Relationship of demoralization with anxiety,depression,and demographics of Chinese dialysis patients:Erratum

In the article entitled“Relationship of demoralization with anxiety,depression,and demographics of Chinese dialysis patients”by Zhuang CL,Zheng JL,Gao L,Huang YL,and Hu WJ(J Integr Nurs 2021;3(4):155-160.DOI:10.4103/jin.jin_46_21),[1]the ethical statement was not provided.

Development of Health Literacy for Regular Hemodialysis Patients in Menoufia Governorate: A Cross-Sectional Study

Health literacy (HL) is essential to access, comprehend, assess and use health data allowing patients to make better health and quality of life decisions. To assess the health literacy level of hemodialysis Egyptian patients, a cross-sectional study from March to September 2020 was conducted at 4 hemodialysis (HD) units on 439 patients. A translated questionnaire including demographic characteristics and health literacy components was conducted. This study adapted Nutbeam’s model incorporating critical health literacy, interactive health literacy, and functional health literacy. Health literacy of hemodialysis patients was satisfactory among 35.5% of the studied patients. The average total score of health literacy questionnaire was (15.53 ± 4.32) distributed as (2.90 ± 1.26) for functional literacy, (3.10 ± 1.26) for basic health knowledge, (1.65 ± 1.21) for communicative literacy, (2.53 ± 0.70) for interactive literacy, (1.75 ± 1.30) for advanced health knowledge, (1.74 ± 0.48) for critical literacy, and (1.83 ± 0.93) for patient safety. It was found that poor health literacy was associated with low income (OR = 2.54, CI 95%: 1.66_3.89, p < 0.001), of increasing age (OR = 0.12 CI 95%: 0.07_0.19, p < 0.001), low education (OR = 1.08, CI 95%: 1.04_1.11, p < 0.001) and the patient did not undergo kidney transplant (OR = 4.19 CI 95%: 1.12_15.62, p = 0.033). There was a prevalent low health literacy among the studied regular hemodialysis patients which was affected by education, age and income and in turn it affected the adherence to treatment. Understanding the linkage between HL and self-care attitudes should enhance efforts to improve hemodialysis outcomes.

The status quo and prospect of transfer and shift in patients receiving hemodialysis in China

Hemodialysis is the main alternative therapy for patients with end-stage renal disease;most of the hemodialysis centers in China are not designed together with the inpatient ward.During the hospitalization period,hemodialysis patients often move back and forth between wards and hemodialysis rooms because of the treatment needed.Hemodialysis patients are a special group of hospitalized patients,most of them are elderly patients.The overall basic diseases of the patients vary very much,and the cause of the disease is complex.Moreover,the chronic inflammation progresses slowly,and immune function declines.Some of the patient are seriously ill or even hav organ failure.All these factors affect the patients in general.Therefore,the transfer safety of patients during hospitalization is facing great challenges.The researchers reviewed the status of transshipment research in Chinese hemodialysis patients and laid the foundation for the research and development of related handover tools and perfect handover mode in the future.

Influence Factors of Mobility-Related Activities of Daily Living in Chronic Dialysis Patients Needing Long-Term Care: Analysis of Long-Term Care Eligibility Assessment Survey Data

Background: In the near future in Japan, chronic dialysis patients will likely face a situation where the aging and the lengthening of hemodialysis treatment periods will adversely affect the mobility-related activities of daily living (MR-ADL). The aim of this study was to investigate chronological change in MR-ADL among chronic dialysis patients in need of long-term care and the effect of admission to long-term care facilities on their MR-ADL. Methods: Data were analyzed from a long-term care eligibility assessment survey conducted in late March 2009 of 1000 individuals residing in Niigata City, Japan who were approved to receive long-term care. Then data from those individuals who had undergone the assessment survey ≥4 times over a period of ≥4 years were statistically evaluated. To reveal change in MR-ADL, this study performed a three-way analysis of variance with mean survey scores from assessment categories 2 - 5 containing questions related to MR-ADL as the independent variable and the number of eligibility assessment surveys (within-subjects factor), facility admission, and dialysis therapy (between-subjects factors) as dependent variables. Results: We observed the effect of facility admission in individuals aged >70 years for categories 2 - 5, and observed the effect of the number of assessment surveys taken only in women ≥80 years for categories 2 and 5. Regarding the effect of dialysis therapy, female dialysis patients aged ≥80 years and in need of long-term care scored significantly higher on survey items for transferring, grooming, toileting, eating, and instrumental activities of daily living, all of which are indicators of a moderate decline in ADL. Conclusions: Because dialysis is often initiated in women aged around 80 years, ADL in this group of individuals can be improved by the initiation and proper provision of dialysis.

Usefulness of Castor Oil for Bowel Preparation for Colon Capsule Endoscopy in the Patients on Dialysis

Since Colon capsule endoscopy (CCE) was approved for reimbursement under the national health insurance system of Japan in January 2014. Dialysis patients are potentially susceptible to bleeding because of the fragile intestine, impaired platelet function, or oral administration of nonsteroidal antiinflammatory drugs (NSAIDs) or anticoagulants. Increasing experience with CCE different bowel preparation regimens have been used with variable results. The patient on dialysis has moisture restrictions. We experienced the case of the half a dose of the previous protocol by a method using the castor oil. In this study, we evaluated the efficacy of bowel preparation with castor oil for improving the capsule excretion rate. In 23 of 24 (95.8%) patients capsule transit time and duration of capsule endoscopy were shortened. The results are presented and briefly discussed in this report.

Patients Returning to Dialysis after Failed Kidney Transplant: How Do They Fare? A Gulf Perspective

An increasing number of failed transplant patients returning to dialysis (FTRD) have been observed with reported worse survival compared to transplant-naive dialysis (TxN) patients. This study aimed to assess outcomes of FTRD vs. matched TxN controls in a Gulf region multi-center trial of 800 HD patients. Similar mortality was seen, likely due to earlier start and better HD adequacy in FTRD. Younger age, less diabetes and living donor transplantation in majority with 27% graft nephrectomy (Nx) might also confer benefits. Subgroup analysis of Nx patients showed more hospitalizations and prior rejection episodes with lower graft survival. The deaths, however, oc-curred only in nonNx group and are likely explained by older age, longer duration on HD, more prevalence of diabetes and CAD. FTRD showed similar survival to TxN. Early intensive HD might account for the benefit. Whether Nx confers advantage is unclear because of the small sample size.

Low intramuscular adipose tissue index is a protective factor of all-cause mortality in maintenance dialysis patients

Objective To investigate the relationship between intramuscular adipose tissue index(IATI)calculated from computed tomography images at transverse process of the first lumbar and all-cause mortality in maintenance dialysis patients,and to provide a reference for improving the prognosis in these patients.Methods It was a multicenter retrospective cohort study.The clinical data of patients who received maintenance hemodialysis or peritoneal dialysis treatment from January 1,2017 to December 31,2019 in 4 grade I hospitals including Zhongda Hospital Affiliated to Southeast University,Taizhou People's Hospital Affliated to Nanjing Medical University,Affiliated Hospital of Yangzhou University,and the Third Affiliated Hospital of Soochow University were retrospectively collected.IATI was calculated by low attenuation muscle(LAM)density/skeletal muscle density.The receiver-operating characteristic curve was used to determine the optimal cut-off value of IATI,and the patients were divided into high IATI group and low IATI group according to the optimal cut-off value.The differences of baseline clinical data and measurement parameters of the first lumbar level between the ttwo groups were compared.Thefollow-upended on December 23,2022.

Influencing factors for hemodialysis initiation in non-diabetic kidney disease patients with predialysis fistula after arteriovenous fistula creation

Objective To explore the influencing factors of hemodialysis(HD)initiation in non-diabetic kidney disease(NDKD)patients with predialysis arteriovenous fistula(AVF)creation.Methods This was a singlecenter prospective cohort study.The NDKD patients undergoing predialysis AVF creation were enrolled at the First Affiliated Hospital of Xi'an Jiaotong University from 2015 to 2018.According to the estimated glomerular filtration rate(eGFR,the Chronic Kidney Disease Epidemiology Collaboration equation)and age,patients were divided into different subgroups,eGFR:group 1[eGFR<10 ml·min^(-1)·(1.73 m^(2))^(-1)],group 2[eGFR between 10 to 15 ml·min^(-1).(1.73 m^(2))^(-1)].

Unplanned hospital readmissions after kidney transplantation among patients in Hefei,China:Incidence,causes and risk factors

Objectives:Unplanned readmissions severely affect a patient's physical and mental well-being after kidney transplantation(KT),which is also independently associated with morbidity.A retrospective study was conducted to identify the incidence,causes and risk factors for unplanned readmission after KT among Chinese patients.Methods:Patients who underwent KT were admitted to the organ transplant center of the Affiliated Hospital of University of Science and Technology of China(2017-2018).Medical records for these patients were obtained through the hospital information system(HIS).Results:In 518 patients,the incidence of unplanned readmissions within 30 days(n=9)was 1.74%,and 90 days(n=64)was 12.35%.The one-year unplanned readmission rate was 22.59%(n=122).Overall,122 patients were readmitted because of infection,renal events,metabolic disturbances,surgical complications,etc.Hemodialysis(OR=10.462,95%CI:1.355-80.748),peritoneal dialysis(OR=8.746,95%CI:1.074-71.238)and length of stay(OR=1.023,95%CI:1.006-1.040)were independent risk factors for unplanned readmissions.Conclusion:Unplanned readmission rates increased with time after KT.Certain risk factors related to unplanned readmissions should be deeply excavated.Targeted interventions for controllable factors to alleviate the rate of unplanned readmissions should be identified.

Quality of life in end stage renal disease patients

AIM： To understand factors associated with quality of life （QOL）, examine types of QOL instruments, and determine need for further improvements in QOL assessment.METHODS： The method used databases （Pubmed, Google scholar） and a bibliographic search using key words QOL, end stage renal disease, Hemodialysis, Peritoneal dialysis, instruments to measure QOL, patients and qualitative/quantitative analysis published during 1990 to June 2014. Each article was assessed for sample size, demographics of participants, study design and type of QOL instruments used. We used WHO defnition of QOL. RESULTS： For this review, 109 articles were screened, out of which 65 articles were selected. Out of 65 articles, there were 19 reports/reviews and 12 question-naire manuals. Of the 34 studies, 82% were quantita-tive while only 18% were qualitative. QOL instruments measured several phenomenon such as physical/psychological health, effects and burdens of kidney dis-ease, social support etc. those are associated with QOL. Few studies looked at spiritual beliefs, cultural beliefs, personal concerns, as per the WHO defnition. Telemedicine and Palliative care have now been successfully used however QOL instruments seldom addressed those in the articles reviewed. Also noticed was that longitudinal studies were rarely conducted. Existing QOL instruments only partially measure QOL. This may limit validity of predictive power of QOL. CONCLUSION： Culture and disease specific QOL in-struments that assess patients’ objective and subjective experiences covering most aspects of QOL are urgently needed.

Sex bias in response to hepatitis B vaccination in end-stage renal disease patients:Meta-analysis

AIM： To systematically review the literature for studies investigating the potential effect of gender of dialysis patients on the immunogenicity of hepatitis B virus vaccines. METHODS： Literature searches were conducted by the MEDLINE and Google Scholar. The key words used included “hepatitis B （HB）”, “vaccine”, “dialysis”, “hemodialysis”, “sex”, “male” and “female”. Data of seroresponse to HB vaccine in clinical trials regarding sex of the recipients have been achieved and analyzed. Finally data from 19 clinical trials have been pooled and analyzed.RESULTS： Analysis of response to HB vaccination in our dialysis population showed males significantly res-pond less to hepatitis B vaccination （P = 0.002, Z = 3.08） with no significant heterogeneity detected [P = 0.766; heterogeneity χ2 = 14.30 （df = 19）; I2 = 0%]. A reanalysis of the pooled data was conducted regarding the dialysis mode to evaluate potential differential impact of sex on HB vaccine response. Hemodialysis was the only subgroup that showed a signifcant difference regarding dialysis mode in response to HB vaccination regarding sex （ P = 0.042, Z = 2.03）.CONCLUSION： This Meta-analysis showed significant effect for the sex of chronic kidney disease and dialysis patients on the immunogenicity of HB vaccine. This sex discrimination was most prominent among hemodialysis patients.

Carnitine Deficiency and Improvement of Muscle Cramp by Administration of Carnitine in Patients with Liver Cirrhosis

Aim: We measured carnitine levels in patients with carnitine including dialysis patients, and examined whether administration of L-carnitine improved muscle symptoms. Methods: We measured carnitine levels in 27 patients with liver cirrhosis who were receiving treatment in our hospital, and administered L-carnitine (600 mg - 1800 mg) to patients having muscle cramps for approximately one month and examined the presence/absence of the symptom. We measured carnitine concentration before and after dialysis, before dialysis after the administration to eight dialysis patients, before and after the administration to 19 nondialytic patients. Results: The total carnitine levels before the dialysis of dialysis patients were an average of 42.2 μmol/L and fell to 17.7 μmol/L after more dialysis, but it was increased to 155 μmol/L after the administration of L-carnitine. In the nondialytic patients, the total carnitine levels were significantly increased from 71.7 μmol/L to 101.7 μmol/L after the administration of L-carnitine (P = 0.038). For symptomatic patients, significant improvement of muscle clamps was observed in the L-carnitine administrated group when compared with the non-administrated group (P = 0.0002). Conclusions: Total carnitine levels were low even before dialysis in the dialysis patients with liver cirrhosis in particular and they further decreased after the dialysis. Administration of L-carnitine increased the total carnitine levels and improved the symptom. Based on these results, we conclude that L-carnitine is useful for carnitine deficiency in patients with liver cirrhosis.

Association of intraperitoneal pressure and clinical symptoms in peritoneal dialysis patients

Objective To explore the association between the intraperitoneal pressure(IPP)and clinical symptoms in peritoneal dialysis(PD)patients.Methods It was a cross-sectional study.PD patients of Peking University First Hospital from January 1,to October 31,2021,were enrolled according to the inclusion and exclusion criterion.

基于终末期肾病患者共享决策下的自动腹膜透析治疗

近年来,我国终末期肾病(end-stage renal disease,ESRD)发病率逐年增长,透析患者常常伴随多种并发症,同时也是焦虑抑郁等心理疾病的高发人群。透析方式及透析过程与患者本人及家属的日常生活息息相关,这类患者更需要以人为本的治疗策略。进入ESRD准备接受肾脏替代治疗前,让患者及家属知晓每种肾脏替代治疗方式的特点,在充分考虑临床治疗需求基础上,结合患者生活环境、工作学习需求、社会回归、心理需求及个性化喜好共同决策选择合适的肾脏替代治疗方式。在此共享决策模式下,越来越多的患者希望进行居家透析治疗。目前鉴于设备技术、经济成本及人力资源等限制,居家血液透析短期内较难普及,作为居家透析主要方式的腹膜透析,也因操作培训及随访管理等问题,存在患者操作不规范、治疗依从性差、处方调整或并发症干预不及时等问题。本文着重就ESRD患者共享决策流程、自动腹膜透析治疗处方设置及患者远程随访管理进行阐述,以期共同提高居家腹透患者的治疗质量及社会回归。

虚拟现实技术在终末期肾病透析患者中应用的研究进展

随着远程医疗模式的兴起,虚拟现实技术也逐渐在医疗领域中展现了广阔的发展前景,文章从虚拟现实技术在终末期肾病透析患者中应用现状、对运动管理、疾病负担、辅助患者培训等方面的作用进行综述,提出未来展望,以期为该技术在我国终末期肾病透析患者中的应用提供参考。

透析中关节活动度运动对维持性血液透析患者疲乏症状和运动能力的影响研究

目的探讨透析中关节活动度运动对维持性血液透析(maintenance hemodialysis,MHD)患者的影响。方法选取2023年4月─10月南昌大学第一附属医院血液透析中心的MHD患者为研究对象,由研究者随机投掷硬币将东湖院区和象湖院区随机分为试验组和对照组,对照组患者给予常规护理,试验组患者在常规护理的基础上实施透析中关节活动度运动。比较2组患者干预前后的疲乏量表-14(fatigue scale-14,FS-14)得分、6分钟步行试验(6 minutes walk test,6MWT)、30秒坐立试验(30-second sit-to-stand test,30s-STS)和简短生活质量量表得分(36-item short form health survey,SF-36)差异。结果透析中关节活动度运动干预后试验组患者的FS-14得分低于对照组(Z=-7.782,P<0.001),6MWT(t=5.812,P<0.001)、30s-STS(t=6.111,P<0.001)、SF-36得分(t=2.583,P=0.012)高于对照组。结论透析中关节活动度运动可有效缓解患者的疲乏症状,提高运动能力、生活质量。

慢性肾功能不全病人经济毒性调查及影响因素分析

目的:调查未透析慢性肾功能不全病人经济毒性现状,并分析其影响因素。方法:采用横断面调查研究方法,选取2023年10月—12月某三级甲等医院长期随访的未透析肾功能不全病人作为研究对象。应用一般资料调查问卷、中文版病人报告结局的经济毒性综合评分量表、社会支持评定量表、Connor-Davidson心理弹性量表、恐惧疾病进展简化量表进行调查。结果:回收有效问卷176份,经济毒性得分为(19.02±8.95)分,慢性肾功能不全病人存在经济毒性。多元线性回归结果显示,家庭平均月收入、目前工作状态、社会支持总分、恐惧疾病进展总分是慢性肾功能不全病人经济毒性的影响因素(P<0.05),模型可解释总变异的61.1%。结论:慢性肾功能不全未透析病人经济毒性的发生率较高,提示临床医护人员需要精准识别高风险经济毒性的慢性肾功能不全病人,进而根据影响因素采取降低经济毒性的有效策略,对缓解慢性肾功能不全病人的经济毒性具有重要意义。

腹膜透析专家型患者核心能力特征要素的质性研究

目的探讨腹膜透析专家型患者(Expert Patient,EP)核心能力特征要素,为培养腹膜透析专家型患者提供参考。方法于2023年4—7月采用目的抽样法选取深圳市3所三级甲等综合医院肾内科工作的20名医护人员进行半结构式深入访谈,运用Colaizzi 7步分析法对资料进行分析。结果共提炼出自我管理能力、学习理解能力、沟通表达能力、教育指导能力、紧急情况处理及组织协调能力、知识获取及文字编辑能力、个人品质7个主题。结论腹膜透析专家型患者需具备多方面的核心能力,可通过加强对腹膜透析专家型患者核心能力的培养,以适应腹膜透析专家型患者角色发展需求。

维持性血液透析合并睡眠障碍患者的中西医护理干预效果探讨

目的中西医护理干预对维持性血液透析(MHD)合并睡眠障碍患者失眠症状与生活质量的改善。方法选取2022年1月至2023年5月寿县中医院血液透析科收治的接受血液透析治疗的40例终末期肾脏病并发睡眠障碍患者,按随机数字表法分组,对照组20例实施常规护理,观察组20例实施中西医护理方法;观察2组的失眠改善情况与生活质量评分。结果观察组失眠改善率为75%,明显高于对照组的15%(P<0.05)。2组护理前组间生活质量评分差异无统计学意义(P<0.05);2组护理后组内生活质量评分均有所提高(P<0.05),且观察组生活质量评分明显优于对照组(P<0.05)。结论对MHD合并睡眠障碍患者行中西医护理有利于改善失眠状况,提高患者的生活质量。

血液透析患者电子健康素养与透析充分性的相关性研究

目的 了解三甲医院维持性血液透析(maintenance hemodialysis,MHD)患者电子健康及透析充分性水平,探讨两者之间的相关性。方法 选取2023年1—6月福建省泉州市第一医院城东院区153例MHD患者。应用自制一般资料调查表、电子健康素养量表(e-Health literacy scale,eHEALS)及透析充分性指标尿素清除分数(single pool clearance index,spKt/V)和尿素下降率(urea reduction ratio,URR)进行调查,当场发放填写当场收回,采用单因素方差分析及t检验等方式研究MHD患者电子健康素养与透析充分性的相关性。结果 MHD患者透析充分性指标SpKt/V为(1.42±0.38),URR为(69.41±8.83)%;e HEALS平均得分较低,为(20.52±12.33)分。性别、年龄、经济收入、文化程度、工作情况、医保情况、查询信息的频率、spKt/V对MHD患者电子健康素养的影响差异有统计学意义(P<0.05),性别、文化程度对MHD患者的透析充分性指标spKt/V及URR的影响差异有统计学意义(P<0.05),电子健康素养在spKt/V达目标值中差异有统计学意义(P<0.05)。在充分性评估中,spKt/V与URR存在相关性(P<0.05)。结论 MHD患者电子健康素养得分相对较低,透析充分性基本可达最低目标值。MHD患者电子健康素养水平与透析充分性无显著的相关性,但血液透析室医务人员就低电子健康素养水平现状制定相应的干预措施,重视MHD患者对网络卫生资源的利用能力,因此提高MHD的自我健康问题管理能力和透析充分性,改善其生活质量。