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Kidney Medicine Oct 2022To what degree and how patient navigators improve clinical outcomes for patients with chronic kidney disease (CKD) and kidney failure is uncertain. We performed a...
RATIONALE & OBJECTIVE
To what degree and how patient navigators improve clinical outcomes for patients with chronic kidney disease (CKD) and kidney failure is uncertain. We performed a systematic review to summarize patient navigator program design, evidence, and implementation in kidney disease.
STUDY DESIGN
A search strategy was developed for randomized controlled trials and observational studies that evaluated the impact of navigators on outcomes in the setting of CKD and kidney failure. Articles were identified from various databases. Two reviewers independently screened the articles and identified those meeting the inclusion criteria.
SETTING & PARTICIPANTS
Patients with CKD or kidney failure (in-center hemodialysis, peritoneal dialysis, home hemodialysis, or kidney transplantation).
SELECTION CRITERIA FOR STUDIES
Studies that compared patient navigators with a control, without limits on size, duration, setting, or language. Studies focusing solely on patient education were excluded.
DATA EXTRACTION
Data were abstracted from full texts and risk of bias was assessed.
ANALYTICAL APPROACH
No meta-analysis was performed.
RESULTS
Of 3,371 citations, 17 articles met the inclusion criteria including 14 original studies. Navigators came from various healthcare backgrounds including nursing (n=6), social worker (n=2), medical interpreter (n=1), research (n=1), and also included kidney transplant recipients (n=2) and non-medical individuals (n=2). Navigators focused mostly on education (n=9) and support (n = 6). Navigators were used for patients with CKD (n=5), peritoneal dialysis (n=2), in-center hemodialysis (n=4), kidney transplantation (n=2), but not home hemodialysis. Navigators improved transplant workup and listing, peritoneal dialysis utilization, and patient knowledge.
LIMITATIONS
Many studies did not show benefits across other outcomes, were at a high risk of bias, and none reported cost-effectiveness or patient-reported experience measures.
CONCLUSIONS
Navigators improve some health outcomes for CKD but there was heterogeneity in their structure and function. High-quality randomized controlled trials are needed to evaluate navigator program efficacy and cost-effectiveness.
PubMed: 36185707
DOI: 10.1016/j.xkme.2022.100540 -
International Journal of Nursing... Dec 2022Peritoneal dialysis (PD) is a major renal replacement therapy modality for patients with end-stage kidney disease (ESKD) worldwide. As poor self-care of PD patients...
BACKGROUND
Peritoneal dialysis (PD) is a major renal replacement therapy modality for patients with end-stage kidney disease (ESKD) worldwide. As poor self-care of PD patients could lead to serious complications, including peritonitis, exit-site infection, technique failure, and death; several nurse-based educational interventions have been introduced. However, these interventions varied and have been supported by small-scale studies so the effectiveness of nurse-based educational interventions on clinical outcomes of PD patients has been inconclusive.
OBJECTIVES
To evaluate the effectiveness of nurse-based education interventions in PD patients.
DESIGN
A systematic review and meta-analysis of Randomized Controlled Trials (RCTs).
METHODS
We performed a systematic search using PubMed, Embase, and CENTRAL up to December 31, 2021. Selection criteria included Randomized Controlled Trials (RCTs) relevant to nurse-based education interventions in ESKD patients with PD in the English language. The meta-analyses were conducted using a random-effects model to evaluate the summary outcomes of peritonitis, PD-related infection, mortality, transfer to hemodialysis, and quality of life (QoL).
RESULTS
From 9,816 potential studies, 71 theme-related abstracts were selected for further full-text articles screening against eligibility criteria. As a result, eleven studies (1,506 PD patients in seven countries) were included in our systematic review. Of eleven studies, eight studies (1,363 PD patients in five countries) were included in the meta-analysis. Sleep QoL in the intervention group was statistically significantly higher than control (mean difference = 12.76, 95% confidence intervals 5.26-20.27). There was no difference between intervention and control groups on peritonitis, PD-related infection, HD transfer, and overall QoL.
CONCLUSIONS
Nurse-based educational interventions could help reduce some PD complications, of which only the sleep QoL showed statistically significant improvement. High-quality evidence on the nurse-based educational interventions was limited and more RCTs are needed to provide more robust outcomes.
TWEETABLE ABSTRACT
Nurse-based educational interventions showed promising sleep quality improvement and potential peritonitis risk reduction among PD patients.
PubMed: 38745642
DOI: 10.1016/j.ijnsa.2022.100102 -
BMC Nephrology Aug 2022Telehealth could potentially increase independency and autonomy of patients treated with peritoneal dialysis (PD). Moreover, it might improve clinical and economic...
BACKGROUND
Telehealth could potentially increase independency and autonomy of patients treated with peritoneal dialysis (PD). Moreover, it might improve clinical and economic outcomes. The demand for telehealth modalities accelerated significantly in the recent COVID-19 pandemic. We evaluated current literature on the impact of telehealth interventions added to PD-care on quality of life (QoL), clinical outcomes and cost-effectiveness.
METHODS
An electronic search was performed in Embase, PubMed and the Cochrane Library in order to find studies investigating associations between telehealth interventions and: i. QoL, including patient satisfaction; ii. Standardized Outcomes in Nephrology (SONG)-PD clinical outcomes: PD-related infections, mortality, cardiovascular disease and transfer to hemodialysis (HD); iii. Cost-effectiveness. Studies investigating hospitalizations and healthcare resource utilization were also included as secondary outcomes. Due to the heterogeneity of studies, a meta-analysis could not be performed.
RESULTS
Sixteen reports (N = 10,373) were included. Studies varied in terms of: sample size; design; risk of bias, telehealth-intervention and duration; follow-up time; outcomes and assessment tools. Remote patient monitoring (RPM) was the most frequently studied intervention (11 reports; N = 4982). Telehealth interventions added to PD-care, and RPM in particular, might reduce transfer to HD, hospitalization rate and length, as well as the number of in-person visits. It may also improve patient satisfaction.
CONCLUSION
There is a need for adequately powered prospective studies to determine which telehealth-modalities might confer clinical and economic benefit to the PD-community.
Topics: COVID-19; Humans; Pandemics; Peritoneal Dialysis; Prospective Studies; Quality of Life; Telemedicine
PubMed: 35999512
DOI: 10.1186/s12882-022-02869-6 -
Langenbeck's Archives of Surgery Nov 2022An increasing number of patients treated with peritoneal dialysis eventually undergo kidney transplantation. Owing to opposing reports, we aimed to find evidence about... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
An increasing number of patients treated with peritoneal dialysis eventually undergo kidney transplantation. Owing to opposing reports, we aimed to find evidence about the best time for peritoneal dialysis catheter removal in transplant patients.
METHODS
We conducted a systematic review and random effects meta-analysis of non-randomized studies of intervention comparing patients with peritoneal dialysis catheters left in place or removed during kidney transplantation in regard to the need for dialysis and occurrence of catheter-related complications. We searched (last update on 8 December 2021) PubMed, Embase, Scopus, and Web of Science for eligible studies. ROBINS-I tool and funnel plot asymmetry analysis were used to assess the quality of included articles.
RESULTS
Eight observational studies were evaluated. Five of them, which involved 338 patients, were included in a meta-analysis. All were at moderate to serious risk of bias. The odds of needing dialysis are more than twice as high for patients with peritoneal dialysis catheters left in situ (pooled odds ratio, 2.21; 95% confidence interval [CI], 1.03 to 4.73; I = 0%). No statistically significant difference was noted when adult and pediatric subgroups were compared (Q = 0.13, P = .720). More individuals with catheters left in place required dialysis (pooled prevalence, 20.9%; 95% CI, 13.6 to 30.7%; I = 59% vs. 12.4%; 95% CI, 5.6 to 25.2%; I = 0%) and experienced catheter-related infections.
CONCLUSION
Available evidence is scarce. Unless new data from a randomized controlled trial are available, the dilemma of peritoneal dialysis catheter removal cannot be solved.
TRIAL REGISTRATION
PROSPERO Protocol ID: CRD42020207707.
Topics: Adult; Humans; Child; Kidney Transplantation; Catheters, Indwelling; Peritoneal Dialysis; Time Factors; Postoperative Complications; Randomized Controlled Trials as Topic
PubMed: 35945300
DOI: 10.1007/s00423-022-02637-y -
The Journal of Antimicrobial... Sep 2022Trichoderma spp. are filamentous fungi causing invasive fungal diseases in patients with haematological malignancies and in peritoneal dialysis patients.
BACKGROUND
Trichoderma spp. are filamentous fungi causing invasive fungal diseases in patients with haematological malignancies and in peritoneal dialysis patients.
OBJECTIVES
To analyse clinical presentation, predisposing factors, treatment and outcome of Trichoderma infections.
METHODS
A systematic literature review was conducted for published cases of invasive Trichoderma infection in PubMed until December 2021 and by reviewing the included studies' references. Cases from the FungiScope® registry were added to a combined analysis.
RESULTS
We identified 50 invasive infections due to Trichoderma species, including 11 in the FungiScope® registry. The main underlying conditions were haematological malignancies in 19 and continuous ambulatory peritoneal dialysis (CAPD) in 10 cases. The most prevalent infection sites were lung (42%) and peritoneum (22%). Systemic antifungal therapy was administered in 42 cases (84%), mostly amphotericin B (n = 27, lipid-based formulation 13/27) and voriconazole in 15 cases (30%). Surgical interventions were performed in 13 cases (26%). Overall mortality was 48% (n = 24) and highest for allogeneic HSCT and solid organ transplantation (SOT) recipients [80% (4/5) and 77% (7/9), respectively]. In patients treated with amphotericin B, voriconazole and caspofungin, mortality was 55% (15/27), 46% (7/15) and 28% (2/7), respectively. Three out of four patients treated with a combination therapy of voriconazole and caspofungin survived.
CONCLUSIONS
Despite treatment with antifungal therapies and surgery, invasive Trichoderma infections are life-threatening complications in immunocompromised patients, especially after HSCT and SOT. In addition, Trichoderma spp. mainly affect the lungs in patients with haematological malignancies and the peritoneum in CAPD patients.
Topics: Amphotericin B; Antifungal Agents; Caspofungin; Hematologic Neoplasms; Humans; Registries; Trichoderma; Voriconazole
PubMed: 35929089
DOI: 10.1093/jac/dkac235 -
Computational and Mathematical Methods... 2022To systematically evaluate the effects of peritoneal dialysis and hemodialysis on renal function and quality of life in patients with end-stage renal disease. An... (Meta-Analysis)
Meta-Analysis
Effects and Clinical Value of Peritoneal Dialysis on Water and Water Balance, Adverse Reactions, Quality of Life, and Clinical Prognosis in Patients with Decompensated Chronic Nephropathy: A Systematic Review and Meta-Analysis.
OBJECTIVE
To systematically evaluate the effects of peritoneal dialysis and hemodialysis on renal function and quality of life in patients with end-stage renal disease. An evidence-based medical rationale would be provided for peritoneal dialysis or hemodialysis treatment in patients with end-stage renal disease.
METHODS
The PubMed, EMBASE, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure (CNKI), China VIP Database, Wanfang, and China Biomedical Literature Database (CBM) online databases were searched. Comparisons on the effects of peritoneal dialysis on renal function and quality of life were taken between patients with end-stage renal disease (RD). The data were extracted independently by two researchers. The bias-risk-included literatures were assessed according to the Cochrane manual 5.1.0 standard. RevMan 5.4 statistical software was used to analyze the collected data via meta-analysis.
RESULTS
Seven RCT articles were finally included. A total of 745 samples were analyzed via meta-analysis. The obvious heterogeneities of serum creatinine (Scr) and blood urea nitrogen (BUN) were discovered ( < 0.00001) in the selective investigations. According to the results of this analysis, it was indicated that the renal function of patients with end-stage renal disease treated by peritoneal dialysis was significantly better than that of hemodialysis. According to the meta-analysis, there was obvious heterogeneity of life quality among the included research data. It was indicated that the score of quality of life of patients with end-stage renal disease treated by peritoneal dialysis was significantly better than that of hemodialysis.
CONCLUSION
Compared with hemodialysis in the treatment of end-stage renal disease, the renal function and quality of life of patients with peritoneal dialysis are better than those of hemodialysis. More further studies and follow-up with higher methodological quality and longer intervention time are still needed for further verification.
Topics: Humans; Kidney Failure, Chronic; Peritoneal Dialysis; Prognosis; Quality of Life; Renal Dialysis; Water
PubMed: 35898489
DOI: 10.1155/2022/9469134 -
Frontiers in Pharmacology 2022Protein binding can diminish the pharmacological effect of beta-lactam antibiotics. Only the free fraction has an antibacterial effect. The aim of this systematic...
Protein binding can diminish the pharmacological effect of beta-lactam antibiotics. Only the free fraction has an antibacterial effect. The aim of this systematic literature review was to give an overview of the current knowledge of protein binding of cephalosporins in human body fluids as well as to describe patient characteristics influencing the level of protein binding. A systematic literature search was performed in Embase, Medline ALL, Web of Science Core Collection and the Cochrane Central Register of Controlled Trials with the following search terms: "protein binding," "beta-lactam antibiotic," and "body fluid." Only studies were included where protein binding was measured in humans . The majority of studies reporting protein binding were performed in serum or plasma. Other fluids included pericardial fluid, blister fluid, bronchial secretion, pleural exudate, wound exudate, cerebrospinal fluid, dialysate, and peritoneal fluid. Protein binding differs between diverse cephalosporins and between different patient categories. For cefazolin, ceftriaxone, cefpiramide, and cefonicid a non-linear pattern in protein binding in serum or plasma was described. Several patient characteristics were associated with low serum albumin concentrations and were found to have lower protein binding compared to healthy volunteers. This was for critically ill patients, dialysis patients, and patients undergoing cardiopulmonary bypass during surgery. While mean/median percentages of protein binding are lower in these patient groups, individual values may vary considerably. Age is not likely to influence protein binding by itself, however limited data suggest that lower protein binding in newborns. Obesity was not correlated with altered protein binding. Conclusions on protein binding in other body fluids than blood cannot be drawn due to the scarcity of data. In serum and plasma, there is a large variability in protein binding per cephalosporin and between different categories of patients. Several characteristics were identified which lead to a lower protein binding. The finding that some of the cephalosporins display a non-linear pattern of protein binding makes it even more difficult to predict the unbound concentrations in individual patients. Taken all these factors, it is recommended to measure unbound concentrations to optimize antibiotic exposure in individual patients. PROSPERO, identifier (CRD42021252776).
PubMed: 35837288
DOI: 10.3389/fphar.2022.900551 -
Frontiers in Bioscience (Landmark... Jun 2022This study was to explore the research status and research hotspots of ferritinophagy in the past eight years.
OBJECTIVE
This study was to explore the research status and research hotspots of ferritinophagy in the past eight years.
METHODS
Relevant papers on ferritinophagy from 2014 to 2021 was retrieved from the science citation extended database of the Web of Science. Through the application of bibliometrics research methods and bibliometrics analysis software VOSviewer to extract, analyze and visualize journals, authors, research institutions and keywords, to clarify the hot spots and development history of peritoneal dialysis research.
RESULTS
A total of 134 studies were screened and included in this study. Overall, the output of ferritinophagy research had fluctuated in the past 8 years. China's research on ferritinophagy had the largest number of published articles. The United States still maintained a leading position in research in this field, and its citation frequency, H-index and funding output are all at the forefront. Among them, international cooperation with relevant institutions was also more frequent. Ferritinophagy was currently mainly focused on cell biology. Tumor research might be the next major clinical research direction in this field. The related research on oxidative stress pathways, cell death methods, and nuclear receptor co-activator 4 (NCOA4) in the field of ferritinophagy were current research hotspots.
CONCLUSIONS
It could be understanding the research status and hotspots of ferritinophagy in the world more clearly and intuitively by using the bibliometric method.
Topics: Bibliometrics; Publications; United States
PubMed: 35748269
DOI: 10.31083/j.fbl2706193 -
Healthcare (Basel, Switzerland) Jun 2022ESKD is a total or near-permanent failure in renal function. It is irreversible, progressive and ultimately fatal without peritoneal dialysis (PD), haemodialysis (HD) or... (Review)
Review
Health Education Programmes to Improve Foot Self-Care Knowledge and Behaviour among Older People with End-Stage Kidney Disease (ESKD) Receiving Haemodialysis (A Systematic Review).
BACKGROUND
ESKD is a total or near-permanent failure in renal function. It is irreversible, progressive and ultimately fatal without peritoneal dialysis (PD), haemodialysis (HD) or kidney transplantation. Dialysis treatments can create new and additional problems for patients, one of which is foot amputation, as a result of non-healing wounds and vascular complications. The association between dialysis therapy and foot ulceration is linked to several factors: physical and psychological health; peripheral arterial disease (PAD); mobility; tissue oxygenation; manual dexterity; neuropathy; visual acuity; anaemia; nutrition; leg oedema; hypoalbuminemia; infection; inadequacy of dialysis; and leg/foot support during dialysis. The potential risk factors for foot ulceration may include: not routinely receiving foot care education; incorrect use of footwear; diabetes duration; neuropathy; and peripheral arterial disease.
AIM
The aim of this review is to examine the factors that help or hinder successful implementation of foot care education programmes for ESKD patients receiving haemodialysis.
METHOD
A comprehensive literature search was completed using five electronic databases. Medline; CINAHL; Embase; PsycINFO; and Cochrane Library. The Joanna Briggs Institute checklist (JBI) was used to quality appraise full text papers included in the review. The systematic review was not limited to specific categories of interventions to enable optimal comparison between interventions and provide a comprehensive overview of the evidence in this important field of foot care.
RESULTS
We found no previously published studies that considered foot care education programmes for haemodialysis patients who are not diabetic; thus, the present systematic review examined four studies on diabetic patients receiving haemodialysis exposed to foot care education programmes from various types of intervention designs.
CONCLUSIONS
This systematic review has provided evidence that it is possible to influence foot care knowledge and self-care behaviours in both diabetic patients receiving haemodialysis and healthcare professionals.
PubMed: 35742194
DOI: 10.3390/healthcare10061143 -
The European Journal of Health... Apr 2023Comparative economic assessments of renal replacement therapies (RRT) are common and often used to inform national policy in the management of end-stage renal disease...
OBJECTIVES
Comparative economic assessments of renal replacement therapies (RRT) are common and often used to inform national policy in the management of end-stage renal disease (ESRD). This study aimed to assess existing cost-effectiveness analyses of dialysis modalities and consider whether the methods applied and results obtained reflect the complexities of the real-world treatment pathway experienced by ESRD patients.
METHODS
A systematic literature review (SLR) was conducted to identify cost-effectiveness studies of dialysis modalities from 2005 onward by searching Embase, MEDLINE, EBM reviews, and EconLit. Economic evaluations were included if they compared distinct dialysis modalities (e.g. in-centre haemodialysis [ICHD], home haemodialysis [HHD] and peritoneal dialysis [PD]).
RESULTS
In total, 19 cost-effectiveness studies were identified. There was considerable heterogeneity in perspectives, time horizon, discounting, utility values, sources of clinical and economic data, and extent of clinical and economic elements included. The vast majority of studies included an incident dialysis patient population. All studies concluded that home dialysis treatment options were cost-effective interventions.
CONCLUSIONS
Despite similar findings across studies, there are a number of uncertainties about which dialysis modalities represent the most cost-effective options for patients at different points in the care pathway. Most studies included an incident patient cohort; however, in clinical practice, patients may switch between different treatment modalities over time according to their clinical need and personal circumstances. Promoting health policies through financial incentives in renal care should reflect the cost-effectiveness of a comprehensive approach that considers different RRTs along the patient pathway; however, no such evidence is currently available.
Topics: Humans; Renal Dialysis; Cost-Benefit Analysis; Kidney Failure, Chronic; Renal Replacement Therapy; Peritoneal Dialysis
PubMed: 35716316
DOI: 10.1007/s10198-022-01478-2