Journal of Nephrology

Iorio, Biagio Di; Cillo, Nicola; Cucciniello, Emanuele; Bellizzi, Vincenzo

doi: 10.1093/joneph/21.s13.s158pmid: N/A

The management of human resources is definitely one of the most important chapters in managerial activities. So, the involved participation of personnel is one of fundamental importance for all systems of quality management. The aim of this study is to analyse satisfaction of personnel in dialysis units. We administered a questionnaire subdivided into 6 basic sections with 34 items regarding the work environment, the material, the environmental climate, the objectives, the quality, and justifications and suggestions. We received 298 replies to the questionnaire, of which 72 from doctors (D) (24.2%) and 226 from nurses (N) (75.8%). From a possible maximum score of 170, the scores reached were 115 points for the D and 113 for the N. It is obvious that N considered the environmental climate, the objectives and the quality of the services to be inferior compared to D. Thirty-nine percent of D and 27% of N were very critical of the items analyzed. A second step was dedicated to the administration of the questionnaire to the dialysis patients to verify if there was agreement. One hundred and twentyfive patients (5.7%) (randomized in a single dialysis unit for age and sex), of a total of 2170 patients responded. Their answers were then compared with those of the personnel. The data of our study showed that most of the personnel did not receive counseling about uncertainties, expectations did not correspond to reality and there was distrust and scarcity of involvement. These elements appeared to cause irritation and dissatisfaction and if not resolved are responsible, together with technical and environmental factors, for the serious burn-out syndrome in the personnel of dialysis units.

Montano, Aniello

doi: 10.1093/joneph/21.s13.s12pmid: N/A

:Phenomenological-existential culture widened our perception of life, health, and illness. In the light of philosophical reflection, the need arose to treat issues related with life and health within a much larger horizon than that allowed by traditional medical practice, adjacent to procedures of anamnesis, diagnosis and therapeutic prescription. The need has emerged to treat them not only in the light of medical competence but also, more specifically, as a social and humanistic issue. At the juncture between medicine and philosophy, of nature and culture, of organic and relational processes, the themes of life and health are seen to link with ethic thought. Bearing in mind this new and much profounder vision of the subject, to continue to think of the medical-sanitary system as a self-referential whole enclosed within itself, with no overture to humanists, exposes it to the danger of de-valuing the importance of lived experience and, consequently to reduce a patient’s reactive resources to pathological conditions.

Berthoux, François; Bartiromo, Marilù

doi: 10.1093/joneph/21.s13.s7pmid: N/A

:The quality of life (QoL) of patients affected with chronic kidney disease (CKD) is clearly diminished, especially at the dialysis or renal transplantation stage. To find an equilibrium and improve his/her QoL, the patient should be active and positive regarding his/her own disease. The patient’s disease profoundly affects the QoL of spouse and family. The patient and his family are in permanent need of more knowledge and information about the disease. Health professionals should be aware of all these consequences and try to help/advise the patient to reach the goal of a better daily life in his/her own environment.

Bornivelli, Christina; Alivanis, Polichronis; Giannikouris, Ioannis; Arvanitis, Antonios; Choustoulakis, Ioannis; Georgopoulou, Katerina; Karvouniaris, Nicolaos; Zervos, Agelos

doi: 10.1093/joneph/21.s13.s78pmid: N/A

Background: Sleep disturbances are usually the outcome of a complex interplay between intrinsicfactors and environmental influences. Aim of this study was to investigate the incidence of insomnia and to assess its relation to clinical and laboratory parameters in hemodialysis patients.Methods: Using Athens Insomnia Scale (AIS), sleeping profile of 45 subjects (32 male, 13 female, mean age 59±16.2 years) was evaluated. According to AIS, patients were divided into two groups. Group A comprised 32 patients with score 0-9 (absence of sleep disorders), whereas group B included 13 patients scoring higher than 9 (clinically assessed disorder). Subjects were compared in terms of socioeconomic, clinical, laboratory parameters and presence of depression (assessed by Hamilton Depression Scale, HAMD).Results: No significant difference was observed with respect to age, sex, family status, education, selfesteem, coffee and alcohol consumption, time in hemodialysis and laboratory parameters. Group B demonstrated significantly lower albumin levels (3.65±0.38 and 3.9±0.24g/dL respectively, p<0.01), higher CRP levels (1.88±1.9 and 0.92±0.64mg/dL respectively, p<0.01) and exhibited depression (HAMD score 13.4±6.4 and 7.8±5.9 respectively, p<0.005). Moreover, significant correlation was observed when AIS scores were related to albumin (r=-0.29, p<0.05), CRP (r=0.38, p<0.01) and HAMD scores (r=0.54, p<0.0001).Conclusions: Sleep disorders are common in hemodialysis patients. They seem to be related to high CRP and low albumin levels and demonstrate strong correlation to mood disorders, which are equally common to such patients.

Mydlík, Miroslav; Derzsiová, Katarína

doi: 10.1093/joneph/21.s13.s129pmid: N/A

Background: Dialysis patients have decreased quality of life compared to healthy controls. In recent years the quality of life in hemodialysis patients has been considered from many points of view. The aim of this retrospective study was to improve quality of life in dialysis patients by supplementing some important vitamins.Patients and methods: Eighty-three patients underwent hemodialysis treatment 3x4hr/weekly using a standard dialyzer with a cellulose membrane. During the investigation of plasma and erythrocyte vitamin E, vitamin E-coated dialyzer was used. Patients who were treated with erythropoietin (EPO) were supplemented over 3 months with Pyridoxine: 20mg/day, folic acid: 10mg/week, vitamin C: 60mg/day. Some erythrocyte and plasma vitamins and plasma malondialdehyde were investigated in all patients. Erythrocyte vitamin B6 was determined by indirect enzymatic method as an effect of pyridoxal-5-phosphate (PLP). Erythrocyte folic acid was determined by radioimmunoassay method, erythrocyte vitamin E and plasma malondialdehyde were determined by fluorometric methods, plasma vitamin C was determined by spectrophotometric method.Results: During above mentioned EPO treatment and supplementation, vitamins significantly increased blood hemoglobin (from 100±5 to 110±4 g/L, p<0.05), erythrocyte vitamin B6 that means decreased effect of PLP (from 30.4±2.4 to 16.4±1.9%, p<0.01), increased erythrocyte folic acid (from 343.3±72 to 734.5±98 ng/mL) and plasma vitamin C (from 63.5±15 to 88.3±10 εmol/L). Three-month use of vitamin E-coated dialyzer led to the increase of erythrocyte vitamin E (from 6.7±0.5 to 7.4±0.4 εmol/L, p<0.05) and to the significant decrease of plasma malondialdehyde (from 2.8±0.5 to 2.2±0.4 εmol/L, p<0.01).Conclusions: 1. Investigated vitamins were decreased in hemodialysis patients and after supplementation increased to normal range. 2. Increased plasma malondialdehyde, as a product of lipid peroxidation, significantly decreased during the use of vitamin E-coated dialyzer. 3. Adequate supplementation of above mentioned vitamins led to increased quality of life in hemodialysis patients from some clinical points of view.

Santoro, Domenico; Gitto, Lara; Iorio, Biagio Di; Savica, Vincenzo; Vecchi, Maurizio Li; Bellinghieri, Guido; De Santo, Natale G.; ,

doi: 10.1093/joneph/21.s13.s118pmid: N/A

Dialysis for octogenarian and nonagenarian patients has increased dramatically in recent decades. Worldwide Registries of dialysis and transplantations show how the incidence rate of patients older than 80 years of age is almost doubled. This increase is probably due to liberalisation of acceptance criteria for dialysis, together with the ageing population. In recent years, the Sicilian and Campanian Registries of dialysis and transplantations have also observed a progressive increase in the elderly population.In order to study survival in this class of patients, we performed a study on a sample of Sicilian and Campanian patients.Regarding Sicilian patients, we considered a sample of 497 patients and grouped them into 3 categories of risk: in the first group (low risk) patients included were <70 years old without any co-morbidities; in the second group (average risk), we selected patients between 70 and 80 years old with one or more co-morbidities: in the third group (high risk patients), we included patients aged more than 80 years or with a high number of co-morbidities. The probabilities of survival in the low risk patients after 48 months of treatment was 96.1%; this probability fell to 82.9% for patients included in the high risk group; while the probability of survival for average risk patients was 91.7%. Given the high risk presented by older patients, we focused the second part of our analysis only on octogenarians, studying both Sicilian and Campanian patients. 64 Sicilian patients (33 males and 31 females – 51.56% and 48.43% respectively) were observed: and their survival was 81.25% after 48 months. The sample of Campanian octogenarian patients considered for this study included 26 patients (12 males – 53.85% - and 14 females – 46.15%), observed for a shorter period (36 months). The probabilities of survival after 36 months was 84.61%.To sum up, elderly patients represent a growing reality on dialysis registries in Sicily and Campania. Future research concerning this class of patients should be developed in order to individualize suitable stratification risk indices; knowing patterns and probability of survival might help physicians in the dialysis decision-making process.

Sabbatini, Massimo; Pisani, Antonio; Crispo, Anna; Nappi, Riccardo; Gallo, Riccardo; Cianciaruso, Bruno; Federico, Stefano

doi: 10.1093/joneph/21.s13.s97pmid: N/A

Renal transplantation is associated with better survival and improved quality of life compared to maintenance dialysis. Although many sleep disorders improve or even disappear after a successful transplantation, sleep quality remains low, and the prevalence of sleep complaints, although lower than in dialysis patients, is much higher than in the general population. Few studies have dealt with sleep problems of renal transplant patients: despite reporting obvious differences in the prevalence of the single sleep disorders, all underline the importance of psychological problems in conditioning sleep. In the diagnosis of sleep disorders, the nephrologist must learn to distinguish medical risk factors (pain, pruritus, tremors, drugs) and psychological aspects (depression, anxiety, fear), since they are potentially modifiable with the appropriate treatment.

Eady, Robin A.J.

doi: 10.1093/joneph/21.s13.s3pmid: N/A

:A kidney patient recalls his experience of almost 45 years of renal replacement therapy covering nearly 25 years of dialysis and 20 years with a transplant. At the beginning, patient or graft survival was a major goal and symbol of successful treatment. But for the patient, what really matters is the quality of his life, assuming he can survive.

Casavola, Francesco Paolo

doi: 10.1093/joneph/21.s13.s30pmid: N/A

Mucsi, Istvan; Kovacs, Agnes Zsofia; Molnar, Miklos Zsolt; Novak, Marta

doi: 10.1093/joneph/21.s13.s84pmid: N/A

Chronic kidney disease (CKD) is frequently associated with other chronic medical conditions. Adjusting for potential confounding factors that are associated with the outcome of interest is important both in clinical research and in everyday clinical practice. Comorbidity is such an important co-variable that it is reported to predict different outcomes in patients with ESRD. Health related quality of life (HRQoL) has increasingly been recognized as an important aspect of health care delivery, measure of effectiveness and patient experience, in chronic medical conditions. The progressively older ESRD patient population of industrialized countries is significantly debilitated by the burden of disease and also by the intrusiveness of renal replacement therapies. For these patients simply prolonging life is not enough.Little information has been published about the association of comorbidity and HRQoL. The aim of this review is to summarize the significance of comorbidity in patients with ESRD, with a special focus on the complex relationship between comorbidity and HRQoL. Several frequently used instruments will be described and the current literature, that compared the relative utility and accuracy of these tools, will be reviewed. Finally, the impact of selected medical conditions on HRQoL of patients with end-stage renal disease will be demonstrated.