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学科主题临床医学
Negotiated care improves fluid status in diabetic peritoneal dialysis patients
Quan, L; Xu, Y; Luo, SP; Wang, L; LeBlanc, D; Wang, T
关键词volume control negotiated care compliance nursing
刊名PERITONEAL DIALYSIS INTERNATIONAL
2006
26期:1页:95-100
收录类别SCI
文章类型Article
WOS标题词Science & Technology
类目[WOS]Urology & Nephrology
研究领域[WOS]Urology & Nephrology
关键词[WOS]HEMODIALYSIS ; MORTALITY ; NONCOMPLIANCE ; EXCHANGES ; TRANSPORT
英文摘要

Background: Volume overload is common in diabetic patients on continuous ambulatory peritoneal dialysis (PD), especially when the patient′s residual renal function decreases with time on PD. Due to the higher dietary salt and fluid intake, diabetic PD patients tend to use more hypertonic glucose solution to remove excess fluid, which in turn may lead to increased membrane permeability. In the present study, we investigated the effect of negotiated care on fluid status in diabetic PD patients.

Methods: All diabetic PD patients who had been on PD for at least 3 months by the end of year 2002 in the First Hospital of Peking University were included in the present study. A primary nurse was assigned to each patient and intensive patient education was implemented, focusing on the importance of dietary salt and fluid restriction, the detrimental effect of using more hypertonic glucose solution, and the consequence of fluid overload. Decisions on dialysis prescriptions were made after extensive discussion among the primary nurse, nephrologists, patients, and patients′ families. A patient support group was also involved when it was necessary. All the patients were followed for 1 year and fluid status, compliance to dietary restriction, and dialysis prescription were evaluated before the start and at the end of the study.

Results: There were 30 diabetic PD patients (age 65.4 +/- 10.3 years; on PD for 24.5 +/- 19.9 months, range 3 - 66 months) included in the study when it was started. During the 1 year of follow-up, 4 patients died of diabetic complications, 3 patients were transferred to hemodialysis due to resistant peritonitis, and 2 patients were transplanted. By the end of follow-up, 21 patients remained on PD, among whom 15 had improved fluid status, 4 did not change, and 2 had worsened fluid status as assessed by clinical and bioimpedance evaluation. Patient compliance to dietary salt and fluid restriction had increased from 19.5% to 76.2%. During the follow-up, 8 patients were anuric at the beginning of the study and the remaining 22 patients had declining residual renal function. Only 4 patients increased their use of hypertonic solution including 2.5% (3 patients) and 4.25% (1 patient) glucose, whereas 5 patients decreased their use of 2.5% dialysis solution. By the end of follow-up, only 1 of the 21 patients was using 4.25% glucose solution and all the patients had good blood glucose control.

Conclusions: Our results suggest that negotiated care can be successfully used in diabetic PD patients. It helps to minimize the use of hypertonic glucose solution and improves patient compliance to dietary restriction of salt and fluid intake, and thus improves their fluid status.

语种英语
WOS记录号WOS:000235412200014
引用统计
被引频次:13[WOS]   [WOS记录]     [WOS相关记录]
文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/62615
专题北京大学第一临床医学院_肾脏内科
作者单位1.Scarborough Gen Hosp, Div Nephrol, Toronto, ON, Canada
2.Peking Univ, Hosp 1, Inst Nephrol, Beijing 100871, Peoples R China
推荐引用方式
GB/T 7714
Quan, L,Xu, Y,Luo, SP,et al. Negotiated care improves fluid status in diabetic peritoneal dialysis patients[J]. PERITONEAL DIALYSIS INTERNATIONAL,2006,26(1):95-100.
APA Quan, L,Xu, Y,Luo, SP,Wang, L,LeBlanc, D,&Wang, T.(2006).Negotiated care improves fluid status in diabetic peritoneal dialysis patients.PERITONEAL DIALYSIS INTERNATIONAL,26(1),95-100.
MLA Quan, L,et al."Negotiated care improves fluid status in diabetic peritoneal dialysis patients".PERITONEAL DIALYSIS INTERNATIONAL 26.1(2006):95-100.
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