Exploring the effect of renaldisease and its treatment on patients' well-being: a cross sectional study of anxiety and depression in a sample of renal patients

Waiting for a kidney transplant, a source of unavoidable but reversible anxiety: a prospective pilot study investigating a psychological intervention

BACKGROUND

Kidney transplantation is the treatment of choice for end-stage renal disease. Psychological problems and the presence of high anxiety have been described at various times over the course of transplantation, starting early at inclusion on the waiting-list. The objective of this study was to investigate anxiety symptoms among patients waiting for a transplant and the efficacy of a psychological intervention in the management of the anxiety.

METHODS

In this prospective trial, 30 patients waiting for a first kidney transplantation were included. Medico-psycho-sociodemographic data were collected. Anxiety symptoms were assessed at inclusion using the State-Trait Anxiety Inventory self-assessment questionnaire for state anxiety (Spielberger and Vagg in Inventaire d'anxiété état-trait, forme Y (STAI-Y) Paris, 1993). A second assessment was carried out after the psychological intervention, which consisted of three sessions conducted by a clinical psychologist.

RESULTS

Anxiety scores were considerably higher in females compared to males (47.5 versus 33.0, p < 0.023) and among those who had a psychological treatment history (60 versus 37, p = 0.003). We found a correlation between the level of anxiety and the length of time spent on the waiting-list (r = 0.552, p = 0.002). Importantly, anxiety scores decreased significantly (44 versus 32, p < 0.0001) after the psychological intervention.

CONCLUSION

This study suggests that early psychological support allows improving anxiety symptoms in patients wait-listed for a kidney transplant.

TRIAL REGISTRATION

Clinical trial NCT02690272.

Health-related quality of life assessment in end-stage renal failure

End-stage renal failure (ESRF) is a life-threatening condition and survival can be maintained only with renal replacement therapy. Furthermore, the complications of ESRF, its treatment and co-existing diseases have been found to have a significant impact on the physical health of patients. It is well documented that the health status of the renal patient population is worse than that of the general healthy population; for this reason the assessment of quality of life of ESRF patients has received considerable attention.

During the 1990s, the focus of health assessment moved away from the disease itself towards health status and wellbeing. The widespread use of the 36-item short-form (SF-36) questionnaire has promoted this. In ESRF studies from data using the SF-36 questionnaire it has been shown that it is the physical functional component of health that is most affected by the patient's condition, with co-morbidity having a significant impact.

There is growing consensus that health-related quality of life is more than just an assessment of health status. Rather, it is the relative importance given by the individuals themselves to the impact of the disease on their life. While this approach is emerging, some of the tools which have been developed to measure individualised quality of life require further scientific validation for use with the ESRF population.

A cross-cultural comparison of family resiliency in hemodialysis patients

The purpose of this descriptive comparative survey was to examine differences in family resiliency between hemodialysis patients and caregivers across three ethnically diverse samples that included Anglo-Americans, Mexican Americans, and South Koreans. The study was based on the Family Resiliency Model developed by McCubbin, Thompson, and McCubbin. The patients were in end-stage renal disease and were receiving hemodialysis treatments at either a freestanding hemodialysis unit or a 30-bed dialysis hospital unit. South Korean patients on hemodialysis and their caregivers perceived the stressors imposed by their illness to be significantly greater than either of the other ethnic groups, and they also scored lower on the resiliency measure than the other two groups. Findings of the study support the need to understand the dynamics of family resiliency from a cultural perspective.

Influence of convection on small molecule clearances in online hemodiafiltration

BACKGROUND

Dialysis efficacy is mostly influenced by dialyzer clearance. Urea clearance may be estimated in vitro by total ion clearance, which can be obtained by conductivity measurements. We have previously used this approach to assess in vitro clearances in a system mimicking predilutional and postdilutional online hemodiafiltration with a wide range of QD, QB, and ultrafiltration rates. Our current study elaborates on a formula that allows the prediction of the influence of ultrafiltration on small molecule clearances, and validates the mathematical approach both experimentally in vitro and clinically in vivo data.

METHODS

Two conductivimeters in the dialysate side of an E-2008 Fresenius machine were used. HF80 and HF40 polysulfone dialyzers were used; reverse osmosis water and dialysate were used for blood and dialysate compartments, respectively. Study conditions included QB of 300 and 400 mL/min and QD of 500 and 590 mL/min, with a range of ultrafiltration rate from 0 to 400 mL/min in postdilutional hemodiafiltration and to 590 mL/min in predilutional hemodiafiltration. Urea clearances were determined in the in vivo studies, which included 0, 50, 100, and 150 mL/min ultrafiltration rates.

RESULTS

The ultrafiltration rate and clearance were significantly correlated (R > 0.9, P < 0.001) and fitted a linear model (P < 0.001) in all of the experimental conditions. The following formula fitted the experimental points with an error <2% for both postdilutional and predilutional online diafiltration in vitro, respectively. K = K0 + [(QB - K0)/(QB)] x ultrafiltration rateK = K0 + [((QD x QB)/(QB + QD) - K0)/QD] x ultrafiltration rate where K is the clearance; K0 is the clearance with nil ultrafiltration rate; QD is the total dialysate produced (in commercial HDF, QD = QDi + Qinf). Since weight loss was maintained at 0, ultrafiltration rate = infusion flow. QB is the "blood" line flow. The formula was also verified in vivo in clinical postdilutional hemodiafiltration with a QB taking into account the cellular and water compartments.

DISCUSSION

In vitro, by simply determining the clearance in conventional dialysis, the total clearance for any ultrafiltration rate may be estimated in both predilutional and postdilutional online diafiltration with an error of less than 2%. The same applies to in vivo postdilutional hemodiafiltration when the formula takes into account the cellular and water composition of blood.