Introduction
One of the most important aspects when conducting the treatment of patients with kidney substitution therapy is the quality of their life. This problem remains the most acute because this group of patients feels constant dependence of their health and life on the factors they have little control of. The dialysis method is the latest in an arsenal of therapeutic agents to be performed in cases where there is no other option to prolong a patient’s life. Today, peritoneal dialysis practice has one of the leading places in the therapy of patients with the terminal stage of chronic kidney disease (CKD) accompanied by chronic renal failure (CRF). According to Sukul et al. (2019, p. 2), “compared with facility hemodialysis, PD is more cost-effective, less technically demanding, and minimizes the exposure of patients to hospital-acquired infections”. Thus, peritoneal dialysis received a large distribution in the urological practice.
With the inaccessibility of home hemodialysis for most patients and certain physiological advantages of peritoneal dialysis, it is the latter that is considered as the optimal first type of replacement therapy. Jung et al. (2019, p. 1) report that “PD shows the better health-related quality of life during the initial period after dialysis even after adjusting for clinical and socioeconomic characteristics, and the effect lasts up to two years.” Moreover, Wong et al. (2018) add that among patients with end stage renal failure, PD posed a lower risk of death in elderly patients. In this essay, a specific case of end stage renal failure treatment is reviewed.
Assessment of the Patient
The patient is a 63-year-old Caucasian female, heterosexual, widowed, has one daughter and two sons. Her medical history reports that she has been suffering from chronic kidney disease for the last five years, and seven months ago, it entered the stage of chronic renal failure. The patient was then put on hemodialysis, which prevented her death; however, her kidney disease is now terminal, and she wants to transfer to peritoneal dialysis in order to perform it at home. Besides chronic kidney disease, the patient also has diabetes mellitus and requires insulin shots. Overall, the patient would like to switch to peritoneal dialysis due to the fact that it will allow her to be discharged home instead of staying or coming and leaving the hospital. She does not have any contraindications for peritoneal dialysis, therefore, it is possible to switch her to it in order to improve her quality of life on the final stage of kidney failure.
Management Plan
The first priority assessment that needs to be conducted is the comprehensive monitoring of all the fluid movement in the patient. It should be performed every day due to the fact that it helps determine the current status of renal function and notice the acute failure in time to prevent dire consequences. Coleman et al. (2017, p. 11) state that “nurse-led chronic kidney disease (CKD) clinics provide a comprehensive approach to achieving clinical targets effective in slowing the progression of CKD.” If the assessment is not conducted accurately, it may lead to fluid overload and, potentially, to an acute failure manifesting quickly. According to Kalantar-Zadeh et al. (2021), there is a significant cardiovascular risk associated with chronic kidney disease, thus, the prevention of acute kidney injury is crucial for managing the patient’s transfer.
Another important assessment is the comprehensive monitoring of the patient’s heart rate and blood pressure at different times during the day. According to Romagnani et al. (2017, p. 1), “the majority of patients with CKD are at risk of accelerated cardiovascular disease and death.” Moreover, for patients with diabetes, CKD is the major risk increase factor, especially in older patients. Thompson (2019, p. 8) adds that “the gender differences in symptom presentation and cardiovascular disease risk in women is increased, to a greater extent, by factors such as diabetes.” Therefore, it is crucial to monitor the main vital signs before, during, and after the process of transition from hemodialysis to peritoneal dialysis. A collaborative approach from multidisciplinary teams is in order here, as the patient must be closely watched for heart complexities, age-related health issues, as well as for effects of diabetes and kidney disease.
Diuretics such as Furosemide should also be prescribed to remove excessive fluid from the patient’s organism. However, seeing as the patient also needs to take diabetes medication, she needs to be closely monitored for potential drug-drug interactions before the process of transition. Wasik et al. (2019) explain that drug and food interactions may influence the pharmacokinetics of the prescribed medication. In patients with kidney failure, the excretion of Furosemide slows down up to 24 hours. The ability of Furosemide to cause a significant increase in the excretion of certain electrolytes may lead to cardiovascular complications. Adibe et al. (2018) also add that patients with CKD have higher risks of drug-drug interactions. Moreover, diuretic-provoked hypokalemia is also often a side effect. Spina et al. (2019) state that clinicians have to account for all drugs a patient takes to reduce the risk of an undesired drug interaction. When the patient’s condition is fully stabilized, the process of transition peritoneal dialysis can begin.
Consideration for Ongoing Care
Seeing as the patient has been diagnosed with both kidney disease and type 2 diabetes mellitus, eating a balanced diet is essential and may help slow the progression of both diseases. Sinopoli et al. (2020, p. e175) suggest that “the patient-related factors are modifiable through culturally appropriate, tailored patient education and treatment strategies.” Most of the energy in the patient’s body should come from carbohydrates and fats; however, she should remember that saturated fat and cholesterol should be kept to a minimum. Zaccagnini and Pechacek (2021) explain that “the person is a behavioral system existing within an environment of multiple components” (p. 17). An individualized meal plan will be designed based on the patient’s medical history and specific limitations. A dietary plan will address specifically patient’s needs regarding their diet to ensure the best outcomes, and the education will help the patient understand the need to adhere to the diet. Kalantar-Zadeh and Foque (2017) also add that dietary interventions may also help in managing uremia in order to delay or avoid the need for dialysis in the future. As both diseases progress, further dietary adjustments may become necessary.
Expected Outcome
Seeing as the patient is currently in the terminal stage of kidney disease, the main target of her treatment and transition to peritoneal dialysis is to make the last months of her life as comfortable and painless as possible. She cannot be expected to recover as she had already experienced kidney failure, and her age is too advanced for remission. Moreover, the comorbidity in the form of diabetes mellitus further complicates her overall condition. Thus, the expected and desired outcome both for her and her clinician would be a peaceful death at home, with the patient’s life prolonged as much as possible without making her suffer.
Future Care Consideration
There is various evidence of the fact that patients with end stage renal diseases experience severe mental problems associated with them. A study concluded by Kao et al. (2020) assessed psychological problems associated with unplanned dialysis and their impact on patients’ quality of life. According to Kao et al. (2020, p. 255), “the causes for sleep disturbance in CKD patients include depression, anxiety, uremic toxins, and adverse effects of drugs, as well as, potentially, the use of dialysis therapy.” The conducted research evaluated specifically the dialysis therapy’s influence on the psychological disturbances through questionnaires and scientific analysis. It was advised that a multidisciplinary care program might help relieve the symptoms of anxiety and depression, as well as help the patient and her family come to terms with her future demise.
Conclusion
Recent studies in the field of the pathogenesis of chronic renal failure show that there is a wide multitude of factors influencing the outcomes of the treatment. Among them, peritoneal dialysis remains one of the most discussed techniques due to the higher dependence of success on external factors, such as catheter type choice. Still, the improvements of approaches to kidney disease complications and concomitant pathologies treatment, as well as intensive development of dialysis technologies, open up wide prospects for optimizing long-term treatment results of patients with CKD. Overall, it is clear that peritoneal dialysis remains a more desired treatment measure for patients, as it allows them to be cared for at home.
Reference List
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