Life Of End-stage Renal Disease Patients Research Articles

Mirtazapine: A One-Drug Intervention for the Physical and Psychological Symptoms of End-Stage Renal Disease (ESRD).

Patients with end-stage renal disease (ESRD), especially those on dialysis, experience myriad medical and psychological symptoms that impact theirquality of life. These symptoms range from nausea, emesis, and insomnia to pruritus, anxiety, depression, and loss of appetite. These symptoms often require multiple medications (e.g., anticholinergics, antihistamines, tricyclics, benzodiazepines, and Z-drugs), which can lead to polypharmacy, medication non-adherence, and potentially harmful drug-drug interactions, especially in older ESRD patients, a population with an age-related decline in drug metabolism, multimorbidity, and polypharmacy. The current perspective article will discuss evidence from extant literature supporting mirtazapine (a noradrenergic antagonist and selective serotonin antagonist, NASSA) as a potentially useful one-stop pharmacologic agent to alleviate multiple symptoms that ESRD patients face. A one-stop strategy has the potential to decrease polypharmacy, reduce adverse drug-drug and drug-disease interactions, reduce healthcare costs, and improve the quality of life in ESRD patients. Mirtazapine use in an ESRD setting merits a large randomized pragmatic double-blinded controlled trial to evaluate its efficacy as a potential pharmacotherapeutic agent for the management of multiple disabling gastrointestinal and other neuropsychological symptoms in older adults living with ESRD.

Comparison of the Efficacy of Gabapentin Versus Levodopa-C for the Treatment of Restless Legs Syndrome in End-Stage Renal Disease on Hemodialysis Patients.

Objective: We aimed to compare the efficacy of gabapentin and levodopa-c for the symptoms of restless leg syndrome in patients of end-stage renal disease (ESRD) undergoing maintenance hemodialysis therapy.Methods: In this observational, cross-sectional study, patients of ESRD on hemodialysis with restless leg syndrome were included after assessment of symptoms and quality of sleep before the treatment by completing two questionnaires: the International Restless Leg Syndrome Study Group (IRLSSG) questionnaire and the Pittsburgh Sleep Quality Index (PSQI) scale. They were randomly divided into two groups. One group was prescribed levodopa-c (110 mg) as a single dose two hours before bedtime for four weeks. The other group was given gabapentin (200 mg) after each hemodialysis session for four weeks. After the treatment, the patients completed the two questionnaires again: the IRLSSG questionnaire and the Pittsburgh Sleep Quality Index.Results: In our study, men were 14 (53.8%), and women were 12 (46.2%). Gabapentin was given to 14 (53.8%) patients, and 12 (46.2%) patients were prescribed levodopa-c. In the levodopa group, the average baseline IRLSS was 24.333 ± 7.936), and the mean baseline PSQI score was 13.583 ± 3.396. After treatment with levodopa for four weeks, the mean IRLSS was 8.666 ± 3.312, and the mean PSQI score was 4.666 ± 2.839; a P-value of 0.00001 was noted. While in the gabapentin group, the mean baseline IRLSS was 26.071 ± 7.936, and the mean baseline PSQI score was 14.857 ± 3.254. After treatment for four weeks with gabapentin, the mean IRLSS was 5.3571 ± 1.392, and the post-treatment average PSQI was 2.992 (SD: 0.916); a P-value of 0.00001 was noted.Conclusion: Both levodopa and gabapentin effectively relieve symptoms of restless leg syndrome and improve the quality of sleep and life in ESRD patients undergoing hemodialysis.

Aspects Of Spirituality And Religiusity In Patients End Stage Renal Disease (ESRD)

Comprehensive and holistic nursing care by professional nurses is continuously improved, especially nursing care in ESRD patients. This has an impact on the importance of knowing the potential to be revamped so that the poor quality of life in ESRD patients can be enhanced one of the aspects of spirituality and religiusity included in the comprehensive and holistic. The aim of this study was to study the aspects of spirituality and religiusity in End Stage Renal Disease (ESRD) patients. This study uses a Litelature review was chosen as the method used for this study by collecting litelature from ProQuest, Wiley Online, and Scientdirect databases using the keywords "sentimental and ESRD Spritual", "Religious beliefs and ESRD "," Spiritual Beliefs and ESRD ", and "Religious and Spiritual Beliefs and ESRD" and the chosen circuit are full text journals published from 2010 to 2019, and written in English. The results is selected journal has been chosen to show that the spiritual and religious aspects are associated with QoL, HRQoL and Self-Caring in the ESRD patients undergoing HD. The relationship formed is a positive relationship where the better aspect of spirituality and religiality of ESRD patients undergoing HD then QoL, HRQoL, and Self-Caring patients are also good. In addition, the themes formed from the results of qualitative analysis, namely decision-making, the ESRD patients, participants ' spiritual pressures, self-caring meaning, self-caring action, Islamic influence on self-caring, and cultural influences on Self-caring. The aspect of spirituality and religiusity is the provision of comprehensive and holistic care services. Both aspects are proven to have a good impact on the Quality of Life (QoL), Health-Related Quality of Life (HRQoL), and self-caring in the ESRD patients undergoing HD.

Dermatologic manifestations in end stage renal disease.

Skin manifestations are commonly seen in end stage renal disease (ESRD). Skin involvement in this population can be extensive and dramatically worsen quality of life. Close observation of the skin and nails of ESRD patients by clinicians allows for timely diagnosis and treatment, which ultimately improves quality of life and reduces mortality. In this article we focus on the cutaneous changes most commonly seen in ESRD patients. PubMed/Medline database search was done for published literature on skin manifestations in ESRD patients. All the available literature was reviewed and relevant articles were used to discuss about clinical features, pathogenesis, histology and treatment of each skin disorder in ESRD patients. Most commonly encountered skin manifestations in patients with ESRD are pruritus, xerosis, pigmentation changes, nail changes, perforating disorders, calcifying disorders, bullous dermatoses and nephrogenic systemic fibrosis. Skin manifestations in ESRD can be difficult to treat and multiple comorbidities in this patient population can exacerbate these disorders. Many of the treatment options are experimental with evidence largely derived from the case reports and small clinical trials. More large-scale trials are needed to firmly establish evidence based treatment guidelines. Prompt evaluation and management of these disorders improve morbidity and quality of life in ESRD patients.

A Descriptive Study to Assess the Quality of Life in ESRD (End Stage Renal Disease) Patients Undergoing Hemodialysis in Selected Hospital of Mohali, Punjab

ESRD is one of the chronic diseases causing high level of disability in different domains of the patient's life. The experience of multiple losses, including kidney functions, family role, work role, sexual function, time and mobility impact significantly on the lives of these patients. So the present study was conducted to assess the quality of life in the end stage renal disease patients undergoing hemodialysis. Quality of life determines the effectiveness and outcome of different treatment method. According to the WHO, quality of life is define as the general perception of individual toward different aspects of life including the dominant culture, value system, goal and achievements, expectations, standards and priorities. The objectives of the present study were to (i) assess the quality of life in ESRD patients undergoing hemodialysis with references to their physical, psychological, social and environmental health dimensions and (ii) associate the quality of life in ESRD patients undergoing hemodialysis with selected socio-demographic variables. The study was conducted at Silver Oaks Hospital phase 9 Mohali. 50 ESRD patients were recruited for the study using convenient sampling technique. Quantitative research approach and non-experimental descriptive design was used. Pretested and validated modified WHO BREFF questionnaire was used to collect the data. The findings of the study revealed that majority (60%) of research participants had poor quality of life followed by (40%) who had very poor quality of life. It also concluded that quality of life in ESRD patients undergoing hemodialysis had no statistically significant association with any of the socio demographic variables.

Effects of extremely low frequency pulsed electromagnetic field added to kinesitherapy procedure on quality of life in patients with end stage renal disease on dialysis

Background/Aim. Extremely Low Frequency Pulsed Electromagnetic Magnetic Field (ELF-PEMF) has a wide range of therapeutic applications which were expanding during the last decades. ELF-PEMF, as non-invasive, longterm safe method of physical therapy can influence a variety of aspects in chronic diseases including quality of life. Patients with chronic kidney disease (CKD), especially with end stage renal disease (ESRD), treated by dialysis, have lower health-related quality of life and changed normal way of living because of ESRD-related comorbid illnesses, associated conditions and complex dialysis procedures. The objective of this study was to assess the effectiveness of longterm ELF-PEMF in concordance with exercising on quality of life in ESRD patients on dialysis. Methods. A total of 124 patients (59 men and 65 women) with ESRD on dialysis program were divided into study group and control group. Patients included in the study group (n = 54) agreed to receive treatment with ELF-PEMF (18 Hz, 2 mT, applied during 40 minutes after ten consecutive dialysis procedures, four times through one year, 120 treatments in total) together with kinesitherapy over three years. The patients in the control group (n = 70) were subjected only to kinesitherapy as a physical therapy procedure. Quality of life was assessed through the Short Form Health Survey, version 2 (SF36v2) and the Functional Assessment of Chronic Illness Therapy, version 4 (FACIT Fatigue v4) questionnaires. Results. In the study group, treatment with ELF-PEMF significantly improved FACIT Fatigue v4 scale score as well as physical health, physical functioning, bodily pain and energy/ fatigue domains of SF=36v2 scale. There were no effects on mental health domain, limitations due to physical health problems, limitations due to personal or emotional problems, emotional well-being, social functioning, and general health perceptions. In the control group, no beneficial effects on FACIT Fatigue v4 scale and SF36v2 scale item were noticed. Conclusion. ELF-PEMF could be a additional and safe strategy for improving quality of life in patients with ESRD on dialysis.

An update of the effect of far infrared therapy on arteriovenous access in end-stage renal disease patients.

The life qualities of end-stage renal disease (ESRD) patients rely largely on adequate dialysis, and a well-functioning vascular access is indispensable for high quality hemodialysis. Despite the advancement of surgical skills and the optimal maintenance of arteriovenous fistula (AVF), malfunction of AVF is still frequently encountered and has great impact on the life of ESRD patients. Several medical, mechanical and genetic prognostic factors are documented to affect the patency of AVF and arteriovenous graft (AVG). Heme oxygenase-1 (HO-1) is one of the genetic factors reported to play a role in cardiovascular disease and the patency of vascular access. Far infrared (FIR), a novel therapeutic modality, can not only conduct heat energy to AVF but also stimulate the non-thermal reactions mediated by HO-1. The use of FIR therapy significantly enhances the primary patency rate and maturation of AVF with fewer unfavorable adverse effects, and also achieves higher post-angioplasty patency rate for AVG. The only limitation in proving the effectiveness of FIR therapy in enhancing patency of AVF is that all the studies were conducted in Chinese people in Taiwan and thus, there is a lack of evidence and experience in people of other ethnicities.

Comparative Costs of Different Renal Replacement Therapies in Lower Middle Income Countries on the Example of Georgia

End-Stage Renal Disease (ESRD) represents one of the most challenging social and medical problems mainly due to substantial treatment-associated costs. The chronic nature of the disease needs expensive continuous care that majority of the patients cannot afford. Therefore, in many countries expenses associated with the ESRD treatment is paid by state government. These treatment options include: hemodialysis, peritoneal dialysis and kidney transplantation. Multiple studies have been conducted throughout the world to assess cost-effectiveness of these treatment modalities. The studies suggest that kidney transplantation not only reduces mortality and morbidity but improves a quality of life of ESRD patients. Furthermore, it is the most cost-effective treatment for the ESRD at least in high-income countries. The goal of our study was to determine whether above-mentioned is true for lower middle income countries, where the cost of the ESRD treatment is substantially lower. Despite the low dialysis costs, transplantation remains the cheapest form of renal replacement therapy RRT in lower income countries like Georgia. Our results reveal, that kidney transplantation is most expensive modality of Renal Replacement Therapy (RRT) at month 1, but count of costs reveals that after the 10th month of treatment, the cumulative cost of transplantation is less than the cumulative cost of peritoneal dialysis and after the 23rd month, cumulative cost of hemodialysis also surpasses the cumulative cost of transplantation-related treatment and this cost comparison is in line with global data from upper-middle and high income countries.

Reliability of the Brazilian version of the PedsQL - ESDR questionnaire to evaluate quality of life of children and adolescents.

To evaluate the reliability of the translation and cultural adaptation of the Pediatric Quality of Life Inventory (PedsQLTM) - End Stage Renal Disease (ESRD) - version 3.0 - children/adolescents and parents reports in Brazilian children with ESRD. A group of 24 children and adolescents with ESRD, followed at Unidade de Nefrologia Pediátrica do Instituto da Criança - HCFMUSP and 32 primary caregivers were interviewed according to the me methodology proposed by the creator of the original questionnaire. Statistical analysis using Cronbach's alpha resulted in values between 0.39 and 0.89 for all domains in initial statistical analysis. The domains that presented values lower than 0.5 were recalculated by age group, resulting in higher Cronbach's alpha values demonstrating the influence of the age in the perception of quality of life in ESRD patients. The overall rating of Cronbach's alpha values resulted in values of 0.81 and 0.71 in patients and PC reports, respectively, demonstrating good internal consistency. Ours results show that the Brazilian version of the questionnaires is valid, reliable and useful for measure HRQoL of children and adolescents ESRD, according to patients and PC reports.

Comparaison de deux enquêtes nationales sur la qualité de vie des patients atteints d’insuffisance rénale chronique terminale entre 2005–2007 et 2011 : des indicateurs sensiblement en baisse

BackgroundThe Epidemiology Network and Nephrology Information provides since 2001 the epidemiological monitoring of end stage renal disease (ESRD) in France. Two cross-sectional studies to estimate the level of quality of life in ESRD patients were performed in 2005 and 2007 and repeated in 2011. The main objective is to analyze the evolution of the quality of life of ESRD between these two surveys. MethodsThe studies were conducted on a representative sample of subjects aged 18 and over, prevalent dialysis or holders of a functioning kidney transplant last year, followed in center dialysis and/or transplantation in one of the eight French regions selected. The quality of life was measured by a generic questionnaire, and two specifics questionnaires. ResultsThe evolution of the quality of life deteriorated slightly between 2005–2007 and 2011. There is however few dimensions affected. The variation in scores is not meaningful in general, with maximum decreases less than 4 points according to the statistical methods used. This diminution is not clinically significant. DiscussionThe quality of life in dialysis patients or transplant did not evolve between 2005–2007 and 2011. Currently, it is difficult to assess the benefits of the national plan for improving the quality of life of people with chronic diseases because the last data are too close to the end of the plan.

Intradialytic Modified Tai Chi Exercise among End-Stage Renal Disease Patients Undergoing Hemodialysis: An Exploratory Pilot Study

Background: Evidence suggests that intradialytic exercise benefits end-stage renal disease (ESRD) patients. We examined the feasibility of intradialytic modified Tai Chi (IMTC) among ESRD undergoing hemodialysis and assessed IMTC’s impact on risk of falls, bone metabolism, oxidative stress damage, and quality of life in ESRD patients. Methods: Forty-five ESRD patients were randomized to either non-exercising control group (CON, n=25) or IMTC group (n=20) who performed IMTC exercise 3/week, 45 min/session while sitting in a recliner with one arm connected to the dialysis machine for 12 weeks. At baseline and 12 weeks, we measured risk-of-falls related parameters (balance, gait, and functioning strength), biomarkers of bone metabolism and oxidative stress damage, and quality of life. Results: Thirty-four participants completed the study. The feedback from participants suggests that IMTC exercise is easy to learn and feasible. After 12 weeks, IMTC tended to lower tartrate- resistant acid phosphatase (bone resorption biomarker) and improved quality of life (role physical and vitality) compared to CON. There was no significant difference in balance, gait, and functional strength, possibly due to a ceiling effect. There was no significant difference in serum bone-specific alkaline phosphatase, calcium, phosphorus and intact parathyroid hormone levels, plasma 8-hydroxy-2’-deoxyguanosine levels, and other domains of quality of life. The CON group experienced a 20% decrease in 25-hydroxy vitamin D at the end of study. Conclusions: IMTC exercise was safe and well accepted by ESRD patients. It improved quality of life, tended to suppress bone resorption, and helped maintain 25-hydroxy vitamin D levels in ESRD patients. These findings need to be confirmed in a larger, more sufficiently powered efficacy study.

Drug therapy for hypertension in hemodialysis patients.

The majority of end-stage renal disease (ESRD) patients are hypertensive. Drug therapy for hypertension in hemodialysis (HD) patients includes all classes of antihypertensive drugs, with the sole exception of diuretics. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers may decrease morbidity and mortality by reducing the mean arterial pressure (MAP), aortic pulse wave velocity, and aortic systolic pressure augmentation, as well as left ventricular hypertrophy (LVH) and probably reduction of C-reactive protein (CRP) and oxidant stress. Potential risk factors include hyperkalemia, anaphylactoid reaction with AN69 membranes (particularly ACE inhibitors), and aggravation of renal anemia. beta-blockers decrease not only mortality, blood pressure (BP), and ventricular arrhythmias, but also improve left ventricular function in ESRD patients. Nonselective beta-blockers can cause an increase in serum potassium (particularly during fasting or exercise). Lisinopril and atenolol have a predominant renal excretion and therefore a prolonged half life in ESRD patients. Thus thrice-weekly supervised administration of these drugs after HD can enhance BP control. The use of calcium channel blockers is also associated with lower total and cardiovascular-specific mortality in HD patients. Minoxidil is a very potent vasodilator that is generally reserved for dialysis patients with severe hypertension. Hypertensive dialysis patients who are noncompliant with their medications may benefit from transdermal clonidine therapy once a week. The majority of dialysis patients need a combination of several antihypertensive drugs for adequate BP control.

Quality of life in patients on chronic dialysis: Self-assessment 3 months after the start of treatment

The aim of the present multicenter study was to assess quality of life of Dutch dialysis patients 3 months after the start of chronic dialysis treatment. The quality of life was compared with the quality of life of a general population sample, and the impact of demographic, clinical, renal function, and dialysis characteristics on patients' quality of life was studied. New end-stage renal disease (ESRD) patients who were started on chronic hemodialysis or peritoneal dialysis in 13 dialysis centers in The Netherlands were consecutively included. Patients' self-assessment of quality of life was measured by the SF-36, a 36-item Short Form Health Survey Questionnaire encompassing eight dimensions: physical functioning, social functioning, role-functioning physical, role-functioning emotional, mental health, vitality, bodily pain, and general health perceptions. One hundred twenty hemodialysis and 106 peritoneal dialysis patients completed the SF-36. Quality of life of hemodialysis and peritoneal dialysis patients was substantially impaired in comparison to the general population sample, particularly with respect to role-functioning physical and general health perceptions. Mean role-functioning physical and general health perceptions scores of the hemodialysis patients corresponded with the lowest scoring 8% and 12%, respectively, of the reference group. Mean role-functioning physical and general health perceptions scores of the peritoneal dialysis patients corresponded with the lowest scoring 10% and 12%, respectively, of the reference group. Hemodialysis patients showed lower levels of quality of life than peritoneal dialysis patients on physical functioning, role-functioning emotional, mental health, and pain. However, on the multivariate level, we could only demonstrate an impact of dialysis modality on mental health. A higher number of comorbid conditions, a lower hemoglobin level, and a lower residual renal function were independently related to poorer quality of life. The variability of the SF-36 scores explained by selected demographic, clinical, renal function, and dialysis characteristics was highest for physical functioning (29.7%). Explained variability of the other SF-36 dimensions ranged from 6.9% for general health perceptions to 15.4% for vitality. We conclude that quality of life of new ESRD patients is substantially impaired. Comorbid conditions, hemoglobin, and residual renal function could explain poor quality of life only to a limited extent. Further research exploring determinants and indices of quality of life in ESRD patients is warranted. From a clinical perspective, we may conclude that quality of life should be considered in the monitoring of dialysis patients.

Changes in the Quality of Life of Patients with End-Stage Renal Disease Treated with High-Efficiency Bicarbonate Hemodialysis in Mexico

In accordance with the epidemiological changes in Mexico, the results of this study are intended to contribute to the evaluation of the end-stage renal disease (ESRD) program of the health services in Mexico. We measured the quality of life of 21 ESRD patients before and after 6 months of exposure to treatment with high-efficiency hemodialysis with bicarbonate (HEHD/bicarbonate). We cross-sectionally assessed the Quality Adjusted Life Year (QALY) index and the biochemical status of the subject pool. The QALY score for patients undergoing HEHD/bicarbonate after 6 months was significantly higher than with the previous dialysis modality (0.95 and 0.74, respectively, p = 0.02). The marked similarities of the biochemical status variables indicated there was little or no effect in the improvement of the quality of life of patients. Dialysis modality likely exerts an important influence on the quality of life of chronic dialysis patients; thus we believe HEHD/bicarbonate does offer greater benefits than hemodialysis alone. Longitudinal studies are needed to better ascertain the effect of the case mix, the treatment approach, and the characteristics of the dialysis in relation to the improvement of the quality of life of ESRD patients.