Are sex differences in the outcome of peritoneal dialysis explained by nurse assistance? A cohort study with data from the Registre de Dialyse Péritonéale de Langue Française.

BACKGROUND: We aimed to evaluate sex differences in peritoneal dialysis (PD) outcomes and to explore direct and indirect effects of nurse-assisted PD on outcomes. METHODS: This was a retrospective study using data from the Registre de Dialyse Péritonéale de Langue Française of incident PD patients between 2005 and 2016. Cox proportional hazards modelling was used to analyse transfer to haemodialysis (HD), death, PD failure, peritonitis and renal transplantation. Mediation analyses with a counterfactual approach were carried out to evaluate natural direct and indirect effects of sex on transfer to HD and peritonitis, with nurse-assisted PD as a mediator a priori. RESULTS: Of the 14 659 patients included, there were 5970 females (41%) and 8689 males (59%). Women were more frequently treated by nurse-assisted PD than men [2926/5970 (49.1%) versus 3357/8689 (38.7%)]. In the multivariable analysis, women had a lower risk of transfer to HD [cause-specific hazard ratio {cs-HR} 0.82 {95% confidence interval (CI) 0.77-0.88}], death [cs-HR 0.90 (95% CI 0.85-0.95)], peritonitis [cs-HR 0.82 (95% CI 0.78-0.87)], PD failure [cs-HR 0.86 (95% CI 0.83-0.90)] and a lower chance of undergoing transplant [cs-HR 0.83 (95% CI 0.77-0.90)] than men. There was a direct effect of sex on the risk of transfer to HD [cs-HR 0.82 (95% CI 0.82-0.83)], with an indirect effect of nurse-assisted PD [cs-HR 0.97 (95% CI 0.96-0.99)]. Nurse-assisted PD had no indirect effect on the risk of peritonitis. CONCLUSIONS: Our results suggest that compared with men, women have a lower risk of both transfer to HD and peritonitis. Mediation analysis showed that nurse assistance was a potential mediator in the causal pathway between sex and transfer to HD.

Nonsurgical and Minimally Invasive Correction of Peritoneal Dialysis Catheter Complications.

Peritoneal dialysis catheter complications that require nonsurgical or noninvasive correction by peritoneal dialysis (PD) nurses or practitioner are reviewed. Topics reviewed include compromised PD fluid flow, pericatheter fluid leakage, mechanical integrity disruption, catheter extrusion, and exit site/tunnel complications.

Assistência de enfermagem em diálise peritoneal: aplicabilidade da teoria de orem - estudo de método misto / Asistencia em enfermería em diálisis peritoneal: aplicabilidad de la teoría de orem - estudio de método mixto / Nursing assistance in peritoneal dialysis: applicability of orem theory -mixed method studya

Resumo Objetivo Compreender a aplicabilidade da Teoria Geral de Enfermagem de Orem na assistência prestada aos pacientes em diálise peritoneal domiciliar. Método Estudo de método misto. Na etapa quantitativa realizou-se uma pesquisa transversal, descritiva e exploratória, com 34 pacientes em diálise peritoneal. Aplicou-se um instrumento para caracterização sociodemográfica e clínica e a escala de avaliação da capacidade para o autocuidado - Appraisal of Self Care Agency Scale Revised. Análise dos dados por estatística descritiva. Na abordagem qualitativa, utilizou-se a Teoria Fundamentada nos Dados. Realizaram-se 23 entrevistas domiciliares com 19 participantes. Análise dos dados seguiu as codificações aberta, axial e seletiva. Resultados Dos participantes, 59% tinham capacidade para o autocuidado operacionalizado. Os pacientes em diálise peritoneal atenderam, em diferentes graus, às seis categorias de requisitos de autocuidado de desvio de saúde para a realização da terapia em domicílio. O apoio e a educação destacaram-se como modalidade de sistema de Enfermagem. Conclusão e implicação para a prática A Teoria Geral de Enfermagem de Orem se aplica na assistência de Enfermagem a pessoas em diálise peritoneal. Sugere-se sua utilização como suporte teórico para o Processo de Enfermagem.

Resumen Objetivo comprender la aplicabilidad de la teoría general de enfermería de Orem para ayudar a los pacientes en diálisis peritoneal en el hogar. Método estudio de método mixto. En la etapa cuantitativa, se realizó un estudio transversal, descriptivo y exploratorio con 34 pacientes en diálisis peritoneal. Se aplicó un instrumento para la caracterización sociodemográfica y clínica y la escala para evaluar la capacidad de autocuidado - Evaluación de la escala de la agencia de autocuidado revisada. Análisis de datos mediante estadística descriptiva. En el enfoque cualitativo, se utilizó la teoría fundamentada. Se realizaron 23 entrevistas domiciliarias con 19 participantes. El análisis de datos siguió una codificación abierta, axial y selectiva. Resultados de los participantes 59% tenían la capacidad de autocuidado operacionalizado. Los pacientes en diálisis peritoneal cumplieron, en diversos grados, las seis categorías de requisitos de autocuidado para la desviación de salud para realizar la terapia en el hogar. El apoyo y la educación se destacaron como una modalidad del sistema de enfermería. Conclusión e implicación para la práctica la teoría general de enfermería de Orem se aplica a los cuidados de enfermería para personas en diálisis peritoneal. Su uso se sugiere como soporte teórico para el Proceso de Enfermería.

Abstract Objective To understand the applicability of Orem's General Nursing Theory in assisting patients on peritoneal dialysis at home. Method Mixed method study. In the quantitative stage, a cross-sectional, descriptive and exploratory study was carried out with 34 patients on peritoneal dialysis. An instrument was applied for sociodemographic and clinical characterization and the scale for assessing the capacity for self-care - Appraisal of Self Care Agency Scale Revised. Analysis of data using descriptive statistics. In the qualitative approach, Grounded Theory was used. 23 home interviews were conducted with 19 participants. Data analysis followed open, axial and selective coding. Results 59% of the participants had the capacity for operationalized self-care. Patients on peritoneal dialysis met, to varying degrees, the six categories of self-care requirements for health deviation to perform therapy at home. Support and education stood out as a modality of the Nursing system. Conclusion and implication for practice Orem's General Nursing Theory applies to nursing care for people on peritoneal dialysis. Its use is suggested as a theoretical support for the Nursing Process.

Efficacy of Omaha system-based nursing management on nutritional status in patients undergoing peritoneal dialysis: A randomized controlled trial protocol.

ABSTRACT: The chronic kidney disease (CKD) patients may have a variety of complications during receiving peritoneal dialysis (PD). The malnutrition in CKD patients is related to their lower life quality, higher hospitalization rates, and higher risk of cardiovascular disease, as well as the increased morbidity and mortality. Hence, it is very important to monitor and then manage the nutritional status of CKD patients. Thus, we perform this randomized controlled study protocol to introduce a continuing nursing program based on Omaha system (OS) for the patients with CKD receiving PD treatment.The randomized trial will be implemented from November 2020 to May 2021 and was granted through the Research Ethics Committee of Wuhan No.1 Hospital (2020003281). Two hundred patients meet inclusion criteria and exclusion criteria are included.Patients who meet the following criteria will be selected: voluntary participation, aged 20 to 60; undergoing the regular PD treatment for at least 3 months. Patients will be excluded if the patients are in unstable status, or experience the intermittent PD or some other kinds of dialysis mode, have severe cachexia, infection, or malnutrition, or if they have mental disorders. In control group, patients are given routine treatment, containing general guidance associated with PD and the outpatient telephone calls from the clinical nurses during follow-up. In study group, the patients are given the continuous nursing treatment scheme based on OS. The clinical results are the biochemical parameters after intervention, anthropometry, as well as the subjective global assessment.Table 1 reveals the clinical endpoints between the 2 groups.This protocol can guide nurses to develop a nursing program based on evidence for patients with CKD receiving PD. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6202).

Conhecimento e Atitude: perfil de pessoas com diabetes em diálise / Knowledge and attitude: profile of diabetics in dialysis / Conocimiento y actitud: perfil de personas con diabetes en diálisis

Objetivo: identificar o conhecimento e o enfrentamento do diabetes junto a pessoas com diabetes em diálise. Método: estudo transversal, realizado com pacientes com diabetes tipo 2. Os instrumentos utilizados foram o Diabetes Knowledge Scale Questionnaire (DKN-A) e o Diabetes Attitude Questionnaire (ATT-19). Resultados: participaram 71 pacientes, com idade média de 61,81±14,93 anos. A retinopatia diabética foi a complicação prevalente (81,69%); hipertensão arterial sistêmica foi a comorbidade (83,09%). A glicemia em jejum apresentou mediana de 152 (124-228,5) mg/dl e a hemoglobina glicada de 7,5 (6,42-8,27) mg/dl. O DKN-A apresentou escore médio de 7,84±2,55 pontos; seu item com maior número de acertos foi a conduta em caso de hipoglicemia; enquanto o com menor número de acertos foi em relação à cetonúria e substituições alimentares. O instrumento ATT-19 obteve média de 50,26±11,7 pontos. Conclusão: pessoas com diabetes, em diálise, apresentam conhecimento deficiente em relação ao diabetes, assim como baixo enfrentamento da doença.

Objective: to identify knowledge of, and coping with, diabetes mellitus among diabetics undergoing dialysis. Method: in this cross-sectional study of patients with type 2 diabetes, the instruments used were the Diabetes Knowledge Scale Questionnaire (DKN-A) and Diabetes Attitude Questionnaire (ATT-19). Results: mean age of the 71 participants was 61.81 ± 14.93 years. The most prevalent complication was diabetic retinopathy (81.69%), and the most prevalent comorbidity was systemic arterial hypertension (83.09%). Median fasting glycemia and glycated hemoglobin were 152 (124-228.5) mg/dl and 7,5 (6,42-8,27) mg/dl, respectively. Average DKN-A score was 7.84 ± 2.55; the highest success rate was on how to respond to hypoglycemia; the lowest was about ketones in urine and substitute foods. Mean ATT-19 score was 50.26 ± 11.7. Conclusion: the diabetics in dialysis showed deficient knowledge of diabetes and had negative attitudes to the disease.

Objetivo: identificar el conocimiento y el afrontamiento de la diabetes mellitus entre los diabéticos en diálisis. Método: en este estudio transversal de pacientes con diabetes tipo 2, los instrumentos utilizados fueron el Diabetes Knowledge Scale Questionnaire (DKN-A) y Diabetes Attitude Questionnaire (ATT-19). Resultados: la edad media de los 71 participantes fue de 61,81 ± 14,93 años. La complicación más prevalente fue la retinopatía diabética (81,69%) y la comorbilidad más prevalente fue la hipertensión arterial sistémica (83,09%). La mediana de la glucemia en ayunas y la hemoglobina glucosilada fueron 152 (124- 228,5) mg / dl y 7,5 (6,42-8,27) mg / dl, respectivamente. La puntuación promedio de DKN-A fue de 7,84 ± 2,55; la tasa de éxito más alta fue sobre cómo responder a la hipoglucemia; el más bajo fue sobre las cetonas en la orina y los alimentos sustitutos. La puntuación media de ATT-19 fue 50,26 ± 11,7. Conclusión: los diabéticos en diálisis mostraban un conocimiento deficiente de la diabetes y actitudes negativas hacia la enfermedad.

Informe de un caso de diálisis peritoneal no asistida en personas con déficit visual grave: ¿Es posible? / Report of a case of unassisted peritoneal dialysis in people with severe visual impairment: is it possible?

DESCRIPCIÓN DEL CASO: Presentamos un informe de un caso sobre entrenamiento en diálisis peritoneal automatizada no asistida en una paciente con una deficiencia visual adquirida grave, cuya pérdida de visión se produjo de forma rápida y progresiva una vez elegida la técnica dialítica. DESCRIPCIÓN DEL PLAN DE CUIDADOS: Se identificaron 5 diagnósticos enfermeros: Conocimientos deficientes: Tratamiento, dieta, higiene en Diálisis Peritoneal; disposición para mejorar el manejo del régimen terapéutico; trastorno de la percepción sensorial visual y auditiva; riesgo de cansancio en el desempeño del rol cuidador; temor y riesgo de infección. Se diseñó un plan de cuidados que incluía un plan de entrenamiento adaptado. EVALUACIÓN DEL PLAN: se logró un adecuado manejo de la técnica y de los problemas detectados, con un cambio positivo en todos los NOC establecidos en el plan: Conocimiento: Procedimientos terapéuticos; Preparación para el alta: Vida independiente; Conducta de cumplimiento; Orientación cognitiva; Conducta de compensación auditiva y visual; Bienestar del cuidador familiar; Conocimiento: Conductas sanitarias; Control del miedo; Integridad del acceso de DP y Control del riesgo. CONCLUSIONES: En nuestra experiencia, la diálisis peritoneal con un entrenamiento dirigido constituye una opción de tratamiento renal sustitutivo eficaz y seguro para personas con deficiencia visual o ceguera. La suma de pequeñas contribuciones nos permitirá aunar esfuerzos que nos ayuden a estandarizar protocolos para la capacitación de pacientes en situaciones especiales

CASE DESCRIPTION: A case report on unassisted automated peritoneal dialysis training in a patient with a severe acquired visual impairment is presented. Loss of vision occurred rapidly and progressively once the dialysis technique was chosen. DESCRIPTION OF THE CARE PLAN: Five nursing diagnoses were identified: Deficient knowledge: Treatment, diet, hygiene in Peritoneal Dialysis; willingness to improve the management of the therapeutic regimen; visual and auditory sensory perception disorder; risk of fatigue in the performance of the caregiver role; fear and risk of infection. A care plan that included an adapted training plan was designed. EVALUATION OF THE PLAN: An adequate management of the technique and the problems detected was achieved, achieving a positive change in all the NOCs established in the plan: Knowledge: Therapeutic procedures; Preparation for discharge: Independent living; Compliance behavior; Cognitive orientation; Hearing and visual compensation behavior; Well-being of the family caregiver; Knowledge: Health behaviors; Control of fear; Integrity of the peritoneal dialysis access and Risk control. CONCLUSIONS: In our experience, peritoneal dialysis with targeted training constitutes an effective and safe renal replacement treatment option for people with visual impairment or blindness. The sum of small contributions will allow us to join forces that will help standardize protocols for the training of patients in special situations

Knowledge Acquisition: What Do Our Patients Receiving Peritoneal Dialysis Really Know about Albumin Consumption?

Patients receiving peritoneal dialysis historically have difficulty keeping albumin and phosphorus levels within therapeutic ranges on a consistent basis. The purpose of this quantitative study was to assess if patients receiving peritoneal dialysis had a working nutritional knowledge related to albumin levels and to determine if increasing egg consumption would result in an increase of albumin levels. This study was conducted using a prospective quantitative pre-test/post-test knowledge test and assessing the recorded pre-albumin and pre-phosphorus lab values from the electronic medical record, which are drawn each month, and compare them over a one-month period. A convenience sample collection was conducted among 30 adult individuals receiving peritoneal dialysis. Findings in this study suggest that education continues to be a key component for positive outcomes for this patient population.

The Peritoneal Dialysis Transfer Set Replacement Procedure.

Peritoneal dialysis transfer sets (extension lines) are replaced every six to nine months to minimize peritoneal dialysis catheter complications. The aim of this study was to compare a revised non-bag transfer set exchange procedure with the standard bag exchange procedure on nursing time, costs, and safety. Thirty-three people were randomized to two groups - a standard bag exchange procedure group (n = 16) and a non-bag transfer set exchange procedure group (n = 17). The standard bag exchange procedure took a median of 32 minutes (interquartile range [IQR] 25 to 38 minutes) compared to the non-bag transfer set exchange procedure of 6 minutes (IQR 4 to 8 minutes) (p Ò 0.0001). There was one episode of peritonitis in each group within the 72-hour follow-up period. The average cost of the non-bag transfer set exchange procedure was $24.54 lower, a 37% cost reduction. This study has shown the revised non-bag transfer set replacement procedure appears to be safe, consume less participant and staff time, and decreases costs.

Intervención de enfermería para disminuir la depresión en pacientes con diálisis peritoneal en un hospital de Veracruz / Nursing intervention to reduce depression in patients with peritoneal dialysis in a Veracruz hospital

Introducción: la depresión en personas con enfermedad renal crónica (ERC) tiene efectos en el cumplimiento y aceptación del régimen terapéutico empleado. Objetivo: evaluar la eficacia de una intervención psicoeducativa de enfermería en la disminución de los síntomas de depresión en pacientes adscritos al Programa de Diálisis Peritoneal del Hospital General de Zona No.32 de Minatitlán, Veracruz. Metodología: estudio cuasi experimental; la muestra se integró con 8 pacientes y el muestreo se estableció por conveniencia. Se utilizó el inventario de depresión de Beck II y se aplicó una intervención de enfermería. Resultados: participaron más mujeres (75%), con 50% que utiliza DPA y 50% DPCA. La depresión mínima (37.5%) y la depresión leve (37.5%) predominaron antes de la intervención; luego de la intervención predominó el grado de depresión mínima (87.5%). La media fue de 14.88 en la prueba preliminar y 5.88 en la posterior (p = 0.007). Conclusiones: la intervención de enfermería mostró eficacia al disminuir los grados de depresión en los pacientes con ERC.

Introduction: Depression in a person with chronic kidney disease (CKD), has an impact on the fulfillment and acceptance of the therapeutic regimen used. Objective: To evaluate the efficacy of a psychoeducational nursing intervention to reduce depression symptoms in patients assigned to the peritoneal dialysis program of the General Hospital of Zone No.32 of Minatitlán, Ver. Methods: Quasi-experimental, study. Sample was 8 patients. Sampling was by Convenience. The Beck-II Depression Inventory was used; a nursing psychoeducational intervention was applied. Results: Most of the participants were women (75%); 50% uses DPA and 50% DPCA. Minimum depression (37.5%) and mild depression (37.5%) predominated before the intervention; after intervention, the minimum depression level predominated (87.5%). The average in the Pretest was 14.88 and 5.88 in the Posttest (p = .007). Conclusion: The nursing psychoeducational intervention showed efficacy to decrease depression levels in the group of CKD patients studied.

Las experiencias de incertidumbre de jóvenes mexicanos en tratamiento de diálisis peritoneal / Uncertainty experiences of young Mexicans in peritoneal dialysis treatment

OBJETIVO: Describir las experiencias de incertidumbre de jóvenes con insuficiencia renal que viven en tratamiento dialítico. MATERIAL Y MÉTODO: Estudio etnográfico en Guadalajara, México. Participaron 12 jóvenes con insuficiencia renal y en diálisis peritoneal. Se realizaron entrevistas narrativas y observación participante. Se hizo análisis hermenéutico. RESULTADOS: Se identificaron dos modalidades de incertidumbre, la personal y la médica. Las fuentes de la personal fueron los cambios corporales, la reconfiguración identitaria y de roles, la falta de recursos materiales y al pensar en los proyectos a futuro. Las fuentes de la médica fueron falta de información, el inicio y el manejo del tratamiento y el progreso de la enfermedad. CONCLUSIONES: La incertidumbre se vuelve una constante en sus vidas y su manejo se ve influenciado por los recursos materiales y los apoyos sociales que reciben

OBJECTIVE: To describe the uncertainty experiences of young people with renal failure with dialysis treatment. MATERIAL AND METHOD: Ethnographic study in Guadalajara, Mexico. Twelve young people with renal failure and on peritoneal dialysis participated. Narrative interviews and participant observation were conducted. Hermeneutical analysis was performed. RESULTS: Two types of uncertainty were identified: personal and medical. The sources of personal uncertainty were bodily changes, identity and role reconfiguration, lack of material resources and when thinking about future projects. The sources of medical uncertainty were lack of information, the initiation and management of treatment, and the progress of the disease. CONCLUSIONS: Uncertainty becomes a constant in the patients' lives and management is influenced by the material resources and social supports they receive

Análisis de fragilidad y riesgo de peritonitis en pacientes ancianos en diálisis peritoneal / Analysis of fragility and risk of peritonitis in elderly patients on peritoneal dialysis

INTRODUCCIÓN: Los pacientes ancianos en diálisis peritoneal tienen mayor riesgo de presentar fragilidad, pérdida de autonomía, comorbilidad y disminución de calidad de vida. OBJETIVO: evaluar la fragilidad, dependencia, depresión y calidad de vida, analizando la repercusión de la fragilidad sobre el tiempo de aprendizaje de la técnica y la aparición del primer episodio de peritonitis. MATERIAL Y MÉTODO: estudio descriptivo retrospectivo. Se incluyeron pacientes mayores de 70 años, desde septiembre 2016 a 2017, las peritonitis hasta final de 2018. Se estudiaron variables demográficas, modalidad dialítica, índices de Charlson, Barthel y escala de depresión de Yesavage Escala de fragilidad clínica, calidad de vida, tiempo de entrenamiento y primera peritonitis. RESULTADOS: Se incluyeron 25 pacientes, 56% hombres, edad media 76,77±5,34 años, el 72% estaban en diálisis peritoneal manual. La media del Charlson 7,88±2,06, del Barthel 88,27±24,66 y del Short form 12 health survey 32,96±8,61. El 40% tenían algún grado de fragilidad, 24% depresión, el 28% precisaban ayuda o estaban institucionalizados. Tiempo medio de entrenamiento en pacientes frágiles fue 16,77±7,93 horas vs no frágiles 15,20±5,06 (p = 0,42). Se recogieron 16 episodios de peritonitis, repartidos al 50%, tiempo medio de aparición frágiles 315,13±212,73 días vs no frágiles 320,25±224,91 (p = 0,44). CONCLUSIONES: La mayoría de los pacientes realizan diálisis peritoneal manual de forma autónoma. Tienen un nivel de fragilidad bajo, no presentan depresión y gozan de buena calidad de vida para su edad. No existe diferencia en el tiempo de aprendizaje entre los dos grupos. Las peritonitis se reparten al 50% en frágiles y no frágiles

INTRODUCTION: Elderly patients on peritoneal dialysis have a higher risk of presenting fragility, loss of autonomy, comorbidity and decreased quality of life. OBJECTIVE: To assess frailty, dependency, depression and quality of life, analysing the repercussion of frailty on the learning time of the technique and the appearance of the first episode of peritonitis. MATERIAL AND METHOD: descriptive retrospective study. Patients older than 70 years were included, from September 2016 to 2017, episodes of peritonitis until the end of 2018. Demographic variables, dialysis modality, Charlson index, Barthel index, Yesavage geriatric depression scale, clinical fragility scale, quality of life scale, training time and first peritonitis were collected. RESULTS: 25 patients were included, 56% men, mean age 76.77±5.34 years, 72% were on manual peritoneal dialysis. The mean value for the Charlson index was 7.88±2.06, for Barthel index 88.27±24.66 and for the Short form 12 health survey 32.96±8.61. 40% had some degree of frailty, 24% depression, 28% needed help or were institutionalized. Average training time in fragile patients was 16.77±7.93 hours versus non-fragile 15.20±5.06 (p = 0.42). 16 episodes of peritonitis were collected, distributed to 50% between both groups. The mean time of appearance of fragile people was 315.13±212.73 days versus 320.25±224.91 days for non-fragile ones (p = 0.44). CONCLUSIONS: Most of the patients perform manual peritoneal dialysis autonomously. They have low frailty levels, no depression and enjoy a good quality of life for their age. There is no difference in learning time between the two groups. Peritonitis is equally distributed in fragile and non-fragile patients

Impact of the implementation of an assisted peritoneal dialysis service on peritoneal dialysis initiation.

BACKGROUND: There is limited information available on the impact that provision of an assisted peritoneal dialysis (PD) service has on the initiation of PD. The aim of this study was to assess this impact in a centre following initiation of assisted PD in 2011. METHODS: This retrospective, single-centre study analysed 1576 patients incident to renal replacement therapies (RRTs) between January 2002 and 2017. Adjusted Cox regression with a time-varying explanatory variable and a Fine and Gray model were used to examine the effect of assisted PD use on the rates and cumulative incidence of PD initiation, accounting for the non-linear impact of RRT starting time and the competing risks (transplant and death). RESULTS: Patients starting PD with assistance were older than those starting unassisted: median (interquartile range): 70.0 (61.5-78.3) versus 58.7 (43.8-69.2) years old, respectively. In the adjusted analysis assisted PD service availability was associated with an increased rate of PD initiation [cause-specific hazard ratio (cs-HR) 1.78, 95% confidence interval 1.21-2.61]. During the study period, the rate of starting PD fell before flattening out. Transplantation and death rates increased over time but this did not affect the fall in PD initiation [for each year in the study cs-HR of starting PD 0.95 (0.93-0.98), sub-distribution HR 0.95 (0.94-0.97)]. CONCLUSIONS: In a single-centre study, introducing an assisted PD service significantly increased the rate of PD initiation, benefitting older patients most. This offsets a fall in PD usage over time, which was not explained by changes in transplantation or death.

Effect of nurse-led food exchange intervention for patients undergoing peritoneal dialysis
.

AIM: We aimed to apply nurse-led food exchange model intervention to peritoneal dialysis (PD) patients and verify its effectiveness. BACKGROUND: Protein-energy malnutrition is a prominent problem in patients on PD, and it has been estimated that 40% of PD patients suffer from malnutrition to some extent. INTRODUCTION: The rate of malnutrition among PD patients has been relatively high in recent years. Although a lot of effort has been made to alter the situation, an effective method has yet to be implemented. MATERIALS AND METHODS: We recruited 142 patients according to the inclusion and exclusion criteria and divided them into study group (n = 71) and control group (n = 71) using a random-number table generated by SPSS22.0. The control group received routine dietary guidance and instruction while the study group received nurse-led food exchange intervention. The subjective global assessment (SGA) scale scores, nutrition parameter, and dialysis efficacy indicators between the two groups were compared at baseline and after 12 months of intervention. RESULTS: There were no significant differences between the two groups in all dimensions at the baseline measures (p > 0.05). However, after 12 months of intervention, the study group represented a higher score of SGA while the control group declined, which was significantly different (p = 0.022). The study group had an improved level of body mass index, triceps skinfold thickness, middle-arm muscle circumference, serum albumin, prealbumin, and normalized protein catabolic rate, while the control group showed decreased levels, and these results were significantly different (p = 0.001, p = 0.019, p = 0.001, p < 0.001, p = 0.043, respectively). Moreover, blood urea nitrogen declined in the study group and increased in the control group, which was significantly different (p = 0.004). CONCLUSION: Nurse-led food exchange model intervention improved nutrition condition of PD patients dramatically. Implications for nursing and/or health policy: Our study provides a basis for health policy designers to develop nutrition programs and encourage clinical nurses to participate in PD patients' diet management.

Visita domiciliar como suporte da enfermagem na diálise peritoneal: revisão integrativa / Visita domiciliaria como asistencia de enfermería en la diálisis peritoneal: revisión integradora / Home visit as a support for nursing in peritoneal dialysis: an integrative review

Resumo Objetivo Identificar na literatura como a visita domiciliar é utilizada pelo enfermeiro como ferramenta do cuidado em dialise peritoneal domiciliar. Métodos Revisão integrativa da literatura de artigos em periódicos, a partir de uma questão norteadora, no período de janeiro de 2014 a janeiro de 2019. A busca bibliográfica foi realizada nas bases Scielo; Web of Science, Pubmed, Scopus, Embase e Cinahl. Resultados Identificaram-se 10 artigos de acordo com as etapas da revisão e as respostas à pergunta norteadora. A visita domiciliar realizada pelo enfermeiro foi descrita como ferramenta de adesão ao tratamento. A prevenção de complicações, como a peritonite, foi citada pelos autores, que em sua maioria, eram médicos e enfermeiros. Conclusão O enfermeiro assiste integralmente ao paciente e família e, assegura o tratamento proposto com fidedignidade. As intervenções de enfermagem no domicílio previnem eventos adversos e frequente avaliação de indicadores do tratamento. Estimular estudos primários nessa área é imprescindível, visto que poucos estudos sobre a temática foram identificados na presente revisão.

Resumen Objetivo Identificar en la literatura cómo se utiliza la visita domiciliaria del enfermero como herramienta de cuidado en diálisis peritoneal domiciliaria. Métodos Revisión integradora de la literatura de artículos en revistas especializadas, a partir de una pregunta orientadora, en el período de enero de 2014 a enero de 2019. La búsqueda bibliográfica fue realizada en las bases Scielo, Web of Science, Pubmed, Scopus, Embase y Cinahl. Resultados Se identificaron diez artículos de acuerdo con las etapas de la revisión y las respuestas a la pregunta orientadora. La visita domiciliaria realizada por el enfermero se describió como herramienta de adherencia al tratamiento. La prevención de complicaciones, como la peritonitis, fue citada por los autores que, en su mayoría eran médicos y enfermeros. Conclusión El enfermero asiste al paciente y a la familia de forma integral y garantiza que el tratamiento propuesto sea fidedigno. Las intervenciones de enfermería en el domicilio previenen eventos adversos y una evaluación frecuente de indicadores del tratamiento. Es imprescindible estimular estudios primarios en esta área, ya que se identificaron pocos estudios sobre esta temática en la presente revisión.

Abstract Objective To identify in the literature how home visit is used by nurses as a tool of care in home peritoneal dialysis. Methods An integrative review of the literature of articles in journals, from a guiding question, from January 2014 to January 2019. The bibliographic search was carried out at Scielo, Web of Science, Pubmed, Scopus, Embase, and CINAHL databases. Results Ten articles were identified according to the review steps and the answers to the guiding question. The home visit performed by nurses was described as a treatment adherence tool. Complication prevention, such as peritonitis, was cited by the authors, who were mostly physicians and nurses. Conclusion Nurses assist patients and family members in full and ensure the proposed treatment with reliability. Nursing interventions at home prevent adverse events and frequent assessment of treatment indicators. Boosting primary studies in this area is essential, since few studies on the subject have been identified in the present review.

Pacientes em diálise peritoneal: associação entre diagnósticos de enfermagem e seus componentes / Pacientes en diálisis peritoneal: relación entre diagnósticos de enfermería y sus componentes / Patients undergoing peritoneal dialysis: association between nursing diagnoses and their components

Resumo Objetivo: Analisar a associação entre os diagnósticos de enfermagem e suas características definidoras, fatores relacionados ou de risco para pacientes em diálise peritoneal. Métodos: Estudo de validação de conteúdo realizado com seis enfermeiros nefrologistas, os quais participaram no presente estudo como peritos. Utilizou-se a técnica de grupo focal. Para análise dos dados foi utilizada a regressão logística. Resultados: Para os quatro diagnósticos de enfermagem estudados foram identificados associação com seus componentes como segue. Fadiga: anemia, falta de energia e verbalização de uma constante falta de energia; Deambulação prejudicada: capacidade prejudicada de subir e descer calçadas, capacidade prejudicada de subir escadas e força muscular insuficiente; Constipação: ingestão insuficiente de líquidos, atividade física insuficiente, dor à evacuação, fezes duras e formadas; Volume de líquidos excessivo: mecanismos reguladores comprometidos, azotemia, ingestão maior que o débito, ganho de peso em curto período e eletrólitos alterados. Conclusão: Os diagnósticos analisados integram os domínios: atividade/repouso, eliminação e troca e nutrição e representam associação com seus componentes para os pacientes em diálise peritoneal.

Resumen Objetivo: Analizar la relación entre los diagnósticos de enfermería y sus características definitorias, factores relacionados o de riesgo en pacientes en diálisis peritoneal. Métodos: Estudio de validación de contenido realizado con seis enfermeros nefrólogos, que participaron en este estudio como peritos. Se utilizó la técnica de grupo focal. Para analizar los datos se utilizó la regresión logística. Resultados: Se identificaron relaciones en los cuatro diagnósticos de enfermería estudiados con sus componentes de la siguiente forma. Fatiga: anemia, falta de energía y verbalización de una constante falta de energía; Deterioro de la deambulación: deterioro de la capacidad de subir y bajar escaleras, deterioro de la capacidad de subir escaleras y fuerza muscular insuficiente; Constipación: ingesta insuficiente de líquidos, actividad física insuficiente, dolor al evacuar, heces oscuras y formadas; Volumen excesivo de líquidos: mecanismos reguladores comprometidos, azotemia, ingesta mayor que las pérdidas, aumento de peso en corto período y electrolitos alterados. Conclusión: Los diagnósticos analizados integran los dominios: actividad/reposo, eliminación y cambio y nutrición y representan relación con sus componentes en pacientes en diálisis peritoneal.

Abstract Objective: To analyze the association between nursing diagnoses and their defining characteristics, related or risk factors for patients on peritoneal dialysis. Methods: Content validation study with six nephrologist nurses, who participated in the study as experts. The focus group technique was used. Logistic regression was used for data analysis. Results: For the four nursing diagnoses studied, was identified an association with its components as follows. Fatigue: anemia, insufficient energy and verbalization of a sustained exhaustion; Impaired walking: impaired ability to navigate curbs, impaired ability to climb stairs and insufficient muscle strength; Constipation: insufficient fluid intake, insufficient physical activity, pain with defecation, hard and formed stools; Excess fluid volume: compromised regulatory mechanisms, azotemia, intake exceeds output, weight gain over short period of time, and electrolyte imbalance. Conclusion: The analyzed diagnoses integrate the following domains: activity/rest, elimination and exchange and nutrition, and are associated with its components for patients undergoing peritoneal dialysis.

Percepción de comportamiento de cuidado de enfermería en adultos con terapia renal de diálisis peritoneal y hemodiálisis / Perception of nursing caring behavior in adults treated with renal therapy for peritoneal dialysis and hemodialysis

Objetivo: Describir y comparar la percepción del comportamiento del cuidado de enfermería que tienen los pacientes en hemodiálisis y diálisis peritoneal en una unidad renal de Bogotá. Material y Método: Estudio descriptivo comparativo realizado con 92 pacientes en terapia renal distribuidos en dos grupos: hemodiálisis (50) diálisis peritoneal (42). Se utilizó el instrumento comportamiento profesional de cuidado de Horner. Para el análisis se acudió a estadística descriptiva, medidas de tendencia central y de dispersión; e inferencial mediante pruebas no paramétricas para comparación de grupos. Resultados: Se obtuvo alto puntaje en los comportamientos de cuidado brindados por enfermería en los dos grupos de pacientes. Los dos grupos perciben en su orden atributos de interacción familia -paciente, cortesía, relación y compromiso, en el cuidado brindado por enfermería. Es ligeramente mayor la percepción dada por los que se encuentran en diálisis peritoneal, sin ser estadísticamente significativa la diferencia frente a los de hemodiálisis. Conclusiones: Los pacientes en terapia renal de hemodiálisis y diálisis peritoneal reconocen altos comportamientos de cuidado de enfermería. Se requiere mantener el componente técnico y el conocimiento teórico propios del quehacer en las unidades renales, y fortalecer las relaciones de confianza, respeto y empatía que la enfermera(o) puede brindar de acuerdo a sus condiciones y las ofrecidas por la institución

Objective: To describe and compare the perception of nursing caring behavior in adults treated with renal therapy for peritoneal dialysis and hemodialysis in a renal unit in Bogotá. Material and Method: Descriptive and comparative study with a sample of 92 patients receiving real therapy distributed in two groups: hemodialysis (n=52) and peritoneal dialysis (n=42). The Professional Performance for Caring Scale of Horner was used. Descriptive statistics were used for the analysis, central tendency and dispersion measures; as well as inferential statistics by non-parametric tests for comparison between the groups. Results: High scores on the caring behavior offered by nursery services were observed for the two groups of patients. Both groups perceive the interactions between different factors such as family- patient relationships, courtesy, relationship and commitment in the care offered by nursing services. The perception of the group of patients treated with peritoneal dialysis was slightly greater, but statistically significant differences between the groups were not observed. Conclusions: Patients treated with renal therapy for peritoneal dialysis and hemodialysis acknowledge high levels of care in the nursing services provided. It is necessary to maintain the technical and theoretical components common to renal unities, as well as strengthen the relationships based on trust, respect and empathy that the nurse can offer according to his/her conditions as well as those provided by the institution

Sobrecarga del cuidador del paciente con tratamiento de diálisis peritoneal / Caregiver burden in patients with peritoneal dialysis

Introducción: La experiencia de ser cuidador produce sensación de satisfacción por el cuidado y búsqueda de bienestar del paciente, pero desafortunadamente la duración del tiempo, técnica y procedimiento que implica la Diálisis Peritoneal produce sobrecarga en el cuidador, sumado a esto la dependencia del paciente según su edad, estado mental y físico. El objetivo fue determinar el nivel de sobrecarga del cuidador del paciente con tratamiento de Diálisis Peritoneal en una zona aledaña a la ciudad de Chiclayo-Perú. Material y Método: Estudio cuantitativo, diseño no experimental transversal descriptiva, el muestreo fue aleatorio simple sin reposición, conformado por 75 cuidadores seleccionados por criterios de inclusión y exclusión. La recolección de datos se realizó mediante el cuestionario de sobrecarga de cuidadores de pacientes de Diálisis Peritoneal, previamente validado por tres expertos y con una confiabilidad de 0,847 (alfa de Cronbach). Los datos se procesaron con el software spss versión 22, en todo momento se respetaron los principios éticos y criterios de rigor científico. Resultados: 94,7% de los cuidadores presentaron un nivel de sobrecarga leve, se evaluó tres dimensiones: la dependencia del paciente 53,3%, auto desempeño del cuidador 96,0% y las repercusiones socio familiares 78,7%. Conclusión: Podemos concluir que, el nivel de sobrecarga del cuidador es leve, y el perfil más prevalente respecto a los datos sociodemográficos de los cuidadores es mujer adulta, esposa del paciente y que vive con el paciente

Introduction: The experience of being a caregiver produces a sense of satisfaction for the care and search for patient well-being. Unfortunately, the duration of time, technique and procedure of peritoneal dialysis produces an overload in the caregiver, added the dependence of the patient according to age, mental and physical state. The objective was to determine the level of caregiver burden in patients with peritoneal dialysis treatment in an area adjacent to the city of Chiclayo-Peru. Methodology: Descriptive cross-sectional study. The sampling was simple random without replacement, consisting of 75 caregivers selected by inclusion and exclusion criteria. Data collection was performed using the caregiver burden questionnaire in patients on peritoneal dialysis, previously validated by three experts and with a reliability of 0.847 (Cronbach's alpha). The data were processed with the statistical package SPSS version 22. At all times, ethical principles and criteria of scientific rigor were respected. Results: 94.7% of the caregivers presented a level of slight burden, three dimensions were evaluated: the dependence of the patient (53.3%), self-care of the caregiver (96.0%) and socio-family repercussions (78, 7%). Conclusion: We can conclude that the level of caregiver burden is mild, and the most prevalent profile regarding socio-demographic data of caregivers is: adult female, patient's wife and living with the patient

Sobrecarga de los cuidadores de pacientes de diálisis peritoneal. Validación de cuestionario y baremos / Carer's burden of peritoneal dialysis patients. Questionnaire and scale validation

INTRODUCCIÓN: Los cuidadores de pacientes en diálisis peritoneal pueden sufrir sobrecarga con características diferentes de la derivada de demencia, cáncer u otras enfermedades dependientes. OBJETIVOS: Analizar la fiabilidad y la validez del Cuestionario de Sobrecarga del Cuidador de Diálisis Peritoneal (CSCDP) elaborado anteriormente y establecer los baremos del mismo. MÉTODOS: Estudio observacional, multicéntrico de cuidadores y pacientes con más de 3 meses en diálisis peritoneal. Se registraron: características sociodemográficas de pacientes y cuidadores, dependencia de pacientes, salud percibida (SF-36) y sobrecarga del cuidador (escala de Zarit), además del CSCDP con 3 escalas: dependencia, sobrecarga subjetiva y sobrecarga objetiva. RESULTADOS: Fueron evaluables 107 cuidadores y pacientes de 8 hospitales. Los cuidadores fueron mayoritariamente mujeres (83,2%), con una edad media de 57,50 ± 14,69 años; un 36,4% trabajaban fuera de casa. La consistencia interna de la escala de Zarit y del CSCDP fue elevada (alfa de Cronbach entre 0,808 y 0,901). La correlación entre la sobrecarga del Zarit y la del CSCDP fue significativa (r = 0,683). La correspondencia entre 3 grados de sobrecarga del Zarit y los tertiles del CSCDP fue buena o aceptable (Tau-b Kendall: 0,570, p < 0,001). El análisis factorial exploratorio de componentes principales mostró 3 componentes coincidentes con el diseño del CSCDP. Se han elaborado los baremos de sobrecarga del cuidador. CONCLUSIONES: El estudio demuestra buena fiabilidad con elevada consistencia interna del cuestionario CSCDP. El análisis factorial denota validez de constructo y la buena correlación y aceptable correspondencia con la escala de Zarit indican validez de criterio. El cuestionario resulta apto para aplicación clínica

INTRODUCTION: Carers of peritoneal dialysis patients may suffer from burden, the characteristics of which differ from burden due to dementia, cancer or other dependent conditions. AIMS: To ascertain the reliability and validity of the Peritoneal Dialysis Carer Burden Questionnaire (PDCBQ), previously created, and to design the burden scale. METHODS: Observational, multicentre study of carers and patients on peritoneal dialysis for more than 3 months. Sociodemographic characteristics of patients and carers, patient dependency, perceived health (SF-36) and carer burden (Zarit scale) were recorded, as well as PDCBQ via 3 scales: dependence, subjective burden and objective burden. RESULTS: One hundred seven patients and their carers from 8 hospitals were evaluable. Carers were mainly women (83.2%), aged 57.50 ± 14.69 years, and 36.4% worked out of the home. The internal consistency of the Zarit scale and the PDCBQ were high (Cronbach's alfa between 0.808 and 0.901). Significant correlation was found between the Zarit scale and PDCBQ (r = 0.683). The concordance analysis between 3 degrees of Zarit Scale and PDCBQ tertiles was good or acceptable (Kendall Tau-b: 0.570, P < .001). The exploratory factor analysis of the main factors revealed 3 factors, which were successfully correlated with the design of the PDCBQ. A new carer burden scale was designed. CONCLUSIONS: The study shows good reliability with high internal consistency of the PDCBQ. Factorial analysis shows good construct and good correlation, and acceptable concordance with the Zarit Burden Scale confirmed criterion validity. The questionnaire is suitable to be applied in clinical practice

¿Es el paciente inmigrante un buen candidato para diálisis peritoneal? / Does the immigrant patient is a good candidate for peritoneal dialysis?

Introducción: El paciente inmigrante a veces presenta barreras que provocan dudas de su inclusión en diálisis peritoneal. Objetivo: Analizar si ser inmigrante influye en los resultados de la diálisis peritoneal. Material y Método: 143 pacientes incidentes en diálisis peritoneal (años 2010-17). Datos demográficos, clínicos y de pronóstico (definición pobre resultado en diálisis peritoneal: peritonitis superior a media de la unidad, transferencia a hemodiálisis en primeros 6 meses y mortalidad relacionada con la técnica). Resultados: Comparando los pacientes inmigrantes y no inmigrantes se observan diferencias: edad (42,4 vs 62,3 años; p=<0,001), numero de sesiones de entrenamiento (7,5 vs 9,27; p=0,037), sexo (61,1 vs 25,2% mujeres; p=0,002), nivel económico (44,4 vs 13,7%; p=0,005), educación (16,7 vs 1,6%; p=0,004), situación laboral (5,6 vs 61,3%; p≤0,001) y grado de autonomía (38,9 vs 13,7% actividad prácticamente normal; p=0,031). Sin diferencias respecto a los datos pronósticos. Un 25,3% de los pacientes presentan un pobre resultado en diálisis peritoneal y el resto un buen resultado. La única diferencia significativa entre ambos grupos son el número de sesiones de entrenamiento (10 sesiones vs 8,7 sesiones; p=0,048). En el análisis multivariante no se encontró asociación entre el pobre resultado de la técnica con ninguna de las variables introducidas en el modelo inicial, tan solo, se aproximó el grado de funcionalidad del paciente, aunque sin alcanzar significación estadística. Conclusiones: Los pacientes inmigrantes, a pesar de condiciones sociodemográficas distintas, tienen un resultado similar a los no inmigrantes en diálisis peritoneal

Introduction: The immigrant patient sometimes presents barriers that cause doubts about their inclusion in peritoneal dialysis. Objective: To analyse if being an immigrant influences the results of peritoneal dialysis. Material and Method: 143 incident patients in peritoneal dialysis (years 2010-17). Demographic, clinical and prognostic data (poor outcome definition in peritoneal dialysis: peritonitis greater than half of the unit, transfer to haemodialysis in the first 6 months and mortality related to the technique). Results: Comparing immigrant and non-immigrant patients, differences were observed: age (42.4 vs 62.3 years, p<0.001), number of training sessions (7.5 vs 9.27, p=0.037), sex (61.1 vs. 25.2% women, p=0.002), economic level (44.4 vs. 13.7%, p=0.005), education (16.7 vs. 1.6%, p=0.004), employment situation (5.6 vs 61.3%, p<0.001) and degree of autonomy (38.9 vs 13.7% practically normal activity, p=0.031). No differences with respect to the prognostic data. A 25.3% of patients present a poor result in peritoneal dialysis and the remaining patients a good result. Only significant differences between both groups were found in the number of training sessions (10 sessions vs 8.7 sessions, p=0.048). The only factor that tends to be associated independently (multivariate analysis) to a poor result in peritoneal dialysis is the degree of functionality of the patient. No associations were found with being an immigrant patient or with other variables. Conclusions: Immigrant patients, in spite of the different sociodemographic conditions, have a similar outcome to non-immigrant patients in peritoneal dialysis

"Reencontrándome a través de la diálisis peritoneal": un abordaje fenomenológico / "Reencountering me through peritoneal dialysis": a phenomenological approach

Objetivo: Describir la experiencia de personas con enfermedad renal crónica en terapia de diálisis peritoneal que asisten a una unidad renal de Huila-Colombia. Material y Método: Investigación cualitativa fenomenológica descriptiva, se realizaron entrevistas en profundidad a 16 participantes que cumplieron los criterios de inclusión. El análisis se realizó a partir del abordaje de Collaizzi. Resultados: 361 descripciones significativas, 94 unidades de significado, y 6 temas comunes: enfrentando la realidad, pérdidas, corporalidad, limitaciones, soporte y ganancias, describen la experiencia. Conclusiones: Padecer una enfermedad renal crónica terminal representa la lucha que tiene el paciente frente a los cambios en su aspecto físico, el auto reconocimiento y las limitaciones que tiene el servicio de salud del país, sin embargo, se refleja también, la transformación tras aceptar la condición, involucrando la terapia dialítica a su vida, permitiendo reencontrarse a través de ella

Objective: To describe the experience of people with chronic kidney disease in peritoneal dialysis therapy attending a renal unit in Huila-Colombia. Materials and methods: Descriptive phenomenological qualitative research. In-depth interviews were conducted with 16 participants who met the inclusion criteria. The analysis was made based on the Collaizzi approach. Results: 361 significant descriptions, 94 units of meaning, and 6 common themes: facing reality, losses, corporality, limitations, support and gains, describe the experience. Conclusions: Having a terminal chronic kidney disease represents the patient’s struggle against changes in physical appearance, self-recognition and the limitations of the country’s health service. However, the transformation is also reflected after accepting the condition, involving dialysis therapy to the patient’s life, allowing them to rediscover themselves