Coping with Intradialytic Events and Stress Associated with Hemodialysis.

Intradialytic events (IDEs), such as cramping, loss of consciousness, bleeding, and allergic reactions, are major stressors for persons on hemodialysis (HD). This study examined the association between coping strategies and stress associated with HD in persons who have experienced an IDE. Using a cross-sectional correlation design, a convenience sample of patients (N=73) completed a Hemodialysis Demographic Form, Ways of Coping Questionnaire, and a Hemodialysis Stress Visual Analog Scale. Most participants were African American (95%), male (52%), with a mean age of 57 (SD=11.98) years, and an average of 41 (SD=31.55) months on HD. Coping strategies explained 34% of the variance in stress associated with HD (F [11, 61] = 2.89; p=0.004); positive reappraisal and planful problem solving were negatively correlated with stress. Emotion-focused coping strategies were used most during an IDE.

Efficacy of cinacalcet with low-dose vitamin D in incident haemodialysis subjects with secondary hyperparathyroidism.

BACKGROUND: Treatment with cinacalcet improves the control of secondary hyperparathyroidism (SHPT) and the achievement of calcium and phosphorus targets. Most data come from subjects receiving cinacalcet after several years of dialysis treatment. We therefore compared the efficacy of treatment with cinacalcet and low doses of active vitamin D to flexible doses of active vitamin D alone for the management of SHPT in patients recently initiating haemodialysis. METHODS: This open-label trial randomized subjects (n = 309) with parathyroid hormone (PTH) >300 pg/mL on dialysis for 3-12 months to either cinacalcet with low-dose active vitamin D, if prescribed (cinacalcet); or usual care without cinacalcet (control). Randomized subjects were stratified by PTH at screening (300-450, >450-600, >600 pg/mL) and by the use of active vitamin D at enrolment. Treatment duration was 12 months, with primary efficacy endpoint (mean PTH reduction ≥ 30% from baseline) assessed at 6 months. RESULTS: The mean [standard deviation (SD)] haemodialysis vintage at enrolment was 7.2 (2.7) months; 53% of subjects were not receiving active vitamin D at enrolment. There was a significant difference in the achievement of the primary endpoint (≥ 30% PTH reduction at 6 months) between cinacalcet-treated subjects and controls in both the entire cohort (63 versus 38%; n = 304; P < 0.0001) and the subgroup of subjects not receiving active vitamin D at enrolment (70 versus 44%; n = 161; P < 0.01). Hypocalcaemia and gastrointestinal adverse events were more commonly observed in cinacalcet-treated subjects. CONCLUSIONS: These results indicate that cinacalcet with low-dose active vitamin D, if prescribed, provides a more effective treatment approach than usual care without cinacalcet for SHPT in incident haemodialysis patients, even in relatively treatment-naive patients.

Web-based nephropathology teaching modules and user satisfaction: the nephrology on-demand experience.

Nephropathology is an integral component of nephrology education. Online teaching sites provide valuable educational materials to learners, but learner satisfaction has not been measured. We developed a nephropathology website and measured learners' satisfaction. The Nephrology On-Demand Histopathology website (http://blog.ecu.edu/sites/nephrologyondemand/?page_id=4502) provided nephropathologic specimens with explanations. Users were asked to complete a Likert-based survey (1-strongly agree . . . 5-strongly disagree) regarding four key areas of content quality: accuracy, currency, objectivity, and usefulness. Learners of all training levels perceived the content quality favorably. The mean (±SD) for accuracy was 1.70 (0.89), currency 1.62 (0.90), objectivity 1.80 (1.01), and usefulness 1.72 (0.95). Nephrology On-Demand Histopathology is a well-received teaching tool to learners of all training levels. Educators may consider using it, as well as other online nephropathology sites, as adjunctive teaching tools.

Platelet adhesion testing may predict early hemodialysis arteriovenous graft and fistula failure in end-stage renal disease patients.

Vascular access thrombosis (VAT) is the most morbid and costly complication in end-stage renal disease (ESRD) patients. Although hypercoagulability is a major risk factor for VAT, in most patients, the cause of hypercoagulability cannot be identified despite clinical suspicion. In this study, platelet hyperreactivity was investigated for a possible role in the hypercoagulability of ESRD and VAT in 42 patients with arteriovenous (AV) grafts or fistulas. Platelet adhesion, platelet aggregation, and the history of VAT were assessed. The statistics included a nonparametric 2-factor ANOVA, a Mann-Whitney analysis, and a Kaplan-Meier analysis of hemodialysis angioaccess survival to examine platelet hyperadhesiveness as a predictor of access survival. The study showed a significant correlation between increased platelet adhesiveness and shortened survival of the primary hemodialysis angioaccess. Collagen-induced platelet aggregation reflected a significantly higher response in those with shortened access survival. These findings may have significant clinical implications for risk assessment and prevention of VAT.

Validation of a dietary intake tool for african-american dialysis patients with low literacy.

BACKGROUND: This study analysed the validity and reliability of a food frequency questionnaire designed for African-American patients with low literacy. This instrument was designed specifically to meet the need for a tool that was short, easy to understand, and met clinical reliability and validity standards. OBJECTIVES: Assessing patient nutritional status and dietary intake is crucial to the care of patients in end stage kidney disease. The development of a quick and reliable nutritional assessment tool for patients with low literacy could increase nutritional counselling effectiveness and improve patient outcomes. DESIGN: The renal food frequency questionnaire (RFF) and a standard 24-hour recall were administered to a general population of African-American patients undergoing dialysis. Registered Dieticians and statistical analyses were used to validate the content and structural validity and reliability of the RFF to adequately measure dietary intake. PARTICIPANTS: The study sample consisted of 30 African-American patients who received dialysis treatment at a regional teaching hospital facility. RESULTS: The RFF was found to be a simple, easy to understand instrument with low reading complexity (grade level 4.4). Inter-rater reliability was found to be high (.81-1.00), and statistical analysis determined a high level of clinical validity. CONCLUSION: The RFF was found to be a valid dietary recall tool that is appropriate for patients with limited literacy. It was found to have acceptable reliability and validity when compared with a standard 24-hour recall and has potential for use as a dietary intake and monitoring tool in patients undergoing dialysis.

Assessing a nephrology-focused YouTube channel's potential to educate health care providers.

INTRODUCTION: YouTube has emerged as a potential teaching tool. Studies of the teaching potential of YouTube videos have not addressed health care provider (HCP) satisfaction; a necessary prerequisite for any teaching tool. We conducted a 4-month investigation to determine HCP satisfaction with a nephrology-specific YouTube channel. METHODS: The Nephrology On-Demand YouTube channel was analyzed from January 1 through April 30, 2011. Sixty-minute nephrology lectures at East Carolina University were compressed into 10-minute videos and uploaded to the channel. HCPs were asked to answer a 5-point Likert questionnaire regarding the accuracy, currency, objectivity and usefulness of the digital format of the teaching videos. Means, standard deviations and 2-sided chi-square testing were performed to analyze responses. RESULTS: Over 80% of HCPs considered the YouTube channel to be accurate, current and objective. A similar percentage considered the digital format useful despite the compression of videos and lack of audio. CONCLUSIONS: The nephrology-specific YouTube channel has the potential to educate HCPs of various training backgrounds. Additional studies are required to determine if such specialty-specific channels can improve knowledge acquisition and retention.

Tweeting the meeting: an in-depth analysis of Twitter activity at Kidney Week 2011.

In recent years, the American Society of Nephrology (ASN) has increased its efforts to use its annual conference to inform and educate the public about kidney disease. Social media, including Twitter, has been one method used by the Society to accomplish this goal. Twitter is a popular microblogging service that serves as a potent tool for disseminating information. It allows for short messages (140 characters) to be composed by any author and distributes those messages globally and quickly. The dissemination of information is necessary if Twitter is to be considered a tool that can increase public awareness of kidney disease. We hypothesized that content, citation, and sentiment analyses of tweets generated from Kidney Week 2011 would reveal a large number of educational tweets that were disseminated to the public. An ideal tweet for accomplishing this goal would include three key features: 1) informative content, 2) internal citations, and 3) positive sentiment score. Informative content was found in 29% of messages, greater than that found in a similarly sized medical conference (2011 ADA Conference, 16%). Informative tweets were more likely to be internally, rather than externally, cited (38% versus 22%, p<0.0001), thereby amplifying the original information to an even larger audience. Informative tweets had more negative sentiment scores than uninformative tweets (means -0.162 versus 0.199 respectively, p<0.0001), therefore amplifying a tweet whose content had a negative tone. Our investigation highlights significant areas of promise and improvement in using Twitter to disseminate medical information in nephrology from a scientific conference. This goal is pertinent to many nephrology-focused conferences that wish to increase public awareness of kidney disease.

Understanding the mobile internet to develop the next generation of online medical teaching tools.

Healthcare providers (HCPs) use online medical information for self-directed learning and patient care. Recently, the mobile internet has emerged as a new platform for accessing medical information as it allows mobile devices to access online information in a manner compatible with their restricted storage. We investigated mobile internet usage parameters to direct the future development of mobile internet teaching websites. Nephrology On-Demand Mobile (NOD(M)) (http://www.nephrologyondemand.org) was made accessible to all mobile devices. From February 1 to December 31, 2010, HCP use of NOD(M) was tracked using code inserted into the root files. Nephrology On-Demand received 15,258 visits, of which approximately 10% were made to NOD(M), with the majority coming from the USA. Most access to NOD(M) was through the Apple iOS family of devices and cellular connections were the most frequently used. These findings provide a basis for the future development of mobile nephrology and medical teaching tools.