Patients' Experiences of a Nurse-Led Self-Management Intervention After Kidney Transplantation.

Self-management after kidney transplantation is challenging. Therefore, current guidelines recommend education programs, but little is known about patients' experiences of such programs. With a qualitative design, we explored patients' experiences of either multiple behavioral interventions or a single educational intervention in the firstyear post-transplant. Patients were struggling to master changes before reassuming normal life post-transplant. They learned to have confidence in their new situation and resumed their social roles. In a therapeutic sense, they were open to information, wanted to recover normal weight, and engaged in physical activity and consistent medication intake. Those who had undergone the behavioral interventions tackled these challenges with more consistency and vigor. Individualized behavioral self-management interventions were well accepted and have the potential to guide patients towards better outcomes.

Experiences of Patients with Chronic Kidney Disease and Their Family Members in an Advanced Practice Nurse-Led Counseling Service.

Chronic kidney disease (CKD) is a major health problem worldwide, but not enough is known about effective self-management interventions. In this qualitative study, we explore how outpatients with CKD Stages 1-5 (without renal replacement therapy) and their family members experienced an individually tailored CKD counseling service led by an advanced practice nurse (APN). Using thematic analysis, 10 pair interviews (N = 20) were conducted and analyzed stepwise. Findings revealed iterative processes along the course of the disease. Participants struggled with an incomprehensible diagnosis. An APN assisted them in their efforts to master CKD. The APN offered information, insights, and understanding. This support helped the families achieve a new outlook and filled some gaps in CKD care. Future development of the service should focus on slowing down CKD progression more effectively. Healthcare providers are encouraged to acknowledge the importance of ongoing guidance and the continuity of care in treating patients with CKD.

First Testing of Literature-Based Models for Predicting Increase in Body Weight and Adipose Tissue Mass After Kidney Transplantation.

Introduction: Weight gain is a risk factor for poor clinical outcomes following kidney transplantation. Research Question: This study's aim was a first testing of 2 models to identify patients early after kidney transplantation who are at risk for weight gain and increase in adipose tissue mass in the first year after kidney transplantation. Design: The literature-based models were evaluated on longitudinal data of 88, respectively 79 kidney transplant recipients via ordinary and Firth regression, using gains ≥ 5% in weight and adipose tissue mass respectively as primary and secondary endpoints. Results: The models included physical activity, smoking cessation at time of kidney transplantation, self-reported health status, depressive symptomatology, gender, age, education, baseline body mass index and baseline trunk fat as predictors. Area under the curve was 0.797 (95%-CI 0.702 to 0.893) for the weight model and 0.767 (95%-CI 0.656 to 0.878) for the adipose tissue mass model-showing good, respectively fair discriminative ability. For weight gain ≥ 5%, main risk factors were smoking cessation at time of transplantation (OR 16.425, 95%-CI 1.737-155.288) and better self-reported baseline health state (OR 1.068 for each 1-unit increase, 95%-CI 1.012-1.128). For the adipose tissue mass gain ≥ 5%, main risk factor was overweight/obesity (BMI ≥ 25) at baseline (odds ratio 7.659, 95%-CI 1.789-32.789). Conclusions: The models have potential to assess patients' risk for weight or adipose tissue mass gain during the year after transplantation, but further testing is needed before implementation in clinical practice.

Comparison of a Behavioral Versus an Educational Weight Management Intervention After Renal Transplantation: A Randomized Controlled Trial.

BACKGROUND: In the first year following renal transplantation, preventing weight gain to minimize overweight or obesity is particularly important. The aim of this study is to test the effect of an 8-month behavioral intervention BMI and physical activity. METHODS: This randomized controlled study included 123 adult kidney or kidney-pancreas recipients. Patients were randomized to usual (1 educational session, then weight self-monitoring) and intervention care (usual care plus 7-8 counseling sessions). Alongside weight, body composition, and physical activity, satisfaction and perceptions regarding care were measured at weeks 2-6 (baseline), then at months 8 and 12. RESULTS: Both groups reported comparably high satisfaction. The intervention group (IG) reported more chronic care-related activities. In patients with BMIs ≥ 18.5, mean weight gain (from baseline) was unexpectedly low in both groups: at month 8, +0.04 kg/m2 in IG patients and +0.14 kg/m2 in the control group (P = 0.590), and respectively, +0.03 kg/m2 and +0.19 kg/m2 at month 12 (P = 0.454). Both groups were physically active, walking averages of 10 807 (IG) and 11 093 (control group) steps per day at month 8 (P = 0.823), and respectively 9773 and 11 217 at month 12 (P = 0.195). CONCLUSIONS: The behavioral intervention had high patient acceptance and supported patients in maintaining their weight, but had no superior effect on a single educational session. Further research is needed to assess patient weight gain risk profiles to stratify the intervention.