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Your search term(s) "Dialysis" returned 150 results.

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Psychosocial Adaptation of Dialysis Patients. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 927-936.

The residual uremic symptoms and the burden of the treatment itself prevent dialysis patients from attaining a state of full health. The perception of a continuous chronic illness combined with the intrusive nature of the dialysis treatments can interfere with many aspects of the patient’s life. The degree to which an individual patient can adapt to these medical and psychosocial stresses will determine quality of life. This chapter on the psychosocial adaptation of dialysis patients is from a comprehensive textbook on the clinical management of patients on dialysis. The author discusses measurement issues, the assessment of overall quality of life, disease-specific quality of life, neuropsychological function, social functioning, functional status, vocational rehabilitation, and patient compliance. The author provides a brief review of related recent research in each of these areas. 1 table. 79 references.

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Psychosocial Care of Children on Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 937-948.

This chapter on the psychosocial care of children on dialysis is from a comprehensive textbook on the clinical management of patients on dialysis. After reviewing what is known about the epidemiology of psychosocial problems in children and adolescents with kidney disease and those on dialysis in particular, the authors discuss general issues of concern in the psychosocial domain with respect to child nephrology and dialysis patients. Topics include psychosomatic relationships, renal failure as a risk factor for psychiatric disorder in children, coping behaviors and psychological defenses in children, care of the dying child, the burden of dialysis treatment and care, the complexity of syndromes associated with chronic renal failure (CRF), nonadherence and patient compliance issues, the early detection of mental health problems, and specific disorders, including adjustment disorders, depression, eating disorders, posttraumatic stress disorders, confusional states, fear of procedures, separation anxiety, and short stature. The authors also introduce and describe a proposed model of psychosocial care. The authors stress that all members of the nephrology clinical team have a role in psychosocial care of these children and their families. A functional psychosocial team should be able to recognize when children have significant mental health problems, seek appropriate advice, and make appropriate referrals for specialist mental health assessment and intervention. 22 references.

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Quality, Safety, and Accountability in Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 963-980.

This chapter on quality, safety, and accountability in dialysis is from a comprehensive textbook on the clinical management of patients on dialysis. The author begins by introducing some of the problems found in end stage renal disease (ESRD) facilities and current goals to address those problems. Patient safety, which is a subset of health care quality, is defined as freedom from accidental injury stemming from the processes of health care. Medical errors are a subset of safety, but patient safety also includes the establishment of an environment that is designed to minimize adverse events that may be unrelated to medical errors. Quality is seen as a subset of a larger universe of health care delivery attributes. The author reviews various models of quality improvement, recommendations for improving patient safety, and accountability issues. The author concludes that, given the complexity of health care delivery in general and the variability and unpredictability of patient outcomes in particular, it is unrealistic for payers and oversight agencies to set rigid standards of performance by providers, especially when no clear unanimity exists regarding many processes of care. A system of public accountability must include case mix adjustment strategies to minimize patient selection bias and to encourage facilities to accept high-risk patients without fear that their adverse outcomes may have a negative impact on the facility’s profile. 2 figures. 13 tables. 62 references.

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Quotidian Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 1055-1072.

Daily (quotidian) hemodialysis is practiced on average six times a week. The short daily form lasts for an average of 2 to 2.5 hours at maximal blood and dialysate flow rates and is practiced in dialysis centers or at home. The long nightly version is practiced mainly at home for an average of 8 hours using lower blood and dialysate flows. This chapter on quotidian hemodialysis is from a comprehensive textbook on the clinical management of patients on dialysis. The authors first review the different types of hemodialysis, then describe the history, method, patient selection and training, and solute removal associated with daily hemodialysis. The authors also consider outcome factors, including health economics and quality of life; cardiovascular outcomes, such as blood pressure, left ventricular geometry, and other cardiovascular changes; mechanistic analyses; erythropoietin dose and anemia control; the role of nutrition; and related factors including mineral metabolism, sleep disorders, patient survival, daily hemofiltration, and a comparison of the modalities. The authors conclude that quotidian hemodialysis in both short and long forms provides improvement in quality of life, blood pressure control, phosphate control, and anemia control, as well as in improved nutrition. The increasing use of these methods, along with other nightlong hemodialysis modalities, will provide revitalization of home hemodialysis, bringing the benefits of increased patient independence and social and vocational rehabilitation to more patients while also providing a solution to the nursing shortage. 1 figure. 2 tables. 127 references.

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Suicide in the United States End-Stage Renal Disease Program. Journal of the American Society of Nephrology. 16(3): 774-781. March 2005.

Although depression and dialysis withdrawal are relatively common among individuals with end-stage renal disease (ESRD), there have been few systematic studies of suicide in this population. This article reports on a study that compared the incidence of suicide in patients in the United States ESRD program with national rates of individuals not in the program. All individuals who were aged 15 years and older and who initiated dialysis between April 1995 and November 2000 were in the cohort. Patients were monitored at the time of death, transplantation, or October 31, 2001. Death as a result of suicide in the ESRD population and the general United States population was ascertained from the Death Notification Form and the Centers for Disease Control and Prevention, respectively. Of the 465,563 patients included in the analysis, 44,465 (9.6 percent) withdrew from dialysis before death and 264 (0.005 percent) died from suicide. The crude suicide rate from 1995 to 2001 was 24.2 suicides per 100,000 patient-years, and the overall standardized incidence ratio for suicide was 1.84. In analyses, age older than 75 years, male gender, white or Asian race, geographic region, alcohol or drug dependence, and recent hospitalization with mental illness were significant independent predictors of death as a result of suicide. Persons with ESRD are significantly more likely to commit suicide than persons in the general population. The authors conclude that risk assessment could be used to identify patients for whom counseling and other interventions might be beneficial. 4 tables. 31 references.

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Support for Acute Renal Failure. Care of the Critically Ill. 21(4): 105-112. August 2005.

This article addresses the definitions, diagnosis, and care of acute renal failure (ARF). The authors note that although critical care physicians can all recognize ARF, there is no agreed-upon definition, nor is there consensus on successful management end points. Patient premorbid states vary significantly, causes of kidney dysfunction are heterogeneous, and renal recovery rates are influenced by whether the primary pathophysiological cause has been controlled. The author briefly reviews the anatomy and physiology of the kidney, then discusses ARF and its measurement, diagnostic and laboratory testing approaches, the causes of renal dysfunction, the principles of RRT (convection, diffusion, adsorption), the choice of renal replacement therapy (RRT, usually dialysis), hemodialysis versus peritoneal dialysis, continuous RRT, dialysis dose, membrane choice, the need for anticoagulation of the extracorporeal circuit, buffer solutions, and how RRT affects mortality. The section on the causes of renal dysfunction covers shock, nephrotoxic drugs, chronic or intrinsic renal disease, and problems with contrast media. 1 figure. 3 tables. 22 references.

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Surgical Issues in Pediatric Peritoneal Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 1081-1090.

Although peritoneal dialysis is the predominant modality for children with end stage renal disease (ESRD), there must be adequate peritoneal access for this method to be successful. This chapter on surgical issues in pediatric peritoneal dialysis is from a comprehensive textbook on the clinical management of patients on dialysis. The author reviews different catheter and surgical insertion techniques as well as lessons to be learned from the literature of this field. Topics covered include access types, preoperative evaluation and preparation, omentectomy, fibrin sealant, the choice of surgical technique, open technique, laparascopic technique, postimplantation care, the timing of catheter use, mechanical complications, exit-site infection, tunnel infection, peritonitis, the timing of catheter removal after kidney transplantation, and complications associated with peritoneal dialysis catheter removal. In each area, the author briefly summarizes the related research literature. 9 figures. 39 references.

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Survival Advantage of Hispanic Patients Initiating Dialysis in the United States Is Modified by Race. Journal of the American Society of Nephrology. 16(3): 782-790. March 2005.

Differences in survival have been reported among ethnic groups in the general population. This article reports on a study of the survival of Hispanic and non-Hispanic patients initiating dialysis in the United States. The overall survival of new end-stage renal disease (ESRD) patients of Hispanic ethnicity is substantially greater than that of non-Hispanics, with a 17 percent lower adjusted mortality risk among those without diabetes and a 30 percent lower adjusted mortality risk among those with diabetes. However, this survival advantage is not consistent across all Hispanic subgroups, with Hispanic whites and Hispanic blacks experiencing the lowest and Hispanic others experiencing the highest mortality rates. These differences in mortality outcomes cannot be explained easily by differences in baseline comorbidity profiles among groups, or by differences in transplantation rates during follow-up. The authors conclude that the survival advantage of Hispanic over non-Hispanic patients who receive chronic dialysis treatment in the United States is not consistent across subgroups and is modified by race. The authors hypothesize that cultural and genetic differences as well as variation in the access and delivery of care before and while on dialysis may account for these differences. 2 figures. 5 tables. 38 references.

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Technologic Aspects of Hemodialysis and Peritoneal Dialysis. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 47-84.

This chapter on the technologic aspects of hemodialysis (HD) and peritoneal dialysis (PD) is from a textbook on the clinical care of dialysis patients. The author focuses on technical aspects related to the delivery of dialysis as well as to the measurement of effects resulting from the perturbations caused by the treatment. There is great need to measure treatment and patient variables to identify the state of the patient, so the extracorporeal blood circulation and the management of dialysate are described in some detail. The author also considers the important question of whether the prescribed dose of dialysis is indeed delivered with every treatment; success in this area will help to reduce treatment variability and system failure and will help improve patient and staff compliance. Specific topics covered include blood flow, pressure, thermal energy flow, the dialysate and its delivery, clearance and dialysis quantification, modes of delivery, feedback control, and peritoneal dialysis, including automated peritoneal dialysis (APD) and the role of telemedicine in PD. 12 figures. 1 table. 165 references.

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Understanding Your Peritoneal Dialysis Options. Tampa, FL: American Association of Kidney Patients, 2005. 16 p.

Peritoneal dialysis (PD) is one of the available treatment options to remove waste products and excess fluid from the blood when the kidneys are no longer functioning properly. This booklet, from the American Association of Kidney Patients (AAKP), reviews the option of PD as a treatment for advanced kidney disease. The booklet first briefly reviews the physiology and function of the kidneys, then explains how PD works by using the patient's own peritoneum as the filter for dialysis. The author explains how access is established to the peritoneal cavity and what to expect during the learning process. The booklet then outlines the two different types of PD: continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD). The booklet guides readers through the decision-making process for each type of PD, considering issues such as responsibility for patient care, body image, fluid overload, discomfort, and peritonitis. The booklet concludes with a glossary of related terms, a list of questions to help patients decide if PD is the right choice for them, blank space for notes, and a form for joining AAKP. 4 figures. 2 tables.

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