ABSTRACT
AIM: To identify and synthesise qualitative studies on barriers and facilitators perceived by dialysis patients in relation to self-care and disease management. DESIGN: Systematic review of qualitative studies. DATA SOURCES: Qualitative study articles were extracted from PUBMED, MEDLINE, COCHRANE, WEB OF SCIENCE (WOS), CINAHL PsycINFO and EMBASE and electronic journals of the Spanish Society of Nephrology and Spanish Society of Nephrological Nursing until May 2022. Studies on barriers and/or facilitators affecting self-care and disease management expressed by people undergoing haemodialysis or peritoneal dialysis were included. REVIEW METHODS: The SPICE (Setting, Perspective, Intervention, Comparison and Evaluation) strategy was used to develop issues and subissues through the thematic synthesis of the qualitative findings. GRADE-CERQual was used to evaluate the articles. RESULTS: From 172 articles, 15 qualitative articles about barriers and facilitators perceived by patients concerning self-care and disease management were finally included. Identified eight facilitators and four barriers. CONCLUSION: Patients perceived a significant number of barriers and facilitators. It is possible to identify which aspects facilitate self-management of their disease and to understand that the processes are individualised. This is why therapeutic strategies should be designed to foster the participation and empowerment of the person in the management of the disease. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Identifying the barriers and facilitators concerning the management of chronic kidney disease furnishes us with knowledge for individualised clinical practice and improved care processes. IMPACT: This review is the first to synthesise barriers and facilitators in haemodialysis patients about the management of their disease and treatment. The results enable the proposal of improvements in the training of healthcare personnel, clinical practice guidelines and action protocols to improve the daily life and management of the disease by patients. No patient or public contribution due to this is a systematic review.
ABSTRACT
Peritoneal dialysis (PD) pericatheter exit-site leaks most commonly occur early, within 30 days of catheter insertion. Late exit-site leaks are rare. The distinction between early and late exit-site leaks is important because the causes and subsequent management strategies may be different. Early leaks can often be first treated by delaying or holding PD therapy, allowing the prolongation of the healing time because fibrous tissue continues to form around the deep cuff. Late leaks are less likely to heal with cessation of PD alone and often require PD catheter replacement. In this case report, we provide an overview of the diagnosis and management of PD catheter exit-site leaks while highlighting a case of a late presenting exit-site leak resulting from a unique cause of PD catheter trauma.
ABSTRACT
A hemodiálise (HD) e a diálise peritoneal (DP) são as terapias renais de substituição mais comumente utilizadas, sendo que o estado nutricional dos pacientes com Doença Renal Crônica (DRC) pode ser influenciado pela modalidade de diálise utilizada. Objetivo: Comparar o estado nutricional de pacientes em HD e em DP, por meio da avaliação antropométrica e bioquímica. Trata-se de um estudo transversal, realizado no setor de nefrologia do Hospital Universitário da Universidade Federal de Juiz de Fora. O estudo foi constituído por 29 pacientes em DP e 36 em HD, totalizando 65 pacientes. Os dados coletados foram: peso corporal seco, estatura, Índice de Massa Corporal (IMC), área muscular do braço (AMB), circunferência muscular do braço (CMB), prega cutânea tricipital (PCT) e circunferência do braço (CB); além dos exames bioquímicos: potássio, fósforo, uréia e albumina. Pode-se observar maior prevalência do sexo feminino na modalidade DP em relação a HD (75% X 44,4%, p = 0,01). Houve diferença nos tempos em diálise entre os grupos (DP: 41,86 ±33,2 meses X HD: 22,36 ±5,4 meses, p = 0,001). Em relação à classificação da CMB, 48,3% dos pacientes em DP e 22,2% em HD foram classificados como eutróficos (p = 0.001). Quanto à AMB, 72,5% dos pacientes em DP e 36,1% dos pacientes em HD foram classificados como eutróficos (p = 0.001). Em relação aos exames bioquímicos, somente o potássio apresentou diferença significante entre os grupos (DP: 4,9 ±0,73 mEq/L e HD: 5,64 ±0,78 mEq/L, p = 0,01). No presente estudo, os pacientes em DP apresentam melhor classificação em relação a CMB e AMB, além de melhor controle do potássio sérico, em relação aos pacientes em HD.
Hemodialysis (HD) and peritoneal dialysis (PD) are the most commonly used renal replacement therapy. The nutritional status of chronic kidney disease (CKD) patients can be influenced by the dialysis modality used. Objective: To compare the nutritional status of patients in HD and PD, through anthropometric and biochemical evaluation. This is a cross-sectional study carried out in the nephrology sector of the University Hospital of the Federal University of Juiz de Fora. The study consisted of 29 patients in PD and 36 in HD, totaling 65 patients. The data collected were: dry body weight, stature, body mass index (BMI), arm muscle area (BMA), arm muscle circumference (BMC), triceps skin fold and arm circumference. In addition, the biochemical tests: potassium, phosphorus, urea and albumin. It is possible to observe a higher prevalence of female sex in the PD modality in relation to HD (75% X 44.4%, p = 0.01). There was a difference in dialysis times between groups (SD: 41.86 ± 33.2 months X HD: 22.36 ± 5.4 months, p = 0.001). Regarding BMC classification, 48.3% of patients in PD and 22.2% in HD were classified as eutrophic (p = 0.001). As for BMA, 72.5% of patients in PD and 36.1% of patients in HD were classified as eutrophic (p = 0.001). In relation to the biochemical tests, only potassium had a significant difference between the groups (SD: 4.9 ± 0.73 mEq / L and HD: 5.64 ± 0.78 mEq / L, p = 0.01). In the present study, patients in PD present better classification in relation to BMC and BMA, in addition to better control of serum potassium, compared to patients in HD.
Subject(s)
Humans , Nutritional Status , Renal Dialysis , Peritoneal Dialysis , Biochemical Phenomena , AnthropometryABSTRACT
Introducción: la diálisis peritoneal es subutilizada en muchos países. Convencionalmente el ingreso de los pacientes agudos a terapia de reemplazo renal se hace a HD. El inicio urgente a diálisis peritoneal ofrece una opción segura y eficaz para evitar el uso de catéteres venosos centrales e incrementar el uso de Diálisis Peritoneal. Material y métodos: Es un estudio retrospectivo, observacional que comparan los pacientes que iniciaron diálisis peritoneal en forma urgente con los que iniciaron en forma convencional luego de 4 semanas. Resultados: Se analizaron 12 pacientes(n=12) ingresados a DP. Seis pacientes iniciaron en forma urgente y seis ingresaron en forma convencional. El tiempo de seguimiento fue menor para los pacientes de inicio urgente. No hubo diferencias significativas entre ambos grupos para: edad, sexo, volumen de inicio, KT/V, albúmina, urea, calcio, fósforo, ferritina, PCR y tipo de catéter. La PTH fue significativamente menor en los pacientes que iniciaron DP en forma urgente (P< 0,047). En cuanto a las complicaciones: dos pacientes presentaron fuga de líquido peritoneal y uno un hematoma de pared en el grupo de inicio urgente. Las complicaciones se resolvieron con tratamientos adecuados y no fueron causa de cambio de modalidad. Conclusiones: El inicio urgente a diálisis peritoneal es seguro y no conlleva a mayores complicaciones. Es una estrategia para disminuir el uso de catéteres de hemodiálisis e incrementar el número de pacientes en el programa de diálisis peritoneal.
Introduction: peritoneal dialysis is under-used in many countries. Usually the admission of acute patients to renal replacement therapy are directed to HD. Urgent start of peritoneal dialysis offers a safe and efficient option to avoid the use of central venous catheters and to increase peritoneal dialysis use. Material and methods: It is a retrospective, observational study comparing patients who started urgent peritoneal dialysis with those that started dialysis in the conventional way, after 4 weeks. Results: 12 peritoneal dialysis patients were analyzed. Six of them under urgent start and the other six received the conventional procedure, follow-up period was shorter for patients receiving urgent start. There were not significant differences between both groups concerning: age, sex, initial volume, KT/V, albumin, urea, calcium, phosphorus, ferritin, PCR and type of catheter. PTH was significantly lower in patients who received urgent start PD (P<0.047). Regarding complications: two patients presented leakage of peritoneal fluid and one patient had wall bruising, in the urgent start group. Complications were solved with adequate treatments and did not cause change of methods. Discussion: Urgent start to peritoneal dialysis is a safe method and does not involve major complications. It is a strategy to decrease the use of hemodialysis catheters and to increase number of patients on dialysis peritoneal programs.
