The knowledge concerning kidney transplantation in the group of patients on the waiting list

Wstęp. Przeszczepianie nerki stanowi standardową metodę leczenia nerkozastępczego, dającą długoletnie przeżycie biorców. Ma na to wpływ postępowanie okołooperacyjne, ale również wiedza i doświadczenia jakie posiada potencjalny biorca.Cel pracy. Celem pracy była ocena wiedzy na temat przeszczepiania nerki u pacjentów oczekujących na transplantację.Materiał i metody. Badania przeprowadzono w 14 ośrodkach dializ województwa mazowieckiego w oparciu o kwestionariusz ankiety. Grupę badaną stanowiło 74 hemodializowanych pacjentów zgłoszonych do Krajowej Listy Oczekujących. Dwadzieścia cztery procent stanowiły osoby po przeszczepieniu, zgłoszone po raz drugi lub trzeci.Wyniki. Dziewięćdziesiąt procent ankietowanych podało jako dawcę narządu osobę zmarłą. O przeszczepieniu wyprzedzającym słyszało 32%, 73% znało lokalizację przeszczepu, 36% podało jako średni czas przeżycia graftu 10 lat. Osiemdziesiąt sześć procent wiedziało, że transplantacja jest poważnym zabiegiem z możliwością powikłań. Większość o tej metodzie leczenia dowiedziała się od lekarza. Pięćdziesiąt trzy procent badanych miało wiedzę na temat leczenia immunosupresyjnego, 50% wiedziało o potrzebie regularnej kontroli pooperacyjnej. Połowa ankietowanych rozumie potrzebę zmiany stylu życia.Wnioski. Wiedza ankietowanych na temat kwalifikacji, pochodzenia organów, przebiegu leczenia i możliwych powikłaniach jest ogólna i niewystarczająca. Wiedza na temat leczenia immunosupresyjnego, wizyt kontrolnych i stylu życia jest niedostateczna. Wdrożenie programów edukacyjnych dla tej grupy chorych wpłynie na zwiększenie wiedzy i poprawę wyników leczenia.Problemy Pielęgniarstwa 2014; 22 (4): 420–425Introduction. Kidney transplantation (KTx) is the best treatment of end stage renal failure, assuring long patient survival. Its outcome is affected not only by surgical technique, but also by the information on the topic and personal experience of recipients, as factors influencing patients behavior after KTx.Aim. The goal of this work was to assess the knowledge of the patients on the waiting list, on the matter of KTx.Material and methods. The information was gathered in 14 dialysis centers in Mazowieckie district, with the use of questionnaire. 74 hemodialysed patients were included to the study. Twenty-four percent of them were submitted for the second transplantation. Results. Ninety percent of patients announced that organ for KTx is harvested from the deceased donor. Thirty-two percent had knowledge of possible preemptive transplantation, 73% knew the localization of the kidney graft after the operation. Thirty-six percent informed of 10 years mean time of graft survival. Eighty six percent were aware that KTx is a large operation and may concern treatment complications. The majority of respondents received their knowledge from physicians. Fifty three percent had some knowledge concerning immunosupression, 50% is aware of the need of systematic medical control. About 50% knows and introduces changes in lifestyle.Conclusions. The knowledge of qualification process, organ origin, treatment and possible complications is general and insufficient. The awareness of immunosuppressive therapy, posttransplant control and changes in everyday life is insufficient. Introduction of educational program for those patients would improve knowledge as well as transplantation results.Nursing Topics 2014; 22 (4): 420–42

Factors associated with urinary tract infections among HIV-1 infected patients.

Urinary tract infections remain an important yet underinvestigated clinical problem among HIV infected patients. Here we analyze factors associated with its occurrence and the spectrum of bacterial pathogens identified in the group of patients followed at the HIV Out-Patient Clinic in Warsaw.Clinic database collected all medical information on patients routinely followed since 1994 to 2015. All patients with available urine culture were included into analyses, only the first culture was included. In statistical analyses logistic regression models were used to identify factors associated with positive culture.In total 608 patients had urine culture performed, 176 (28.9%) were females and 432 (71,1%) were males, 378 (62.2%) registered in care before/in 2007, 258 (42.4%) infected through homosexual contact. Median baseline lymphocyte CD4+ count was 385 (IQR:204-565) cells/μl and median nadir lymphocyte CD4+ count 197 (86-306) cells/μl. One hundred and eighteen patients were actively infected with HCV, as defined by positive real-time PCR. In total 141 (23.2%) patients had positive urine culture, the most common bacterial pathogen was E.coli (58.2%) and E. faecalis (12.8%). Patients with urinary tract infection were more likely to be female (51.8% vs. 22.1%, p<0.0001), infected through other than homosexual mode (80.1% vs. 50.7%, p<0.0001), with lower nadir CD4 count (139 vs. 221 cells/μl, p<0.0001) and lower baseline HIV RNA (4.02 vs. 4.35 log copies/ml, p = 0.01) and less likely to be HCV RNA positive (26.9% vs. 49.2%, p = 0.01). In multivariate regression model being registered before/in 2007 (OR = 2.10; [95%CI: 1.24-3.56]), infected through other than homosexual mode (2.05;[1.18-3.56]) and female gender (2.14;[1.33-3.44]) were increasing and higher nadir CD4+ count decreasing (0.92;[0.85-0.99]) the odds of urinary tract infection.We have identified that almost one third of patients had urinary tract infections with non-typical bacterial pathogens. Population with increased odds of urinary tract infections are women, patients infected through other than homosexual contacts and those registered before 2007

Patients' inclusion into analyses according to STROBE diagram.

<p>Patients' inclusion into analyses according to STROBE diagram.</p

Univariate and multivariate logistic regression models for positive urine culture.

<p>Univariate and multivariate logistic regression models for positive urine culture.</p

Bacterial pathogens identified by urine culture.

<p>Bacterial pathogens identified by urine culture.</p

Chronic Kidney Disease and Nephrology Care in People Living with HIV in Central/Eastern Europe and Neighbouring Countries&mdash;Cross-Sectional Analysis from the ECEE Network

Chronic kidney disease (CKD) is a significant cause of morbidity and mortality among patients infected with human immunodeficiency virus (HIV). The Central and East Europe (CEE) region consists of countries with highly diversified HIV epidemics, health care systems and socioeconomic status. The aim of the present study was to describe variations in CKD burden and care between countries. The Euroguidelines in the CEE Network Group includes 19 countries and was initiated to improve the standard of care for HIV infection in the region. Information on kidney care in HIV-positive patients was collected through online surveys sent to all members of the Network Group. Almost all centres use regular screening for CKD in all HIV (+) patients. Basic diagnostic tests for kidney function are available in the majority of centres. The most commonly used method for eGFR calculation is the Cockcroft&ndash;Gault equation. Nephrology consultation is available in all centres. The median frequency of CKD was 5% and the main cause was comorbidity. Haemodialysis was the only modality of treatment for kidney failure available in all ECEE countries. Only 39% of centres declared that all treatment options are available for HIV+ patients. The most commonly indicated barrier in kidney care was patients&rsquo; noncompliance. In the CEE region, people living with HIV have full access to screening for kidney disease but there are important limitations in treatment. The choice of dialysis modality and access to kidney transplantation are limited. The main burden of kidney disease is unrelated to HIV infection. Patient care can be significantly improved by addressing noncompliance