Chapter IV Results :
Quality of Life:
Comparison Between Hemodialysis and Continuous Ambulatory Peritoneal Dialysis
(5000 Words)
Chapter IV Results
Critique the Ten Articles
Article 1: Hemodialysis and Peritoneal Dialysis: Comparison of Adjusted Mortality Rates According to the Duration of Dialysis: Analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis 2
Focus: The title of the second article is “Hemodialysis and Peritoneal Dialysis: Comparison of Adjusted Mortality Rates According to the Duration of Dialysis: Analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis 2 by Termorshuizen et al (2003). The title indicates the topic that is being discussed by the article which is the comparison of Hemodialysis and Peritoneal Dialysis according to the duration.
Background: In the second article Termorshuizen et al analyzed the differences in the mortality rates of Hemodialysis and Peritoneal Dialysis patients. The researchers investigated by having an analysis in which the potential biases were taken into account. Patients with End-Stage Renal Dialysis were monitored until transplant or death by the Netherlands Cooperative Study on the Adequacy of Dialysis.
Terms of Reference: The aim of the Temorshuizen et al study is to investigate the differences in mortality rates between Hemodialysis and Peritoneal Dialysis patients that participated in the Netherlands Cooperative Study on the Adequacy of Dialysis.
Study Design: In the study conducted by Ford et al, the researchers used quantitative method in measuring the suicide rates of patients on dialysis. The data were collected from the U.S. Renal Data System (USRDS) in a standard analysis file. The file contains 572,162 observations on 25 variables on all patients in the End Stage Renal Disease Program. The data are cross-sectional observations on each patient.
Data Collection Tools: In the study by Termorshuizen et al the data on demographic characteristics, primary kidney diseases and comorbidities were collected from the patients upon the entry to the research. The data on residual renal function, nutritional status, biochemical parameters and dialysis characteristics were accumulated three months after renal residual therapy began and six months intervals after. According to the codes of the European Renal Association Dialysis and Transplantation Association the primary kidney disease was classified. Comorbidity index was classified as having no, intermediate or severe comorbidity. Diabetic status was identified on the basis of diabetes mellitus registered as a primary kidney disease or as a comorbid situation. The volume of urine produced in the long interdialytic interval was recorded for hemodialysis patients while the volume produced in a 24-hour was recorded for Peritoneal Dialysis patients.
Sample: In articlenumber 2 patients were selected from the Netherlands Cooperative Study on the Adequacy of Dialysis. The patients that survived the first three months of dialysis were categorized according to the treatment modality. The first three months was excluded to avoid analytical problems related with late referral to nephrologists, early modality switching and acute renal failure. There were a total of 742 Hemodialysis patients and 480 Peritoneal Dialysis patients included in the analysis.
Data Presentation: The authors used tables to present the statistical data of the study, a graph was also created to show the unadjusted death rates and relative risk of death in Hemodialysis and Peritoneal Dialysis and lastly it was presented in text format for the discussion of the study.
Main Findings: The research has observed that there is no statistical significant difference in the adjusted mortality rates between Peritoneal Dialysis and Hemodialysis during the first two years of dialysis. Afterwards, there is an increase of mortality rates among Peritoneal Dialysis and a decrease in Relative risk for Hemodialysis. This was observed on patients > 60 years old.
Conclusions and Recommendations: In this study the results suggested that using Peritoneal Dialysis in long period of time especially on elderly patients is associated with the increase in mortality. The authors suggested on the further analyses in determining the probable role of dialysis adequacy in the long term observation of differences in mortality rates between Hemodialysis and Peritoneal Dialysis patients in order to establish the possible benefits of Peritoneal Dialysis patients switching to Hemodialysis on their survival.
Article 2: Suicide as an indicator of Quality of Life: Evidence from Dialysis Patients
Focus: The title of the first article is “Suicide as an indicator of Quality of Life: Evidence from Dialysis Patients” by Ford Ford and Kaserman (2000). The title itself of the article gives the summary and overview of the whole article. It entices the readers’ interest on the impact of using the two methods of dialysis in determining suicide among dialysis patients.
Background: In this first article Ford Ford and Kaserman used suicide rates as an objective measure in the quality of life within the population of dialysis patients. The researchers estimated the suicide rates among patients undergoing hemodialysis and peritoneal dialysis. The study has shown favorable results regarding hemodialysis because of its lower rates in suicide. The article is current and justifies the research done.
Terms of Reference: The purposes of the article of Ford Ford and Kaserman are to provide evidence and demonstrate the possibility of using the rates of suicide in dialysis patients as an objective indicator in the quality of life.
Study Design: In the study conducted by Ford and Kaserman, the researchers used quantitative method in measuring the suicide rates of patients on dialysis. The data were collected from the U.S. Renal Data System (USRDS) in a standard analysis file. The file contains 572,162 observations on 25 variables on all patients in the End Stage Renal Disease Program. The data are cross-sectional observations on each patient.
Data Collection Tools: In this study Ford and Kaserman obtained their data from the U.S. Renal Data System (USRDS). The sample was limited to patients who received in-center Hemodialysis or peritoneal dialysis. The samples size was reduced from 572,162 to 456,513 because of restrictions and missing data.
Sample: In this study the researchers chose the patients file of the US Renal Data Systems (USRDS). It contains 572,162 observations having 25 variables for all patients of End Stage Renal Disease (ESRD). The sample was limited to patients receiving in-center hemodialysis and peritoneal dialysis. The sample was reduced to 456,513 obesrvations due to limitations and missing information and data.
Data Presentation: The researchers presented the study in table and in text format. They made a table comparing Hemodialysis and Peritoneal Dialysis, table containing the variable names, definitions and means and regression results using suicide as dependent variable. The tables are presented in raw numbers.
Main Findings: In this study Ford and Kaserman used a Heckman selection model in estimating the relative suicide rates across patients in hemodialysis and peritoneal dialysis. The results yielded, that patients undergoing hemodialysis have relatively lower suicide rates after controlling the other factors. The results indicated that 141 fewer suicides will occur in every 1000 patients shifted from peritoneal dialysis to hemodialysis.
Conclusions and Recommendations: In this study the authors stated that the quality of life of patients receiving hemodialysis is higher or on average. Regardless of the improvement on the quality of life is enough to justify the huge expenditures and improve general social welfare it could not be established in these findings. These authors merely highlight the probable usefulness of using suicide rate as an indicator on quality of life in making budgetary and modality choices in the health care industry.
Article 3: Peritoneal Dialyis compared with Hemodialysis in the treatment of end-stage renal disease
Focus: The title of the article is “Peritoneal Dialyis compared with Hemodialysis in the treatment of end-stage renal disease” by Alloati et al (2000). The title of the study indicates the focus of the article which is the comparison of using Peritoneal Dialysis and Hemodialysis in treating End Stage Renal Diseases (ESRD).
Background: In the third article Alloati et al reviewed different studies comparing survival of patients on Hemodialysis and Peritoneal Dialysis. The different studies showed either superiority of Hemodialysis or superiority of Peritoneal Dialysis or even the equivalence of these two procedures. The researchers brought two clear phases in the analysis of the comparison as a whole.
Terms of Reference: Alloati et al objectives in their study is to come up with a critical, independent review on the topic of comparison between peritoneal dialysis and hemodialysis in treating End-stage renal disease, in which it has a significant outcomes in terms of clinical end results and far-reaching managerial and economic implications.
Study Design: In Alloati et al article the qualitative method was used because the analysis was presented in a narrative form. The authors used different related literatures in their study in comparing peritoneal dialysis and hemodialysis in the treatment of end-stage renal disease.
Data Collection Tools: Alloati et al collected data from different relevant related literature on the study. Literatures and data on peritoneal dialysis and hemodialysis were collected from different parts of the world and a comparison of the treatments was made by the authors.
Sample: In this study the authors did not make a sample. They only review past literatures related to Peritoneal Dialysis and Hemodialysis and the treatment to End Stage Renal Disease.
Data Presentation: The researchers presented the results using literature reviews and also presented a table showing the use of Peritoneal Dialysis in Various Parts of the World and Comparison of Peritoneal Dialysis and Hemodialysis. A figure from Nolph KD was also shown in the study.
Main Findings: The authors found out in this study that during the first residual renal function peritoneal dialysis is more advantageous than Hemodialysis but when Kt/V is reduced as Residual Renal Function declines Peritoneal Dialysis becomes a potential risk. Patients without renal residual function undergoing Peritoneal Dialysis have a hard time controlling hypertension and more prone to hyperhydration. High-turnover and low-turnover bone lesions are more frequent in Hemodialysis patients. Anemia, blood lipids and nutritional indices is better controlled in Peritoneal Dialysis and Peritoneal Dialysis is preserves renal function better than Hemodialysis.
Conclusions and Recommendations: In this study the authors concluded that dialytic centers must establish a combined Peritoneal Dialysis and Hemodialysis program because these two methods are not competitive but different tools for the treatment and rehabilitation of patients undergoing kidney diseases.
Article 4: The experience with Continuous Ambulatory Peritoneal Dialysis in Moscow
Focus: The title of the article is “The experience with Continuous Ambulatory Peritoneal Dialysis in Moscow” by Tomilina et al (2000). The title draws the general interest of readers in examining the experiences of Continuous Ambulatory Peritoneal Dialysis (CAPD) patients in Moscow, whether it’s positive or negative.
Background: In the fourth article discussed by Tomilina et al, the article outlines the biggest Continuous Ambulatory Peritoneal Dialysis (CAPD) in Russia which is the CAPD Moscow program during January 1995 to December 1998. Afterwards, the results of Continuous Ambulatory Peritoneal Dialysis (CAPD) therapy were compared with Hemodialysis.
Terms of Reference: The aim of Tomalina et al study is to compare the results of the Continuous Ambulatory Peritoneal Dialysis (CAPD) program in Moscow to the results of Hemodialysis.
Study Design: The study conducted by Tomilina et al used a quantitative method. The researchers estimated the treatment outcomes by mortality rate, which is the percentage of deaths over one year, calendar, and also uses Kaplan-Meier in calculating the technique survival and peritonitis probability. Cox regression model with c2 criterion were used in assessing the impact of separate factors on the treatment.
Data Collection Tools: Tomilina et al collected the information and data from the Moscow City End Stage Renal Disease Registry that was created in January 1995.
Sample: In this study the researchers investigated using the sample from the Moscow City End Stage Renal Disease Registry. The samples taken were dated from January 1, 1995 to December 31, 1998. There were 1289 patients with End Stage Renal Disease treated by dialysis. 324 patients were treated using Continuous Ambulatory Peritoneal Dialysis (CAPD) and 765 patients treated using Hemodialysis. The age of the patients’ ranges from 15-85 years old and patients ages 40-65 being the dominant age group.
Data Presentation: The authors presented the results in figures and text. The results were shown in seven figures having raw numbers and percentages on the graphs. The discussion was in the text format.
Main Findings: The researchers observed thatMortality rate in Continuous Ambulatory Peritoneal Dialysis Patients (CAPD) was 10.5%. The mortality structure was not significantly different in Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis (HD). The most common cause of death in both treatment modalities were cardiovascular diseases. The CAPD and Hemodialysis rendered different results in the diseases; congestive heart failure was the frequent cause of death in Hemodialysis patients while in CAPD patients strokes were more frequent. CAPD only yielded 53% in the three-year technique survival. The most common problem in Hemodialysis patients is overhydration and peritonitis was less frequent.
Conclusions and Recommendations: In this study, Continuous Ambulatory Peritoneal Dialysis (CAPD) in Russia can be considered a very good outlook renal replacement therapy options that has the same effect with Hemodialysis.
Article 5: The Effects of Body Size and Body Composition on Survival in Hemodialysis Patients
Focus: The title of the article is “The Effects of Body Size and Body Composition on Survival in Hemodialysis Patients” by Beddhu et al (2003). This study investigates if the body size and composition have significant effect on the survival of patients on Hemodialysis treatment. The title is a good indicator of the article’s main focus.
Background: In the fifth article Beddhu et al used a twenty-four-hour urinary creatinine (UCr) excretion in measuring the patients’ muscle mass. The end result of patients under hemodialysis with high Body Mass Index and normal or high muscle mass (low body fat) and high Body Mass Index and low muscle mass (high body fat) were investigated to find out the effects of body composition on the results.
Terms of Reference: The purpose of Beddhu et al study is to investigate if increased muscle mass or body fat indicates the survival advantage in patients undergoing hemodialysis that are having a high body mass index (BMI).
Study Design: Beddhu et al employed a quantitative study on their research, the use of x² test, one-way ANOVA or Kruskal-Wallis rank sum test in determining the baseline characteristics of high and normal BMI groups and patients with UCr ≤ 25thpercentile and > 25th percentile within high Body Mass Index group.
Data Collection Tools: The data collected by Beddhu et al were gathered from the Form 2728 from January 1, 1995 to December 31, 1999, patients with creatinine clearances and serum creatinine were chosen. And from these patients, patients with duplicate entries, previous renal replacement therapies age 18 years and below, incomplete follow-up information, missing data for serum albumin, height and weight were excluded.
Sample: The sample used in this study was obtained from the Medical Evidence (Form 2728) form. The study population was patients having creatinine clearances and serum creatinine reported from January 1, 1995 to December 31, 1999.
Data Presentation: The researchers used tables in showing the statistical analysis of body mass index and Multivariable Cox Regression Models. A figure was also shown using the Kaplan-Meier curves in comparing the cause of death. Text was also used in narrating the literatures and discussion.
Main Findings: In this study the main findings were when a patient is compared with normal Body Mass Index group, patients with high Body Mass Index had lower chances of death. But when compared to patients having Normal Body Mass Index with UCr > 25th percentile, patients with high Body Mass Index patients UCr > 0.55 g/d had lower chances of all-cause and cardiovascular death, and high Body Mass Index with UCr ≤ 0.55 g/d had higher chances of all-cause death and cardiovascular death
Conclusions and Recommendations: In this study body size and body compositions are great predictors of death among dialysis patients. Compared to normal Body Mass Index patients having a normal or high muscle mass, the survival advantage by high Body Mass Index in patients undergoing dialysis is limited to normal or high muscle mass. In addition, patients having high Body Mass Index and low muscle mass have higher all-cause and cardiovascular mortality. Hence, cardiovascular risk factors might be important in the End Stage Renal Disease population; further studies regarding this subject are recommended.
Article 6: Comparison of Mortality between Patients Treated with Hemodialysis and Peritoneal Dialysis
Focus: The title of the article is “Comparison of Mortality between Patients Treated with Hemodialysis and Peritoneal Dialysis” by Bloembergen et al (1995). The title of the study is significant in drawing the reader’s attention to its focus which is to compare the mortality rates of patients undergoing Hemodialysis and Peritoneal Dialysis.
Background: In the sixth article Bloembergen at al collected data from the US Renal Data System on dialysis patients on January 1 of the years 1987, 1988 and 1989, each patient with a 1 yr. follow up. The patients were examined during transplantation and the mortality rates per 100 patient years were compared between hemodialysis and peritoneal dialysis, with an adjustment on the race, gender, age, cause of End-Stage Renal Disease (ESRD) and year of prior ESRD.
Terms of Reference: Bloembergen et al objective was to compare mortality in prevalent hemodialysis and Peritoneal dialysis patients in a huge national sample with adjustment on the demographic characteristics.
Study Design: Quantitative study was used in Bloembergen et al research. The death rate was calculated by the total number of deaths divided by the total number of patient years at risk. The mortality rate for Peritoneal Dialysis and Hemodialysis was compared using Poisson regression which can make adjustments for age, gender, and race, cause of End Stage Renal Disease (ESRD) and duration of ESRD therapy.
Data Collection Tools: The data of Bloembergen et al were collected from the U.S. Renal Data System (USRDS). The data included were three national cohorts of prevalent patients undergoing Continuous Ambulatory Peritoneal Dialysis or Cycling Peritoneal Dialysis, and Hemodialysis during January 1 of the years 1987, 1988 and 1989 each with a year follow-up.
Sample: In the article the sample size were obtained from the United States Renal Data System (USRDS). The sample population is patients that survived a minimum of 90 days on renal replacement therapy and receiving Peritoneal Dialysis and Hemodialysis on January 1, 1987, 1988 and 1989 with 365 days of follow-up.
Data Presentation: The authors presented their study in table form showing the demographic characteristics and relative risk of mortality by End Stage Renal Disease. Figures indicated adjusted Death Rate for Hemodialysis and Peritoneal Dialysis Patients and text format was also presented in the study fro other discussions.
Main Findings: This article found out that there are 42,372 deaths that occur in 170,700 patient years. On the average, patients undergoing treatment with peritoneal dialysis had a higher adjusted mortality risk of 19% than hemodialysis patients. This risk was irrelevant for ages < 55 and increasingly significant and huge for > 55 years old. It was emphasized in diabetics, although it was also present in nondiabetics. It is more stressed on females than males.
Conclusions and Recommendations: In this study it has found that the mortality rates are higher in Peritoneal Dialysis than in Hemodialysis particularly among diabetic patients. The technical features of Peritoneal Dialysis contributed to the excess mortality. The selection of Peritoneal Dialysis of patients who are at risk of death can also be accounted for the results. Other explanations regarding this study include differential dosage of dialysis, compliance of Peritoneal Dialysis and Hemodialysis patients to the treatment modalities and the difference on the quality of the health care system. Further studies are encouraged to separate the effects of patient selection, differential dose of dialysis, nutrition, patient compliance and medical quality.
Article 7: Peritoneal Dialysis in Europe: An Analysis of its Rise and fall
Focus: The title of the article is “Peritoneal Dialysis in Europe: An Analysis of its Rise and fall” by Lameire et al (2006). This study focuses on the reasons and factors on the increasing and declining utilization of Peritoneal Dialysis of patients in Europe. The title is a favorable in indicating its main focus.
Background: In the seventh article Lameire et al discussed the wide variability of the utilization of Peritoneal Dialysis throughout Europe. The researchers investigated the medical factors and the non-medical factors in determining the choice of patients’ renal replacement therapy modality.
Terms of Reference: In Lameire et al study the objective is to identify the medical and non-medical factors on the use of Peritoneal Dialysis in the whole of Europe and the main factors of the variations.
Study Design: Lameire et al used qualitative study in their article, several studies were used and critique by the authors. The researchers examined the different data gathered from different countries in Europe and assessed the medical and non-medical factors that affect the rise and fall of Peritoneal Dialysis usage across Europe.
Data Collection Tools: Lameire et al gathered their data from different studies all over Europe related to the topic and figures from Dialysis and Transplantation Association/European Renal Association.
Sample: In this study the researchers did not create a sample in this research. It did not involve any patient participation. The authors provided a methodical literature review and included the available literatures sources regarding this study.
Data Presentation: The researchers presented the study in a form of text in different literature reviews. Figures courtesy by Maria Wiedemann was shown in the study, and also tables from Dialysis and Transplantation Association/ European Renal Association.
Main Findings: The researchers in this study found out that the most important factors of the variation of Peritoneal Dialysis across Europe are not medical but preferably changes in reimbursement and other financial considerations. The general structure of the health care system in each country is also a determining factor in the use of different renal replacement therapy.
Conclusions and Recommendations: In this study the authors concluded that the utilization of Peritoneal Dialysis in Europe differs widely. In other countries the use of peritoneal dialysis has risen for the past years while other countries like non-European ones there is a decline of its usage. The reasons for these differences are numerous, and this paper strived to outline the non-medical and medical factors.
Article 8: Comparison of Continuous Ambulatory Peritoneal Dialysis and Hemodialysis Patients Survival with Evaluation of Trends during the 1980s
Focus: The title of the topic is “Comparison of Continuous Ambulatory Peritoneal Dialysis and Hemodialysis Patients Survival with Evaluation of Trends during the 1980s” by Nelson et al (1992). The study evaluates the Dialysis trends during the 1980s when Peritoneal Dialysis was first introduced and made a comparison between Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialyis patients.
Background: In the eight article Nelson et al evaluated the mortality rates of patients undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis (HD), Michigan residents ages 20 to 59 years old who admitted therapy for End Stage Renal Disease during 1980s were studied. The patient population was arranged by primary and renal diagnosis and it was analyzed by Cox proportional hazards methods that controls the age, race, sex and year the chronic dialysis started. Intent to Threat and treatment history censoring criteria was also used.
Terms of Reference: The purpose of Nelson et al study is to examine the mortality rates of patients undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis in all of the Michigan residents aged 20 to 59 during the 1980s.
Study Design: In the study conducted by Nelson et al, quantitative study was used. The researchers used Statistical methods in comparing the Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis patients during the 1980s. The Cox proportional hazards regression model was used in the evaluation of the mortality of Continuous Ambulatory Peritoneal Dialysis (CAPD) patients comparative to Hemodialysis patients.
Data Collection Tools: In the study conducted by Nelson et al, the data were gathered from the Michigan Kidney Registry which contains information of all End Stage Renal Disease Patients in the state of Michigan since 1973. The dataset used in the analysis have 4,288 Michigan resident information who had therapy for End Stage Renal Disease (ESRD) between January 1, 1980 and August 31, 1989, and patients using in-center Hemodialysis or home Continuous Ambulatory Peritoneal Dialysis at day 120 of the ESRD.
Sample: In theinclusion criteria for this particular study were Michigan End Stage Renal Disease patients between January 1, 1980 and August 31, 1989who wereusing Hemodialysis or Peritoneal Dialysis at day 120 of End Stage Renal Disease. The exclusion criteria were patients receiving other treatment modality, recovered renal function, prior transplant and patients that began End Stage Renal Disease Therapy before January 1, 1980. The patients were classified according to the treatment modality they are undergoing.
Data Presentation: The authors used tables, text and figures in presenting the data of their study. Tables were shown regarding the number of deaths in the sample, demographic characteristics, percentage of patients using Continuous Ambulatory Peritoneal Dialysis (CAPD), Diagnosis for specific risk of death for CAPD and the comparison on Hemodialysis. Figures on the percentage of patients using CAPD, risk of death on Diabetics and change in mortality in CAPD and Hemodialysis diabetic patients.
Main Findings: This research has observed that there was no significant difference in mortality rates of patients on CAPD and HD with hypertension and other causes of End Stage Renal Disease (ESRD). In the Intent-to-threat analysis diabetic and glumerulonephritic patients experienced lower mortality rates if they undergo Continuous Ambulatory Peritoneal Dialysis (CAPD). The evaluation of trends in mortality during the decade showed a decrease in diabetic CAPD while diabetic HD mortality increased. Diabetic men had higher mortality compare to women. In nondiabetics results did not change when treatment history censoring criteria (RxHx) was used, while on diabetics’ mortality rates of CAPD and HD patients were similar.
Conclusions and Recommendations: In this study researchers concluded that in the state of Michigan the use OF Continuous Ambulatory Peritoneal Dialysis (CAPD) has raised since 1989. In young diabetics, the use of CAPD in a long-term basis has shown to be lower in CAPD patients on day 120 of End Stage Renal Disease (ESRD) but not different from the day 120 of ESRD until the first change of therapy. In young non-diabetics, CAPD patients having glumerulonephritis had lower mortality rates than Hemodialysis patients, while those with hypertension and other illness have shown no difference. Future studies on dialysis adequacy and factors that might affect the use of CAPD and HD are recommended.
Article 9: Analysis of Depression in Continuous Ambulatory Peritoneal Dialysis Patients
Focus: The title of the topic is “Analysis of Depression in Continuous Ambulatory Peritoneal Dialysis Patients” by Jung et al (2002). The title is a good indicator of the focus of the research. This article focuses on the severity of depression among Continuous Ambulatory Peritoneal Dialysis (CAPD) patients and the factors that affect them.
Background: In the ninth article Jung at al evaluated every patient’s depressive mood and hopelessness with the use of Center for Epidemiologic Studies Depression (CES-D) scale and Beck Hopelessness scale. The degree of stress of every patient was also examined via internal individual stress scale.
Terms of Reference: The primary purpose of Jung et al study was to evaluate and perform an analysis on the depression tendency among Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients, which is an important factor on the survival and prognosis of patients.
Study Design: Jung et al used quantitative study in their analysis of depression on Continuous Ambulatory Peritoneal Dialysis (CAPD) patients. The researchers employed the Center for Epidemiologic Studies Depression Scale (CES-D scale) and Beck Hopelessness Scale (BHS). Serum albumin, Hemoglobin, Blood Urea Nitrogen and Creatinine were also measured. The results were expressed as mean ± standard deviation.
Data Collection Tools: In Jung et al study; the data were collected from Samsung Seoul Hospital in which there are Ninety-six percent of patients using Continuous Ambulatory Peritoneal Dialysis (CAPD). The numbers of male were sixty three and thirty three were female. The mean age, marital status and dialysis of the patients were also gathered.
Sample: In this study the sample was ninety-six patients receiving Continuous Ambulatory Peritoneal Dialysis (CAPD) at Samsung Seoul Hospital wherein sixty-three were male and thirty three were female. The clinical parameters that were measured were the serum albumin, hemoglobin, blood urea nitrogen and creatinine.
Data Presentation: The researchers used Tables and text in the presentation of the study. Tables on the comparison of depression to other parameters by gender, comparison of patients according to depression, correlations among factors associated with depression and regression analysis of depression in Continuous Ambulatory Dialysis Patients were shown.
Main Findings: In this study the researchers investigated that there are no relevant gender differences in the psychological factors like depression, hopelessness and internal individual stress. Demographic factors like duration of dialysis, age, albumin, hemoglobin, blood urea nitrogen also have no gender differences. Patients having depression suffered a greater degree of hopelessness and experienced rigid internal individual stress.
Conclusions and Recommendations: In this study the researchers confirmed that the total number of cases of depression among Continuous Ambulatory Peritoneal Dialysis (CAPD) patients was mainly influenced by psychological factors. This research is a cross-sectional study and a further study with or without therapeutic intervention is encouraged.
Article 10: Survival Comparison between Hemodialyis and Peritoneal Dialysis based on Matched Doses of Delivered Therapy
Focus: The title of the topic is “Survival Comparison between Hemodialyis and Peritoneal Dialysis based on Matched Doses of Delivered Therapy” by Churchill et al (2002). This article compares Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis patients’ survival based on the dosages of the treatments delivers. The title is a good indicator of the focus of the article.
Background: In the tenth article Churchill et al investigated 968 Hemodialysis patients at the Regional Kidney Disease Program from the year 1987 to June 1995. The results that were generated were compared with the 680 Continuous Ambulatory Peritoneal Dialysis (CAPD) patients from September 1990 to December 31, 1992 of the Canadian-United States prospective trial (CANUSA). And a follow-up was made on December 31, 1993.
Terms of Reference: Churchill et al aim is to show a direct comparison of equivalently dosed Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis (HD).
Study Design: Quantitative study was also used in Churchill et al research the authors employed the Cox proportional hazards model in comparing the survival of patients on the two renal treatment therapy modalities. Age, diabetes mellitus, history of cardiovascular diseases serum albumin, and Kt/V were selected covariates.
Data Collection Tools: Churchill et al collected their data for Hemodialysis patients from the Regional Kidney Disease Program (RKDP) in Minneapolis, Minnesota. 968 Hemodialysis patients who entered the program between January 1, 1987 and December 31, 1994 and followed until June 30, 1995 were included. For Peritoneal Dialysis patients the data were gathered from centers in Canada and USA (CANUSA), 680 patients who entered the program between September 1, 1990, and December 31, 1992 with a follow-up until December 31, 1993 were chosen.
Sample: The study chose the sample of 968 Hemodialysis patients that entered the treatment between Januray 1, 1987 and December 31, 1994 and had a follow-up until June 30, 1995 from the Regional Kidney Disease Program (RKDP) in Minneapolis, Minnesota. Patients having a measurement of Kt/Vurea on dialysis, residual renal function and serum albumin were included. For the Peritoneal Dialysis, 680 patients commencing Peritoneal Dialysis continuously in 14 centers in Canada and United States between September 1, 1990 and December 31, 1992 and a follow-up on December 31, 1993 were included.
Data Presentation: The authors primarily used text and tables in presenting and discussing the results of the study. Eight tables were presented in the article showing the different results in the statistical analysis by using the Cox Analysis method.
Main Findings: The authors found out after evaluating the effect of comorbid conditions and dialysis therapy in time-dependent method using a Cox proportional hazards model. It yielded a mean total Kt/V of 1.59 both residual renal function and dialytic therapy among Hemodialysis patients. The CANUSA patients delivered a weekly 2.38 Kt/V at the start of the baseline period and 1.99 after two years of follow-up. In Hemodialysis 7% lower risk death with a similar *% lower risk death on CAPD was associated in a 1-unit increase in Kt/V. Diabetic patients’ ages 40-60 years old had identical 2-year survival estimates on Hemodialysis compared to CAPD. Older patients have comparable results in both Hemodialysis and Peritoneal Dialysis.
Conclusions and Recommendations: In this study the analysis have shown that it is clear g Moreover, this study exhibits that when the dosage of dialysis is matched Hemodialysis and Continuous Ambulatory Peritoneal Dialysis (CAPD) yielded a comparable 2-year survival rate, independent of age, status of diabetes and history of Cardiovascular disease.
Ethical Considerations
The principal ethical principle of a research is the respondents must not be harmed as a result in participating in researches. The researchers must give consent to the participants.
The articles and researches gathered were considered ethical as a whole because most of the data that were gathered came from previous studies. In articles 1 and 6 the information were gathered from the U.S. Renal Data System (USRDS), article 2 information were gathered from the Netherlands Cooperative Study on the Adequacy of Dialysis. In article 4, the data were collected from Moscow City End Stage Renal Disease Registry. In article 5 the information were gathered from the Medical Evidence (Form 2728) by the Centers for Medicare and Medicaid. In article 7 the data came from Dialysis and Transplantation Association/European Renal Association. In article 8 information were gathered from the Michigan Kidney Registry. On article 9 patients were observed in Samsung Seoul Hospital with the consent of the patient and his/her family. And on the tenth article the information and data were collected from the Regional Kidney Disease Program in Minneapolis and centers in Canada and USA (CANUSA). Before any researcher can study or gather the data and information, procedure and process are followed in order to obtain the ethical standards governing the system and the research.
Readability
The ten articles were written in a simple and plain language which enables me to read and understand the whole concept of those studies. Although some of the measurement instrument and statistical tools were a bit complex and wasn’t elaborated, it was further explained on the discussion nonetheless all articles can be easily understood.
Implications for practice
Being a health care professional, I must know the different factors that influence the quality of life in patients undergoing Hemodialysis and Continuous Ambulatory Peritoneal Dialysis (CAPD). Knowing the latest studies and trends in treatment modalities of renal diseases is a useful tool in providing the best possible health care to the patients. By knowing the factors that can improve the patient’s quality of life a broader health care plan can be made for each patient.