Higher dialysis adequacy with 3 mEq/lit versus 1 mEq/lit Potassium hemodialysis solution

Routinely hemodialysis (HD) solution with a K+ concentration of 1 mEq/lit is being used in Iranian HD centers. This dialysate K+ concentration may cause dangerous hypokalemia during HD session, and other K+ concentrations of HD solutions are not available. In two previous studies, the effects of different K+ concentrations on dialysis efficacy were studied, which had conflicting results. So we studied the effect of one and three mEq/lit K+ concentrations of HD solutions on dialysis efficacy and serum K+ level at the end and 30 minutes after HD session. 30 chronic stable HD patients contributed in a double blind crossover study. Patients in the first session of two consecutive weeks were hemodialyzed with 1 and 3 mEq/lit K+ dialysis. At 30 seconds after HD, dangerous hypokalemia ([K+]5.5 mEq/lit) was similar with both K+ concentrations. 30 minutes after completion of HD, better HD adequacy was achieved with 3 mEq/lit compared with 1 mEq/lit K+ dialysate concentration measured with Kt/V (0.93±0.3 vs. 0.84±0.34, P<0.05) and urea reduction ratio (0.52±0.12 vs. 0.48±0.17, P<0.05). Therefore using 3 mEq/lit K+ dialysate concentration is safer and causes a higher dialysis efficacy compared with 1 mEq/lit K+ dialysate concentratio

CAN I DO…? LIFE WITH TYPE II DIABETES: A PHENOMENOLOGICAL STUDY

Background: Diabetes is a chronic disease affects many aspects of daily life. We need a bio-psychosocial approach to patients and their problems in diabetes management. Since patient’s beliefs about health and disease will guide self management measures, a holistic understanding toward subject is necessary. The aim of this study was to identify and describe the lived experiences of patients with diabetes in a qualitative study. Methods: A descriptive phenomenological framework used to guide the project of inquiry. Eleven volunteered patients (6 men, 5 women) were recruited by purposed sampling from “Glands and Metabolism Research Center” and “Al-Zahra Hospital” of Isfahan in 2006. In-depth unstructured one to one interviews conducted and interview data were transcribed and analyzed for themes using collizi method. Results: Five themes were identified including; "Why I get", "Disease requirements", "Can I do", "Limitations", "Silent motion towards death". 3 first items belongs to participants' perception about diseases etiology, treatment, and their feeling about their situation, respectively. “Silent movement towards death” and “limitation” pointed to the patients' belief about limitation in nutrition and having a healthy child and nature of disease. Conclusion: Based on findings, patients’ beliefs about their disease and health situation can affect health behaviors and self-management, and act as barriers and facilitators in patient behaviors. Findings suggest considering this factor in self management preparing program

Facilitators of adherence to Self-management in type 2 diabetic patients: A phenomenological study

Abstract Introduction: Diabetes is chronic disease affecting all aspects of daily life and hence is a priority health care strategy. Its treatment needs a bio-psychosocial approach. One of the major problems in its management is patient noncompliance to therapeutic regimens. This qualitative phenomenological study aimed at assessing to patient experiences of factors facilitating self-management. Materials and Methods: Patients were recruited from the “Glands and Metabolism Research Center” and “Alzahra hospital” in Isfahan in 2006.

Supporting hemodialysis patients: A phenomenological study

Background: Chronic renal disease and hemodialysis cause numerous psychological, social, cultural, and spiritual challenges for both patients and their families. Overcoming these challenges is possible only through providing holistic support for the patients. Today, despite the support provided by family and professional caregivers for the patients, patients still express dissatisfaction with the support provided and believe it to be inadequate. In fact, patients and family caregivers and healthcare practitioners seem to have different understandings of the notion of support. Thus, the researcher decided to examine the concept of support from the viewpoint of hemodialysis patients. Materials and Methods: This descriptive phenomenological research was conducted on 17 patients with end-stage renal disease (ESRD) who were undergoing hemodialysis. Purposive sampling was performed and continued until data saturation. Data were collected through 30–60 min unstructured interviews and analyzed using Colaizzi's method. Results: From the analysis of data, 4 themes (psychological support, accompaniment, social support, and spiritual support) and 11 sub-themes were obtained. Psychological support consisted of two sub-themes of psychological support by healthcare practitioners and emotional support by family and relatives. Accompaniment included three sub-themes of assistance in transportation, providing and using medicine, and daily activities. Social support was identified with four sub-themes of promotion of the society's understanding of the patients' condition, improvement of communication with others, the need for employment, and independence. Spiritual support was identified with two sub-themes of the need for faith and trust in God or Imams and the need to resolve spiritual contradictions. Conclusion: The results showed that from the viewpoint of the participants, the concept of support consisted of psychological support, social support, accompanying the patient, and spiritual support. Hence, it can be concluded that this concept should be considered in healthcare planning, in order to improve the health and quality of life of these patients and their adaptation to the disease and its treatment process

The lived experiences of patients undergoing hemodialysis with the concept of care: a phenomenological study

Abstract Background Providing patient-centered care needs in patients with chronic renal failure undergoing hemodialysis is important in inspiring their confidence to continue their treatment and promote their mental and social health. Therefore, recognizing the concept of care from the viewpoint of these patients can be helpful in designing the care programs of this vulnerable group. Accordingly, the aim of this study was to reveal the meaning and concept of care based on the experience of patients with chronic renal failure undergoing hemodialysis. Methods Using a descriptive phenomenological method, this study was conducted on 17 patients who were undergoing hemodialysis. Purposive sampling was performed and data was collected through 30 to 60 min, face-to-face and in-depth semi-structured interviews. Data analysis was performed using Colaizzi’s method. Results Seventeen patients (9 women 8 men) aged between 24 and 83, and a minimum of 10 and maximum of 168 months history of hemodialysis participated in the study. After data analysis, 4 themes and 9 sub-themes were extracted, and the concept of care emerged for the participants as empathy, companionship in everyday needs, social support and concern, and good-quality dialysis. Conclusions Based on the results of this study, the concept of care from the viewpoint of patients emerged in the form of empathy, companionship in everyday needs, social support and concern, and good-quality dialysis. It is recommended that caregivers of patients consider these concepts in the design of patient-centered care programs

Comparison of the effect of topical application of rosemary and menthol for musculoskeletal pain in hemodialysis patients

Background: Pain is the most common problem experienced by hemodialysis patients, especially musculoskeletal pain in lower extremities, which is usually not completely treated and adversely affects their quality of life. The present study was conducted with the aim to determine and compare the effects of topical application of menthol and rosemary for musculoskeletal pain in hemodialysis patients. Materials and Methods: The present single-blind clinical trial recruited 105 eligible patients undergoing hemodialysis in selected hospitals affiliated to Isfahan University of Medical Sciences; patients were selected by convenient sampling. Participants' severity of pain was determined prior to intervention. They were then randomly divided into rosemary, menthol, and placebo groups. All three groups applied medication on the site of pain on their legs three times a day for three days and recorded the severity of pain four hours after morning and afternoon applications. The statistical analysis of data was performed using SPSS 18. Results: The mean score of severity of pain before the intervention was not significantly different among the three groups (p = 0.83), but it became significantly different after intervention (p = 0.001). Significant differences were observed in mean severity of pain before and after intervention in rosemary and menthol groups (p < 0.001), but not in the placebo group (p = 0.21). Conclusions: Topical application of menthol and rosemary can alleviate severity and frequency of recurrence of musculoskeletal pain in hemodialysis patients; however, according to the results of the study, none had precedence over the other

Effect of hope therapy on depression, anxiety, and stress among the patients undergoing hemodialysis

Background: Renal failure is a major public health problem in the world. These patients experience high levels of psychological tension, anxiety, and depression, which leads to their lowered quality of life, increased health care costs, and early mortality. Due to medication side effects in these patients, non-medicational methods are more in demand now. This study aimed to investigate the effect of hope therapy on depression, anxiety, and stress among the patients undergoing hemodialysis. Materials and Methods: This is a clinical trial. Fifty patients undergoing hemodialysis were selected. Patients were assigned to two groups of hope therapy and placebo. Intervention of hope therapy was administered for 60–90 min during dialysis sessions once a week for eight sessions. In the placebo group, non-specific intervention was administered with the same number of sessions. Depression, Anxiety, and Stress scale (DASS)-21 questionnaire was completed at the end of the last session and 4 weeks later. Data were analyzed by paired t-test, repeated measures analysis of variance (ANOVA), and least significant difference (LSD) post hoc test through SPSS 18. Results: There was a significant difference in mean scores of depression, anxiety, and stress in hope therapy group before, immediately after, and 1 month after intervention (P < 0.05), while there was no significant difference in mean scores of depression, anxiety, and stress before and immediately after intervention in the placebo group. Changes in mean scores of depression, anxiety, and stress were significantly higher in hope therapy group compared to placebo (P < 0.05). Conclusions: The obtained results showed that hope therapy is effective on reduction of depression, anxiety, and stress

“Exercise during hemodialysis and health promoting behaviors: a clinical trial”

Abstract Background Health promoting behaviors are among the determinants of health. Hemodialysis causes significant changes in the lives of patients and affects their health promoting behaviors. Accordingly, this study aimed at investigating the effect of exercise during hemodialysis on health promotion behaviors in patients undergoing hemodialysis. Methods This study was a two-stage (before and after) clinical trial. The sample of the study consisted of 60 hemodialysis patients in two hospitals in Isfahan who were selected randomly and divided into two groups of control and intervention using random allocation method. A 8-week exercise program by stationary bicycles (Mini-bike) was designed for the intervention group, while the control group underwent a 10-min limbering exercise for 8 weeks. Data were collected using demographic questionnaire and the Health Promoting Lifestyle Profile II (HPLP-II) questionnaire before and after the intervention and were analyzed using SPSS21 software. Results Based on the independent t-test results, no significant difference was observed between the mean score of health promoting behaviors and its areas before the intervention (P > 0.05). However, the results of this test showed that the mean score of health promoting behaviors and its areas, except for the areas of responsibility (P = 0.052) and spirituality (P = 0.211), was significantly different between the two groups after the intervention (p < 0.05). Conclusions The results of this study showed that exercise with stationary bicycle during hemodialysis could promote health promoting behaviors. Thus, this exercise is recommended to be considered as part of the therapeutic protocol of these patients in hemodialysis departments. Trial registration The clinical trial was found to be in accordance to the ethical principles and the national norms and standards for conducting medical research in Iran. IRCT registration number: IRCT20150116020675N3. Registration date: 2019-01-18, 1397/10/28 Approval ID: IR.MUI.RESEARCH.REC.1397.014 Approval Date: 2018-07-01 Evaluated by: Vice-Chancellor in Research Affairs -Medical University of Isfaha

Nonadherence behaviors and some related factors in kidney transplant recipients

Background: Kidney transplantation is the renal replacement therapy of choice for most patients with end-stage renal disease (ESRD), however, adherence to the recommended lifestyle is critical for a positive prognosis. The purpose of this study was to assess adherence to immunosuppressive therapy and lifestyle recommendations along with some related factors among kidney transplant patients. Materials and Methods: In this descriptive analytical study, all patients completed a questionnaire regarding medication intake and lifestyle recommendations (preventing of infection, self-monitoring, prevention of cardiovascular disease (CVD), and sun protection). The participants were divided into 4 groups according to the level of adherence (good, partial, poor, and nonadherent) indicated in their responses. Results: Most kidney recipients were adherent to their drug prescriptions, but were partial, poor, or nonadherent regarding lifestyle recommendations. Increased passage of time since transplantation and low family support and educational level resulted in nonadherence. Men showed greater adherence to medication intake than women. Patients with lower number of drugs and reported drug side-effects illustrated better adherence to medication intake. Women adhered to infection protection recommendations more than men, and older and married patients adhered to cardiovascular prevention recommendations more than others. However, younger patients showed greater adherence to self-monitoring recommendations, and singles, young individuals, and women were adherent to sun protection recommendations. Conclusions: Nonadherence is common among kidney transplant recipients. Thus, it is necessary to determine patients who are at risk of nonadherence and to introduce more educational programs to improve their adherence and their quality of life (QOL)

Effect of fordyce's happiness program on stress, anxiety, and depression among the patients undergoing hemodialysis

Background: Patients with end-stage renal disease on hemodialysis are affected by psychological stressors, which contribute to poor quality of life and negative clinical outcomes. Stress, anxiety, and depression are highly prevalent in this population. Fordyce's happiness program has been believed to be one of the complementary therapies that could promote psychological wellbeing. The goal of this study was to evaluate the effects of Fordyce's happiness program on the stress, anxiety, and depression in patients with hemodialysis. Materials and Methods: This is a clinical trial. A total of 50 patients undergoing hemodialysis were randomly recruited into the study group (n = 25) and the control group (n = 25). Intervention of Fordyce's happiness program was administrated for 20 minutes during hemodialysis sessions once a week for 6 sessions. For the control group, 3 sessions were held by the researcher's colleague through communication, dialogue, and listening to the patients' problems individually. The data was collected by the Stress, Anxiety and Depression (DASS-21) questionnaire. Results: There was a significant difference in the mean scores of stress, anxiety, and depression in the intervention group before immediately after and one month after intervention (P < 0.05), whereas there was no significant difference in the mean scores of stress, anxiety, and depression before, immediately after, and 1 month after intervention in control group. Conclusions: The obtained results showed that Fordyce Happiness Training Program can reduce the stress, anxiety, and depression in patients treated with hemodialysis