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Zhang Y, Liu L, Chen L, He L, Shi M, Chen H. Investigation of core symptoms and symptom clusters in maintenance hemodialysis patients: A network analysis. J Nurs Scholarsh 2024. [PMID: 38741291 DOI: 10.1111/jnu.12982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/11/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE To construct a symptom network of maintenance hemodialysis patients and identify the core symptoms and core symptom clusters. Finally, this study provides a reference for accurate symptom management. DESIGN AND METHOD A correlational cross-sectional design. A total of 368 patients who underwent maintenance hemodialysis were enrolled from two hemodialysis centers in Chengdu, Sichuan Province, China. A symptom network was constructed with the R coding language to analyze the centrality index. Symptom clusters were extracted by exploratory factor analysis, and core symptom clusters were preliminarily determined according to the centrality index of the symptom network. FINDINGS The most common symptoms in maintenance hemodialysis patients were fatigue, dry skin, and pruritus. In the symptom network, headache had the highest mediation centrality (rB = 2.789) and closeness centrality (rC = 2.218) and the greatest intensity of numbness or tingling in the feet (rS = 1.952). A total of six symptom clusters were extracted, including pain and discomfort symptom clusters, emotional symptom clusters, gastrointestinal symptom clusters, sleep disorder symptom clusters, dry symptom clusters, and sexual dysfunction symptom clusters. The cumulative variance contribution rate was 69.269%. CONCLUSIONS Fatigue, dry skin, and pruritus are the sentinel symptoms of maintenance hemodialysis patients, headache is the core symptom and bridge symptom, and pain symptom clusters are the core symptom clusters of MHD patients. Nurses can develop interventions based on core symptoms and symptom clusters to improve the effectiveness of symptom management in maintenance hemodialysis patients. CLINICAL RELEVANCE Understanding the core symptoms and symptom groups that plague maintenance hemodialysis patients is critical to providing accurate symptom management. To ensure that maintenance hemodialysis patients receive effective support during treatment, reduce the adverse effects of symptoms, and improve the quality of life of patients.
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Affiliation(s)
- Yingjun Zhang
- Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Li Liu
- Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Lin Chen
- Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Li He
- Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Mei Shi
- Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Hui Chen
- Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
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Shahri HA, Salmi IA, Rajhi WA, Shemshaki H. Effectiveness of the Eutectic Mixture of Local Anaesthetics Cream in the Management of Arteriovenous Fistula Needle Insertion Pain in Patients Undergoing Haemodialysis. Sultan Qaboos Univ Med J 2024; 24:7-19. [PMID: 38434453 PMCID: PMC10906758 DOI: 10.18295/squmj.10.2023.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/27/2023] [Accepted: 10/03/2023] [Indexed: 03/05/2024] Open
Abstract
This review aimed to assess the effectiveness of the eutectic mixture of local anaesthetics (EMLA) cream in the management of arteriovenous fistula (AVF) needle insertion pain in adult patients undergoing haemodialysis (HD) compared with other alternative interventions. The main search was conducted in November 2020 and updated in December 2021. In the search strategy, keywords and synonyms were used and multiple databases were searched with no date limitation to ensure a comprehensive search that would yield all studies relevant to the review and minimise location bias. A total of 209 studies were found in this search and filtered. After filtering through these studies, only five studies were finally included in the review. EMLA-cream was found to be effective in reducing AVF needle insertion pain among adult patients undergoing HD. Despite EMLA cream's effectiveness in reducing HD needle insertion pain and its fewer side effects, the findings of the included studies should be interpreted with caution, as there are some limitations, and further research is required.
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Affiliation(s)
- Hamed Al Shahri
- Renal Medicine Department, Sultan Qaboos Hospital, Salalah, Oman
| | - Issa Al Salmi
- Department of Renal Medicine, The Royal Hospital, Muscat, Oman
| | - Waleed Al Rajhi
- College of Pharmacy and Nursing, Nizwa University, Nizwa, Oman
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Chan FHF, Goh ZZS, Zhu X, Tudor Car L, Newman S, Khan BA, Griva K. Subjective cognitive complaints in end-stage renal disease: a systematic review and meta-analysis. Health Psychol Rev 2023; 17:614-640. [PMID: 36200562 DOI: 10.1080/17437199.2022.2132980] [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: 11/08/2021] [Accepted: 09/30/2022] [Indexed: 11/04/2022]
Abstract
Cognitive impairment is common in patients with end-stage renal disease (ESRD) and is associated with compromised quality of life and functional capacity, as well as worse clinical outcomes. Most previous research and reviews in this area were focused on objective cognitive impairment, whereas patients' subjective cognitive complaints (SCCs) have been less well-understood. This systematic review aimed to provide a broad overview of what is known about SCCs in adult ESRD patients. Electronic databases were searched from inception to January 2022, which identified 221 relevant studies. SCCs appear to be highly prevalent in dialysis patients and less so in those who received kidney transplantation. A random-effects meta-analysis also shows that haemodialysis patients reported significantly more SCCs than peritoneal dialysis patients (standardised mean difference -0.20, 95% confidence interval -0.38 to -0.03). Synthesis of longitudinal studies suggests that SCCs remain stable on maintenance dialysis treatment but may reduce upon receipt of kidney transplant. Furthermore, SCCs in ESRD patients have been consistently associated with hospitalisation, depression, anxiety, fatigue, and poorer quality of life. There is limited data supporting a strong relation between objective and subjective cognition but preliminary evidence suggests that this association may be domain-specific. Methodological limitations and future research directions are discussed.
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Affiliation(s)
- Frederick H F Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Zack Z S Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Xiaoli Zhu
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Nursing Services, National Healthcare Group Polyclinics, Singapore
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Stanton Newman
- School of Health Sciences, Division of Health Services Research and Management, City University of London, London, UK
| | - Behram A Khan
- National Kidney Foundation, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Chen PC, Sun JL, Hsu HC, Lai YH, Liao YC, Chen PY, Chang HC. Comparison of puncture methods in patients with hemodialysis: A randomized controlled trial. Semin Dial 2023; 36:454-461. [PMID: 36726291 DOI: 10.1111/sdi.13142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/17/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Arteriovenous fistula or arteriovenous graft is essential to long-term survival and quality of life in patients receiving hemodialysis. To date, no research has examined the clinical impacts of different puncture methods. This study compared the rope ladder and area puncture techniques in terms of vascular patency, pain, and quality of life among patients receiving hemodialysis. METHODS A prospective longitudinal study was performed with 6-month follow-up. A total of 98 participants recruited from a hemodialysis center in Taiwan were randomly assigned to receive the rope ladder technique (experimental group) or the area puncture technique (control group). Vascular patency was assessed by examining access flow and percutaneous transluminal angioplasty rate. Pain and quality of life were measured using the Numerical Pain Rating Scale (NPRS) and Kidney Disease Quality of Life Instrument (KDQOL-36™), respectively. All outcome variables were measured repeatedly and analyzed using a generalized estimating equation. RESULTS Overall, quality of life was significantly better for the experimental group than for the control group (β = 47.23, p < 0.001). The percutaneous transluminal angioplasty rate was lower for the experimental group than for the control group (12.0% vs. 18.8%). However, no significant differences were found in access flow and pain level between the two groups over time. CONCLUSION Hemodialysis patients who received the rope ladder puncture technique had a lower percutaneous angioplasty rate and better quality of life than patients who received the area puncture technique, suggesting that the rope ladder technique could be implemented as a routine cannulation method in hemodialysis clinics.
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Affiliation(s)
- Pei-Ching Chen
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
- Dialysis Center, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Jia-Ling Sun
- Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Hsiu-Chuang Hsu
- Dialysis Center, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Yao-Hui Lai
- Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Department of Nursing, MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Yu-Chien Liao
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Pei-Ying Chen
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Hui-Chen Chang
- School of Nursing and Midwifery, Western Sydney University, Rydalmere, NSW, Australia
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Wu HH, Poulikakos D, Hurst H, Lewis D, Chinnadurai R. Delivering Personalized, Goal-Directed Care to Older Patients Receiving Peritoneal Dialysis. KIDNEY DISEASES (BASEL, SWITZERLAND) 2023; 9:358-370. [PMID: 37901709 PMCID: PMC10601915 DOI: 10.1159/000531367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/26/2023] [Indexed: 10/31/2023]
Abstract
Background An aging population living with chronic kidney disease and progressing to kidney failure, subsequently receiving peritoneal dialysis (PD) is growing. A significant proportion of these patients are also living with multi-morbidities and some degree of frailty. Recent practice recommendations from the International Society of Peritoneal Dialysis advocate for high-quality, goal-directed PD prescription, and the Standardized Outcomes of Nephrology-PD initiative emphasized the need for an individualized, goal-based care approach in all patients receiving PD treatment. In older patients, this approach to PD care is even more important. A frailty screening assessment, followed by a comprehensive geriatric assessment (CGA) prior to PD initiation and when dictated by change in relevant circumstances is paramount in tailoring PD care and prescription according to the needs, life goals, as well as clinical status of older patients with kidney failure. Summary Our review aimed to summarize the different dimensions to be taken into account when delivering PD care to the older patient - from frailty screening and CGA in older patients receiving PD to employing a personalized, goal-directed PD prescription strategy, to preserving residual kidney function, optimizing blood pressure (BP) control, and managing anemia, to addressing symptom burden, to managing nutritional intake and promoting physical exercise, and to explore telehealth opportunities for the older PD population. Key Messages What matters most to older PD patients may not be simply extending survival, but more importantly, to be living comfortably on PD treatment with minimal symptom burden in a home environment and to minimize treatment complications.
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Affiliation(s)
- Henry H.L. Wu
- Department of Renal Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
- Renal Research, Kolling Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Dimitrios Poulikakos
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Helen Hurst
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Paula Ormandy School of Health and Society, University of Salford, Salford, UK
| | - David Lewis
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Rajkumar Chinnadurai
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
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Chan FHF, Newman S, Khan BA, Griva K. Prevalence and trajectories of subjective cognitive complaints and implications for patient outcomes: A prospective study of haemodialysis patients. Br J Health Psychol 2023; 28:651-671. [PMID: 36720474 DOI: 10.1111/bjhp.12645] [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: 10/20/2022] [Revised: 01/03/2023] [Accepted: 01/13/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Cognitive impairment is common in haemodialysis patients and is associated with increased hospitalization and mortality. However, subjective cognitive complaints (SCCs), the self-experienced difficulties in everyday cognitive activities, remain poorly understood. This study examined the prevalence and course of SCCs in haemodialysis patients and its longitudinal associations with sociodemographic, clinical and patient-reported variables. DESIGN Observational prospective study with baseline and 12-month follow-up assessment. METHODS Based on a validated cut-off point on the Kidney Disease Quality of Life Cognitive Function subscale, haemodialysis patients (N = 159; 40.3% female, mean age 53.62) were classified into cognitive complaint trajectories: (1) resilient (60.4%; no/low SCCs throughout); (2) persistent (8.8%; stable high SCCs); (3) deterioration (17.6%; from no/low to high SCCs); and (4) recovery (13.2%; from high to no/low SCCs). Sociodemographic/clinical characteristics, self-efficacy, self-management skills, adherence, mood and biochemical assays were measured at both assessments and compared among trajectories using mixed ANOVAs. RESULTS Interaction effects indicated significant improvements in the recovery group in clinical outcomes (i.e., decreased phosphorus and calcium-phosphorus product), self-efficacy and mood over time. Group effects indicated significantly poorer self-efficacy, self-management skills and adherence in the persistent group than other trajectories across both assessments. None of the sociodemographic/clinical characteristics was associated with SCC trajectories. CONCLUSIONS The extent of SCCs vary over time across haemodialysis patients. Routine screening of SCCs in dialysis settings may help identifying patients at risk of poor self-management and worse prognosis. Strategies that compensate for cognitive lapses may mitigate the perceived cognitive burden of this population.
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Affiliation(s)
- Frederick H F Chan
- Population/Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - Stanton Newman
- Division of Health Services Research and Management, School of Health Sciences, City University of London, London, UK
| | - Behram A Khan
- National Kidney Foundation, Singapore City, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Konstadina Griva
- Population/Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
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7
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Bernardes CM, Houkamau K, Lin I, Taylor M, Birch S, Claus A, Bryant M, Meuter R, Isua J, Gray P, Kluver JP, Jones C, Ekberg S, Pratt G. Communication and access to healthcare: Experiences of Aboriginal and Torres Strait Islander people managing pain in Queensland, Australia. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:1041968. [PMID: 36561982 PMCID: PMC9763606 DOI: 10.3389/fpain.2022.1041968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
Background Pain management requires a multidisciplinary approach and a collaborative relationship between patient-provider in which communication is crucial. This study examines the communication experiences of Aboriginal and Torres Strait Islander patients and Aboriginal and Torres Strait Islander Hospital Liaison Officers (ATSIHLOs), to improve understanding of how pain is managed in and through patient-health professional communication. Methods This qualitative study involved a purposive sample of patients attending three persistent pain clinics and ATSIHLOs working in two hospitals in Queensland, Australia. Focus groups and in-depth interviews explored the communication experiences of patients managing pain and ATSIHLOs supporting patients with pain. This study adopted a descriptive phenomenological methodology, as described by Colaizzi (1978). Relevant statements (patient and ATSIHLOs quotes) about the phenomenon were extracted from the transcripts to formulate meanings. The formulated meanings were subsequently sorted into thematic clusters and then integrated into themes. The themes were then incorporated into a concise description of the phenomenon of communication within pain management. Findings were validated by participants. Results A total of 21 Aboriginal and Torres Strait Islander participants were involved in this study. Exploration of the communication experiences of patients and ATSIHLOs revealed overlapping themes of important barriers to and enablers of communication that affected access to care while managing pain. Acknowledging historical and cultural factors were particularly important to build trust between patients and health professionals. Some patients reported feeling stigmatized for identifying as Aboriginal and Torres Strait Islander, while others were reluctant to disclose their background for fear of not having the same opportunity for treatment. Differences in the expression of pain and the difficulty to use standard pain measurement scales were identified. Communication was described as more than the content delivered, it is visual and emotional expressed through body language, voice intonation, language and the speed of the conversation. Conclusion Communication can significantly affect access to pain management services. Aboriginal and Torres Strait Islander patients highlighted the burden of emotional pain caused by historical factors, negative stereotypes and the fear of discrimination. Pain management services and their health professionals need to acknowledge how these factors impact patients trust and care.
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Affiliation(s)
- Christina Maresch Bernardes
- Aboriginal and Torres Strait Islander Health Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia,Correspondence: Christina Maresch Bernardes
| | - Kushla Houkamau
- Aboriginal and Torres Strait Islander Health Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Ivan Lin
- WesternAustralian Center for Rural Health, University of Western Australia, Geraldton, WA, Australia
| | - Marayah Taylor
- North Queensland Persistent Pain Management Service, Townsville Hospital and Health Service, Townsville, QLD, Australia
| | - Stephen Birch
- Centre for Business and Economics of Health, Faculty of Business, St Lucia, QLD, Australia
| | - Andrew Claus
- Tess Cramond Pain and Research Centre, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Matthew Bryant
- North Queensland Persistent Pain Management Service, Townsville Hospital and Health Service, Townsville, QLD, Australia
| | - Renata Meuter
- School of Psychology and Counselling, Faculty of Health, Brisbane, QLD, Australia
| | - Jermaine Isua
- Aboriginal and Torres Strait Islander Health Division, Cultural Capability Services, Brisbane, QLD, Australia
| | - Paul Gray
- Tess Cramond Pain and Research Centre, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Joseph P Kluver
- Persistent Pain Clinic, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Corey Jones
- Aboriginal and Torres Strait Islander Health Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Stuart Ekberg
- School of Psychology and Counselling, Faculty of Health, Brisbane, QLD, Australia
| | - Gregory Pratt
- Aboriginal and Torres Strait Islander Health Research Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
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Yi C, Ye H, Lin J, Chang Y, Zhang X, Zhou T, Yang R, Yang X. The incidence of pain and its association with quality of life in patients with peritoneal dialysis. Ren Fail 2022; 44:724-730. [PMID: 35491880 PMCID: PMC9068003 DOI: 10.1080/0886022x.2022.2068444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/13/2022] [Accepted: 04/13/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The aims of this study were to investigate the incidence of pain in peritoneal dialysis (PD) patients and to analyze the correlation between pain and quality of life. METHODS PD patients who followed up in our PD center from March 2016 to December 2017 were included. The Short-Form McGill Pain Questionnaire was used to assess pain status. Depression status, sleep quality, quality of life and clinical data were also collected. RESULTS A total of 463 PD patients were included, of whom 153 patients (33.1%) with pain. The main cause of pain was calcium and phosphorus metabolism disorder (51.6%). About 101 patients (66.0%) had multiple sites of pain, and 28 patients (18.3%) with pain were treated with analgesic drugs. Binary Logistic regression analysis showed that older age (OR = 1.026; p = 0.032) and higher intact parathyroid hormone level (OR = 1.043; p = 0.040) were independent risk factors for pain in PD patients. Multivariate analysis showed that score of pain rating index was an independent risk factor for depressive symptoms (OR = 1.100; p = 0.015), the score of Pittsburgh sleep quality index (B = 0.005; p = 0.044) and the score of physical component scale (B= -0.727; p = 0.016) in PD patients. CONCLUSIONS The incidence of pain in PD patients was 33.1%. Older age and higher intact parathyroid hormone level were independent risk factors for pain. Pain was independently associated with depressive symptoms, sleep quality and quality of life in PD patients.
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Affiliation(s)
- Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Jianxiong Lin
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Yao Chang
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Xiaodan Zhang
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Ting Zhou
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Rui Yang
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
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Ethical Challenges When Caring for African American Older Adults Requesting to Withdraw From Dialysis. J Hosp Palliat Nurs 2022; 24:209-217. [PMID: 35488364 DOI: 10.1097/njh.0000000000000862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The number of African American adults 65 years and older with end-stage kidney disease receiving maintenance hemodialysis is increasing. The high symptom burden (ie, pain, fatigue, depression) can make it challenging for many to continue dialysis, which can lead to request to withdraw from dialysis. This can present ethical challenges when someone has diminished decision-making capacity and no advance directives or family to assist with this complex decision. This article will provide a brief overview of ethical issues to consider when responding to an older adult's request to withdraw from a life-sustaining treatment such as dialysis. Suggestions for research to address the gaps in knowledge will be presented.
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Pain in Patients With Chronic Kidney Disease Undergoing Hemodialysis: A Systematic Review. Pain Manag Nurs 2021; 22:605-615. [PMID: 34217608 DOI: 10.1016/j.pmn.2021.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/11/2021] [Accepted: 05/29/2021] [Indexed: 12/26/2022]
Abstract
AIMS To assess the presence of pain, its location, intensity, and effects on the daily activities of patients with chronic kidney disease (CKD) undergoing hemodialysis (HD). PARTICIPANTS/SUBJECTS Patients with chronic kidney disease (CKD) undergoing hemodialysis (HD). DESIGN A systematic review. METHODS We carried out search for articles published until December 2020, including publications in Portuguese, English, and Spanish during the past 15 years (2005-2020), using the Embase, SciELO, PubMed, and Web of Science databases. The following information was collected: type of pain, pain treatment, pain assessment instrument, prevalence of pain, location, and influence of pain on quality of life. RESULTS Twenty-five studies were selected for a systematic review. These studies involved a total of 98,162 adult and elderly patients with CKD who were undergoing HD. There was a high prevalence of pain in patients with CKD on HD. The most frequent sites of pain were the head, back, bones, chest, and the upper and lower limbs. The presence of acute, chronic, neuropathic pain, and myalgia was also reported in the studies. In addition, there was a higher frequency of moderate and severe pain, which influenced daily activities, the ability to walk, mood, relationships with other people, sleep, and work in patients on dialysis. CONCLUSIONS The analyzed studies suggest that acute and chronic pain is a prevalent complaint in adults and elderly patients undergoing HD. There was a higher frequency of moderate and severe pain in different parts of the body, and pain interfered with everyday activities.
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Lightfoot CJ, Wilkinson TJ, Song Y, Burton JO, Smith AC. Perceptions of exercise benefits and barriers: the influence on physical activity behaviour in individuals undergoing haemodialysis and peritoneal dialysis. J Nephrol 2021; 34:1961-1971. [PMID: 33770396 PMCID: PMC8610943 DOI: 10.1007/s40620-021-01024-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/07/2021] [Indexed: 11/29/2022]
Abstract
Background Despite growing evidence about the benefits of physical activity and exercise in patients receiving dialysis, physical inactivity is highly prevalent. This may be due to uncertainty and lack of appropriate guidance about exercise, or driven by the relative barriers and benefits that patients perceive. Understanding these perceptions in dialysis patients may inform interventions aimed to increase exercise participation. Methods Perceived benefits and barriers to exercise were measured by the ‘Dialysis Patient-perceived Exercise Benefits and Barriers Scale’ (DPEBBS). Self-reported physical activity status was assessed by the ‘General Practice Physical Activity Questionnaire’. Barriers and benefits to exercise were classed as binary variables (i.e. yes and no). Frequency analyses and chi-squared tests were conducted to compare the differences perceived by people on haemodialysis (HD) and peritoneal dialysis (PD). Binominal logistical regression was performed to determine which perceived barriers and benefits had the biggest impact on physical activity status. Results One thousand twenty-two HD and 124 PD patients completed the DPEBBS. A greater proportion of HD than PD patients reported ‘reduces body pain’ (P = 0.013), ‘delays decline in body function’ (P = 0.01), and ‘improves quality of life’ (P = 0.033) as benefits of exercise. No differences in barriers were observed. Tiredness was the most reported barrier to exercise. Patients who perceived ‘other comorbidities’ (OR 3.389, P < 0.001) or ‘burden of family’ (OR 3.168, P < 0.001) as barriers were 3 times more likely to be inactive. Conclusions Dialysis patients perceive several barriers which may prevent them from engaging in physical activity. Addressing these barriers may be key to increasing participation in physical activity and exercise. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-01024-y.
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Affiliation(s)
- Courtney J Lightfoot
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, LE17RH, UK. .,Leicester NIHR Biomedical Research Centre, Leicester, UK.
| | - Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, LE17RH, UK.,Leicester NIHR Biomedical Research Centre, Leicester, UK
| | - Yan Song
- Medical School, Nantong University, Nantong, China
| | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, LE17RH, UK.,Leicester NIHR Biomedical Research Centre, Leicester, UK
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Comparison of the Effects of Visual and Auditory Distractions on Fistula Cannulation Pain among Older Patients Undergoing Hemodialysis: A Randomized Controlled Clinical Trial. Geriatrics (Basel) 2020; 5:geriatrics5030053. [PMID: 32948045 PMCID: PMC7555170 DOI: 10.3390/geriatrics5030053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/28/2020] [Accepted: 09/15/2020] [Indexed: 11/16/2022] Open
Abstract
Pain associated with fistula cannulation is a challenge for nurses who provide care to older patients undergoing hemodialysis. Several non-pharmacological methods have been suggested for relieving fistula cannulation pain, but the benefits of visual and auditory distraction methods among older patients undergoing hemodialysis have not been investigated yet. Therefore, this study aimed to compare the effects of visual and auditory distractions on fistula cannulation pain among older patients undergoing hemodialysis. This randomized controlled clinical trial was conducted on 120 older patients undergoing hemodialysis. They were randomly assigned to three groups of visual distraction, auditory distraction, and the control (n = 40 in each group) using a simple random assignment method. The distraction interventions continued for three consecutive sessions and the numeric rating scale of pain severity was used for data collection. Descriptive and inferential statistics were used for data analysis using SPSS. It was found that pain severity significantly reduced after the distraction interventions in either the auditory or visual distraction groups and also after all three distraction sessions (p = 0.001). However, visual distraction had a better effect on the reduction of pain severity. Therefore, while both visual and auditory distractions reduced pain severity in older patients undergoing hemodialysis, visual distraction was more effective. Nurses are encouraged to incorporate visual distraction as a safe and non-pharmacologic technique into routine nursing care for reducing older patients’ suffering and improving their wellbeing when fistula cannulation is performed.
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