BackgroundEnd-stage kidney disease (ESKD) incidence has been increasing over time, contributing signi cantly to morbidity and early mortality.However, there is limited data examining the psychosocial factors affecting people with ESKD and how the social worker ts within the multidisciplinary CKD care. This integrative systematic review aims to summarise the existing evidence on psychosocial determinants of outcomes in ESKD and the role of renal social worker. Method:Literature search was conducted using PubMed and MEDLINE targeting articles published from database inception until May 2021.This systematic review was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The Joanna Briggs Institute tools were employed to assess the quality of included studies. ResultsOf the 397 citations, 13 studies applicable to 1465 patients met the inclusion criteria. The studies were of cross-sectional, experimental, and exploratory qualitative design in nature. The ndings of the studies were summarised into three major themespsychosocial factors, role of the renal social worker, and impact of the renal social worker. The studies demonstrated that concerns related to adjustment, death and dying, family and social functioning, and loss were common amongst participants of the included studies indicating the need for a social worker. Three studies explored the impact of social workers in ESKD, revealing people who receive support from social workers had an improved quality of life, lower depression scores, reduced hospitalisations, and emergency room visits. ConclusionThis review reports the multitude of physical and psychological stressors that patients with ESRD face, highlights the positive role renal social workers can play in improving the psychosocial stressors in this patient group and the need for large-scale randomised trials to understand the role of renal social workers as part of a multidisciplinary care.

Previous studies have suggested that acetate hemodialysis causes myocardial depression. This study examines the acute effects of hemodialysis using, alternately, bicarbonate and acetate in the dialysate, on cardiac function in ten patients. These patients were also studied during acetate dialysis using a large surface area (SA) dialyzer. Each patient was dialyzed for 4 hr with: (1) 1.0 m2 SA dialyzer and bicarbonate dialysate; (2) 1.0 m2 SA dialyzer and acetate bath, and; (3) 2.5 m2 SA dialyzer and acetate dialysate. All studies were performed during isovolemic dialysis to separate the effects of changes in cardiac filling volume with hemodialysis, from changes in myocardial contractility. Myocardial function, as assessed by pre- and postdialysis echocardiographically derived fractional shortening (Fs) and mean velocity of circumferential shortening (VCF), improved (P less than 0.05) to the same extent, after all three dialysis treatments. This occurred despite greater increases (P less than 0.002) in pH and bicarbonate after bicarbonate dialysis and decreases (P less than 0.05) in PO2, PCO2 and bicarbonate after acetate dialysis with 2.5 m2 SA dialyzer. These results indicate that diffusive dialysis with both acetate and bicarbonate dialysate improves myocardial function and do not support the view that acetate influx during dialysis can lead to myocardial depression.

Carotid pulse tracings and M-mode echocardiography were recorded in 25 patients on maintenance haemodialysis pre- and post-dialysis. Myocardial function, as assessed by fractional shortening and velocity of circumferential fibre shortening, was depressed in 7 out of 25 patients pre-dialysis (28%). Acute haemodialysis resulted in significant changes in body weight, mean arterial pressure, urea, creatinine and packed cell volumes in all patients. Left ventricular function, however, improved significantly only in that group of patients in which it was depressed prior to dialysis. Echocardiography provides a simple means for evaluating left ventricular function in patients on chronic haemodialysis and shows that cardiac performance improves with acute dialysis when it is depressed pre-dialysis.

Background End-stage kidney disease (ESKD) incidence has been increasing over time, contributing significantly to morbidity and early mortality. However, there is limited data examining the psychosocial factors affecting people with ESKD and how the social worker fits within the multidisciplinary CKD care. This integrative systematic review aims to summarise the existing evidence on psychosocial determinants of outcomes in ESKD and the role of renal social worker. Method: Literature search was conducted using PubMed and MEDLINE targeting articles published from database inception until May 2021. This systematic review was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The Joanna Briggs Institute tools were employed to assess the quality of included studies. Results Of the 397 citations, 13 studies applicable to 1465 patients met the inclusion criteria. The studies were of cross-sectional, experimental, and exploratory qualitative design in nature. The findings of the studies were summarised into three major themes — psychosocial factors, role of the renal social worker, and impact of the renal social worker. The studies demonstrated that concerns related to adjustment, death and dying, family and social functioning, and loss were common amongst participants of the included studies indicating the need for a social worker. Three studies explored the impact of social workers in ESKD, revealing people who receive support from social workers had an improved quality of life, lower depression scores, reduced hospitalisations, and emergency room visits. Conclusion This review reports the multitude of physical and psychological stressors that patients with ESRD face, highlights the positive role renal social workers can play in improving the psychosocial stressors in this patient group and the need for large-scale randomised trials to understand the role of renal social workers as part of a multidisciplinary care.