Identifying Outcomes Important to Patients with Glomerular Disease and Their Caregivers.

BACKGROUND AND OBJECTIVES: Shared decision making in patients with glomerular disease remains challenging because outcomes important to patients remain largely unknown. We aimed to identify and prioritize outcomes important to patients and caregivers and to describe reasons for their choices. DESIGN: , setting, participants, & measurementsWe purposively sampled adult patients with glomerular disease and their caregivers from Australia, Hong Kong, the United Kingdom, and the United States. Participants identified, discussed, and ranked outcomes in focus groups using the nominal group technique; a relative importance score (between zero and one) was calculated. Qualitative data were analyzed thematically. RESULTS: Across 16 focus groups, 134 participants (range, 19-85 years old; 51% women), including 101 patients and 33 caregivers, identified 58 outcomes. The ten highest-ranked outcomes were kidney function (importance score of 0.42), mortality (0.29), need for dialysis or transplant (0.22), life participation (0.18), fatigue (0.17), anxiety (0.13), family impact (0.12), infection and immunity (0.12), ability to work (0.11), and BP (0.11). Three themes explained the reasons for these rankings: constraining day-to-day experience, impaired agency and control over health, and threats to future health and family. CONCLUSIONS: Patients with glomerular disease and their caregivers highly prioritize kidney health and survival, but they also prioritize life participation, fatigue, anxiety, and family impact.

Health-related quality of life in glomerular disease.

There is scant literature describing the effect of glomerular disease on health-related quality of life (HRQOL). The Cure Glomerulonephropathy study (CureGN) is an international longitudinal cohort study of children and adults with four primary glomerular diseases (minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and IgA nephropathy). HRQOL is systematically assessed using items from the Patient-Reported Outcomes Measurement Informative System (PROMIS). We assessed the relationship between HRQOL and demographic and clinical variables in 478 children and 1115 adults at the time of enrollment into CureGN. Domains measured by PROMIS items included global assessments of health, mobility, anxiety, fatigue, and sleep impairment, as well as a derived composite measure incorporating all measured domains. Multivariable models were created that explained 7 to 32% of variance in HRQOL. Patient-reported edema consistently had the strongest and most robust association with each measured domain of HRQOL in multivariable analysis (adjusted ß [95% CI] for composite PROMIS score in children, -5.2 [-7.1 to -3.4]; for composite PROMIS score in adults, -6.1 [-7.4 to -4.9]). Female sex, weight (particularly obesity), and estimated glomerular filtration rate were also associated with some, but not all, domains of HRQOL. Primary diagnosis, disease duration, and exposure to immunosuppression were not associated with HRQOL after adjustment. Sensitivity analyses and interaction testing demonstrated no significant association between disease duration or immunosuppression and any measured domain of HRQOL. Thus, patient-reported edema has a consistent negative association with HRQOL in patients with primary glomerular diseases, with substantially greater impact than other demographic and clinical variables.

The role of tryptophan degradation in the association between inflammatory markers and depressive symptoms in chronic dialysis patients.

BACKGROUND: Among chronic dialysis patients, associations have been found between inflammatory markers and depressive symptoms. In this population, no studies have examined the mechanism linking the association between inflammatory markers and depressive symptoms. We examined whether the association between inflammatory markers and depressive symptoms is mediated by tryptophan (TRP) degradation along the kynurenine (KYN) pathway. METHODS: The data are part of an observational, prospective cohort study in five urban dialysis centres in The Netherlands. Depressive symptoms were determined with the Beck Depression Inventory. Peripheral blood was collected before dialysis to measure inflammatory markers [high sensitivity C-reactive protein (HsCRP), interleukin (IL)-1ß, IL-6, IL-10 and tumour necrosis factor-α (TNF-α)], TRP, KYN and 3-hydroxykynurenine. The KYN/TRP ratio was used as a measure of TRP degradation. The association between inflammatory markers and depressive symptoms was determined using linear regression analysis and adjusted for the KYN/TRP ratio. RESULTS: In total, 490 chronic dialysis patients were included. HsCRP [ ß = 3.8; confidence interval (CI): 1.0-6.6], IL-6 ( ß = 9.1; CI: 4.0-14.1) and TNF-α ( ß = 1.3; CI: 0.9-1.7) were associated with the KYN/TRP ratio. We found significant associations between HsCRP ( ß = 0.8; CI: 0.3-1.3) and IL-6 ( ß = 1.2; CI: 0.3-2.2) levels and depressive symptoms. However, this association was not attenuated after adjustment for the KYN/TRP ratio. Also, no significant associations were found between the KYN/TRP ratio and depressive symptoms. CONCLUSION: The association between inflammatory markers and depressive symptoms in chronic dialysis patients was not mediated by TRP degradation along the KYN pathway.

Ansiedade, depressão e qualidade de vida em pacientes com glomerulonefrite familiar ou doença renal policística autossômica dominante / Anxiety, depression, and quality of life in patients with familial glomerulonephritis or autosomal dominant polycystic kidney disease

INTRODUÇÃO: Aspectos psicológicos, transtornos psiquiátricos e qualidade de vida são frequentemente avaliados em pacientes em terapia renal substitutiva. Entretanto, não existem estudos que analisem ansiedade, depressão e qualidade de vida especificamente em pacientes portadores de doenças renais familiares. OBJETIVO: Avaliar a frequência de traços e estados ansiosos e depressivos e qualidade de vida, verificando as possíveis relações com os principais achados laboratoriais, clínicos, socioeconômicos e culturais de pacientes portadores de glomerulonefrites (GN) familiares ou de doença renal policística autossômica dominante (DRPAD). MÉTODOS: Noventa pacientes adultos (52 GN familiares e 38 DRPAD) foram avaliados utilizando Inventário de Ansiedade Traço-Estado (IDATE), Inventário de Depressão Beck (Beck) e Questionário de Qualidade de Vida Short Form-36 (SF-36), além de uma breve entrevista. RESULTADOS: Observou-se ansiedade moderada em ambos os grupos, depressão em 34,6 por cento das GN e em 60,5 por cento das DRPAD. De um modo geral, ansiedade e depressão associaram-se mais ao gênero feminino na GN familiar e ao pior nível educacional na DRPAD. Pacientes de ambos os grupos apresentaram duas dimensões mais afetadas no que se refere à qualidade de vida, o aspecto emocional e a percepção geral do estado de saúde. Além disso, o SF-36 revelou que na presente amostra, a qualidade de vida foi pior para o sexo feminino, e para pacientes de cor branca, com baixa escolaridade e sem parceiros estáveis. CONCLUSÃO: Os questionários aplicados permitiram identificar frequência e graus de ansiedade, depressão e comprometimento da qualidade de vida nos pacientes com doença renal familiar, que poderiam afetar a aderência desses pacientes ao tratamento. Esses achados podem contribuir para o planejamento de um melhor atendimento multidisciplinar para ambas as doenças.

INTRODUCTION: Psychological aspects and quality of life are often evaluated in patients under renal replacement therapy, but studies about anxiety, de>pression, and quality of life in familial renal diseases are lacking. OBJECTIVES: To evaluate the frequency of anxiety, depression, and quality of life (QOL) and their eventual associations with the main laboratory, clinical, socioeconomic, and cultural parameters in familial glomerulonephritis (GN) or autosomal dominant polycystic kidney disease (ADPKD). METHODS: Ninety adult patients (52 familial GN and 38 ADPKD) completed the questionaires of State Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), and QOL-Short-Form SF-36, and were also submitted to a short interview. RESULTS: Moderate anxiety was detected in both groups. Depression was found in 34.6 percent of familial GN and 60.5 percent of ADPKD patients. Anxiety and depression were more associated with female gender in familial GN, and with poorer schooling in ADPKD. Patients of both groups presented two quality of life unfavorable dimensions: emotional role function and general health perception. In addition, quality of life was worse among females, unmarried, and Caucasian subjects, and those individuals with a poorer educational level. CONCLUSION: The use of these instruments allows one to appreciate the frequency and levels of anxiety, depression, and quality of life in patients with familial renal diseases that could affect their compliance to treatment. These findings can contribute to planning a better multidisciplinary assistance to such groups of patients.

[Clinical varieties of chronic glomerulonephritis and psychic characteristics of patients]. / Varianty klinicheskogo techeniia khronicheskogo glomerulonefrita i osobennosti psikhicheskogo sostoianiia bol'nykh.

AIM: To clarify correlations between clinical variants of chronic glomerulonephritis (CGN) and psychic status of CGN patients. MATERIAL AND METHODS: 10 patients with latent nephritis, 17 patients with nephrotic nephritis, 8 patients with mixed nephritis and 7 patients with rapidly progressive nephritis have undergone clinical and psychic examination both in the disease exacerbation and remission. RESULTS: No significant correlations were found between the severity of CGN and severity of mental disorders though it was noticed that with deterioration of CGN the rate of mental deviations grows. This necessitates psychological correction for improving the results of combined treatment of chronic renal diseases. CONCLUSION: Further studies of correlations between somatic and mental status of patients will clarify the effects of mental status on the progress of somatic pathology.

Personality dimensions of haemodialysis patients related to initial renal disease.

OBJECTIVE: The aim of the study was to investigate personality dimensions in uraemic patients undergoing haemodialysis (HD. The relationship between the disease that led to renal failure (and the subsequent need for haemodialysis) and the personality of the haemodialysis patients in question were investigated. METHODS: In the present study, which was conducted in three Greek hospitals, 103 patients were analysed and compared to 138 control patients matching the groups according to their age, sex and place of residence. The investigation was conducted using the Eysenck Personality Questionnaire (EPQ), a reliable method for clinical studies that measures three dimensions of personality: neuroticism, psychoticism and introverted/extroverted. RESULTS: The results from the EPQ were compared to the three disease categories that cause renal failure: glomerulonephritis, polycystic disease, and vascular disease. It was concluded that haemodialysis systematically affected all three scales of personality disorders in the patients. Male patients scored higher in neuroticism, while female patients appeared to score higher in psychoticism. Renal disease, the responsible factor for renal failure and the need for haemodialysis, significantly affected personality disorders. CONCLUSION: The findings show that dialysis modality influences the personalities of patients, and that initial renal disease must be strongly considered in the psychosocial evaluation and care of these patients.

[Glomerulonephritis in the aspect of patient self-assessment]. / Hlomerulonefryt v aspekti samootsinky patsiienta.

It is shown that organization of dispensary follow-up of patients with glomerulonephritis fails to ensure completeness of records-taking and control of the disease course in a timely fashion. The following items were found to influence negatively the quality of specialized medical aid: too late applying of patients for medical advice, non-adherence to the physician's prescriptions and self-curing, which fact is not infrequently related to the patients' inadequate material gains and lack of care in respect of their own health. This warrants heightening of medical-and-educational activities. Risk groups to be targeted for special care include women (in spite of greater disability rates among male subjects), persons aged less than 20 and those beyond 40 years old, those persons that have not completed high education, and those residing in rural areas.

[Treatment of bone disorders in renal diseases]. / Lechenie patologii kostnoi sistemy pri zabolevaniiakh pochek.

AIM: To study possible correction of bone disorders (osteopenia, Ca/P-imbalance, bone pain, limited volume of indolent movements) which are still a serious complication associated with renal diseases and pathogenic therapy (steroids). MATERIALS AND METHODS: The bone disorders were treated in 10 uremic hemodialyzed patients (8 men, 2 women; group 1) with vitamin D3 (calcitriol made in Russia) + rhEPO (recormon; Boehringer Mannheim), in 15 patients (15 women, 0 men) with lupus-nephritis (group 2) with vitamin D3 (n = 5, group 2a) or miscalcic (Sandoz) (n = 10, group 2b), in 2 patients (2 men, 0 women) with glomerulonephritis (group 3) with vitamin D3 + miacalcic. Additionally all the patients received Ca salts. In groups 2 and 3 renal function was normal. The duration of the treatment was 3-6 months. RESULTS: In all the groups we obtained an analgetic effect (attenuation of bone pain and more indolent movements), improvement of life quality, diminished need in analgetics, elevation of serum Ca level (p > 0.05). CONCLUSION: Treatment of renal patients with bone affection with vitamin D3 and miacalcic has an analgetic effect, improves life quality.