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S 23 Parallel Session
Programme of the Session
Title: Improving quality of renal care
GS: Eva Segura (Spain)
Challenges in exercise implementation for patients undergoing haemodialysis
O 51
The missing piece: Selfmanagement support desires of patients with chronic kidney disease
Kathryn Havas (Australia)
O 52
The impact of psychological conditions and established adaptation strategies to QoL in ESRD patients
Berislav Poje (Croatia)
O 53
Symptom experience in non-dialysis-dependent chronic kidney disease: a UK qualitative study
Karen Pugh-Clarke (UK)
O 54
Predictors of health status in patients with CKD
Michaela Kelleher (Australia)
Abstracts
GUEST SPEAKER
Challenges in exercise implementation for patients undergoing haemodialysis
E. Segura1
1Physiotherapy, Universidad CEU Cardenal Herrera, UCH CEUs, Valencia, Spain
Background
Physical function of subjects undergoing hemodialysis is lower compared to healthy counterparts. Factors that explain this low physical condition include impaired kidney function, decreased physical activity and low muscle mass. We will analyze which of these factors are more important to explain physical function. By the other hand, there is a wide variety of tests used to measure physical function in this cohort, but there is a need to identify the most reliable ones and to standardize measurement procedures. We will show results regarding reliability studies of several commonly used physical function tests. Since the early 80’s exercise has been implemented in different hemodialysis units around the world, and it has resulted in benefits for subjects undergoing hemodialysis, including the improvement of physical function. So, why exercise is not implemented as a routine for this cohort? We will analyze the literature regarding the reasons why the adherence to exercise is low. We will review barriers for subjects undergoing hemodialysis to exercise and barriers from health care professionals working at hemodialysis units to implement exercise programs. We will discuss possible options to overcome these barriers, including home exercise programs and the use of new technologies. Preliminary results on the use of virtual reality combined with intradialytic exercise will be discussed.
BIOGRAPHY OF THE GUEST SPEAKER
O 51
The missing piece: Self-management support desires of patients with chronic kidney disease
K. Havas1, 2, A. Bonner1, 2, 3, C. Douglas1
1School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia; 2Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Australia; 3Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Australia
Background
People with chronic kidney disease (CKD) must self-manage their illness to slower disease-progression, but this is complex, and people desire support. Despite the importance of person-centred care, people with CKD are rarely consulted regarding their desires for self-management support (SMS).
Objectives
To investigate the SMS preferences of CKD patients.
Methods
A cross-sectional survey was conducted face-to-face in a Queensland primary-care clinic and distributed Australia-wide via an online interface promoted by Kidney Health Australia during 2015. Participants were ≥18 years old and had a diagnosis of CKD (any stage; N=97). The survey was based upon literature identifying 10 areas that those with CKD require as an additional support.
Results
Of the 97 participants, 36 completed a hardcopy survey, and 61 completed the online version. Just over half (60.8%) were female, age ranged from 16-89 (M=56.44), and time since diagnosis ranged from just diagnosed to 60 years (Mdn=8.08 years). Strong interest in receiving additional support was reported across all 10 areas (Mdns=8.00–10.00), with “keeping a positive attitude and taking care of mental and physical health” receiving the highest rating. Those who were: younger (p<.001); more highly educated (p<.001); working (p<.001); diagnosed longer ago (p=.015); and women (p=.050) expressed stronger desire for additional support.
Conclusion/Application to practice
In addition to information about CKD and medications, everyday strategies ought to be prioritised in patient education. Varying levels of engagement and eagerness to learn more about self-management, highlights the need for a person-centred approach to SMS.
O 52
The impact of psychological conditions and established adaptation strategies to QoL in ESRD patients
B. Poje1, Z. Vidic1, S. Siljegovic1, V. Babic1, A. Rundic1, D. Petric2, J. Grkovic2
1Department of Nephrology, Dialysis and Kidney Transplant, KBC Rijeka, Rijeka, Croatia; 2Psychiatric Clinic, KBC Rijeka, Rijeka, Croatia
Objectives
This study aimed to examine how anxiety and depression affect mental state and to measure adaptation strategies (coping skills) and consequently the quality of life of patients with chronic kidney disease in pre-dialysis stage and on renal replacement therapy.
Methods
Study involved 119 patients; 28 patients in the pre-dialysis education program, 36 patients treated with regular haemodialysis up to five years, 28 patients treated with continuous ambulatory peritoneal dialysis less than five years, and 29 patients who had a kidney transplant for less than five years. Beck’s scale was used to determine the degree of depression (BDI). For level of anxiety we used (STAI-X1) and for anxiety related to personality traits we used (STAI-X2). Coping skills were assessed with COPE questionnaire. Quality of life was measured by the Manchester Short Assessment of Quality of Life (MANSA).
Results
Depression significantly differed related to the CKD stage (F (3,115) = 05.04; p=0.009). Quality of life was significantly different related to the stage of chronic kidney disease (F (3,115) = 3.15; p=0.028). Patients on haemodialysis had the lowest quality of life, significantly lower than transplant patients (p=0.004) and patients on peritoneal dialysis (p=0.033).
Conclusion/Application to practice
Quality of life differed significantly when comparing the stages of chronic kidney disease. Patients on haemodialysis had the lowest quality of life, significantly lower than the transplant patients and patients on CAPD.
O 53
Symptom experience in non-dialysis-dependent chronic kidney disease: a UK qualitative study
K. Pugh-Clarke1, S. Read2, J. Sim2
1Kidney Unit, Royal Stoke University Hospital NHS Trust, Stoke-on-Trent, United Kingdom; 2Research Institute for Social Sciences, Keele University, Staffordshire, United Kingdom
Background
Studies indicate that symptoms attributable to impaired kidney function are important determinants of quality of life and functional status in patients with chronic kidney disease (CKD). Accordingly, symptom assessment and subsequent control are prerequisites to high-quality care in this patient population. Whilst symptom burden in patients with advanced CKD managed without dialysis has been likened to that of palliative care cancer populations, there is little information about the nature and range of symptoms in earlier stages of the CKD trajectory. This paper reports the preliminary findings of the first phase of a PhD study aimed at exploring the symptom experience in patients with CKD Stages 4 and 5.
Methods
Eighteen semi-structured patient interviews were conducted, using an interview schedule developed specifically to guide discussion. Data were analyzed using thematic analysis to identify symptom themes and patterns across the patient experiences.
Results
Patients reported a wide range of symptoms, with over 50 different themes and sub-themes emerging from the interview data. Themes could be broadly classified into physical symptoms, such as ‘Altered taste perception’, ‘Sleep disturbance’, and ‘Fatigue’; and psychological symptoms, such as ‘Forgetfulness’, ‘Poor concentration’, and ‘A sensation of gradually slowing down’. Of note, when questioned further, patients indicated that they would not usually report their symptoms to clinicians.
Conclusion/Application to practice
This study suggests that patients with CKD Stages 4 and 5 may have a high symptom burden. The finding that patients did not routinely report their symptoms emphasises a need for clinicians to incorporate symptom assessment into routine clinical consultations.
O 54
Predictors of health status in patients with CKD
M. Kelleher1, P. Paul1, G. Wong1
1Nephrology, Prince of Wales Hospital, Sydney, Australia
Background
There is an extensive body of literature examining the health status of patients with chronic kidney disease (CKD). It is well reported that patients on dialysis experience numerous stressors, both physical and psychosocial, associated with dialysis treatment for instance itchiness, poor sleep quality and fatigue just to name a few.
Objectives
The objective of this paper is to explore the predictors of health status in patients with CKD.
Methods
191 patients with chronic kidney disease were enrolled in the study. The following physiological data was collected on each participant: weight, height, BMI, comorbidities and body composition. Body composition was determined using bioimpedence spectroscopy. Each participant was asked to complete a questionnaire which collected data on 9 domains of health status which included questions pertaining to general health, sleep quality and symptomatology.
Results
The data was analysed using SPSS 23. Multiple linear multiple regression was used to determine the greatest predictors
of health status. From the analyses participants who worked (t = 4.042; p<.0001) and lean tissue mass (t = 2.109; p = .037)
were the greatest predictors of health status (f = 3.685; p,.0001).
Conclusion/Application to practice
The results from this study will assist in developing rehabilitation programmes for
patients with CKD focusing on the importance of work and physical activity to
maintain lean muscle.
BIOGRAPHY OF THE SPEAKER