusios dializių techninės bazės, vis dar išlieka didelis hemodializėmis gydomų pacientų sergamumas bei mirtingumas ir gana prasta gyvenimo kokybė. Jų išgyvenimas nėra vienodas skirtingose šalyse, nes skiriasi valstybių geografiniai, socialiniai ir ekonominiai ypatumai bei sveikatos apsaugos politika. Todėl labai svarbu kiekvienoje valstybėje nagrinėti tokių pacientų išgyvenimą ir išskirti būtent tai šaliai būdingus išgyvenimą lemiančius veiksnius, kad iš esmės būtų galima pagerinti šios didėjančios pacientų populiacijos gyvenimo prognozę ir kokybę. Daugelyje pasaulio valstybių veikia inkstų ligų registrai, renkantys duomenis ir analizuojantys įvairių lėtinių inkstų ligų stadijų dažnį, gydymo būdus, pacientų mirtingumą bei jų išgyvenimą. Lietuvoje kol kas nėra oficialaus inkstų ligų registro, todėl ilgai buvo nežinomi net pagrindiniai demografiniai sergančiųjų galutiniu inkstų nepakankamumu rodikliai. Todėl mūsų tyrimo tikslas buvo nustatyti pacientų, sergančių galutiniu inkstų nepakankamumu ir gydomų hemodializėmis, išgyvenimą bei su juo susijusius veiksnius. Į tyrimą įtraukti visi Lietuvos pacientai... [toliau žr. visą tekstą]

The impact of end-stage renal disease (ESRD) on healthcare costs is significant. In 2013, the cost of providing care for the ESRD patient population was 7.1% of total Medicare expenses. ESRD patients' non-adherence with the medical plan is a reason for the high cost of care and poor patient outcomes. Staff education can have a positive impact on patient adherence in terms of the management of chronic illnesses, such as ESRD. This DNP project was an education program for hemodialysis (HD) staff regarding empowering patients to learn about self-care strategies aimed at improving ESRD patients' adherence to fluid restriction and treatment schedules. The staff education project was developed using Malcolm Knowles' adult learning theory and Dorothea Orem's self-care theory. Three in-center hemodialysis (ICHD) clinics located in a large southeast inner city of the United States with predominantly African American patients participated in the DNP project. All the participating clinics were selected based on their underperformance in missed patient treatments and fluid goals. The goal of the educational program was to teach staff current evidence-based practice self-care strategies for patients to improve adherence to required fluid restrictions and treatment schedules. The program was delivered through 5 different sessions over 3 days at 2 locations. Thirty staff members participated in the program. Missed treatment rates and the intradialytic weight gain (IDWG) percent showed improvement 1-month post education for each of the 3 clinics. This project has the potential to promote social change through staff education on patient self-care strategies for adherence to fluid and treatment plans, thus improving patient outcomes and quality of life.

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The progression of End Stage Renal Disease (ESRD) among type II diabetics is preventable, yet complications continue to plague many. Reports show that 29.1 million people (9.3%) in the United States have diabetes, and 40% of those individuals develop ESRD. Four research questions explored the relationship between ESRD, health literacy, and healthcare. Data from 2010-2015 from the National Institute of Health (NIH) was quantitatively analyzed. The conceptual framework was the revised health service utilization theory. The target population included 3939 diverse males and females between the ages of 20-75 diagnosed with type II Diabetes. Results from Chi-square, cross-tabulation, binary, and multinomial logistic regression revealed that there is a statistically significant relationship between inadequate health literacy and ESRD (p= <0.05), inadequate health literacy and healthcare services (p= <0.05), and healthcare services and development of ESRD (p=<.001). Findings exposed significant demographic co-factor differences. Males developed ESRD more than females, and African American and Hispanic populations were almost 2 times more likely than Caucasians to develop ESRD. As participants age, odds for developing ESRD increase about 2-3 times. Both race and education were significant predictors of inadequate health literacy. African Americans and Hispanics were 3 times more likely to have inadequate health literacy than Caucasian participants. Lower education increased the odds of having inadequate health literacy approximately 7.6 times. Results show that Caucasian participants had higher education levels and private health insurance, whereas African Americans and Hispanics had lower education and no insurance or Medicaid. Implications from this research show that social determinants among vulnerable populations are impacting an individual's health literacy and ability to adequately manage their health. Evidence from this study generates social change through recognition that health literacy is fundamental when attempting to prevent chronic disease complications and promote positive health.

End stage renal disease (ESRD) patients have an excess cardiovascular risk, above that predicted by traditional risk factor models. Despite the advances in both Cardiovascular disease (CVD) management and renal replacement therapy (RRT), there still is a major burden of cardiovascular mortality and morbidity in the chronic kidney disease (CKD) population. Declining renal function itself represents a continuum of cardiovascular risk and in those individuals who survive to reach ESRD, the risk of suffering a cardiac event is uncomfortably and unacceptably high. Pro-thrombotic status may contribute to this increased risk. Global thrombotic status assessment, including measurement of occlusion time (OT) the time taken to form an occlusive platelet rich thrombus and thrombolytic status (time taken to lyse such thrombus) as assessed by measuring Lysis Time (LT), may identify vulnerable patients. The aim of this study was to assess overall thrombotic status in ESRD and relate this to cardiovascular and peripheral thrombotic risk. Small sub studies were also planned to establish the effect of RRT modality on the thrombotic status.

Hospital readmissions are a major burden for patients with end stage renal disease (ESRD). On average, one in three hospital discharges among patients with ESRD are followed by a readmission within 30 days. Currently, dialysis facilities are held accountable for readmissions via the ESRD Quality Incentive Program standardized readmission ratio (SRR) clinical measure. However, little is known about facility-level factors associated with readmission. Additionally, unlike other standardized measures of quality in the dialysis setting, incident patients within their first 90-days of dialysis are included in the performance calculation. This study analyzed CMS Dialysis Facility Report data from 2013 to 2016 to examine dialysis facility and incident patient factors associated with SRR using multivariate mixed models. Among 5,419 dialysis facilities treating 104,768 incident patients, the mean SRR remained stable across all four study years at 0.99. Factors significantly associated with a lower SRR (p<0.0001) included Western geographic region and higher patient care technician ratios. Several incident patient pre-dialysis nephrology care characteristics were associated with lower SRRs including higher percentages of patients with a fistula present at first dialysis treatment, higher percentages of patients receiving 6-12 months or greater than 12 months of nephrology care prior to dialysis and higher facility average hemoglobin. Factors significantly associated with a higher SRR (p<0.0001) included Northeastern geographic region, higher registered nurse ratios, higher percentage of incident patients, and higher facility average GFR. Understanding facility-level and patient-level factors associated with higher SRRs may inform interventions to reduce 30-day hospital readmission among patients receiving dialysis.

RATIONALE & OBJECTIVE: Patients receiving maintenance dialysis have higher mortality after primary percutaneous coronary intervention (pPCI) than patients not receiving dialysis. Whether pPCI confers a benefit to patients receiving dialysis that is similar to that which occurs in lower-risk groups remains unknown. We compared the effect of pPCI on in-hospital outcomes among patients hospitalized for ST-elevation myocardial infarction (STEMI) and receiving maintenance dialysis with the effect among patients hospitalized for STEMI but not receiving dialysis. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: We used the National Inpatient Sample (2016-2018) and included all adult hospitalizations with a primary diagnosis of STEMI. PREDICTORS: Primary exposure was PCI. Confounders included dialysis status, demographics, insurance, household income, comorbidities, and the elective nature of the admission. OUTCOME: In-hospital mortality, stroke, acute kidney injury, new dialysis requirement, vascular complications, gastrointestinal bleeding, blood transfusion, mechanical ventilation, palliative care, and discharge destination. ANALYTICAL APPROACH: The average treatment effect (ATE) of pPCI was estimated using propensity score matching independently within the group receiving dialysis and the group not receiving dialysis to explore whether the effect is modified by dialysis status. Additionally, the average marginal effect (AME) was calculated accounting for the clustering within hospitals. RESULTS: Among hospitalizations, 4,220 (1.07%) out of 413,500 were for patients receiving dialysis. The dialysis cohort was older (65.2 ± 12.2 vs 63.4 ± 13.1, P < 0.001), had a higher proportion of women (42.4% vs 30.6%, P < 0.001) and more comorbidities, and had a lower proportion of White patients (41.1% vs 71.7%, P < 0.001). Patients receiving dialysis were less likely to undergo angiography (73.1% vs 85.4%, P < 0.001) or pPCI (57.5% vs 79.8%, P < 0.001). Primary PCI was associated with lower mortality in patients receiving dialysis (15.7% vs 27.1%, P < 0.001) as well as in those who were not (5.0% vs 17.4%, P < 0.001). The ATE on mortality did not differ significantly (P interaction = 0.9) between patients receiving dialysis (-8.6% [95% CI, -15.6% to -1.6%], P = 0.02) and those who were not (-8.2% [95% CI, -8.8% to -7.5%], P < 0.001). The AME method showed similar results among patients receiving dialysis (-9.4% [95% CI, -14.8% to -4.0%], P < 0.001) and those who were not (-7.9% [95% CI, -8.5% to -7.4%], P < 0.001) (P interaction = 0.6). Both the ATE and AME were comparable for other in-hospital outcomes in both groups. LIMITATIONS: Administrative data, lack of pharmacotherapy and long-term outcome data, and residual confounding. CONCLUSIONS: Compared with conservative management, pPCI for STEMI was associated with comparable reductions in short-term mortality among patients irrespective of their receipt of maintenance dialysis.