196 research outputs found
Educating Primary Care Nurses on Phosphorus Management in Chronic Kidney Disease Patients
Fifteen percent of adults in the United States have been diagnosed with chronic kidney disease (CKD). CKD is the slow, progressive, and irreversible loss of kidney function. The most effective means of controlling CKD is by managing dietary phosphorus intake. It is important that staff nurses be educated about effective patient education tools to improve dietary phosphorus management. The purpose of this project was to educate primary care nurses about phosphorus management in CKD patients through the introduction of the phosphorus pyramid as a visual tool. The project sought to understand if an educational intervention regarding phosphorus management in CKD patients could increase the primary care nurse\u27s knowledge. The John Hopkins evidence-based practice model informed the development of this project. Ten primary care nurses participated in a 45-minute education program which focused on the use of the Phosphorus Pyramid. A pre and post-test of knowledge was completed via a Likert scale questionnaire that measured knowledge related to the educational objectives of the program. The posttest scores showed an increase of 15% overall in staff\u27s knowledge regarding dietary phosphorus management, the participants were more likely to correctly answer questions related to the phosphorus content of food and drink. The phosphorus pyramid will serve as a user-friendly tool to assist patients in identifying high phosphorus foods that need to be avoided and low phosphorus foods that are recommended to incorporate in their renal diet. This project supports social change by improving the healthcare team\u27s knowledge regarding dietary recommendations for CKD patients thereby contributing to improved patient outcomes and reduced healthcare costs
Conservative kidney management and kidney supportive care:core components of integrated care for people with kidney failure
Integrated kidney care requires synergistic linkage between preventative care for people at risk for chronic kidney disease and health services providing care for people with kidney disease, ensuring holistic and coordinated care as people transition between acute and chronic kidney disease and the 3 modalities of kidney failure management: conservative kidney management, transplantation, and dialysis. People with kidney failure have many supportive care needs throughout their illness, regardless of treatment modality. Kidney supportive care is therefore a vital part of this integrated framework, but is nonexistent, poorly developed, and/or poorly integrated with kidney care in many settings, especially in low- and middle-income countries. To address this, the International Society of Nephrology has (i) coordinated the development of consensus definitions of conservative kidney management and kidney supportive care to promote international understanding and awareness of these active treatments; and (ii) identified key considerations for the development and expansion of conservative kidney management and kidney supportive care programs, especially in low resource settings, where access to kidney replacement therapy is restricted or not available. This article presents the definitions for conservative kidney management and kidney supportive care; describes their core components with some illustrative examples to highlight key points; and describes some of the additional considerations for delivering conservative kidney management and kidney supportive care in low resource settings.</p
2017 Kidney Disease: Improving Global Outcomes (KDIGO) Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) Guideline Update Implementation: Asia Summit Conference Report
Improving Global Outcomes (KDIGO) Clinical Practice Guideline on Chronic Kidney Disease–Mineral and Bone Disorder (CKD–MBD) 2009 provided recommendations on the detection, evaluation, and treatment of CKD-MBD in patients CKD who are and are not undergoing dialysis. Because of the accumulation of evidence since this initial publication, the CKD-MBD Guideline underwent a selective update in 2017. In April 2018, KDIGO convened a CKD-MBD Guideline Implementation Summit in Japan with the key objective to discuss various barriers to the uptake and implementation of the CKD-MBD Guideline in 8 Asian countries/regions. These countries/regions were comparable according to their high-to-middle economic ranking assigned by the World Bank. The discussion took into account the availability of CKD-MBD medication therapies and government health policies that may influence reimbursement and practice patterns in the region. Most importantly, Summit participants developed a framework of multifaceted strategies aimed at overcoming barriers to guideline implementation. The Summit attendees suggested a shared decision-making approach between clinicians and patients in CKD-MBD management, as well as individualized care based on the treatment risk-benefit ratio. The Summit participants also discussed how KDIGO, as a guideline development organization, may work in partnership with local and national nephrology societies to provide education and facilitate implementation of the guideline by clinicians. The conclusions drawn from this Summit in Asia may serve as an important guide for other regions to follow
Targeted, structured text messaging to improve dietary and lifestyle behaviours for people on maintenance haemodialysis (KIDNEYTEXT): Study protocol for a randomised controlled trial
Introduction Managing nutrition is critical for reducing morbidity and mortality in patients on haemodialysis but adherence to the complex dietary restrictions remains problematic. Innovative interventions to enhance the delivery of nutritional care are needed. The aim of this phase II trial is to evaluate the feasibility and effectiveness of a targeted mobile phone text messaging system to improve dietary and lifestyle behaviours in patients on long-term haemodialysis. Methods and analysis Single-blinded randomised controlled trial with 6 months of follow-up in 130 patients on haemodialysis who will be randomised to either standard care or KIDNEYTEXT. The KIDNEYTEXT intervention group will receive three text messages per week for 6 months. The text messages provide customised dietary information and advice based on renal dietary guidelines and general healthy eating dietary guidelines, and motivation and support to improve behaviours. The primary outcome is feasibility including recruitment rate, drop-out rate, adherence to renal dietary recommendations, participant satisfaction and a process evaluation using semistructured interviews with a subset of purposively sampled participants. Secondary and exploratory outcomes include a range of clinical and behavioural outcomes and a healthcare utilisation cost analysis will be undertaken. Ethics and dissemination The study has been approved by the Western Sydney Local Health District Human Research Ethics Committee-Westmead. Results will be presented at scientific meetings and published in peer-reviewed publications. Trial registration number ACTRN12617001084370; Pre-results
Consensus evidence-based clinical practice recommendations for the diagnosis and treat-to-target management of osteoporosis in chronic kidney disease stages G4-G5D and post-transplantation: An initiative of Egyptian Academy of Bone Health
The aim of this study was to reach a consensus on an updated version of the recommendations for the diagnosis and Treat-to-Target management of osteoporosis that is effective and safe for individuals with chronic kidney disease (CKD) G4-G5D/kidney transplant. Delphi process was implemented (3 rounds) to establish a consensus on 10 clinical domains: (1) study targets, (2) risk factors, (3) diagnosis, (4) case stratification, (5) treatment targets, (6) investigations, (7) medical management, (8) monitoring, (9) management of special groups, (10) fracture liaison service. After each round, statements were retired, modified, or added in view of the experts' suggestions, and the percent agreement was calculated. Statements receiving rates of 7-9 by more than 75% of experts' votes were considered as achieving consensus. The surveys were sent to an expert panel ( = 26), of whom 23 participated in the three rounds (2 were international experts and 21 were national). Most of the participants were rheumatologists (87%), followed by nephrologists (8.7%), and geriatric physicians (4.3%). Eighteen recommendations, categorized into 10 domains, were obtained. Agreement with the recommendations (rank 7-9) ranged from 80 to 100%. Consensus was reached on the wording of all 10 clinical domains identified by the scientific committee. An algorithm for the management of osteoporosis in CKD has been suggested. A panel of international and national experts established a consensus regarding the management of osteoporosis in CKD patients. The developed recommendations provide a comprehensive approach to assessing and managing osteoporosis for all healthcare professionals involved in its management. [Abstract copyright: Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel.
A comparative investigation of the indications for renal replacement therapy and the optimal timing for commencing the therapy
ThesisEnd stage renal disease (ESRD) is a major health problem resulting
in conside rably increased morbidity and mortality, in decreased
qual ity of life and in high costs from renal replacement therapy
(RRT) . There are almost a million people that owe their lives to
dialys is and currently there is a 5 yea r survival rate of chronic renal
failure (CRF) patients . Today optimization of dialys is must
guarantee the full time restitution t o . society of a totally
rehab ilitated individual. This study a ims at investigating the
indications for commencing RRT and the optima l timing for
commencing the therapy , derived from comparative investigations ,
and incorporat ing factors affecting renal failure patients. It includes
the benefits of screening high risk individua ls for renal d isease, and
the benefits of managing factors affecting renal function to pro long
the pretreatment phase . It also looks at the effectiveness and
opt imal timing for commencing a pre-end stage renal disease
(PESRD) program, and considers whether there is patient
imp rovement in patients managed before development of renal
failure . Finally the study aims at investigating a way to reduce the
financial aspect related to treatment.
The research was twofold. First ly it involved a screening of 100
indiv iduals at tht: risk of chronic kidney disease (CKD), whereby a
serum creat in ine va lue was taken and the glomerular filtration rate
(OFR) calculated . Secondly it incorporated a biochemical and
clinical assessment of 95 CRF patients , a month prior to RRT, at
commencement of RRT, at I month and 3 months after RRT.
The screening revealed a mean creatin ine for males 128.45 flmollL
and for females 108 .99 flmollL. Twen ty-four percent (24%) of
patien ts had a OFR of between 30 - 59 , 6% of patients had a OFR of
between 15 29, and 3% of pat ients had a OFR of < 15
ml / minlI.73m2. T his strongly ind icates the need to screen
individua ls at risk for renal failure . The second part of the study
revealed that at commencement the mean OFR was 6.7
ml/ minlI .73m2, uremia , malnutrition, anemia, hyperparathyroid ism,
hyperphosphatemia, and other electro lyte imbalances were present ,
all predisposing a patient to a poor clinical outcome , an inc rease in
morbidity and mortal ity, and a dec rease in the qual ity of life. From
the investigation of patients commencing dialysis it was determined
that the optimal timing for commenc ing RRT was at the first clin ical
evidence of deterioration in the presence of uremia and / o r
malnutrit ion despite medical in tervention . It was found that RRT
should not be postponed until creatinine falls within mandated
range , as postponement adversely affects the patient, and the survival of dialysis patients depends on their condition at the time
dialysis is first initiated. Postponing treatment was found to have
adverse effects on patients commencing RRT, with an increase in
the number of acute hemodialysis (AHD) sessions and increase in
the number of access. Patients managed prior to commencement of
RRT and patients commencing dialys is at a higher GFR experienced
fewer complications, when compared to patients who commenced
dialysis later. There is an improvement in patient outcome in
patients managed prior to the commencement of RRT and it is
beneficial to manage factors affecting renal function in order to
prolong the pre-treatment phase . The PESRD educational program is
an effective component in the management of kidney disease and
initiating a PESRD program early in the course of kidney disease is
advantageous to the patient. The financial costs related to renal
replacement are extremely high, and can be reduced allowing more
patients to be treated for the same amount of money.
From the results obtained from the study it is clear that effective
PESRD management and early commencement of RRT in dialysis
patients leads to an improved qual ity of life, and a decline in
complications experienced
A comparative investigation of the indications for renal replacement therapy and the optimal timing for commencing the therapy
ThesisEnd stage renal disease (ESRD) is a major health problem resulting
in conside rably increased morbidity and mortality, in decreased
qual ity of life and in high costs from renal replacement therapy
(RRT) . There are almost a million people that owe their lives to
dialys is and currently there is a 5 yea r survival rate of chronic renal
failure (CRF) patients . Today optimization of dialys is must
guarantee the full time restitution t o . society of a totally
rehab ilitated individual. This study a ims at investigating the
indications for commencing RRT and the optima l timing for
commencing the therapy , derived from comparative investigations ,
and incorporat ing factors affecting renal failure patients. It includes
the benefits of screening high risk individua ls for renal d isease, and
the benefits of managing factors affecting renal function to pro long
the pretreatment phase . It also looks at the effectiveness and
opt imal timing for commencing a pre-end stage renal disease
(PESRD) program, and considers whether there is patient
imp rovement in patients managed before development of renal
failure . Finally the study aims at investigating a way to reduce the
financial aspect related to treatment.
The research was twofold. First ly it involved a screening of 100
indiv iduals at tht: risk of chronic kidney disease (CKD), whereby a
serum creat in ine va lue was taken and the glomerular filtration rate
(OFR) calculated . Secondly it incorporated a biochemical and
clinical assessment of 95 CRF patients , a month prior to RRT, at
commencement of RRT, at I month and 3 months after RRT.
The screening revealed a mean creatin ine for males 128.45 flmollL
and for females 108 .99 flmollL. Twen ty-four percent (24%) of
patien ts had a OFR of between 30 - 59 , 6% of patients had a OFR of
between 15 29, and 3% of pat ients had a OFR of < 15
ml / minlI.73m2. T his strongly ind icates the need to screen
individua ls at risk for renal failure . The second part of the study
revealed that at commencement the mean OFR was 6.7
ml/ minlI .73m2, uremia , malnutrition, anemia, hyperparathyroid ism,
hyperphosphatemia, and other electro lyte imbalances were present ,
all predisposing a patient to a poor clinical outcome , an inc rease in
morbidity and mortal ity, and a dec rease in the qual ity of life. From
the investigation of patients commencing dialysis it was determined
that the optimal timing for commenc ing RRT was at the first clin ical
evidence of deterioration in the presence of uremia and / o r
malnutrit ion despite medical in tervention . It was found that RRT
should not be postponed until creatinine falls within mandated
range , as postponement adversely affects the patient, and th
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