RESUMO
End stage renal disease (ESRD) unduly affects black families in the U.S., including black women who are the family caregivers of affected patients. Nephrology nurses who support chronic hemodialysis recipients may be the first to recognize depressive and anxiety symptoms in this understudied caregiver population. This article describes the risk factors for depression in black women who care for persons receiving chronic hemodialysis therapy and INSIGHT therapy as a potential intervention to reduce depressive symptoms.
Assuntos
Ansiedade/prevenção & controle , Negro ou Afro-Americano/etnologia , Cuidadores/psicologia , Terapia Cognitivo-Comportamental/organização & administração , Depressão/prevenção & controle , Diálise Renal , Negro ou Afro-Americano/educação , Ansiedade/etnologia , Ansiedade/etiologia , Atitude Frente a Saúde/etnologia , Cuidadores/educação , Depressão/etnologia , Depressão/etiologia , Família/etnologia , Feminino , Assistência Domiciliar/psicologia , Humanos , Falência Renal Crônica/etnologia , Falência Renal Crônica/terapia , Modelos Psicológicos , Pesquisa Metodológica em Enfermagem , Pobreza/etnologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Diálise Renal/enfermagem , Diálise Renal/psicologia , Fatores de Risco , Autoimagem , Fatores Sexuais , Apoio Social , Estereotipagem , Mulheres/educação , Mulheres/psicologiaRESUMO
Heart rate variability (HRV), a measure of autonomic function, is associated with mortality in non-end stage renal disease (ESRD). The purpose of this pilot study was to determine if HRV was predictive of mortality in patients on dialysis and to identify at-risk factors. Patients on chronic hemodialysis (n = 53) were assessed at baseline and again 24 months later. Baseline measures quantified 24-hour HRV, health, depression, and quality of life (QoL). Twenty-four-month data determined mortality. Participants were African American, 49% male, aged 47.8+/-13.3 years, with 62.4+/-60 months of dialysis. Outcomes of 24-hour HRV measures were impaired for all groups. Factors including exercise and smoking were associated with diminished HRV. The low frequency-high frequency ratio was found to be the most influential HRV determinant of death. The ability to identify patients at-risk for death and to prescribe therapy to reduce risk could have significance for the care of patients with ESRD.
Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Frequência Cardíaca , Falência Renal Crônica/mortalidade , Falência Renal Crônica/fisiopatologia , Monitorização Fisiológica/métodos , Diálise Renal , Análise de Variância , Ansiedade/complicações , Ansiedade/diagnóstico , Depressão/complicações , Depressão/diagnóstico , Complicações do Diabetes/complicações , Feminino , Análise de Fourier , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/normas , Projetos Piloto , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco/métodos , Medição de Risco/normas , Fatores de Risco , Fumar/efeitos adversos , Análise de SobrevidaRESUMO
The correction of anemia in dialysis patients with erythropoietin (EPO) can be frustrated by insufficient iron. To address this effect, we preloaded candidate EPO patients with intravenous iron in the early 1990s. Preloading with 900-1,525 mg of iron yielded the following results: 70% of patients had increasing hematocrits (HCTs) without EPO, and 40% of patients had HCTs greater than 30%. Apparent lack of iron led to blood loss studies. Routes evaluated were blood sampling, dialyzer clotting, blood in the dialyzer circuit and postdialysis bleeding. Projected annual losses were between 2,516 and 5,126 ml, depending on circuit and posttreatment losses. In terms of red cell loss, the results are comparable to those in the early days of dialysis before the introduction of current technology. Extension of these studies to daily dialysis predicts possible losses with this 6 times a week therapy of between 4,663 and 9,884 ml per year.
