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Managing Diabetic Kidney Disease: What to know before you referDiabetic nephropathy patient empowerment -
The support system comprising health care providers and caregivers plays a crucial role as most patients rely on them in making decisions, and for the necessary adjustments in their health behavior [ 13 ]. In LIC regions, where there are often a relatively low number of physicians and even lower number of kidney care providers per population especially in rural areas, a stepwise approach can involve local and national stakeholders including both non-governmental organizations and government agencies by: 1 extending kidney patient education in rural areas, 2 adapting telehealth technologies if feasible to educate patients and train local community kidney care providers, and 3 implementing effective retention strategies for rural kidney health providers including adapting career plans and competitive incentives.
Many patients in low resource settings present in very late stage needing to commence emergency dialysis [ 14 ]. The very few fortunate ones to receive kidney transplantation may acquire an indescribable chance to normal life again, notwithstanding the high costs of immunosuppressive medications in some countries.
For some patients and care-partners in low-income regions, spirituality and religiosity may engender hope, when ill they are energized by the anticipation of restored health and spiritual wellbeing.
For many patients, informing them of a diagnosis of kidney disease is a harrowing experience both for the patient and caregivers and the health care professional. Patients diagnosed with glomerulonephritis who have an appropriate characterization of their disease from kidney biopsies and histology, who receive appropriate therapies and achieve remission are relieved and are very grateful.
Patients are glad to discontinue dialysis following resolution of AKI or acute on CKD. Many CKD patients who have residual kidney function appreciate being maintained in a relatively healthy state with conservative measures, without dialysis.
They experience renewed energy when their anemia is promptly corrected using erythropoiesis-stimulating agents. They are happy when their peripheral edema resolves with treatment. For those on maintenance hemodialysis who had woeful stories from emergency femoral cannulations, they appreciate the construction of good temporary or permanent vascular accesses.
Many patients in low-resource settings present in very late stage needing to commence emergency dialysis. Patients remain grateful for waking from a uremic coma or recovering from recurrent seizures when they commence dialysis. The requirement of patient engagement is needed.
Engaged patients are better able to make informed decisions about their care options. Patient engagement may also promote mutual accountability and understanding between patients and health care providers.
Informed patients are more likely to feel confident to report both positive and negative experiences and have increased concordance with mutually agreed care management plans. This not only improves health outcomes but also advances learning and improvement while reducing adverse events.
I will forget; Show me. I will remember; Involve me. I will understand. WKD would like to promote to the policy makers on increasing focus and resources on both drug and non-drug programs in improving patient wellness.
Examples include funding for erythropoiesis-stimulating agents and anti-pruritic agents for managing anemia and itchiness, respectively, just to name but a few [ 15, 16 ].
Home dialysis therapies have been consistently found to improve patient autonomy and flexibility, quality of life in a cost-effective manner, enhancing life participation.
Also, examples like self-management programs, cognitive behavioral therapy, and group therapies for managing depression, anxiety, and insomnia should be promoted before resorting to medications [ 17 ].
The principle of equity recognizes that different people with different levels of disadvantage require different approaches and resources to achieve equitable health outcomes.
The kidney community should push for adapted care guidelines for vulnerable and disadvantaged populations.
The involvement of primary care and general physicians especially in LICs and LMICs would be useful in improving the affordability and access to services through the public sector in helping the symptom management of CKD patients and improve their wellness.
Early detection with a prolonged course of wellness despite kidney disease, after an effective secondary prevention program, should be promoted [ 18 ].
Prevention of CKD progression can be attempted by lifestyle and diet modifications such as a plant-dominant low protein diet and by means of effective pharmacotherapy including administration of sodium-glucose transport protein 2 SGLT2 inhibitors [ 19 ].
WKD continues to call for increased awareness of the importance of preventive measures throughout populations, professionals, and policy makers, applicable to both developed and developing countries [ 18 ]. Effective strategies to empower patients and their care-partners strive to pursue the overarching goal of minimizing the burden of CKD-related symptoms in order to enhance patient satisfaction, health-related quality of life, and life participation.
Whereas the WKD continues to emphasize the importance of effective measures to prevent kidney disease and its progression [ 18 ], patients with preexisting kidney disease and their care-partners should feel supported to live well through concerted efforts by kidney care communities and other stakeholders throughout the world even during a world-shattering pandemic as COVID that may drain many resources [ 20 ].
Living well with kidney disease is an uncompromisable goal of all kidney foundations, patient groups, and professional societies alike, to which the International Society of Nephrology and the International Federation of Kidney Foundation World Kidney Alliance are committed at all times.
reports honoraria from Abbott, Abbvie, ACI Clinical, Akebia, Alexion, Amgen, Ardelyx, Astra-Zeneca, Aveo, BBraun, Cara Therapeutics, Chugai, Cytokinetics, Daiichi, DaVita, Fresenius, Genentech, Haymarket Media, Hospira, Kabi, Keryx, Kissei, Novartis, Pfizer, Regulus, Relypsa, Resverlogix, Dr Schaer, Sandoz, Sanofi, Shire, Vifor, UpToDate, and ZS-Pharma.
reports personal fees from Fibrogen and Astra-Zeneca. reports personal fees from Multicare, Novartis, Sandoz, and Astra-Zeneca. reports nonfinancial support from Genesis Pharma.
Members of the World Kidney Day Steering Committee are: Philip Kam Tao Li, Kamyar Kalantar-Zadeh, Sharon Andreoli, Alessandro Balducci, Sophie Dupuis, Latha Kumaraswami, Vassilios Liakopoulos, Siu-Fai Lui, Gamal Saadi, and Ifeoma Ulasi.
This article is being published in Kidney International and reprinted concurrently in several journals. Any of these versions may be used in citing this article. Note that all authors contributed equally to the conception, preparation, and editing of the manuscript.
Members of the World Kidney Day Steering Committee are listed in the Appendix. Sign In or Create an Account. Search Dropdown Menu. header search search input Search input auto suggest. filter your search All Content All Journals Nephron. Advanced Search. Skip Nav Destination Close navigation menu Article navigation.
Volume , Issue 3. Patient Priorities for Living Well: A Focus on Life Participation. Patient Empowerment, Partnership, and a Paradigm Shift towards a Strengths-Based Approach to Care.
The Role of Care-Partner. Living with Kidney Disease in Low-Income Regions. World Kidney Day Advocacy. Conflict of Interest Statement. Article Navigation. Editorials February 25 Living Well with Kidney Disease by Patient and Care-Partner Empowerment: Kidney Health for Everyone Everywhere.
Subject Area: Nephrology. Kamyar Kalantar-Zadeh Kamyar Kalantar-Zadeh. a The International Federation of Kidney Foundation — World Kidney Alliance IFKF-WKA , Division of Nephrology and Hypertension and Kidney Transplantation, University of California Irvine, Orange, California, USA.
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Empowering people with diabetic nephropathy. Rachel Hawley. Page: Save, Share, Print Article. Study objectives: phase one Phase one of the study aimed to: Assess the level of knowledge about current treatment and practical aspects of care for diabetes of patients attending the renal diabetes clinic.
Establish whether the information provided met their needs. Themes for discussion had been prepared and included: How does diabetes impact on life now and where does it fit in among other problems and sexual issues?
Diabetes control and what it means When the news of renal complication was broken. Information relating to the three themes was collected with respect to: Information Emotional responses Organisation of care Information was a particularly important theme for focus group participants and a number of issues were raised, including: Availability or lack of information Quality and consistency of information Honesty and trust regarding the exchange of information.
Study aims: phase two Phase two of the study aimed to: Design and develop materials for information to meet the specific needs of people with diabetic nephropathy. It addresses the key areas: Common feelings for families Practical information Contact information for further help if needed Families and friends, to help them gain confidence and a greater feeling of control.
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By contrast, the inclusion of English speaking participants from an Australian health-care system, the lack of rural participants and the relative lack of participants who were female and who were receiving peritoneal dialysis may limit the transferability of results to other populations or non-English speaking health-care settings.
The inherent weaknesses of qualitative research including the potential for researcher and participant bias and lack of large-scale generalisability of results, is also acknowledged. Our qualitative study explored important factors and barriers to the optimal health-care of patients with multi-morbidity due to diabetes and CKD, across CKD stages 3 to 5.
All patients and their carers emphasised the importance of patient empowerment and self-management, and public awareness of diabetes and CKD and its prevention, and identified adverse experiences related to co-morbid diabetes as a barrier.
Barriers to health-care such as poor access, poor continuity and coordination of care and poor identification of psychological morbidity were emphasised more in participants of later CKD stages compared to earlier stages. A preventive, patient-centred health-care model, promoting self-management and targeted interventions, especially in later CKD stages, to improve health-care access, continuity and coordination of care, and recognition and management of psychological morbidity may improve health-care delivery.
We want to acknowledge S. Chaviaras, D. Giannopoulos, R. McGrath and S. Coggan for help in study conduct. Conceived and designed the experiments: CL HT DI SZ. Performed the experiments: CL HT DI SZ. Analyzed the data: CL HT DI SZ AC MG GF GJ KM TM PK KP RW.
Wrote the paper: CL HT DI SZ AC MG GF GJ KM TM PK KP RW. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Article Authors Metrics Comments Media Coverage Reader Comments Figures.
Abstract Background Multi-morbidity due to diabetes and chronic kidney disease CKD remains challenging for current health-systems, which focus on single diseases.
Results Twelve focus groups with 58 participants and 8 semi-structured interviews of carers were conducted. Conclusions According to patients and their carers the health-care of co-morbid diabetes and CKD may be improved via a preventive, patient-centred health-care model which promotes self-management and that has good access, continuity and coordination of care and identifies and manages psychological morbidity.
Introduction Multi-morbidity can be defined as the co-existence of more than one chronic condition where one is not necessarily more central than the other [ 1 ]. Materials and Methods This qualitative study, underpinned by a pragmatic worldview [ 17 , 18 ] was a research collaboration between 4 large tertiary health-services, 2 research institutes, and 2 national consumer stake-holder groups Diabetes Australia and Kidney Health Australia.
Data collection The focus group and semi-structured interview questions S1 Table were developed by the research team, informed by a review of the literature and consensus with leading stakeholders.
Results Fifty-eight participants, with type 2 diabetes of mean duration Download: PPT. Table 2. Characteristics of patients whose carers participated in semi-structured interviews. Table 3. Summary of the main factors influencing health-care of co-morbid diabetes and CKD. Fig 1. Patient level factors influencing health-care of co-morbid diabetes and CKD Patient self-management.
Socio-economic situation. Nothing is a big problem. Adverse experiences related to co-morbid diabetes and CKD, and its treatment. Health service level factors influencing health-care of co-morbid diabetes and CKD Both patients and carers expressed general satisfaction and gratitude for health services.
Prevention and awareness of co-morbid diabetes and CKD. Patient and carer empowerment. Poor coordination and continuity of care. Poor recognition of psychological co-morbidity.
Discussion In this large multi-site qualitative study, we inform the development of person-centred health systems by exploring important factors relating to the health-care of co-morbid diabetes and CKD, from the perspectives of patients and their carers.
Supporting Information. S1 File. s DOCX. S1 Table. Initial Questions inventory for focus groups and semi-structured interviews. Acknowledgments We want to acknowledge S. Author Contributions Conceived and designed the experiments: CL HT DI SZ.
References 1. Fortin M. BMJ, Atun R. Lancet, View Article Google Scholar 3. Collins A. Am J Kidney Dis, A6—7, s1— Foley R. Journal of the American Society of Nephrology: JASN, Penfornis A. Insights from the observational OREDIA study.
Vasc Health Risk Manag, Hill C. national diabetes audit. Diabet Med, De Cosmo S. Nephrol Dial Transplant, View Article Google Scholar 9. Stevens P. Kidney and Blood Pressure Research, Lenz O. BMC Nephrology, Morrow B. View Article Google Scholar Sakraida T. and Robinson M. West J Nurs Res, Wilkinson E.
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BMC Diabetc volume DiwbeticArticle number: 71 Diabetic nephropathy patient empowerment this nephripathy. Metrics nephropatthy. Hemodialysis is the most abdominal weight loss treatment of end-stage renal disease. Effective self-management has proven crucial for the alleviation of symptoms. According to Social Cognitive Theory, social capital and patient empowerment may be important variables for predicting self-management. To date, few studies have explored the mechanisms underlying these results. The study aimed to verify whether patient empowerment mediated the effect of social capital on the self-management of hemodialysis patients.
Leticia A. Shea, PharmD, BCACP Longevity and work-life balance Professor Empowermemt University Nephropatny of Pharmacy Denver, Diabeitc. Micheline Diabetic nephropathy patient empowerment. Goldwire, PharmD, Diabetic nephropathy patient empowerment, Paient, BCPS Professor Sports nutrition Director, Drug Information Services Regis University School of Pharmacy Denver, Colorado. Shea and Goldwire have no actual or potential conflicts of interest in relation to this activity. Postgraduate Healthcare Education, LLC does not view the existence of relationships as an implication of bias or that the value of the material is decreased.
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