Development and Evaluation of the Psychometric Properties of the CKD-MBD Knowledge and Behavior (CKD-MBD-KB) Questionnaire for Patients With Chronic Kidney Disease.

CONTEXT: Chronic kidney disease-mineral and bone disorder (CKD-MBD) is one of the most complicated morbidities among patients with end-stage renal disease. At present, a specific questionnaire assessing relevant knowledge and behavior for patients with CKD-MBD is still unavailable. OBJECTIVES: To develop and evaluate a valid and reliable questionnaire specific to patients with CKD-MBD. METHODS: Both quantitative and qualitative analyses were combined to develop and estimate the CKD-MBD knowledge and behavior (CKD-MBD-KB) questionnaire. Three hundred thirteen and 295 patients, respectively, participated in the investigation during the period from November 2013∼October 2014. Reliability and validity testing were conducted to analyze the psychometric properties of questionnaire. RESULTS: The final version of the CKD-MBD-KB questionnaire encompasses two domains, five facets, and 50 items. Reliability analysis showed that the Cronbach alpha of the five facets ranged from 0.578 to 0.854. Retest correlation coefficients of the five facets ranged from 0.825 to 0.944. Nine common factors were extracted from exploratory factor analysis that interpreted the cumulative variation of 64.1%, and factor loadings of all items were greater than 0.4. The results of confirmatory factor analysis indicated that the model had a satisfactory goodness of fit; the root mean square error of approximation = 0.070. Meanwhile, a significant correlation was found between each item and its facet. CONCLUSION: This CKD-MBD-KB questionnaire has been confirmed to have adequate psychometric properties (good reliability and validity) and may be useful in the assessment of patient-related knowledge, intervention programs, and treatment protocols.

A Review of Pediatric Chronic Kidney Disease.

Chronic kidney disease is complex in both adults and children, but the disease is far from the same between these populations. Here we review the marked differences in etiology, comorbidities, impact of disease on growth and quality of life, issues unique to adolescents and transitions to adult care, and special considerations of congenital kidney and urinary tract anomalies for transplantation.

Chronic kidney disease mineral bone disorder and health-related quality of life among incident end-stage renal-disease patients.

OBJECTIVE: Our objective was to determine the extent to which chronic kidney disease mineral bone disorder (CKD-MBD) is associated with health-related quality of life among incident dialysis patients. DESIGN: This study's design was a cross-sectional analysis. SETTING: This was part of the United States Renal Data System Dialysis Morbidity and Mortality Study (DMMS), Wave 2. PATIENTS: The patients comprised 2590 adult participants in DMMS Wave 2, for whom quality of life and laboratory data were available. METHODS: We stratified patients according to their serum concentrations of phosphorus, calcium, and parathyroid hormone (PTH), and compared health-related quality of life as a function of these indicators in analyses adjusted for demographic, clinical, and other laboratory variables. MAIN OUTCOME MEASURES: Main outcome measures included Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, and the Symptom score of the Kidney Disease Quality of Life. RESULTS: Both high and low serum phosphorus concentrations were associated with lower PCS scores (-1.25 to -1.48 points compared with the reference category), as was low PTH (-1.49 points). Low serum phosphorus was associated with more severe symptoms of kidney disease (-3.88 points), but there were no associations between high phosphorus or either extreme of PTH and the Symptom score. Serum calcium concentration and the calcium x phosphorus product were unassociated with PCS or Symptom scores. There were no associations among phosphorus, calcium, or PTH and MCS. Analyses simultaneously controlling for serum phosphorus, calcium, and PTH showed similar results. CONCLUSION: High and low serum phosphorus and low PTH are associated with slightly poorer self-reported physical functioning. Clinical trials will be necessary to determine whether and to what extent improvement in health status may occur with the correction of selected disorders of mineral metabolism.

Osteotomía femoral distal en una joven con raquitismo renal / Femoral distal osteotomy in a young women with renal rhachitis

El Raquitismo Renal ú Osteodistrofia Renal, es una enfermedad de los primeros años de la vida, que no ha curado por completo y que se ha mantenido en estado de latencia durante 10 a 15 años de la infancia para luego, en un momento del crecimiento ó "segundo estirón", adopta formas graves a predominio renal y ortopédico a través de un hiperparatiroidismo secundario que genera la insuficiencia renal y gran parte de su notable detención del crecimiento. En este trabajo presentamos la conducta quirúrgica ante el valgismo bilateral de rodillas, adelantándonos al traplante renal, no sin prever los inconvenientes que dicho adelantamiento podía generar, especialmente de los planes inmunológicos a seguir. El hecho de que la osteotomía correctora se llevará a cabo antes del trasplante renal, fue motivado por la dificultad que padecía la enferma durante la marcha junto al deterioro estético declarado por la misma. (AU)

Treatment strategies for renal bone disease.

Renal bone disease encompasses a wide range of bone abnormalities that are intricately linked with metabolic systems that are driven by calcium, phosphorus, PTH, and D hormone levels. An integrated approach to treatment must involve both dietary measures, use of phosphate binders as appropriate, and D hormone replacement. Not incidentally, implementation of this integrated approach involves not only our patients but everyone associated in their care, especially the nephrologist, nephrology nurse, and renal dietitians. Improving patient outcomes--preventing or minimizing renal bone disease and the complications of secondary hyperparathyroidism--will require communication and cooperation between all of us on behalf of our patients.

Multidimensional health locus of control as partial predictor of serum phosphorus in chronic hemodialysis.

The Multidimensional Health Locus of Control Scale was administered to 137 chronic hemodialysis outpatients in a survey designed to examine the relationship of these scores to serum phosphorus, a laboratory indicator of dietary compliance in end-stage renal disease. In a multiple regression analysis, scores on the Powerful Others Locus of Control subscale accounted for 8.9% of the variance in serum phosphorus. Discussion includes a tentative explanation of the findings and limitations of the design.