Kidney transplantation: determination of the problems encountered by Turkish patients and their knowledge and practices on healthy living

The phenomenon of urinary tract infection experienced by women with a kidney transplant

BACKGROUND

Urinary tract infection is the most common infection among people with a kidney transplant and increases the risk of graft rejection. Women have a higher risk. A literature search did not identify any description of the phenomenon of urinary tract infection experienced by women with a kidney transplant.

OBJECTIVE

To examine how women with a kidney transplant experienced the phenomenon of a urinary tract infection.

DESIGN

A qualitative study with a phenomenological approach.

APPROACH

Eight individual semistructured interviews based on van Manen's four lifeworld existentials and analysed using systematic text condensation.

PARTICIPANTS

Women with a kidney transplant and recently been admitted to the hospital due to a urinary tract infection.

FINDINGS

We identified four themes: (1) Feeling both typical and atypical symptoms; (2) Becoming aware of the body and trying her best to prevent urinary tract infection; (3) Having a urinary tract infection is a dual experience, both good and bad; (4) Support from relatives.

CONCLUSION

The urinary tract infection symptoms pathway varied between participants but also between individual episodes of incidents among each participant. Participants felt secure when they experienced a common symptom pattern, but a new symptom pattern made them insecure. Together with their relatives, they experienced a urinary tract infection as a disruption of their everyday life and it decreased their experiences of happiness. They experienced to be supported by relatives but also by healthcare professionals, but needed more information on how to prevent, observe and react to a urinary tract infection in the future.

Life Quality and Compliance After Transplant: The Case of Turkey

OBJECTIVE

Chronic renal failure is one of the most significant health problems in Turkey, as it is all over the world, and negatively affects quality of life. The aim of this study is to find factors affecting compliance levels and quality of life of patients undergoing kidney transplant.

MATERIALS AND METHODS

The population of the study consisted of 244 patients who underwent kidney transplant. Although the study aimed to cover the entire target population in the sampling selection, it was conducted among 206 patients. The data were collected by face-to-face interview.

RESULTS

Of the patients, 92.7% were between 46 and 59 years of age, 54.4% had a living donor transplant, 54.9% had adverse effects, and 2.9% had rejection due to incompatibility. There was a significant relationship between compliance and quality of life; increasing frequency of adverse effects would decrease in direct proportion to compliance, which would, therefore, increase quality of life. All the subscale scores of the 36-Item Short Form Health Survey were found to have an average of 60 and above. The mean of the compliance scale was 48.33 (SD, 3.21), and, with the maximum score at 55, the mean of the group was high. In our country, patients view transplant as a final and definite treatment method. This might be related to fact that the longer the time after transplant, the lower the level of compliance.

Level of Daily Life Activities and Learning Needs in Renal Transplant Patients

OBJECTIVES

Transplantation affects the patient's psychological state and daily life activities. Although there are various studies regarding the quality of life of patients, there are limited studies on the daily life activities and learning needs of patients after renal transplant. Here, we investigated the daily life activities and learning needs of patients after renal transplant.

MATERIALS AND METHODS

This descriptive and cross-sectional study was conducted on 120 renal transplant recipients. Data were collected using the "Patient Information Form," the "Nottingham Extended Activities of Daily Living Scale," and the "The Patient Learning Needs Scale." Data were evaluated with t test, analysis of variance, and Pearson correlation analyses.

RESULTS

In our patient group, the mean general health score was 6.8 ± 2.34, and the fatigue score was 4.53 ± 2.88. Although 66.7% of our patients reported that they had information about the drugs that they used, 58.3% could not answer questions regarding the most important adverse effects of their drugs. We found that 20% of the patients had a respiratory problem, 34.2% had sexual problems, and 26.7% had sleep problems. The average Nottingham Extended Activities of Daily Living Scale levels were lower in patients with only primary school education, patients who did not work, and patients with other illnesses. Learning needs of patients were as follows in order: quality of life, feelings related to the conditions, treatment, and complications.

CONCLUSIONS

Our study patients reported that their overall daily life activities and quality of life, given the holistic approach to treatment and care, were good. However, when we examined each activity separately, our findings showed that patients lacked information regarding how to cope with stress, emotions, and the effects of renal transplant on their life.

Medication compliance and lifestyle adherence in renal transplant recipients in Kuwait

INTRODUCTION AND AIM

Kidney transplantation is the optimal treatment choice for end stage renal disease; this option needs a major change in the recipients' lifestyle and requires strict adherence to medications. The study aim was to assess the compliance of renal transplant patients to medications and lifestyle modifications in the Hamed Al-Essa Organ Transplant Center in Kuwait.

PATIENTS AND METHODS

One-hundred and twenty renal transplant patients were interviewed for their lifestyle behaviors after transplantation, including transplant adherence to their medications, healthy meals, personal hygiene, physical activity, regular out-patient follow up visits, and preventive measures against infection and cancer, in addition to sexual function. The questionnaire used was created by staff of the Faculty of Medicine, Mansura University, Egypt.

RESULTS

Sixty percent of the renal transplant patients were compliant with medications and lifestyle. Risk factors associated with poor medication compliance were being Kuwaiti citizens, women, and having had unrelated living donors (p<0.05). Compliance with medications was associated with less transplant related complications (p=0.003). Only 15% of the participants were compliant with low-salt diet, 8% with low-fat, and 11% with low-carb. One fourth of patients were compliant with a daily shower and 20% were physically active. More than 70% of the patients were regularly visiting the out-patient clinic. Compliance to preventive measures against infection was observed in 85% of patients but only 5% were avoiding direct sun exposure. Half of the male patients had sexual dysfunction but only half of them were consulting their nephrologists about it.

CONCLUSION

Kidney transplant patients in Kuwait had moderate compliance with medications and lifestyle modifications. Closer assessment is needed to identify the risk factors before and after transplantation to avoid any complications associated with non-compliance.

Skin Cancer Risk Awareness and Sun-Protective Behavior Among Solid-Organ Transplant Recipients

OBJECTIVES

Solid-organ transplant recipients are at an increased risk of developing skin cancer; this risk is due to long-term graft-preserving immunosuppressive therapy, and excessive sun exposure is a major contributing factor to this process. The aim of this study was to evaluate the skin cancer awareness and sun-protective behavior of solid-organ transplant recipients.

MATERIALS AND METHODS

In all, 70 consecutive solid-organ transplant recipients were evaluated regarding knowledge of their increased skin cancer risk and regarding the influence of this knowledge on their sun-protective practices, by applying a questionnaire during their routine check-up visits.

RESULTS

Of 70 solid-organ transplant recipients, 38 (54.3%) stated knowledge of hazardous consequences of sun exposure; however, only 28 (40%) had the knowledge of causal relationship between sun and skin cancer development. There were 31 patients (44.3%) who were unable to recall anybody giving any information to them about sun protection, and 40 patients (57.1%) had never visited a dermatology clinic. The 10 solid-organ transplant recipients (14.3%) who used sunscreen creams daily had been undergoing regular dermatologic examination. Regarding sun-protective clothing, only 8 patients (11.4%) had been wearing a suitable hat, long sleeves, and sunglasses when outdoors. There was a statistically significant difference between the groups who had visited a dermatology clinic versus those who had not regarding knowledge of sun protection, the causal relationship between sun exposure and skin cancer, the use of sunscreens, and use of sun-protective clothing (P < .05).

CONCLUSIONS

Our data showed that dermatologic examination and education of patients about skin cancer development and sunscreen measures improved the sun-protective habits of solid-organ transplant recipients. Therefore, orderly visits once or twice a year should be strongly advised for this patient population by their medical care providers.

Quality of life and protein-energy wasting in kidney transplant recipients

PURPOSE

Chronic kidney disease has profound effects on the health-related quality of life (HRQoL) of patients, with serious physiological, psychological and socio-economic implications. The co-occurrence of protein-energy wasting and inflammation in end-stage renal disease patients is associated with worse HRQoL and increased mortality. We designed this study to examine the relationship between nutritional and inflammatory status and HRQoL in kidney transplant recipients.

METHODS

Data from 100 randomly selected kidney transplant patients were analyzed in a cross-sectional survey. Socio-demographic parameters, laboratory results, transplantation-related data, comorbidities, medication and malnutrition-inflammation score (MIS) (Kalantar Score) were tabulated at baseline. Patients completed the Kidney Disease Quality of Life-SF (KDQoL-SF™) self-administered questionnaire.

RESULTS

Mean age was 51 ± 13 years, median (interquartile range, IQR) time since transplantation 66 (83) months, 57% were men, and 19% had diabetes. The median (IQR) MIS was 3 (3). The MIS significantly and negatively correlated with almost all HRQoL domains analyzed, and this association remained significant in multivariate linear regression analysis for the log-transformed scores on energy/fatigue (β = -0.059 P < 0.001), bodily pain (β = -0.056 P = 0.004), physical functioning (β = -0.029, P = 0.022) and symptoms/problems (β = -0.023 P = 0.005) domains after statistical correction for age, gender, eGFR, dialysis vintage, Charlson Comorbidity Index and occupational status. Additionally, cubic spline analyses revealed linearly increasing, "dose-response" relationship between almost all domains of KDQoL-SF™ and the MIS.

CONCLUSIONS

Malnutrition-inflammation score is independently associated with different dimensions of HRQoL in kidney transplant recipients.

[Kidney transplanted patients: nursing diagnoses association analysis]

Chronic kidney inadequacy is a disease with serious physical, psychological and socioeconomic implications for the patient. The renal transplant provides life quality to chronic renal patients. The purpose of this study is to analyze associations among nursing diagnoses, related factors and defining characteristics present in renal transplanted patients of a university hospital. A descriptive, exploratory, cross sectional study was performed with 58 patients from December 2004 to April, 2005. Data collection instruments were: interview scripts and physical exams. Results showed associations between Sleep pattern disturbance and Sexual dysfunction, Sleep pattern disturbance and Altered sexuality pattern, Sexual dysfunction and Altered sexuality pattern. The study contributes for the identification of nursing diagnoses related to specific characteristics of these patients.

Diagnósticos de enfermagem em adultos em tratamento de hemodiálise

OBJETIVO: Analisar a distribuição dos diagnósticos de enfermagem presentes em adultos de uma clínica de hemodiálise de Petrópolis - Rio de Janeiro. MÉTODOS: Estudo quantitativo do tipo transversal, de caráter exploratório e descritivo. Foram avaliados 20 pacientes nos meses de abril e maio de 2006. Os instrumentos de coleta de dados foram: roteiro de entrevista e exame físico. RESULTADOS: Verificou-se que metade eram mulheres, sendo a maioria casada, com média de 2 filhos. Foram identificados 16 diagnósticos de enfermagem, quatro desses acima do percentil 75, são eles: Risco de infecção; Perfusão tissular ineficaz: renal; Padrão de sono perturbado e Intolerância à atividade. CONCLUSÃO: O estudo proporcionou maior conhecimento da realidade desses pacientes, contribuindo para uma possível implementação de ações de enfermagem mais eficientes para a solução dos problemas identificados.

Prolonged rehospitalizations following renal transplantation: causes, risk factors, and outcomes

BACKGROUND

Although some studies have described rehospitalization after transplantation, few have focused on risk factors and consequences of prolonged hospital stay. Our goal was to determine the causes, risk factors, and outcomes of prolonged rehospitalizations after renal transplantation.

PATIENTS AND METHODS

In this retrospective study, 574 randomly selected rehospitalization records of kidney transplant recipients were reviewed from 1994 to 2006. Admissions were divided into group 1, prolonged stay (length of stay >14 days, n=149), and group II, short stay (length of stay <or=14 days, n=425). Demographic data, cause of end-stage renal disease (ESRD), cause of readmission, ICU admission, time interval between transplantation and rehospitalization, costs, and in-patient mortality were compared between the two groups.

RESULTS

Mean (+/-SD) hospital stay was 10.6 +/- 9.8 days. Median hospital stay was 5 days for renal stones, 7 days for surgical complications, 8 days for malignancy, 9 days for infection, and 10 days for renal dysfunction. We found higher rates of ESRD due to diabetes in group I (28% vs. 15.4%; P=.006). Admissions due to infections (56.4% vs 42.4%; P=.003) or renal dysfunctions (55% vs 41.4%; P=.004) were the cause of higher proportions of total hospitalizations with prolonged stay. Prolonged stay also correlated with higher ICU admissions (8.8% vs 2.8%; P=.002) and mortality (6.7% vs 3.05%; P=.001). Mean total hospital cost for short versus prolonged hospitalizations were US$ 586 versus US$ 2750, respectively.

CONCLUSION

In this study, we found that prolonged hospital stays accounted for >62% of all hospital costs; however, they comprised only 26% of the patients. High-risk kidney transplant recipients for prolonged hospitalizations should be closely observed for infections and graft rejection.

Health-related quality of life among haemodialysis patients--relationship with clinical indicators, morbidity and mortality

AIM

To verify the association between quality of life and morbidity, mortality and clinical indicators in haemodialysis patients.

BACKGROUND

While a number of therapies have been reported to increase quality of life in end-stage renal disease, patients report that they remain substantially burdened by limited physical functioning and by dialysis-related symptoms. Indeed, quality of life may be the most critical outcome for those undergoing haemodialysis. Furthermore, quality of life has been associated with clinical indicators, morbidity and survival in haemodialysis patients.

DESIGN

Descriptive cohort study of patients undergoing haemodialysis at the Nephrology Hemodialysis Unit of the Hospital de Clínicas in Porto Alegre, Brazil.

METHODS

Forty haemodialysis patients were followed for 12 months and evaluated for demographics, time on dialysis, diabetes mellitus, clinical indicators (dose of dialysis--Kt/V, haematocrit and serum albumin) and comorbidities. The comorbidities were evaluated with the end-stage renal disease severity index and health-related quality of life with The Medical Outcomes Study 36 (SF-36).

RESULTS

Men present higher health-related quality of life scores in the energy and fatigue component (P = 0.04). Patients treated for over one year at the beginning of follow up and patients with less schooling had better results in General Health Perception (P < 0.05). The health-related quality of life evaluation of patients who later died showed that they already had a worse perception of physical functioning as compared to the survivors (P = 0.05). Patients with diagnosed diabetes perceived their physical functioning more negatively compared with those with other etiologies of end-stage renal disease (P = 0.045). We found a correlation between physical functioning and serum albumin (r = 0.341, P < 0.05) and between physical functioning and haematocrit (r = 0.317, P < 0.05). The end-stage renal disease severity index was more strongly related to physical functioning (r = -0.538, P < 0.001). Comparing the patients' results to the indicators above and below the established targets, we observed a trend to worse health-related quality of life in patients with Kt/V above target. However, in the case of albumin, patients with results above target tended to have better results.

CONCLUSION

A close relationship was observed between quality of life and morbidity and mortality. Among the clinical indicators, albumin and haematocrit have the greatest influence on quality of life.

RELEVANCE TO CLINICAL PRACTICE

Haemodialysis patients experience various problems that may adversely influence their quality of life. Special care must be given to those who have diabetes mellitus, high morbidity scores, low serum albumin and low haematocrits.

Disease-Specific Quality of Life in Turkish Patients After Successful Kidney Transplantation

To investigate disease-specific quality of life (QOL) in Turkish patients after successful kidney transplantation, the End-Stage Renal Disease Symptom Checklist Transplantation Module (ESRD-SCL-TM), a multidimensional questionnaire measuring disease-specific QOL, was translated and administered to a sample of successfully transplanted patients. Intercultural differences between Turkish and German patients as well as the influence of demographic (age, gender) and clinical (duration of graft function, living versus cadaver transplantation) data in the Turkish patients were evaluated by multivariate analyses of variance, and correlative techniques. The 152 investigated Turkish patients, including 106 (69.7%) men and 46 (30.3%) women, had a mean age of 34.8 years (SD = 10.8, range, 14 to 67 years). Time since successful kidney transplantation varied between 1 and 297 months (mean = 19.2 months; SD = 36.9). One hundred twelve patients (73.7%) received a kidney from a living donor, and 40 (26.3%) from a cadaver. The Turkish patients suffered statistically significantly more from disease-specific distress than the German patients (19% explanation of variance). They reported higher distress regarding four of six subscales. Turkish women suffered statistically significantly more from "Limited Physical Capacity," and "Side-effects of Corticosteroids" (10% explanation of variance) than men. The demonstrated higher disease-specific distress in successfully transplanted Turkish patients compared to the German samples may be the result of intercultural differences in reporting psychological and disease-specific distress. On the other hand, the higher distress of women compared to men is well known. Both results pointed out the necessity of psychological support.