Although relatively rare, encapsulating peritoneal sclerosis (EPS) is nonetheless a major concern within the renal community. Risk of developing EPS is associated with long-term peritoneal dialysis. Surgery now offers better outcomes. Research into EPS continues to focus on imaging and early detection methods, genetics, biomarkers and preventive strategies. No previous studies have examined patients' experiences of EPS, or their perception of the effect of EPS on health-related quality of life. Aims: The aim of the present study was to explore the experience of patients who have undergone surgery for EPS in one centre in the north of England. Methods: Nine participants were recruited out of a total of 18 eligible. Most participants were interviewed twice conducted on two occasions over a 12-month period. This was October 2009 to October 2010. Analysis: Interpretative data analysis was conducted, following the philosophical tradition of hermeneutics. Following the first interview a summary was sent to each participant before the second interview. Both interviews were analysed and are presented as themes. Results: EPS presents the biggest challenge these patients have had to face since developing chronic kidney disease. Three major themes were identified each with subcategories: 1. Understanding EPS -self interpretation, 'not being heard', gaps in information and knowledge, diagnosis shock and relief-confronting death 2. EPS an embodied experience- endurance, bodily awareness from others and within, struggles with eating 3. Adjustments and Transitions 'A journey of survival'- losses, support structures and their impact and locating self. Conclusions: The findings of this study highlight a number of important issues relevant to clinical practice, including lack of information and understanding of EPS, particularly its early symptoms, the extent of the surgery and the support required. At the time patients transfer from peritoneal to haemodialysis, the provision of adequate information about the risks and potential early signs of EPS may improve not only their experiences but in addition may assist its early detection.

Factors Influencing Women's Adaptation to Hemodialysis When Renal Transplantation is not an Option The intent of this study was to explore and describe factors that influence adaptation from the perspective of women on hemodialysis for whom renal transplantation is not an option. Phenomenology was the research design selected for this study in order to understand the experience of these women clients. Data were collected during audio-taped interviews of eight women and were analyzed concurrently with data collection to identify common themes. Two central themes emerged: the adaptation process and the theme of connectedness. The adaptation process was described as a six-phase process. Connectedness was defined as being connected to others and/or sources of life's energy. Several key factors that either facilitated or interfered with adaptation were identified for each of these two themes. Key factors that facilitated adaptation throughout the adaptation process Included a first run on dialysis, experience with adversity, emotional and instrumental support, coping behaviors such as asserting control and reframing the situation, diversions, adequate rest and confidence in health-care professionals. Factors interfering with adaptation to hemodialysis throughout the adaptation process included the gradual and ambiguous nature of renal disease, increasing dependence, reduced energy, transportation to dialysis, compromised somatic health, difficulty with assertiveness, prolonged stressors and lack of confidence in health-care professionals. Specific factors that influenced connectedness were identified. The facilitating factors identified were satisfactory relationships, nurturing others, normalizing, a harmonious atmosphere on the hemodialysis unit and pleasurable activities. Key factors interfering with adaptation related to the connectedness theme were isolation from others, unsympathetic others, ineffective communication with health-care professionals, and exclusion from activities. The findings relative to the adaptation process were discussed in the light of the literature on adapting to illness and stress. Connectedness was discussed primarily in relation to the literature exploring the socialization of women. Implications for nursing practice, education and research arising from these findings were outlined. / Applied Science, Faculty of / Nursing, School of / Graduate

Les phases de transitions entre les différentes stratégies de prise en charge de l'insuffisance rénale chronique terminale peuvent être associées à une augmentation de la morbidité et de la mortalité lorsqu’elles ne sont pas anticipées. Il faut donc pouvoir définir des trajectoires de patient et faire en sorte de maîtriser les changements d’état afin d’améliorer la prise en charge du patient insuffisant rénal chronique. Cela ne peut être atteint sans une phase exploratoire préalable visant à étudier les phases de transition du parcours de soins intégrés. L’objectif de ce travail était donc d’étudier trois transitions présentes dans le parcours de soins du patient atteint d’insuffisance rénale chronique.Nous avons montré que chez le patient qui débute la dialyse péritonéale, le temps passé au préalable dans un autre traitement de suppléance, que ce soit en hémodialyse ou en transplantation rénale, peut précocement impacter son devenir dans la technique. Cette importance du traitement antérieur renforce notre conviction qu’il faut avoir une vision globale et intégrée de la prise en charge du patient insuffisant rénal chronique terminal. De même, la survenue d’une péritonite dans les premiers mois en dialyse péritonéale est associée à l’arrêt précoce de la technique. Il est donc indispensable à la prise en charge initiale et au cours des premiers mois de traitement en dialyse péritonéale de s’interroger sur le risque de transfert précoce en hémodialyse du patient et sur la nécessité de lui créer une fistule artério-veineuse. Nous avons également rapporté le fait que les infections liées à la fistule en dialyse hors centre sont des événements relativement peu fréquents. Cependant, une approche différente de ces infections, en distinguant le risque de première infection et le risque de récidive infectieuse chez un patient, permettra de diminuer la fréquence de ces événements responsables de transition non programmée entre les différentes structures de dialyse. Enfin, nous avons choisi d’étudier la transition entre stade V de l’insuffisance rénale et le traitement par dialyse dans la population des patients atteints de cancer. Nous avons montré que l’incidence de la dialyse dans cette population n’est pas plus importante que dans la population générale. La survie en dialyse de ces sujets semble également comparable à celle des dialysés sans cancer diagnostiqué. Nos résultats suggèrent que seuls les patients avec un cancer en bonne condition générale ont la possibilité d’être traité par dialyse chronique. Il existe un réel rationnel scientifique à considérer le parcours de soins du patient insuffisant rénal chronique stade V comme un parcours intégré, comprenant plusieurs états et de nombreuses phases de transition, qui doivent être explorées finement tout en tenant compte de l’ensemble de la trajectoire du patient. / Transitions between treatment strategies in chronic kidney disease are often not prepared and can lead to morbidity and mortality. It is necessary to anticipate these transitions to improve patients outcomes and health care organisation. We aimed at studying three pathways observed in the career of chronic kidney disease patients.We have shown that patients treated by hemodialysis before peritoneal dialysis start and failed transplant patients had a higher risk of early peritoneal dialysis failure. Early peritonitis was also associated with a higher risk of early technical failure. It is therefore important to evaluate the necessity to create an arterio-venous fistula in peritoneal dialysis patients during the first months on dialysis, to avoid transfer in hemodialysis on a central venous catheter.We reported that the rate of arterio-venous fistula infections in satellite dialysis units was low. However, it seems necessary to distinguish the risk for having a first infection and the risk for having a relapse of infection. This consideration can help decreasing the number of fallback between stallite units and hospital dialysis centers.Finally, we studied transition between end-stage renal disease and dialysis in cancer patients. We showed that incidence of chronic dialysis initiation in that population was not higher then the one observed in the general population. Survival in dialysis was not different in cancer patients compared to matched patients without malignancy. We can hypothesise that only cancer patients in good condition are proposed for dialysis programs.It is necessary to consider the chronic kidney disease patients' care as an integrated care program, with transitions between treatment strategies that can be improved and anticipated.

Orientador: Daniela Ponce / Resumo: Introdução: Peritonite é complicação grave nos pacientes em diálise peritoneal (DP) e a principal causa de transição para hemodiálise. O uso intraperitoneal (IP) de aminoglicosídeo e vancomicina é opção para o tratamento empírico. No entanto, a absorção sistêmica dessas drogas é controversa e pouco estudada. Objetivo: Descrever os níveis plasmáticos e do dialisato de amicacina e vancomicina administrados IP em pacientes com peritonite em DP nos momentos de 30 e 120 min após administração, após 24h da administração da amicacina e 48h da vancomicina e associá-los com o desfecho da peritonite. Metodologia: Estudo observacional realizado de novembro/2017 a abril/2019, que incluiu 32 episódios de peritonites. Análise de amostras foi realizada no 1º, 3º e 5º dias. No momento de pico, foram consideradas concentrações terapêuticas de amicacina valores entre 25 e 35 mg/L e no vale (antes da infusão do dialisato) concentrações de 4-8 mg/L ; e de vancomicina no vale de 15–20 mg/L. Resultados: A idade foi de 60 ± 11,3 anos, a principal causa da doença renal foi diabetes (42,4%) e 63,3% eram homens. Entre as culturas 39,4% foram gram negativos, 36,3% gram positivos e 21,2% negativas. Houve cura em 84,8% dos episódios. Vancomicina foi administrada IP a cada 72h e amicacina diariamente. Avaliando-se os períodos antes e depois da peritonite, não houve mudanças no tipo de transporte peritoneal (p=0,76), mas houve diferenças na função renal residual (p=0,05) e redução do débito urinário (p=0,0... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Peritonitis is a serious complication in patients on peritoneal dialysis and the main cause of transition to hemodialysis. The intraperitoneal use of aminoglycoside and vancomycin is an option for empiric treatment. However, the systemic absorption of these drugs is controversial and little studied. Objectives: Describe intraperitoneal amikacin and vancomycin dialysate levels in patients with peritonitis on peritoneal dialysis at 30 and 120 minutes after administration, 48 hours after vancomycin and 24 hours after amikacin and associating them with the peritonitis outcome. Methodology: Observational study conducted from August 2017 to April 2019, which included 32 episodes of peritonitis. Samples were analyzed on the 1st, 3rd and 5th days. At peak moment, therapeutic concentrations of amikacin were considered to be between 25 and 35 mg/L and at baseline concentrations of 4-8 mg/L; and vancomycin at the valley moment of 15-20 mg/L. Results: Age was 60 ± 11.3 years, the main cause of kidney disease was diabetes (42.4%) and 63.3% were men. Among the cultures 39.4% were gram negative, 36.3% gram positive and 21.2% negative. There was cure in 84.8% of the episodes. Vancomycin was administered intraperitoneal every 72 hours and amikacin daily. There were no changes in the peritoneal transport type (p = 0.76), but there were differences in residual renal function (p = 0.05) and reduction in urinary output (p = 0.02). Regarding the outcomes of cure and non-cure, there w... (Complete abstract click electronic access below) / Mestre

Introducción: La insuficiencia renal es una de las complicaciones extrapulmonares más frecuente en pacientes hospitalizados con COVID-19 condicionando peores desenlaces que podría afectar al sistema de salud en Perú. Sin embargo, estudios comparan pacientes con insuficiencia renal aguda (IRA) o crónica (ERC) con pacientes sanos. Objetivo: Determinar características clínicas de pacientes con COVID-19 e insuficiencia renal hospitalizados y evaluar el efecto del tipo de insuficiencia renal y el recibir hemodiálisis en los desenlaces clínicos negativos. Métodos:Cohorte descriptiva incluyó pacientes con algún tipo de insuficiencia renal y COVID-19 hospitalizados durante marzo y julio del 2020, que tuvieron una interconsulta con nefrología. La insuficiencia renal se clasificó como aguda, crónica, y crónica en estadio V con hemodiálisis crónica. Se recolectó información sobre mortalidad, uso de inotrópicos, ventilación mecánica y recibir hemodiálisis aguda. Resultados: Se analizó a 279 pacientes, 22.6% tenían IRA, 33.3% tenían ERC, y 44.1% tenían ERC V. Se describe una mortalidad general de 32.9%, y 27% usaron inotrópicos y recibieron ventilación mecánica. Entre los pacientes con IRA y ERC el 12.9% recibió hemodiálisis por primera vez. Los adultos con ERC y ERC V en HD estudiados tienen menor prevalencia de diabetes mellitus (23.7.3% y 43.9%, respectivamente) e hipertensión arterial (31.2% y 59.4%, respectivamente) en comparación con los adultos que desarrollan IRA (81.0% y 73%, respectivamente) (valor p<0.001). El desarrollo de IRA se asoció a ventilación mecánica (RPa: 6.46), uso de inotrópicos (RPa: 7.02) y morir (RPa: 2.41), en comparación con los que tenían sólo ERC. Entre quienes tenían IRA o ERC, aquellos que recibieron hemodiálisis por primera vez tienen mayor prevalencia de morir (RPa: 2.95; IC95%:2.20 a 3.94) en comparación con los que no recibieron hemodiálisis. La hemodiálisis aguda podría ser un modificador de efecto de la asociación entre tipo de insuficiencia renal (IRA o ERC) y desenlaces clínicos negativos (p<0.001). Conclusión: Es importante Identificar a pacientes hospitalizados por COVID-19 que desarrollan IRA y/o necesitan hemodiálisis aguda pues se encuentran en alto riesgo de tener una mala evolución clínica.

Bakgrund: Vid avancerad njursjukdom krävs behandling med dialys eller njurtransplantation för att överleva. Dialysbehandlingen påverkar patienternas liv i stor utsträckning och är ofta mycket krävande, både fysiskt och psykiskt. Sjuksköterskan har en central roll i att med säker och god omvårdnad få patienten att känna sig trygg vid dialysbehandlingen. Syfte: Syftet med studien var att belysa vilka egenskaper hos sjuksköterskan som patienter upplever skapar en trygg och säker omvårdnad vid dialysbehandling. Metod: Studiens design var en allmän litteraturstudie med induktiv ansats som utfördes med strukturerad sökmetod. Resultat: Patienter upplevde sjuksköterskans kompetens och närvaro som betydande delar för en säker omvårdnad vid dialys. Att erhålla information och undervisning om behandlingen samt att ha en god relation till sjuksköterskan var också viktigt. Resultatet genererade fyra huvudkategorier: betydelsen för patienter att vårdas av en kompetent sjuksköterska, en närvarande sjuksköterska skapar trygghet för patienter, betydelsen för patienter att utveckla en god relation till sjuksköterskan och individanpassad kommunikation ochinformation en viktig del i vårdprocessen för patienterna. Konklusion: Sjuksköterskor inom olika vårdinstanser kan komma att möta personer som genomgår dialys och behöver besitta adekvat kunskap inom området. God personaltillgång behövs för att öka sjuksköterskors tillgänglighet och för att kunna ge en heltäckande vård till patienterna. / Background: In advanced kidney disease, treatment with dialysis or kidneytransplantation is required to survive. The nurse has a central role by providing safeand good care for the patient and make them feel safe during the dialysis treatmentAim: The aim was to illustrate which qualities of the nurse that patients experiencecreates a safe and secure nursing care during dialysis treatment. Method: Generalliterature review with an inductive approach performed with a structured searchmethod. Results: The result showed that patients experienced the nurse's competenceand presence as important parts of safe nursing care during dialysis. Receivinginformation and education about the treatment as well as having a good relationshipwith the nurse were also important aspects that emerged. The result generated fourmain categories: the importance for patients of being cared for by a skilled nurse, thepresence of the nurse creates security for the patients, the importance for patients todevelop a good relationship with the nurse and individualized communication andinformation an important part of the care process for patients. Conclusion: Nurses indifferent care institutions may meet people who are undergoing dialysis and need topossess relevant knowledge in the field. Adequate staffing is needed to increase thenurse’s availability and to be able to provide comprehensive care for patients.

The triglyceride/high-density cholesterol-lipoprotein (TG/HDL-c) is a biomarker of cardiovascular events and mortality. In hemodialysis patients, the evidence is controversial. A systematic review was carried out in the Medline, Scopus, Embase, Web of Science, and Pubmed databases to identify the relevant cohort studies on cardiovascular events and mortality in hemodialysis patients the role of TG/HDL-c as a risk factor. Four cohort-type studies were evaluated, with a total of 52,579 hemodialysis patients. Three studies conducted in Asian populations and one study in the United States had the highest percentage of the sample (50,673 patients). The elevated TG/HDL-c ratio is associated with better survival, and there is a consistent gradual inverse association between TG/HDL-c and mortality in all analysis subgroups. In the decile categorization of the exposure variable, a 21% decrease in the risk of cardiovascular mortality and a 15% decrease in all-cause mortality in the highest decile compared to the reference group (D10 aHR = 0.79; 95% CI: 0.69–0.91 and D10 aHR = 0.85; 95%CI: 0.78–0.92). Our results show that the TG/HDL-c ratio is a protective factor for cardiovascular outcomes and mortality in the American population and a risk factor for them in the population from Asia. / Revisión por pares

The aim of this study sets out to better understand nephrology nurses’ lived experiences of dying and deaths of patients with ESKD following withdrawal of dialysis. A qualitative research design using an interpretative phenomenological approach was used to explore the experiences of a purposive heterogeneous sample of eight nephrology nurses who were working in private dialysis units. Information was gathered by phenomenological conversations and feed-back sessions. Colaizzi’s phenomenological method was employed to formulate four main themes: 1. Emotional trauma 2. Detachment 3. Loss of altruistic values in nursing 4. being-with-death For the participants in this study, emotional trauma was the most significant. The participants experienced a sense of powerlessness which caused emotions of hopelessness and anger and subsequently a sense of premature mourning and detachment. This state of hopelessness proved to be an obstacle in patient care, resulting in the altruistic values of nursing to be no longer applied. The participants’ ontological confrontation of being-with-death was evident, as they came to terms with the reality of their own death. Recommendations are offered to address the educational aspects of death and dying for nephrology nurses. This study endorses the need for further research into patients with ESKD ‘end-of-life’ which can influence how healthcare professionals should treat these patients during this phase.

No description available.

No description available.