[Knowledge and quality of life in chronic kidney disease and peritoneal dialysis]. / Conocimiento y calidad de vida en enfermedad renal crónica y diálisis peritoneal.

Background: Knowledge of one's own chronic kidney disease (CKD) can improve long-term quality of life (QoL). Peritoneal dialysis presents with residual symptoms that reduce the QoL. Objective: To correlate knowledge of the disease and QoL in patients with CKD and on continuous ambulatory peritoneal dialysis (CAPD). Material and methods: A descriptive, cross-sectional, and prospective study was carried out in patients with CKD treated at a second-level hospital of the Mexican Institute for Social Security (Instituto Mexicano del Seguro Social) in Puebla. SF-36 and KiKS questionnaires were applied. Age, sex, education, marital status, perception of QoL, and level of knowledge were recorded. Descriptive statistics and Spearman's coefficient were used. Results: 199 patients with CKD in CAPD were included, 62.8% women, minimum age range was 18 to 20 years with 4% and maximum of 61 years or more with 49.2%, 35.6% of patients completed primary school, and 65.3% were married. The most frequent comorbidity was diabetes (57.2%). The least affected QoL domain was pain. KiKS recorded a mean of 0.54 (regular knowledge about the disease). It was recorded a weak and significant correlation in the QoL domains: physical health, physical role, pain, general health, mental health (p ≤ 0.05). Conclusions: There is a significant but weak correlation between the perception of QoL and the level of knowledge of the disease in CKD patients with CAPD.

Introducción: el conocimiento adecuado de la enfermedad renal crónica (ERC) puede mejorar la calidad de vida (CV) a largo plazo. La diálisis peritoneal cursa con síntomas residuales que reducen la CV. Objetivo: correlacionar el conocimiento de la enfermedad y la CV en pacientes con ERC y en diálisis peritoneal continua ambulatoria (DPCA). Material y métodos: se llevó a cabo un estudio descriptivo, transversal y prospectivo en pacientes con ERC atendidos en un hospital de segundo nivel de atención del Instituto Mexicano del Seguro Social (IMSS) en Puebla. Se les aplicaron los cuestionarios SF-36 y KiKS. Se registró edad, sexo, escolaridad, estado civil, percepción de calidad de vida, nivel de conocimiento. Se utilizó estadística descriptiva y coeficiente de Spearman. Resultados: se incluyeron 199 pacientes con ERC en DPCA, 62.8% mujeres, edad mínima de 18 a 20 años (4%) y máxima 61 años o más (49.2%), 35.6% de los pacientes cursó primaria completa, y 65.3% estaban casados. La comorbilidad más frecuente fue diabetes (57.2%). El dominio de CV menos afectado fue el dolor. El KiKS registró una media de 0.54 (conocimiento regular sobre la enfermedad). Se registró una correlación débil y significativa en los dominios de CV: salud física, rol físico, dolor, salud general, salud mental (p ≤ 0.05). Conclusiones: existe una correlación significativa pero débil entre la percepción de la CV y el nivel de conocimiento de la enfermedad en los pacientes con ERC con DPCA.

Desarrollo y conducta adaptativa en niños con insuficiencia renal crónica en DPCA / Development and adaptative behavior in children with chronic renal insuffiency on CAPD

Los niños con enfermedad renal crónica encuentran un riesgo aumentado de presentar compromiso de su neurodesarrollo. El objetivo de este trabajo fue la evaluación cognitiva y adaptativa de 15 niños con insuficiencia renal crónica en tratamiento de reemplazo con diálisis peritoneal ambulatoria. El desarrollo cognitivo fue normal o superior en 3 pacientes (20%) y retrasado en 12 (80%). La conducta adaptativa fue adecuada en 8 (53%) y baja o muy baja en 7 (47%). No hubo relación entre el desarrollo cognitivo y la escolaridad materna o el nivel socio económico, ni entre la conducta adaptativa y el nivel de escolaridad materna. La relación entre el NSE y la conducta adaptativa fue significativa (p 0.04). Esto sugeriría que si bien la enfermedad renal crónica compromete el desarrollo cognitivo, un nivel socioeconómico medio/alto puede proveer oportunidades para una mejor conducta adaptativa.

Children with chronic kidney disease are at increased riskof having impaired neurodevelopment. The objective of thepresent study was to perform a cognitive and adaptive eva-luation of 15 children with chronic renal insufficiency onoutpatient peritoneal dialysis. Cognitive development wasnormal or above normal in 3 patients (20%) and delayed in12 (80%). Adaptive behavior was adequate in 8 (53%) andlow or very low in 7 (47%). No correlation was found eitherbetween cognitive development and maternal education orsocio-economic level or between adaptive behavior andeducation of the mother. A significant correlation was foundbetween socio-economic level and adaptive behavior (p0.04). This would suggest that although chronic kidney dise-ase compromises cognitive development, middle or uppersocio-economic level may provide opportunities for impro-ved adaptive behavior.

Nurse-patient communication while performing home dialysis: the patients' perceptions.

This study aimed at describing patients' perception of their communication with nurses when performing home dialysis. Data were collected from interviews guided by the question: "What is communication like, between you and nurses, during home dialysis treatment?" Results show participants' perception of treatment during home peritoneal dialysis [Continuous ambulatory peritoneal dialysis (CAPD)]; relationship with nurses and family and the effects of treatment on one's existence. Patients can be self-caring and they learn to value the autonomy in their own care. However, some are unable to assume the responsibility for self-care. It was discovered that the connotation of "inspection" that some participants attributed to the nurse's visits, led to an alienation from the education process in the CAPD education. Findings suggest that effective communication and the development of the relationship of a working partnership with patients is crucial. Improvement in the nurses' communication, aiming at adapting it to the characteristics, limitations and specific needs of each patient, is significant for achieving better outcomes.

[Quality of life in patients with continuous ambulatory peritoneal dialysis]. / Calidad de vida en pacientes con diálisis peritoneal continua ambulatoria.

OBJECTIVE: To evaluate different aspects of the quality of life of patients with continuous ambulatory peritoneal dialysis, using the survey SF-36 (Medical Outcomes Study 36-Short Form Health Survey). METHODOLOGY: A cross-sectional study was carried out with patients older than 18 years having chronic renal failure and being registered in the continuous ambulatory peritoneal dialysis program in the last three months. A sample size of 48 patients was estimated. The version 1.1 of the SF-36 survey previously adapted for Mexican people was used to evaluate quality of life. RESULTS: Forty-eight patients were included, among which 52% were males, the mean of age was 45 years old. All eight domains of health were analyzed. The role limitations due to physical health showed the lower score (mean = 19.79; men: 13, women: 27.1) while mental health showed the higher (mean = 61.66; men: 59.68 women: 63.83).

Health-related quality of life predicts outcomes but is not affected by peritoneal clearance: The ADEMEX trial.

BACKGROUND: We hypothesized that increasing small solute clearance in peritoneal dialysis (PD) would lead to improvements in patient health-related quality of life (HRQOL). METHODS: Patients were randomized to a control group [standard 4 x 2 L continuous ambulatory peritoneal dialysis (CAPD)] and an intervention group (CAPD with a target creatinine clearance >/=60 L/week/1.73 m(2)). The Kidney Disease Quality of Life Short Form was obtained at baseline and at 6, 12, and 24 months. Physical (PCS), mental (MCS), and kidney disease component summary (KDCS) scores were computed. RESULTS: The two groups were comparable at baseline with respect to HRQOL. Baseline variables highly predictive of better QOL included absence of diabetes, younger age, higher starting GFR, and serum albumin. Baseline values of QOL were highly predictive of survival and hospitalizations. An unadjusted comparison revealed that patients in the intervention group had significantly higher PCS and KDCS scores at six months. However, there were no significant differences between the intervention and control patients at 12 or 24 months. When similar analyses were carried out adjusting for different patterns of patient dropout, there were no significant differences between the two groups at any time point in terms of PCS, MCS, and KDCS scores. CONCLUSION: We found no evidence of a long-term benefit in HRQOL of CAPD patients by increasing peritoneal small-solute clearances when HRQOL parameters were adjusted for patient dropout. Measures of HRQOL have a significant predictive value for patient survival and hospitalizations.

[Self-esteem in Mexican pediatric patients on peritoneal dialysis and kidney transplantation]. / Autoestima en pacientes pediátricos mexicanos con diálisis peritoneal y trasplante renal.

It has been reported in literature that self-esteem increases in patients who pass from continuous ambulatory peritoneal dialysis to renal transplantation. However, our clinical observations in the Department of Nephrology of Hospital Infantil de México Federico Gómez indicate otherwise. Therefore, we carried out this research on 60 patients, children and adolescents, male and female between the ages from 8 to 15 years old, and we applied them the Coopersmith self-esteem questionnaire, which has been validated in mexican population. These findings indicate that the social environment continuous ambulatory peritoneal dialysis patients feel more adapted than patients in renal transplant (p = 0.05). However it was also observed that these patients tried to show a better image on their situation through compensatory mechanisms (defense p = 0.03). It was concluded that it would be necessary to follow the adaptation of the transplanted patients, in order to help them achieve complete rehabilitation.

Impacto da diálise peritoneal ambulatorial contínua (CAPD) na qualidade de vida de doentes renais crônicos submetidos a esse tratamento / Impact of the continuous ambulatory peritoneal dialysis (CAPD) in the quality of life of chronic renal patients submitted to treatment

Com o avanço tecnológico e cientifico no tratamento dos doentes renais crônicos, o aumento da sobrevida desses pacientes em tratamento dialítico é uma realidade. A atençäo portanto, deve estar voltada para proporcionar um método de diálise que ofereça, também uma melhor qualidade de vida a esses doentes renais. Objetivos: Analisar o impacto da Diálise Ambulatorial contínua (CAPD) na qualidade de vida de doentes renais crônicos submetidos a esse tratamento. Método: Através de um estudo qualitativo de cunho exploratório, e utilizando a metodologia do Discurso do Sujeito Coletivo (DSC), procurou-se selecionar todos os doentes renais em programas de CAPD numa clinica de diálise de Feira de Santana-Ba. Foram estudados 23 doentes renais e , após serem submetidos a uma entrevista semi-estruturada, gravada e transcrita literalmente, selecionaram-se as idéias centrais com suas expressöes-chaves correspondentes, com as quais foram construídos os DSCs. Esses Discursos, que é fala dos sujeitos, permitiram compreender os significados atribuídos as vivências experimentadas por esses doentes renais enquanto usuários da CAPD. Consideraçöes finais: A partir da analise dos Discursos pode-se considerar que a qualidade de vida desses doentes renais melhorou após uso da CAPD, tendo apresentado os seguintes resultados: maior disposiçäo e liberdade para desempenharem as tarefas do dia-a-dia; permaneceram em suas casas desfrutando da companhia dos familiares, cuidando de si mesmos e recebendo apoio dos seus; oportunidade de voltar a trabalhar, estudar, viajar, passear e manter uma vida social normal; melhora no relacionamento com os amigos, por poder estar tempo perto deles; permissäo para adotar dieta sem restriçäo; e finalmente em relaçäo a sexualidade, uma parte dos entrevistados refere que näo houve alteraçäo. Aqueles que referem diminuiçäo da atividade sexual näo atribuem ao CAPD.

Intellectual output of children with chronic renal failure on continuous ambulatory peritoneal dialysis.

The aim of this study is to quantify the intelligence output in our pediatric population on continuous ambulatory peritoneal dialysis (CAPD) treatment. A total of 30 children were studied, with an age range of eight to 18 years. For evaluating a global intelligence quotient (IQ), the Wechsler test was applied according to their age. And, as a complement, a Bender test was also requested to deny or confirm brain damage. The Wechsler test showed an average intelligence quotient in most of the children (76.7%); a small group (16.7%) was classified as dull normal, 1 child had mild retardation, and 1 was borderline. All of them had a Bender test that did not correlate with brain damage. Most of them maintained a very high verbal IQ, but, when the performance IQ was qualified, 34% got a low score, and a certain difficulty in solving this part of the test was observed. Maybe this was influenced by chronicity of the sickness and/or the blood urea nitrogen level. In conclusion, the child's plasticity is his best quality to cope with uremia and the alterations caused by it. Therefore the idea is to consider the intelligence quotient as the capacity that the subjects have to use their own resources to cope with their environment. And, even though the neurological alterations exist, the child's plasticity helps him/her maintain a good global intelligence quotient, even though he/she is not having immediate transplantation.

[Application of the Orem theory of self help to adolescents in continuous ambulatory peritoneal dialysis]. / Aplicação da teoria do autocuidado de Orem em adolescente em diálise peritoneal ambulatorial contínua.

The Orem's Self-Care Theory was used as a guide for a nursing care plan of a 16 year-old adolescent with renal failure in continuous ambulatory peritoneal dialyses (CAPD). The theory was used to assess the self-care deficits, the ability of the family to meet the patient's self-care demands, and the nursing actions needed in this case. Conditioning factors such as motivation, social economic status and education greatly interfered on the ongoing process of self-care.

[Little difference in quality of life of dialysis patients in Utrecht and Willemstad]. / Kwaliteit van leven van dialysepatiënten in Utrecht en Willemstad weinig verschillend.

OBJECTIVE: To assess and compare the quality of life of patients treated with haemodialysis and chronic ambulatory peritoneal dialysis (CAPD) in Utrecht and Willemstad, Curaçao. DESIGN: Transverse multicentre study. METHODS: All haemodialysis and CAPD patients in Utrecht and all haemodialysis patients in Curaçao under treatment for over 6 months were studied. The objective tests applied were the 'Nottingham health profile', the 'affect balance scale', the 'index of well-being' and the 'Amsterdam complaint profile'. Possible correlations between individual patient-related and treatment-related factors and biochemical variables were also investigated. RESULTS: The objective and subjective tests revealed only slight differences in quality of life in the three groups. In a few respects, the CAPD patients rated the quality of life slightly better. In the Utrecht group a positive relationship was seen between haematocrit (higher owing to treatment with erythropoietin) and plasma bicarbonate concentration, and the quality of life.