Role of Different Blood Purification Nursing Models in Uremic Patients: A Preliminary Report.

BACKGROUND Accumulation of uremic toxins is closely associated with chronic kidney disease (CKD)-related complications such as cerebrovascular accidents and cardiovascular diseases. Clinical nursing is accepted as a critical clinical prognosis factor for hospitalized patients. The present study was designed to compare the effects of different blood purification nursing models on clinical outcomes in patients with uremia. MATERIAL AND METHODS A total of 68 patients with uremia were selected and divided to control and intervention groups. The patients in the control group received traditional nursing model care, while the patients in intervention group received comprehensive high-quality nursing care for 6 months. RESULTS After 6 months of treatment, the quality of life, anxiety, and depression were obviously ameliorated in both groups. The levels of blood urea nitrogen (BUN), parathyroid hormone (PTH), creatinine, ß2-microglobulin (ß2-MG), total cholesterol (TC), albumin (ALB), interleukin-1ß (IL-1ß), IL-6, tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), 8-isoprostane, and malondialdehyde (MDA), as well as superoxide dismutase (SOD) and catalase (CAT) activities were all significantly improved in both groups of patients, but the intervention group exhibited better results than the control group. CONCLUSIONS Our results demonstrated that comprehensive high-quality nursing care rectified the metabolic disorders and inhibited systematic inflammatory factors, and oxidative stress, which may be responsible for better amelioration of quality of life in patients with uremia.

Saliva composition and upper gastrointestinal symptoms in chronic kidney disease.

OBJECTIVE: To investigate self-reported upper gastric symptoms experienced by patients with chronic kidney disease (CKD) and compare associations between uraemic symptoms and saliva composition. METHODS: In a cross-sectional observational study, 30 patients with Stages 4 and 5 CKD were selected from a tertiary hospital renal outpatient clinic. Subjects answered a questionnaire to assess upper gastrointestinal (GI) symptoms. A saliva sample was collected to determine biochemical composition. Possible associations between saliva composition and uraemic upper GI symptoms were assessed. RESULTS: Only 3 (10%) patients reported no upper GI symptoms whilst 19 (63%) complained of a dry mouth, 16 (56%) had a change in taste, 9 (30%) had nausea, 7 (23%) vomited and 7 (23%) dry retched. Lower saliva bicarbonate concentration related to both dry mouth (p < 0.003) and dry retching (p < 0.01). An elevated level of saliva calcium was also implicated in a dry mouth sensation (p < 0.01). Nausea was associated with higher saliva sodium levels (p < 0.03) and a higher saliva sodium/potassium ratio (p < 0.02). CONCLUSION: Altered saliva composition in patients with Stages 4 and 5 CKD may be associated with uraemic upper GI symptoms. In particular, lower saliva concentrations of bicarbonate are associated with dry mouth and retching. Higher saliva calcium levels are also related to a dry mouth whilst higher saliva sodium levels and a greater sodium/potassium ratio are associated with nausea. Further studies investigating strategies to improve uraemic symptoms via changes in saliva are required.

Calcific uremic arteriolopathy: overview for the nurse.

Calcific uremic arteriolopathy is a little understood diagnosis of increasing prevalence seen predominantly in patients with chronic kidney disease, particularly those who are approaching end-stage renal disease, who are undergoing renal dialysis, and who have secondary hyperparathyroidism. Calcific uremic arteriolopathy affects women more frequently than men, at a ratio of 3:1, and the median age at diagnosis is 48 years. A clear understanding of the pathogenesis and definitive plans of care are lacking. Nurses should be familiar with the clinical picture of calcific uremic arteriolopathy. Early recognition is important to develop optimal treatment plans and to limit progression of this rare but often fatal disease. Nurses have a pivotal role in maintaining the patient's comfort and dignity, while setting realistic goals of care. Calcific uremic arteriolopathy remains a rare and complex clinical condition that requires a multidisciplinary health care team approach to provide the optimal level of care. Nurses have an essential role in the care of patients with the diagnosis of calcific uremic arteriolopathy.

Predialysis patient education: effects on functioning and well-being in uraemic patients.

This study evaluated the effects of a predialysis patient education programme on functioning and well-being in 28 uraemic patients. The programme consisted of four group sessions with the following themes: renal disease and dietary restriction, active renal replacement therapy, physical exercise, and the impact of chronic renal failure on economy, family and social life. Three to 9 months after having started dialysis the patients were evaluated regarding symptoms, perceived health (Health Index), functional (SIP) and emotional (STAI) status. Twenty-eight patients already on dialysis treatment informed according to conventional routines constituted the comparison group. There were no significant differences between the groups regarding age, sex, educational or social background, duration of kidney disease, choice of dialysis treatment, cause of renal disease and laboratory tests except for s-urea. The patients who participated in the education programme scored significantly better mood, less mobility problems (HI), less functional disabilities (SIP) and lower levels of anxiety (STAI) compared to the comparison group. There were no significant differences between the two groups regarding symptoms and overall health. The differences between the groups prevailed during the first 6 months on dialysis treatment, after which the differences disappeared. In the comparison group age correlated significantly to anxiety and overall SIP, which was not the case in the experimental group. In conclusion, the experimental group that participated in a predialysis patient education programme, showed better functional and emotional well-being than the non-educated comparison group. The positive effects of participating in an education programme prevailed during the first 6 months of dialysis treatment. Moreover, the younger patients seemed especially to benefit from participation in a predialysis patient education programme. It is suggested that patient education should be ongoing for patients with end-stage renal failure initiated during the predialysis stage and continued after maintenance dialysis has been established.

Uremic pericarditis in chronic renal failure: nursing implications.

Cardiovascular complications are the leading cause of death in patients with chronic renal failure. Pericardial disease is among the first recognized manifestations of uremia. This article explores the pathophysiology of uremic pericarditis, assessment of chronic renal failure patients at risk for developing pericarditis, and major complications of pericarditis. Current treatment modalities and nursing care for the patient with uremic pericarditis are included.