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Chronic kidney disease (CKD) has considerable effects on the quality of life of female patients. Receiving the diagnosis and beginning renal replacement therapy (RRT) has a great personal impact on patients. The purpose of this study was to describe the experience of female patients with CKD at an ambulatory dialysis unit regarding diagnosis, life changes, and initiation of RRT. A qualitative exploratory study was conducted based on a social contructivism framework. Participants were recruited using purposeful sampling. In total, 18 women who received treatment for CKD with RRT were included. The women were attending the Ambulatory Dialysis Unit at a hospital belonging to the public health system of Madrid (Spain). Unstructured and semi-structured in-depth interviews, researchers' field notes, and women's personal letters were used. A systematic text condensation analysis was performed. The criteria used to control trustworthiness were credibility, transferability, dependability, and confirmability. Two themes emerged from the data: (a) A turning point in their lives, and (b) The emotional journey of beginning RRT. The diagnosis of CKD and the beginning of treatment implies changing routines and adapting to a new life with CKD. The first dialysis and puncture of the arteriovenous fistula is a major experience. Support from other CKD patients with more experience is perceived as a necessity and a tool to share their experiences and resolve doubts among peers. The diagnosis and initiation of RRT leads to numerous changes in the lives of women with CKD, which may influence the acceptance of treatment.

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BACKGROUND: Patients on hemodialysis are particularly vulnerable to COVID-19 and may have a reduced response to vaccination because of a decreased immune response. The nutritional status before or during the infection could also impact on the clinical effectiveness of vaccination. OBJECTIVES: We aim to describe the evolution of clinical and nutritional biomarkers of hemodialysis patients infected with SARS-CoV-2 and to assess their association with vaccination status. METHODS: An observational, analytic, longitudinal, retrospective multicenter study was carried out in 82 patients on hemodialysis with SARS-CoV-2 infection. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), anthropometry, and biochemical parameters. The association of the vaccine doses with clinical- and nutritional-related variables was also evaluated. RESULTS: The percentage of vaccinated patients was similar to that of nonvaccinated patients. Before infection, most of the patients were malnourished. They presented lower albumin, creatinine, and urea levels than the well-nourished patients. Significant deterioration of nutritional status after infection was evidenced considering GNRI score, dry weight, and body mass index. Albumin and creatinine also decreased significantly after infection, whereas C-reactive protein increased in the acute phase. Significant inverse correlation was found between the variation of post-pre GNRI scores and basal albumin and C-reactive protein at 7 days. In addition, we observed the opposite trend between albumin at 30 days and basal cholesterol. A negative value in the GNRI variation was associated with bilateral pneumonia, need for hospitalization, and nutritional support. Vaccinated patients presented substantially less bilateral pneumonia and hospitalization. No significant effects were observed between vaccine doses and the variation in nutritional status, although a positive correlation was detected with the albumin at 7 days and C-reactive protein before infection and the number of vaccine doses received. DISCUSSION: COVID-19 is associated with affectations in the nutritional status and biomarkers in hemodialysis patients. In this study, vaccines have shown a protective effect against the clinical consequences of COVID. However, they have shown limitations in preventing the deterioration of nutritional status after infection. The results highlight the importance of promoting the vaccination in these patients as well as incorporating nutritional assessment before, during, and after the infection.

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La investigación es la plataforma para que la enfermería pueda contribuir a la calidad y gestión en el cuidado de los pacientes. La enfermería se hará visible a los ojos de los propios profesionales como de la sociedad a medida que aplique más intervenciones basadas en la investigación, de esta manera habrá una mayor necesidad de crear conocimiento potenciando la enfermería como disciplina humanista y revelando el carácter autónomo y social que la profesión posee.El propósito del siguiente artículo es narrar desde la mirada de una enfermera la experiencia de realizar una investigación cualitativa con mujeres con enfermedad renal crónica en una unidad de diálisis de un hospital público de la Comunidad de Madrid. (AU)

Research is the platform for nursing to contribute to the quality and management of patient care. Nursing will become visible in the eyes of the professionals themselves as well as of society as it applies more research-based interventions, in this way there will be a greater need to create knowledge, promoting nursing as a humanistic discipline and revealing the autonomous and social character that the profession possesses.The purpose of the following article is to narrate from the perspective of a nurse the experience of conducting qualitative research with women with chronic kidney disease in a dialysis unit of a public hospital in the Community of Madrid. (AU)

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BACKGROUND: End-stage kidney disease (ESKD) has considerable effects on the quality of life, impairing daily activities and leading to lifestyle changes. The purpose of this study was therefore to explore the experience of motherhood and taking care of children in women with ESKD. METHODS: A qualitative exploratory study was conducted based on an interpretive framework. Participants were recruited using non-probabilistic purposeful sampling. In total, 14 women with ESKD were included, who were treated at the dialysis unit of a Spanish hospital. In-depth interviews (unstructured and semi-structured interviews) and researchers' field notes were used to collect the data. A systematic text condensation analysis was performed. The techniques performed and application procedures used to control trustworthiness were credibility, transferability, dependability, and confirmability. RESULTS: Three themes emerged from the data. "Coping with being a mother" described how women are faced with the decision to become mothers and assess the risks of pregnancy. The second theme, called "Children and the experience of illness", highlighted the women's struggle to prevent the disease from affecting their children emotionally or disrupting their lives. The third theme, "Fear of genetic transmission", was based on the women's fear of passing the disease on to their children. CONCLUSIONS: Deciding to become a mother and taking care of children represents a challenge for women with ESKD, coupled with the losses in their lives caused by the disease. These findings are only relevant to women on dialysis.

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Chronic kidney disease (CKD) has considerable effects on the quality of life of patients, impairing everyday activities and leading to lifestyle changes, as well as affecting body image and intimate relationships. Our aim was to describe the experience of female patients with CKD at an ambulatory dialysis unit regarding body changes and sexuality. A qualitative phenomenological study exploring how 18 female patients, treated at the dialysis unit of a Spanish hospital, perceived their sexuality and intimate relationships. Data were collected using in-depth interviews, researcher field notes, and patients' personal letters. A thematic analysis was performed. Four main themes arose from the data describing the experience of how CKD impacts body changes and sexuality: (a) Accepting body changes, (b) The catheter, the fistula, and body image, (c) Experiencing a different sexuality, and (d) The catheter, the fistula, and sexuality. Patients experienced changes in their body, perceiving it as being bloated or deformed, together with overall decline. The catheter and/or the fistula triggered changes in the way the women dress in an attempt to hide port sites. Women experience sexuality changes, affecting sexual desire and satisfaction. The presence of catheters was found to be the most cumbersome during sexual acts.

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Introducción: La enfermedad renal crónica (ERC), produce una pérdida gradual e irreversible de la función de los riñones. Sus modalidades de tratamiento son invasivas y la existencia de un acceso vascular adecuado para hemodiálisis es fundamental para garantizar la supervivencia de los pacientes. Las diferencias de género existen con respecto a la epidemiología, la evolución y el pronóstico de las enfermedades crónicas del riñón, y pueden existir diferencias en las respuestas y perspectivas de las mujeres ante la ERC. Objetivos: Describir la experiencia de los pacientes con enfermedad renal crónica en hemodiálisis; su experiencia como portadores de un catéter venoso central (CVC), y si existen diferencias de género en las experiencias y vivencias de los portadores/as. Material y Método: Estudio cualitativo fenomenológico. Se aplicó un muestreo por propósito, se recogieron datos a través de entrevistas en profundidad, y se aplicó un análisis temático. Resultados: La enfermedad renal crónica supone un gran impacto en sus vidas. Todos los pacientes narran su preferencia sobre el CVC, son conscientes de su implicación en su tratamiento y en su expectativa vital, y se preocupan de su viabilidad y seguridad. Conclusiones: Existen diferencias de género, sobre todo en el impacto de la enfermedad y el tratamiento en el trabajo y en su nivel de autonomía y actividad

Introduction: Chronic Kidney Disease (CKD) is a disease that involves the gradual and irreversible loss of kidney function. The existence of adequate vascular access for hemodialysis is fundamental to guarantee a survival of the patients. Gender differences exist with respect to the epidemiology, evolution and prognosis of chronic kidney diseases. There are differences in the responses and perspectives of women on CKD. Objectives: To describe the experience of patients with CKD on hemodialysis; their experience as holders of a central venous catheter (CVC), and if there are gender differences in the responses and experiences of the holders. Material and Method: Qualitative phenomenological study was applied. Purposeful sampling was used and in-depth interviews was applied by researchers. Also, thematic analysis was used to qualitative data analysis. Results: CKD has a great impact on the patients’ lives. All patients report their preference about the use of CVC, are aware of the involvement in the treatment and their life expectancy, and are concerned about the viability and safety. Conclusions: There are gender differences, especially in the impact of the disease and treatment at work and in their level of autonomy and activity

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