Since end-stage renal disease leads to a variety of problems such as disability,reduced quality of life,and mental and psychological disorders,it has become a serious public health problem around the globe.Renal palliative care integrates palliative care philosophy in the care for patients with end-stage renal disease.As a planned,comprehensive,patient-centered care,renal palliative care focuses on the patient's symptoms and needs,aiming to reduce the suffering throughout the course of the disease,including but not limited to end-of-life care.This study reports the palliative care practice for a patient on maintenance dialysis in the Blood Purification Center of Peking Union Medical College Hospital and reviews the present situation of palliative care in end-stage renal disease.
Humans ; Palliative Care/psychology* ; Quality of Life ; Kidney Failure, Chronic/therapy* ; Terminal Care/psychology* ; Renal Dialysis/psychology*

PURPOSE: Professional hemodialysis (HD) nursing tends to be task-oriented and lack consideration of the client's viewpoint. This study aims to interpret the process of psychosocial adaptation to dealing with HD in people with end-stage renal disease (ESRD). METHODS: A grounded theory guided this study. Theoretical sampling included 15 people receiving HD at the HD center of a hospital from July to November 2010. Participants received an information sheet in writing, a verbal invitation, and informed consent forms before interviews were conducted. A constant comparative data analysis was analyzed using open, axial and selective coding. The computer software ATLAS.ti assisted data management. Credibility, transferability, dependability, and confirmability ensured the rigor of study process. RESULTS: This study identified "adopting life with hemodialysis", which captures the process of the psychosocial adaptation in people with ESRD as one transformation. Four categories that evolved from "adopting HD life" are (a) slipping into, (b) restricted to a renal world, (c) losing self control, and (d) stuck in an endless process. CONCLUSIONS: The findings of this investigation indicate the multidimensional requirements of people receiving maintenance dialysis, with an emphasis on the deficiency in psychosocial and emotional care. The study's findings contribute to clinical practice by increasing the understanding of the experience of chronic HD treatment from the recipient's viewpoint. The better our understanding, the better the care provided will meet the needs of the people receiving HD.
*Adaptation, Psychological ; Adult ; Aged ; Female ; Humans ; Kidney Failure, Chronic/*psychology/therapy ; Male ; Middle Aged ; Qualitative Research ; Renal Dialysis/*psychology

This review article is intended to show and understand psychosocial factors in patients with chronic kidney disease (CKD) including end-stage renal disease (ESRD) on renal replacement therapy. These patients suffered from many psychosocial factors such as depression, sleep disorder, and chronic pain, etc. The prevalence of major depression or a defined psychiatric illness in ESRD patients is not clearly defined, but is roughly estimated between 5% and 50%. Unfortunately many sufferers do not seek treatment, and of those who do, significant numbers are improperly diagnosed or are not appropriately treated. They should be managed by psychiatric medication and interview, because depression could affect medical outcomes in ESRD patients through several mechanisms. Sleep disorders are common in ESRD patients treated with dialysis and are associated with patients' perceptions of quality of life, assessed by diverse measures, as well as depressive mood. Although pain has been considered as a problem for ESRD patients for more than 20 years, few studies exist on this subject. Pain appears to be an undervalued problem for ESRD patients. These psychosocial factors could affect morbidity, mortality and life quality in CKD and ESRD patients. The physicians, especially managing CKD patients, need to consider these factors.
Chronic Pain ; Depression ; Dialysis ; Dyssomnias ; Humans ; Kidney Failure, Chronic ; Mortality ; Prevalence ; Psychology* ; Quality of Life ; Renal Insufficiency, Chronic* ; Renal Replacement Therapy ; Sleep Wake Disorders

We conducted a study to determine whether the hemocontrol biofeedback system (HBS) can improve intradialytic hypotension (IDH) in hypotension-prone hemodialysis (HD) patients compared with conventional HD. In this multicenter prospective crossover study, 60 hypotension-prone patients were serially treated by conventional HD for 8 weeks (period A), by HD with hemoscan blood volume monitoring for 2 weeks (period B0), and by HBS HD for 8 weeks (period B1). The number of sessions complicated by symptomatic IDH during 24 HD sessions (14.9+/-5.8 sessions, 62.1% in period A vs 9.2+/-7.2 sessions, 38.4% in period B1, P<0.001) and the number of IDH-related nursing interventions in a session (0.96+/-0.66 in period A vs 0.56+/-0.54 in period B1, P<0.001) significantly decreased in period B1 than in period A. Recovery time from fatigue after dialysis was significantly shorter in period B1 than in period A. The patients with higher post-dialysis blood pressure, lower difference between pre- and post-dialysis blood pressure, less frequent IDH, and higher pre- and post-dialysis body weight in period A responded better to HBS in period B1 in regard to the reduction of IDH. In conclusion, HBS may improve the patient tolerability to HD by reducing the IDH frequency and promoting faster recovery from fatigue after dialysis.
Adolescent ; Adult ; Aged ; *Biofeedback, Psychology ; Blood Pressure ; Blood Volume ; Body Weight ; Cross-Over Studies ; Fatigue ; Female ; Humans ; Hypotension/etiology/*prevention & control ; Kidney Failure, Chronic/*therapy ; Male ; Middle Aged ; Prone Position ; Prospective Studies ; Renal Dialysis/adverse effects ; Young Adult

PURPOSE: Patients with chronic kidney disease frequently show cognitive dysfunction. The association of depression and cognitive function is not well known in maintenance dialysis patients. We evaluated cognitive impairment and depression, as well as their relationship in regards to methods of dialysis, maintenance hemodialysis (MHD) and chronic peritoneal dialysis (CPD). MATERIALS AND METHODS: Fifty-six maintenance dialysis patients were recruited and their clinical and laboratory data were collected. The Korean version of the mini-mental state exam (K-MMSE) was applied to screen the patient's cognitive function, while the Korean version of the Beck Depression Inventory (K-BDI) was used for depression screening. RESULTS: The average age of the participants was 54.2+/-10.2 years; 29 (51.8%) were female. The average dialysis vintage was 4.2+/-3.8 years. The CPD group showed significantly higher K-MMSE score (27.8+/-2.9 vs. 26.1+/-3.1, p=0.010) and lower K-BDI score (12.0+/-8.4 vs. 20.2+/-10.4, p=0.003) compared with the MHD group. The percentage of patients with depression symptoms was higher in the MHD group (51.7% vs. 18.5%). There was a negative correlation between cognitive function and prevalence of depressive symptoms. Depression and education level were shown to be independent predictors for cognitive impairment in multivariate analysis. CONCLUSION: Cognitive impairment was closely correlated with depression. It is important to detect cognitive impairment and depression early in maintenance dialysis patients with simple bedside screening tools.
Adult ; Cognition Disorders/etiology/*physiopathology ; Depression/etiology/*physiopathology ; Female ; Humans ; Kidney Failure, Chronic/physiopathology/psychology/therapy ; Male ; Middle Aged ; Renal Dialysis/*adverse effects/*psychology

PURPOSE: The purpose of this study was to investigate the effect of stretching, muscle strengthening, and walking exercise on the cardiopulmonary function and health-related quality of life in hemodialysis patients. METHODS: Twenty-one patients in the intervention and the control group participated in the exercise respectively on maintenance hemodialysis at four university hospitals. The exercise was composed of 20 to 60 min per session, 3 sessions a week for 12 weeks. The effect of exercise was assessed by cardiopulmonary function (peak oxygen uptake, peak ventilation, peak respiration rate, maximal heart rate, and exercise duration) using a cycle ergometer. Grip strength was measured by dynamometer, and flexibility was measured by sit and reach measuring instrument. Health-related quality of life was measured using Medical Outcomes Study Short Form-36. RESULTS: Peak oxygen uptake, peak ventilation, peak respiration rate, exercise duration, grip strength, flexibility, and physical component scale were significantly improved in the intervention group after 12 week's exercise compared to the control group. CONCLUSION: These findings indicate the exercise can improve cardiopulmonary function, grip strength, flexibility, and physical component scale of health-related quality of life in hemodialysis patients.
Adult ; *Exercise Therapy ; Female ; Humans ; Kidney Failure, Chronic/physiopathology/psychology/*therapy ; Male ; Middle Aged ; Muscle Strength ; Oxygen Consumption ; *Physical Fitness ; Quality of Life/*psychology ; Range of Motion, Articular ; *Renal Dialysis

Medical co-morbidities are very common in patients with psychiatric conditions. Although respecting one's autonomy to make treatment decisions is the ethical default position, the capacity to make such decisions may need to be assessed, especially when patients are in relapse of their psychiatric condition, and/or when the decisions made are high-risk and possibly fatal. This case report highlights the ethical issues of refusing potential life-saving treatment in a patient who is in relapse of her schizoaffective disorder. In particular, the assessment of decisional capacity and the role of the doctors (if the patient lacks capacity) are discussed. Recommendations are also made on how to better manage such situations.
Adult ; Female ; Humans ; Kidney Failure, Chronic ; therapy ; Mental Competency ; Patient Care ; ethics ; Patient Participation ; psychology ; Personal Autonomy ; Schizophrenia

Health Status ; Humans ; Kidney Failure, Chronic ; psychology ; therapy ; Quality of Life

Sexual dysfunction is a highly prevalent problem among patients with chronic renal failure, which affects patients in the quality of life. However, it has not received enough attention. The genesis of sexual dysfunction is multifactorial, including physiological, psychological and organic factors. This review summarized the incidence, main manifestation, evaluation, risk factors and treatments associated with sexual dysfunction in patient of the chronic renal failure.
Female ; Humans ; Kidney Failure, Chronic ; complications ; physiopathology ; psychology ; Male ; Sexual Dysfunction, Physiological ; etiology ; therapy ; Sexual Dysfunctions, Psychological ; etiology ; therapy

It is well known that depression and sense of hopelessness worsen the quality of life in end-stage renal disease (ESRD) patients receiving dialysis. However, the characteristics of depression in continuous ambulatory peritoneal dialysis (CAPD) patients have not been analyzed in detail. We performed this study to investigate the severity of depression and the factors affecting depression in CAPD patients. With 96 CAPD patients, we evaluated each patient's depressive mood and hopelessness with CES-D (Center for Epidemiologic Studies Depression) scale and Beck Hopelessness Scale. We also evaluated the degree of stress of each patient with internal individual stress scale. Most CAPD patients experienced severe depression compared with the general population. Their depression was better explained by psychological factors, such as stress and sense of hopelessness, than by demographic or physical factors. On the basis of these findings, we suggest that the treatment of depression in CAPD patients might be possible by modulation of psychological factors.
Adult ; Aged ; Depression/*etiology ; Female ; Humans ; Kidney Failure, Chronic/psychology/*therapy ; Male ; Middle Aged ; Peritoneal Dialysis, Continuous Ambulatory/*adverse effects ; Sex Factors ; Stress, Physiological