Desfecho clínico de pacientes em urgência dialítica: uma revisão integrativa da literatura / Resultado clínico de pacientes en urgencia dialítica: una revisión integradora de la literatura / Clinical outcome of patients in dialysis urgency: an integrative literature review

RESUMO Objetivo : Investigar o desfecho clínico de pacientes em urgência dialítica submetidos à terapia renal substitutiva, por meio de uma revisão integrativa da literatura. Método : Revisão integrativa da literatura de estudos publicados de janeiro de 2010 a julho de 2020, na íntegra, em inglês e português, nas bases de dados: Literatura Latino Americana e do Caribe em Ciência da Saúde, Medical Literature Analysis and Retrieval System Online, Base de dados de Enfermagem e PUBMED. Foram utilizadas palavras-chave e descritores: "hemodiálise", "emergência", "diálise renal", "mortalidade, "desfecho clínico" e "urgência dialítica". Os textos foram pré-selecionados a partir da leitura dos títulos e resumos, verificando sua aderência ao tema, encontrando-se 344 artigos. A seguir, foi realizada a leitura dos resultados e considerações dos estudos. Dos 334 artigos pré-selecionados, apenas 13foram incluídos. Resultados : Há recorrência da urgência dialítica, sendo o óbito o principal desfecho clínico. Conclusão : Os estudos acerca dos desfechos clínicos de pacientes em urgência dialítica ainda são poucos se comparado à dimensão que a doença renal possui na população mundial. Conhecer esses desfechos dará subsídios para novos estudos sobre a sobrevida desses pacientes e para políticas de saúde mais eficazes.

RESUMEN Objetivo : investigar el resultado clínico de pacientes en urgencia dialítica sometidos a la terapia renal sustitutiva, por medio de una revisión integradora de la literatura. Método : revisión integradora de la literatura de estudios publicados de enero de 2010 a julio de 2020, en su totalidad, en inglés y portugués, en las bases de datos: Literatura Latino Americana e do Caribe em Ciência da Saúde, Medical Literature Analysis and Retrieval System Online, Base de dados de Enfermagem y PUBMED. Fueron utilizados los descriptores y las palabras clave en portugués: "hemodiálise", "emergência", "diálise renal", "mortalidade, "desfecho clínico" y "urgência dialítica". Los textos fueron pre-seleccionados a partir de la lectura de los títulos y resúmenes, verificando su adherencia al tema, fueron encontrados 344 artículos. A continuación, fue realizada la lectura de los resultados y las consideraciones de los estudios. De los 334 artículos pre-seleccionados, apenas 13 fueron incluidos. Resultados : hay recurrencia de la urgencia dialítica, siendo el óbito el principal resultado clínico. Conclusión: los estudios acerca de los resultados clínicos de pacientes en urgencia dialítica todavía son pocos comparados a la dimensión que la enfermedad renal posee en la población mundial. Conocer estos resultados dará herramientas para nuevos estudios respecto a la pervivencia de estos pacientes y para políticas de salud más eficaces.

ABSTRACT Objective: To investigate the clinical outcome of patients in dialysis urgency who have undergone renal replacement therapy, through an integrative literature review. Method: Integrative literature review of studies published from January 2010 to July 2020, in full, in English and Portuguese, in the databases: Latin American and Caribbean Literature in Health Science, Medical Literature Analysis and Retrieval System Online, Nursing and PUBMED database. The keywords and descriptors were used: "hemodialysis", "emergency", "renal dialysis", "mortality", "clinical outcome" and "dialysis urgency". The texts were pre-selected from reading the titles and abstracts, verifying their adherence to the theme, and 344 articles were found. Next, the results and study considerations were read. Of the 334 pre-selected articles, only 13 were included. Results: There is recurrence of dialysis urgency, with death being the main clinical outcome. Conclusion: Studies on the clinical outcomes of patients in dialysis urgency are still few compared to the dimension that kidney disease has in the world population. Knowing these outcomes will provide support for further studies on the survival of these patients and for more effective health policies.

Continuous venovenous renal replacement therapy in critically ill patients: A work load analysis.

OBJECTIVES: To evaluate the nursing workload related to two techniques of continuous renal replacement therapy. RESEARCH METHODOLOGY: We analysed retrospectively the nursing work load caused directly by continuous renal replacement therapy in a cohort of patients admitted consecutively over 10 months. Two types of continuous renal replacement therapy have been compared: dialysis with regional citrate anticoagulation and haemodiafiltration with systemic heparin coagulation. SETTING: Academic Hospital Intensive Care Unit. MAIN OUTCOME MEASURES: The nursing workload was defined by the time spent in the management of continuous renal replacement therapy, including preparation of the circuit and related biological controls. RESULTS: 60 patients underwent a total of 202 sessions of continuous renal replacement therapy. The nursing workload as expressed as % time of nursing care was similar (12.3 [9.4-18.8] vs 13.4 [11.7-17.0] %, for haemodiafiltration and dialysis respectively, P=0.06). However, the distribution of the nursing workload is different: the bigger proportion of care is circuit preparation in haemodiafiltration and biology control in dialysis. CONCLUSIONS: Nursing time dedicated to continuous renal replacement therapy is similar whatever the renal replacement therapy technique. However, a longer duration of the filter and a better circuit predictability with dialysis and citrate anticoagulation are potential benefits for nursing workload.

The impact of "early" versus "late" initiation of renal replacement therapy in critical care patients with acute kidney injury: a systematic review and evidence synthesis.

BACKGROUND: The optimal timing of initiating renal replacement therapy (RRT) in critical illness complicated by acute kidney injury (AKI) is not clearly established. Trials completed on this topic have been marked by contradictory findings as well as quality and heterogeneity issues. Our goal was to perform a synthesis of the evidence regarding the impact of "early" versus "late" RRT in critically ill patients with AKI, focusing on the highest-quality research on this topic. METHODS: A literature search using the PubMed and Embase databases was completed to identify studies involving critically ill adult patients with AKI who received hemodialysis according to "early" versus "late"/"standard" criteria. The highest-quality studies were selected for meta-analysis. The primary outcome of interest was mortality at 1 month (composite of 28- and 30-day mortality). Secondary outcomes evaluated included intensive care unit (ICU) and hospital length of stay (LOS). RESULTS: Thirty-six studies (seven randomized controlled trials, ten prospective cohorts, and nineteen retrospective cohorts) were identified for detailed evaluation. Nine studies involving 1042 patients were considered to be of high quality and were included for quantitative analysis. No survival advantage was found with "early" RRT among high-quality studies with an OR of 0.665 (95 % CI 0.384-1.153, p = 0.146). Subgroup analysis by reason for ICU admission (surgical/medical) or definition of "early" (time/biochemical) showed no evidence of survival advantage. No significant differences were observed in ICU or hospital LOS among high-quality studies. CONCLUSIONS: Our conclusion based on this evidence synthesis is that "early" initiation of RRT in critical illness complicated by AKI does not improve patient survival or confer reductions in ICU or hospital LOS.

Continuous Renal Replacement Therapy (CRRT) practices in Canadian hospitals: Where are we now?

BACKGROUND: Acute kidney injury (AKI) is a common complication in critically ill patients. Renal replacement therapy is prescribed for as many as 70% of critically ill patients in AKI and may be provided in the form of intermittent or continuous dialysis including intermittent hemodialysis, sustained low-efficiency dialysis, and continuous renal replacement therapy (CR RT). CRRT is commonly used for unstable critically ill patients, as it involves a slow continuous process. The nursing work involved with CR RT is highly complex and the learning requirements are challenging; therefore, it is important to identify nursing practices. PURPOSE: A national survey was conducted to gain insight into CRRT nursing practices. METHODS: T he design for this study was descriptive using a survey The target population for this survey was ICU nurse educators at Canadian teaching and community hospitals. Topics in the survey included staff education, CRRT ordering and initiation practices, vascular access, filters and filter life, fluids used, anticoagulation methods, adverse events, and greatest concerns. FINDINGS: One hundred and twenty-nine surveys were sent out and 73 were returned for a response rate of 57%. Thirty-six hospitals used CRRT and of these, 73% had used CR RT for more than eight years. The findings revealed that educators identified achieving and maintaining competence as their greatest concern related to CRRT practices. CONCLUSION: The fndings of this research revealed that consistent training programs were not the norm. The complexity of caring for patients on CRRT requires consideration of when to introduce to staff the technology and care of patients on CRRT and how to sustain their competence.

Development of Online Learning Modules as an Adjunct to Skills Fairs and Lectures to Maintain Nurses' Competency and Comfort Level When Caring for Pediatric Patients Requiring Continuous Renal Replacement Therapy (CRRT).

Continuous renal replacement therapy (CRRT) for pediatric patients is an extremely specialized therapy requiring knowledge of the patient's diagnosis, understanding of the principles of the therapy, astute patient assessment, and proficiency with complicated equipment. The complexity of CRRT is compounded by its relatively rare occurrence, in the pediatric population. Maintaining staff competency with this high-risk/low-volume therapy is extremely difficult. This article discusses the development and implementation of a structured system and set of resources to support routine education, and the development of two online, interactive learning modules to provide additional exposure to GRRT throughout the year. The modules are an efficient, effective, and inexpensive way to provide additional education and information to large groups of staff.

[The impact of continuous renal replacement therapy training on nursing competence]. / Impact d'une formation en épuration extrarénale continue sur la compétence infirmière.

Specific training adapted to the needs of caregivers in intensive care enables professional competence and quality of care to be developed in continuous renal replacement therapy. In addition, it contributes to reducing the stress felt by caregivers and the costs of this technique.

Using High-Fidelity Simulation to Assess Knowledge, Skills, and Attitudes in Nurses Performing CRRT.

Continuous renal replacement therapy (CRRT) is an acute therapy for critically ill patients. There are many life-threatening complications that can occur; therefore, it is imperative that nurses are highly trained in the use and troubleshooting of CRRT. A structured simulation exercise was added to an existing CRRT education program by developing and implementing an annual assessment of knowledge, skills, and attitudes (KSAs) using high-fidelity simulation. The use of high-fidelity simulation as an intervention during annual evaluation of KSAs was shown to be effective in increasing nurse satisfaction, understanding of CRRT principles, and critical thinking skills with the operation of CRRT.

Continuing education: preparing patients to choose a renal replacement therapy.

BACKGROUND: Patients with progressive chronic kidney disease face a series of treatment decisions that will impact the quality of life of themselves and their family. Renal replacement therapy option education (RRTOE), generally provided by nurses, is recommended by international guidelines OBJECTIVES: To provide nurses with advice and guidance on running RRTOE. DESIGN: A consensus conference. PARTICIPANTS: Four nurses, 5 nephrologists and 1 clinical psychologist (9 renal units; 6 European countries) from units that had extensive experience in RRTOE or were performing research in this field. APPROACH: Experts brainstormed and discussed quality standards for the education team, processes, content/topics, media/material/funding and quality measurements for RRTOE. RESULTS: Conclusions and recommendations from these discussions that are particularly pertinent to nurses are presented in this paper. CONCLUSIONS: Through careful planning and smooth interdisciplinary cooperation, it is possible to implement an education and support programme that helps patients choose a form of RRT that is most suited to their needs. This may result in benefits in quality of life and clinical outcomes. APPLICATION TO PRACTICE: There are large differences between renal units in terms of resources available and the demographics of the catchment area. Therefore, nurses should carefully consider how best to adapt the advice offered here to their own situation. Throughout this process, it is crucial to keep in mind the ultimate goal - providing patients with the knowledge and skill to make a modality choice that will enhance their quality of life to the greatest degree.

Early mobility activities during continuous renal replacement therapy.

Continuous renal replacement therapy (CRRT) is a therapeutic technique used to support critically ill patients with acute renal failure in intensive care units. CRRT is preferred over hemodialysis for patients who cannot tolerate the rapid fluid and electrolyte shifts associated with hemodialysis because of their tenuous hemodynamic state. Traditionally, such patients have not been candidates for mobilization and have remained on strict bed rest. Mobilization is now being initiated on patients undergoing CRRT in intensive care units. This case study chronicles the successful mobilization of a patient undergoing CRRT. This experience suggests that CRRT patients who are appropriate candidates may be mobilized safely and therefore should not automatically be excluded from mobilization therapies.

[Psychological experiences and coping strategies of children and adolescents with chronic kidney disease on renal replacement therapy]. / Psychische Belastungen und Coping- Strategien von niereninsuffizienten Kindern und Jugendlichen unter Nierenersatztherapie.

Children, adolescents and young adults with end-stage renal disease need a renal replacement therapy (dialysis) or a renal transplant to survive. The dialysis is related to a very complex care, which includes invasive and painful procedures. Chronic diseases have a strong influence not only on the physical but also on the psychological development of children and adolescents. The most important psychological consequences include social isolation, differences in body image, limited lifestyle, as well as the changed personal relationships with family and friends. Therefore, caregivers should also have knowledge about the psychological consequences, being able to provide adequate help and support to children, adolescents and young adults.

Self-management programmes in stages 1-4 chronic kidney disease: a literature review.

BACKGROUND: Chronic kidney disease (CKD) is a complex health problem, which requires individuals to invest considerable time and energy in managing their health and adhering to multifaceted treatment regimens. OBJECTIVES: To review studies delivering self-management interventions to people with CKD (Stages 1-4) and assess whether these interventions improve patient outcomes. DESIGN: Systematic review. METHODS: Nine electronic databases (MedLine, CINAHL, EMBASE, ProQuest Health & Medical Complete, ProQuest Nursing & Allied Health, The Cochrane Library, The Joanna Briggs Institute EBP Database, Web of Science and PsycINFO) were searched using relevant terms for papers published between January 2003 and February 2013. RESULTS: The search strategy identified 2,051 papers, of which 34 were retrieved in full with only 5 studies involving 274 patients meeting the inclusion criteria. Three studies were randomised controlled trials, a variety of methods were used to measure outcomes, and four studies included a nurse on the self-management intervention team. There was little consistency in the delivery, intensity, duration and format of the self-management programmes. There is some evidence that knowledge- and health-related quality of life improved. Generally, small effects were observed for levels of adherence and progression of CKD according to physiologic measures. CONCLUSION: The effectiveness of self-management programmes in CKD (Stages 1-4) cannot be conclusively ascertained, and further research is required. It is desirable that individuals with CKD are supported to effectively self-manage day-to-day aspects of their health.

Comparison of circuit patency and exchange rates between 2 different continuous renal replacement therapy machines.

BACKGROUND: Continuous renal replacement therapy (CRRT) is an important tool in the care of critically ill patients. However, the impact of a specific CRRT machine type on the successful delivery of CRRT is unclear. The purpose of this study was to evaluate the effectiveness of CRRT delivery with an intensive care unit (ICU) bedside nurse delivery model for CRRT while comparing circuit patency and circuit exchange rates in 2 Food and Drug Administration-approved CRRT devices. This article presents the data comparing circuit exchange rates for 2 different CRRT machines. MATERIALS AND METHODS: A group of ICU nurses were selected to undergo expanded training in CRRT operation and empowered to deliver all aspects of CRRT. The ICU nurses then provided all aspects of CRRT on 2 Food and Drug Administration-approved CRRT devices for 6 months. Each device was used exclusively in the designated ICU for a 2-week run-in period followed by 3-month data collection period. The primary end point for the study was the differences in average number of filter exchanges per day during each CRRT event. RESULTS: A total of 45 unique patients who underwent 64 separate CRRT treatment periods were included. Four CRRT events were excluded (see text for details). Twenty-eight CRRT events occurred in the NxStage System One arm (NxStage Medical, Lawrence, Mass) and 32 events in the Gambro Prismaflex arm (Gambro Renal Products, Boulder, Colo). Average (SD) filter exchanges per day was 0.443 (0.60) for the NxStage System One machine and 0.553 (0.65) for Gambro Prismaflex machine (P = .09). CONCLUSIONS: There was no demonstrable difference in circuit patency as defined by the rate of filter exchanges per day of CRRT therapy.

Descripción de la calidad de vida percibida en pacientes con insuficiencia renal crónica en tres modalidades de tratamiento sustitutivo renal, en el estado de Guanajuato / Description of the perceived quality of life in patients with chronic renal failure in three modes of renal replacement therapy in the state of Guanajuato, México", "_i": "

Introducción: La evaluación de la calidad de vida del paciente representa un impacto percibido que una enfermedad y su consecuente tratamiento tienen en el bienestar del mismo. Objetivo: Describir la calidad de vida percibida por los pacientes con insuficiencia renal crónica en etapa avanzada y en tres modalidades de tratamiento sustitutivo renal. Material y métodos: Es un estudio descriptivo transversal de 30 pacientes adultos, en tres modalidades diferentes de tratamiento sustitutivo renal, tratados en una clínica del estado de Guanajuato. Se utilizó el cuestionario SF-36 para medición subjetiva de calidad de vida en ocho diferentes dominios y PASW statistics 18 para el análisis estadístico. Resultados: En la escala del 1 al 100 los pacientes reportaron los puntajes: función física 37.6, rol físico 35.8, dolor corporal 64.7, salud general 58.5, vitalidad 59, función social 86.7, rol emocional 68.9 y salud mental 77.2. Se observa una tendencia a percibir una mejor calidad de vida en diálisis peritoneal automatizada, que con la diálisis peritoneal continúa ambulatoria y hemodiálisis. Conclusión: La calidad de vida del paciente en diálisis se reporta afectada principalmente en su función física. Conocer el estado general de la salud que el paciente percibe, informa sobre la eficacia del tratamiento y proporciona una guía para diseñar estrategias de cuidado de enfermería con enfoque holístico.

Introduction: Quality of life assessment represents the perceived impact of the disease and the consequent treatment on patient wellness. Objective: To describe the quality of life perceived by patients with end stage renal disease. Material and methods: This is a cross-sectional descriptive study on 30 adult patients in three different renal replacement therapies attending to a dialysis clinic located in Guanajuato state. SF-36 questionnaire was used to measure quality of life through eight different domains. PASW statistics 18 was used for statistical analysis. Results: In a 1 to 100 scale, the scores per domain were: physical function 37.6, physical role 35.8, pain 64.7, general health 58.5, vitality 59, social function 86.7, emotional role 68.9 and mental health 77.2. There is a trend to perceive a better quality of life in automated peritoneal dialysis compared with continued ambulatory peritoneal dialysis and hemodialysis. Conclusion: The quality of life from renal disease patients was most affected with respect to physical function. To know the perceived general health status of patients reported on the effectiveness of treatment and provides guidance for designing strategies for nursing care with a holistic approach.

Comparación del nivel de cumplimiento del proceso de hemodiafiltración en línea posterior a un programa de capacitación / Comparison of the compliance level in the process of online hemofiltration after a training program", "_i": "

Introducción: Dada la importancia del tratamiento de hemodiafiltración en línea es necesario estandarizar la eficiencia del procedimiento realizado por el personal de enfermería e implementar, cuando sea necesario, acciones para mejorar la calidad de atención. Objetivo: Comparar las escalas de cumplimiento del procedimiento HDFL antes y después de un programa de capacitación. Material y métodos: Estudio comparativo, prospectivo y longitudinal desde mayo del 2008 a octubre del 2011. Muestra por conveniencia de 60 procedimientos realizados por profesionales de enfermería. Se diseñó una cédula de auditoría con 23 elementos con respuestas dicotómicas, otorgando 0 al procedimiento realizado parcialmente o no aplicado y de 1 a 3 a la actividad realizada al 100%. Se determinaron las escalas de cumplimiento de la siguiente manera: 91 a 100% nivel de excelencia, 85-90% significativo, entre 75 y 84% cumplimiento mínimo y menor de 70% nivel de no cumplimiento. Se analizaron los datos con frecuencias, porcentajes, asociación de Pearson (categoría laboral), t de Student (turno y años) y ANOVA de una vía para categoría laboral, considerándose estadísticamente significativo p ‹ 0.05. Resultados: El índice de cumplimiento antes y después de la capacitación fue de excelencia (97.15 ± 2.70 versus 97.70± 2.4) sin ser estadísticamente significativa (t = 0.840, gl = 58, p = 0.404). Las enfermeras generales tienen el mejor índice de cumplimiento. Conclusiones: A pesar de obtener índice global de excelencia, existen oportunidades de mejora, lo que demuestra que se tiene que reforzar el procedimiento en actividades donde se obtuvieron puntuaciones bajas.

Introduction: Given the importance of the treatment of hemodiafiltration on-line it is necessary to have a standard that assess the efficiency of the process carried out by nursing and allow, if necessary, implement improvement actions focused on raising the quality of care. Objective: To compare the level of compliance of the HDFL process before and after a training program. Material and methods: longitudinal, prospective and comparative study of May 2008 to October 2011. Displays for convenience of 60 procedures performed by nurses. A certificate of audit was designed with 23 items with dichotomous responses, giving 0 to the procedure carried out partially or not implemented, and 1 to 3 to the activity carried out at 100%. The level was determined in accordance with the following scale: 91 to 100% level of excellence; 85-90%, significant; between 75 and 84%, minimum compliance; and less than 70%, level of non-compliance. We analysed the data frequencies, percentages, Pearson (labour category) Association, (turn to years) Student’s t and ANOVA of a pathway for category work, statistically significant p < 0.05. Results: The level of compliance before and after the training was excellent (97. 15 + 2. 70 versus 97. 70 + 2. 4) without being statistically significant (t = 0.840, gl = 58, p = 0.404). General nurses who have a better level of compliance. Conclusions: Despite get global index of excellence, there are opportunities for improvement, which shows that you have to strengthen the procedure in activities where low scores were obtained.

[Update in continuous renal replacement techniques]. / Actualización en técnicas continuas de reemplazo renal.

Acute renal failure affects 25% of patients hospitalized in intensive care units. Despite technological advances, the mortality of these patients is still high due to its associated complications. Continuous renal replacement techniques are one of the treatments for acute renal failure because they make it possible to treat the complications and decrease mortality. The nurse's knowledge and skills regarding these techniques will be decisive for the success of the therapy. Consequently, the nurse's experience and training are key components. The objective of this article is to update the knowledge on continuous renal replacement techniques. Keeping this in mind, a review has been made of the physical and chemical principles such as diffusion and convection, among others. A description of the different continuous renal replacement techniques, a presentation of the main vascular access, and a description of the nursing cares and complications related to techniques used have also been provided.

Diagnósticos de enfermagem em paciente submetido à terapia de reposição renal contínua / Nursing diagnoses in paqtient who received continuous renal replacement therapy

A insuficiência renal aguda é uma complicação freqüente em pacientes críticos, sendo a terapia de reposição renal continua o método de tratamento mais usado nesta população, com uma taxa de utilização de 80%. Este método exige do enfermeiro conhecimento e habilidades para o raciocínio clinico, sendo fundamental a aplicação dos diagnósticos de enfermagem para a definição de condutas. Objetivo: Identificar diagnósticos de enfermagem mais freqüentes em um paciente submetido à este tratamento. Método: Relato de caso de um paciente com diagnóstico de insuficiência renal aguda após internação na unidade de terapia intensiva e em uso de terapia de reposição renal contínua. Os diagnósticos de enfermagem foram elencados diariamente por meio de dados do prontuário durante os dias do tratamento. Resultados: Foram identificados 7 diagnósticos, sendo que destes, 6 obtiveram uma freqüência de 100% e apenas 1 obteve uma freqüência de 50%. Os diagnósticos identificados foram perfusão tissular renal ineficaz, volume de líquidos excessivo, proteção ineficaz, débito cardíaco diminuído, risco de integridade da pele prejudicada, risco para infecção e termorregulação ineficaz. Conclusão: Os diagnósticos encontrados coincidem com outros estudos de pacientes em tratamento de diálise intermitente e estão relacionados aos eventos desencadeados por este tratamento.

Pre- and post-transplant care: nursing management of the renal transplant recipient: part 2.

This is the second article in a three part continuing education series on renal transplantation which addresses the specialised knowledge and skills required in order to prepare a patient admitted to hospital for renal transplantation and then how to care for that patient afterwards. The first article in this series addressed patient health and well-being while waiting for a renal transplant. The third article will look at the long-term care of kidney recipients.

Nursing issues in renal replacement therapy: organization, manpower assessment, competency evaluation and quality improvement processes.

For the patient with acute kidney injury, continuous renal replacement therapy (CRRT) is a treatment option that has application for the hemodynamically unstable critically ill patient. The decision to initiate a continuous renal replacement modality depends not only on the physician, either the nephrologist or intensivist, but also on the availability of specially trained nursing resources. This article will explore the nursing collaborative model of care at a large university-based research and teaching Medical Center in Southern California. The focus will be on nursing issues in CRRT including organization of educational programs, manpower assessment, competency evaluation, and quality improvement processes.