Adherence to Treatment in Patients after Kidney Transplantation Author: Barbora Vaňková Tutor: PharmDr. Josef Malý, Ph.D. Consultant: PharmDr. Kateřina Ládová, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: Kidney transplantation (KT) is the best treatment option for patients with end- stage renal disease. However, despite its numerous benefits it requires a lifelong medical regimen of immunosuppressive treatment (IS) with a special emphasis on a strict medication adherence (MA). The objective of our study was to analyse MA in KT outpatients. We also intended to analyse non- adherence as one of the drug-related problems. Furthemore, we focused on analysis of the main self- management tasks. Methods: The prospective cross-sectional study was undertaken in one year period from March 2016 to March 2017 at the Haemodialysis Centre in the Teaching Hospital Hradec Králové. Patients ≥ 18 years old and at least 3 weeks after KT were addressed within their regularly scheduled visit to the nephrologist. Structured interview was performed by pharmacist to determine patients' self-reported MA to IS using validated Czech version of Medication Adherence Report Scale (MARS-CZ). In addition, patients were interviewed about other...

Risk of skin cancer and lymphoproliferative diseases in patients after kidney transplantation Author: Kristína Sidorová Tutor: doc. PharmDr. Josef Malý, Ph.D. Consultant: Mgr. Barbora Vaňková Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: Organ transplantations (Tx) are associated with the lifelong use of immunosuppressive therapy (IS), which carries with it, among other risks, an increased incidence of malignancies. The most common malignancies after Tx are skin tumors, post-transplant lymphoproliferative diseases (PTLD) are also more common in transplant patients. The aim of the study was to determine the incidence of skin tumors and PTLD in patients with kidney Tx within one transplant center and to analyze the risk factors associated with these diseases. Methods: Retrospective longitudinal study was conduted in the Teaching Hospital Hradec Králové. The study included patients from the age of 18 who had overcome kidney Tx until 24 April 2019, were registered in a transplant clinic in Hradec Králové and had a medical record in the hospital information system. Data collection from medical records took place from 15 April 2019 to 31 December 2019. Collected data included demographic characteristics, family history,...

Bakgrund: Njurtransplantation är en behandling mot kronisk njursvikt och är den vanligaste formen av organtransplantation. Det är däremot ingen botande behandling. För att undvika avstötning av den nya njuren följer en livslång behandling med immunhämmande medicinering. Syfte: Syftet med studien var att beskriva personers erfarenheter av att leva med en transplanterad njure.  Metod: Nio kvalitativa empiriska artiklar valdes ut från databaserna CINAHL, PsycINFO och Pubmed. En kvalitativ innehållsanalys genomfördes.  Resultat: Följande tre huvudkategorier identifierades i analysen: Att vara fri men samtidigt begränsad, Att uppleva motstridiga känslor samt Att genomgå en personlig utveckling i relation till omgivningen. Ytterligare sju subkategorier identifierades.  Konklusion: Denna litteraturstudie lyfter den komplexa livssituationen efter en njurtransplantation där personerna upplever en paradox mellan hälsa och ohälsa samt frihet och begränsningar. En insikt i personernas levda erfarenheter är betydelsefullt för mötet med denna patientgrupp. Ensamhet, oro och att inte känna sig förstådd kan underlättas genom sjuksköterskeledda interventioner för en bättre anpassning till det nya livet. / Background: Kidney transplantation is a treatment for chronic kidney disease, and it is the most common form of organ graft replacement. However, it is not a curative treatment. Kidney transplants require a lifelong regimen of immunosuppressive medication to avoid rejection.  Aim: The objective of this study was to describe the lived experiences of kidney transplant recipients. Methods: Nine qualitative empirical articles were chosen from the databases CINAHL, PsycINFO, and Pubmed. A qualitative content analysis was used to analyze the chosen articles.  Results: The following three categories were identified: Liberty with limitations, To experience conflicting emotions and Personal development in relation to the environment. An additional seven subcategories were identified.  Conclusion: This literature study illustrates the complexity of life for those having undergone a kidney transplant; individuals experienced a paradox between health and illness, as well as between freedom and limitation. The study provides insight into patients’ experience, which is notably important for the treatment of this particular patient group. Isolation, anxiety, and feelings of being misunderstood could be helped through interventional nursing that stresses adapting to new life changes.

Background: In the United States, increasing ethnic diversity has been apparent. However, the epidemiology and trends of BKV genotypes remain unclear. This meta-analysis was conducted with the aim to assess the prevalence of BKV genotypes among kidney transplant (KTx) recipients in the United States. Methods: A comprehensive literature review was conducted through October 2018 utilizing MEDLINE, Embase, and Cochrane Database to identify studies that reported the prevalence of BKV subtypes and/or subgroups in KTx recipients in the United States. Pooled prevalence rates were combined using random effects, generic inverse variance method. The protocol for this study is registered with PROSPERO (no. CRD42019134582). Results: A total of eight observational studies with a total of 193 samples (urine, blood, and kidney tissues) from 188 BKV-infected KTX recipients were enrolled. Overall, the pooled estimated prevalence rates of BKV subtypes were 72.2% (95% confidence of interval [CI]: 62.7-80.0%) for subtype I, 6.8% (95% CI: 2.5-16.9%) for subtype II, 8.3% (95% CI: 4.4-15.1%) for subtype III, and 16.1% (95% CI: 10.4-24.2%) for subtype IV, respectively. While metaregression analysis demonstrated a significant positive correlation between year of study and the prevalence of BKV subtype I (slopes = +0.1023, P =.01), there were no significant correlations between year of study and percentages of BKV subtype II-IV (P >.05). Among KTx recipients with BKV subtype I, the pooled estimated percentages of BKV subgroups were 22.4% (95% CI: 13.7-34.5%) for subgroup Ia, 30.6% (95% CI: 17.7-47.5%) for subgroup Ib1, 47.7% (95% CI: 35.8-59.9%) for subgroup Ib2, and 4.1% (95% CI:1.2-13.3%) for subgroup Ic, respectively. Conclusion: BKV subtype I is the most prevalent subtype among KTx recipients in the United States and its prevalence seems to increasing overtime. Subgroup Ib2 is the most common subgroup among BKV subtype I.

Bakgrund: Det är mer fördelaktigt att en organdonation sker med levande donator istället för avliden donator, då det är lägre risk för avstötning. Det är många som väntar på att få en njure vilket gör att levande donation blir allt vanligare. I Sverige genomfördes 147 levande njurdonationer år 2019. Njurdonation ökar vilket leder till ökat behov av kunskap och förståelse hos sjuksköterskan. Syfte: Syftet var att belysa donatorns upplevelser i samband med njurdonation. Metod: Studien genomfördes via en litteraturstudie, där 12 vetenskapliga artiklar granskades och analyserades från två databaser. Resultat: Resultatet består av tre teman och sju subkategorier. Temat Kommunikation med subkategorierna upplevelsen av kommunikation med vårdpersonal och anknytning till mottagaren, temat upplevda känslor med subkategorierna oro, glädje och hopp, temat upplevelsen av stöd med subkategorierna socialt stöd och ekonomiskt stöd. Slutsatser: Upplevelserna hos donatorerna var individuella, genomgående var upplevelsen av bristande kommunikation och oro. Bristen på kommunikation indikerar till ett ökat kunskapsbehov hos sjuksköterskor för att göra donationsupplevelsen bra. / Background: It is more advantageous that a organdonation to take place with a living donor instead of a deceased donor, as there is a lower risk of rejection. There are many waiting for a new kidney, thus living donations are becoming more frequent. In 2019 there were 147 living kidney donations in Sweden. Because of the increase in kidney donations, the nurses are in need of more knowledge and understanding of the whole procedure. Aim: The aim was to give an account of the donor’s experience throughout the process of donating a kidney. Method: The study was conducted through literary research, where 12 scientific articles from two databases were reviewed and analyzed. Result: The result consists of three themes and seven sub categories; Communication - Communication experience between patients and medical staff andConnection to the recipient, Emotions - Worry, Joy and Hope, Support - Social support and Economical support. Conclusion: The donor’s feelings were varied, but overall they felt a lack of communication and therefore worry. This indicates that the nurses are in need of improved communication skills in order to make the donation experience as good as possible.

Bakgrund: Njursvikt är något som kan utvecklas kroniskt eller akut och njurtransplantation är oftast den mest effektiva behandlingen mot kronisk njursvikt. Efter en njurtransplantation krävs livslång immunsuppressiv behandling. Syfte: Syftet var att beskriva patienters upplevelse efter en njurtransplantation. Metod: En allmän litteraturstudie baserad på tio resultatartiklar som kvalitetsgranskats och analyserats vilket bildade fyra kategorier, Ett nytt liv med glädje och oro, Patienters upplevelser av coping och självhantering, Upplevelsen kring immunsuppressiv medicinering livet ut och Patienters behov av stöd från sjuksköterksan. Resultat: Resultatet beskriver hur patienterna ser sin transplanterade njure som en gåva och hur majoriteten av patienternas liv och livskvalité förbättrats. Många patienter upplever en rädsla för att stöta bort njuren men använder sig av olika copingstrategier för att hantera utmaningar som uppstår. Efter en njurtransplantation följer en livslång behandling med immunsuppressiv medicin vilket är en utmaning för patienterna. Patienterna önskade mer adekvat information, stöd och råd om deras nya vardag från sjuksköterskan. Konklusion: Patienterna upplever många känslor efter en njurtransplantation. Det är viktigt för patienterna att sjuksköterskornas omvårdnad fokusera på att ge information, uppföljning och stöd. / Background: Kidney disease can develop chronic or acute and a kidney transplantation is often the most effective treatment for the permanent kidney failure. After a kidney transplantation, lifelong immunosuppressive medication is required. Aim: The aim of this literature study was to describe patients’ experience after a kidney transplantation. Method: The literature study was based on ten articles. The articles were reviewed based on quality and analysed which created four categories, A new life with joy and worries, Patientes experiences regarding coping and selfmanagement, Experiences regarding life-long immunosuppressive medication and Patientes need of support from the nurse. Results: The result describes how patients view their new kidney as a gift and how the majority of the patient’s life and quality of life has increased. A lot of patients experience fear of rejecting the kidney and other challenges but are using different coping strategies to manage. After a kidney transplantation the patient needs to take immunosuppressive medication for the rest of their life which is a challenge for the patient. The patients wanted more adequate information, support and advice from the nurse about their new everyday life. Conclusion: Patients experience a lot of emotions post kidney transplantation. It is essential for the patients that nurses focuses on providing information, check-ups and support.

Polyoma BK virus is associated with graft dysfunction leading to BK viral nephropathy (BKVN) in 1-10% of kidney transplant recipients, moreover 30-80% of kidney transplant recipients experience asymptomatic reactivation of the virus that does not result in BKV associated damage of the renal allograft. The first aim of this study was to introduce monitoring of BK virus replication in the blood and urine of patients within first year after transplantation. Risk factors were evaluated and limit values for viremia and viruria for BKVN development was established. Positive BK viruria >107 copies/ml and positive BK viremia >104 copies/ml occurred in 25.8% and 5%; respectively. 3 patients out of monitoring study developed BKVN. Using ROC analysis, limit values for the development of BKVN were set at 103 copies/ml serum for BK viremia and 6.7x107 copies/ml BK viruria. The second objective was to determine the expression profile of the immune genes in kidney biopsies in three groups of patients with varying degrees of reactivation of the BK virus (without virus reactivation, with asymptomatic viruria, BKVN). 90 genes of immune response were measured by the TaqMan® low density array RT-qPCR. The analysis of biopsies from patients with non-signalling viruses led to the identification of 5 differentially...

Syftet med denna studie var att undersöka hur personer med egenadministrerad peritonealdialys (PD) upplever sitt dagliga liv. Metoden var en intervjustudie där sju personer som behandlades med PD intervjuades med hjälp av en semistrukturerad intervjuguide. Materialet som analyserades med en manifest kvalitativ innehållsanalys resulterade i tre huvudkategorier: kroppsliga förändringar, upplevelser av PD-behandling samt egenvård. Resultatet visade att PD hade inverkan på olika plan i informanternas dagliga liv. Ett viktigt fynd var hur informanterna uppfattade att PD hade lett till vissa kroppsliga förändringar, exempelvis vad gäller vikt och aptit. Det mest framträdande fyndet var emellertid att PD ledde till en bundenhet, vilket orsakade en oönskad passivitet hos informanterna. Det framkom dessutom att de informanter som väntade på njurtransplantation upplevde att denna väntan ledde till mer inskränkning i det dagliga livet än vad PD gjorde. Informanterna beskrev även de positiva aspekterna av PD-behandlingen och betonade fördelen med att PD möjliggjorde en självständighet och en flexibilitet. Denna studie gav ett brett perspektiv av hur personer med PD upplever sitt dagliga liv och visade att det inte bara är de kroppsliga förändringarna som påverkar personerna utan att PD även leder till känslor av bundenhet och passivitet. / The purpose of this study was to explore how people with self-administered peritoneal dialysis (PD) experience their daily life. The method was an interview study in which seven people who were treated with PD were interviewed using a semistructured interview guide. The material was analyzed with a manifest content analysis and resulted in three main categories: bodily changes, sensations of PD treatment and self-care. The results showed that PD had an effect in different levels in the informants’ daily lives. One important finding was how the informants perceived that the PD had led to certain bodily changes for example in terms of weight and appetite. The most striking finding, however, was that the PD led to a lack of freedom causing an undesirable passivity of the informants. It also showed that respondents who were waiting for kidney transplantation felt that this anticipation led to more restriction in daily life than PD did. The informants also described the positive aspects of PD treatment and stressed advantages such as that PD allowed autonomy and flexibility. This study gave a broad perspective of how people with PD experience their daily life and showed that not only the physical changes affected them but also led to feelings of restraint and passivity.

No description available.

BACKGROUND: The incidence and mortality of renal cell carcinoma (RCC) after kidney transplantation (KTx) remain unclear. This study's aims were (1) to investigate the pooled incidence/incidence trends, and (2) to assess the mortality/mortality trends in KTx patients with RCC. METHODS: A literature search was conducted using the MEDLINE, EMBASE and Cochrane databases from inception through October 2018. Studies that reported the incidence or mortality of RCC among kidney transplant recipients were included. The pooled incidence and 95% CI were calculated using a random-effect model. The protocol for this meta-analysis is registered with PROSPERO; no. CRD42018108994. RESULTS: A total of 22 observational studies with a total of 320,190 KTx patients were enrolled. Overall, the pooled estimated incidence of RCC after KTx was 0.7% (95% CI: 0.5-0.8%, = 93%). While the pooled estimated incidence of de novo RCC in the native kidney was 0.7% (95% CI: 0.6-0.9%, = 88%), the pooled estimated incidence of RCC in the allograft kidney was 0.2% (95% CI: 0.1-0.4%, = 64%). The pooled estimated mortality rate in KTx recipients with RCC was 15.0% (95% CI: 7.4-28.1%, = 80%) at a mean follow-up time of 42 months after RCC diagnosis. While meta-regression analysis showed a significant negative correlation between year of study and incidence of de novo RCC post-KTx (slopes = -0.05, = 0.01), there were no significant correlations between the year of study and mortality of patients with RCC ( = 0.50). Egger's regression asymmetry test was performed and showed no publication bias in all analyses. CONCLUSIONS: The overall estimated incidence of RCC after KTX was 0.7%. Although there has been a potential decrease in the incidence of RCC post-KTx, mortality in KTx patients with RCC has not decreased over time.