S 11 Lunch Symposium

 

GUEST SPEAKER

Care of the renal patient with multimorbidity: a guide to clinical practice
K. Pugh-Clarke^1
1Kidney Unit, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, United Kingdom

Background: One of the greatest challenges in nephrology nursing is providing optimal care for kidney patients with multiple chronic conditions, or ‘multimorbidity’. The prevalence of multimorbidity (the simultaneous presence of two or more chronic conditions) has risen substantially in recent decades, and, as a consequence of the obesity epidemic and an aging population, will continue to rise in the future.
Multimorbidity, within the context of kidney patients, is associated with many adverse outcomes, including acceleration of the underlying renal disease process, impaired quality of life, functional incapacity, and mortality. Furthermore, multimorbidity also has significant financial implications in terms of health care provision and utilisation.       
It is therefore timely that I introduce this latest EDTNA handbook, the aim of which is to provide nurses with the knowledge and skills required to care for kidney patients with complex chronic illnesses. The opening chapters of this handbook will explore the concept of multimorbidity, in terms of predisposing factors and prevalence in kidney patient populations. A case studies approach will then be employed to examine the nursing and pharmacological management of kidney patients with specific multimorbidities.
The notion of evidence-based practice with be emphasised throughout this handbook, in addition to promoting holistic patient assessment and facilitating self-care.

 BIOGRAPHY OF THE GUEST SPEAKER 

 "It’s not just my kidneys!" Caring holistically for the patient with CKD & multimorbidity
T. Kafkia^1
1Department of Nursing, Alexander Technological Educational Institute, Thessaloniki, Greece

Background: In CKD population clinical outcome is affected by multimorbidity.  Diabetic Nephropathy (DN), leading cause of End-Stage Renal Disease, has genetic predisposition, different rates of hypertension, obesity, and other socioeconomic factors affecting early diagnosis and treatment.  Worldwide, hypertension is present in 20% of all CKD and >80% of DN patients.  Lifestyle modifications and antihypertensive therapy can contribute in its management.  Furthermore, chronic volume overload and mineral metabolism abnormalities attribute to arteriosclerosis which exacerbates left ventricular hypertrophy causing restrictive or dilated cardiomyopathy and myocardial ischaemia.  Cardiovascular Disease (CVD) affects almost 63% of patients with advanced CKD, compared to 6% in non-CKD adults, and is accounting for 45% of deaths in dialysis population.  Hypertension and risk factors management improve quality of life and is believed to reduce CKD progression.  In addition, renal anaemia is associated, not only, with poor quality of life, but also with increased hospital admissions, CVD and mortality.  The clinical outcome is even inferior in the presence of Renal Osteodystrophy (RO).  Anaemia management focuses on optimization of Hb and iron status with of ESAs and iron supplements.  Administration of phosphate binders, vitamin D supplements and dietary intake is thought to contribute in RO management.  Finally, research has shown that depression is negatively affecting social and professional life, as well as physical health and functional status.  The estimated prevalence is depending on the stage of CKD varying from 23% to 40%.

Conclusion/Application to practice: It is the multiprofessional team cooperation that can attribute to holistic assessment and management of renal patient. 

BIOGRAPHY OF THE GUEST SPEAKER

O 17
Prevalence of PAIN in Spanish dialysis units
D. Hernán¹, R. Martin², C. Pereira¹, S. Muňoz¹, J. Guerrero¹, L. Sanchez¹, N. Mouriňo¹, M. Pereira¹, J. Cabrejos¹, C. Ledesma^1
1Nursing, Fundación Renal Íñigo Álvarez de Toledo, Madrid, Spain; ²Nephrologist, Fundación Renal Íñigo Álvarez de Toledo, Madrid, Spain

Background: Pain is present in healthy older people, so we can assume that in dialysis patients, with an average age between 65-70 years, prevalence of pain will be higher. But we don´t know how much higher. The main objective of the study is to assess the degree of pain that dialysis patients suffer and to develop strategies for early detection by nursing personnel in order to effectively manage it and improving the quality of life for renal patients.
Objectives:
1 - To determine prevalence of pain, type, severity and restraints

2 - To determine impact of pain on quality of life, and daily activities. Management strategies
3 - On a second stage, to recommend ways to effectively manage pain, as well as to provide education and training to nurses and nephrologists about pain management in dialysis patients
Methods:Sample: 250 dialysis patients from 18 dialysis clinics and hospital units.
Methods: nurses have evaluated pain using the following surveys:  Mc Gill pain  questionnaire,  SF -36, Wisconsin Brief Pain Questionnaire and anxiety questionnaire
Statistical analysis: Logistic regression and multiple linear regressions. Sampling stratified by center and sex.
Results: Based on a preliminary study of the data collected, at least, 40% of patients present some degree of pain (we are still analyzing the questionnaires collected).
Conclusion/Application to practice:Prevalence of pain among dialysis patients is high. Pain isn´t effectively managed in dialysis units. Measures like training and educating nurses and nephrologists in the use of analgesics or engaging patients in activities during dialysis sessions are the next step on our study.

Disclosure: No conflict of interest declared

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