Computerized adaptive technology for the assessment of HRQOL of PD and CKD patients.

This study was designed as a pilot study to see whether electronic patient-reported outcome measures using computer adaptive technology (CAT) could be successfully implemented in clinics caring for chronic kidney disease (CKD) and peritoneal dialysis (PD) patients. The results demonstrate the feasibility of using CAT on an iPad to assess the symptom burden and health-related quality of life of both PD and CKD patients.

The Impact of Anemia Treatment on Health-Related Quality of Life in Patients With Chronic Kidney Disease in the Contemporary Era.

The treatment of anemia with erythropoietic-stimulating agents is now part of the routine care of patients with CKD with guidelines for anemia management carefully outlined by Kidney Disease Improving Global Outcomes. The treatment of anemia impacts the health-related quality of life of CKD patients, primarily affecting the domains of energy/vitality and physical functioning. Improvements in these domains occur, in general, most noticeably when hemoglobin levels are raised from below 9 g/dL to the 10-12 range, with limited improvements occurring when hemoglobin levels are increased above 12 g/dL. Importantly, individual patient responses to anemia treatment vary depending on a variety of factors and it is important to assess the impact of treatment on each patient, particularly as nephrology care moves to a patient-centered care model.

The experience of dialysis therapy among younger adults.

The present study was undertaken to examine the experience of younger dialysis patients with end-stage renal disease (ESRD) care. Structured tape-recorded interviews focusing on perceptions of ESRD care and how that care could be improved were initially conducted with 25 dialysis patients [16 on conventional hemodialysis (HD), 6 on nocturnal in-center HD, 2 on home peritoneal dialysis (PD), and 1 on home HD]. The mean age of the patients was 43.8 +/- 12.2 years, and their mean dialysis duration was 4.6 +/- 3. Oyears. Five important domains were identified from the interviews. Based on those findings, a questionnaire was developed and distributed to 62 ESRD patients (49 on HD, 13 on PD). Several domains were identified that provide insight into how the patients thought their care could be improved. Our results suggest that certain changes in ESRD care might improve the experience of younger dialysis patients.

Quality of life of chronic kidney disease patients in developing countries.

In the developing world, the emphasis of care for the patient with chronic kidney disease is, in general, focused on the basics of care and patient survival; attention is not primarily focused on quality of life assessments. However, this arena is beginning to attract more attention. It is important to determine if standardized instruments are valid in the developing world and which unique assessments need to be utilized in individual cultural settings.

Assessing and improving the health-related quality of life of patients with ESRD.

Impairment of the health-related quality of life (HRQOL) of patients with end-stage renal disease (ESRD) is now well documented. These impairments involve a wide variety of domains and can be assessed using an array of well-validated instruments. Incorporation of at least some of these instruments into routine patient care is important in order to measure the physical and psychological impact of a disease and its treatment on the HRQOL of patients. How this implementation can be achieved in a practical way is, however, a challenge. As more research focuses on improving the HRQOL of patients with ESRD, the systematic evaluation of HRQOL and incorporation into patient care is becoming increasingly important. Whether strategies to improve the HRQOL of patients will translate into improved patient outcomes--as evidenced by reduced mortality and hospitalizations--and lower costs, remains to be determined.

Reassessment of the care of the patient with chronic kidney disease.

The paper by Fischer et al. focuses attention on the striking prevalence of depressive symptoms in non-dialyzed chronic kidney disease patients. The presence of depressive symptoms correlated with various health-related quality of life measures and economic status. These findings suggest that our view of providing care needs to broaden to incorporate not only thorough medical care, education, and dietary support, but also psychosocial assessments. They also underscore the importance of providing this care to those who are most vulnerable.

An approach to addressing depression in patients with chronic kidney disease.

Depressive symptoms and clinical depression are commonly noted in patients with end-stage renal disease and chronic kidney disease (not on dialysis). This association is important since depressive symptoms have been associated with both an impaired quality of life and increased morbidity and mortality. It is, therefore, important to develop strategies to screen patients with chronic kidney disease for depression and to develop strategies to treat clinical depression in this group of patients.

Health related quality of life and the CKD patient: challenges for the nephrology community.

The compromised health-related quality of life (HRQOL) of patients with chronic kidney disease is now well documented. The recent mandate by the Center for Medicare Services in the United States that all dialysis units monitor HRQOL as a condition of coverage has focused attention on the importance of these measures. The challenge for the nephrology care team is understanding how to interpret and utilize the information obtained from these HRQOL measurements. Can HRQOL of these patients be improved? The present review addresses this issue by commenting on strategies that have been used to improve the HRQOL of chronic kidney disease patients. A systematic approach is suggested for nephrology care providers to attempt to evaluate and improve the HRQOL of CKD patients.

Depression and end-stage renal disease: a therapeutic challenge.

Hedayati et al. document a 26.5% incidence of clinical depression and a strong association between depression and hospitalizations and mortality in hemodialysis patients. We can no longer ignore the impact of depression on end-stage renal disease patients. Appropriate therapeutic regimens and trials need to be explored.

Psychosocial assessment of the patient on chronic peritoneal dialysis: an overview.

The psychosocial assessment of the patient with end-stage renal disease is critically important because (1) there is growing evidence that the psychosocial status of the patient impacts medical outcomes and (2) the objective of therapy is to maximize a patient's sense of well-being and quality of life. This is particularly true for patients receiving a home-based therapy such as chronic peritoneal dialysis. The present review outlines a possible structure and format for performing psychosocial evaluations for patients maintained on chronic peritoneal dialysis. But, each facility must design its own format, making sure that the critical domains discussed in this review are addressed.

Effects of home hemodialysis on health-related quality of life measures.

In recent years, there has been an increased interest in performing hemodialysis (HD) more frequently than thrice weekly, particularly in the home setting. This interest has been stimulated by some studies that have indicated significant benefits to performing more frequent HD on various medical and quality of life outcome measures. However, only a few studies using varying quality of life instruments have critically examined the impact of frequent HD on the quality of life of patients. Although not consistent across studies, results suggest a positive impact of more frequent HD on patients' quality of life. It is hoped that the results of two landmark studies, now in progress (the Frequent Hemodialysis Network trial and the FREEDOM study), will provide more insight into the impact of more frequent HD on quality of life.

Therapy Insight: sexual dysfunction in patients with chronic kidney disease.

Sexual dysfunction is common in people with chronic kidney disease (CKD). Sexual dysfunction in these patients should be thought of as a multifactorial problem that is affected by a variety of physiological and psychological factors, as well as by comorbid conditions. Assessment of sexual difficulties in patients with CKD, therefore, involves a careful investigation of a variety of domains. The development of treatment strategies presents challenges as it is often difficult to determine the primary factor(s) responsible for the sexual dysfunction. It is important to think of the treatment in the overall context of the management of various medical problems presented by patients with CKD. It must be remembered that the design of therapeutic approaches for each patient is dependent on the systematic evaluation of the functional and psychosocial problems presented, and assessment of the cause(s) of sexual dysfunction.

Integration of cognitive behavioral therapy into psychiatric rehabilitation day programming.

Cognitive Behavioral Therapy has substantial empirical support for the treatment of people with severe and persistent mental illnesses. Efforts to integrate this type of therapy into psychiatric rehabilitation practices are growing. This paper describes an innovative integration of Cognitive Behavioral Therapy into a psychiatric rehabilitation day program attended by people with severe and persistent mental illnesses and frequently co-occurring substance use disorders. The challenges of maintaining the cognitive model and other core features of Cognitive Behavioral Therapy in a heterogeneous, large, group-based program are discussed.