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This article describes the care experience of a case of end stage renal disease in which the patient was unable to cope with the progression of the disease and caused spiritual distress. The nursing care period is from January 24 to February 23, 2021. Patient data was collected using physical, psychological, spiritual and social assessments, through direct care, medical records and interviews. The identified health issues were ineffective airway clearance, compromised skin integrity, and spiritual distress. Physiological problems were treated with nursing measures such as oral care, chest physiotherapy care, keeping the skin dry, and choosing an appropriate wound dressing method. The case effectively eliminated sputum, and there was no new sign of infection in the pressure injury wound. In terms of psychological problems, interprofessional collaborative practice provided psychological support and spiritual comfort, and guided the patient to participate in medical decisions and end-of-life discussions, conduct life reviews, build self-worth, and achieve the goal of spiritual wellness. Caregivers are encouraged to participate in courses on hospice care and advance care planning to enhance the sensitivity and communication skills of clinical care in this kind of case. [ABSTRACT FROM AUTHOR]

Objective To investigate the attitudes and influencing factors of transplantation-related populations towards kidney xenotransplantation. Methods From June 2022 to January 2023, stratified random sampling was performed from patients awaiting kidney transplantation, patients after kidney transplantation, patients' relatives and medical students. Four hundred subjects were collected from each population and 1600 subjects were investigated using a self-designed questionnaire. Baseline data of the respondents, their attitudes towards kidney xenotransplantation and the reasons of rejecting kidney xenotransplantation were analyzed. The influencing factors of attitudes towards kidney xenotransplantation were also identified. Results A total of 1 493 valid questionnaires were collected, and the questionnaire retrieval rate was 93.31%. About 93.10% of the respondents accepted allogeneic kidney transplantation, and 66.78% had heard of kidney xenotransplantation. Seven hundred and ninety-five respondents suggested that they could accept kidney xenotransplantation "when kidney xenotransplantation and allogeneic kidney transplantation yielded the same results and risks". Six hundred and ninety-eight respondents indicated that they were "unable" or "uncertain" whether they could accept kidney xenotransplantation (χ² =16.409, P=0.001). Among these 698 respondents, the proportion of them who were willing to accept kidney xenotransplantation when they did not meet the conditions of allogeneic kidney transplantation was 10.9%. About 35.8% of respondents were willing to accept kidney xenotransplantation if it yielded less risk and better prognosis compared with allogeneic kidney transplantation. If the time of awaiting kidney xenotransplantation was shorter than that of allogeneic kidney transplantation, 21.2% were willing to accept kidney xenotransplantation. If the cost of kidney xenotransplantation was less than that of allogeneic kidney transplantation, 24.5% of them were willing to accept kidney xenotransplantation. The main reasons of rejecting kidney xenotransplantation included surgical risk and other unknown risks. Multivariate analysis showed that respondents residing in cities and towns for a long period of time, those who accept allogeneic kidney transplantation and those who have heard of kidney xenotransplantation showed more positive attitudes towards kidney xenotransplantation. Conclusions Different transplantation-related populations have different attitudes towards kidney xenotransplantation, and the overall attitudes are positive. Active promotion of kidney xenotransplantation research and carrying out relevant popular science education contribute to improving public attitudes towards the acceptance of kidney xenotransplantation. [ABSTRACT FROM AUTHOR]

Objective To investigate whether adding renal histological score（MEST-C）to the Kidney Failure Risk Equation（KFRE）could improve predicting the risk of progression in advanced IgA nephropathy. Methods This was a prospective cohort study in which 205 patients with advanced IgA nephropathy［15 ~ 59 mL/（min·m²）］were enrolled and followed up to 2 years. The timepoint of renal biopsy was defined as baseline. The 4-variable/8-variable KFRE was used to estimate 2-year risk of progression to end stage renal disease（ESRD, defined as need for receiving maintenance dialysis or renal transplantation）. AUCs were calculated to evaluate the performance of risk prediction using KFRE and MEST-C alone or in combination. Risk classification for progression to ESRD was assessed by net reclassification index（NRI）and integrate discrimination index（IDI）. Results Among 205 patients with advanced IgA nephropathy, 38（18.5%）progressed to ESRD within 2 years of follow up. The 4-variable KFRE predicted the progression of advanced IgA nephropathy with an AUC of 0.81（95%CI：0.73 ~ 0.89）, while the 8-variable KFRE with an AUC of 0.79（95%CI：0.71-0.87）, the MEST-C with an AUC of 0.74 （95%CI：0.64 ~ 0.83）. Adding MEST-C to the 4-variable KFRE produced an overall AUC of 0.85（95%CI：0.78 ~ 0.91）and significant improvement for risk classification for ESRD（NRI, 0.47 and IDI 0.05）. Conclusion Adding renal histological score to the Kidney Failure Risk Equation improved risk prediction and reclassification of progression to ESRD in patients with advanced IgA nephropathy. [ABSTRACT FROM AUTHOR]

Diabetic kidney disease (DKD) is the main cause of end stage renal disease and deathin patients with diabetic mellitus (DM) . Prognostic assessment for patients with DKD is critical to reducethe risk of disease progression and incidence of complications or deaths. This review mainly discussedthe current research status of biomarkers which might predict the progression of DKD, includingthe commonly used albuminuria and glomerular filtration rate (GFR) , as well as novel biomarkerslike tumor necrosis factor receptor (TNFR) and renal tubular markers. Meanwhile, we discussed thepotential challenges in the development and application of these biomarkers in progressive DKD.

Chronic kidney disease is a global public health problem threatening human health and affects the function of multiple organ systems. The oral health of patients is often affected as the disease progresses. Dental implants have become the best way to repair tooth loss. It is necessary and challenging to provide safe and reliable dental implant treatment for patients with chronic kidney disease. Dental clinicians should evaluate the health of patients comprehensively, complete blood biochemistry, coagulation function, and imaging examinations, and provide feasible, reliable and personalized treatment plans. During the treatment phase, dental clinicians need to consider prophylactic antibiotics, painless minimally invasive surgery, infection control, and delayed restoration, and they must cooperate with other clinicians in multiple disciplines to reduce risks to provide personalized, safe, and effective oral implant treatment for patients with chronic kidney disease.

This article describes an experience providing nursing care to a patient under hemodialysis with the end-stage renal disease who had developed depression, loathing, and other, negative personal perceptions and gradually gave up on life goals due to hopelessness. The duration of nursing care, from August 23rd through August 29th, 2019, was revisited to identify the patient's hopelessness in the dimensions of physiology, mental status, society, and spirituality. The author applied Swanson's Caring Theory to facilitate the process of "knowing" and "being with" while performing direct nursing care and attentive listening to assist the patient to become more open-minded and to express personal perceptions toward the disease with the goal of further engaging the patient to increase selfawareness recognition, sense of loss, and negative perceptions. Through "doing for" and "enabling," the author reinforced infection control and identified the symptoms of fluid-overload, moisture, and salinity to raise the patient's self-awareness and self-caring techniques and to lower the risk of hospitalization. Meanwhile, by "maintaining the patient's belief," accompanied by the encouragement and attention from family members and providing linkages to patient-support communities, the patient was guided to identify and aggregate to foster positive thinking and self-worth to increase acceptance of living with the disease. Nursing personnel may apply Swanson's Caring Theory to better consider the patient's perspective, provide individual caring schemes, and strengthen the recognition, selfcaring techniques and supportive systems of patients, increasing patient perceptions of self-worth, restoring their confidence, promoting their adaption to their disease, and improving attentiveness. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical characteristics and the experience of multi-disciplinary team (MDT) on recurrence of primary hyperoxaluria (PH) type I after renal transplantation. Methods One case presenting with unexplained rapid decline of renal allograft function after allogeneic renal transplantation was discussed by MDT. The role of MDT in diagnosing rare hereditary diseases and improving the long-term survival of renal transplant recipients was summarized. Results After MDT consultation, the patient was diagnosed with recurrence of PH type I. Routine immunosuppressive regimen was initiated after the exclusion of rejection. The patient was instructed to drink a large quantity of water, and given with high-quality protein and low-phosphorus diet, vitamin B6, calcium and other conservative therapies to actively prevent and treat postoperative complications. The deterioration of renal graft function was delayed. Nevertheless, regular hemodialysis was resumed at 5 months after renal transplantation until the submission date of this manuscript. Conclusions Recurrence of PH type I after renal transplantation is relatively rare. The main clinical manifestations are recurrent kidney stones and decreased renal function with multiple complications and poor prognosis. The condition of the patient is consulted by MDT for confirming the diagnosis, determining the optimal treatment scheme, delaying the progression and improving the clinical prognosis. [ABSTRACT FROM AUTHOR]

Elderly patients with end stage renal disease (ESRD) frequently suffer from frailty, multiple comorbidities, and complications that greatly increase the mortality rate for this population. The irreversibility and variability of ESRD directly affect quality of life, which highlights the importance of gaining an early understanding of the preferences and expectations of these patients with regard to end-of-life care. This article describes a nursing experience that used ethical analysis to help an elderly ESRD patient and the dilemma faced by his family as to whether to sustain or withdraw hemodialysis. This article examines the uncertain trajectories of this disease and how to use shared decision making with the patient and his/her family to make the best decisions. A comprehensive assessment was conducted to identify the major health-related problems, to elicit the dilemmas faced in making the decision to sustain or end hemodialysis, and to understand the pain and suffering of the patient. Symptom control and comfort were identified as the most important goals of the patient, followed by building trust and rapport with his family. An analysis of the pros and cons of treatment was conducted using the 4-box ethical analysis developed by Josen, Siegler, and Winslade. The shared decision-making process was applied to help the patient express his expectations for his end-of-life care. While the health professionals considered that pain and suffering may influence the patient's decision, the patient found his connection between himself and others, self-value, and meaning of life through family love and support. A needs-based, flexible approach was adopted that established a continuous-care plan that was designed to provide the best care for the patient under a variety of possible scenarios while involving the family, which created a family-centered decision-making process that improved the quality of life of the elderly ESRD patient. [ABSTRACT FROM AUTHOR]

This article aimed to present an intensive care experience of an end-stage renal disease patient on chronic hemodialysis withdrawing from life-sustaining treatment after admitted to ICU due to coma after choking. The nursing period lasted from November 18th to December 10th, 2015. The authors utilized Gordon's functional health patterns for a comprehensive assessment. Data was collected by direct nursing, physical assessment, observation, and interview. The patient's health problems were ineffective breathing pattern, readiness for enhanced decision making, and anticipatory grieving. We recommend all healthcare professionals regardless of disciplines to receive training on withdrawal of life-sustaining treatment. We would also like to promote early medical decision making for end-stage renal disease patients to effectively enhance the quality of care for these patients. [ABSTRACT FROM AUTHOR]

Objective To investigate the fatigue status in patients with maintenance hemodialysis（MH） and analyze the relevant factors affecting it. Methods A general conditions questionnaire was used to collect general conditions including patient's gender，age，marital status，number of children， home address， economic status， medical insurance，education level，job，sleep，diet，and mood，et al; Fatigue Scale FS-14 was used to assess the degree of fatigue. The clinical data of patients were collected at the same time，including blood routine，liver function，renal function，electrolytes，anemia-related examinations，and bone metabolism-related examinations， et al. Results Among 121 investigated hemodialysis patients，the fatigue score of FS-14 was （7.73±2.36）； 79.33 percent of patients were troubled with fatigue，mainly involved in physical fatigue. When FS-14 score was used as a dependent variable，it was negatively correlated with the time of falling asleep at night（B= -0.307， =-5.172,P=0.000），and positively correlated with number of children （BP=0.324， = 2.641，P=0.011）， alkaline phosphatase （BP=0.009，P=2.066，P=0.040），and urea nitrogen （BP=0.070， = 3.241，P=0.001）；The data were analyzed by multivariate linear stepwise regression analysis. Conclusions Fatigue is a high-frequency event in the patients with MH and should be taken into account in clinical work. It is of great value to improve life quality of hemodialysis patients by taking active measures against these factors. [ABSTRACT FROM AUTHOR]

Objective: To explore the effects of peritoneal dialysis (PD) and hemodialysis (HD) on calcium-phosphorus metabolism and micro inflammatory state in patients with end-stage renal disease (ESRD). Results: 94 patients with ESRD who were treated in our hospital fromJanuary 2016 to February 2017 were selected as the subjects, the patients were divided into PDgroup (47 cases) and HD group (47 cases) by random number table, the PD group were treated with ambulatory continuous PD treatment, the HD group were treated with HD, after 6 months treatment, the levels of serumcalcium, phosphorus metabolism and micro inflammation were compared between the two groups, the incidence of complications in the two groups was also counted. After 6 months treatment, the serum calcium levels of the two groups increased significantly, serum phosphorus levels decreased significantly (P<0.05), but there was no significant difference between the HD group and the PD group (P>0.05). After 6 months treatment, the levels of serum c-reactive protein (CRP) in two groups were significantly increased, and the HD group was higher than the PD group, the differences were statistically significant (P<0.05). After 6 months treatment, the level of procalcitonin (PCT) was lower than that at before treatment, the difference was statistically significant (P<0.05), but there was no significant difference between the HD group and the PD group (P>0.05). The incidence of infection and hypoproteinemia in PD group were higher than that in HD group, and the incidence of hypertension, arrhythmia andcongestive heart failure in HDgroup were higher than that inPDgroup, the differenceswere statisticallysignificant (P<0.05). Conclusion: The PD and HD treatment both can improve the metabolismof calcium and phosphorus in patients with ESRD, but both of them will aggravate the micro inflammatory reaction, and HD has more influence on the micro inflammatory state of the patients. [ABSTRACT FROM AUTHOR]

Objective:To compare the effect of hemodialysis and peritoneal dialysis on the prognosis and safety of patients with end-stage renal disease (ESRD). Methods:246 patients with dialysis in our hospital from January 2010 to April 2016 were selected and divided into two groups: hemodialysis group and peritoneal dialysis group, the survival and incidence of complications were compared between the two groups. Results:The causes of death in both groups were heart failure, gastrointestinal bleeding, severe infection, cerebral infarction, and the fatality rate and cause of death showed no statistically significant difference (P>0.05). The 1-year, 3-year and 5-year survival rates of ESRD patients in the peritoneal dialysis group were significantly higher than those of the hemodialysis group (P<0.05), no statistical difference was found in the 7-year survival rate between two groups (P>0.05). For the first time in over 60 years of age in patients with end-stage renal disease, the 1-year, 3-year, 5-year and 7-year survival rates were significantly lower than those of the hemodialysis group(P<0.05). The incidence of heart failure, arteriovenous fistula occlusion of hemodialysis group were higher than those of the peritoneal dialysis group (P<0.05), the incidence of peritonitis in peritoneal dialysis group was higher than that of the hemodialysis group (P<0.05), the total complication rate in the hemodialysis group was higher than that of the peritoneal dialysis group (P<0.05). Conclusion:Hemodialysis and peritoneal dialysis had their own advantages and disadvantages, we should choose the mode of dialysis for patients with end-stage renal disease, reduce the complications, improve the quality of life and the survival rate. [ABSTRACT FROM AUTHOR]

Kidney transplantation is the best approach for treating patients with end stage renal disease, offering patients the best chance of returning to normal health. While the techniques used in kidney transplantation surgery are mature and highly successful, there is a severe shortage of donor organs. Statistics show a serious imbalance between organ donations and patients on the waiting list for organ transplantation. Moreover, evidence from empirical studies has shown a better transplantation outcome for patients who receive living donor transplantation than for those who receive organs from cadavers. Although using relatives as donors offers an effective way to reduce the problem of organ shortage, this strategy faces many challenges and many other factors affect the promotion of living donor transplantation. This article elaborates how cultural and psychological factors, kidney transplantation awareness, and ethics and laws impact upon living kidney donations and then proposes coping strategies for promoting living kidney transplantation. [ABSTRACT FROM AUTHOR]

This article described the nursing process of assisting an ESRD post-surgery patient who had been admitted to hospital due to bladder cancer, but complicated with posterior reversible encephalopathy syndrome (PRES); the nursing period lasted from April 22nd to July 15th, 2009. Information was collected by interview and observation. Two main health problems were identified: fatigue and caregiver role strain, as the result of physical, psychological and social fatigue derived from long hospitalization and social isolation due to acute and chronic diseases. Through caring, accompanying, providing consultation and encouraging ambulation process, the patient not only adapted to the fatigue after surgery, but also regained functional independence. This nursing experience can help nursing staffs to thoroughly understand the reactions of ESRD Patients who are complicated with PRES, as well as providing a basis for an effective enhancement of the home care skills of the caregivers. [ABSTRACT FROM AUTHOR]

This article describes an experience providing nursing care to a patient under hemodialysis with the end-stage renal disease who had developed depression, loathing, and other, negative personal perceptions and gradually gave up on life goals due to hopelessness. The duration of nursing care, from August 23rd through August 29th, 2019, was revisited to identify the patient`s hopelessness in the dimensions of physiology, mental status, society, and spirituality. The author applied Swanson`s Caring Theory to facilitate the process of "knowing" and "being with" while performing direct nursing care and attentive listening to assist the patient to become more open-minded and to express personal perceptions toward the disease with the goal of further engaging the patient to increase self-awareness recognition, sense of loss, and negative perceptions. Through "doing for" and "enabling," the author reinforced infection control and identified the symptoms of fluid-overload, moisture, and salinity to raise the patient`s self-awareness and self-caring techniques and to lower the risk of hospitalization. Meanwhile, by "maintaining the patient`s belief," accompanied by the encouragement and attention from family members and providing linkages to patient-support communities, the patient was guided to identify and aggregate to foster positive thinking and self-worth to increase acceptance of living with the disease. Nursing personnel may apply Swanson`s Caring Theory to better consider the patient`s perspective, provide individual caring schemes, and strengthen the recognition, self-caring techniques and supportive systems of patients, increasing patient perceptions of self-worth, restoring their confidence, promoting their adaption to their disease, and improving attentiveness.

Elderly patients with end stage renal disease (ESRD) frequently suffer from frailty, multiple comorbidities, and complications that greatly increase the mortality rate for this population. The irreversibility and variability of ESRD directly affect quality of life, which highlights the importance of gaining an early understanding of the preferences and expectations of these patients with regard to end-of-life care. This article describes a nursing experience that used ethical analysis to help an elderly ESRD patient and the dilemma faced by his family as to whether to sustain or withdraw hemodialysis. This article examines the uncertain trajectories of this disease and how to use shared decision making with the patient and his/her family to make the best decisions. A comprehensive assessment was conducted to identify the major health-related problems, to elicit the dilemmas faced in making the decision to sustain or end hemodialysis, and to understand the pain and suffering of the patient. Symptom control and comfort were identified as the most important goals of the patient, followed by building trust and rapport with his family. An analysis of the pros and cons of treatment was conducted using the 4-box ethical analysis developed by Josen, Siegler, and Winslade. The shared decision-making process was applied to help the patient express his expectations for his end-of-life care. While the health professionals considered that pain and suffering may influence the patient's decision, the patient found his connection between himself and others, self-value, and meaning of life through family love and support. A needs-based, flexible approach was adopted that established a continuous-care plan that was designed to provide the best care for the patient under a variety of possible scenarios while involving the family, which created a family-centered decision-making process that improved the quality of life of the elderly ESRD patient.

Objective: To evaluate the safety and efficacy of total hip arthroplasty (THA) in patients with end stage renal disease (ESRD)., Methods: Between December 2009 and May 2016, 30 THAs were performed in 28 patients with dialysis-dependent renal failure (18 patients) or renal transplantation (10 patients). A retrospective case control study was carried out to compare these 28 ESRD patients (ESRD group) with a matched cohort of 28 nonrenal patients (control group). There was no significant difference in gender, age, hip side, American Society of Anesthesiology (ASA) classification, comorbidities, and preoperative Harris score and hemoglobin (Hb) level between 2 groups ( P >0.05). The complications during hospitalization, Hb level changes, perioperative transfusion rate, hospital stay, and hospitalization costs in 2 groups were evaluated; and the creatinine changes of dialysis patients in ESRD group were evaluated. During the follow-up period, 90 days readmissions, periprosthetic infection, prosthesis loosening, hip Harris score, and deaths were recorded., Results: There was no loss of follow-up. The mean postoperative follow-up of ESRD group was 3.4 years (range, 1.0-7.4 years) and control group was 3.5 years (range, 1.0-7.4 years). Differences in hospital stay and the drop of Hb was not significant between 2 groups ( P >0.05). The hospitalization costs and perioperative transfusion rate were significantly higher in ESRD group than in control group ( P <0.05). There was no significant difference in creatinine value of dialysis patients in ESRD group between pre- and post-operation ( t =1.804, P =0.089). At last follow-up, the Harris score was significantly higher than preoperative score in both groups ( P <0.05); however, there was no significant difference in Harris score between groups ( t =1.278, P =0.207). In ESRD group, 5 patients presented complications, 1 patient was readmitted to hospital, and 2 patients died during the follow-up. In control group, 1 patient presented complications, and there was no 90 days readmission and no death. During the follow-up period, there was no loosening or revision in 2 groups and the prosthesis was in good position., Conclusion: THA can improve joint function and life quality of ESRD patients, but the risks of operation, perioperative complications, transfusion rate, and cost are high. Correct perioperative evaluation and management can help ESRD patients safely go through the perioperative period.

Kidney transplantation is the best approach for treating patients with end stage renal disease, offering patients the best chance of returning to normal health. While the techniques used in kidney transplantation surgery are mature and highly successful, there is a severe shortage of donor organs. Statistics show a serious imbalance between organ donations and patients on the waiting list for organ transplantation. Moreover, evidence from empirical studies has shown a better transplantation outcome for patients who receive living donor transplantation than for those who receive organs from cadavers. Although using relatives as donors offers an effective way to reduce the problem of organ shortage, this strategy faces many challenges and many other factors affect the promotion of living donor transplantation. This article elaborates how cultural and psychological factors, kidney transplantation awareness, and ethics and laws impact upon living kidney donations and then proposes coping strategies for promoting living kidney transplantation.