Survival of Patients With Transplant and Pediatric Dialysis

Survival in Pediatric Dialysis and Transplant Patients

Children that have to undergo kidney transplantation or dialysis at an early age are at much more risk than the healthier ones. The mortality rate risks have been identified to be around thirty times more. End-stage Renal Diseases (ESRD) can cause either or more of the following consequences in children: cognition and response, lack of muscular coordination, cardiovascular issues, tantamount to quality of life. As a result, science has evolved to assure techniques and methodologies in Kidney transplantation and dialysis for children in the last few decades. The records show improved short-term mortality in patients following the technological advances, in children that have undergone transplantation and dialysis. The allograft outcomes have been positive, too. There is an absence of such affirmation, however in longer-term care as the treated children are required to move out from pediatric care to adult care centers in later years (Samuel, et al., 2011).

Significance to nursing

With the growing awareness about pediatric care in nephrology, an increasing number of nurses practice pediatric nephrology, which is growing subspecialty. It is also a satisfying job for the nurses. APN (Advanced Practice Nurses) comprises of CNS (Clinical Nurse Specialist) as well as NP (Nurse Practice) in the sub-specialty of nephrology. This branch deals with treatment and follow-up care in all kidney related afflictions. Nurses often provide services as clinicians when acting as CNS and AP for the inpatient as well as outpatients. The construct and training allows them to provide services as researchers, educators, and consultants too. The patients they tend to are adults, children, and geriatric patients that belong to diasporas of ethnicities. Usually, the nurses find themselves tending to kidney failure or patients on the threshold of one (ANNA, n.d.).

Patients tended to, may come from a variety of backgrounds in different stages of affliction- including but not limited to drug addiction, bone diseases, infections, or the more common ones like diabetes, hypertension, and cardiovascular disease. As a result, they may be under duress facing psychosocial issues, too. A knowledgeable, compassionate caregiver helps them overcome the social and personal stigma through well-defined methodologies. The nursing can help the patients lead a more normative life by overcoming complex psychological issues and at the same time taking care of their disease effectively (ANNA, n.d.).

Purpose

In this study, we aimed to identify the risk factors for the ESRD population and the means to achieve survival in the long run. Subsequently we assessed the advances made in therapies and treatments meant for improving mortality of such patients.

Objectives: research question and/or hypothesis

Define long-term survival,

Identify risk factors that may lead to death,

Two time periods' survival ratio comparison for ESRD patients

Concepts, phenomena

Chronic kidney disease (CKD) or renal failure is the condition when the patients kidneys fail to function effectively in removing toxins from the blood, irreversibly. Such a malfunction leads to many negative health consequences. Normal functioning of the kidney for an average adult is calculated at, at least 100 ml/min/1.73m2, whereas less than75 ml/min/1.73 m2, that is 75% functioning is the threshold for the condition called CKD. For children, the measurements are scaled down and considered ml/min/1.73 m2 instead of ml/min to account for the size of their smaller body. Constant vigil becomes necessary regarding growth in children that have undergone kidney transplant. Such children do not grow up to be tall enough by normal standards. Growth problems in children with kidney transplants may be attended by hormone injections. Generally, kidney transplants in infants result in better mortality than in later stages. The mortality rate for patients with kidney transplants whether grown up children or adults do not vary by much (Henry & Dharnidharka, 2008).

Methods of study

Quantitative or qualitative

Quantitative

Research design

In this study, we decided to assimilate data from the national organ failure registry constructs and healthcare systems for authenticity of data. We obtained the mandatory and stipulated approvals pertaining to Ethical considerations prior to reach patients (

Sample

Purposive Sampling

Procedures

The total number of children (aged, 0 to 18) who had undergone RRT (renal replacement therapy) taken up in the study are 843. This study followed up the cases until the patient died or became untraceable (median follow-up, 6.8 years; inter-quartile range, 3.0 to 10.6). The assessment points were- risk factor for death and cause specific mortality. Institutional ethical permissions were sought and obtained from the University of Calgary. In absence of permission from Quebec, patient details were not obtained from there (Samuel, et al., 2011).

Results of study

What did they find?

107 (12.7%) patients out of the 5991 patient-years follow-up died. Raw cumulative survival for the study group under consideration was found to be 91.7% (95% CI, 89.8 to 93.7%) at 5 years and 85.8% (95% CI, 82.8 to 88.8%) at 10 years. The most fatalities occurred in patients who had to begin dialysis when less than 1 year of age. There were no apparent Ethnical impacts on the overall results. Over time, pre-emptive dialysis seemed to have become the norm. In spite of pre-emptive dialysis, the survival rate seemed to offer no advantage over those that underwent dialysis for two years consistently prior to transplant (hazard ratio [HR], 1.53; 95% CI, 0.63 to 3.67) (Samuel, et al., 2011).

Mortality on Dialysis:

The mortality of those who had undergone transplant after their age of 10 years showed better chances of survival than the infants (

Mortality after Transplantation:

One observation, not statistically very significant, is that the patients who underwent transplantation in the period after 2000 (up to 2007) have a better (50%) mortality rate compared to those who had a transplant earlier (1992-99) in the data accessed in the study (HR, 0.50; 95% CI, 0.21 to 1.17). Donor mortality rates were also similar with the following figures: HR, 1.13; 95% CI, 0.58 to 2.21. The instantiation of return to dialysis following Graft failure also causes mortality risk in an adjusted model that took into account a functioning graft for comparison (HR, 7.17; 95% CI, 3.86 to 13.34). The mean-time (median value) for graft failure to occur in cases of deceased-donor recipients was measured at 4.75 years (IQR, 1.33 to 6.96), and for those with living donor was not much different at 4.87 years (IQR, 1.17 to 7.86). Since repeated transplantation did not offer a change in the adjusted survival statistics, the data pertaining to same was left out (Samuel, et al., 2011).

Implications to nursing

Studies show that caring for patients with CKD poses significant problems for caregivers. They reveal that haemodialysis centers in community constructs face major problems in their follow up care. The patients need knowledgeable, compassionate, and trained hands at renal pathology and diseases, in addition to being alert to extreme fatigue faced by patients that restricts normal movements and has an effect on their quality of life (Horigan, Rocchiccioli, & Trimm, 2012).

Explain how the findings contribute to nursing knowledge/science. Would it impact practice, education, administration, or all areas of nursing?

The main consideration of nursing to patients undergoing dialysis is to ensure a better quality of life. The cause of falling quality of life is often the debilitating fatigue patient's encounter. Since nurses attend to patients with greater proximity, they are in a better position to suggest, monitor and execute prescriptions that are in consonance and agreement with patient's individual capabilities and condition. In addition to medical and therapeutic interventions, the nurses are in a better position to advice the patient about the physiological advantages of a personalized, customized schedule (based on laboratory and diagnostic results) to follow that would ensure relief from fatigue and weakness. The Nurses can help the patient device a beneficial diet, sleep and exercise schedule that improves the quality of life for the patient (Horigan, Rocchiccioli, & Trimm, 2012).

Ethical Considerations

Was the study approved by an Institutional Review Board?

Yes, the study was approved by the Institutional Review Board.

Was patient privacy protected?

Yes, privacy of the patients was protected.

Were there ethical considerations regarding the treatment or lack of?