[Influence of the nursing professional over the quality of life in patients receiving kidney transplants.]

BACKGROUND

Kidney transplantation represents the treatment choice for most people with chronic kidney disease due to the benefits it provides compared to other renal replacement therapies. This population requires specific monitoring, where the nursing professional must attend to determining factors of health-related quality of life (HRQoL) in order to guarantee an effective approach to the difficulties that arise. This bibliographic review pretends to determine the altered physical, psychological, and social components of health-related quality of life maintained by kidney transplant recipients as a way to improve quality of care through the most appropriate nursing interventions.

METHODS

The literature review was conducted in PubMed, Medes, LILACS, CINAHL, Dialnet and Scopus databases. From a total of 718 articles identified, 30 publications were selected in order to meet the aim of the review and the established inclusion, exclusion and PRISMA Statement criteria.

RESULTS

The quality of the published studies was set at a mean score of 6.07 according to the PEDro scale, for clinical trials and 10.5, according to the Amstar scale, for bibliographic reviews. 50% of the total were published in the last two years (2018-2019) and 75% are between Q1 and Q2 of the JCR and SJR impact factors.

CONCLUSIONS

An improvement in HRQoL has been identified in these patients compared to the previous period of dialysis, although it is not still comparable to the general population. The physical area seems to be the most affected. The nursing professional can develop health education, psychological counseling and self-management activities.

[SARS-CoV-2: recommendations on nursing care for dialyzed and transplanted patient]

Coronavirus disease 2019 is an infectious respiratory syndrome caused by the virus called SARS-CoV-2, belonging to the family of coronaviruses. The first ever cases were detected during the 2019-2020 pandemic. Coronaviruses can cause a common cold or more serious diseases such as Middle Eastern Respiratory Syndromes (MERS) and Severe Acute Respiratory Syndrome (SARS). They can cause respiratory, lung and gastrointestinal infections with a mild to severe course, sometimes causing the death of the infected person. This new strain has no previous identifiers and its epidemic potential is strongly associated with the absence of immune response/reactivity and immunological memory in the world population, which has never been in contact with this strain before. Most at risk are the elderly, people with pre-existing diseases and/or immunodepressed, dialyzed and transplanted patients, pregnant women, people with debilitating chronic diseases. They are advised to avoid contacts with other people, unless strictly necessary, and to stay away from crowded places, also observing scrupulously the recommendations of the Istituto Superiore di Sanità. In this article we detail the recommendations that must be followed by the nursing care staff when dealing with chronic kidney disease patients in dialysis or with kidney transplant patients. We delve into the procedures that are absolutely essential in this context: social distancing of at least one meter, use of PPI, proper dressing and undressing procedures, frequent hand washing and use of gloves, and finally the increase of dedicated and appropriately trained health personnel on ward.

Low-Activity Kidney Transplant Center, A Single-Center Experience: Early Care as a Major Challenge

OBJECTIVES

In many countries, some kidney transplants are performed in small centers, from which clinical data are rarely specifically reported. The aim of this study was to describe patient and graft survival rates and their correlates in a low-activity kidney transplant center.

MATERIALS AND METHODS

We performed a retrospective cohort study of all patients who underwent transplant between January 2002 and May 2012 at a university hospital. Patient, graft, and death-censored graft survival rates were assessed with Kaplan-Meier analyses and compared by log-rank test, with associated factors analyzed by Cox proportional hazards modeling.

RESULTS

Among a total of 162 patients, the mean age was 41.8 ± 13.5 years, and 92% received a living-donor graft. At 1, 3, and 5 years, patient survival was 88.6%, 86%, and 82.9%. Graft survival was 86.9%, 83%, and 77%, and death-censored graft survival was 98.1%, 96.6%, and 92.9% at the same time points. Most graft losses were due to patient death from infection and occurred within the first year after transplant. After adjustment, age over 42 years (hazard ratio of 3.94; 95% confidence interval, 1.39-11.13), deceased donor graft (hazard ratio of 11.41; 95% confidence interval, 1.2-108.35), and higher average education (hazard ratio of 4.96; 95% confidence interval, 1.01-24.32) were independently associated with graft loss.

CONCLUSIONS

The observed patient and graft survival rates were similar to those described in large databases; however, early mortality remains a major challenge. Improving posttransplant care is a key issue to increasing survival in small transplant centers.

Teaching Patients about Kidney Transplantation: Documentation

Increasing demands are being placed on transplant nurse coordinators for more precise documentation of their teaching of kidney transplant patients, but the amount of time nurses have for this added documentation remains unchanged or has diminished. After a thorough review of the literature, our transplant team found no patient teaching documentation format that assisted us in overcoming the problem of increased demands. Consequently, following the Joint Commission on Accreditation of Healthcare Organization standards, we developed a Renal Transplant Patient Teaching Record that has assisted our team in documenting the pre- and post-transplant patient teaching that we complete.

"We're not going to say it's suffering; we're going to say it's an experience": The lived experience of maternal caregivers in pediatric kidney transplantation

Advances in the surgical and immunological aspects of pediatric kidney transplantation have resulted in significant improvements in long-term outcome and survival rates. However, there continues to be a negative impact reported on overall family functioning despite the reported good health and quality of life for the transplanted child. This research utilizes a phenomenological approach to examine the lived experiences of seven mothers of children who had undergone kidney transplantation. Findings of the study illuminate that the experience of mothering in the context of pediatric kidney transplantation is reflected in (1) the significance of relationships to the experience of self; (2) the lived experience of time; and (3) opportunities for growth and personal development. This research identifies that, while maternal caregiving in this context is fraught with challenges, there are opportunities for the development of skills and personal growth within the experience. By embracing a strength-based perspective, social work is well positioned to offer support for maternal meaning-making and adjustment during times of stress and uncertainty.

Intrasubject Medication Adherence Patterns

The purpose of this prospective descriptive study was to explore the patterns of intrasubject (between medication) adherence of two similarly timed, twice-daily medications using the Medication Event Management System® electronic monitoring cap. Medication adherence was measured for 6 months using electronic monitoring in 25 adult renal-transplant recipients. Data were available from 7,119 electronic medication events. Results indicated that two twice-daily medications scheduled to be taken simultaneously were taken within 5 min of each other 77% of the time and within 10 min, 92% of the time. When only the first scheduled dose of the day was examined, the results are 79% and 95%, respectively. These findings are important to researchers and clinicians who must evaluate medication adherence in transplant recipients while balancing cost and subject burden. This study provides empirical support for monitoring a single immunosuppressive medication electronically to estimate medication adherence with double or triple immunosuppressive drug therapy.

Culturally Responsive Interventions to Enhance Immunosuppressive Medication Adherence in Older African American Kidney Transplant Recipients

Context

Immunosuppressive medication nonadherence is variable among older kidney transplant recipients and is a problem in African American recipients despite the severe consequences of this behavior. Many factors place older African American recipients at risk for medication nonadherence.

Objective

To provide an overview of interventions to enhance immunosuppressive medication adherence in older African American kidney transplant recipients using a culturally responsive model. Culturally sensitive, innovative, and transformation interventions are discussed. Situations when each intervention would be most and least appropriate are described.

Conclusion

Moving culturally appropriate interventions forward into practice and testing their effectiveness in improving adherence outcomes in vulnerable, older African American kidney transplant recipients is a worthy practice and research goal for transplant nursing.

The Development of Kidney Transplant Nursing

An analysis of published literature, interviews with early transplant nurses, and other primary source materials shows how evolving medical treatments for rejection, nurses' ability to learn on the job, and their commitment to patients influenced the development of kidney transplantation as a specialized area of practice. The work of these nurses work is discussed in the context of unfolding nursing specialization at the middle of the twentieth century.

An Overview of Transplant Immunosuppression--History, Principles, and Current Practices in Kidney Transplantation

From the historical first transplant in 1954 to the current transplant era, tremendous strides have been made in transplant immunology and immunosuppression. The most common immunosuppressive regimens use a combination of agents with differing modes of action to maximize efficacy and minimize the toxicities associated with each class of agent. The general categories of immunosuppressives are glucocorticoids, antimetabolites, calcineurin inhibitors, anti-lymphocyte antibody therapies (monoclonal and polyclonal), costimulation blockers, and mTOR inhibitors. This article reviews immunosuppressant medications, their actions, and significant side effects; discusses clinical management issues of immunosuppression; and describes future directions for the development of immunosuppressive medications.

BK Virus in Recipients of Kidney Transplants

Since its discovery in 1971, the BK virus, a human polyomavirus, has emerged as a significant cause of renal dysfunction and transplant graft loss in kidney transplant recipients. Improved screening methods have been effective in assisting in the early identification of the virus, and thus, prompt intervention to prevent the progression of the disease. Treatment options for the virus are limited; therefore, lowering immunosuppressive medications should be considered the first line of treatment. Current adjunctive therapies are not guaranteed to control the viral activity and may have limited therapeutic value.

The Independent Living Donor Advocate: An Essential Role for Living Kidney Donation

Prior to 2007, living kidney donors who donated a kidney to a person with chronic kidney disease were screened, educated, and cared for by the same healthcare team caring for the recipient of the transplant. The independent living donor advocate or advocate team was created out of the need to ensure that the rights of the person donating a kidney are protected, respected, and maintained. Transplant programs must now have an advocate or advocate team who is separate from the recipient healthcare team to provide objective support for the donor, without regard for the recipient, and avoid any perception of a conflict of interest between the donor and recipient.

[Kidney transplant coordinator, a collaborative nursing practice]

A transplant nurse coordinator presents her missions, notably with living donors wishing to give their kidney to a relative or close friend. This therapeutic solution requires a specific medical and legal procedure before the transplant, at the heart of which the kidney transplant nurse coordinator plays an essential role.

Live kidney transplant from an unrelated donor

This article provides an insight into the experience of live donation from the donor and recipient perspectives from diagnosis until 18 months after transplantation. The lead author details the diagnosis of end-stage renal failure in her partner and their decision for her to donate a kidney.

[The changing life of caregiving mothers of children with chronic kidney disease--a single case study]

BACKGROUND

The scientific literature shows, that caring parents of children with chronic kidney disease experience profound changes of life-world in terms of their welfare and their health. The different experiences that by the child's illness influenced the life-world of the parents in the two stages of life "living with peritoneal dialysis" and "living after kidney transplantation" have not yet been described in the German literature.

METHODOLOGY

To study the changing life-world in the two stages of life "living with peritoneal dialysis" and "living after kidney transplantation" of the child, a single case study was carried out. The mother was interviewed using a problem-centered-interview. The analysis of the interview was based on Mayring's technique of content analysis (2002).

RESULTS

The category system shows that mother's life-world is influenced by different experiences in both stages of life. Subjectively, the mother saw her greatest challenge during the "life with peritoneal dialysis" in following the hygienic rules and the prevention of peritation" was her fear that the donor kidney would be rejected by her child.

IMPLICATIONS

The results of this study correspond to the results of previous studies in the English literature. Healthcare professionals, including nurses can use the results of this study to build up a professional relationship, for empathic support and for improvement of parental well-being. Further qualitative research should focus on healthcare professionals' view regarding the experiences and needs of caring parents of children with chronic kidney disease in order to compare with parents' view.

Post-kidney transplant rejection and infection complications

The care of a patient after kidney transplant is multifactorial and complex, often involving other organ systems. The clinical picture can frequently be complicated with symptoms that may be misleading, and hence, challenging to assess. The nephrology nurse caring for the recipient of a transplant should be able to assess the entire clinical situation, rather than focus only on renal function. When caring for recipients of transplants, nephrology nurses need to use their extensive knowledge base and employ critical thinking skills. Although all members of the multidisciplinary team are important for success, the patient remains the focal point of the team. Post-transplant management will be successful when patients actively participate in their care. Patient teaching plays a critical role in this success, and it starts when a transplant is anticipated and continues as long as the grafted kidney is functioning.

[Caring for a patient before a kidney transplant]

Renal transplantation is one of the possible substitution treatments for end-stage chronic renal failure. Nurses have an important part to play both before and after the transplant through their technical, interpersonal and educational role.

Ethical issues in live donor kidney transplant: views of medical and nursing staff

OBJECTIVES

The ongoing development of live donor kidney transplant has generated many ethical dilemmas. It is important to be aware of the attitudes of transplant professionals involved in this practice.

MATERIALS AND METHODS

An anonymous and confidential questionnaire was sent to 236 members of the medical and nursing staff of the West London Renal and Transplant Centre, to assess their views on the ethics of the current practice of live donor kidney transplant.

RESULTS

Of the 236 questionnaires, 108 (45.8%) were returned. Respondents considered live donor kidney transplant ethically acceptable between blood relatives (100%), nonblood relatives and friends (92.6%), and strangers (47.2%). Most respondents were willing to donate a kidney to a blood relative (92.6%) or a nonblood relative or friend (81.5%), and 12.0% were willing to donate to a stranger. Considering themselves as potential recipients if they had end-stage renal disease, most would accept a kidney from a blood relative (91.7%) or nonblood relative or friend (85.2%),while 44.5% would accept a kidney from a stranger. The highest number of respondents (43.5%) believed that the recipient should approach the potential donor. About one-third believed there should be no financial reward, not even compensation for expenses, for donors; 8% favored direct financial rewards for donors known to recipients, and 18% favored rewards for donors not known to recipients. Slightly more than half were in favor of accepting donors with mild to moderate medical problems.

CONCLUSIONS

Live related and unrelated kidney donation are considered ethically acceptable procedures, and nondirected donation is gaining support among transplant professionals. A substantial minority favored direct financial rewards for donors, especially in the case of nondirected donation.

Caring for patients after kidney transplantation

This article examines the care and management of patients following solid organ transplantation. It focuses on kidney transplantation and the nursing role in optimising long-term patient outcomes and quality of life.

Clinical management of the HIV-positive kidney transplant recipient

Tremendous progress has been achieved in the management of HIV, allowing individuals infected with this virus to live longer, healthier lives; however, the result of this progress is that HIV-infected individuals are developing end stage liver and kidney disease, and many are either dying from organ failure or living on dialysis. HIV infection was once a contraindication to transplantation, but transplantation is now a possibility for carefully selected patients at several transplant centers in the United States. This article provides an overview of transplantation in patients with HIV infection and describes the evolving clinical management of HIV-infected transplant recipients.

[Comparison of quality of life between kidney transplant and hemodialysis patients]

PURPOSE

The purpose of this study was to discover kidney transplant and hemodialysis patients' quality of life(QOL) and provide basic data to improve their QOL.

METHOD

One hundred two hemodialysis patients and 106 kidney transplant patients were given a self-administered questionnaire from Mar. 6 to Mar. 31, 2006. The instrument consisted of demographic variables, therapeutic-related characteristics and QOL. Collected data was processed using the SPSS 12.0 statistical program for real numbers, percentages, ANCOVA, t-test, ANOVA, Stepwise multiple regression and the Scheffe test.

RESULTS

Kidney transplantpatients' QOL was higher than hemodialysis patients. The demographic variables which showed a significant difference in overall QOL were religion, children and monthly income for kidney transplantpatients and educational background for hemodialysis patients. The therapeutic-related variable which showed a significant difference in overall QOL was the patients' perceived health condition for both groups. The influencing factor on overall QOL for both groups was the health condition perceived by themselves. The total variance of the variable for QOL was 42% for kidney transplant patients and 19% for hemodialysis patients.

CONCLUSION

This study revealed that kidney transplant patients have a higher QOL and how patients perceive their health is the strongest influencing factor for QOL. However, there is a large difference between the demand and supply of kidney donors. To solve this problem the standards for donation should be reviewed and revised.

The role of the nurse post-renal transplantation

The previous article explored the role of the nurse pre-renal transplantation, which addressed the physical, psychological and educational support that the patient and family members require prior to this life-changing surgery. The following article explores the continual role of the nurse in caring for and educating the patient post-renal transplantation. Renal transplantation is considered the optimal treatment of choice for patients with end-stage renal failure (ESRF) and who are receiving dialysis. The nurse plays a pivotal role in assisting the patient in facing the many challenges that are associated post-renal transplantation, including the complications and the long-term physical and psychosocial implications.

Renal nursing and the Human Tissue Act 2004

The Human Tissue Act of 2004 was introduced in the UK on 1 September 2006. It replaced all Acts that previously governed the procurement and utilization of tissues, cells and organs. It has promoted changes in requirements predominantly in transplantation settings. Past research has highlighted a shortage of organs for transplantation, particularly in renal donation. The new act hopes to remedy this so that future renal transplantations will occur more frequently, therefore improving choice and quality of life for patients with end stage renal disease. For UK renal nurses, the implementation of the Human Tissue Act 2004 presents challenges requiring adaptations of prior learning with new nursing roles. Recommendations can be made to help during the change process. Kurt Lewin's model of change provides a foundation for the understanding and recognition of change processes that occur in the implementation of individual and organizational change.

The role of the nurse in pre-renal transplantation

The following two articles explores the role of the nurse in caring for and educating the patient both pre- and post-renal transplantation. The nurse plays a pivotal role in assisting the patient facing the many challenges that are associated with transplantation. Renal transplantation is considered the optimal treatment of choice for patients with end stage renal failure (ESRF) and who are receiving dialysis. This first article will explore the role that nurses play regarding the care of the patient pre-transplant, including the physical, psychological and educational support required to assist the patient and family members deal with the many challenges associated with transplantation.