The effects of supported shared‐care and hemodialysis self‐care on patient psychological well‐being, interdialytic weight gain, and blood pressure control

Maharjan, Sarju Raj Singh; Davenport, Andrew

doi:10.1111/hdi.12799

Cited by 10 publications

(11 citation statements)

References 30 publications

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“…Patient comorbidity was coded using both the Charlson co‐morbidity score, excluding both age and chronic renal failure, and the UK Stoke–Davies grading [11,12], and the distress thermometer used to assess patient psychological wellbeing [13]. Hand grip and pinch strength (HGS, PS) [14,15], and the Rockwood clinical frailty scale [16] (Appendix S1) were used to assess physical function.…”

Section: Methodsmentioning

confidence: 99%

Prehemodialysis hyponatremia and extracellular water: Is it simply too much water?

Chhabra

Davenport

2021

Ther Apher Dial

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Observational hemodialysis (HD) studies report an association between hyponatremia and increased mortality. As volume overload is also associated with mortality, we wished to determine whether hyponatremia is linked to increased extracellular water (ECW). We measured ECW, total body water (TBW) and body composition predialysis with multifrequency bioimpedance, arm strength with pinch gauge and hand grip strength (PS, HGS), standard biochemistry profiles, comorbidity and clinical frailty scores (CFS). We reviewed 324 patients, 195 (60.2%) male, mean age 62.3 ± 15.6 years. Thirty‐eight (11.7%) patients were hyponatremic (sodium ≤135 mmol/L), ECW/height2 was not different, but ECW/TBW (0.409 ± 0.016 vs. 0.402 ± 0.016, p < 0.01), C reactive protein (CRP) (9(4–6) vs. 5(2–12) g/L, p < 0.05), CFS (5(4–6) vs. 4(3–6), p < 0.05) were higher in hyponatremic patients, whereas appendicular lean mass index (8.6 ± 1.7 vs. 9.4 ± 1.8 kg/m2, p < 0.01), serum albumin (36.3 ± 5.5 vs. 38.8 ± 5.0 g/L, p < 0.01) and PS (3.7(2.7–4.7) vs. 4.7 (3.2–6.5) kg, p < 0.05)) were lower. Both serum sodium, and serum sodium after adjustment for glucose were associated with serum creatinine (β 4.26, (95% confidence limits [CL] 1.9–6.7), β 3.98 (CL 1.6–6.4), both p = 0.001, respectively) and negatively with CRP (β −0.76, [CL] ‐1.5 to −0.5), β −0.72 (CL −1.44 to −0.12), p = 0.036, p = 0.046, respectively) in a multivariable model. Hyponatremic HD patients did not simply have an increased ECW, as the increased ECW/TBW and ECW/ICW ratios were more likely secondary to loss of muscle mass and strength, associated with increased CRP and reduced albumin, suggesting that hyponatremia is associated with inflammation, loss of muscle mass and increasing frailty.

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Section: Methodsmentioning

confidence: 99%

Prehemodialysis hyponatremia and extracellular water: Is it simply too much water?

Chhabra

Davenport

2021

Ther Apher Dial

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“…Worldwide, haemodialysis (HD) is the most common form of treatment (2)(3)(4). Although it allows patients to extend their life expectancy (5), this treatment is highly complex and requires several restrictions and life readjustments, not only for the patients but also for their family members (1,4,6,7). Patients need to adhere to a restrictive diet and fluid intake (6,8) and regularly attend to dialysis centres or consultations, hospitals, and clinics, and take different medications.…”

Section: Introductionmentioning

confidence: 99%

“…Although it allows patients to extend their life expectancy (5), this treatment is highly complex and requires several restrictions and life readjustments, not only for the patients but also for their family members (1,4,6,7). Patients need to adhere to a restrictive diet and fluid intake (6,8) and regularly attend to dialysis centres or consultations, hospitals, and clinics, and take different medications. As a consequence, patients and their close family members have to reschedule their lives to fit these demands (8,9), which may have a negative impact on their quality of life (QoL) and psychological well-being.…”

Section: Introductionmentioning

confidence: 99%

“What do we fear the most?”: Exploring fears and concerns of patients, family members and dyads in end‐stage renal disease

Frontini

Sousa

Ribeiro

et al. 2020

Scandinavian Caring Sciences

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Introduction: End-stage renal disease (ESRD) and the need for haemodialysis (HD) treatment are increasing. The course of the disease and all the life readjustments needed may generate a multitude of fears in patients and families. Aim: This study aimed to explore the main fears and concerns of patients with ESRD undergoing HD and their family members.Study design.A qualitative study was performed. Methods: Individual semi-structured interviews were conducted with three groups: 20 patients, 14 family caregivers and 15 patient-family dyads. Interviews were audiotaped, transcribed verbatim and submitted to thematic analysis.Findings.Five major themes emerged: (i) fear of death (fear of earlier death, fear of a sudden death and fear of dying); (ii) fear of problems during HD (fears related to the vascular access, and fear of complications during HD); (iii) concerns related to the disease (fear of loss of autonomy, fears of getting worse, fears related to renal transplantation and concerns about dietary restrictions); (iv) fear about the future; and (v) absence of fears and concerns. Discussion: Patients with ESRD undergoing HD and their family members expressed different fears related to the disease and the treatments required. Renal care staff must acknowledge and understand such concerns and help patients and families to cope. This is important to improving people's quality of life (QoL), the dialogue between health professionals, patients, and family members, and the care offered by the dialysis care settings. Moreover, this study highlights the impact this disease has at a familial level. Future family-based interventions should acknowledge possible fears and concerns of this population and integrate them into their programs.

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“…Single center observational studies of in‐center self‐care hemodialysis have reported positive findings with respect to hospitalization rates, missed treatments and survival compared to patients receiving conventional in‐center hemodialysis 14 . Self‐care approaches have been successful in other chronic disease states as well as in chronic kidney disease 15‐22 …”

Section: Introductionmentioning

confidence: 99%

“…14 Self-care approaches have been successful in other chronic disease states as well as in chronic kidney disease. [15][16][17][18][19][20][21][22] One of the barriers to self-care hemodialysis both in the home and in-center settings has been the absence of technology that enables patients to easily learn and confidently manage their treatment in a time efficient manner with minimal burden on health care workers or caregivers. 15 The Tablo hemodialysis system is an all-in-one, patientcentric system designed to be easy to learn and manage with on-demand dialysate production and two-way wireless connectivity.…”

Section: Introductionmentioning

confidence: 99%

Self‐care training using the Tablo hemodialysis system

Plumb

Álvarez²,

Ross³

et al. 2020

Hemodialysis International

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Introduction Recently published results of the investigational device exemption (IDE) trial using the Tablo hemodialysis system confirmed its safety and efficacy for home dialysis. This manuscript reports additional data from the Tablo IDE study on the training time required to be competent in self‐care, the degree of dependence on health care workers and caregivers after training was complete, and participants' assessment of the ease‐of‐use of Tablo. Methods We collected data on the time required to set up concentrates and the Tablo cartridge prior to treatment initiation. We asked participants to rate system setup, treatment, and takedown on a Likert scale from 1 (very difficult) to 5 (very simple) and if they had required any assistance with any aspect of treatment over the prior 7 days. In a subgroup of 15 participants, we recorded the number of training sessions required to be deemed competent to do self‐care dialysis. Findings Eighteen men and 10 women with a mean age of 52.6 years completed the study. Thirteen had previous self‐care experience using a different dialysis system. Mean set up times for the concentrates and cartridge were 1.1 and 10.0 minutes, respectively. Participants with or without previous self‐care experience had similar set‐up times. The mean ease‐of‐use score was 4.5 or higher on a scale from 1 to 5 during the in‐home phase. Sixty‐five percent required no assistance at home and on average required fewer than four training sessions to be competent in managing their treatments. Results were similar for participants with or without previous self‐care experience. Conclusions Participants in the Tablo IDE trial were able to quickly learn and manage hemodialysis treatments in the home, found Tablo easy to use, and were generally independent in performing hemodialysis.

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The effects of supported shared‐care and hemodialysis self‐care on patient psychological well‐being, interdialytic weight gain, and blood pressure control

Cited by 10 publications

References 30 publications

Prehemodialysis hyponatremia and extracellular water: Is it simply too much water?

Prehemodialysis hyponatremia and extracellular water: Is it simply too much water?

“What do we fear the most?”: Exploring fears and concerns of patients, family members and dyads in end‐stage renal disease

Self‐care training using the Tablo hemodialysis system

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