Long-term survival outcomes in pediatric dialysis and transplant patients

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

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?

The study of the data was segregated into two phases of patient years- the first one started from the initiation of dialysis terminating at transplant, and the second phase of the study took into account developments after the dialysis. The researchers had no access to specific causes that mandate transplant. Consequently, instances of ineligible patients (age or co-morbidity) undergoing transplantation cannot be ruled out altogether. The measurement of higher mortality risk may arise from such reasons, too, (Samuel, et al., 2011).

Conclusion

In this study we studied mortality from a long-term perspective among ESRD patients (pediatric) treated in the period 1992-2007; we used authentic data from the national organ failure registry. The overall percentage for survival for 10 years was found to be at 86%. The dominating factor of risk to mortality was assessed as dialysis in RRT cohorts with patient age of less than one year as the onset of RRT. The study observed no significant improvement on mortality in patients undergoing transplantation after 2000 when compared to those with transplantation in the earlier 1992-97 period. There was no apparent reduction in risk to mortality over the entire study period. The best results, as far as survival is considered, was associated with transplantation amongst the ESRD patients. Similarly, pre-emptive transplantation offered no advantage to survival risk in the adjusted data (Samuel, et al., 2011).

North American Pediatric Renal Transplant Cooperative Study annual reports and the United States Renal Data System (10,11) reporting also arrives at the same results- there is no significant improvement in survival of pediatric patients undergoing RRT. As such, the causes of risks to survival amongst children with kidney transplant need further investigations and analysis. Such a consideration should also involve mechanisms to address threats arising out of BK virus to the allograft function. Individual cases may have to be dealt independently allowing for targeted immunosuppressant strategies to improve survival in patients receiving transplants (Samuel, et al., 2011).