| 1. |
- Lindberg, Magnus, et al.
(författare)
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A behavioural nursing intervention for reduced fluid overload in haemodialysis patients : Initial results of acceptability, feasibility and efficacy
- 2011
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Ingår i: Journal of nursing and healthcare of chronic illness. - : Wiley-Blackwell. - 1752-9824 .- 1752-9816. ; 3:2, s. 87-98
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Describe and perform an initial test of a tailored treatment programme based on a behavioural medicine approach to enhance haemodialysis patients’ self-management of fluid restriction. Methods: Cognitive-behavioural techniques were used in four quasi-experimental case-studies. Central features in the programme were individual analysis of dietetic knowledge and fluid intake, setting goals, self-monitoring and prevention of relapse. Fluid overload was continuously assessed. Results: Acceptability and feasibility of the intervention were demonstrated. A clear reduction of fluid overload was shown. Some problems related to treatment fidelity were identified. Conclusion: The behavioural medicine approach resulted in reduction of fluid overload in each of the four cases included. Practice implications: This approach could be used as a method for tailoring interventions targeted to fluid intake behaviour in a heterogeneous group of HD patients with excessive fluid overload. Such treatment should take account of individual cognitive-behavioural patterns and include self-efficacy to low fluid intake. The efficacy of the tailored approach in regular practice has to be further tested in controlled trials.
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| 2. |
- Lindberg, Magnus, et al.
(författare)
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Self-efficacy in relation to limited fluid intake amongst portuguese haemodialysis patients
- 2010
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Ingår i: Journal of renal care. - : Wiley. - 1755-6678 .- 1755-6686. ; 36:3, s. 133-138
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Tidskriftsartikel (refereegranskat)abstract
- Self-efficacy is a temporary and influenceable characteristic, related to situations and tasks, mediating health-promoting behaviours. This study aimed to evaluate psychometric properties of a Portuguese version of the Fluid Intake Appraisal Inventory, and to describe self-efficacy in relation to limited fluid intake amongst Portuguese haemodialysis patients. Respondents were recruited from three dialysis units, and 113 of 155 eligible patients gave their informed consent. The translated scale was distributed and collected by the head nurses. Interdialytic weight gain was calculated as percentage of dry weight. Satisfactory psychometric properties were estimated in the Portuguese context. The participants' self-efficacy in relation to low fluid intake was asymmetrically distributed; the majority had moderately to high self-efficacy while some patients had very low self-efficacy to limited fluid intake. There was a significant difference in self-efficacy to fluid restrictions; patients with a weight gain of 3.5% or less presented higher self-efficacy scores than did patients exceeding the cutoff point.
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| 3. |
- Lindberg, Magnus, et al.
(författare)
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Subgroups of haemodialysis patients in relation to fluid intake restrictions : a cluster analytical approach
- 2010
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 19:21-22, s. 2997-3005
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Tidskriftsartikel (refereegranskat)abstract
- Aims To determine whether definable subgroups exist in a sample of haemodialysis patients with regard to self-efficacy, attentional style and depressive symptomatology and to compare whether interdialytic weight gain vary between patients in groups with different cognitive profiles.Background Theory-based research suggests that cognitive factors (e.g. self-efficacy and attentional style) and depressive symptomatology undermine adherence to health protective regimens. Preventing negative outcomes of fluid overload is essential for haemodialysis patients but many patients cannot achieve fluid control and nursing interventions aimed to help the patients reduce fluid intake are ineffective. Understanding the interaction between cognitive factors and how this is related to adherence outcomes might therefore lead to the development of helpful nursing interventions.Design Explorative cross-sectional multi-centre surveyMethods The sample consisted of 133 haemodialysis patients. Data were collected using structured questionnaires. A brief self-report form and data on interdialytic weight gain was also used. Two-step cluster analysis was used to identify subgroups. One way analysis of variance (ANOVA) or Pearson’s chi-square test were used for comparing subgroups.Results Three distinct subgroups were found and subsequently labelled: 1) low self-efficacy, 2) distraction and depressive symptoms and 3) high self-efficacy. The subgroups differed in fluid intake, but not in age, dialysis vintage, gender, residual urine output, or in receiving any fluid intake advice.Conclusions Clinically relevant subgroups of haemodialysis patients could be defined by their profiles regarding self-efficacy, attentional style and depressive symptoms.Relevance to clinical practice Based on this study we would encourage clinical practitioners to take into account cognitive profiles while performing their work. This is especially important when a targeted nursing intervention, which aims to encourage and maintain the patient’s fluid control, is introduced.
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| 4. |
- Lindberg, Magnus
(författare)
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Depressive Symptoms and Prescription of Antidepressants in Hemodialysis Patients
- 2011
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Ingår i: Dialysis & Transplantation. - : Wiley. - 0090-2934 .- 1932-6920. ; 40:5, s. 218-221
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Depressive symptoms are commonly noted in patients on hemodialysis treatment. The objective of the present study was to evaluate the psychological care of patients receiving in-center hemodialysis treatment. Thus the aim was to describe the occurrence of depressive symptoms and prescription of antidepressive agents, as well as to assess the agreement between present symptoms and ongoing pharmacological treatment in clinical practice. METHODS: The occurrence of self-reported depressive symptoms and documented ongoing pharmacological treatment was assessed in a cross-sectional survey including 141 hemodialysis patients. Agreement between depressive symptoms and prescription of antidepressants was analyzed. RESULTS: Thirty-five percent of the participants suffered from self-reported depressive symptoms, and there was poor agreement between depressive symptoms and prescription of an antidepressant agent. DISCUSSION: Depressive symptomatology is a significant problem in hemodialysis patients. It is therefore important to use systematic approaches to screen patients for depression, diagnose clinical depression, plan for treatment strategies, and follow up depression treatment outcomes.
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| 5. |
- Lindberg, Magnus, et al.
(författare)
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Interdialytic weight gain and ultrafiltration rate in hemodialysis : lessons about fluid adherence from a national registry of clinical practice
- 2009
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Ingår i: Hemodialysis International. - : Wiley. - 1492-7535 .- 1542-4758. ; 13:2, s. 181-188
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Tidskriftsartikel (refereegranskat)abstract
- Excessive interdialytic weight gain (IWG) and ultrafiltration rates (UFR) above 10 mL/h/kg body weight imply higher morbidity and mortality. This study aimed to estimate the prevalence of high fluid consumers, describe UFR patterns, and describe patient characteristics associated with IWG and UFR. The Swedish Dialysis DataBase and The Swedish Renal Registry of Active Treatment of Uremia were used as data sources. Data were analyzed from patients aged >/=18 on regular treatment with hemodialysis (HD) and registered during 2002 to 2006. Interdialytic weight gain and dialytic UFR were examined in annual cohorts and the records were based on 9693 HD sessions in 4498 patients. Differences in proportions were analyzed with the chi-square test and differences in means were tested using the ANOVA or the t test. About 30% of the patients had IWG that exceed 3.5% of dry body weight and 5% had IWG >/=5.7%. The volume removed during HD was >10 mL/h/kg for 15% to 23% of the patients, and this rate increased during the first dialytic year. Patient characteristics associated with fluid overload were younger age, lower body mass index, longer dialytic vintage, and high blood pressure. By studying IWG and dialytic UFR as quality indicators, it is shown that there is a potential for continuing improvement in the care of patients in HD settings, i.e., to enhanced adherence to fluid restriction or alternatively to extend the frequency of dialysis for all patients, e.g., by providing daily treatment.
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| 6. |
- Wheeler, David C., et al.
(författare)
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The dapagliflozin and prevention of adverse outcomes in chronic kidney disease (DAPA-CKD) trial : baseline characteristics
- 2020
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Ingår i: Nephrology, Dialysis and Transplantation. - OXFORD ENGLAND : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 35:10, s. 1700-1711
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Tidskriftsartikel (refereegranskat)abstract
- Background. The Dapagliflozin and Prevention of Adverse outcomes in Chronic Kidney Disease (DAPA-CKD; NCT03036150) trial was designed to assess the effect of the sodium-glucose co-transporter 2 (SGLT2) inhibitor dapagliflozin on kidney and cardiovascular events in participants with CKD with and without type 2 diabetes (T2D). This analysis reports the baseline characteristics of those recruited, comparing them with those enrolled in other trials. Methods. In DAPA-CKD, 4304 participants with a urinary albumin:creatinine ratio (UACR) <= 200mg/g and estimated glomerular filtration rate (eGFR) between 25 and 75mL/min/1.73m(2) were randomized to dapagliflozin 10mg once daily or placebo. Mean eGFR was 43.1mL/min/1.73m(2) and median UACR was 949 mg/g (108mg/mmol). Results. Overall, 2906 participants (68%) had a diagnosis of T2D and of these, 396 had CKD ascribed to a cause other than diabetes. The most common causes of CKD after diabetes (n = 2510) were ischaemic/hypertensive nephropathy (n = 687) and chronic glomerulonephritis (n = 695), of which immunoglobulin A nephropathy (n = 270) was the most common. A total of 4174 participants (97%) were receiving an angiotensinconverting enzyme inhibitor or angiotensin receptor blocker, 1882 (43.7%) diuretics, 229 (5.3%) mineralocorticoid receptor antagonists and 122 (2.8%) glucagon-like peptide 1 receptor agonists. In contrast to the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE), the DAPA-CKD trial enrolled participants with CKD due to diabetes and to causes other than diabetes. The mean eGFR of participants in the DAPA-CKD trial was 13.1mL/min/1.73m(2) lower than in CREDENCE, similar to that in the Finerenone in Reducing Kidney Failure and Disease Progression in DKD (FIDELIO-DKD) trial and the Study Of diabetic Nephropathy with AtRasentan (SONAR). Conclusions. Participants with a wide range of underlying kidney diseases receiving renin-angiotensin system blocking therapy have been enrolled in the DAPA-CKD trial. The trial will examine the efficacy and safety of dapagliflozin in participants with CKD Stages 2-4 and increased albuminuria, with and without T2D.
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| 7. |
- Stenberg, Jenny, 1976-, et al.
(författare)
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Brain natriuretic peptide reflects individual variation in hydration status in hemodialysis patients
- 2019
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Ingår i: Hemodialysis International. - : Wiley. - 1492-7535 .- 1542-4758. ; 23:3, s. 402-413
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Fluid management in hemodialysis patients is a controversial topic. Brain natriuretic peptide (BNP) is secreted from the heart in response to volume overload, and may be a marker of overhydration in hemodialysis patients. Our aim was to investigate the correlation between BNP and overhydration in a cohort of hemodialysis patients, and to find out whether BNP and overhydration correlate in repeated measurements within individuals with elevated BNP.METHODS: The study was prospective, observational, and had a cross-sectional part and a longitudinal follow-up. The distribution of BNP was investigated in a cohort of 64 hemodialysis patients. Blood samples and bioimpedance spectroscopy measurements were performed before midweek dialysis. Subsequently, 11 study participants with elevated BNP concentrations (>500 pg/mL) were assessed in another nine dialysis sessions each. These individuals also had their cardiac function and heart rate variability (HRV) examined.FINDINGS: BNP was above 500 pg/mL in 38% of the participants, and correlated positively with overhydration (rs = 0.381), inflammation and malnutrition, but not with systolic blood pressure. In comparison to participants with BNP below 500 pg/mL, participants with elevated BNP were older, had lower muscle strength, lower bodyweight and lower levels of hemoglobin and albumin. Echocardiography revealed cardiac anomalies in all 11 participants in the longitudinal follow-up, and HRV, as measured by SDNN, was pathologically low. In repeated measurements, the between-individuals variation of BNP in relation to overhydration was greater (SD = 0.581) than the within-person variation (SD = 0.285).DISCUSSION: BNP correlates positively to overhydration, malnutrition, and inflammation. In a subgroup of patients with elevated BNP, who are mainly elderly and frail, BNP reflects individual variation in hydration status, and hence seems to be a modifiable marker of overhydration. These data suggest that BNP is best applied for measuring changes in hydration status within an individual over time.
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| 8. |
- Stenberg, Jenny, 1976-, et al.
(författare)
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Implementation of a decision aid for recognition and correction of volume alterations (Recova®) in haemodialysis patients
- 2020
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Ingår i: Upsala Journal of Medical Sciences. - : Taylor & Francis Group. - 0300-9734 .- 2000-1967. ; 125:4, s. 281-292
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Fluid overload is associated with mortality in haemodialysis patients, and 30% of patients remain fluid-overloaded after dialysis. The aim of this study was to evaluate if implementation of Recova®, a decision aid combining clinical assessment with bioimpedance spectroscopy, facilitates individualization of target weight determination and thereby contributes to improved fluid status in maintenance haemodialysis patients.METHODS: The impact of the implementation was measured as the proportion of participants at an adequate target weight at the end of the study, assessed as change in symptoms, hydration status, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Nurses were instructed to use Recova every 2 weeks, and the process of the intervention was measured as frequencies of fluid status assessments, bioimpedance measurements, and target weight adjustments.RESULTS: Forty-nine patients at two haemodialysis units were enrolled. In participants with fluid overload (n = 10), both overhydration and fluid overload symptom score decreased. In fluid-depleted participants (n = 20), target weight adjustment frequency and the estimated target weight increased. The post-dialytic negative overhydration was reduced, but NT-proBNP increased.CONCLUSIONS: Implementation of Recova in haemodialysis care increased the monthly frequencies of bioimpedance measurements and target weight adjustments, and it contributed to symptom reduction.TRIAL REGISTRATION: The Uppsala County Council Registry of Clinical Trials: FoU 2019-0001-15.
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| 9. |
- Stenberg, Jenny, 1976-, et al.
(författare)
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Systematic fluid assessment in haemodialysis : Development and validation of a decision aid
- 2020
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Ingår i: Journal of Renal Care. - : Wiley. - 1755-6678 .- 1755-6686. ; 46:1, s. 52-61
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAbout a third of patients undergoing haemodialysis have poorly controlled fluid status, which may affectsurvival. Clinical assessment is subjective and imprecise, which has led to the increasing use of devices based on bioimpedancespectroscopy (BIS). However, BIS cannot provide a simple target applicable to all patients. Our aim was to developand validate a decision aid combining clinical assessment of fluid status with information from BIS in target weightdetermination.MethodsThe decision aid was based on empirical experience and a literature review identifying physiological parametersalready used in the clinical assessment of fluid status. Content validity was established by patient representatives, interdisciplinarystakeholders and external experts, who assessed item relevance and comprehensiveness. Reliability was assessedby inter‐rater agreement analysis between nurses assessing typical patient cases.ResultsThe decision aid for Recognition and Correction of Volume Alterations (RECOVA) consists of three parts (1) a scoringsystem; (2) thresholds and triggers; (3) a decision aid algorithm. Agreement between raters in the assessment of symptomswas almost perfect, with Intraclass Correlation Coefficient > 0.90. Agreement in clinical response was only fair, but increasedto moderate, with training and self‐reported confidence.ConclusionRECOVA may enable systematic clinical assessment of fluid status, facilitating early recognition of fluid alterations,and incorporation of bioimpedance into target weight management. However, implementation into clinicalpractice will require training of staff. Clinical intervention studies are required to evaluate if RECOVA facilitates response toand correction of recognised fluid alterations.
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| 10. |
- Lindberg, Magnus, et al.
(författare)
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Competencies for practice in renal care : a national delphi study
- 2012
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Ingår i: Journal of Renal Care. - : Wiley. - 1755-6678 .- 1755-6686. ; 38:2, s. 69-75
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe essential competencies relevant for professional renal nursing in Sweden. A Delphi study with four rounds was conducted from November 2008 to April 2009. A national sample of renal nurses was used to achieve consensus about the core competencies required. The 43 competencies were reviewed for face validity by external experts representing general nursing, renal nursing, stakeholders and nephrologists. The core competencies were categorised in nine areas according to their structure; nursing and medical science, information and teaching, examinations and therapies, promoting health and preventing ill health, palliative care, safety and quality, care environment, research and development and management and cooperation in the patient care pathway. Altogether these categories represent a national description of competence in renal nursing.
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