Prevalence and predisposing factors of depressive symptoms in continuous ambulatory peritoneal dialysis patients: a cross-sectional single center study

BACKGROUND

The aim of this study was to identify the prevalence of the depressive symptoms and the factors associated with the depressive symptoms in peritoneal dialysis patients.

METHODS

A cross-sectional study was carried out to evaluate the prevalence and associated factors of depression in 132 continuous ambulatory peritoneal dialysis patients. Depression was evaluated using Zung Self-Rating Depression Scale. Sociodemographic and clinical characteristic were also investigated. Univariate analysis and multivariate logistic regression analysis were performed to select factors associated with depressive symptoms.

RESULTS

Their median age was 57.5 years, and 58.3% were male. The rate of depressive symptoms in peritoneal dialysis patients was 78.0%. The rate of moderate/severe depressive symptoms was 64.4%. Multivariable logistic regression analysis showed that lower serum hemoglobin was significantly associated with increased risks of depression (OR = 0.989, 95CI%=0.979-0.998, p = 0.023).

CONCLUSION

Depression was highly prevalent in the peritoneal dialysis patients. Serum hemoglobin was independent risk factor for depressive symptoms in peritoneal dialysis patients.

Adherence to the ambulatory peritoneal dialysis procedure and limitations of care of older adults or their caregivers

BACKGROUND

Continuous Ambulatory Peritoneal Dialysis is an appropriate technique for older adults and its success is mainly based on the correct exchange technique. However, individuals may present barriers to compliance, due to deterioration of physical and cognitive function, depression, and prevalence of visual impairments.

OBJECTIVE AND METHODOLOGY

A descriptive correlational study was conducted to determine the relationship between adherence to the continuous ambulatory peritoneal dialysis procedure and the limitations of care for older adults with chronic renal failure or their caregivers. For convenience, 54 participants from two institutions were selected. A home visit was made at exchange times and a certificate of sociodemographic variables was applied, data such as training days, time of performing the procedure and number of home visits they received were included. Adherence to the procedure was evaluated with a checklist of correctly performed steps in the dialysis technique with Ultra Bag® twin bag equipment (from Baxter). To measure care limitations, we evaluated near visual acuity with Jaeger's equivalent primer, visual fields with the confrontational visual field test, manual sensory dexterity and acuity with Moberg's Pick-Up test, cognitive function using Folstein's MMSE, and depressive symptoms using the CES-D20 instrument.

RESULTS AND CONCLUSIONS

In adherence to the procedure, participants correctly performed an average of 23.42 (SD ± 5.54) steps, which corresponds to 71.72% of the technique. Regarding care limitations, 55.6% presented impaired near visual acuity, 29.6% visual field deficit, 33.3% impaired manual dexterity, 14.8% alteration in manual sensory acuity, 46.3% possible impairment of cognitive function, and 18.5% depressive symptomatology. Participants with greater adherence to the CAPD procedure had better dexterity in the dominant (p = 0.010) and non-dominant (p = 0.010) hand, better sensory acuity of the non-dominant hand (p = 0.023), and greater cognitive function (p = 0.044). It is concluded that the care limitations (manual dexterity, manual sensory acuity, and cognitive function) are related to adherence to the dialytic procedure.

Patient-Doctor Contact Interval and Clinical Outcomes in Continuous Ambulatory Peritoneal Dialysis Patients

BACKGROUND

The optimal patient-doctor contact (PDC) interval remains unknown in peritoneal dialysis (PD) patients. The aim was to investigate the association between PDC interval and clinical outcomes in continuous ambulatory PD (CAPD) patients.

METHODS

In this retrospective cohort study, CAPD patients who resided in Guangzhou city between January 2006 and December 2012 were included. According to receiver operating characteristic curve analysis, all patients were classified as high (PDC interval ≤2 months) and low (PDC interval >2 months) PDC frequency groups. Biochemical data, clinical events, and clinical outcomes during the follow-up period were compared.

RESULTS

Of 433 CAPD patients, the mean age was 51.3 ± 15.7 years, 54.3% of patients were male, and 29.1% with diabetes. The median vintage of PD was 45.8 (26.3-69.1) months. Patients with high PDC frequency (n = 233) had better patient-survival rates (99.6, 87.7, and 76.5% vs. 92.7, 76.5, and 58.7% at 1, 3, and 5 years; p < 0.001), lower peritonitis rate (0.17 vs. 0.23 episodes per patient-year; p < 0.001), and hospitalization rate (0.49 vs. 0.67 episodes per patient-year; p < 0.001) than those in the low PDC frequency group (n = 200). After adjustment for confounders, PDC interval of no more than 2 months was independently associated with better patient survival (hazard ratio 0.60, 95% CI 0.42-0.86, p = 0.006).

CONCLUSION

A PDC interval of 2 months or less was associated with better clinical outcomes in CAPD patients. This indicates that a shorter PDC interval should be encouraged for them to achieve better clinical outcomes.

Thinking outside the box: an extraordinary woman on home peritoneal dialysis

At the home peritoneal dialysis unit (HPDU) of the University Health Network in Toronto, Ontario, we offer training to help patients perform peritoneal dialysis at home with ongoing support, which includes clinic visits and on-call services. Not every patient is able to carry out independent dialysis, however. Additional support at home is often provided in conjunction with Community Care Access and home care nurses. We recently had the privilege to learn from an extraordinary patient, whose special needs provided us with challenges and opportunities. This paper describes the interaction, flexibility and creativity between our unit, home care nurses, the patient and her family. It demonstrates that with commitment, there truly are many ways to solve even seemingly impossible problems.

Personal abilities in patients undergoing peritoneal dialysis and hemodialysis. A pilot study using the existence scale

Personality psychology is increasingly used in various clinical medicine settings to help in decision-making in difficult situations, especially in chronic disease. Patients with chronic renal disease are very dependent on modern medicine, and psychological aspects could help give answers in certain circumstances. Logotherapy and Existence analysis, after Viktor Frankl (Third Viennese School of Psychotherapy), is the theory of the possibilities and conditions for a fulfilled existence and evaluates a different aspect of personality psychology, namely meaning (in life). We used the existence scale questionnaire in this pilot study to investigate the personal abilities self-distancing, self-transcendence, freedom and responsibility in dialysis patients and compared a group of hemodialysis (HD) patients with patients treated with continuous ambulatory peritoneal dialysis (CAPD). We studied a mixed dialysis cohort (24 HD, 24 CAPD) at two Austrian centers (Innsbruck Medical University Hospital and Wilhelminenspital of the City of Vienna). Overall, results for dialysis patients (n = 48) were very close to those reported for healthy persons; however, CAPD patients scored significantly better than HD patients (p = 0.017) on the subscale self-distancing. This significant difference was also seen in the overall scores (p = 0.045). Our results might indicate that contented CAPD patients have personal abilities that predestine them for this type of treatment. The existence scale might help decide between CAPD and HD treatment alternatives.

Quality of life in CAPD, transplant, and chronic renal failure patients with diabetes

Although quality of life (QoL) is an important outcome measure, there are few studies of QoL in diabetic patients. We performed a cross-sectional study to assess QoL in such patients comparable for age, sex, and co-morbidity.

PATIENTS

Group CAPD: DM (n = 19, 12 males), diabetic CAPD patients; group CAPD: no DM (n = 26, 15 males) CAPD patients without diabetes; group TXP (n = 20, 10 males), diabetic transplant patients; and group CKD: DM (n = 20, 11 males), diabetics with chronic kidney disease. Two valid QoL instruments were used: a generic one (SF-36) and one that is disease-specific (RQLP).

RESULTS

As a whole, CAPD patients scored badly as far as concerned the physical domain, but with a good mental adaptation. Diabetic CAPD patients exhibited worse QoL for physical functioning, energy, vitality, leisure activity, and eating/drinking limitations. Diabetic transplant patients exhibited the best QoL. The RQLP instrument had better discriminative power for domains such as eating/drinking, treatment effects, and psychosocial aspects. Using analysis of co-variance and adjusting for age, sex, and co-morbidity, QoL differences disappeared. In conclusion, diabetic CAPD patients exhibited the worst QoL though with a satisfactory mental adaptation, a renal-specific instrument had better discriminative power, and the prevention of co-morbidity is likely to improve QoL in such patients.

[Quality of life in patients with continuous ambulatory peritoneal dialysis]

OBJECTIVE

To evaluate different aspects of the quality of life of patients with continuous ambulatory peritoneal dialysis, using the survey SF-36 (Medical Outcomes Study 36-Short Form Health Survey).

METHODOLOGY

A cross-sectional study was carried out with patients older than 18 years having chronic renal failure and being registered in the continuous ambulatory peritoneal dialysis program in the last three months. A sample size of 48 patients was estimated. The version 1.1 of the SF-36 survey previously adapted for Mexican people was used to evaluate quality of life.

RESULTS

Forty-eight patients were included, among which 52% were males, the mean of age was 45 years old. All eight domains of health were analyzed. The role limitations due to physical health showed the lower score (mean = 19.79; men: 13, women: 27.1) while mental health showed the higher (mean = 61.66; men: 59.68 women: 63.83).

Quality of life of dialysis patients in Malaysia

The aims of this retrospective analysis were (i) to examine the trends of quality of life (QoL) scores and (ii) to identify the risk factors for QoL scores among 6908 dialysis patients entering dialysis between 1997 and 2002. The Spitzer QoL Index was the instrument used by the National Renal Registry of Malaysia to assess the QoL amongst dialysis patients. Demographic and biochemical data were analysed to identify risk factors for poor QoL. The median QoL-index score ranged between 9 and 10. Significant risk factors for poor QoL were female gender, age > 40, diabetes, cohort starting dialysis 2001-2002, haemodialysis modality, body mass index < 18.5, albumin < 30g/dL, cholesterol < 3.2 mmol/L, haemoglobin < 10 g/dL, diastolic blood pressure of > 90 mHg, iPTH < 100 pg/ml. The overall QoL of dialysis patients is satisfactory. The negative impact of diabetes and haemodialysis on QoL warrants further evaluation as each factor involves 50% and 90% of our dialysis population.

The experiences of loneliness, depression, and social support of Turkish patients with continuous ambulatory peritoneal dialysis and their caregivers

AIM

The aim of the study was to examine the relationship between loneliness, depression and social support of Turkish patients with continuous ambulatory peritoneal dialysis and their caregivers.

BACKGROUND

By altering the lifestyle of the patient and family or caregiver, chronic illness and continuous ambulatory peritoneal dialysis can create loneliness and depression. Perceived social support may facilitate coping with illness.

DESIGN

Descriptive correlational design was used.

METHODS

Data were collected by using the UCLA loneliness scale, the Beck's depression scale and the perceived social support from family and friends scales and demographic data form.

RESULTS

A total of 130 subjects including 65 patients with continuous ambulatory peritoneal dialysis and 65 caregivers took part in this study. The mean ages of the patients and caregivers were similar (44.69 +/- 17.22 and 43.90 +/- 8.52 years respectively). Scores of loneliness and depression were below cut-off scores in both groups. However, scores of the loneliness of patients were higher than that of the caregivers. Perceived social support from family and friend were above cut-off scores in both groups and it was different for patients and caregivers.

CONCLUSION

The results of this study indicate that Turkish patients with continuous ambulatory peritoneal dialysis and their caregivers did not experience loneliness and depression.

RELEVANCE TO CLINICAL PRACTICE

Results of the study suggest that the nurses need to be aware of patients' and caregivers' psychological reactions to continuous ambulatory peritoneal dialysis, which may be expressed in feelings of loneliness and depression, and employ social support resources for patients with peritoneal dialysis and caregivers to cope with their illness and to adapt lifestyle changes.

Quality of life of patients having renal replacement therapy

AIM

This paper reports a study to compare the quality of life and its correlates for patients undergoing various types of renal replacement therapy.

BACKGROUND

Patients with end stage renal disease need renal replacement therapy as a substitute for their original kidneys. Different renal replacement therapies have different levels of impact on physical, psychological and social health. Quality of life as perceived by patients with end-stage renal disease is an important measure of patient outcome.

METHODS

A cross-sectional, descriptive, correlational study was carried out in 2002. A total of 240 patients were recruited from two medical centres in northern Taiwan. These patients were currently undergoing one of following types of renal replacement therapies: haemodialysis, continuous ambulatory peritoneal dialysis or transplantation. The study instrument used was the WHOQOL-BREF-TAIWAN. Data were analysed using descriptive and inferential statistics.

RESULTS

The scores for quality of life of transplantation patients were higher than those for both haemodialysis and continuous ambulatory peritoneal dialysis patients. The lowest scores for all three groups were in the psychological domain. The mean age for haemodialysis and continuous ambulatory peritoneal dialysis patients was significantly higher than that for transplant patients. The educational level, proportion of single people, and employment status of transplant patients were significantly higher than those of haemodialysis and continuous ambulatory peritoneal dialysis patients. Perception of economic status as 'balanced' or 'proficient' for transplant patients was significantly higher than for continuous ambulatory peritoneal dialysis and haemodialysis patients.

CONCLUSION

Information about the quality of life of patients having various types of renal replacement therapy will assist physicians, nurses, patients and their families to make decisions on treatment selection. There is a need to establish support groups for patients having renal replacement therapy in order to enhance their quality of life, especially in the psychological domain.

Health-related quality of life predicts outcomes but is not affected by peritoneal clearance: The ADEMEX trial

BACKGROUND

We hypothesized that increasing small solute clearance in peritoneal dialysis (PD) would lead to improvements in patient health-related quality of life (HRQOL).

METHODS

Patients were randomized to a control group [standard 4 x 2 L continuous ambulatory peritoneal dialysis (CAPD)] and an intervention group (CAPD with a target creatinine clearance >/=60 L/week/1.73 m(2)). The Kidney Disease Quality of Life Short Form was obtained at baseline and at 6, 12, and 24 months. Physical (PCS), mental (MCS), and kidney disease component summary (KDCS) scores were computed.

RESULTS

The two groups were comparable at baseline with respect to HRQOL. Baseline variables highly predictive of better QOL included absence of diabetes, younger age, higher starting GFR, and serum albumin. Baseline values of QOL were highly predictive of survival and hospitalizations. An unadjusted comparison revealed that patients in the intervention group had significantly higher PCS and KDCS scores at six months. However, there were no significant differences between the intervention and control patients at 12 or 24 months. When similar analyses were carried out adjusting for different patterns of patient dropout, there were no significant differences between the two groups at any time point in terms of PCS, MCS, and KDCS scores.

CONCLUSION

We found no evidence of a long-term benefit in HRQOL of CAPD patients by increasing peritoneal small-solute clearances when HRQOL parameters were adjusted for patient dropout. Measures of HRQOL have a significant predictive value for patient survival and hospitalizations.

[The effects of a physical activity reinforcement program on exercise compliance, depression, and anxiety in continuous ambulatory peritoneal dialysis patients]

PURPOSE

This study was to evaluate the effects of a physical activity reinforcement program on exercise compliance, depression, and anxiety in continuous ambulatory peritoneal dialysis(CAPD) patients.

METHOD

A nonequivalent control group with a pre-post test was designed. Data collection was done from December, 2002 to June, 2003 at a hospital. The degree of depression and anxiety of the patients was assessed by the score of SCL-90-R, and exercise compliance was measured by exercise period, frequency, time and intensity. The experimental group was composed of 19 participants who were educated based on an exercise education protocol and carried out walking exercises two to four times a week after hearing verbal persuasion biweekly through the telephone or a face-to-face interview for 12 weeks, while 17 participants in control group received no intervention.

RESULT

1. The experimental group showed significant improvement in self-efficacy of exercise compliance (U=79.00, p=.01), exercise period (chi2=20.84, p=.00), exercise frequency (chi2=9.03, p=.01), exercise time (chi2=9.03, p=.01) and exercise intensity (chi2=11.09, p=.00) compared to those of the control group. 2. The experimental group showed a lower depression score (U=84.50, p=.01) than the results of the control group. 3. However, there were no changes in anxiety level compared to the control group.

CONCLUSION

The physical activity reinforcement program was found to have an effect on exercise compliance and the depression score of CAPD patients. The results provided evidence for the importance of physical activity and verbal persuasion in CAPD patients.

How strong are patients' preferences in choices between dialysis modalities and doses?

BACKGROUND

How dialysis patients feel about their treatment may influence how they respond to information suggesting that survival is better with a higher dose or different treatment modality. We assessed the strength of dialysis patients' preferences for their current treatment modality versus other modalities, how differences in survival between modalities and doses could influence preferences, and whether preferences differ by patient characteristics.

METHODS

We measured preference values for current health on dialysis therapy and for standardized descriptions of dialysis modalities and doses by using a sample of dialysis patients in Maryland and Massachusetts and a time trade-off technique scaled between 0 (death) and 1 (perfect health).

RESULTS

We interviewed 109 patients on hemodialysis therapy, 57 patients on continuous ambulatory peritoneal dialysis (CAPD), and 22 patients on continuous cycling peritoneal dialysis (CCPD). Hemodialysis, CAPD, and CCPD patients had similar preference values for current health (mean, 0.69, 0.74, and 0.70, respectively; P > 0.1) and lower preference values for alternative modalities (eg, mean of 0.55 assigned to CAPD by hemodialysis patients). More than 75% of patients would choose a high dose over a lower dose of dialysis if it increased length of survival by 20%, but more than 30% would not switch modality, even if it increased survival by 100%. The only characteristic associated with a difference in preference values was depression, with weaker preferences among those with mild to moderate depressive mood.

CONCLUSION

Dialysis patients have strong preferences for their current modality and are more likely to accept a higher dose of dialysis than switch modality to increase survival. Physicians should talk with patients about the modality and dose they prefer because preferences cannot be predicted by patient characteristics.

Encouraging adherence to treatment regimen in a CCPD patient

By adapting the clinic blood draw appointment time to accommodate this employed patient, one of the outcome criterion was met. In addition, information discovered by the social worker regarding current family dynamics will assist the nursing staff in meeting this patient's needs in the future. If clinic visits can be arranged in a similar fashion, the nephrologist would be available to discuss blood pressure medications, side effects, and laboratory values. By working together as a multidisciplinary team, some of C.B.'s problems have been addressed, appropriate measures taken, and his needs met in a way that accommodates his work and lifestyle.

Depression in dialysis patients

Many psychiatric disorders can be seen in patients with chronic renal failure (CRF). Haemodialysis (HD), which is a renal replacement treatment, causes various psychiatric and psychosocial problems. Patients are dependent on treatment and the illness causes various problems. In addition, strict diet and continuous treatment are other stress factors (1,2). Various studies have been published in different regions and countries about the prevalence of depression and the relation between sociodemographic factors and depression in patients treated by continuous ambulatory peritoneal dialysis (CAPD), which has gradually become common in Turkey. However studies, which reflect the authors' region, have become necessary (2,3).

[Self-esteem in Mexican pediatric patients on peritoneal dialysis and kidney transplantation]

It has been reported in literature that self-esteem increases in patients who pass from continuous ambulatory peritoneal dialysis to renal transplantation. However, our clinical observations in the Department of Nephrology of Hospital Infantil de México Federico Gómez indicate otherwise. Therefore, we carried out this research on 60 patients, children and adolescents, male and female between the ages from 8 to 15 years old, and we applied them the Coopersmith self-esteem questionnaire, which has been validated in mexican population. These findings indicate that the social environment continuous ambulatory peritoneal dialysis patients feel more adapted than patients in renal transplant (p = 0.05). However it was also observed that these patients tried to show a better image on their situation through compensatory mechanisms (defense p = 0.03). It was concluded that it would be necessary to follow the adaptation of the transplanted patients, in order to help them achieve complete rehabilitation.

Response to inadequate dialysis in chronic peritoneal dialysis patients. Results from the 2000 Centers for Medicare and Medicaid (CMS) ESRD Peritoneal Dialysis Clinical Performance Measures (PD-CPM) Project

BACKGROUND

It is not known if patient prescriptions are being changed if patients are receiving an inadequate dose of peritoneal dialysis.

METHODS

Data from the 2000 Centers for Medicare and Medicaid were used to obtain data on dialysis adequacy and dialysis prescriptions.

RESULTS

A total of 359 of 1,268 (28%) adult peritoneal dialysis patients had a total weekly Kt/V urea (twKt/V) less than 2.0 and 436 of 1,245 (35%) patients had a total weekly creatinine clearance (twCrCl) less than 60 L/wk/1.73 m2, defined as "inadequate dialysis." Among chronic ambulatory peritoneal dialysis (CAPD) patients, 81 of 188 (43%) patients had inadequate dialysis and a change in the peritoneal dialysis prescription within 6 months of the initial adequacy value. Among cycler patients, 106 of 197 (54%) patients had inadequate dialysis and a change in the prescription. Thirty-six of 46 (78%) CAPD patients and 48 of 56 (86%) cycler patients had an improvement in twKt/V after the prescription was revised. Thirty-two of 42 (76%) CAPD patients and 45 of 57 (79%) cycler patients had an improvement in twCrCl after the prescription was changed. For these patients, twKt/V increased from 1.6 +/- 0.3 to 2.1 +/- 0.5, with an increase in the peritoneal Kt/V urea from 1.5 +/- 0.3 to 1.9 +/- 0.4. Similarly, twCrCl increased from 46.3 +/- 7.5 to 59.1 +/- 10.6 L/wk/1.73 m2 with an increase in the peritoneal CrCl dose from 42.0 +/- 9.1 to 52.7 +/- 9.9 L/wk/1.73 m2.

CONCLUSION

About half of peritoneal dialysis patients with inadequate dialysis did not have a prescription change and could benefit from modifications in their dialysis prescription.

[Mood and illness-related stress in dialysed patients]

The aim of the paper was to evaluate the mood and attitude to the illness-related stress and correlations between them among patients treated with haemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). The following psychological questionnaires were used: the Cognitive Stress Appreciation Questionnaire (CSAQ), the Social Appreciation Questionnaire and the Profile of Mood States. The total of 26 HD (17M, 9F) and 28 CAPD (17M, 11F) patients were studied. The control group (CONTR) consisted of 48 (26M, 22F) healthy volunteers who filled the questionnaires as if they had a "bad cold". The dispositional attitude to the stress was similar in the studied groups. The dialysed patients evaluated their disease-related stress mainly as a threat as compared to the healthy volunteers (p < 0.01). Additionally, HD patients evaluated their disease as a loss as compared to the CAPD group and CONTR group (p < 0.05). In HD and CAPD patients Confusion-Bewilderment had significantly higher values in comparison to the healthy group (p < 0.01), whereas only HD group had higher values of Fatigue-Inertia as compared to CAPD and control groups (p < 0.01). Additionally our results showed a significant correlation between evaluation of renal disease as a loss and Fatigue--Inertia emotion in the HD group (r = 0.89; p < 0.01). From the psychological point of view CAPD seems to be better than HD, since the patients treated by this method evaluated better their mood and illness-related stress, similarly as the healthy volunteers suffering from acute infectious disease.

Relationship of age and psychosocial factors with biological ratings in patients with end-stage renal disease undergoing dialysis

BACKGROUND AND AIMS

Dialysis is a time-consuming procedure and may cause psychological distress. The aim of the present study was to investigate the relationship between age, emotional state, life satisfaction, sexual functioning and the method of dialysis in patients suffering from end-stage renal failure.

METHODS

Eighty-two patients of 97 with end-stage chronic renal failure entered the study; 56 were under hemodialysis (HD), and 26 were under continuous ambulatory peritoneal dialysis (CAPD). Zung Depression Rating Scale (ZDRS), the Life Satisfaction Inventory (LSI), the Lasry Sexual Functioning Scale (LSFS), and a protocol aiming to register sociodemographic variables and variables considering the physical disorders were used.

RESULTS

No significant differences between groups were found in the ZDRS (HD patients: 40.7 +/- 8.2, CAPD patients: 41.88 +/- 10.44; p = 0.57), LSI scores (HD patients: 87.9 +/- 14.7, CAPD patients: 87.03 +/- 5.25; p = 0.7) and LSFS scores. Multiple linear regression analysis showed that LSI scores depended only on gender (females were less satisfied) and individual items on level of albumins and the presence of other physical disorders; ZDRS individual items depended on leukomatine level, gender, diabetes mellitus, albumins, age, creatinine and duration of disease; sexual functioning on age, and urea and sleep on albumin level (all with p < 0.001).

DISCUSSION

No statistically significant differences were detected in depressive symptomatology, sexual function and life satisfaction between patients undergoing HD or CAPD. Some aspects of depressive symptomatology, sexual functioning and life satisfaction may be influenced by age, the kind of treatment and its effectiveness. Age was positively related with satisfaction from general quality of life, frequency of sexual activity, tiredness and feelings of usefulness.

Patient-focused care on a complex continuing care dialysis unit: Rose's story

Using the standards of patient-focused care and the values of Parse's human becoming school of thought, nurses at Sunnybrook and Women's College Health Sciences Centre in Toronto, Ontario are exploring new ways to be with patients needing continuous ambulatory peritoneal dialysis on complex continuing care units. For patients such as Rose, health and quality of life are being enhanced through the practice of these methodologies. "I feel cared for." How can health care professionals nurture persons in a manner that makes them feel cared for? On one complex continuing care unit at Sunnybrook and Women's College Health Sciences Centre in Toronto, this outlook is one that is threaded through nurses' daily practice. At Sunnybrook and Women's, the philosophy of care revolves around a true value of patient-focused care. Nursing practice based on this philosophy involves being truly present to persons as they move beyond the moment. Nurses are led to view patients as human beings with health needs and not as diagnoses or problems (Saltmarche, Kolodny & Mitchell, 1998). The standards of nursing practice at Sunnybrook and Women's have led the way for nurses and other health care professionals to begin the processes of listening and dialoguing in a new way. The standards for nursing focus on the nurse-person process. This paper will outline the standards of practice at Sunnybrook and Women's, the processes of listening and dialoguing, along with a case example showing how the standards helped one person move through an "uneasy time" relocating from home to a complex continuing care dialysis unit.

The psychometric properties of the Chinese Dialysis Quality of Life Scale for Hong Kong dialysis patients

AIMS

This paper describes the process by which the Chinese Dialysis Quality of Life Scale was developed, and the preliminary testing and psychometric evaluation of the scale in a sample of dialysis patients.

BACKGROUND

Quality of life as a specific outcome variable has not been systematically and satisfactorily studied in Chinese dialysis patients in Hong Kong. A single global quality of life measure that is both reliable and valid for dialysis patients has yet to be developed. Without measurement tools, it is impossible to judge progress towards this goal.

DESIGN

A list of key issues was first derived from an in-depth literature review, then verified by semi-structured interview on seven patients. The initial list of 87 items was then further refined through two rounds of content analysis. The remaining 50 items were finalized by pilot test on seven patients. Of the refined 40 items, face validity was assessed by a team including one professor and ten patients. The 40-item scale was further evaluated by stability, internal consistency and criterion validity with a convenience sample of 164 patients. The scale demonstrated high internal consistency and good test-retest reliability and criterion validity when used.

CONCLUSIONS

The psychometric evaluations suggest that the instrument is worthy of further development. Continued validation of this scale on larger sample and Chinese population living outside Hong Kong has the potential to provide nurses with a valid assessment and treatment guide, and researchers with a valid measurement tool.

Informal and incidental learning with patients who use continuous ambulatory peritoneal dialysis

Adults learn continuously from the complex interplay of experiences in their day-to-day lives. This article reports on qualitative research conducted with 8 individuals with a diagnosis of end stage renal disease (ESRD) (6 women, 2 men) who were using continuous ambulatory peritoneal dialysis (CAPD). Interviews with each individual in his or her home focussed on how the participants made sense and learned from their experiences. The authors examined the data to determine the informal and incidental learning in the patients' homes, as well as the conditions that supported or limited this learning. Learning themes included understanding of medical and professional language, trusting their own experience, and living on the border of life and death. Barriers to learning included a diminished sense of personhood and the low literacy level of participants. Aspects of informal and incidental learning theory (Watkins & Marsick, 1992) are used to examine the informal learning that occurred. The authors acknowledge the adult learning implications and urge nurses to examine informal learning more closely.

Coping strategies and health-related quality of life among spouses of continuous ambulatory peritoneal dialysis, haemodialysis, and transplant patients

In the study reported here 55 spouses of patients living with end-stage renal disease (ESRD) were investigated with respect to coping strategies and health-related quality of life. Findings from the study were compared to two random samples of the Swedish general population (n = 454, and n = 1200). The study design was correlational and comparative. Coping was measured by the Jalowiec Coping Scale, and quality of life (QoL) by the Swedish Health-Related Quality of Life Survey (SWED-QUAL). Data were analysed using a number of statistical tests including Pearson's product moment correlations, Student's t-test and two way ANOVAs. The combined sample of spouses used significantly more optimistic and palliative coping than the general population, but less confrontative, self-reliant, evasive and emotive coping. In the study fatalistic, evasive and emotive coping was associated with low perceived efficiency in handling various aspects of the partners' situation. The male spouses used significantly less optimistic, supportive and palliative coping than did the female spouses. The spouses of transplant patients had better overall quality of life than the continuous ambulatory peritoneal dialysis and haemodialysis spouse groups, most likely due to the lower age of the former group. The study findings suggest that emotive, evasive and fatalistic coping are less than optimal ways to deal with problems occasioned by the partner's treatment.

Perceived consequences of being a renal failure patient

This study describes the perceived consequences of illness and treatment among end stage renal disease (ESRD) patients. A qualitative, explorative-descriptive design was used, which included continuous ambulatory peritoneal dialysis (CAPD) (n = 26), hemodialysis (HD) (n = 30), and transplantation (n = 30) patients. Data collection was performed using unstructured interviews, mostly in the patients' homes. All interviews were tape-recorded with permission from the informants, transcribed verbatim, and analyzed by content analysis. An overall theme was identified, "Wishes for independence and normality." Four main categories emerged: "Wish for normality," "Wish to manage one's own life," "Deprivation of one's normal life," and "Concerns." Interview statements were classified in 11 subcategories: live as usual, keep up appearances, social comparison, hope/fulfilled dreams, freedom/lack of freedom, control/lack of control, losses, dependence on others, physical problems, disgusted with oneself, and broodings. The perceived consequences of being an ESRD patient are multidimensional and involve several aspects of everyday life. It is important for nurses to appreciate the patient's view of illness as well as the patient's perceived stressors and expectations. It may help to direct the focus of nursing assessment in planning and implementing nursing care.

Differences in quality of life across renal replacement therapies: a meta-analytic comparison

A meta-analysis compared emotional distress and psychological well-being across renal replacement therapies (RRTs) and examined whether differences could be explained by: (1) treatment modalities, (2) case mix, or (3) methodologic rigor. Standard meta-analytic procedures were used to evaluate published comparative studies. Successful renal transplantation was associated with: (1) lower distress (effect size, d = -0.43 SD) and greater well-being (d = 0. 62 SD) than in-center hemodialysis (CHD) and (2) lower distress (d = -0.29 SD) and greater well-being (d = 0.53 SD) than continuous ambulatory peritoneal dialysis (CAPD). CAPD was characterized by greater well-being (d = 0.18 SD) than CHD and CHD was associated with greater distress (d = 0.16 SD) than home hemodialysis. Although methodologic rigor and case-mix differences did not correlate with the magnitude of psychosocial differences across RRTs, 10 of the 12 comparisons (83%) were threatened by publication bias (ie, that nonsignificant comparisons may have been underrepresented in the published literature). Thus, although significant quality-of-life differences were evident across treatment groups, the types of patients representative of the various RRTs also differed significantly in terms of case-mix variables relevant to psychosocial well-being and emotional distress. Published findings indicating differential quality of life across RRTs may thus be attributable to: (1) valid differences in effective renal replacement, reduced medical complications, and lifestyles afforded by these treatment modalities; (2) case-mix differences in the patient samples selected to represent them in research comparisons; or (3) both of these alternative explanations.

The biopsychosocial impact of end-stage renal disease: the experience of dialysis patients and their partners

This phenomenological study was conducted to investigate the biopsychosocial impact of end-stage renal disease on dialysis patients and their partners. Forty-four participants were interviewed separately (22 patients and their partners) by way of two open-ended questions, and multiple themes were identified from verbatim transcripts. Both the patients and partners viewed their relationship very positively, and both were overwhelmed by the impact of dialysis on their lives. Anger, depression and hopelessness were evident in the patients, whilst a pervasive sadness, resentment, guilt and loss were prevalent in the partners. This study gives a unique perspective on the negative impact which dialysis can have on couples, yet it also suggests that some are able to cope in a positive way despite the many life-style adjustments required by dialysis. The results of this study indicate that nurses need to recognize and respond to the tremendous emotional impact that chronic illness and its treatment can have on families in an era where it is possible to sustain life for years with the use of life support technology.

Factors related to psychosocial adjustment in children with end-stage renal failure

Psychological functioning and adjustment to dialysis were assessed in the families of 60 children and adolescents undergoing chronic dialysis. Sociodemographic factors, treatment variables, health status and satisfaction with health care provision were also measured. Correlation analyses identified a number of important factors associated with poor adjustment to dialysis and/or anxiety and depression in children and parents. Particularly at risk are parents in lower socioeconomic status households, parents with large families, parents with limited support and parents of young children. Children were more at risk where there was greater functional impairment caused by illness.

Lessons from the experience of using a video camera for research

This paper discusses the practical and theoretical issues associated with the use of video cameras in a field setting to collect data of nurse-patient communication. In particular, the advantages and difficulties of filming participants are addressed and strategies put forward for overcoming potential problems. This paper aims to provide a useful insight into the use of these methods for other researchers.

Stay.safe. A new PVC free system in long-term CAPD treatment

Stay.safe is a new PVC free double bag PD system that was introduced two years ago for CAPD. The system has been evaluated by three target groups, patients, nurses and physicians in 2 different studies. In the pilot study stay.safe was compared to the previous system and in the multi centre study, new patients judged stay.safe over a longer period of time. The pilot study showed better handling and function judgement by experienced patients of the new system compared to previous. In the multi centre study the overall satisfaction with the new system including use with disabled patients was very good and this high valuation was maintained over time.

Use of focus groups to identify concerns about dialysis. Choice Study

BACKGROUND

Patients with end-stage renal disease (ESRD) may have quality-of-life (QOL) concerns that are not fully appreciated by their providers. The authors conducted focus groups with dialysis patients and dialysis professionals to determine whether this qualitative method would reveal differences between patients' and providers' views about: 1) domains of QOL that are affected by ESRD and dialysis; and 2) aspects of dialysis that affect QOL.

METHODS

Separate focus group discussions were held with: 8 adult hemodialysis patients (mean age 50 years; 3 women; mean duration of dialysis 8.5 years), 5 adult peritoneal dialysis patients (mean age 54 years; 3 women; mean duration of dialysis 4.6 years), 8 nephrologists (mean of 12 years of dialysis practice), and 9 other health professionals involved in dialysis care (3 nurses, 2 dietitians, 2 social workers, and 2 technicians; mean of 10 years experience in dialysis care). Discussions were audiotaped, transcribed verbatim, and reviewed independently by three investigators to identify and categorize distinct thoughts.

RESULTS

1,271 distinct thoughts were identified and grouped into 20 related categories, which included ten QOL domains and ten aspects of dialysis that affect QOL. Compared with the professionals, the patients identified one additional relevant QOL domain (10 vs 9), and one additional aspect of dialysis that affects QOL (10 vs 9), and expressed more thoughts per domain (p < 0.05), although the contents of their comments were frequently similar. Among QOL domains, the numbers of related thoughts identified by patients and professionals, respectively, were: freedom/control (60, 89); social relationships (36, 11); anxiety (37, 4); role function (24, 10); energy (12, 10); body image (16, 4); sex (11, 21); mental attitude (21, 0); sleep (15, 1), and cognitive function (13, 7). Among aspects of dialysis that affect QOL, the numbers of thoughts identified by patients and professionals were: general dialysis issues (159, 105); relationships with staff (62, 110); patient education (63, 68); diet (44, 40); scheduling (57, 3); vascular or peritoneal access issues (31, 17), adaptation to dialysis (16, 14); dialysis dose (18, 8); symptoms (25, 0), and self-care (5, 24).

CONCLUSIONS

Although health professionals have a good understanding of patient concerns about the effects of ESRD and dialysis, the focus group discussions revealed a breadth and depth of QOL concerns that they may not fully appreciate.

Comparative evaluation of CAPD and PD-plus effectiveness

Decline in residual renal function in CAPD patients often leads to reduced overall solute clearances. Inadequate dialysis has been linked to malnutrition and increased morbidity and mortality rates. Achieving dialysis adequacy targets is often difficult by the conventional method of increasing CAPD exchange volumes. In comparison, substantial increases in solute clearances can be achieved with the use of automated peritoneal dialysis with large fill volumes and an extra daytime exchange.

The impact of renal replacement therapy on toddler time

The impact of renal replacement therapy on the day-to-day activity of 5 toddlers is presented. For those on hemodialysis, 50% of the waking hours involved activity related to management of the renal failure; the remainder was spent feeding or in normal (play) activity. Peritoneal dialysis demanded only 10% of waking hours for direct renal activity. The data are potentially useful in counseling families when discussing the impact of renal failure and its management on the toddler.

Predialysis education helps patients choose dialysis modality and increases disease-specific knowledge

The aims of this study were first, to evaluate the effects of a patient-education programme for a group of 28 uraemic patients (the Experimental (EG) group) with regard to their knowledge and perceived amount of information and to relate these effects to their sense of coherence and secondly, to study the patients' perception of their dialysis treatment. The results were compared with a comparison group (the Companion (CG) group, n = 28) which had received routine information only. The education programme seemed to have covered what the EG wanted to know. Significantly more patients in the EG group stated that they had acquired sufficient knowledge to enable them to participate in choosing dialysis modality compared with the CG group. The EG patients were significantly more informed in the post-educational evaluation compared with the pre-educational evaluation. In the EG, there was a significant relationship between the scores for knowledge and perceived amount of information. Men and younger patients perceived that they had received a greater amount of information than women and older patients. After having started dialysis treatment, there were no differences in the scores for knowledge and information between the EG and the CG. This indicates that other sources of knowledge and information were available to the CG patients. There was no significant correlation between the score of the Sense of Coherence (SOC) scale and the knowledge and information scores. Kidney transplantation, progression of renal failure, other patients' experiences of dialysis, dependence - independence, present and future wellbeing, how to cope with physical and psycho-social demands and continuity in their contacts with doctors and other health professionals were predominant concerns for the two groups of patients.

CONCLUSION

the predialysis group education programme enabled patients to choose dialysis modality to achieve an understanding of their illness and its treatment. It also provided the possibility of informal support by fellow patients and health professionals. The study emphasizes the special needs of elderly patients and we recommend that education programmes are tailored to their requirements.

Coping strategies and quality of life among patients on hemodialysis and continuous ambulatory peritoneal dialysis

A consecutive series of hemodialysis (HD) patients (n = 30) was included in a descriptive-comparative design. The aim was to study coping strategies and quality of life compared to a group of patients on continuous ambulatory peritoneal dialysis (CAPD). Coping was measured on the Jalowiec Coping Scale. Quality of life was measured by the Swedish Health-Related Quality of Life Survey (SWED-QUAL). An optimistic coping style was the most widely adopted by men and women in both groups, and this style was also considered to be the most effective in terms of dealing with stressful treatment aspects. The HD sample used more evasive coping strategies than the CAPD sample. Compared to a sample from the general population, HD patients had lower values on all SWED-QUAL subscales. Further, the CAPD women scored lower on general health than did the HD women. Significant gender differences were found in that men in both samples regarded themselves as better able to cope with physical aspects of the illness. Women in both samples scored lower on general health. It seems important to identify patients who use emotive, evasive and palliative coping techniques extensively, because they seem to be less effective at handling their illnesses.

Bridging the Quantum gap: attaining adequacy utilizing the Quantum night-time exchange device

BACKGROUND

The advent of night-time exchange devices (NXDs), such as the Quantum, gives the client on home peritoneal dialysis the option of five exchanges well spaced in a day or, for those who need only four exchanges a day, the ability to change their long dwell to the daytime.

PURPOSE

To ascertain whether we were able to attain the NKF-DOQI recommended Kt/V of 2.0 for CAPD clients by adding a fifth exchange utilizing the Quantum NXD or by introducing a long daytime dwell for clients who only needed four exchanges per day. We also looked at alternative uses for a NXD.

METHOD

As part of our CQI process for all clients on home peritoneal dialysis, dialysis adequacy testing is performed two weeks after the start of full prescription and biannually thereafter. In this study, the first group of clients, the "lifestyle group", changed to using the NXD to allow more daytime freedom. This first group had repeated 24 hour dialysate collections to ensure they maintained adequate Kt/Vs. The second group of clients, the "adequacy group", had Kt/Vs falling below the NKF-DOQI recommendation of 2.0. This second group had their peritoneal dialysis prescription optimized utilizing a computer modeling program. Their prescription was then changed accordingly Two weeks after the change in prescription, 24 hour dialysate collections were repeated for each client to ensure the new Kt/Vs were within the predicted parameters.

RESULTS

CONCLUSIONS

We were able to attain the NKF-DOQI recommended Kt/V, utilizing the CANUSA recommended fill volumes, for all clients underdialyzed on CAPD through the addition of a fifth exchange using the NXD. Other clients who may benefit from the use of NXDs are those who need more daytime freedom.

[Patient training in peritoneal dialysis: 1. Training in self care, cognitive study]

Authors consider education for dialytic patients a tool for patients' self-care and better quality of their life. In our Country the peritoneal dialysis involve 10% of the total dialytic population where the patient assumes a quite emerging role. The educational process is called training and the responsibility of the nurse is primarily important due to the trust and the consequential nurse-patient relationship. The article is divided in two parts: in the first, we explore the importance of the training as teaching methodology and in the second, we present the results of a national survey to better understand the role of the nurse and the methodology utilised in different Centers.

Humour and dialysis

There are many articles on the connection between the spirit and the body and the influence of a good mood on the way people deal with physical problems. This paper will demonstrate that the use of humour is a way of influencing our patients' spirit in order to help them deal with problems relating to their illness. In our every day experience with renal patients, we have noticed that humour helps us reduce patients' anxiety, before the first dialysis, before using the dialysis needles, or before performing painful procedures. Humour also helps us to offset the anger patients often express during treatment. Humour brings about a better atmosphere and the possibility of creating positive communication with the patients in a more relaxed environment and in a much more effective way. Our findings are similar to those in the literature and conclude that humour is an aid for dealing with patients' problems.

Neuropsychological, physical, and psychosocial functioning of individuals with end-stage renal disease

Individuals (N = 24) being treated for end-stage renal disease (ESRD) were compared to healthy control participants (N = 20) on measures of neuropsychological, physical, and psychosocial functioning. ESRD patients scored significantly lower than controls (p < .03) on Trail Making Test--Part B; 37.5% of ESRD patients were classified as impaired versus 15% of controls. ESRD patients scored lower than controls on SF-36 measures of Physical Functioning (p < .001). Psychosocial deficits were on the Affect Balance Scale (p < .04) and in employment (p < .04). The hypotheses that neuropsychological status would be associated with psychosocial differences in terms of decrements in both affect and employment rates were also supported. Mediational analysis suggested that neuropsychological status plays a role in the lower employment rates seen among ESRD patients. Clinical and research implications are discussed.

Teaching CAPD to the visually impaired

The increasing number of patients on CAPD (continuous ambulatory peritoneal dialysis) offers multiple challenges to the home dialysis unit. During the last year we have changed our nursing practice and have successfully trained five visually impaired clients to perform CAPD exchanges utilizing a disconnect system without a helper or caregiver. In this article we will discuss the methods we used, the assist devices and the patient outcomes in our population. We measured our success in terms of peritonitis rate, adequacy of dialysis and lifestyle considerations for this population.