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Kanbay M, Basile C, Battaglia Y, Mantovani A, Yavuz F, Pizzarelli F, Luyckx VA, Covic A, Liakopoulos V, Mitra S. Shared decision making in elderly patients with kidney failure. Nephrol Dial Transplant 2024; 39:742-751. [PMID: 37742209 PMCID: PMC11045282 DOI: 10.1093/ndt/gfad211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Indexed: 09/26/2023] Open
Abstract
'Elderly' is most commonly defined as an individual aged 65 years or older. However, this definition fails to account for the differences in genetics, lifestyle and overall health that contribute to significant heterogeneity among the elderly beyond chronological age. As the world population continues to age, the prevalence of chronic diseases, including chronic kidney disease (CKD), is increasing and CKD frequently progresses to kidney failure. Moreover, frailty represents a multidimensional clinical entity highly prevalent in this population, which needs to be adequately assessed to inform and support medical decisions. Selecting the optimal treatment pathway for the elderly and frail kidney failure population, be it haemodialysis, peritoneal dialysis or conservative kidney management, is complex because of the presence of comorbidities associated with low survival rates and impaired quality of life. Management of these patients should involve a multidisciplinary approach including doctors from various specialties, nurses, psychologists, dieticians and physiotherapists. Studies are mostly retrospective and observational, lacking adjustment for confounders or addressing selection and indication biases, making it difficult to use these data to guide treatment decisions. Throughout this review we discuss the difficulty of making a one-size-fits-all recommendation for the clinical needs of older patients with kidney failure. We advocate that a research agenda for optimization of the critical issues we present in this review be implemented. We recommend prospective studies that address these issues, and systematic reviews incorporating the complementary evidence of both observational and interventional studies. Furthermore, we strongly support a shared decision-making process matching evidence with patient preferences to ensure that individualized choices are made regarding dialysis vs conservative kidney management, dialysis modality and optimal vascular access.
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Affiliation(s)
- Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
| | - Yuri Battaglia
- Department of Medicine, University of Verona, Verona, Italy
- Nephrology and Dialysis Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Furkan Yavuz
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | | | - Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center – ‘C.I. Parhon’ University Hospital, and ‘Grigore T. Popa’ University of Medicine, Iasi, Romania
| | - Vassilios Liakopoulos
- Second Department of Nephrology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sandip Mitra
- Manchester Academy of Health Sciences Centre (MAHSC), Manchester University Hospitals and University of Manchester, Manchester, UK
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Martino FK, Novara G, Nalesso F, Calò LA. Conservative Management in End-Stage Kidney Disease between the Dialysis Myth and Neglected Evidence-Based Medicine. J Clin Med 2023; 13:41. [PMID: 38202048 PMCID: PMC10779521 DOI: 10.3390/jcm13010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
In the last few decades, the aging of the general population has significantly increased the number of elderly patients with end-stage kidney disease (ESKD) who require renal replacement therapy. ESKD elders are often frail and highly comorbid with social issues and seem to not benefit from dialysis in terms of survival and quality of life. Conservative management (CM) could represent a valid treatment option, allowing them to live for months to years with a modest impact on their habits. Despite these possible advantages, CM remains underused due to the myth of dialysis as the only effective treatment option for all ESKD patients regardless of its impact on quality of life and survival. Both CM and dialysis remain valid alternatives in the management of ESKD. However, assessing comorbidities, disabilities, and social context should drive the choice of the best possible treatment for ESKD, while in elderly patients with short life expectancies, referring them to palliative care seems the most reasonable choice.
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Affiliation(s)
- Francesca K. Martino
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, 35124 Padua, Italy; (F.K.M.); (F.N.)
| | - Giacomo Novara
- Department of Surgery, Oncology and Gastroenterology, Urology Clinic University of Padua, 35124 Padua, Italy
| | - Federico Nalesso
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, 35124 Padua, Italy; (F.K.M.); (F.N.)
| | - Lorenzo A. Calò
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, 35124 Padua, Italy; (F.K.M.); (F.N.)
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Alshammari B, Alkubati SA, Pasay-an E, Alrasheeday A, Madkhali N, Edison JS, Bakthavatchaalam V, Alshammari MS, AlRashidi AA, Alshammari F. The influence of social support on sleep and fatigue level among patients receiving hemodialysis in Saudi Arabia: a cross-sectional correlational design. Front Psychol 2023; 14:1272500. [PMID: 38148785 PMCID: PMC10749965 DOI: 10.3389/fpsyg.2023.1272500] [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: 08/14/2023] [Accepted: 11/27/2023] [Indexed: 12/28/2023] Open
Abstract
Background Patients on hemodialysis (HD) are more likely to experience sleep problems and fatigue that may affect their health outcomes. Management of these patients with social support may improve their sleep quality and fatigue as well as their health. Aim This study aimed to assess the influence of social support on sleep quality and fatigue levels among HD patients. Methods A cross-correlational study was conducted among 260 conveniently sampled HD patients from four dialysis centers in Hail and Al-Qassim cities of Saudi Arabia from Jun 2022 to January 2023. Besides sociodemographic data, the Pittsburgh Sleep Quality Index (PSQI), the Multidimensional Assessment of Fatigue (MAF) and the Oslo Social Support Scale (OSSS-3) were used to assess sleep quality, fatigue levels and social support, respectively. Chi-square test was used to determine the association between categorical variables, while Pearson's correlation coefficient was used to test the correlation between sleep quality, fatigue, and social support. Results Poor sleep and high fatigue were significantly higher in older patients compared to younger patients (p <0.001), while strong social support was significantly lower in older patients than younger and middle-aged ones (p = 0.001). On the other hand, poor sleep and high fatigue were significantly higher in males than females (p = 0.022 and p <0.001, respectively), while strong social support was significantly higher in females than males (p <0.001). Married patients showed significantly poorer sleep than single ones (p = 0.019), but single patients received significantly stronger social support. Retired patients showed significantly poorer sleep, higher fatigue and weaker social support than other groups (p <0.001). There was a significant negative correlation between fatigue and sleep quality among HD patients, where patients with more fatigue had poorer sleep (r = -0.510, p <0.001). A significant positive correlation was found between social support and sleep quality, where patients with stronger social support had more normal sleep (r = 0.415, p <0.001). However, a significant negative correlation was found between social support and fatigue, where patients with stronger social support had lower levels of fatigue (r = -0.479, p <0.001). Conclusion Saudi patients on HD who have stronger social support have better sleep quality and reduced fatigue levels than those with less social support. There is a need to design and implement intervention studies with structured social support programs, and to evaluate their effectiveness on improving sleep and reducing fatigue among HD patients.
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Affiliation(s)
- Bushra Alshammari
- Department of Medical Surgical Nursing, College of Nursing, University of Hail, Hail, Saudi Arabia
| | - Sameer A. Alkubati
- Department of Medical Surgical Nursing, College of Nursing, University of Hail, Hail, Saudi Arabia
- Department of Nursing, Faculty of Medicine and Health Sciences, Hodeida University, Hodeida, Yemen
| | - Eddieson Pasay-an
- Department of Medical Surgical Nursing, College of Nursing, University of Hail, Hail, Saudi Arabia
| | - Awatif Alrasheeday
- Department of Nursing Administration, College of Nursing, University of Hail, Hail, Saudi Arabia
| | - Norah Madkhali
- Department of Nursing, College of Nursing, Jazan University, Jazan, Saudi Arabia
| | - J. Silvia Edison
- Department of Medical Surgical Nursing, College of Nursing, University of Hail, Hail, Saudi Arabia
| | | | - Marim Saud Alshammari
- Department of Health Awareness, King Salman Specialist Hospital, Hail Health Cluster, Hail, Saudi Arabia
| | - Amnah Ayed AlRashidi
- Department of Obstetrics and Gynecology, Hail General Hospital, Hail Health Cluster, Hail, Saudi Arabia
| | - Farhan Alshammari
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail, Saudi Arabia
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Martínez-Magaña JF, Godínez-Victoria M, García-Hernández AL, Noyola-Ávila I. [Peritoneal dialysis impact on quality of life in elderly]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:S429-S436. [PMID: 37934898 PMCID: PMC10750793 DOI: 10.5281/zenodo.8319823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/08/2023] [Indexed: 11/09/2023]
Abstract
Background Nowadays elderly live longer but with more diseases and geriatric syndromes which can deteriorate their quality of life (QoL). Peritoneal dialysis (PD) is a renal replacement therapy which seeks to prolong an improve QoL; however, this is uncertain in elderly. Therefore, comparing QoL before and after starting dialysis in this population may let us know if there is a benefit at this level. Objective Identify the QoL that patients have before and after PD. Material and methods Longitudinal, comparative, prospective cohort, before and after study. Elderly with End Stage Renal Disease in whom hospitalization for PD was indicated. QoL was measured the instrument KDQOL SF 1.3. before and after 2 months of PD. Statistical Analysis: T paired test was performed with the basal value of QoL and after. Risks with 95% confidence intervals and X2 were obtained between the basal characteristics and the dependent variable of QoL. Results 21 patients. After 2 months the QoL had an increment in comparison to basal QoL, but with no statistical significance (63.47 [SD 16.63] Vs 56.83 [16.01], P= 0.22. In the 7th decade PD increased QoL by 13.01 points (P= 0.04). Conclusions PD increases QoL in the 7th decade.
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Affiliation(s)
- Josafat Francisco Martínez-Magaña
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital General “Dr. Gaudencio González Garza”, Servicio de Medicina Interna y Geriatría. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Marycarmen Godínez-Victoria
- Instituto Politécnico Nacional, Escuela Superior de Medicina, Sección de Estudios de Posgrado e Investigación. Ciudad de México, MéxicoInstituto Politécnico NacionalMéxico
| | - Ana Lilia García-Hernández
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital General “Dr. Gaudencio González Garza”, Servicio de Medicina Interna y Geriatría. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Immer Noyola-Ávila
- Universidad Nacional Autónoma de México, Facultad de Estudios Superiores Iztacala, Sección de Osteoinmunología, Laboratorio de Investigación Odontológica. Cuautitlán Izcalli, Estado de México, MéxicoUniversidad Nacional Autónoma de MéxicoMéxico
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Tan W, Boodagh P, Selvakumar PP, Keyser S. Strategies to counteract adverse remodeling of vascular graft: A 3D view of current graft innovations. Front Bioeng Biotechnol 2023; 10:1097334. [PMID: 36704297 PMCID: PMC9871289 DOI: 10.3389/fbioe.2022.1097334] [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: 11/13/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
Vascular grafts are widely used for vascular surgeries, to bypass a diseased artery or function as a vascular access for hemodialysis. Bioengineered or tissue-engineered vascular grafts have long been envisioned to take the place of bioinert synthetic grafts and even vein grafts under certain clinical circumstances. However, host responses to a graft device induce adverse remodeling, to varied degrees depending on the graft property and host's developmental and health conditions. This in turn leads to invention or failure. Herein, we have mapped out the relationship between the design constraints and outcomes for vascular grafts, by analyzing impairment factors involved in the adverse graft remodeling. Strategies to tackle these impairment factors and counteract adverse healing are then summarized by outlining the research landscape of graft innovations in three dimensions-cell technology, scaffold technology and graft translation. Such a comprehensive view of cell and scaffold technological innovations in the translational context may benefit the future advancements in vascular grafts. From this perspective, we conclude the review with recommendations for future design endeavors.
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Affiliation(s)
- Wei Tan
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, United States,*Correspondence: Wei Tan,
| | - Parnaz Boodagh
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Sean Keyser
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, United States
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Haug K, Buffington A, Zelenski A, Hanlon BM, Stalter L, Kwekkeboom KL, Rathouz P, Bansal AD, Cheung K, Crews D, Frazier R, Koncicki H, Lam D, Moss A, Rao M, Wolfgram DF, Yi J, Brill C, Kendrick R, Campbell TC, Jhagroo R, Schwarze M. Best Case/Worst Case: protocol for a multisite randomised clinical trial of a scenario planning intervention for patients with kidney failure. BMJ Open 2022; 12:e067258. [PMID: 36328383 PMCID: PMC9639110 DOI: 10.1136/bmjopen-2022-067258] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Given the burdens of treatment and poor prognosis, older adults with kidney failure would benefit from improved decision making and palliative care to clarify goals, address symptoms, and reduce unwanted procedures. Best Case/Worst Case (BC/WC) is a communication tool that uses scenario planning to support patients' decision making. This article describes the protocol for a multisite, cluster randomised trial to test the effect of training nephrologists to use the BC/WC communication tool on patient receipt of palliative care, and quality of life and communication. METHODS AND ANALYSIS We are enrolling attending nephrologists, at 10 study sites in the USA, who see outpatients with advanced chronic kidney disease considering dialysis. We aim to enrol 320 patients with an estimated glomerular filtration rate of ≤24 mL/min/1.73 m2 who are age 60 and older and have a predicted survival of 18 months or less. Nephrologists will be randomised in a 1:1 ratio to receive training to use the communication tool (intervention) at study initiation or after study completion (wait-list control). Patients in the intervention group will receive care from a nephrologist trained to use the BC/WC communication tool. Patients in the control group will receive usual care. Using chart review and surveys of patients and caregivers, we will test the efficacy of the BC/WC intervention with receipt of palliative care as the primary outcome. Secondary outcomes include intensity of treatment at the end of life, the effect of the intervention on quality of communication (QOC) between nephrologists and patients (using the QOC scale), the change in quality of life (using the Functional Assessment of Chronic Illness Therapy-Palliative Care scale) and receipt of dialysis. ETHICS AND DISSEMINATION Approvals have been granted by the Institutional Review Board at the University of Wisconsin (ID: 2022-0193), with each study site ceding review to the primary IRB. All nephrologists will be consented and given a copy of the consent form. No patients or caregivers will be recruited or consented until their nephrology provider has chosen to participate in the study. Results will be disseminated via submission for publication in a peer-reviewed journal and at national meetings. TRIAL REGISTRATION NUMBER NCT04466865.
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Affiliation(s)
- Karlie Haug
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Anne Buffington
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Amy Zelenski
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Bret M Hanlon
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Biostatistics & Medical Informatics, University of Wisconsin, Madison, WI, USA
| | - Lily Stalter
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Kristine L Kwekkeboom
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- School of Nursing, University of Wisconsin, Madison, WI, USA
| | - Paul Rathouz
- Department of Biostatistics & Medical Informatics, University of Wisconsin, Madison, WI, USA
| | - Amar D Bansal
- Division of Nephrology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Katharine Cheung
- Division of Nephrology, University of Vermont, Burlington, Vermont, USA
| | - Deidra Crews
- Division of Nephrology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rebecca Frazier
- Division of Nephrology, Northwestern Memorial HealthCare Corp, Chicago, Illinois, USA
| | - Holly Koncicki
- Division of Nephrology, Mount Sinai Health System, New York, New York, USA
| | - Daniel Lam
- Division of Nephrology, University of Washington, Seattle, Washington, USA
| | - Alvin Moss
- Section of Nephrology, West Virginia University, Morgantown, West Virginia, USA
| | - Maya Rao
- Division of Nephrology, Columbia University, New York, New York, USA
| | - Dawn F Wolfgram
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jeniann Yi
- Department of Surgery, University of Colorado Health, Aurora, Colorado, USA
| | | | | | - Toby C Campbell
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Roy Jhagroo
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Margaret Schwarze
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Chan K, Wong FKY, Tam SL, Kwok CP, Fung YP, Wong PN. Effectiveness of a brief hope intervention for chronic kidney disease patients on the decisional conflict and quality of life: a pilot randomized controlled trial. BMC Nephrol 2022; 23:209. [PMID: 35701732 PMCID: PMC9195369 DOI: 10.1186/s12882-022-02830-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background Stage 5 chronic kidney disease (CKD) patients often experience decisional conflict when faced with the selection between the initiation of dialysis and conservative care. The study examined the effects of a brief hope intervention (BHI) on the levels of hope, decisional conflict and the quality of life for stage 5 CKD patients. Methods This is a single-blinded, randomized controlled trial (ClinicalTrials.gov identifier: NCT03378700). Eligible patients were recruited from the outpatient department renal clinic of a regional hospital. They were randomly assigned to either the intervention or the control group (intervention: n = 35; control: n = 37). All participants underwent a customized pre-dialysis education class, while the intervention group received also BHI. Data were collected prior to the intervention, immediately afterwards, and one month following the intervention. The Generalized Estimating Equation was used to measure the effects in the level of hope, decisional conflict scores (DCS) and Kidney Disease Quality of life (KDQOL-36) scores. Estimated marginal means and standard errors with 95% confidence intervals of these scores were also reported to examine the within group and between group changes. Results An increase of the hope score was found from time 1 (29.7, 1.64) to time 3 (34.4, 1.27) in the intervention group. The intervention had a significant effect on the KDQOL-36 sub-scores Mental Component Summary (MCS) (Wald χ2 = 6.763, P = 0.009) and effects of kidney disease (Wald χ2 = 3.617, P = 0.004). There was a reduction in decisional conflict in both arms on the DCS total score (Wald χ2 = 7.885, P = 0.005), but the reduction was significantly greater in the control group (effect size 0.64). Conclusions The BHI appeared to increase the level of hope within the intervention arm. Nonetheless, differences across the intervention and control arms were not significant. The KDQOL-36 sub-scores on MCS and Effects of kidney disease were found to have increased and be higher in the intervention group. The DCS total score also showed that hope was associated with reducing decisional conflict. Trial Registration ClinicalTrials.gov Protocol Registration, NCT03378700. Registered July 12 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02830-7.
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Affiliation(s)
- Kitty Chan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, People's Republic of China.
| | - Frances Kam Yuet Wong
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, People's Republic of China
| | - Suet Lai Tam
- Department of Medicine and Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, People's Republic of China
| | - Ching Ping Kwok
- Department of Medicine and Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, People's Republic of China
| | - Yuen Ping Fung
- Department of Medicine and Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, People's Republic of China
| | - Ping Nam Wong
- Department of Medicine and Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, People's Republic of China
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Kitamura M, Takazono T, Yamamoto K, Harada T, Funakoshi S, Mukae H, Nishino T. Low humoral immune response to the BNT162b2 vaccine against COVID-19 in nursing home residents undergoing hemodialysis: a case-control observational study. RENAL REPLACEMENT THERAPY 2022; 8:8. [PMID: 35308296 PMCID: PMC8924726 DOI: 10.1186/s41100-022-00397-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 03/08/2022] [Indexed: 12/30/2022] Open
Abstract
Background Patients on hemodialysis (HD) face a high mortality risk from coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and they are therefore prioritized for vaccination. However, the efficacy of vaccination in this vulnerable population has not been confirmed. Although age is negatively correlated with serum immunoglobulin (Ig) levels, humoral responses to vaccination in elderly patients undergoing HD have not been investigated. To address this issue, we evaluated the anti-SARS-CoV-2 spike protein antibodies in nursing home residents on HD after BNT162b2 vaccine administration. Methods Patients on HD from a nursing home and care workers (controls) receiving two doses of the BNT162b2 vaccine between April and May 2021 were enrolled in this study. Those with a prior history of COVID-19 were excluded. Anti-spike protein antibodies were measured with the Elecsys (Roche) immunoassay system. Results The study included 26 nursing home residents (41% male; median age, 86 years) and 184 care workers (28% male; median age, 45 years). The median HD vintage was 51 months. After two doses of BNT162b2, 73% of the nursing home residents and 99.5% of the control group developed sufficient anti-spike protein antibodies (> 29 U/mL) to neutralize SARS-CoV-2. Three weeks after the second dose, median IgG titers of the residents and care workers were 83 [interquartile range (IQR) 17–511] and 1365 (IQR 847–2245) U/mL, respectively (p < 0.001). Conclusions The humoral response to BNT162b2 among elderly HD patients was relatively low; therefore, the optimal vaccination strategy for this population should be studied further to avoid COVID-19 outbreaks in healthcare facilities. Supplementary Information The online version contains supplementary material available at 10.1186/s41100-022-00397-5.
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Affiliation(s)
- Mineaki Kitamura
- Nagasaki Renal Center, Nagasaki, Japan.,Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
| | - Takahiro Takazono
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Kazuko Yamamoto
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | | | | | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.,Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
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Soldati A, Poggi MM, Azzolino D, Vettoretti S, Cesari M. Frailty index and adverse outcomes in older patients in haemodialysis. Arch Gerontol Geriatr 2022; 101:104673. [DOI: 10.1016/j.archger.2022.104673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022]
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Kim EY, Son YJ. Developing a conceptual model of older patients' decision-making process in choosing dialysis or conservative care using meta-ethnography. J Adv Nurs 2021; 78:1-13. [PMID: 34227152 DOI: 10.1111/jan.14945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/13/2021] [Accepted: 06/15/2021] [Indexed: 01/23/2023]
Abstract
AIMS To systematically review and synthesize qualitative evidence related to decision-making for treatment modalities among older adults with end-stage renal disease. DESIGN A meta-synthesis of the qualitative research was conducted. DATA SOURCES A comprehensive literature review using PubMed, CINAHL, PsycINFO, Embase, Web of Sciences and Cochrane was systematically conducted. Qualitative studies published in English from January 2010 to October 2020 were considered. REVIEW METHODS Qualitative studies were systematically identified and critically appraised. Data synthesis was performed independently by two reviewers. This review followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement. RESULTS Seven qualitative studies, with publication years ranging from 2015 to 2019, were included in the analysis. Overall, the review comprised studies with a total of 133 participants aged between 61 and 93 years. Through meta-synthesis, three themes were identified: 'reflecting on treatment options', 'confronting difficult decisions' and 'maintaining hope in everyday life'. CONCLUSION Our findings reflect that older adults have varying preferences for treatment options. These preferences are influenced by various factors such as considering the possibility of opting for dialysis and the practical applicability of treatment options. The synthesized conceptual model serves as the first step towards the conceptualization of the treatment-related decision-making process facilitated by adequate communication, in which patients should be encouraged to speak up, and healthcare providers should listen actively to their patients. This review can provide a strategy for providers to communicate treatment options with older patients with ESRD. IMPACT Healthcare providers should be sensitive to older adults' preferences, priorities and treatment goals related to worrying about burdening their families and their outlook on life before deciding treatment modality. Our findings highlight that shared decision-making should be tailored to each of the older patients to provide comprehensive and individualized patient-centred care.
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Affiliation(s)
- Eun Young Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
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Abstract
OBJECTIVE To determine if addition of the S-nitrosylating agent ethyl nitrite (ENO) to the preservation solution can improve perfusion parameters in pumped human kidneys. BACKGROUND A significant percentage of actively stored kidneys experience elevations in resistance and decreases in flow rate during the ex vivo storage period. Preclinical work indicates that renal status after brain death is negatively impacted by inflammation and reduced perfusion-processes regulated by protein S-nitrosylation. To translate these findings, we added ENO to the preservation solution in an attempt to reverse the perfusion deficits observed in nontransplanted pumped human kidneys. METHODS After obtaining positive proof-of-concept results with swine kidneys, we studied donated human kidneys undergoing hypothermic pulsatile perfusion deemed unsuitable for transplantation. Control kidneys continued to be pumped a 4°C (ie, standard of care). In the experimental group, the preservation solution was aerated with 50 ppm ENO in nitrogen. Flow rate and perfusion were recorded for 10 hours followed by biochemical analysis of the kidney tissue. RESULTS In controls, perfusion was constant during the monitoring period (ie, flow rate remained low and resistance stayed high). In contrast, the addition of ENO produced significant and sustained reductions in resistance and increases in flow rate. ENO-treated kidneys had higher levels of cyclic guanosine monophosphate, potentially explaining the perfusion benefits, and increased levels of interleukin-10, suggestive of an anti-inflammatory effect. CONCLUSIONS S-Nitrosylation therapy restored the microcirculation and thus improved overall organ perfusion. Inclusion of ENO in the renal preservation solution holds promise to increase the number and quality of kidneys available for transplant.
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