scholarly journals Itch and Ache on Dialysis: New Approaches to Manage Uremic Pruritus and Restless Legs

2019 ◽  
Vol 49 (1-2) ◽  
pp. 222-227 ◽  
Author(s):  
Soraya Arzhan ◽  
Maria-Eleni Roumelioti ◽  
Mark L. Unruh
Keyword(s):  
Treatment Options ◽  
Healthcare Providers ◽  
Restless Legs ◽  
Uremic Pruritus ◽  
Health Related Qol ◽  
Health Related ◽  
Maintenance Dialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: Uremic pruritus (UP) and restless legs syndrome (RLS) are highly prevalent complaints among patients with end-stage renal disease (ESRD) undergoing chronic dialysis. These chronic troublesome symptoms lead to a significant decrease in quality of life (QOL) and increase in mortality rate. Despite their distressing characteristics, these symptoms usually remain under-recognized by healthcare providers. Therefore, careful history intake, and stepwise treatment are essential. Numerous pharmacological and non-pharmacological treatments have been demonstrated to help in controlling these 2 conditions. Summary: In this review, we discuss the latest findings regarding UP and RLS among ESRD patients on maintenance dialysis. We also examine different treatment options in this group of patients. The majority of these patients do not have the opportunity to receive a kidney transplant and need other treatments for these burdensome symptoms in order to improve their QOL and prognosis. Key Messages: UP and RLS are common but underdiagnosed conditions in ESRD patients on maintenance dialysis that are related to a decline in patients’ QOL and poor prognosis. The pathophysiology of these conditions remains not well understood. Therefore, controversies still exist on treatment options. Treating these conditions provides an opportunity to improve the health-related QOL and outcomes of dialysis patients.

Treatment with Cinacalcet in Hemodialysis Patients with Severe Secondary Hyperparathyroidism, Influences Bone Mineral Metabolism and Anemia Parameters

2020 ◽  
Vol 15 (3) ◽  
pp. 249-263
Author(s):  
Maria Aktsiali ◽  
Theodora Papachrysanthou ◽  
Ioannis Griveas ◽  
Christos Andriopoulos ◽  
Panagiotis Sitaras ◽  
...  
Keyword(s):  
Bone Mineral ◽  
Mineral Metabolism ◽  
Treatment Options ◽  
Dry Weight ◽  
Chronic Hemodialysis ◽  
Protective Agent ◽  
Positive Correlation ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: Due to the premium rate of Chronic Kidney Disease, we have increased our knowledge with respect to diagnosis and treatment of Bone Mineral Disease (BMD) in End- Stage Renal Disease (ESRD). Currently, various treatment options are available. The medication used for Secondary Hyper-Parathyroidism gives promising results in the regulation of Ca, P and Parathormone levels, improving the quality of life. The aim of the present study was to investigate the relation of cinacalcet administration to not only parathormone, Ca and P but also to anemia parameters such as hematocrit and hemoglobin. Materials and Methods: retrospective observational study was conducted in a Chronic Hemodialysis Unit. One-hundred ESRD patients were recruited for twenty-four months and were evaluated on a monthly rate. Biochemical parameters were related to medication prescribed and the prognostic value was estimated. Cinacalcet was administered to 43 out of 100 patients in a dose of 30-120 mg. Results: Significant differences were observed in PTH, Ca and P levels with respect to Cinacalcet administration. Ca levels appeared to be higher at 30mg as compared to 60mg cinacalcet. Furthermore, a decreasing age-dependent pattern was observed with respect to cinacalcet dosage. A positive correlation was observed between Dry Weight (DW) and cinacalcet dose. Finally, a positive correlation between Hematocrit and Hemoglobin and cinacalcet was manifested. Conclusions: Cinacalcet, is a potential cardiovascular and bone protective agent, which is approved for use in ESRD patients to assist SHPT. A novel information was obtained from this study, regarding the improvement of the control of anemia.

Nonclinical Factors Associated with Treatment with Peritoneal Dialysis in Esrd Patients in Taiwan

2010 ◽  
Vol 30 (6) ◽  
pp. 638-643 ◽  
Author(s):  
Hsiu-Chen Huang ◽  
Jiun-Yi Wang ◽  
Chia-Chu Chang ◽  
Ping-Fang Chiu ◽  
Ming-Che Chiang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Family Support ◽  
Univariate Analysis ◽  
Healthcare Providers ◽  
Early Referral ◽  
Factors Associated ◽  
Stage Renal Disease ◽  
End Stage ◽  
To Receive ◽  
Esrd Patients

ObjectivesLess than 10% of end-stage renal disease (ESRD) patients in Taiwan receive peritoneal dialysis (PD), which reveals the situation of underutilization of PD. We thus aimed to investigate factors associated with treatment with PD in ESRD patients in Taiwan.PatientsPatients that were 18 years of age or older and had been on dialysis for at least 3 months since 2001 were recruited and interviewed with a structured questionnaire.Results98 hemodialysis (HD) and 102 PD patients were recruited. In univariate analysis, age, sex, level of education, employment status, marital status, traffic time, family support, patient cognition, and receptivity were correlated with treatment with PD. Multivariate analysis showed that patients that were not married ( p = 0.006), that spent more time traveling to the dialysis clinic ( p = 0.006), that were not emergent at the start of dialysis ( p = 0.003), and that had better family support ( p = 0.045), a higher cognition of dialysis ( p = 0.034), and stronger receptivity to dialysis ( p < 0.001) were more likely to receive PD.ConclusionsWe recommend patients follow the standard process to obtain more exhaustive information, consultation, and early referral. In addition, we suggest healthcare providers remind patients to take into account such nonclinical factors as family support and patient receptivity when they choose their dialysis modality.

Clinical management of restless legs syndrome in end-stage renal disease patients

CNS Spectrums ◽  
2016 ◽  
Vol 22 (1) ◽  
pp. 14-21 ◽  
Author(s):  
Zeyad T. Sahli ◽  
Jae Jo ◽  
Shaker A. Mousa ◽  
Frank I. Tarazi
Keyword(s):  
Renal Disease ◽  
Restless Legs Syndrome ◽  
End Stage Renal Disease ◽  
Treatment Guidelines ◽  
Small Sample ◽  
Limited Information ◽  
Restless Legs ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Restless legs syndrome (RLS) is a common neurological movement disorder, characterized by restless and unpleasant sensations in the deep inside of legs. The symptoms of RLS are less noticeable during daytime, but more prevalent at night. Therefore, the disorder can induce low quality of life, insomnia, and impairment of daytime activity. RLS in end-stage renal disease (ESRD) patients is especially problematic due to premature discontinuation of dialysis and increased mortality. The prevalence of RLS among dialysis patients is much higher compared to the prevalence of the same disorder in patients with normal renal functions. Even though there are recommended treatment guidelines for the general population established by Medical Advisory Board of the RLS foundation, which include the use of dopamine agonists, levodopa, gabapentin, benzodiazepines, and opioids, limited information is available on the effects of these therapies in ESRD patients. Since the existing clinical data were extrapolated from small sample sizes in short-term clinical trials, further clinical studies are still needed to better assess the efficacy, safety, and tolerability of these medications in patients with ESRD.

scholarly journals Health-Related Quality of Life in End-Stage Renal Disease Patients: How Often Should We Ask and What Do We Do with the Answer?

2016 ◽  
Vol 41 (1-3) ◽  
pp. 218-224 ◽  
Author(s):  
Shan Shan Chen ◽  
Saleem Al Mawed ◽  
Mark Unruh
Keyword(s):  
Quality Of Life ◽  
Patient Reported Outcomes ◽  
Dialysis Patients ◽  
Patient Reported ◽  
Related Quality ◽  
Health Related ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: End-stage renal disease (ESRD) patients have poor health-related quality of life (HRQOL) comparing to general population and comparable HRQOL to patients with other major chronic diseases. Poor HRQOL is associated with shorter survival. There is a limited threshold to which dialysis dose and parameters management can improve HRQOL in ESRD patients. Numerous studies have sought to find interventions to improve HRQOL. This article is to review the symptoms associated with poor HRQOL and how frequent the quality of life (QOL) should be evaluated to improve the outcome. Summary: It is required by the Center for Medicare and Medicaid Services to evaluate HRQOL of dialysis patients annually. KDIGO recommends the symptoms to be assessed regularly and the treatment is redirected toward a patient-centered care model. Studies have shown that measuring patient-reported outcomes frequently, from 4 times a day to every 3-6 months, without intervention did not improve the HRQOL significantly. Appropriate intervention of the symptoms may improve the quality of life (QOL). Studies in oncology have also showed a similar result. The commonly used tools to evaluate the HRQOL in dialysis patients take up to 30 min for completion. Therefore, frequent assessment of all the symptoms can provide more burden than benefit to the patients. In addition to the annual HRQOL measurements, more frequent evaluation of targeted symptoms can be helpful. For appropriate intervention of the symptoms, effective communication between providers, as well as a multidisciplinary approach, is essential to improve HRQOL and outcomes in dialysis patients. Key Messages: Measurement of patient-reported outcomes may provide an opportunity to improve outcomes in ESRD. The frequent measurement of symptoms and QOL may be burdensome. Consider targeted measurement of symptoms to complement HRQOL measurement. Improved communication and the use of a multidisciplinary team provide mechanisms to improve HRQOL in ESRD.

scholarly journals Clinical correlates of the restless legs syndrome

2012 ◽  
Vol 70 (7) ◽  
pp. 529-531 ◽  
Author(s):  
Luis Fabiano Marin ◽  
Andre Carvalho Felicio ◽  
William Adolfo Santos ◽  
Lucila Bizari Prado ◽  
Gilmar Fernandes Prado
Keyword(s):  
Restless Legs Syndrome ◽  
Treatment Options ◽  
Disease Onset ◽  
Epidemiological Studies ◽  
Deficiency Anemia ◽  
Clinical Correlates ◽  
Restless Legs ◽  
Male Sex ◽  
Stage Renal Disease ◽  
End Stage

OBJECTIVE: To determine the clinical correlates of the restless legs syndrome (RLS) in a Brazilian sleep disorders center. METHODS: We retrospectively studied 118 patients with RLS from January, 2004, to December, 2010. The analyzed variables were: age at disease onset, gender, race, years of school instruction, primary and secondary RLS, and treatment options. RESULTS: Among the studied patients, 83.9% were women with a female/male sex ratio of 5:1. Mean age of the patients at symptom onset ± standard deviation was 41.7±17.9 years-old. The primary RLS was found in 85% of patients. The other 15% remainders consisted of secondary forms, and they were associated with neuropathy, iron deficiency anemia, end-stage renal disease, or Parkinson's disease. Drug therapy for RLS was introduced in 67% of patients. CONCLUSIONS: Most patients presented primary RLS with an early disease onset. Further epidemiological studies are welcomed to provide better information on secondary RLS in Brazil.

scholarly journals Lived Experience of Patients Undergoing Hemodialysis: Quality of Life Perspective

2016 ◽  
Vol 3 (2) ◽  
Author(s):  
Mrs. Rohini. T ◽  
Dr. Punitha. V. Ezhilarasu
Keyword(s):  
Quality Of Life ◽  
Lived Experience ◽  
Structured Interviews ◽  
Van Manen ◽  
Related Quality ◽  
Health Related ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

There is growing recognition of Health-Related Quality of Life (HRQOL) issues in End Stage Renal Disease (ESRD) patients undergoing Hemodialysis (HD). The aim of the present study was to explore the lived experience of Quality of Life (QOL) among patients undergoing Hemodialysis. The study involved a qualitative approach that used an interpretive hermeneutic phenomenology based on Van Manen’s method. The sample included seven patients undergoing Hemodialysis in two selected hospitals at Ernakulam district in Kerala. They were recruited by purposive sampling. Data were collected using semi-structured interviews. The thematic analysis followed the six steps delineated by Max Van Manen and four themes emerged. They were crestfallen life (3 sub themes; hard pressed life, deserted life and abounding losses); support and comfort; accompanying death and unfulfilled wishes. The findings shed light on the lived experience of QOL that has not yet been researched in an Indian scenario. The generated knowledge can be used by health professionals including nurses to help patients undergoing HD lead a life with better quality of life.

scholarly journals Health-related quality of life in end-stage renal disease patients, using the Missoula-Vitas quality of life index: a multicenter study

2019 ◽  
Author(s):  
Rositsa Dimova ◽  
Donka Keskinova ◽  
Valeri Tzekov ◽  
Gergana Ginova-Noncheva
Keyword(s):  
Quality Of Life ◽  
Health Related Quality ◽  
Life Index ◽  
Related Quality ◽  
Health Related ◽  
Quality Of Life Index ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background and aims. Assessment of Health-related Quality of Life in chronic hemodialysis patients (CHD) is a predictive indicator of the outcome of the disease, including mortality and hospitalization. Regular surveys of the quality of life (QoL) in CHD patients have been conducted  worldwide, using various, internationally validated and standardized tools, including the Missoula-VITAS Quality of Life Index scale (MVQOLI). The aim of this study was to examine the reliability and validity of the Bulgarian version of the Missoula-VITAS Quality of Life Index-15 (B-MVQOLI-15) and QoL in CHD patients using this instrument. Methods. Our study was designed as multi-center cross-sectional. It incorporated 263 end-stage renal disease (ESRD) patients on CHD from across the country and applied the B-MVQOLI-15. Internal consistency and convergent validity of the index were assessed. Non-parametric methods were used to evaluate  the impact of demographic factors on the different dimensions scores and on the total score. The relationship between the total QoL score, the total MVQOLI-15 score and dimensions scores were measured based on Spearman's rho Correlation Coefficient. Results. The total MVQOLI-15 score in the study was 16.44, which is slightly above the middle of the index scale. The patients with higher education were less satisfied with the level of their symptom control compared to patients with lower education. However, high education patients seem to manage better with everyday life compared to those with low education. Men seem to feel more satisfied  than women when fulfilling their daily activities (Р=0.026). Retired patients and unemployed expressed more satisfaction, compared to the employed (P=0.021). Also, patients on dialysis for over 5 years had lower QoL scores (Р=0.043). Conclusions. B-MVQOLI-15 is a reliable instrument to measure QoL in Bulgarian patients with CHD. The majority of CHD patients rate their QoL as “Fair“. Four of all five dimensions positively affect the QoL of CHD patients. The most important dimensions positively affecting the QoL of CHD patients were: interpersonal relationships and transcendent factors. Future studies are necessary to assess the adequacy of the delivered dialysis, the level of medico-social care and the needs of ESRD patients treated with CHD in order to improve their QoL.

Issues Related to the Care of Critically Ill Patients with End Stage Renal Failure

1992 ◽  
Vol 3 (3) ◽  
pp. 585-596
Author(s):  
Christy A. Price
Keyword(s):  
Renal Failure ◽  
Intensive Care ◽  
Critically Ill ◽  
End Stage Renal Disease ◽  
Treatment Options ◽  
Nursing Interventions ◽  
End Stage Renal Failure ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

End stage renal disease (ESRD) affects every aspect of an individual’s lifestyle. Pharmacologic, dietary, and treatment options and other organ involvement become daily realities for ESRD patients. When ESRD patients are admitted to intensive care units, these realities become concerns for the nurses. This article addresses the considerations that must be included in the nursing interventions for the critically ill ESRD patients

scholarly journals Freedom and Confinement: Patients’ Experiences of Life with Home Haemodialysis

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
C. Vestman ◽  
M. Hasselroth ◽  
M. Berglund
Keyword(s):  
Treatment Options ◽  
Healthcare Providers ◽  
Well Being ◽  
Dialysis Treatment ◽  
Home Haemodialysis ◽  
Need For Support ◽  
New Treatment ◽  
Stage Renal Disease ◽  
End Stage ◽  
And Control

Patients with chronic end stage renal disease need dialysis to survive; however, they also need a treatment that suits their life situation. It is important that healthcare providers provide reliable, up-to-date information about different dialysis treatment options. Since home haemodialysis is a relatively new treatment, it is necessary to gather more knowledge about what the treatment entails from the patient’s perspective. The aim of this study was to describe patients’ experiences of having home haemodialysis. To gain access to the patients’ experiences, they were asked to write narratives, which describe both their good and bad experiences of life with the treatment. The narratives were analysed with a qualitative method. The results of this analysis are subdivided into five themes: freedom to be at home and control their own treatment, feeling of being alone with the responsibility, changes in the home environment, need for support, and security and well-being with home haemodialysis. The conclusion is that home haemodialysis provides a certain level of freedom, but the freedom is limited as the treatment itself is restrictive. In order to improve patients’ experiences with home haemodialysis, more research based on patients’ experiences is needed and it is necessary to involve the patients in the development of the care.

scholarly journals Duchenne Smile is Associated with Quality of Life and Survival in Hemodialysis Patients

2020 ◽  
Vol 44 (3) ◽  
pp. 313-325
Author(s):  
Mabel Aoun ◽  
Ghassan Sleilaty ◽  
Leony Antoun ◽  
Racha Dib ◽  
Dania Chelala
Keyword(s):  
Quality Of Life ◽  
Hemodialysis Patients ◽  
Physical Component Score ◽  
Dialysis Patients ◽  
Duchenne Smile ◽  
Health Related Qol ◽  
Health Related ◽  
Stage Renal Disease ◽  
End Stage

Objectives: Hemodialysis is the most used renal replacement modality for end-stage renal disease patients. Dialysis patients are usually assessed for quality of life (QoL) but smiling was never studied. Duchenne smile is a genuine expression of joy, associated with better survival in some groups of the general population. In this study, we aimed to evaluate whether the smile of dialysis patients can predict their QoL and mortality. Methods: All hemodialysis patients in Saint-George Hospital were included in this prospective study. Patients were interviewed using the Health-Related QoL questionnaire and followed for 10 days for smile screening. Those who smiled more than 34% of time were considered as smiling, then followed for death over 2 years. Results: Overall, 71 patients were studied. Duchenne smile was associated with death at 1 and 2 years (HR = 0.194 [95% CI 0.039-0.958], p = .044) but not with sex or diabetes. Smiling showed a statistically significant correlation with older age, fewer hospitalizations, vitality, physical component score, several QoL scores and general health. Conclusions: A simple observation of patients' Duchenne smile by nephrologists in hemodialysis units can give an idea about their QoL and 2-year survival.

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