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Patient characteristics according to rehabilitation and employment status in Korean hemodialysis patients.

ABSTRACT: Background:While the final goal of renal replacement therapy is to achieve normal social adaptation and employment, many studies to date have focused on the analysis of complications and causes of death. In contrast, the analysis of dialysis patients with normal job employment and exhibiting a good medical status can be important for clinical treatment policy. This study assessed various clinical parameters according to rehabilitation and employment status to elucidate characteristics correlated with better rehabilitation status among hemodialysis patients. Methods:A total of 29,865 hemodialysis patients who were registered with rehabilitation status information in the Korean Society of Nephrology end-stage renal disease registration program from January 2017 to April 2019 were included and divided into five groups according to their rehabilitation status. Results:About half (47%) of enrolled patients belonged to the "independent but without a job" group and 21% of patients belonged to the "employed with a full-time job" group. Analysis revealed significantly younger mean age, longer mean hemodialysis duration, a higher proportion of male sex, and a lower proportion of diabetic nephropathy cases in the full-time job group than in the other hemodialysis patient groups. Also, hemoglobin, albumin, and phosphorus levels were higher but the urea reduction ratio was lower in the full-time job group. Conclusion:A better rehabilitation and employment state of hemodialysis patients was associated with younger age, male sex, and underlying chronic glomerulonephritis. Patients with full-time jobs generally have better laboratory data but lower dialysis efficacy.

SUBMITTER: Lee JY

PROVIDER: S-EPMC7530362 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Patient characteristics according to rehabilitation and employment status in Korean hemodialysis patients.

Lee Jong Yun JY Jin Dong-Chan DC

Kidney research and clinical practice 20200901 3

<h4>Background</h4>While the final goal of renal replacement therapy is to achieve normal social adaptation and employment, many studies to date have focused on the analysis of complications and causes of death. In contrast, the analysis of dialysis patients with normal job employment and exhibiting a good medical status can be important for clinical treatment policy. This study assessed various clinical parameters according to rehabilitation and employment status to elucidate characteristics co ...[more]

PMID: 32868495

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Project description:BackgroundPatient activation is associated with better outcomes and lower costs. Although the concept is widely investigated, little attention was given to patient activation and its predictors in patients undergoing hemodialysis. Hence, we aimed to investigate the level of patient activation and aimed to determine patient- and treatment-related predictors of activation in patients undergoing hemodialysis.MethodsThis cross-sectional observational study recruited patients undergoing hemodialysis in three Flemish hospitals. Participants were questioned about patient characteristics (i.e., age, sex, education, employment, children, social support, leisure-time, living condition, and care at home), treatment- and health-related characteristics (i.e., hospital, time since first dialysis, transplantation, self-reported health (EQ-VAS) and depressive symptoms (PHQ-2)), and patient activation (PAM-13). Univariate and multiple linear regression analyses with dummy variables were conducted to investigate the associations between the independent variables and patient activation.ResultsThe average patient activation-score was 51. Of 192 patients, 44% patients did not believe they had an important role regarding their health. Multiple linear regression showed that older patients, who reported being in bad health, treated in a particular hospital, without leisure-time activities, and living in a residential care home, had lower patient activation. These variables explained 31% of the variance in patient activation. Based on literature, we found that activation of patients on hemodialysis is low, compared to that of other chronic patient groups.ConclusionIt could be useful to implement patient activation monitoring, since the level of activation is low in patients undergoing hemodialysis. Older patients, who reported being in bad health, treated in a particular hospital, without leisure-time activities, living in a residential care home, are at higher risk for lower activation.

Project description:Risk of cardiovascular associated death in dialysis patients is the highest among all other co-morbidities. Improving the identification of patients with the highest cardiovascular risk to design an adequate treatment is, therefore, of utmost importance. There are several non-invasive cardiovascular state biomarkers based on the pulse (pressure) wave propagation properties, but their major determinants are not fully understood. In the current study we aimed to provide a framework to precisely dissect the information available in non-invasively recorded pulse wave in hemodialysis patients. Radial pressure wave profiles were recorded before, during and after two independent hemodialysis sessions in 35 anuric prevalent hemodialysis patients and once in a group of 32 healthy volunteers. Each recording was used to estimate six subject-specific parameters of pulse wave propagation model. Pressure profiles were also analyzed using SphygmoCor software (AtCor Medical, Australia) to derive values of already established biomarkers, i.e. augmentation index and sub-endocardial viability ratio (SEVR). Data preprocessing using propensity score matching allowed to compare hemodialysis and healthy groups. Augmentation index remained on average stable at 142 ± 28% during dialysis and had similar values in both considered groups. SEVR, whose pre-dialytic value was on average lower by 12% compared to healthy participants, was improved by hemodialysis, with post-dialytic values indistinguishable from those in healthy population (p-value > 0.2). The model, however, identified that the patients on hemodialysis had significantly increased stiffness of both large and small arteries compared to healthy counterparts (> 60% before dialysis with p-value < 0.05 or borderline) and that it was only transiently decreased during hemodialysis session. Additionally, correlation-based clustering revealed that augmentation index reflects the shape of heart ejection profile and SEVR is associated with stiffness of larger arteries. Patient-specific pulse wave propagation modeling coupled with radial pressure profile recording correctly identified increased arterial stiffness in hemodialysis patients, while regular pulse wave analysis based biomarkers failed to show significant differences. Further model testing in larger populations and investigating other biomarkers are needed to confirm these findings.

Project description:BackgroundHigher numbers of registered nurses (RNs) per patient have been associated with improved patient outcomes in acute-care facilities. Variation in and associations of patient care staffing levels and hemodialysis facility characteristics have not been examined previously.Study designCross-sectional study using Poisson regression to examine associations between patient care staffing levels and hemodialysis facility characteristics.Setting & participants4,800 US hemodialysis facilities in the 2009 Centers for Medicare & Medicaid (CMS) End-Stage Renal Disease Annual Facility Survey (CMS-2744 form).PredictorsFacility characteristics, including profit status, freestanding status, chain affiliation, and geographic region, adjusted for facility size, capacity, functional type, and urbanicity.OutcomesPatient care staffing levels, including ratios of RNs, licensed practical nurses (LPNs), patient care technicians (PCTs), composite staff (RN + LPN + PCT), social workers, and dietitians to in-center hemodialysis patients.ResultsAfter adjusting for background facility characteristics, ratios of RNs and LPNs to patients were 35% (P < 0.001) and 42% (P < 0.001) lower, respectively, but the PCT to patient ratio was 16% (P < 0.001) higher in for-profit than nonprofit facilities (rate ratios of 0.65 [95% CI, 0.63-0.68], 0.58 [95% CI, 0.51-0.65], and 1.16 [95% CI, 1.12-1.19], respectively). Regionally, compared to the Northeast, the adjusted RN to patient ratio was 14% (P < 0.001) lower in the Midwest, 25% (P < 0.001) lower in the South, and 18% (P < 0.001) lower in the West. Even after additional adjustments, the large for-profit chains had significantly lower RN and LPN to patient ratios than the largest nonprofit chain, but a significantly higher PCT to patient ratio. Overall composite staffing levels also were lower in for-profit and chain-affiliated facilities. The patterns hold when hospital-based units were excluded.LimitationsNursing hours were not available. Two part-time staff were counted as one full-time equivalent, which may not always be accurate.ConclusionsThe significant variation in patient care staffing levels and its associations with facility characteristics warrants inclusion in future large-scale hemodialysis outcomes studies. End-stage renal disease networks and hemodialysis facilities should attend to quality assurance and performance improvement initiatives that maximize licensed nurse staffing levels in hemodialysis facilities.

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Patient characteristics according to rehabilitation and employment status in Korean hemodialysis patients.

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Patient characteristics according to rehabilitation and employment status in Korean hemodialysis patients.

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