Dialysis Physicians Research Articles

A survey of environmental sustainability in Japanese dialysis facilities.

Dialysis practice has a particularly high environmental impact, including responsible for carbon emissions and climate change. Insufficient research has been conducted on environmental sustainability activities in dialysis therapy in Japan. We conducted an online Green Survey comprising 30 question items based on a previously conducted survey in Australia. Between August and September 2023, this was sent to members of the Japanese Association of Dialysis Physicians, including hospital and clinic physicians, working across 885 dialysis facilities in Japan. In total, 255 (29%) facilities responded to the survey. More than half of the facilities (n = 157; 61.6%) responded that they did not have a strategy, policy, or action plan for environmental sustainability. In four-fifths of the facilities (n = 208; 81.6%), no "green team" or committee had been formed to promote environmental protection. By contrast, most of the surveyed facilities had emergency strategies for natural disasters, such as covering for patient visits and staff commuting during extreme weather conditions (n = 169; 66.3%), water shortages (n = 159; 62.4%), and power outages (n = 188; 73.7%). Following the UK, Australia and New Zealand, and Portugal, this is the fourth Green Survey to be conducted, and the first on environmental sustainability among kidney health-care providers in Japan. The results indicated that daily activities for environmental protection are still lacking at many facilities, even though the management of dialysis treatment during a natural disaster is well conducted.

Vaccination acceptance and its associated factors in patients on hemodialysis in Austria: A nationwide survey.

Vaccines are essential in disease prevention among patients on chronic hemodialysis (HD). However, during the coronavirus disease 2019 pandemic, there has been an increased rate of vaccination hesitancy. A better understanding of patients' opinions may help identify a more targeted approach to increase vaccination rates. Questionnaires with 43 questions based on the recommendations of the Strategic Advisory Group of Experts (SAGE) on Immunization Working Group on Vaccine Hesitancy were administered to patients during routine HD sessions at different dialysis centers in Austria. In total, 347 patients participated in this study. Approximately 81% of the patients were aged > 54 years, and 65% were men. Further, 53% of patients were receiving HD from private units. In ~ 72% of patients, the dialysis physicians were the source of vaccination information. Meanwhile, the source of information in 28% of patients was the primary care physician (28%), and 18% of patients obtained vaccination details from the internet. The number of younger (aged < 55 years) patients who were more likely to use online content as the main source of information was significantly higher than that of older patients (32 vs. 15%, p = 0.001). Furthermore, the number of older patients who wanted to receive more information from the dialysis physician was significantly higher than that of younger patients (57 vs. 38%, p = 0.009). Only 65% of patients had a good understanding of the mechanisms of action of vaccines. The younger population (aged 18 - 54 years) had a higher number of individuals with a good understanding of vaccine mechanisms than the older population (78 vs. 62%, p = 0.016). Moreover, 86% of the whole population wanted to complete the recommended vaccinations. However, only 39% of respondents had sufficient information about the vaccination plan in Austrian. Numerous patients receiving HD wanted to obtain more information from their dialysis physicians. Increased awareness among providers and targeted communication might increase vaccination rates.

Newspaper Campaign to Promote Deceased Organ Donation: Who Can Appeal to the General Japanese Population?

Various interventions are reportedly effective in promoting organ donor registration. However, the identity of those who best serve as presenters to appeal to the general public is not known. A campaign for organ donor registration was conducted through a local newspaper advertisement in Japan. The advertisement appeared in 439,733 copies of the newspaper on January 9, 2021. In addition to the main message, 6 different presenters with photos of their faces and quick response codes were listed in the advertisement, namely a urologist, transplant physician, nephrologist, dialysis physician, ophthalmologist, and kidney transplant recipient who was a nephrologist himself (ie, a recipient and nephrologist). Newspaper readers watched each video about deceased organ donation via the quick response codes, and the number of video views acquired 30 days after the appearance was the main outcome, which was assessed using YouTube analytics. The proportions (95% CI) of people who watched each video among 439,733 newspaper readers were compared among the 6 presenters. The analyzed videos were viewed 262 times. The video produced by the recipient and nephrologist had the highest number of views among the 6 presenters (proportion: 0.019% [95% CI, 0.015-0.023]), followed by the one produced by the dialysis physician (0.011% [95% CI, 0.008-0.014]), the nephrologist (0.010% [95% CI, 0.007-0.014]), the urologist (0.008% [95% CI, 0.006-0.012]), the transplant physician (0.006% [95% CI, 0.004-0.009]), and the ophthalmologist (0.005% [95% CI, 0.004-0.008]). The appeal by the recipient and the nephrologist reached the highest proportion of people who watched the video about deceased organ donation in Japan.

MO921: Pandemic Experiences, Perceptions and Burnout Among Haemodialysis Units Personnel in the COVID-19 Era

BACKGROUND AND AIMSThe coronavirus disease 2019 (COVID-19) pandemic is one of the greatest challenges facing healthcare systems worldwide in recent years. Burnout was found to be an important factor in the professional landscape of nephrology already prior to the COVID-19 outbreak and is expected to worsen during the pandemic due to increased workload and changes in the work environment. As a life-saving procedure, haemodialysis (HD) delivery could not undergo profound organizational adjustments, what was the case of out-patient settings, which largely turned towards telemedicine services. Poor COVID-19 outcomes of maintenance HD patients with mortality rate exceeding 20% may be also considered among personnel's aggravating factors. The aim of our study was to assess pandemic experiences, perceptions and burnout among Polish dialysis unit professionals in the COVID-19 era.METHODA web-based survey was distributed via e-mail to Polish dialysis units and was shared via social media channels gathering nephrology professionals, the survey was open between the 1 September 2021 and the 31 December 2021. The study survey consisted of two validated questionnaires––Pandemic Experiences and Perceptions Survey and Maslach Burnout Inventory––Human Services Survey for Medical Personnel, as well as self-created questions about experiences with SARS-CoV-2 infection. The study group comprised 215 nurses (208 F, 5 M, median age 50 years, IQR 10), 148 physicians (77 F, 70 M, mean age) and 16 respondents of other medical professions. 35.3% of the study group confirmed that they suffered from SARS-CoV-2 infection.RESULTSAccording to 40% of nurses and 43.9% of physicians, the pandemic largely affected the work of dialysis units, 19% of nurses and 12% of physicians stated that it completely dominated the work. A total of 54.8% of nurses and 52.7% of physicians agreed that personal protective equipment was completely or mostly adequate. Information about safety procedures received from the dialysis unit management staff was evaluated as adequate by 53.5% of nurses and 59.5% of physicians. A total of 8.8% and 54.4% of nurses perceived life-threatening and serious risk at work during the pandemic, respectively; similar risk ratios were reported by physicians (9.45% and 55.4%, respectively). Importantly, 58.6% of nurses and 54.4% of physicians stated that their work is associated with at least serious risk for their family members. A total of 44.2% of nurses and 49.2% of physicians confirmed that they feel burned out. Out of these, 85.7% of nurses and 76.2% of physicians stated that the feeling of burnout was aggravated during the pandemic. Emotional exhaustion did not differ between nurses and physicians, while depersonalization was significantly lower (P = 0.0001) and the feeling of personal accomplishments was significantly higher (P = 0.035) among nurses than physicians. The level of burnout in three dimensions perceived by dialysis nurses and physicians during the COVID-19 is provided in Table 1. Burnout was lower among those who assessed their personal protection equipment as adequate. Also, participants who felt that the training, equipment and support provided them with a good control over their contact with the virus were found to be less burned out.CONCLUSIONThe COVID-19 pandemic has largely affected work in dialysis units, contributing to an increased risk of work-related psychological distress and burnout in this vulnerable population of healthcare professionals. Providing proper training, equipment and support during these unprecedented times of the COVID-19 outbreak may decrease burnout among dialysis nurses and physicians.Table 1.Prevalence of high, moderate and low levels of burnout in particular dimensions and of the overall burnout among dialysis nurses and physicians in the COVID-19 era

Improving management of needle distress during the journey to dialysis through psychological education and training\u2014the INJECT study feasibility pilot protocol

BackgroundNeedle-related distress is a common yet poorly recognised and managed problem among haemodialysis (HD) patients. The aim of this pilot study is to test the feasibility and acceptability of the INJECT Intervention—an innovative psychology-based intervention to empower patients to self-manage needle distress with the support of dialysis nurses.MethodsThis investigator-initiated, single-arm, non-randomised feasibility study will take place in a large dialysis service in Adelaide, Australia. Participants will include patients aged ≥ 18 years, commencing or already receiving maintenance HD, recruited through dialysis physicians and nursing staff as individuals believed to be at risk of needle distress. They will be screened for inclusion using the Dialysis Fear of Injection Questionnaire (DFIQ) and enrolled into the study if the score is ≥ 2. The multi-pronged intervention encompasses (i) psychologist review, (ii) patient self-management program and (iii) nursing education program. The primary aim is to evaluate feasibility and acceptability of the intervention from patient and dialysis nurse perspectives, including recruitment, retention, engagement with the intervention and completion. Secondary exploratory outcomes will assess suitability of various tools for measuring needle distress, evaluate acceptability of the nursing education program and measure cannulation-related trauma and vascular access outcomes.ConclusionThe results will inform the protocol for larger trials addressing needle distress in HD patients.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000229875, approved 4 April 2021, https://www.anzctr.org.au/.

Questionnaire for dialysis physicians regarding withholding and withdrawal from dialysis and kidney palliative care

Questionnaire for dialysis physicians regarding withholding and withdrawal from dialysis and kidney palliative care

Survival and predictive factors in dialysis patients with COVID-19 in Japan: a nationwide cohort study

BackgroundThe Japanese Association of Dialysis Physicians, the Japanese Society for Dialysis Therapy, and the Japanese Society of Nephrology jointly established COVID-19 Task Force Committee and began surveying the number of newly infected patients.MethodsThis registry of the COVID-19 Task Force Committee was used to collect data of dialysis patients; a total of 1010 dialysis patients with COVID-19 were included in the analysis. Overall survival of patients was investigated with stratification by age group, complication status, and treatment. In addition, predictive factors for mortality were also investigated. The overall survival was estimated by Kaplan–Meier methods and compared by using log-rank test. Multivariate analysis was performed to identify the risk factor of mortality. For all statistical analyses, p < 0.05 was considered to be statistically significant.ResultsThe mortality risk was increased with age (p < 0.001). The mortality risk was significantly higher in patients with peripheral arterial disease (HR: 1.49, 95% CI 1.05–2.10) and significantly lower in patients who were treated with remdesivir (HR: 0.60, 95% CI 0.37–0.98). Multivariate analysis showed increased risk of mortality with increment in BMI, and increment in CRP, and decreased risk with increment in albumin.ConclusionDialysis patients have a high severity of illness and a high risk of mortality in cases of COVID-19. Treatment with remdesivir might be effective in shortening the duration of hospitalization and reducing the risk of mortality.

Characteristics of ESRD Patients who have been on Long-term Hemodialysis Therapy in Egypt

Background: It is well-known that hemodialysis extends the life of end-stage renal disease (ESRD) patients, who would have otherwise died. The characteristics of long-term patients on hemodialysis (HD) were not evaluated before in Egypt. We aimed at identifying the specific characteristics of the patients who have survived on hemodialysis for more than 20 years in Egypt. Subjects and Methods: During the years 2018 and 2019, the twenty-seven governorate health affairs Directories of the Egyptian Ministry of Health were contacted to participate in data collection. The dialysis physicians in each hemodialysis unit were sent a questionnaire form requesting to submit information, on the characteristics of patients who have been on HD therapy for twenty years or more.&#x0D; Results: Seventy-three patients were encountered from a total number of 26000 HD patients to have been on HD therapy; with a range between 20 and 30 years. Males constituted the majority of these patients. Sixty-eight patients were dialyzed through working arteriovenous fistulas (A-V fistulas). The mean urea reduction ratio (URR) of these patients was 0.65±0.095. Acute intradialytic complications afflicted only 20.3% of these patients. More than three-quarters of the patients had a positive serology test for HCV antibodies. None of these patients has diabetes mellitus. On the other hand, complaints related to the skeletal system were present in 47.4% of the patients. There is a statistically significant higher rate of acute complications in the female gender and a statistically significant higher fertility rate after hemodialysis in the male gender.&#x0D; Conclusion: Long-term dwellers on hemodialysis therapy are not unusual in Egyptian ESRD patients and their characteristics are reasonable.

Infection prevention measures for patients undergoing hemodialysis during the COVID-19 pandemic in Japan: a nationwide questionnaire survey

BackgroundCoronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic affecting a variety of medical treatments, including hemodialysis. This study aims to investigate the implementation of infection control measures, to examine the shortage of personal protective equipment (PPE) and disinfectants, and to quantify the number of nosocomial COVID-19 transmissions in hemodialysis facilities in Japan during the pandemic.MethodsWe conducted a nationwide questionnaire survey between 20 October and 16 November 2020 (i.e., between the “second wave” and “third wave” in Japan) in the 4198 dialysis facilities of the Japanese Association of Dialysis Physicians and the Japanese Society for Dialysis Therapy. A total of 2227 facilities (53.0%) responded. The questionnaire consisted of (i) characteristics of facilities, (ii) infection prevention measures in routine dialysis practices, (iii) shortage of PPE, (iv) feasibility of various isolation measures, and (v) nosocomial transmission.ResultsHalf of the responding facilities were hospitals with multiple departments, and the other half were clinics specialized in dialysis. Several infection prevention measures such as health checks of staff and patients, donning of masks before and after hemodialysis, and disinfection of frequently contacted areas were implemented during the COVID-19 pandemic. There was a significant improvement in the implementation rate of these measures during the pandemic, compared to before it, which reached over 90%. More than half of the facilities reported a shortage of disposable masks (67.2%) and hand sanitizer alcohol (56.7%). Isolation of COVID-19 patients in private rooms was possible only in 52.7% of the facilities. The majority of facilities (73.3%) could not accept COVID-19 dialysis patients due to lack of space and manpower. Nosocomial transmission of COVID-19 occurred in 4.0% of the facilities. Of those infected, 51.9% were staff.ConclusionsThis survey revealed that most hemodialysis facilities in Japan had improved implementation of infection control measures and had shortage of PPEs and disinfectants, though some facilities did not implement infection prevention measures adequately, mainly due to the limited space of the facility. It may be recommended that each facility immediately establishes isolation measures to prepare for the pandemic of COVID-19.

How and who manage hemodialysis inpatients at national university hospitals in Japan? Based on questionnaire survey

BackgroundMore than three hundred thousand hemodialysis (HD) patients exist in Japan. The average of vintage of Japanese hemodialysis patients was longer than Western country. Longer and older hemodialysis patients tend to have various complications to be hospitalized and treated by various departments. However, the clinical management practices for HD inpatients are not well-known. In this study, we investigated the clinical management practices for HD inpatients in national university hospitals in Japan.MethodsThe questionnaire-based survey was conducted among HD management specialists of 42 national university hospitals in Japan via online correspondence or letters. This survey investigated their clinical management practices for HD inpatients of other departments. The responses were obtained from 173 (69%) of 249 HD management specialists among 37 (90%) of the 42 facilities.ResultsThe majority (87%) of HD management specialists were aware of the importance of medical intervention by HD specialists for the management of HD inpatients. However, only approximately 20% of HD management specialists regularly ordered blood examination and chest X-ray for the management of HD inpatients of other departments. Dialysis physicians with less experience faced more difficulty in managing HD inpatients of other departments, than experienced HD management specialists. The main reason for this difficulty was poor communication with the attending physicians, lack of management rules, and short duration of hospital stay of HD inpatients.ConclusionsThis study indicated that the clinical management practices for HD inpatients in other department were different for each HD management specialists and were affected by their clinical experience. Good communication and established inter-departmental HD management rules would be necessary.

Cognition and Implementation of Disaster Preparedness among Japanese Dialysis Facilities.

Introduction Few quantitative studies have explored disaster preparedness in dialysis facilities worldwide. This study examined the levels of disaster preparedness and their related factors in dialysis facilities in Japan. Methods We conducted a mail survey using a self-administered questionnaire for key persons responsible for disaster preparedness in dialysis facilities (N = 904) associated with the Japanese Association of Dialysis Physicians. Levels of disaster preparedness were evaluated by the implementation rates of four domains: (1) patient, (2) administration, (3) network, and (4) safety. Additionally, we focused on cognitive factors related to disaster preparedness, such as risk perception, outcome expectancy, self-efficacy, self-responsibility, and support from the surroundings. Results A total of 517 participants answered the survey (response rate: 57.2%). Implementation rates differed according to the domains of disaster preparedness. While the average implementation rate of the safety domain was 81.8%, each average implementation rate was 57.9%, 48.3%, and 38.4% for the administration, network, and patient domains, respectively. The study found that self-efficacy and support from the surroundings of the participants were significantly associated with the four domains of disaster preparedness. Alternatively, risk perception and support from surroundings were significantly associated with one particular domain each. Conclusion Our results suggest that boosting self-efficacy and support from surroundings among key persons of disaster preparedness in dialysis facilities may contribute to the advancement of the different domains of disaster preparedness.

COVID-19 and End-stage Kidney Disease in Morocco: Staying Safe during Dialysis

Since World Health Organization (WHO) declared a global Health Emergency at the end of January 2020 caused by the novel coronavirus 2019-nCoV, the rapid spread of this pandemic poses unprecedented challenges throughout the world. Hemodialysis patients are more susceptible to SARS-CoV-2 pneumonia than the general population. Dialysis physicians, health workers should have clinical knowledge of epidemic COVID-19, epidemic prevention tools, and required guidelines. This paper aims to focus on the Moroccan society of nephrology recommendations and the Ministry of Health guidelines to protect both healthcare workers and hemodialysis patients from the virus. A package of measures has been recommended by the Ministry of Health to ensure continuity of health services for hemodialysis patients with Covid-19. Besides, the Moroccan society of nephrology recommendations has been adopted to ensure quality care for this vulnerable category throughout the epidemic.

Dialysis physicians' referral behaviors for hemodialysis patients suspected of having cancer: A vignette-based questionnaire study.

BackgroundAlthough cancer management in dialysis patients has become a commonly encountered issue, known as “onco-nephrology”, few evidence-based clinical recommendations have been proposed. Here, we examined the variation in referral behaviors adopted by dialysis physicians on encountering dialysis patients with signs/symptoms suggestive of cancer.MethodsWe conducted a vignette-based study in August 2015. We sent a 14-page questionnaire to 191 dialysis physicians, including the representative dialysis facilities participating in a Japanese dialysis cohort (the Japan Dialysis Outcomes and Practice Patterns Study). Using vignette scenarios for respiratory, digestive, and urological areas, we assessed the referral behaviors (expert referral or not) adopted by dialysis physicians on encountering dialysis patients with symptoms suggestive of cancer. Each scenario contained three patient functional factors: age (60 or 75 years), performance status (PS 0 or 1), and cognitive dysfunction (absence or presence). We examined the association between physician factors, patient factors, and referral behaviors.ResultsWe obtained 94 replies (response rate: 49.2%). For the respiratory scenarios, 38.3% and 51.9% of physicians reported watchful waiting when encountering bilateral and unilateral pleural effusion, respectively. In digestive and urologic scenarios, most physicians (>85%) selected expert referral. We detected differences in referral behaviors between scenarios with different cancer biological factors. However, we found consistency in referral behaviors within the same scenario, even with different patient functional factors (intra-class correlation coefficients within each scenario all >0.7).ConclusionsPhysicians’ referral behaviors for dialysis patients suspected of having cancer vary for different cancer biological factors (probability of having cancer). However, the referral behaviors are similar for different patient functional factors (age, PS, and cognitive dysfunction).

Korean clinical practice guidelines for preventing the transmission of infections in hemodialysis facilities.

Patients receiving hemodialysis are vulnerable to infectious diseases due to their impaired immunity and high risk of exposure to pathogens. To protect patients, staff, and visitors from potential infections, each hemodialysis unit should establish and follow standard infection control and prevention measures. Therefore, clinical practice guidelines were developed by a working group of nephrologists and infection control specialists to provide evidence-based guidance for dialysis physicians and nurses, with the aim of preventing infection transmission and controlling infection sources in hemodialysis facilities. The areas of infection control covered by these guidelines include standard precautions, isolation strategies, vascular access, water treatment, cleaning/disinfecting/sterilizing, and vaccination. This special report summarizes the key recommendations from the Korean clinical practice guidelines for preventing the transmission of infections in hemodialysis facilities.

Unmet service needs evaluated by case managers among disabled patients on hemodialysis in Japan.

BackgroundThis study aimed to investigate the levels of unmet needs for home and community-based services (HCBS) evaluated by case managers (CMs) among disabled patients on hemodialysis (DPHD) and to examine factors related to unmet needs. Unmet needs for HCBS were defined as situations in which patients do not use or underuse HCBS despite needing them. Candidates for the factors relating to unmet needs for HCBS included three dimensions: predisposing, enabling, and need factors.MethodsSelf-administrated questionnaires were collected from 391 CMs of DPHD certified with long-term care insurance. These were introduced by the dialysis facilities that a member of the Japanese Association of Dialysis Physicians belonged to. CMs were asked questions about their management of each individual case. HCBS included home help, visiting nursing, daycare, and short stay.ResultsThe prevalence of unmet needs for each HCBS ranged from 32% for home help to 48% for short stay. Barriers to service usage in the patients were associated with unmet needs for all four services. The patients with more severe cognitive malfunction were more likely to have unmet needs for visiting nursing and short stay. Heavier burden with caregiving was associated with more likelihood of unmet needs for home help and short stay.ConclusionCMs need to monitor unmet needs after coordinating HCBS for DPHD and need to encourage HBCS use among patients with impaired cognitive function and caregivers with heavier caregiving burdens.

Barriers to Effective Case Management for Disabled Patients on Hemodialysis.

The present study examined the performance level and its related factors on the process of case management for disabled patients on hemodialysis. Case management performance was evaluated at three stages: patient assessment, making a care plan, and monitoring/evaluation. Candidates for targeting the factors relating to performance included four dimensions: nursing care level, physical malfunction, cognitive malfunction, and barriers to service were used as patient factors; the period of case management for the patient and the knowledge of dialysis emerged as case manager factors; work load was included as an organizational factor; and community resources for these services and communication with surrounding persons were included as system factors. Self-administrated questionnaires were collected from 391 case managers of patients with hemodialysis certified long-term insurance. These were introduced by the dialysis facilities that a member of the Japanese Association of Dialysis Physicians belonged to. Case managers were asked questions about their management of each individual case. The results indicate, for example, that poor knowledge of dialysis is significantly related to poor patient assessment, inadequate development of a care plan, and lower levels of monitoring/evaluation. In addition, work overload and diabetic nephropathy as the primary kidney disease were also found to be significantly related to poor patient assessment. Increasing the opportunity for case managers to learn about dialysis may be needed for better case management performance in respect of the hemodialysis of disabled patients.

Asunaprevir and daclatasvir in hemodialysis patients with chronic hepatitis C virus genotype 1b infection.

Background and AimPatients requiring hemodialysis show high morbidity with hepatitis C virus (HCV) infection, but there are difficulties associated with interferon‐based therapies. Asunaprevir and daclatasvir could help patients with HCV genotype 1b because the drugs have a nonrenal metabolism and show good viral eradication. We evaluated the efficacy and safety of combined asunaprevir and daclatasvir therapy.MethodsThis was a multicenter prospective trial of patients with chronic hepatitis or compensated cirrhosis from HCV genotype 1b who had end‐stage renal disease requiring chronic hemodialysis. Asunaprevir and daclatasvir were administered orally (100 mg twice daily and 60 mg once daily, respectively) for 24 weeks. The primary end‐point was the proportion of patients achieving sustained virological response 12, defined as HCV RNA <15 IU/mL undetectable at 12 weeks after completion of asunaprevir and daclatasvir treatment.ResultsBetween December 2014 and December 2015, 23 dialysis patients were enrolled, and 22 patients completed the protocol therapy. Sustained virological response 12 rates were 91.3% (95% confidence interval: 72.0–98.9) in the intention‐to‐treat and 95.5% (95% confidence interval: 77.2–99.9) in the per‐protocol populations. Serum aminotransferase significantly decreased after initiation of asunaprevir and daclatasvir (P < 0.01), although the level was low at baseline. Asunaprevir and daclatasvir were well tolerated; however, one patient could not continue because of infective endocarditis and cerebral infarction.ConclusionsAsunaprevir and daclatasvir could help patients with chronic hepatitis C receiving hemodialysis. Close collaboration with dialysis physicians is important when treating these patients because hemodialysis carries life‐threatening risks.

Analysis of hemodialysis patients' thoughts about kidney transplantation and the national organ transplant system in terms of organ transplantation services management

Introduction: Kidney transplantation is the most effective treatment of end-stage renal failure. Although many patients continue to wait for a kidney transplant, there are constraints in organ supply. This situation needs to be analyzed and to be managed effectively. Objective: The objective of this study was to determine the status of information regarding kidney transplants provided to patients treated with hemodialysis, the patients’ thoughts regarding kidney transplants and the national organ transplant system as well as assessing their registration status at transplant centers. Methods: 273 patients receiving hemodialysis treatment at 4 private dialysis centers in Ankara/Turkey were evaluated within the scope of this descriptive study. The data were collected through a survey method. The survey consisted of 18 questions in total which had been developed by the authors. Results: It was determined that the hemodialysis patients responding to the survey were in the 20-95 age group with an average age of 58,64±15,64 years. 87,9% of the patients reported that they had been briefed about kidney transplants, 32,2% of those had been briefed said that the information had been delivered by the dialysis physician, 77,7% stated that they wanted a kidney transplant from a cadaver, 49,5% did not want a kidney transplant from a live donor and 35,5% indicated that the national organ transplant system operated adequately. Furthermore, it was noted that 50,9% of the responders were registered on the waiting lists of kidney transplant centers. Conclusions: It was concluded that it is necessary to provide sufficient information to hemodialysis patients about kidney transplants and the national organ transplant system to steer them to transplant centers. It is anticipated that the results of this study will assist officers of the Ministry of Health, politicians involved in health issues, decision makers and health professionals.

Renal Dialysis and its Financing

ABSTRACTThe incidence of end-stage renal disease (ESRD) and its associated comorbidities such as diabetes and hypertension continue to increase as the population ages. As most ESRD patients qualify for Medicare coverage, the U.S. government initiated reforms of the payment system for dialysis facilities in an effort to decrease expenditures associated with ESRD reimbursement. The effects of reduced reimbursement rates, bundled payment options, and quality incentives on the current dialysis system, including kidney dialysis units, physicians, and patients, are examined.

Enquête auprès des néphrologues français sur les pratiques de dépistage et de décolonisation du portage nasal de Staphylococcus aureus des patients dialysés chroniques

Staphylococcus aureus nasal carriage is frequent in dialysis patients and is associated with an increased risk of staphylococcal infections in this population. Data from the literature showed that decolonization of S. aureus nasal carriers in hemodialysis and peritoneal dialysis reduce S. aureus catheter-related infections. During the last national congress of nephrology, a survey was conducted among volunteer dialysis physicians to evaluate their practice about screening and decolonization of S. aureus nasal carriage among their patients. Only 30 participants (45.5% [30/66]) declared to screen S. aureus nasal carriage in patients of hemodialysis and 59.6% (31/52) in peritoneal dialysis. Participants declared to decolonize their patients before insertion of a vascular catheter in 55.8% of cases. This small study would need to be completed by a national survey.