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Ren JX, Qu Y, Gao Y, Ma HY, Zhang P, Guo ZN, Yang Y. Beat-to-Beat Blood Pressure Variability Within 24 Hours of Ischemic Stroke Onset: A Potential Predictor of Functional Prognosis. J Am Heart Assoc 2024; 13:e034575. [PMID: 39023075 DOI: 10.1161/jaha.124.034575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Beat-to-beat blood pressure variability (BPV) is based on each heartbeat and represents a dynamic equilibrium process modulated by artery and cardiac involvement of pressure-receptive reflexes. To date, there remains a lack of prospective studies illustrating the clinical value of beat-to-beat BPV within 24 hours of acute ischemic stroke onset. METHODS AND RESULTS This study prospectively monitored beat-to-beat blood pressure and heart rate in patients with acute ischemic stroke within 24 hours of onset using a noninvasive plethysmograph and calculated beat-to-beat BPV, heart rate variability, and the cross-correlation baroreflex sensitivity. A modified Rankin Scale score of ≥2 at 90 days was defined as an unfavorable prognosis. Multivariate logistic regression was performed, and the nomogram model was developed by adding the beat-to-beat BPV to the traditional model for predicting prognosis. Beat-to-beat BPV increased significantly in the unfavorable outcome group (P<0.05) compared with that in the favorable outcome group, whereas no difference was observed in beat-to-beat heart rate variability and cross-correlation baroreflex sensitivity between both groups (P>0.05). Furthermore, beat-to-beat BPV within 24 hours of acute ischemic stroke onset was independently associated with unfavorable outcome at 90 days (P<0.005). The addition of beat-to-beat BPV to the traditional model for predicting prognosis enhanced the area under the receiver operating characteristic curve from 0.816 to 0.830. CONCLUSIONS Increased beat-to-beat BPV within 24 hours of acute ischemic stroke onset was independently associated with a poor prognosis at 90 days and may be a potential predictor for discriminating unfavorable prognosis.
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Affiliation(s)
- Jia-Xin Ren
- Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
| | - Yang Qu
- Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
| | - Yi Gao
- Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
| | - Hong-Yin Ma
- Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
| | - Peng Zhang
- Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
| | - Zhen-Ni Guo
- Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
- Neuroscience Research Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
| | - Yi Yang
- Stroke Center, Department of Neurology The First Hospital of Jilin University Chang Chun China
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Hirano Y, Fujikura T, Kono K, Yamaguchi T, Ohashi N, Yokoyama Y, Toda M, Yamauchi K, Yasuda H. Effect of rehabilitation on renal outcomes after acute kidney injury associated with cardiovascular disease: a retrospective analysis. BMC Nephrol 2024; 25:222. [PMID: 38997657 PMCID: PMC11242010 DOI: 10.1186/s12882-024-03666-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) incidence is extremely high worldwide, and patients who develop AKI are at increased risk of developing chronic kidney disease (CKD), CKD progression, and end-stage kidney disease (ESKD). However, there is no established treatment strategy for AKI. Based on the idea that exercise has a stabilizing effect on hemodynamics, we hypothesized that rehabilitation would have beneficial renal outcomes in patients with AKI associated with cardiovascular disease. Therefore, the purpose of this study was to determine whether rehabilitation can stabilize hemodynamics and positively impact renal outcomes in patients with AKI associated with cardiovascular disease. METHODS In total, 107 patients with AKI associated with cardiovascular disease were enrolled in this single-center retrospective study and were either assigned to the exposure group (n = 36), which received rehabilitation at least once a week for at least 8 consecutive weeks, or to the control group (n = 71). Estimated glomerular filtration rate was assessed at baseline before admission, at the lowest value during hospitalization, and at 3, 12, and 24 months after enrolment. Trends over time (group × time) between the two groups were compared using generalized estimating equations. Moreover, congestive status was assessed by amino-terminal pro-B-type natriuretic peptide (NT-proBNP), and the effect of rehabilitation on congestion improvement was investigated using logistical regression analysis. RESULTS The time course of renal function after AKI, from baseline to each of the three timepoints suggested significant differences between the two groups (p < 0.01). However, there was no significant difference between the two groups at any time point in terms of percentage of patients who experienced a 40% estimated glomerular filtration rate reduction from that at baseline. The proportion of patients with improved congestion was significantly higher in the exposure group compared with that in the control group (p = 0.018). Logistic regression analysis showed that rehabilitation was significantly associated with improved congestion (p = 0.021, OR: 0.260, 95%CI: 0.083-0.815). CONCLUSION Our results suggest that rehabilitation in patients with AKI associated with cardiovascular disease correlates with an improvement in congestion and may have a positive effect on the course of renal function.
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Affiliation(s)
- Yuma Hirano
- Department of Rehabilitation Medicine, Hamamatsu University Hospital, Hamamatsu City Shizuoka, Japan.
| | - Tomoyuki Fujikura
- Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu City Shizuoka, Japan
| | - Kenichi Kono
- Department of Physical Therapy, International University of Health and Welfare School of Health Science at Narita, Narita City Chiba, Japan
| | - Tomoya Yamaguchi
- Department of Rehabilitation Medicine, Hamamatsu University Hospital, Hamamatsu City Shizuoka, Japan
| | - Naro Ohashi
- Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu City Shizuoka, Japan
| | - Yurina Yokoyama
- Department of Rehabilitation Medicine, Hamamatsu University Hospital, Hamamatsu City Shizuoka, Japan
| | - Masahiro Toda
- Department of Rehabilitation Medicine, Hamamatsu University Hospital, Hamamatsu City Shizuoka, Japan
| | - Katsuya Yamauchi
- Department of Rehabilitation Medicine, Hamamatsu University Hospital, Hamamatsu City Shizuoka, Japan
| | - Hideo Yasuda
- Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu City Shizuoka, Japan
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Sriprachot N, Seangpraw K, Ong-Artborirak P. Health Literacy, Self-Care Behaviors, and Biochemical Parameters Among Hypertensive Patients with Renal Complications in the Tai Lue Ethnic Community of Thailand. Vasc Health Risk Manag 2024; 20:97-107. [PMID: 38464676 PMCID: PMC10922938 DOI: 10.2147/vhrm.s450775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/27/2024] [Indexed: 03/12/2024] Open
Abstract
Purpose Hypertension (HT) can cause renal complications or deterioration of kidney function. HT management is very important because it reduces the severity of illnesses. This study aimed to investigate the relationship between health literacy (HL), self-care behaviors (SCB), and biochemical parameters in hypertensive patients with renal complications. Methods A cross-sectional study of 405 hypertensive patients with renal complications among Tai Lue people living in Thailand was conducted using simple random sampling. Face-to-face interviews with questionnaires were used to collect information. Blood pressure (BP) and biochemical parameters, such as fasting blood sugar (FBS) and estimated glomerular filtration rate (eGFR), were measured. Results The participants' mean age was 68.3 years. A significant correlation was found between HL score, SCB score, systolic BP (SBP), diastolic BP (DBP), FBS, and eGFR (p<0.01). Multiple linear regression revealed that eating salty foods was a risk factor for SBP in males and for SBP and DBP in females. Body mass index (BMI) (B = 0.54), sweet food consumption (B = 13.90), and SCB score (B = -0.29) were significantly associated with FBS level (R2 = 17.8%, p<0.05). Employment (B = 2.55), eating bland food (B = 4.07), receiving information from family (B = 3.53), SCB (B= 0.31), and age (B = -0.51) were all significant factors for eGFR (R2 = 35.0%, p<0.05). Conclusion HL and SCB levels were associated with the health of hypertensive patients with renal complications in the Tai Lue ethnic community. The significance of organizing health education programs is to emphasize increasing HL to lead to self-care decisions and reduce complications in patients, resulting in improved SCB and quality of life in the future.
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Affiliation(s)
| | | | - Parichat Ong-Artborirak
- Department of Research and Medical Innovation, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, 10300, Thailand
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Ho HK, Koh EYL, Abdullah A, Tan NC. Health literacy and self-care among patients with chronic kidney disease in a primary care setting. Singapore Med J 2024:00077293-990000000-00078. [PMID: 38212993 DOI: 10.4103/singaporemedj.smj-2023-068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/20/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION The study objective was to determine the levels of self-care and health literacy (HL) and their associations among patients with chronic kidney disease (CKD). METHODS This was a cross-sectional, questionnaire-based study conducted in a public primary care setting in Singapore. A total of 289 participants aged 21-80 years with hypertension were recruited. Self-care profiles were measured using the Hypertension Self-Care Profile (HTN-SCP; range 0-240, domain range 0-80). Health literacy was measured using the Short-Form Health Literacy Scale (HLS-SF12; range 0-50, limited literacy ≤33). RESULTS The mean self-care score was 182.7 (standard deviation [SD] 23.2). The median HL score was 34.7 (interquartile range [IQR] 31.9-40.3), and 31.1% of participants had limited HL. Self-care was not associated with age, CKD status, household income and education, but was associated with gender and HL score. In the final regression model, lower HL scores (adjusted β = 1.03, 95% confidence interval [CI] 0.7 to 1.36, P < 0.001) and male gender (adjusted β = -5.29, 95% CI -10.56 to -0.03, P = 0.049) were associated with lower self-care scores. The HL scores were associated with self-care domains of self-efficacy (HL: β = 0.30, 95% CI 0.17 to 0.42, P < 0.001), motivation (HL: β = 0.40, 95% CI 0.26 to 0.53, P < 0.001) and behaviour (HL: β = 0.38, 95% CI 0.26 to 0.50, P < 0.001). CONCLUSION Thirty-one percent of the participants had limited HL. Self-care was not associated with age, race, CKD status, household income or education. Male gender and limited HL were associated with lower self-care. Self-care was associated with self-efficacy, motivation and behaviour. Future research could focus on more targeted approaches to improve self-care and HL among patients with CKD.
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Affiliation(s)
| | | | - Adina Abdullah
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Ngiap-Chuan Tan
- Department of Singhealth Polyclinic Research, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore
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Wang SL, Shien TWH, Chen TH, Hsiao PN, Hsiao SM, Kung LF, Hwang SJ, Chiu YW, Tsai YC, Chang JM. The factors of perceived disease knowledge and self-care behavior in type 2 diabetic patients with chronic kidney disease: A cross-sectional study. Medicine (Baltimore) 2023; 102:e34791. [PMID: 37933073 PMCID: PMC10627621 DOI: 10.1097/md.0000000000034791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/26/2023] [Indexed: 11/08/2023] Open
Abstract
Chronic kidney diseases (CKD) is an important public health issue worldwide, and diabetes mellitus is the main cause of CKD. Having sufficient disease knowledge and good self-care behavior both help to prevent the progression of diabetes mellitus and CKD. This cross-sectional study enrolled 181 type 2 diabetic patients with CKD from July 2017 to October 2017. Perceived Kidney Knowledge survey and structured questionnaires of self-care behavior were used to measure perceived disease knowledge and CKD Self-Care (CKDSC) scales respectively with the determinants analyzed by linear regression. Meanwhile, socio-demographic information, kidney function and laboratory data were collected. Of 181 enrolled patients, the mean age was 66.8 ± 9.7 years, 59.1% were male and the mean estimated glomerular filtration rate was 33.1 ± 23.1 mL/min/1.73 m2. The mean scores of CKDSC and perceived disease knowledge were 63.2 and 22.4, respectively. High scores of disease knowledge were significantly correlated with low glycated hemoglobin (P = .03) and high scores of overall self-care behavior (P = .03) and aspects of self-care behavior, including diet (P = .003), exercise (P = .02), and home blood pressure monitoring (P = .04). The relationship between young age and high scores of disease knowledge was found (P = .001); however, old age was significantly associated with high scores of overall self-care behavior (P < .001) while additionally, married patients had high scores of regular medication behavior (P = .03). Our findings identified the significant factors correlated with disease knowledge and self-care behavior in type 2 diabetic patients with CKD. Healthcare givers should establish personalized health education plans to improve perceived disease knowledge and self-care behavior.
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Affiliation(s)
- Shu-Li Wang
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Tzu-Hui Chen
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Ni Hsiao
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Ming Hsiao
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Lan-Fang Kung
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Department of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung M University, Kaohsiung, Taiwan
- Doctoral Degree Program in Toxicology, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Wen Chiu
- Department of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung M University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chun Tsai
- Department of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung M University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of General Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Liquid Biopsy and Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jer-Ming Chang
- Department of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung M University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Raja M, Radhakrishnan S, Milan RA, Hurse D, Dean C. Assessing Chronic Kidney Disease Knowledge, Beliefs, and Risk among Detroit Residents. AMERICAN JOURNAL OF HEALTH EDUCATION 2023. [DOI: 10.1080/19325037.2022.2163006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Krepker FF, Arreguy-Sena C, Braga LM, Krempser P, Santos JDC, Dutra HS. Protocolo de enfermagem na prevenção de doença renal crônica em pessoas idosas na atenção primária. Rev Bras Enferm 2023. [DOI: 10.1590/0034-7167-2022-0052pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivos: desenvolver um protocolo para a operacionalização do Processo de Enfermagem na abordagem de pessoas idosas com vulnerabilidade para doença renal crônica na Atenção Primária à Saúde, alicerçado nos estressores de Neuman. Métodos: estudo metodológico, realizado em duas etapas: síntese das evidências por estratégia indutiva (estudo de método misto) e desenvolvimento do protocolo para subsidiar a operacionalização do Processo de Enfermagem com pessoas idosas adstritas a uma Unidade Básica de Saúde, utilizando estratégia dedutiva (conceitos de estressores de Neuman, taxonomias NANDA, NIC e NOC, linha de raciocínio de Risner e mapeamento cruzado), descrito segundo A Step-by-Step Guide to Developing Protocols. Resultados: participaram 102 idosos. Foram captados 17 diagnósticos, 34 intervenções e 26 resultados de enfermagem. Conclusões: o protocolo elaborado constitui uma tecnologia que possibilita operacionalizar o processo de enfermagem alicerçado nos estressores de Neuman e em referenciais taxonômicos, conceituais e assistenciais, norteando o cuidado e os registros de enfermagem.
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Krepker FF, Arreguy-Sena C, Braga LM, Krempser P, Santos JDC, Dutra HS. Nursing protocol in chronic kidney disease prevention in older adults in primary care. Rev Bras Enferm 2022; 76:e20220052. [PMID: 36449972 PMCID: PMC9728820 DOI: 10.1590/0034-7167-2022-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/09/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES to develop a protocol for Nursing Process operationalization in approaching older adults with vulnerability to chronic kidney disease in Primary Health Care, based on Neuman's stressors. METHODS a methodological study, carried out in two stages: 1) synthesis of evidence using an inductive strategy (mixed method study) and 2) protocol development to support the nursing process operationalization with older adults enrolled in a Basic Health Unit, using a deductive strategy (Neuman's stressor concepts, NANDA, NIC, and NOC taxonomies, Risner's line of reasoning, and cross-mapping), described according to A Step-by-Step Guide to Developing Protocols. RESULTS 102 older adults participated, and 17 diagnoses, 34 interventions and 26 nursing outcomes were identified. CONCLUSIONS the protocol developed is a technology that makes it possible to operationalize the Nursing Process, based on Neuman's stressors and on taxonomy, conceptual and care frameworks, guiding care and nursing records.
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Affiliation(s)
| | | | | | - Paula Krempser
- Universidade Federal de Juiz de Fora. Juiz de Fora, Minas Gerais, Brazil
| | | | - Herica Silva Dutra
- Universidade Federal de Juiz de Fora. Juiz de Fora, Minas Gerais, Brazil
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Ahn JW, Lee SM, Seo YH. Factors associated with self-care behavior in patients with pre-dialysis or dialysis-dependent chronic kidney disease. PLoS One 2022; 17:e0274454. [PMID: 36227926 PMCID: PMC9560058 DOI: 10.1371/journal.pone.0274454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/29/2022] [Indexed: 11/07/2022] Open
Abstract
Self-care behavior plays a pivotal role in the management of chronic kidney disease. Improved self-care behavior in patients with chronic kidney disease is a key factor in health management and treatment adherence. This study aimed to evaluate the participants’ general and medical condition-related characteristics, physiological indices and the level of health literacy affecting self-care behavior in patients with chronic kidney disease in South Korea. The data of 278 participants were analyzed using t-test, analysis of variance, correlation coefficient, and linear multiple regression analysis. There were significant differences in self-care behavior scores depending on participants’ age and cohabitation status, employment, and smoking status as well as having dialysis due to end-stage kidney disease; number of comorbidities; levels of serum hemoglobin, calcium, and creatinine; and estimated glomerular filtration rate. The results of regression analysis revealed that not currently working, non-smoker, end-stage kidney disease, and positive response to the “actively managing my health” scale of the Health Literacy Questionnaire significantly affected self-care behavior in patients with chronic kidney disease, and the explanatory power of the model was 32.7%. Therefore, it is necessary to identify each patient’s barriers or needs according to individual characteristics, such as age, cohabitation and employment status, and daily life circumstances, including smoking habits, comorbidities, social support, and level of health literacy to develop efficient support strategies for promoting adequate self-care behavior with CKD.
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Affiliation(s)
- Jung-Won Ahn
- Department of Nursing, Gangneung-Wonju National University, Wonju-si, Gangwon-do, Korea
| | - Sun Mi Lee
- Department of Nursing Science, Pai Chai University, Seo-gu, Daejeon Metropolitan City, Korea
| | - Yon Hee Seo
- Department of Nursing, Yeoju Institute of Technology, Yeoju-si, Gyeonggi-do, Korea
- * E-mail:
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Lin MY, Chiu YW, Hsu YH, Wu MS, Chang JM, Hsu CC, Yang CW, Yang WC, Hwang SJ. CKD Care Programs and Incident Kidney Failure: A Study of a National Disease Management Program in Taiwan. Kidney Med 2022; 4:100485. [PMID: 35812528 PMCID: PMC9257411 DOI: 10.1016/j.xkme.2022.100485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Rationale & Objective Taiwan implemented national pay-for-performance programs for chronic kidney disease (CKD) care in 2006 and 2011; however, it is unknown whether this affected trends in maintenance dialysis. This study assessed the temporal trends in the incidence, prevalence, and mortality of individuals treated with maintenance dialysis from 2002-2016 in Taiwan. Study Design Follow-up study using Taiwan Renal Disease System Databases. Setting & Participants Participants who received dialysis for ≥90 days. Predictors Age, sex, and calendar year. Outcomes Incidence, prevalence of maintenance dialysis, or death, ascertained using the National Death Registry database. Analytical Approach The estimated annual percentage change was assessed by a generalized linear model, and the association of the programs with changes in the incidence of maintenance dialysis was evaluated using an age-period-cohort model. Results A total of 144,258 incident cases with a follow-up of 346 million person-years were analyzed during the observed periods. The estimated annual percentage change of the expected crude incidence rate was slightly reduced by 0.41% (95% CI, −1.06 to 0.24) and was more obvious in women and patients aged greater than 70 years; whereas, it was significantly increased in those aged greater than 75 years. After disentangling age and cohort effects, the implementation of the care programs was associated with an overall net drift of −1.09% (95% CI, −1.65 to −0.52) per year and a significant linear reduction in the period rate ratio from 1.06 (95% CI, 1.02-1.09) in the years 2002-2006 to 0.95 (95% CI, 0.92-0.98) in 2012-2016, using years 2007-2011 as reference. Limitations The findings of the study may have limited inferences to other countries with different health care systems. Conclusions The implementation of universal CKD care programs in Taiwan has significantly reduced the long-term trends in the incidence of maintenance dialysis; hence, devoting governmental resources to CKD care and prevention is advocated.
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Affiliation(s)
- Ming-Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Ho Hsu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Taipei Medical University-Hsin Kuo Min Hospital, Taoyuan, Taiwan
| | - Mai-Szu Wu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Chih-Wei Yang
- Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wu-Chang Yang
- Division of Nephrology, Landseed International Hospital, Taoyuan 32001, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Program in Toxicology, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Address for Correspondence: Shang-Jyh Hwang, MD, Department of Renal Care, Kaohsiung Medical University, 100, TzYou 1st Rd, San-Ming District, Kaohsiung 807, Taiwan.
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Tsai MD, Tsai JP, Chen ML, Chang LC. Frailty, Health Literacy, and Self-Care in Patients with Chronic Kidney Disease in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095350. [PMID: 35564744 PMCID: PMC9102108 DOI: 10.3390/ijerph19095350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022]
Abstract
Chronic kidney disease (CKD) is a chronic and often irreversible disease that requires active self-care to mitigate adverse outcomes. This study aimed to analyze the associations of demographic and disease data, frailty, health literacy (HL), and CKD self-care (CKDSC) in patients with CKD. We conducted a cross-sectional study at two hospitals in Taiwan. A total of 144 CKD patients with a mean age of 66.8 ± 9.1 years were included in the study. Among them, 79.2% were in CKD G3, and the mean time since diagnosis of CKD was 86 ± 48 months. Approximately 62.5% were identified as non-frail. The mean of HL and CKDSC were 11.76 ± 4.10 and 62.12 ± 9.31. In multivariate linear regression analysis, age ≥ 65 years (odds ratio (OR) = 5.67, 95% confidence interval (CI) 1.59–9.75), non-frailty (OR = 2.19, 95% CI 0.02–5.40), and high critical HL (OR = 1.43, 95% CI 0.13–2.90) showed significant positive correlation with CKDSC. Therefore, management of patients with CKD should focus on the young population, reinforcing health education strategies that improve critical HL and preventing frailty that may interfere with self-care. In addition, the patient’s social support resources should be expanded to achieve the goal of CKDSC.
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Affiliation(s)
- Mu-Dan Tsai
- Department of Nursing, Douliou Tzu Chi Hospital, Yunlin City 64041, Taiwan;
| | - Jen-Pi Tsai
- Department of Nephrology, Dalin Tzu Chi Hospital, Chiayi City 62247, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Min-Li Chen
- School of Nursing, Chang Gung University of Science and Technology, Chiayi City 61363, Taiwan;
| | - Li-Chun Chang
- School of Nursing, Chang Gung University of Science and Technology, Taoyuan City 33303, Taiwan
- Chang Gung Memorial Hospital, Keelung 20401, Taiwan
- Department of Nursing, Chang Gung University, Taoyuan City 33302, Taiwan
- Correspondence:
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Sarker MHR, Moriyama M, Rashid HU, Rahman MM, Chisti MJ, Das SK, Jahan Y, Saha SK, Arifeen SE, Ahmed T, Faruque ASG. Health Education Through a Campaign and mHealth to Enhance Knowledge and Quality of Life Among Patients With Chronic Kidney Disease in Bangladesh: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e30191. [PMID: 34806998 PMCID: PMC8663577 DOI: 10.2196/30191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023] Open
Abstract
Background Despite the growing burden of chronic kidney disease (CKD), disease knowledge and understanding are still lacking, especially in Bangladesh. Objective The aim of this study was to evaluate the outcome of a health education intervention in order to enhance knowledge, health-related quality of life (QOL), and motivation regarding healthy lifestyles among rural and periurban adults suffering from CKD. Methods A parallel-group (1:1) randomized controlled trial is ongoing in the Mirzapur subdistrict, Bangladesh, where two groups of patients with CKD are being compared. Patients aged 18 years and over with CKD (stages 1-3) were enrolled in November 2020. Patients were randomly allocated into either the intervention group (n=63) or the control group (n=63). The control group received usual treatment, while the intervention group received health education through a CKD campaign facilitated by a nephrologist and via mHealth (ie, periodic mobile phone calls) from community health workers. Both groups were followed up for a period of 6 months. The primary endpoint is patients’ increased knowledge measured using the Chronic Kidney Disease Knowledge Questionnaire. The secondary endpoints are improved QOL measured using the standardized EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire as well as improvements in the levels of blood pressure, BMI, serum creatinine, fasting blood sugar, hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen, and albumin to creatinine ratio. Results Enrollment of participants began in November 2020; the intervention and follow-up were completed in May 2021. We enrolled 126 patients in the study. Patients’ mean ages were 57.97 (SD 15.03) years in the control group and 57.32 (SD 14.37) years in the intervention group. There were 45 out of 63 (71%) females in the control group and 38 out of 63 (60%) females in the intervention group. In addition, there were 38 out of 63 (60%) literate patients in the control group and 33 out of 63 (52%) literate patients in the intervention group. Conclusions It is expected that a combined approach, incorporating both a CKD campaign and mHealth, for health education may be an effective tool for increasing knowledge and improving QOL among patients with CKD. Trial Registration ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831 International Registered Report Identifier (IRRID) DERR1-10.2196/30191
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Affiliation(s)
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Harun Ur Rashid
- Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Sumon Kumar Das
- Menzies - School of Health Research, Charles Darwin University, Darwin, Australia
| | - Yasmin Jahan
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Samir Kumar Saha
- Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - A S G Faruque
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
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Lim CC, Mok IY, Tan HZ, Tan C, Yeo F, Choo JC. Health Literacy in Glomerulonephritis and Renal Vasculitis Attending Nephrology Clinics. GLOMERULAR DISEASES 2021; 1:129-134. [PMID: 36751495 PMCID: PMC9677738 DOI: 10.1159/000517886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/12/2021] [Indexed: 11/19/2022]
Abstract
Aims Glomerulonephritis is one of the leading causes of progressive chronic kidney disease worldwide and treatment requires shared decision-making to improve self-care and plan immunosuppressant therapy. However, information on health literacy (HL) in patients with glomerulonephritis is scanty. We aimed to assess HL in our multiethnic population with glomerulonephritis. Methods Single-center cross-sectional study of patients with glomerulonephritis receiving induction immunosuppressants at the ambulatory nephrology clinic and who completed the anonymized self-administered HLS-EU-47 questionnaire. The standardized HL index and domain item mean scores were compared with participant sociodemographic characteristics. Results Among 65 patients who attend the clinics over a month, 27 agreed to participate in the survey. After excluding responses with significant missing information, we included 23 participants (16 Chinese, 4 Malay, 2 Indian, and 1 other ethnicity) in the analysis. The median age was 39 (interquartile range 27, 60 years). The median general HL index was 26.2 (19.8, 29.8). The item mean scores were 2.64 (2.43, 2.77), 2.45 (2.09, 2.72), 2.33 (2.17, 2.58), and 2.50 (2.25, 2.75) for the domains of accessing, understanding, appraising, and applying health-care-related information, respectively. Male patients had significantly higher HL indices and higher scores for accessing and appraising health information, while higher personal income was significantly associated with higher score for applying health knowledge. Conclusion Patients with glomerulonephritis had lowest HL in the domain of appraising health information. Further research on targeted interventions to improve the HL in appraising treatment options and vaccinations in patients with glomerulonephritis is required.
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Affiliation(s)
- Cynthia Ciwei Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore,*Cynthia Ciwei Lim,
| | - Irene Y.J. Mok
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Claire Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Fiona Yeo
- Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - Jason C.J. Choo
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
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