Continuous ambulatory peritoneal dialysis in high-risk patients: patients with cardiovascular diseases--role of the nurse.

Most patients receiving renal replacement therapy have cardiovascular disease. The most frequent conditions are left ventricular hypertrophy and coronary artery disease. Hemodialysis is associated with a characteristic spectrum of acute complications (such as hypotension, sudden death) that can be explained by typical dialysis-induced effects on the heart. With continuous peritoneal dialysis (CAPD) some of the cardiovascular complications are ameliorated owing to slow ultrafiltration and absence of an arteriovenous fistula. CAPD might be concluded to be the preferable option in patients with cardiovascular disease, but a few disadvantages, such as hyperlipidemia and hyperinsulinemia, also exist. Nurses also play an important role in the therapeutic success and outcomes of these patients.

Reduced incidence of acute renal graft failure in patients treated with peritoneal dialysis compared with hemodialysis.

In a case-control study performed in two centers, the incidence of delayed graft function (DGF), defined as the necessity to perform dialysis after transplantation, was analyzed according to prior treatment with continuous ambulatory peritoneal dialysis (CAPD; n = 117) or hemodialysis (HD; n = 117). The patients were matched for age, sex, HLA compatibility, and cold ischemia time. The patients were followed up for 6 months to monitor renal graft function (serum creatinine [Screa] level immediately after transplantation, at 6 weeks, at 6 months) and postoperative complications. No significant differences were found in the warm ischemia time of the graft or previous time on dialysis. DGF occurred in 27 CAPD patients (23.1%) and 59 HD patients (50.4%; P < 0.0001). The decline in Screa level after transplantation was faster in CAPD patients: the time for Screa level to decrease 50% after transplantation (T1/2Screa) was reached after 5.0 +/- 6.6 days in the CAPD group compared with 9.8 +/- 11.5 days in the HD group (P < 0.0001). A greater number of patients developed acute rejection episodes in the CAPD group (P < 0. 05), but Screa level was not different in the two groups 6 weeks and 6 months after transplantation. No differences were observed in infectious or surgical complications. This study shows that immediate renal function after transplantation is better in CAPD patients and that peritoneal dialysis should be considered as a first choice for pretransplantation therapeutic modality.

Emotions and psychopathology.

Few psychological assessment instruments exist for Jamaicans. Studies that address the appropriateness of foreign instruments for Jamaicans are sparse and empirical focus on psychopathology and its aetiology in Jamaican adults is virtually nonexistent. The present study addressed these deficits via Confirmatory Factor Analyses (CFA) which revealed that factors on the Toronto Alexithymia Scale (TAS-20) and Brief Symptom Inventory (BSI) were not replicated for a Jamaican sample (N = 352). Exploratory Factor Analyses (EFA) on the TAS-20 revealed one factor labelled Unawareness and Confusion Regarding Emotions (UCRE). Also, EFA yielded six BSI dimensions labelled Somatic Complaints, Paranoia, Hostility, Mild Depression/Dysthymia, Major Depression with Psychotic Features, and Agoraphobia with Panic. Regression analyses on the Jamaican-based TAS-20 and BSI factors revealed a positive relationship between UCRE and each BSI factor and total BSI score. Mild Depression, Agoraphobia with Panic, Paranoia, Hostility, Mild Depression and Major Depression were higher for women and younger Jamaicans, respectively, but younger Jamaicans with higher UCRE scores had higher scores on Paranoia, Major Depression, and total score. The findings suggest that Jamaican mental health policy and programmes should focus on the difficulties some Jamaicans experience in recognising and expressing their emotions.

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.

Delivering adequacy in PD therapy.

Providing appropriate peritoneal dialysis is an ongoing challenge to renal care providers. As the residual renal function and the peritoneal permeability are likely to change with time, the dose provided by the PD regimen needs to be adjusted. Rather than waiting for clinical signs of underdialysis, the practising nephrologist and the PD nurse today have access to diagnostic tools to assist in the prescription of adequate therapy. Peritoneal dialysis prescription involves setting up a personalized dialysis schedule aimed at obtaining satisfactory clearance and ultrafiltration rates while respecting the patient's life-style as far as possible. The PD nurse has the most patient contact and thus plays a pivotal role with the other healthcare professionals in the care of the patients. As providers, it is our responsibility to inform the patients about their own care. As PD is a method of home dialysis, patients must have self responsiveness, technical and psycho social skills to deal well with the method.

The nurse's role in prescription therapy, what does it mean?

Survival during end-stage renal disease is possible only when uraemic toxins are eliminated, such as by dialysis. Survival quality depends on the quantity eliminated. An objective definition of the adequacy of this dialysis refers to how much removal in how much time is necessary for each individual. Some may define adequacy of dialysis by clinical assessment of patient well-being (1).

The European Task Force for Disaster Relief: a multi-disciplinary team approach.

After the earthquake in Armenia, the International Society of Nephrology (ISN) Commission on Acute Renal failure, in cooperation with the United States National Kidney Foundation, has created a Disaster Relief Task Force to deal with post-disaster nephrology assistance to the affected victims (1). Its main purpose is to prevent and treat crush injury-induced ARF that occurs following traumatic rhabdomyolysis.

Disturbed host defense in peritoneal cavity during CAPD: characterization of responsible factors in dwell fluid.

In this study, the factors in overnight dwell fluid (8 to 10 hr dwell) depressing granulocyte (GC) NAD(P)H-oxidase dependent radical species production are characterized. At present, most studies have essentially focused on fresh, unspent dialysate and on peritoneal macrophages. The response to Staphylococcus aureus (Staph A) was dose-dependently depressed for both GC CO2 production (from 91.3 +/- 8.4 to 9.0 +/- 1.5 dpm/10(3) GC, P < 0.01) and chemiluminescence (CL) (peak from 7.3 +/- 0.8 to 1.6 +/- 0.8 cps x 10(3)/GC, P < 0.01). Stimulation with formyl-methionine-leucine-phenylalanine (f-MLP), phorbol myristic acid (PMA), Staphylococcus epidermidis (Staph Epi), E. coli, latex and zymosan revealed a parallel depression, pointing to an intrinsic metabolic defect, rather than failure of particle ingestion. The addition of glucose to the normal cell medium to obtain the same concentration as in the CAPD effluent (2.9 +/- 0.3 mg/dl) depressed function but not to the same extent as the genuine PD effluent. Opsonization of Staph A and E. coli induced a partial correction. No effect of pH or osmolality was observed. HPLC fractionation of CAPD effluent on a polarity based gradient revealed an elution of depressive factors in hydrophobic fractions with a nadir in F7 and F12. Analysis of the elution pattern of various uremic solutes revealed elution in F12 of p-cresol, a solute with known inhibitory effect on GC function. These events may be related to recent peritonitis (CL in response to Staph A 0.3 +/- 0.1 in effluent of 6 patients with recent peritonitis versus 2.6 +/- 0.8 cps x 10(3)/GC in 12 patients without recent peritonitis (P < 0.01). We conclude that the GC response is depressed in the presence of CAPD effluent due to excess glucose, lack of opsonization, and uremic solutes of which p-cresol is one of the responsible compounds.

Patient and technique survival after treatment shifts between CAPD and haemodialysis in a single centre.

In the last decade, there has been a renewed interest in peritoneal dialysis and this modality has been proposed as a possible alternative to haemodialysis in the care of patients with end-stage renal disease. Attempts have been made to compare various aspects of these two modes of dialysis (4,6). Clinical trials have been performed particularly comparing CAPD with haemodialysis in the treatment of certain subgroups of patients, such as children or patients with diabetic nephropathy (1,5).

Study of the chromium binding in plasma of patients on continuous ambulatory peritoneal dialysis.

The distribution of chromium (Cr) among the proteins in plasma of three continuous ambulatory peritoneal dialysis (CAPD) patients and in dialysis solutions was studied with 'in vitro' and 'in vivo' 51Cr-labelled plasma. Radiolabelling allows the kinetics of newly added Cr to be investigated. The separation of the proteins was achieved by ion exchange fast protein liquid chromatography, ensuring quantitative recoveries of the 51Cr activity, transferrin and albumin. In all fractions the proteins were qualitatively characterised by iso electric focusing. The concentrations of transferrin and albumin were determined by nephelometry. The 51Cr distribution among the plasma proteins was similar for the three patients. The 51Cr activity was mainly bound to transferrin and, in the beginning of the incubation, in a lesser degree also to albumin. After 1-6 h a shift was observed of the 51Cr from albumin to an unidentified low molar mass complex (+/- 5000 Da). Two 51Cr species showed up in the subsequently drained dialysate, but they could not be identified.

Epidemiology of behavioral and emotional problems among children of Jamaica and the United States: parent reports for ages 6 to 11.

Research on child behavior problems requires standardized methodology in order to identify similarities and differences between societies. The present study compared parent-reported behavior problems of 360 Jamaican and 946 U.S. children aged 6 to 11. It revealed few differences in individual, total, internalizing (e.g., depression), and externalizing (e.g., fighting) problem scores as a function of nationality, gender, or age. Findings from this and other studies indicate the feasibility of a common methodology in cross-national studies of children's problems, but also the need for further refinement.

A longitudinal, five year survey of urea kinetic parameters in CAPD patients.

This study reports on the five years' evolution of the KT/V urea index and protein catabolic rate (PCR) in 16 CAPD patients who were treated with a constant daily dialysis dose. Total KT/V urea index decreased with time from a value of 0.96 +/- 0.06 at the start to 0.55 +/- 0.05 at five years of treatment. This decline was due to the opposite changes of two important parameters affecting the index. First, the contribution of the residual urinary KT/V gradually decreased from 28.6% at the start to 8 to 9% after four years. Second, the distribution volume of urea calculated as a constant fraction of body weight gradually increased. The body weight increased from 58.2 +/- 2.79 kg at start to 70.6 +/- 3.33 kg at five years. Peritoneal urea clearances and ultrafiltration rates remained stable. In 12 patients with stable body weight between 24 and 48 months, PCR decreased from 0.98 +/- 0.05 to 0.87 +/- 0.05 g/kg/day. A positive correlation between KT/V urea and PCR and a negative correlation between KT/V urea and number of hospitalization days, peritonitis rates and peripheral nerve conductivity was found. The same negative correlation was found when only the KT/V urea index obtained during the first year of treatment was considered. In conclusion, the KT/V urea index decreases in CAPD patients primarily because residual renal function decreases and body weight increases, while the peritoneal clearing for urea is maintained. The index correlates with some clinical parameters, and may have some prognostic value.

Jamaican and American adult perspectives on child psychopathology: further exploration of the threshold model.

Although several factors determine whether children receive psychological intervention, cultural determinants may be particularly influential. Cultural factors may influence adults' levels of concern over child psychopathology. This possibility was explored by comparing adult attitudes in two socioculturally different societies. Jamaican and American parents, teachers, and clinicians (total N = 382) judged vignettes of two children, one with overcontrolled (e.g., fearfulness) and one with undercontrolled (e.g., fighting) problems. Regression analyses revealed that although years of education affected some adult ratings, culture had the most profound effect.

Principal components analyses of behavior problems in Jamaican clinic-referred children: teacher reports for ages 6-17.

Factor analyses of child behavior problems have often yielded two broad-band syndromes, Overcontrolled (e.g., worrying, fearfulness, withdrawal) and Undercontrolled (e.g., restlessness, fighting, disobedience). We explored whether these two broad-band syndromes might be identified for youngsters in Jamaica. We obtained teacher reports for 320 clinic-referred Jamaican youngsters on a 24-item problem checklist designed by Jamaican clinicians for the assessment of child behavior problems and subjected these to principal components analyses. Regardless of whether the sample was split according to age or sex, the analyses revealed factors similar to the Over- and Undercontrolled syndromes most often found in other cultures. The analyses also revealed school absence factors in each age and sex group; school avoidance was correlated with crying in children (aged 6-11) but with conduct problems in adolescents (aged 12-17). The findings suggest important similarities and possible differences between the factor structures of child behavior problems in Jamaica and the United States.