This study aimed to measure the physical performance of 62 patients undergoing hemodialysis using the Short Physical Performance Battery (SPPB) scale. The study found that the patients' physical performance was below predicted levels at baseline and deteriorated further over three assessments spaced four weeks apart. The results indicated poor physical performance in patients with chronic kidney disease undergoing hemodialysis. This was related to low physical activity levels in this patient population rather than demographic or clinical factors.
Assessment Outcomes Dyslipidaemia in Dialysis PatientAI Publications
Background: Chronic kidney disease is defined as the presence, for more than three months, of changes in the structure or function of the kidneys, secondary to a progressive decline in the number of nephrons, with a consequent deterioration in health resulting from the inability of the kidneys to perform their excretory functions, softener, and metabolism. Chronic kidney disease (CKD) is a clinical condition caused by the progressive and progressive loss of kidney function. Chronic kidney disease is not only implicated by the gradual deterioration of quality of life and life expectancy when it progresses to more advanced stages but also by the increase in cardiovascular morbidity and mortality, which is the leading cause of death in these patients. Aim: This paper aims to assess the outcomes of dyslipidemia in a dialysis patient. Patients and method: In this study, a descriptive cross-sectional study was applied to study the Assessment Outcomes of Dyslipidemia in Dialysis Patients in Iraq from 4th January 2021 to 7th August 2022. Data were collected for 150 patients in different hospitals in Iraq, where the patients were divided into two groups, the first group of patients, which included DIALYSIS PATIENTS, which included 80, and the second group, the control group, which included patients, which include 70 patients. Results and discussions: collected 150 cases distributed according to dialysis patients (80) and controls (70); the most frequent ages in this study ranged from 40-49 years old 34 (42.5%) patients group, 33 (47.14%) control group with a statistical difference of 0.0831. In this study was evaluated the Outcomes of dyslipidemia in a dialysis patient. Imbalances were found in levels of dyslipidemia which LDL 5.12±3.4 of the patients' group, as for the control group 2.1±3.3-HDL 2.43±2.4 of the patients' group, 1.4±1.5 for the control group, TRIGLYCERIDE 1.75±1.8 of patients group, 0.55±0.43 for the control group with A statistically significant relationship were found between dyslipidemia levels and outcomes in the group of patients at P value < 0.05.
Anaemia in Chronic Renal Failure Patients Undergoing Haemodialysis: A across ...Neeleshkumar Maurya
ABSTRACT Chronic renal failure disease is frequently associated with anaemia and the level of anaemia correlates with the stage of chronic kidney disease (CKD). A cross-sectional study was conducted in 44 chronic kidney disease patients in the department of medicine, M.L.B. Medical College, Jhansi during the period January to June, 2018. The study was evaluating the profile of anaemia and to find the association between the severity of anaemia and ckd-5 patients time period of taking on haemodialysis. Haemoglobin, blood urea, serum albumin, serum creatinine levels were examined using standard techniques. There was a significant difference in the haemoglobin of CKD patients taking 30 days regular interval 3 times values (P <0.05). All 44 patients (100%) were anaemic there was no significant correlation between the severity of anaemia and serum creatinine levels (P > 0.82) the most frequent anaemia in chronic kidney disease patients was a malnourished type of a moderate degree anaemic (7 10mg/dl). A significant correlation was not found between the severity of anomie and serum creatinine levels 30 day interval of CKD of patients on haemodialysis. Keywords: - haemodialysis, anomie, serum creatinine, haemoglobin, malnutrition.
Study of Barthel Score among CKD Patients Belonging from Tribal Areas in Tert...ijtsrd
Chronic Kidney Disease CKD is one of the independent diseases which can lead to sever disability and it is a major emerging public health concern worldwide because it often leads to poor patient outcome 1 . Some of the associated factor with impaired functional status with CKD patients has not been fully elucidated, but some traditional such as cardiovascular diseases hypertension, myocardial ischemia , cerebrovascular diseases, and diabetes mellitus as well as non-traditional factors such as malnutrition-inflammation syndrome and depression may involve. A cross-sectional and longitudinal study has shown that risk of low functional status is directly proportional to kidney impairment 2, 3 . Thus, individuals with chronic kidney disease CKD have 40-70 higher risk of functional limitation than those without CKD 4 . In one study to assess the functional status of the CKD patients by using Barthel index found that 50 patients were dependent for the basic activities of daily life 5 In the current study, we hypothesize that there is a close relationship between the presence of CKD and the functional status of renal patients. We conducted this study with objective to assess the functional status of patients with Chronic Kidney Disease by using Barthel Index as a assessment tool on patients who were admitted under Nephrology Unite of Dr. B.R.A.M Hospital Raipur, CG. Dr. Dolly Ajwani Ratre | Rashmi Nande | Navin Kumar Ratre "Study of Barthel Score among CKD Patients Belonging from Tribal Areas in Tertiary Care Hospital, Chhattisgarh" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd20266.pdf
Paper URL: https://www.ijtsrd.com/medicine/other/20266/study-of-barthel-score-among-ckd-patients-belonging-from-tribal-areas-in-tertiary-care-hospital-chhattisgarh/dr-dolly-ajwani-ratre
Running head MEDICAL CARE PLANNING FOR PATIENTS WITH CHRONIC KIDN.docxjeanettehully
Running head: MEDICAL CARE PLANNING FOR PATIENTS WITH CHRONIC KIDNEY DISEASE
Medical care planning for patients with Chronic Kidney DiseaseNorys GilSouth University
Medical care planning for patients with Chronic Kidney Disease
Introduction
Chronic Kidney is a disorder that disturbs the correct working of the kidney, which is increasingly becoming a challenge to the health care sector. Just like any other chronic disease, CKD comes with the responsibility of ensuring that a patient gets maximum medical treatment facilities and attention as much as possible. “The definition and classification of chronic kidney disease (CKD) have evolved, but current international guidelines define this condition as decreased kidney function as shown by glomerular filtration rate (GFR) of less than 60 mL/min per 1·73 m2 or markers of kidney damage, or both, of at least three months duration, regardless of the underlying cause”, Morton & Masson, 2017.
Morbidity and comorbidity of chronic Kidney disease
Weak/low results are closely associated with CKD; this is because of the burdens that are so high when it comes to comorbidity. Many pieces of research have indicated that CKD relates to diabetes and hypertension conditions. Intense conditions of chronic kidney disease also lead to heart complications. There is little information on the mental difficulties that come with CKD.
“Chronic kidney disease (CKD) can be associated with adverse clinical outcomes, poor quality of life, and high health-care costs; clinicians need to understand that these observations result from a high burden of comorbidity among CKD patients”, (Manns &Hemmelgarn 2010). Key morbidities of CKD, therefore, include pulmonary complications, diabetes, hypertension, and atrial fibrillation. CKD, to a very high degree, leads to characteristics such as myocardial infarction, dementia, hypothyroidism, depression, and stroke. All comorbidities remain classified as concordant others that closely relate with CKD but ranked as discordant include; asthma, constipation, lymphoma dementia, etc.
Impacts of chronic kidney disease
Various medical reports by the health care agencies and organizations, including the World Health Organization show that CKD is a growing complication that has become a big concern of the public health care sector not just in the United States but around the globe. An estimation of over 26 million people is affected by CKD in the country. Annual reports have shown that this number is likely to increase if serious investments are in the health care sector. Hypertension and diabetes are proven, leading causes of kidney complications. To an individual, CKD can lead to other primary complications such as nephropathy, lupus, and continuity of kidney failure. The country invests billions of money annually, something that is becoming hard to sustain because of the annual increase in population and the number of those affected by CKD.
As of 2006, over $23 billion was spent on C ...
Аллопуринол и прогрессирование ХБП и кардиоваскулярные события. РКИ / Allopur...hivlifeinfo
Allopurinol and Progression of CKD and Cardiovascular Events- Long-term Follow-up of a Randomized Clinical Trial.Am J Kidney Dis. 2015 Apr
Background:Asymptomatic hyperuricemia increases renal and cardiovascular (CV) risk. We previously
conducted a 2-year, single-blind, randomized, controlled trial of allopurinol treatment that showed improved
estimated glomerular filtration rate and reduced CV risk.
Study Design:Post hoc analysis of a long-term follow-up after completion of the 2-year trial.
Setting & Participants:113 participants (57 in the allopurinol group and 56 in the control group) initially
followed up for 2 years and 107 participants followed up to 5 additional years.
Intervention: Continuation of allopurinol treatment, 100 mg/d, or standard treatment.
Outcome:Renal event (defined as starting dialysis therapy and/or doubling serum creatinine and/or$50%
decrease in estimated estimated glomerular filtration rate) and CV events (defined as myocardial infarction,
coronary revascularization or angina pectoris, congestive heart failure, cerebrovascular disease, and peripheral vascular disease).
Results:During initial follow-up, there were 2 renal and 7 CV events in the allopurinol group compared with
6 renal and 15 CV events in the control group. In the long-term follow-up period, 12 of 56 participants taking
allopurinol stopped treatment and 10 of 51 control participants received allopurinol. During long-term follow-up,
an additional 7 and 9 participants in the allopurinol group experienced a renal or CV event, respectively, and an
additional 18 and 8 participants in the control group experienced a renal or CV event, respectively. Thus,
during the initial and long-term follow-up (median, 84 months), 9 patients in the allopurinol group had a
renal event compared with 24 patients in the control group (HR, 0.32; 95% CI, 0.15-0.69; P50.004;
adjusted for age, sex, baseline kidney function, uric acid level, and renin-angiotensin-aldosterone system
blockers). Overall, 16 patients treated with allopurinol experienced CV events compared with 23 in the
control group (HR, 0.43; 95% CI, 0.21-0.88;P50.02; adjusted for age, sex, and baseline kidney function).
Limitations:Small sample size, single center, not double blind, post hoc follow-up and analysis.
Conclusions: Long-term treatment with allopurinol may slow the rate of progression of kidney disease and
reduce CV risk.
Assessment Outcomes Dyslipidaemia in Dialysis PatientAI Publications
Background: Chronic kidney disease is defined as the presence, for more than three months, of changes in the structure or function of the kidneys, secondary to a progressive decline in the number of nephrons, with a consequent deterioration in health resulting from the inability of the kidneys to perform their excretory functions, softener, and metabolism. Chronic kidney disease (CKD) is a clinical condition caused by the progressive and progressive loss of kidney function. Chronic kidney disease is not only implicated by the gradual deterioration of quality of life and life expectancy when it progresses to more advanced stages but also by the increase in cardiovascular morbidity and mortality, which is the leading cause of death in these patients. Aim: This paper aims to assess the outcomes of dyslipidemia in a dialysis patient. Patients and method: In this study, a descriptive cross-sectional study was applied to study the Assessment Outcomes of Dyslipidemia in Dialysis Patients in Iraq from 4th January 2021 to 7th August 2022. Data were collected for 150 patients in different hospitals in Iraq, where the patients were divided into two groups, the first group of patients, which included DIALYSIS PATIENTS, which included 80, and the second group, the control group, which included patients, which include 70 patients. Results and discussions: collected 150 cases distributed according to dialysis patients (80) and controls (70); the most frequent ages in this study ranged from 40-49 years old 34 (42.5%) patients group, 33 (47.14%) control group with a statistical difference of 0.0831. In this study was evaluated the Outcomes of dyslipidemia in a dialysis patient. Imbalances were found in levels of dyslipidemia which LDL 5.12±3.4 of the patients' group, as for the control group 2.1±3.3-HDL 2.43±2.4 of the patients' group, 1.4±1.5 for the control group, TRIGLYCERIDE 1.75±1.8 of patients group, 0.55±0.43 for the control group with A statistically significant relationship were found between dyslipidemia levels and outcomes in the group of patients at P value < 0.05.
Anaemia in Chronic Renal Failure Patients Undergoing Haemodialysis: A across ...Neeleshkumar Maurya
ABSTRACT Chronic renal failure disease is frequently associated with anaemia and the level of anaemia correlates with the stage of chronic kidney disease (CKD). A cross-sectional study was conducted in 44 chronic kidney disease patients in the department of medicine, M.L.B. Medical College, Jhansi during the period January to June, 2018. The study was evaluating the profile of anaemia and to find the association between the severity of anaemia and ckd-5 patients time period of taking on haemodialysis. Haemoglobin, blood urea, serum albumin, serum creatinine levels were examined using standard techniques. There was a significant difference in the haemoglobin of CKD patients taking 30 days regular interval 3 times values (P <0.05). All 44 patients (100%) were anaemic there was no significant correlation between the severity of anaemia and serum creatinine levels (P > 0.82) the most frequent anaemia in chronic kidney disease patients was a malnourished type of a moderate degree anaemic (7 10mg/dl). A significant correlation was not found between the severity of anomie and serum creatinine levels 30 day interval of CKD of patients on haemodialysis. Keywords: - haemodialysis, anomie, serum creatinine, haemoglobin, malnutrition.
Study of Barthel Score among CKD Patients Belonging from Tribal Areas in Tert...ijtsrd
Chronic Kidney Disease CKD is one of the independent diseases which can lead to sever disability and it is a major emerging public health concern worldwide because it often leads to poor patient outcome 1 . Some of the associated factor with impaired functional status with CKD patients has not been fully elucidated, but some traditional such as cardiovascular diseases hypertension, myocardial ischemia , cerebrovascular diseases, and diabetes mellitus as well as non-traditional factors such as malnutrition-inflammation syndrome and depression may involve. A cross-sectional and longitudinal study has shown that risk of low functional status is directly proportional to kidney impairment 2, 3 . Thus, individuals with chronic kidney disease CKD have 40-70 higher risk of functional limitation than those without CKD 4 . In one study to assess the functional status of the CKD patients by using Barthel index found that 50 patients were dependent for the basic activities of daily life 5 In the current study, we hypothesize that there is a close relationship between the presence of CKD and the functional status of renal patients. We conducted this study with objective to assess the functional status of patients with Chronic Kidney Disease by using Barthel Index as a assessment tool on patients who were admitted under Nephrology Unite of Dr. B.R.A.M Hospital Raipur, CG. Dr. Dolly Ajwani Ratre | Rashmi Nande | Navin Kumar Ratre "Study of Barthel Score among CKD Patients Belonging from Tribal Areas in Tertiary Care Hospital, Chhattisgarh" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd20266.pdf
Paper URL: https://www.ijtsrd.com/medicine/other/20266/study-of-barthel-score-among-ckd-patients-belonging-from-tribal-areas-in-tertiary-care-hospital-chhattisgarh/dr-dolly-ajwani-ratre
Running head MEDICAL CARE PLANNING FOR PATIENTS WITH CHRONIC KIDN.docxjeanettehully
Running head: MEDICAL CARE PLANNING FOR PATIENTS WITH CHRONIC KIDNEY DISEASE
Medical care planning for patients with Chronic Kidney DiseaseNorys GilSouth University
Medical care planning for patients with Chronic Kidney Disease
Introduction
Chronic Kidney is a disorder that disturbs the correct working of the kidney, which is increasingly becoming a challenge to the health care sector. Just like any other chronic disease, CKD comes with the responsibility of ensuring that a patient gets maximum medical treatment facilities and attention as much as possible. “The definition and classification of chronic kidney disease (CKD) have evolved, but current international guidelines define this condition as decreased kidney function as shown by glomerular filtration rate (GFR) of less than 60 mL/min per 1·73 m2 or markers of kidney damage, or both, of at least three months duration, regardless of the underlying cause”, Morton & Masson, 2017.
Morbidity and comorbidity of chronic Kidney disease
Weak/low results are closely associated with CKD; this is because of the burdens that are so high when it comes to comorbidity. Many pieces of research have indicated that CKD relates to diabetes and hypertension conditions. Intense conditions of chronic kidney disease also lead to heart complications. There is little information on the mental difficulties that come with CKD.
“Chronic kidney disease (CKD) can be associated with adverse clinical outcomes, poor quality of life, and high health-care costs; clinicians need to understand that these observations result from a high burden of comorbidity among CKD patients”, (Manns &Hemmelgarn 2010). Key morbidities of CKD, therefore, include pulmonary complications, diabetes, hypertension, and atrial fibrillation. CKD, to a very high degree, leads to characteristics such as myocardial infarction, dementia, hypothyroidism, depression, and stroke. All comorbidities remain classified as concordant others that closely relate with CKD but ranked as discordant include; asthma, constipation, lymphoma dementia, etc.
Impacts of chronic kidney disease
Various medical reports by the health care agencies and organizations, including the World Health Organization show that CKD is a growing complication that has become a big concern of the public health care sector not just in the United States but around the globe. An estimation of over 26 million people is affected by CKD in the country. Annual reports have shown that this number is likely to increase if serious investments are in the health care sector. Hypertension and diabetes are proven, leading causes of kidney complications. To an individual, CKD can lead to other primary complications such as nephropathy, lupus, and continuity of kidney failure. The country invests billions of money annually, something that is becoming hard to sustain because of the annual increase in population and the number of those affected by CKD.
As of 2006, over $23 billion was spent on C ...
Аллопуринол и прогрессирование ХБП и кардиоваскулярные события. РКИ / Allopur...hivlifeinfo
Allopurinol and Progression of CKD and Cardiovascular Events- Long-term Follow-up of a Randomized Clinical Trial.Am J Kidney Dis. 2015 Apr
Background:Asymptomatic hyperuricemia increases renal and cardiovascular (CV) risk. We previously
conducted a 2-year, single-blind, randomized, controlled trial of allopurinol treatment that showed improved
estimated glomerular filtration rate and reduced CV risk.
Study Design:Post hoc analysis of a long-term follow-up after completion of the 2-year trial.
Setting & Participants:113 participants (57 in the allopurinol group and 56 in the control group) initially
followed up for 2 years and 107 participants followed up to 5 additional years.
Intervention: Continuation of allopurinol treatment, 100 mg/d, or standard treatment.
Outcome:Renal event (defined as starting dialysis therapy and/or doubling serum creatinine and/or$50%
decrease in estimated estimated glomerular filtration rate) and CV events (defined as myocardial infarction,
coronary revascularization or angina pectoris, congestive heart failure, cerebrovascular disease, and peripheral vascular disease).
Results:During initial follow-up, there were 2 renal and 7 CV events in the allopurinol group compared with
6 renal and 15 CV events in the control group. In the long-term follow-up period, 12 of 56 participants taking
allopurinol stopped treatment and 10 of 51 control participants received allopurinol. During long-term follow-up,
an additional 7 and 9 participants in the allopurinol group experienced a renal or CV event, respectively, and an
additional 18 and 8 participants in the control group experienced a renal or CV event, respectively. Thus,
during the initial and long-term follow-up (median, 84 months), 9 patients in the allopurinol group had a
renal event compared with 24 patients in the control group (HR, 0.32; 95% CI, 0.15-0.69; P50.004;
adjusted for age, sex, baseline kidney function, uric acid level, and renin-angiotensin-aldosterone system
blockers). Overall, 16 patients treated with allopurinol experienced CV events compared with 23 in the
control group (HR, 0.43; 95% CI, 0.21-0.88;P50.02; adjusted for age, sex, and baseline kidney function).
Limitations:Small sample size, single center, not double blind, post hoc follow-up and analysis.
Conclusions: Long-term treatment with allopurinol may slow the rate of progression of kidney disease and
reduce CV risk.
Effectiveness of Nurse Led Heart Failure Management Program on Quality of Lif...ijtsrd
Background Heart failure HF is characterized by poor quality of life QOL with high hospitalization rates, and poor prognosis. Younger age groups are more affected in developing countries like India. HF can be very disabling, and QOL of patients can be severely affected Objectives 1. To assess the Quality of Life of Heart Failure patients in Experimental and Control Group. 2. To Compare the effectiveness of Nurse Led Heart Failure Management Program on Quality of life of heart failure patients in Experimental and Control Group. Method The study was conducted for 3 months from 1 Dec to 1 March 2019, in cardiology OPD, at KGMU, U.P, based on simple random sampling the groups were divided into control group and experimental group in which the control group received no intervention and Interventions of Nurse led Heart failure management program was given in experimental group with a Log book which they have to fill once a week for 3 months. Post test questionnaire for Quality of life and log book data will be collected from both the groups after 3 months. Results The result showed significant difference between Quality of life P 0.002 as measured by KCCQ, mean Quality of life was found to be significantly higher among the subjects of Experimental group 60.50±12.10 than control group 46.73±16.23 at post intervention. Conclusion Simple systemic educational intervention that was targeted towards patient to provide a tailored educational intervention through an holistic Perspective, focused on preserving or enhancing health and Self management goal achievement has improve quality of life of heart failure patients those who received NLP i.e, Experimental group, Their Quality Scores were High as Compared to Control group. Conclusion The study concluded that, structured information brochure is an effective way to improve the knowledge and reduce the anxiety among the patient planned for angioplasty. The study recommended that structured information brochure about the post procedural care about the angioplasty should be implemented to improve the knowledge and reduce the anxiety among the patient for providing a better care. Richi Lal | Rashmi P. John | Sharad Chandra "Effectiveness of Nurse-Led Heart Failure Management Program on Quality of Life of Heart Failure Patients in Cardiology OPD, at KGMU, U.P" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-1 , December 2021, URL: https://www.ijtsrd.com/papers/ijtsrd48046.pdf Paper URL: https://www.ijtsrd.com/medicine/cardiology/48046/effectiveness-of-nurseled-heart-failure-management-program-on-quality-of-life-of-heart-failure-patients-in-cardiology-opd-at-kgmu-up/richi-lal
Role of the Biochemistry Labs in Promoting the Health Care Services for the I...IJERA Editor
The health care in the State of Kuwait depends to a greater extent on the biochemical and clinical labs attached
at each hospital. The data obtained from these laboratories will facilitate the process of diagnosing the disease
accurately. This will have a positive impact on the selection of appropriate treatment for the patients in general
and for diabetics specifically.
The main objective of this research was to build a profile for lab analysis and a database for building a
comprehensive system of integrated activities to raise health care for diabetic patients in Kuwait. The study
revealed the burden of admitted diabetic cases on the blood chemistry laboratory in Sabah Hospital (in relation
to length of stay and total numbers of lab requests). The aim was fulfilled by designing a model of the
biochemical tests for diabetics; filling in forms from the reality of patient data, completing and analyzing the
results electronically.
The study showed the importance of biochemical and clinical labs since they act as the link of patient's
information at the secondary health care level.
Renal failure and Quality ofLlife Indicators in Kidney Transplantationkomalicarol
Health-related quality of life (HRQL) contains many aspects of
patients' health such as physical, psychological, social functioning
and a general well-being. Progress in renal transplantation and immunosuppressive therapies have increased significantly in recent
decades, resulting in allograft survival rates at one year is now
over 90%. Numerous clinical trials have established the importance of quality of life in a variety of diseases, and it is extremely
popular to evaluate quality of life in clinical trials as a measure of
patients' subjective state of health. The purpose of the study was
to identify factors associated with quality of life after renal transplantation.
This presentation reviews ETC participant assessment, aggregation, and payment mechanisms, including achievement benchmarks for measurement years 1-, 2-, and 3-.
Background: One of the commonest complications of poorly controlled Type 2 diabetes mellitus (T2DM) is Diabetic nephropathy (DN), which occurs in 30-40% of DM cases. It is important to identify the high-risk group who are likely to develop DN with the modifiable and non-modifiable risk factors. This study had the objectives to estimate and correlate the levels of the urine albumin creatinine ratio (UACR) with age, anthropometric measures, glycaemic control markers, lipids, and renal function. To estimate each variable as independent and multivariate risk factors.
Materials and Methods: It was an observational and cross-sectional study conducted in a tertiary care center in Eastern India. Totally, 221 consecutive ambulatory T2DM subjects were recruited after obtaining their written consent.
Results: The diabetics were classified as having diabetic nephropathy by the urine albumin creatinine ratio (ACR) of >30 mg/gm. 53.4% of our study group had DN. There was a significant risk associated with PPBS with p=0.043 (<0.05), serum creatinine with p=0.032 (<0.05), and urine albumin with p=0.0001 (<0.001). In the multivariate regression analysis of all these variables, there was a highly significant likelihood ratio for predicting DN with p=0.0001 (<0.001) with a predictive value of 74.5% in females and 75% in males.
Conclusion: The additive factors contributed by the risk factors in the prediction of DN will benefit the DM in the prevention of DN.
Keywords: diabetic nephropathy, risk factors, diabetic kidney disease, Asian Indian
Running Head Nursing Care Plan Nursing Care Plan for an 80-ye.docxtoltonkendal
Running Head: Nursing Care Plan
Nursing Care Plan for an 80-year-old female with Chronic Kidney Disease
Student’s name; Daysi Fernandez
South University
Course: Illness & Disease Management
Nursing Care Plan for an 80-year-old female with Chronic Kidney Disease
Case study
An 80-year-old female presents to the clinic with grievances of asthenia, malaise, headache, weight gain, and a decrease in urination. A tentative diagnosis of acute renal failure is made. She has a history of alcohol and drug abuse. Her medical history is unremarkable, and she has not been taking any medicines. The laboratory results include values of a serum sodium level of 151mg/dl. The potassium level is 2.7mg/dl, chloride is 123mg/dl, and bicarbonate is 14mg/dl. Blood urea nitrogen is 95mg/dl. Blood glucose is 757mg/dl. Serum calcium is 7.5mg/dl, and leukocyte counts are 8000/mm3. The patient is hydrated. She is diagnosed with diabetic ketoacidosis.
Chronic Kidney Disease Patient Questionnaire
1. Have you been diagnosed with kidney disease? Y / N
2. How long has it been your first diagnosed? ____Months / ____years
3. Do you take pain or anti-inflammatory medication? Y / N
4. Do you use herbal treatments? Y / N
5. Do you take blood pressure medication? Y / N
6. Do you check your blood pressure at home? Y /N
7. Have you heard any family heart diseases? Y /N
8. Have you had a history of diabetes or prediabetes? Y /N
9. Have you ever been diagnosed with anemia, or low hemoglobin count? Y / N
10. Have you had any history of osteoporosis, osteopenia, brittle, thin or broken bones? Y / N
11. Summary
I. If you responded yes to any of the questions above, please give more detail___
II. Do you have any question about your Kidney disease that we can help you? ___
Chronic kidney disease (CKD) according to (Bomback and Bakris, 2011) is a continuous decrease of working renal tissue whereby the residual kidney mass cannot sustain the body’s internal environment. CKD is an illness that progressively develops for years or as an effect from an occurrence of kidney related diseases from which the patient has not improved. Acute Renal Failure (ARF) is a continuous and quick weakening of the working of the kidneys (Healthy people 2010, 2013). It occurs when there is a high accumulation of toxic substances in the kidney and left unattended. Development of ARF happens when the kidney fails to remove waste materials from the kidney in the form of urine. Therefore kidney disorders have stopped functioning and lost their strength to remove water and waste from the blood. Deterioration of kidney functioning will lead to other problems in the body such as anemia, poor nutritional health, high blood pressure and nerve damage (Wong et al., 2010). Early diagnosis of this disorder is essential when it comes to its management. Researchers assert that when CKD is detected early, its progression is slowed down and managed (Bomback an ...
Introduction: Chronic Kidney Disease (CKD) is a worldwide public health problem and it is increasing over time. Cardiovascular disease is a major concern for patients with end stage renal disease, especially those on hemodialysis. It is the leading cause of death among patients with chronic kidney
disease, particularly in dialysis population.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Effectiveness of Nurse Led Heart Failure Management Program on Quality of Lif...ijtsrd
Background Heart failure HF is characterized by poor quality of life QOL with high hospitalization rates, and poor prognosis. Younger age groups are more affected in developing countries like India. HF can be very disabling, and QOL of patients can be severely affected Objectives 1. To assess the Quality of Life of Heart Failure patients in Experimental and Control Group. 2. To Compare the effectiveness of Nurse Led Heart Failure Management Program on Quality of life of heart failure patients in Experimental and Control Group. Method The study was conducted for 3 months from 1 Dec to 1 March 2019, in cardiology OPD, at KGMU, U.P, based on simple random sampling the groups were divided into control group and experimental group in which the control group received no intervention and Interventions of Nurse led Heart failure management program was given in experimental group with a Log book which they have to fill once a week for 3 months. Post test questionnaire for Quality of life and log book data will be collected from both the groups after 3 months. Results The result showed significant difference between Quality of life P 0.002 as measured by KCCQ, mean Quality of life was found to be significantly higher among the subjects of Experimental group 60.50±12.10 than control group 46.73±16.23 at post intervention. Conclusion Simple systemic educational intervention that was targeted towards patient to provide a tailored educational intervention through an holistic Perspective, focused on preserving or enhancing health and Self management goal achievement has improve quality of life of heart failure patients those who received NLP i.e, Experimental group, Their Quality Scores were High as Compared to Control group. Conclusion The study concluded that, structured information brochure is an effective way to improve the knowledge and reduce the anxiety among the patient planned for angioplasty. The study recommended that structured information brochure about the post procedural care about the angioplasty should be implemented to improve the knowledge and reduce the anxiety among the patient for providing a better care. Richi Lal | Rashmi P. John | Sharad Chandra "Effectiveness of Nurse-Led Heart Failure Management Program on Quality of Life of Heart Failure Patients in Cardiology OPD, at KGMU, U.P" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-1 , December 2021, URL: https://www.ijtsrd.com/papers/ijtsrd48046.pdf Paper URL: https://www.ijtsrd.com/medicine/cardiology/48046/effectiveness-of-nurseled-heart-failure-management-program-on-quality-of-life-of-heart-failure-patients-in-cardiology-opd-at-kgmu-up/richi-lal
Role of the Biochemistry Labs in Promoting the Health Care Services for the I...IJERA Editor
The health care in the State of Kuwait depends to a greater extent on the biochemical and clinical labs attached
at each hospital. The data obtained from these laboratories will facilitate the process of diagnosing the disease
accurately. This will have a positive impact on the selection of appropriate treatment for the patients in general
and for diabetics specifically.
The main objective of this research was to build a profile for lab analysis and a database for building a
comprehensive system of integrated activities to raise health care for diabetic patients in Kuwait. The study
revealed the burden of admitted diabetic cases on the blood chemistry laboratory in Sabah Hospital (in relation
to length of stay and total numbers of lab requests). The aim was fulfilled by designing a model of the
biochemical tests for diabetics; filling in forms from the reality of patient data, completing and analyzing the
results electronically.
The study showed the importance of biochemical and clinical labs since they act as the link of patient's
information at the secondary health care level.
Renal failure and Quality ofLlife Indicators in Kidney Transplantationkomalicarol
Health-related quality of life (HRQL) contains many aspects of
patients' health such as physical, psychological, social functioning
and a general well-being. Progress in renal transplantation and immunosuppressive therapies have increased significantly in recent
decades, resulting in allograft survival rates at one year is now
over 90%. Numerous clinical trials have established the importance of quality of life in a variety of diseases, and it is extremely
popular to evaluate quality of life in clinical trials as a measure of
patients' subjective state of health. The purpose of the study was
to identify factors associated with quality of life after renal transplantation.
This presentation reviews ETC participant assessment, aggregation, and payment mechanisms, including achievement benchmarks for measurement years 1-, 2-, and 3-.
Background: One of the commonest complications of poorly controlled Type 2 diabetes mellitus (T2DM) is Diabetic nephropathy (DN), which occurs in 30-40% of DM cases. It is important to identify the high-risk group who are likely to develop DN with the modifiable and non-modifiable risk factors. This study had the objectives to estimate and correlate the levels of the urine albumin creatinine ratio (UACR) with age, anthropometric measures, glycaemic control markers, lipids, and renal function. To estimate each variable as independent and multivariate risk factors.
Materials and Methods: It was an observational and cross-sectional study conducted in a tertiary care center in Eastern India. Totally, 221 consecutive ambulatory T2DM subjects were recruited after obtaining their written consent.
Results: The diabetics were classified as having diabetic nephropathy by the urine albumin creatinine ratio (ACR) of >30 mg/gm. 53.4% of our study group had DN. There was a significant risk associated with PPBS with p=0.043 (<0.05), serum creatinine with p=0.032 (<0.05), and urine albumin with p=0.0001 (<0.001). In the multivariate regression analysis of all these variables, there was a highly significant likelihood ratio for predicting DN with p=0.0001 (<0.001) with a predictive value of 74.5% in females and 75% in males.
Conclusion: The additive factors contributed by the risk factors in the prediction of DN will benefit the DM in the prevention of DN.
Keywords: diabetic nephropathy, risk factors, diabetic kidney disease, Asian Indian
Running Head Nursing Care Plan Nursing Care Plan for an 80-ye.docxtoltonkendal
Running Head: Nursing Care Plan
Nursing Care Plan for an 80-year-old female with Chronic Kidney Disease
Student’s name; Daysi Fernandez
South University
Course: Illness & Disease Management
Nursing Care Plan for an 80-year-old female with Chronic Kidney Disease
Case study
An 80-year-old female presents to the clinic with grievances of asthenia, malaise, headache, weight gain, and a decrease in urination. A tentative diagnosis of acute renal failure is made. She has a history of alcohol and drug abuse. Her medical history is unremarkable, and she has not been taking any medicines. The laboratory results include values of a serum sodium level of 151mg/dl. The potassium level is 2.7mg/dl, chloride is 123mg/dl, and bicarbonate is 14mg/dl. Blood urea nitrogen is 95mg/dl. Blood glucose is 757mg/dl. Serum calcium is 7.5mg/dl, and leukocyte counts are 8000/mm3. The patient is hydrated. She is diagnosed with diabetic ketoacidosis.
Chronic Kidney Disease Patient Questionnaire
1. Have you been diagnosed with kidney disease? Y / N
2. How long has it been your first diagnosed? ____Months / ____years
3. Do you take pain or anti-inflammatory medication? Y / N
4. Do you use herbal treatments? Y / N
5. Do you take blood pressure medication? Y / N
6. Do you check your blood pressure at home? Y /N
7. Have you heard any family heart diseases? Y /N
8. Have you had a history of diabetes or prediabetes? Y /N
9. Have you ever been diagnosed with anemia, or low hemoglobin count? Y / N
10. Have you had any history of osteoporosis, osteopenia, brittle, thin or broken bones? Y / N
11. Summary
I. If you responded yes to any of the questions above, please give more detail___
II. Do you have any question about your Kidney disease that we can help you? ___
Chronic kidney disease (CKD) according to (Bomback and Bakris, 2011) is a continuous decrease of working renal tissue whereby the residual kidney mass cannot sustain the body’s internal environment. CKD is an illness that progressively develops for years or as an effect from an occurrence of kidney related diseases from which the patient has not improved. Acute Renal Failure (ARF) is a continuous and quick weakening of the working of the kidneys (Healthy people 2010, 2013). It occurs when there is a high accumulation of toxic substances in the kidney and left unattended. Development of ARF happens when the kidney fails to remove waste materials from the kidney in the form of urine. Therefore kidney disorders have stopped functioning and lost their strength to remove water and waste from the blood. Deterioration of kidney functioning will lead to other problems in the body such as anemia, poor nutritional health, high blood pressure and nerve damage (Wong et al., 2010). Early diagnosis of this disorder is essential when it comes to its management. Researchers assert that when CKD is detected early, its progression is slowed down and managed (Bomback an ...
Introduction: Chronic Kidney Disease (CKD) is a worldwide public health problem and it is increasing over time. Cardiovascular disease is a major concern for patients with end stage renal disease, especially those on hemodialysis. It is the leading cause of death among patients with chronic kidney
disease, particularly in dialysis population.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Evaluate of the Physical Performance of Patients Undergoing Hemodialysis
1. Journal of Cardiovascular Disease Research
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Evaluate of the Physical Performance of Patients
Undergoing Hemodialysis
Ahmed Lateef Alkhaqani1
*, Assis. Prof. Dr. Diaa K. Abd Ali 2
1. MSc, Adults Nursing Department, Faculty of Nursing, University of Kufa, Najaf, Iraq
2. Ph.D. in Adult Nursing, College of Nursing, University of Al-Ameed, Karbala, Iraq
*Corresponding Author Email ID: ahmedl.alkhaqani@student.uokufa.edu.iq
Abstract
Background: Chronic kidney disease (CKD) is a worldwide health burden with high costs to the health system. It is
associated with increased morbidity and mortality as well as a reduced quality of life. With the increase in the
number of maintenance hemodialysis patients, debilitating conditions of muscle wasting and atrophy have become
one of the biggest concerns for patients with CKD.
Objectives: The present study aimed to measure the physical performance level of patients with end-stage kidney
disease and undergoing regular hemodialysis through using a short physical performance battery (SPPB) scale.
Methods: A descriptive design study (cross-sectional) was conducted on participants selected from the Dialysis
Kidney Unit at Al-Sadder Medical Hospital in Al-Najaf City in order to achieve the study aim. The period of study
is from 20th
December 2020 to 28th
February 2021. A non-probability (purposive sample) technique was used
consisted of (62) patients who are medically diagnosed with CKD and undergoing hemodialysis included in the
present study. The data were collected using a questionnaire consisting of three parts, including socio-demographic,
clinical data form, and short physical performance battery (SPPB) scale.
Results: Show that there is a significant difference between means throughout three periods of test-1 (6.10), test-2
(6.16), and test-3 (5.40) at P=0.024, that the levels of all of the physical performance are below the predicted levels
at the baseline assessment and they still deteriorate even at the third assessment The results indicated that the poor
physical performance of patients suffer from chronic kidney disease and undergoing hemodialysis treatment.
Conclusion: Patients with end-stage kidney disease and undergoing hemodialysis have a low level of physical
performance. This result is related to the physical activity regarding the population on hemodialysis, not being
related to the demographic and clinical data evaluated.
Keywords: Assessment, Physical activity, ESKD and Hemodialysis, Physical performance
Introduction
Patients with chronic kidney disease (CKD) present with multiple and stressful symptoms, and the number and
severity of these symptoms have been described as being comparable to those of hospitalized cancer patients in
palliative care settings (Davison et al. 2021). CKD is one of the chronic conditions and major public health
problems; it’s referred to as an umbrella term describing kidney damage or a decrease in the glomerular filtration
rate (GFR) that lasts for three months or more (Himmelfarb et al. 2020). The challenges behind chronic diseases; the
patient still suffers from them for a long time. Furthermore, it requires ongoing long-term management (WHO
2015).
The global burden of chronic renal failure is increasing, and it is projected to become the 5th
most
common cause of years of globally life by 2040 (Reese et al., 2020) , accounted for by 77.5% of patients with CKD
in the end-stage on renal replacement therapy (RRT), with 43.1% alone provided by hemodialysis (Khor et al.
2020). Hemodialysis and transplantation cost about 2–3% budget of the annual health care in high-income countries;
spending on less than 0.03% of the total population of these countries in low-and middle-income countries, most
people with renal failure don’t get enough access to life-saving dialysis and kidney transplantation (Hostetter et al.
2020; Stanifer et al. 2016). Hemodialysis forms 89% of the global treatment for patients with end-stage kidney
disease (ESKD).
The most common end-stage kidney disease complications include: anemia, bone disease,
cardiovascular disease, and fluid buildup (Kielstein and Marcus 2014). In addition, sleep disturbances, fatigue, and
sexual dysfunction are also CKD (Urquhart-Secord et al., 2016). These problems may impair the patient’s ability to
carry out activities of daily living.
The burden of physical inactivity and poor physical performance among patients with CKD and
hemodialysis, in particular, is a known global and multifactorial problem (Manfredini and Lamberti 2014). The
World Health Organization, reported that “physical inactivity is already a major global health risk and prevalent in
both industrialized and developing countries, causing approximately 5.2 million deaths. Physical inactivity is the
primary cause of most chronic diseases, and it is one of the fourth main risk factors of CKD” and resulting in 6% of
all-cause death globally (CDC, 2019).
Physical activity is very important in today’s world. Exercise keeps the body strong and healthy
(National Kidney Foundation 2020). Thus, increasing physical activity is an essential aspect of disease prevention
and management in patients with CKD (Kirkman et al., 2014). The "National Institute for Health and Care
Excellence" “NICE” recommends in guidelines for CKD in adults the following: Encourage people with CKD to
take exercise, stop smoking and achieve a healthy weight (Robinson-Cohen et al. 2010). Physical activity enhances
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various metabolic benefits that may moderate and reduce the long-term risk of kidney dysfunction progression
(Heiwe and Jacobson 2019).
Considering that patients with chronic renal disease who are undergoing hemodialysis therapy deal
with many comorbidities associated with a sedentary lifestyle, it is important to assess their level of physical activity
to develop strategies to encourage and monitor it, especially during the hemodialysis period.
Study objective: The current study aimed to an assessment of the patient’s physical performance level who have
chronic kidney disease and undergoing hemodialysis through using a short physical performance battery (SPPB)
scale.
Methodology
Design of study: A descriptive design (cross-sectional) study was used through the present study to
an assessment of the physical performance of patients with chronic kidney disease among patients treated in Al-
Sadder Medical Hospital in Al-Najaf City during a period of the study is from 20th December 2020 to 28th February
2021.
Selection of Participants: According to the American Society of Nephrology and "National Kidney
Foundation" (NKF), chronic kidney disease diagnosis clinical practice guideline (Andrew et al. 2015), patients
eligible were recruited to participate in the current study (62 participants were selected randomly from each center,
"Al-Sadder Medical City"/ Hemodialysis Center) who admitted there during the time of the study period. Those
patients were diagnosed with end-stage renal disease undergoing hemodialysis, meeting the inclusion criteria for
participation.
Study setting: The study was conducted in Al-Najaf City / Al-Najaf Health Directorate /Al-Sadder
Medical City (specialized center for kidney transplantation and nephrology disease).
Sample and Sampling Technique: utilized a non-probability (purposive sample) technique, selected
of (62 patients) are included in the current study. All patients are medically diagnosed with end-stage kidney disease
and receiving hemodialysis. Those were subjected to the following: taking a medical history and complete a clinical
examination.
Criteria for Sample Inclusion: The researcher used the following criteria for specifying the study
subjects who are included in the study, patients out of these criteria are basically excluded:
1. All patients are diagnosed with chronic kidney disease and undergoing hemodialysis.
2. The age of all patients is 20 years and older.
3. Alert patients and free from any change in the level of consciousness because the study requires subjective
measurements.
4. All patients are from the Iraqi Nationality because of the Iraqi society nature that differs from other
cultures.
5. Medically stable patients as reported verbally by the physician; to avoid complications.
These specifications were determined with the help of subspecialty nephrologists.
Criteria for Sample Exclusion: Patients with end-stage renal disease who had absolute or relative
contraindications to the physical performance test.
Sample Size: based on statistical power, in randomized controlled trials, statistical power is usually
set to a number equal to or greater than 0.80, with many experts in clinical trials now advocating a power set of 0.90
(Sullivan 2015). But the researcher set the statistical power at 0.95 to reduce to 0.05 the possibility of a “false
negative” result, and to increase the power of the study; the researcher increases the sample size to (58) participants,
become the actual power 95%, to recruit this number of patients. The researcher depended on the confidence
interval (0.95) to determine whether there was a considered statistically significant difference (p-value <0.05) for
assessment of the physical performance.
Study Instrument: An assessment tool is adopted by the researchers based on the previous literature
to measure physical performance for patients with CKD. The final instrument of study consists of three parts: Part I:
patients’ socio-demographic data, Part II: patients’ clinical data, Part III: short physical performance battery (SPPB)
measurement.
“This questionnaire information was gathered from multiple recent resources, including comprehensive clinical
nephrology, Harrison nephrology, and recent studies about CKD”.
Data Collection: Utilization of the interviews face-to-face for the socio-demographic. Regarding
physical performance assessment, the researcher uses the guided observation technique to assess the patients’
physical performance. The data collection method started from 21st December 2020 to 18th February 2021. The
physical performance is assessed through the ask patient collected using the SPPB tool while the patients were
closely monitored.
Each patient required a time between (5-10) minutes to answer the questions and checklist; the
researcher has chosen the "short physical performance battery" (SPPB) tool as a performance-based measure of
physical function. Because it uses simple equipment, requires little training to administer, and only takes a few
minutes to complete.
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Figure (1): Participant’s Flow Diagram
Physical Performance Measures: measured physical performance at baseline and two additional
measurements four weeks “two months”. It selected a two-month interval because the measurement tool was used in
previous studies to identify physical functional changes among nursing home residents receiving hemodialysis.
These studies recommended that there be an interval of at least one month between measurements. Two measures of
physical performance were used with high test-retest reliability of the SPPB scale in the dialysis population to assess
physical performance among older adults (Guralnik et al. 2000). The SPPB consisting three assessments (balance, 4-
m gait speed, and chair stand tests); each test was scored on a scale of (0 to 4) points, based on ability to attempt the
task or/and time to completion, for a total score ranging from 0 (worst) to 12 (best), using cutpoint criteria
established by Guralnik et al., (1994) as follows: (0-6 points) low performance, (7-9 points) intermediate
performance, and (10-12 points) high performance. No aspect of the test should be attempted unless both the
examiner and the participant feel it is safe to do so (Stookey et al. 2014). The SPPB is a widely used test of physical
performance among older populations, and it’s widely used in both clinical and research settings also, it’s a
validated measure of lower extremity function in CKD and is predictive of disability, hospitalization, and mortality
(Hargrove et al. 2019).
Statistical Analyses: In order to achieve the study objective, all continuous variables were tested for
statistical normal distribution using the Shapiro–Wilk test and showed it distributed normally. The following
approaches to statistical data analysis are used the Statistical Package for the Social Sciences (SPSS) version 23 and
Microsoft Excel (2019). The analysis included two types of statistics: Descriptive data analysis; the
sociodemographic variables were conducted through frequency distribution presented as tables, percentages, graphic
presentation by using bar charts, and the participants' statistical mean and standard deviation were calculated.
Inferential data analysis; according to the distribution and type of variables, statistical tests were applied, followed
by the analysis of the association between the level of physical performance categorization and sociodemographic
and clinical variables, using chi-square.
"This study was conducted according to the Strengthening the Reporting of Observational Studies in Epidemiology
(STROBE) reporting guideline for cross-sectional studies".
Participated (62) patients with chronic kidney disease,
on maintenance receive hemodialysis, aged between
20–70 and meeting the inclusion criteria
Enrolment
Patients excluded; 1 patient has a
history of cardiac events
1 patient recently had surgery
1 Patient with stroke complications
2 Patient (self-withdrawn)
unable to participate regularly
for two months
N=62 patients interviewed (Baseline assessment; test-1)
After “4 weeks” second assessment (test-2)
N=50
Follow-up
Total study sample (40); Outcome data analysis
12 patients discontinued
(Declined to continue)
Analysis
Lost to follow-up 3 patients
(1 patients died and 2 patients
transfers to another hospital)
7 patients drop out (refusals)
After “8 weeks” third assessment (test-3)
N=40
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Study results
Table (1) Summary Statistics of The Study Sample Socio-Demographic Data
Variables Intervals and Rating Frequency Percentage
Age (year)
20 - 29 4 6.5
30 - 39 10 16.1
40 - 49 18 29.0
50 - 59 18 29.0
60+ and more 12 19.4
x
̄ ± S.D. 48.83 ± 11.31
Gender
Male 42 67.7
Female 20 32.3
Education Level
Doesn’t read and write 10 16.1
Read and write 22 35.5
Primary school graduated 16 25.8
Intermediate school graduated 2 3.2
Secondary school graduated 6 9.7
Institutes, college, or
postgraduate
6 9.7
Occupation Status
Governmental employed 10 16.1
Own worker or self-employed 6 9.7
Retired 2 3.2
Housewife 18 29.0
Jobless 18 29.0
Disable 8 12.9
Monthly Income
Insufficient (Low) 34 54.8
Sufficient to some extent
(Moderate)
26 41.9
Sufficient (High) 2 3.2
Total 62 100.0
x
̄ : Mean; S.D: Standard deviation;
Socio-demographic characteristics of the participants:
Table (1) indicates the statistical distribution of the participants according to their socio-demographic data.
Regarding the study sample, the study result indicates that most of the participants are 40-59 years old, mean age
was 48.83 (SD, 11.31) years; male (67.7%), does read and write (35.5%), occupation status between a housewife
(29.0%) and jobless (29.0%) and their income is insufficient (54.8%).
Table (2) Statistics Distribution of Participants According to Clinical Characteristic
Clinical Characteristic Rating and interval Frequency Percentage
Period of Hemodialysis
(Years)
less than or 1 8 12.9
2 – 3 20 32.3
4 - 5 26 41.9
6 or more 8 12.9
Duration of hemodialysis
session (Hours)
2.5 2 3.2
3.0 30 48.4
3.5 6 9.7
4.0 24 38.7
Number of Hemodialysis
Sessions (per week)
2 30 48.4
3 26 41.9
4 6 9.7
Duration of Diagnosis Renal
Failure (years)
less than or 1 2 3.2
2 - 4 28 45.2
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5 or more 32 51.6
Smoking Habit
Smoker 12 19.4
Ex-smoker 24 38.7
Non-smoker 26 41.9
Total 62 100.0
Clinical characteristics of the participants:
Table (2) Shows the statistical distribution of the study sample according to their clinical characteristic; the
study result indicates that the majority of the study subjects are; duration of hemodialysis between 4 - 5 years; three
hours per session; two times hemodialysis session per week; duration of diagnosis renal failure 5 years and more;
and non-smoker.
Table (3) Summary Statistics Overall Assessment of Physical Performance
Physical Performance
Levels
Baseline assessment
(test-1)
Second assessment
(test-2)
Third assessment (test-
3)
Frequency Percentage Frequency Percentage Frequency Percentage
Low 40 64.5 28 56.0 30 75.0
Intermediate 20 32.3 20 40.0 8 20.0
High 2 3.2 2 4.0 2 5.0
Total 62 100.0 50 100.0 40 100.0
Low physical performance (0-6 points), Intermediate physical performance (7-9 points), and High physical
performance (10-12 points).
Table (3) Shows the overall assessment of the physical performance among the study sample; the
majority of them have a low physical performance at the baseline assessment (test-1), second assessment (test-2),
and third assessment (test-3). That indicate that there is a non-improvement in the physical performance throughout
three periods of measurements.
Figure (2) Overall Assessment physical performance throughout Three Periods of Measurements
Table (4) Applying One-Way Analysis of Variance Test (ANOVA) of Physical Performance throughout Three
Periods of Measurements
Measurement interval N Mean Std. Deviation F-value Sig.
Baseline assessment (test-1) 62 6.10 1.68
1.43
0.024
S
Second assessment (test-2) 50 6.16 1.65
Third assessment (test-3) 40 5.40 1.60
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N (number), F (ANOVA value); S: Significant
Table (4) Show that there is a significant difference between means throughout three periods of
measurement baseline assessment (test-1), second assessment (test-2), and third assessment (test-3), that the levels
of all of the physical performance are below the predicted levels at the baseline assessment and they still deteriorate
even at the third assessment (i.e., there is deterioration in the physical performance of patients as long as they are
undergoing hemodialysis).
Figure (3) Overall Mean of Physical Performance Throughout Three Periods of Measurements
Table (5) Effect of Demographic Data on Patients’ Physical Performance
Variable Chi-Square Value df Sig. (P-Value)
Age (year) 10.37 8
0.24
NS
Gender 6.38 2
0.04
S
Level of Education 8.69 10
0.56
NS
Occupation status 13.35 10
0.20
NS
Socio-economic status 2.87 4
0.57
NS
*df: degree of freedom; S: Significant at P<0.05; NS: Non-significant
The chi-square test is conducted to describe the association between the demographic data and
patients’ physical performance. The study findings presented in table (5) indicate that there is a significant
association between the patient’s gender. While there is a non-significant association with the other socio-
demographic data.
Table (6) Effect of Clinical Characteristic on Patients’ Physical Performance
Clinical Characteristic
Chi-Square
Value
df Sig. (P-Value)
Duration of Hemodialysis (years) 4.67 6
0.02
S
Hours of hemodialysis per session 2.14 6
0.90
NS
Number of hemodialysis session per week 1.78 6
0.93
NS
Duration of diagnosis renal failure 3.98 4
0.40
NS
Smoking habit 4.68 4
0.32
NS
*df: degree of freedom; S: Significant at P<0.05; NS: Non-significant
The chi-square analysis is conducted to determine the association between the patients’ physical
performance and their clinical data. The study results presented in table (6) indicate that there is a significant
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association between the duration of hemodialysis (years) and patients’ physical performance, while there is a non-
significant association with the other clinical characteristic.
Discussion
Low physical performance is a common complication associated with CKD; low physical performance and
impairment are associated with elevated risks of disability and death (Alkhaqani and Ali 2021). In addition, this
concept has been expanded further to show that CKD is also associated with weak functional status (Shlipak et al.,
2004).
This descriptive study contributes to the overall objective of addressing gaps in present knowledge around
the assessment levels of physical performance for patients with CKD. The outcome of the current study is to
examine the physical performance level of patients with chronic kidney disease and receive hemodialysis. After
implementation of the SPPB measurement through the present work, the study results indicated that a low level of
physical performance is extremely common and often severe across diverse chronic kidney disease populations.
Most patients who report physical performance level as either low (i.e., there is deterioration in the physical
performance of patients diagnosed with chronic kidney disease and undergoing hemodialysis treatment).
The study results agree with several other studies. Araújo Filho et al. (2016), studied the “Physical activity
level of patients on hemodialysis” they reported that individuals with chronic kidney disease undergoing
hemodialysis therapy have a low level of physical performance. Most of the patients in this study were sedentary.
Although the presence of fatigue and symptoms related to depression as likely potential causes for not performing
physical activity due to changes in lifestyle, self-image, and chronic kidney disease, it is recognized that these
factors may somehow contribute to a decrease in the level of physical performance among those on hemodialysis. A
narrative review study have been conducted on the importance of physical performance in patients with chronic
renal disease by Bakker et al. (2021), that entitled “assessing physical activity and function in patients with chronic
kidney disease” they noted that the level of physical activity specifically, for those undergoing hemodialysis
therapy, was lower than for healthy sedentary individuals. Patients who receive hemodialysis show markedly
impaired physical performance, health, and functioning. In addition, Manfredini and Lamberti (2014), studied the
“performance assessment of patient on dialysis” they stating regarding hemodialysis time and physical activity that
there was no observed association between the number of years of the process of hemodialysis and physical
functioning in patients with maintenance hemodialysis, most patients in this study were deterioration in the physical
performance as long as continue undergoing hemodialysis.
The study results show there is a non-significant association between socioeconomic, demographic data,
and other clinical characteristics. In contrast to the results seen in this study, França et al. (2009) found that persons
with higher socioeconomic status were more inactive, and attributed this to the fact that persons from lower
economic classes use active mobility more often, such as walking, which is a significant part of the overall physical
activity for these people.
Low physical performance levels in patients undergoing hemodialysis may have a multifactorial cause,
such as a state of chronic fatigue that occurs during hemodialysis, possibly because the metabolic clearance that can
be provided through hemodialysis is greatly inadequate compared to normal renal function. In addition, patients
often have multiple comorbidities, which lead to a lower general activity pattern, i.e., a more passive lifestyle.
Additionally, protein-energy wasting often occurs in patients suffered from end-stage kidney disease, which is
defined as an inflammatory condition that results to diminished muscle mass and strength, which can have a
significant impact on physical capacity (Dam et al. 2019).
According to the study by Delgado and Johansen (2012), reported only a small proportion of nephrologists
assessment of physical activity levels for their patients and provide them with guidance for the exercises. These
authors noted that these professionals didn’t direct their patients because they didn’t feel confident in providing
guidance on the subject, nor do they also didn’t believe that patients undergoing hemodialysis would increase their
physical activity level if they were asked to and did so. Consider exercise as important as other aspects related to
chronic kidney disease.
Conclusions
The study has concluded that patients with end-stage kidney disease and undergoing hemodialysis have a low level
of physical performance and deterioration as long as they are undergoing hemodialysis. This result is related to the
physical activity regarding the population on hemodialysis, not being related to the demographic and clinical
characteristics evaluated.
Recommends: The researchers recommend that comprehensive and longer follow-up population-based studies
could be conducted to determine the physical performance of patients with chronic disease. Assessment of the
physical capacity of patients with chronic disease or undergoing hemodialysis should be part of their routine
management. This routine assessment of patients may allow stratifying risks of the patients (hospitalizations,
complications of the peripheral disease, etc.) to identify patients' interest in receiving advice regarding the benefits
of exercise into specific rehabilitation therapy programs. Incorporate routine assessment of physical activity and
physical function into the clinical workflow, for example, by adding easy procedures of measures to the patient file.
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Limitation: The present study encounters some limitations, such as the dropout in the number of patients before
they complete the study. A relatively short follow-up duration due to the limited study period is an additional
limitation. One of the barriers to routine measurements is understanding which physical performance measures
should be used in this population. Future studies should try to overcome these limitations.
Ethical Considerations: A legal, governmental agreement obtained the ethical study approval before conducting
the study according to the standards for conducting research with human beings from the National Research Ethics
Committee (NREC). The objectives of the study and participation right or withdrawal from the study were explained
clearly to the study participants, and the participation was voluntary and signed an informed consent form.
Funding: No funding was received for this study.
Conflicts of interest: Authors declare no conflict of interest.
Acknowledgement: The authors are grateful to all patients involved in the study.
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