- Email: [email protected]
Kidney Function Predicts Cognition in Patients with Heart Failure
Abstracts
153
5 INFLAMMATORY AND HYPERCOAGULATORY STATUS IS A RISK OF DEATH IN DIABETIC HEMIDIALYSIS (HD) PATIENTS Michi Inoue, Emi Kihara, Yumiko Asada, Miho Kando, Kazuko Arita, Katsutoshi Maeda, Hiroaki Oda. Oda Medical Clinic. Hiroshima, Japan. Life prognosis of patients on hemodialysis primary due to diabetic nephropathy still remains poor. The purpose of this study is to investigate the features which contribute to death in diabetic HD patients. Forty-four diabetic HD patients, 22 dead and 22 alive, were subjected to this study. The average age and HD duration in dead vs. alive were 67.5 vs. 68.0 years old and 54.0 vs. 51.2 months, respectively. Serum concentrations of total protein (TP), albumin (Alb), creatitine (Cr), blood urea nitrogen (BUN), electrolytes, ȕ2 microglobulin (ȕ2-m), liver enzymes, C-reactive protein (CRP), intact parathyroid hormone (i-PTH) and alminium (Al) were measured and inflammatory markers using protein electrophoresis as well as coagulatory markers were also evaluated. Compared with the survivors, the dead patients showed significantly higher serum concentrations of potassium, ȕ2-m, alkaline phosphatase (ALP), lactate dehydrogenase (LDH), CRP, Al and fibrinogen together with a lower percentage of Alb and higher percentages of Į1 globulin (Į1-gl), Į2 globulin (Į2-gl) and ȕ globulin (ȕ-gl) by electrophoresis suggesting inflammatory status, while there were no significant differences in serum levels of TP, Alb, Cr, BUN, calcium, phosphorus and liver enzymes. The dead patients showed significantly lower prothrombin time (PT) activities than survivors. There were no differences in equibrated Kt/V and cardio-thoracic ratio (CTR) values. No specific electrocardiogram findings directly related to death were found in the dead patients. CRP fibrinogen Alb Į1-gl Į2-gl ȕ-gl (mg/dl) (mg/dl) (%) (%) (%) (%) Dead 1.47 356 57.8 3.3 9.9 8.7 Alive 0.30 283 60.7 2.7 8.0 7.8 p value <0.05 <0.05 <0.05 <0.01 <0.01 <0.05 In conclusion, inflammatory and hypercoagulatory status is a risk of death in diabetic HD patients.
7 NURSING IMPLICATIONS FOR IMPLEMENTATION OF A CLINICAL PATHWAY FOR THE DECEASED DONOR RENAL TRANPLANT PATIENT Ashley Seawright, Nichole Anderson, Fauzia Butt University of Mississippi Medical Center, Jackson, Mississippi. Clinical pathways have been used to systematically approach patient care in many acute hospital settings. Nursing staff fill the central role in implementation of clinical pathways in this setting. The purpose of this study was to explore the nursing implications of implementation of a new clinical pathway for deceased donor renal transplant (DDRT) patients. This descriptive exploratory qualitative study explored staff nurses’ perceptions of the clinical pathway’s usefulness in assisting patient care and allowing the nurse to be more involved in directing patient care. An open-ended questionnaire was sent to all 8 staff nurses who cared for the DDRT patients regularly and utilized the clinical pathway in a 24 hour acute care setting during a 7 month period. Six nurses completed the questionnaire, with responses all in favor of use of the clinical pathway as a patient care aid in achieving patient goals. Respondents also felt more involved in directing patient care in interactions with multidisciplinary team members, and felt it would supplement preexisting standardized postoperative nursing care. In conclusion, staff nurses found the clinical pathway to be useful in keeping patients on target for their postoperative goals. Use of the pathway also empowered staff nurses to become an integral part of the multidisciplinary team and be involved in decision making processes regarding care of the DDRT patient.
6 KIDNEY FUNCTION PREDICTS COGNITION IN PATIENTS WITH HEART FAILURE Houry Puzantian, Barbara Riegel University of Pennsylvania, Philadelphia, PA, USA Kidney function has been shown to be associated with cognition in the general population. Although 25-50% of patients with heart failure (HF) have cognitive decline, the association of kidney function and cognition has not been investigated in this population. This study explored the predictive role of kidney function on cognition in patients with HF. We recruited 274 patients with HF from 3 sites in the northeastern US. Patients on dialysis, with major depression or dementia were excluded. Clinical parameters were obtained from medical records and demographics were provided by self-report. Glomerular filtration rate was estimated (eGFR) by the new CKD Epi equation; patients were grouped by eGFR at a cut-off point of 60ml/min/1.73 m2. Five neuropsychological tests were used to measure cognitive function: Digital Symbol Substitution Test (DSST), Probed Memory Recall Test (PMR), Trail Making Test A and B (TMTA/B), the Letter Number Sequencing Test and lapses on the Psychomotor Vigilance Task (PVT). To assess the predictive role of kidney function in cognition, linear and logistic regressions were performed. Significance was set at p<0.05. The sample was 64% male with a mean age of 62+ 12years, 54% had at least some college education, and 58% were in New York Heart Association (NYHA) class III. The mean eGFR was 64.5+25.7ml/min/ 1.73m2. Compared to HF patients with eGFR >60ml/min/1.73m2, those with eGFR<60ml/min/1.73m2 had higher odds of having 2 or more abnormal measures of cognitive functioning (OR=1.88, p=0.034), specifically scoring below the norm on DSST (ȕ= -5.86, p=0.001), TMTA (ȕ=8.02, p=0.002) and TMTB (ȕ=15.48, p=0.022) after adjusting for age, gender, race, clinical site, and highest level of education achieved. In conclusion, deteriorating kidney function is a determinant of cognitive decline in HF patients. Efforts to defer kidney function deterioration may improve cognitive function in adults with HF.
8 SAVE THE VEIN BRACELET MAKES IMPACT ON VEIN PRESERVATION IN ADULT CKD PATIENTS Michelle Shields, Jan Crowell FMCNA, Pittsburgh, PA Arteriovenous fistula (AVF) is a patient’s lifeline on hemodialysis. The purpose of this study is to review the impact of Save the vein bracelets on vein preservation. All clinic patients with GFR <20 were educated on the importance of early placement of fistula. Each patients was given a Save the Vein bracelet to wear to encourage vein preservation in designated arm. Evaluations were completed at 30, 60 and 180 days to see if patients were still wearing their bracelets, had AVF/AVG placed or started dialysis with a functional AVF. Results: At 180 days, 21 bracelets were given to patients in the CKD program. 34% were for vein preservation before placement. 85% agreed to wear, 81 % were wearing on the next visit. At 180 days, 100% of patients have started HD have a functional AVF. Of those who have not yet started HD, 100% have AVF/AVG placed which are maturing. 4 patients refused to wear, of which 50% did not have AVF placed. In summary, patients who wear Save the Vein bracelets are more likely to have access placed. Bracelets also prevented any damage to the new fistulas due any unexpected ER visits, blood draws, accidents and the patient was unable to communicate. FMCNA has moved to provide the Save the Vein bracelets as part of its national catheter reduction collaboration to improve and preserve vascular access placement.
153
5 INFLAMMATORY AND HYPERCOAGULATORY STATUS IS A RISK OF DEATH IN DIABETIC HEMIDIALYSIS (HD) PATIENTS Michi Inoue, Emi Kihara, Yumiko Asada, Miho Kando, Kazuko Arita, Katsutoshi Maeda, Hiroaki Oda. Oda Medical Clinic. Hiroshima, Japan. Life prognosis of patients on hemodialysis primary due to diabetic nephropathy still remains poor. The purpose of this study is to investigate the features which contribute to death in diabetic HD patients. Forty-four diabetic HD patients, 22 dead and 22 alive, were subjected to this study. The average age and HD duration in dead vs. alive were 67.5 vs. 68.0 years old and 54.0 vs. 51.2 months, respectively. Serum concentrations of total protein (TP), albumin (Alb), creatitine (Cr), blood urea nitrogen (BUN), electrolytes, ȕ2 microglobulin (ȕ2-m), liver enzymes, C-reactive protein (CRP), intact parathyroid hormone (i-PTH) and alminium (Al) were measured and inflammatory markers using protein electrophoresis as well as coagulatory markers were also evaluated. Compared with the survivors, the dead patients showed significantly higher serum concentrations of potassium, ȕ2-m, alkaline phosphatase (ALP), lactate dehydrogenase (LDH), CRP, Al and fibrinogen together with a lower percentage of Alb and higher percentages of Į1 globulin (Į1-gl), Į2 globulin (Į2-gl) and ȕ globulin (ȕ-gl) by electrophoresis suggesting inflammatory status, while there were no significant differences in serum levels of TP, Alb, Cr, BUN, calcium, phosphorus and liver enzymes. The dead patients showed significantly lower prothrombin time (PT) activities than survivors. There were no differences in equibrated Kt/V and cardio-thoracic ratio (CTR) values. No specific electrocardiogram findings directly related to death were found in the dead patients. CRP fibrinogen Alb Į1-gl Į2-gl ȕ-gl (mg/dl) (mg/dl) (%) (%) (%) (%) Dead 1.47 356 57.8 3.3 9.9 8.7 Alive 0.30 283 60.7 2.7 8.0 7.8 p value <0.05 <0.05 <0.05 <0.01 <0.01 <0.05 In conclusion, inflammatory and hypercoagulatory status is a risk of death in diabetic HD patients.
7 NURSING IMPLICATIONS FOR IMPLEMENTATION OF A CLINICAL PATHWAY FOR THE DECEASED DONOR RENAL TRANPLANT PATIENT Ashley Seawright, Nichole Anderson, Fauzia Butt University of Mississippi Medical Center, Jackson, Mississippi. Clinical pathways have been used to systematically approach patient care in many acute hospital settings. Nursing staff fill the central role in implementation of clinical pathways in this setting. The purpose of this study was to explore the nursing implications of implementation of a new clinical pathway for deceased donor renal transplant (DDRT) patients. This descriptive exploratory qualitative study explored staff nurses’ perceptions of the clinical pathway’s usefulness in assisting patient care and allowing the nurse to be more involved in directing patient care. An open-ended questionnaire was sent to all 8 staff nurses who cared for the DDRT patients regularly and utilized the clinical pathway in a 24 hour acute care setting during a 7 month period. Six nurses completed the questionnaire, with responses all in favor of use of the clinical pathway as a patient care aid in achieving patient goals. Respondents also felt more involved in directing patient care in interactions with multidisciplinary team members, and felt it would supplement preexisting standardized postoperative nursing care. In conclusion, staff nurses found the clinical pathway to be useful in keeping patients on target for their postoperative goals. Use of the pathway also empowered staff nurses to become an integral part of the multidisciplinary team and be involved in decision making processes regarding care of the DDRT patient.
6 KIDNEY FUNCTION PREDICTS COGNITION IN PATIENTS WITH HEART FAILURE Houry Puzantian, Barbara Riegel University of Pennsylvania, Philadelphia, PA, USA Kidney function has been shown to be associated with cognition in the general population. Although 25-50% of patients with heart failure (HF) have cognitive decline, the association of kidney function and cognition has not been investigated in this population. This study explored the predictive role of kidney function on cognition in patients with HF. We recruited 274 patients with HF from 3 sites in the northeastern US. Patients on dialysis, with major depression or dementia were excluded. Clinical parameters were obtained from medical records and demographics were provided by self-report. Glomerular filtration rate was estimated (eGFR) by the new CKD Epi equation; patients were grouped by eGFR at a cut-off point of 60ml/min/1.73 m2. Five neuropsychological tests were used to measure cognitive function: Digital Symbol Substitution Test (DSST), Probed Memory Recall Test (PMR), Trail Making Test A and B (TMTA/B), the Letter Number Sequencing Test and lapses on the Psychomotor Vigilance Task (PVT). To assess the predictive role of kidney function in cognition, linear and logistic regressions were performed. Significance was set at p<0.05. The sample was 64% male with a mean age of 62+ 12years, 54% had at least some college education, and 58% were in New York Heart Association (NYHA) class III. The mean eGFR was 64.5+25.7ml/min/ 1.73m2. Compared to HF patients with eGFR >60ml/min/1.73m2, those with eGFR<60ml/min/1.73m2 had higher odds of having 2 or more abnormal measures of cognitive functioning (OR=1.88, p=0.034), specifically scoring below the norm on DSST (ȕ= -5.86, p=0.001), TMTA (ȕ=8.02, p=0.002) and TMTB (ȕ=15.48, p=0.022) after adjusting for age, gender, race, clinical site, and highest level of education achieved. In conclusion, deteriorating kidney function is a determinant of cognitive decline in HF patients. Efforts to defer kidney function deterioration may improve cognitive function in adults with HF.
8 SAVE THE VEIN BRACELET MAKES IMPACT ON VEIN PRESERVATION IN ADULT CKD PATIENTS Michelle Shields, Jan Crowell FMCNA, Pittsburgh, PA Arteriovenous fistula (AVF) is a patient’s lifeline on hemodialysis. The purpose of this study is to review the impact of Save the vein bracelets on vein preservation. All clinic patients with GFR <20 were educated on the importance of early placement of fistula. Each patients was given a Save the Vein bracelet to wear to encourage vein preservation in designated arm. Evaluations were completed at 30, 60 and 180 days to see if patients were still wearing their bracelets, had AVF/AVG placed or started dialysis with a functional AVF. Results: At 180 days, 21 bracelets were given to patients in the CKD program. 34% were for vein preservation before placement. 85% agreed to wear, 81 % were wearing on the next visit. At 180 days, 100% of patients have started HD have a functional AVF. Of those who have not yet started HD, 100% have AVF/AVG placed which are maturing. 4 patients refused to wear, of which 50% did not have AVF placed. In summary, patients who wear Save the Vein bracelets are more likely to have access placed. Bracelets also prevented any damage to the new fistulas due any unexpected ER visits, blood draws, accidents and the patient was unable to communicate. FMCNA has moved to provide the Save the Vein bracelets as part of its national catheter reduction collaboration to improve and preserve vascular access placement.