Tag: peritoneal (Page 37 of 47)

Recently (June 17-18, 2023. P. A5), The Wall Street Journal ran a piece by Betsy McKay titled “Testosterone Therapy Shown Not to Increase Heart Risks.” At first blush, this does not appear to have much impact on those of us on Dialysis. But wait. The fifth paragraph states, “While the study found no risk of major cardiovascular events such as heart attacks, researchers did report a few cases of pulmonary embolism, or a blood clot affecting the lungs; atrial fibrillation, a heart-rhythm disorder; acute kidney injury; and small blood pressure increases among men who received testosterone treatment. (Emphasis provided.)

I am and have been for years on Testosterone Therapy and the “acute kidney injury” got my attention. What is this all about?

McKay’s article cited the study upon which her article was based as being published in the New England Journal of Medicine. It was based on a new clinical trial of about 5,200 men funded by AbbVie et al. With the information, I did a Google, found, and created the original report in searchable PDF format. I then searched for the word “kidney.” This is where things get interesting!

Buried in the body of the report is the following statement: “There were more cases of nonfatal arrhythmias warranting intervention, atrial fibrillation, and acute kidney injury among patients who received testosterone than among those who received placebo; these adverse events were not expected.“ (Again, emphasis provided.) And this is pretty much where it was left for this study – EXCEPT.

Refer to Figure 3 at the end, a screen capture from the report. To impart a little more understanding to what is shown, a little about “p” values in statistics is merited. In this study, it was assumed that there are no differences between the two groups of men, ie, those taking testosterone and those who do not. This is called a null hypothesis in statistical testing. The “p” value, or probability value, describes how likely the data support the null hypothesis, in this case, no difference between the groups. A “p” value of 0.05 or less is generally accepted as a strong indicator that, in this case, THERE IS A DIFFERENCE. 1-p is the inverse, that is, there is a difference rather than there is not. For acute kidney injury, 1-p=1-.04=96% probability that there is a difference in the groups. In layman’s terms, we can be 96% certain that the administration of testosterone therapy adversely affected those from a kidney perspective who took it compared to those who did not.

Like analysis holds true for Atrial Fibrillation, only even stronger, that is, the probability is 98% that those who were on testosterone therapy were adversely affected in this regard compared to those who were not on the therapy.

To me, these are stupendous findings. I recognize that the researchers were investigating therapy as related to cardio aspects, but to state “these adverse events were not expected” is a vast understatement and a disservice. You can see from the table below that 60 men on therapy suffered acute kidney injury compared to 40 not on therapy who did not. Let’s put this into perspective! Full 50% more men on therapy suffered acute kidney injury compared to the 40 men in the control group. That’s right, half again as many. Have your attention yet?

I didn’t stop here. I turned to my faithful AI subscription and asked, “What is the tie, if any, between testosterone-replacement therapy and acute kidney injury?”

The AI summarized findings thusly: “However, the evidence in humans is limited and somewhat mixed. Some observational studies have found higher testosterone associated with lower mortality in CKD patients and higher estimated glomerular filtration rate (eGFR), a measure of kidney function. However, a clinical case report showed testosterone therapy induced renal impairment, and a small randomized controlled trial in 48 men showed that 6-month testosterone treatment lowered eGFR. The lack of large-scale randomized controlled trials makes it difficult to assess the long-term effect of testosterone on CKD definitively​.”

So, I’m sitting here thinking, Oh crap, or stronger words, what’s next to crawl out from the woodwork?

On the Fresenius-sponsored PatientHub app, the moderator posted the following question: “What is the biggest hurdle you’ve overcome while on home dialysis?” Over a four-year period, there were 63 responses to the question. I thought it would be nice to summarize for readers of this blog what actual patients on PD reported. Thus, this blog entry.

In statistics, there is a methodology named “content analysis.”
Content analysis is a statistical methodology used to analyze text data by categorizing or coding the content into various groups. The process involves identifying specific words, themes, characters, or concepts within the text and quantifying their frequency or pattern of occurrence. This objective, systematic, and quantitative description of the manifest content of communication allows for inferences to be made about the messages within the texts, the sender(s), the audience, or the culture and time of its creation. The methodology can be applied to a broad array of texts, such as speeches, interviews, articles, social media posts, and more, allowing researchers to draw empirical insights from qualitative data.

Methodology: I cut and pasted all of the responses into a Word document. I then copied this Word document and pasted it into my ChatGPT4 bot and instructed it to run a content analysis on the input and provide a summary output. This output is next:

The content analysis of the provided text reveals several themes and challenges faced by individuals undergoing peritoneal dialysis (PD) treatment. The identified themes include:

1. Diet: Many individuals mention the challenge of managing their diet, particularly in relation to phosphorus intake. The love for certain foods like cheese can make it difficult to adhere to dietary restrictions.
2. Sleep and discomfort: Sleep-related issues are a common hurdle. People mention difficulty sleeping due to the noise and light from the cycler machine. Staying still during sleep can also be a challenge, leading to concerns about inadvertently causing complications such as infiltrating venous needles.
3. Storage and space management: The storage and organization of supplies can pose logistical challenges, especially for individuals with limited space. The large quantity of supplies delivered can be overwhelming and may require dedicated storage areas.
4. Infection and complications: Infections, graft ruptures, and other complications are mentioned as significant hurdles in the PD treatment process. These complications can lead to additional interventions, changes in treatment modalities, and emotional distress.
5. Weight management: Weight gain or loss can be challenging for individuals on PD. Balancing nutritional needs, limited dietary options, and the effects of dialysis on metabolism can make weight management difficult.
6. Emotional and psychological impact: Various emotional and psychological challenges are discussed, including guilt, shame, body image concerns, frustration, and anxiety. People share their experiences of feeling like a burden, dealing with insecurities, and navigating changes in relationships and sexuality.
7. System and healthcare provider challenges: Some individuals express frustration with the supply chain, pharmacy services, and healthcare providers. Issues with ordering, lack of communication, and perceived indifference from healthcare teams are mentioned as challenges that could be addressed to improve the overall experience of PD treatment.
8. Time management and routine: Establishing and maintaining a routine that accommodates treatment, work, appointments, and other responsibilities is highlighted as an anxiety-inducing task. The need to calculate preparation time, dialysis time, and other factors adds to the complexity.
9. Fatigue: Several individuals mention feeling tired or experiencing a lack of energy, which can be a persistent challenge in managing daily activities alongside PD treatment.

This content analysis provides insight into the lived experiences of individuals undergoing PD treatment, shedding light on the diverse challenges they face and the strategies they employ to overcome them.

Age, as we traditionally understand it, is a numerical construct, straightforward and unchanging. However, the concept of age is multi-dimensional, encompassing not just chronological age (the number of years a person has lived), but also perceived or subjective age (how old a person feels). Research has shown that there can be a significant discrepancy between a person’s chronological and subjective age, a phenomenon known as subjective age bias.

Subjective age bias is the discrepancy between one’s chronological age and how old one feels. This bias can manifest in two ways: individuals may feel younger or older than their chronological age. While feeling younger may seem like a positive bias, both directions of bias can have implications for health and well-being. For instance, those who feel significantly younger may engage in behaviors that are more suitable for younger individuals, which could potentially harm their health. On the other hand, feeling significantly older could lead to reduced motivation, social engagement, or physical activity.

This concept has important implications in the healthcare setting. Subjective age bias can significantly impact health outcomes, patient compliance, and overall quality of life. One specific area where the subjective age bias is particularly relevant is in patients undergoing peritoneal dialysis for end-stage renal disease.

Peritoneal dialysis (PD) is a treatment for patients with severe chronic kidney disease. The process involves using the patient’s peritoneum in the abdomen as a membrane across which fluids and substances are exchanged from the blood. It requires rigorous self-care practices and adherence to a strict schedule, making it a demanding therapy that can significantly impact a patient’s lifestyle.

Subjective age can influence how these patients perceive their ability to manage their disease and their treatment. For instance, patients who feel younger may be more optimistic and motivated to adhere to the strict routine required by PD. They may view the disease as a temporary setback and remain hopeful about their recovery. This can lead to better compliance with treatment regimens, less psychological distress, and ultimately better health outcomes.

Conversely, PD patients who feel older than their chronological age may feel overwhelmed by their disease and the demands of their treatment. They may perceive the disease as an inevitable part of aging and have less hope for their recovery. This can lead to poorer compliance, increased psychological distress, and worse health outcomes.

However, it’s important to note that these are general trends, and individual experiences can vary widely. Healthcare providers should be aware of the subjective age bias and consider their patient’s subjective age when planning and providing care. For example, motivational interviewing and psychological support could be particularly beneficial for PD patients who feel older than their chronological age. On the other hand, patients who feel younger might benefit from education about the importance of adhering to treatment regimens, despite feeling healthier or more capable than their chronological age would suggest.

In conclusion, subjective age bias is a significant factor that can influence the health and well-being of patients on peritoneal dialysis. By understanding this bias and its implications, healthcare providers can provide more personalized and effective patient care. The psychological aspects of age perception are just as important as the physical realities of aging, and they should be considered an integral part of holistic healthcare.

How do we measure where a person lies along the subjective age bias spectrum?

Subjective age bias is typically measured through self-report questionnaires or surveys. The simplest method involves asking people to state the age they feel, often in comparison to their chronological age. For example, an individual might be asked: “Regardless of your chronological age, what age do you feel most of the time?”

Responses can range from much younger to much older than one’s chronological age, or they may coincide with chronological age if a person feels their ‘actual’ age. These responses can then be analyzed to determine if an individual has a subjective age bias and, if so, in which direction.

Another approach is to ask people to indicate how old they feel on a scale, such as from 0 (as young as possible) to 100 (as old as possible), or to rate their subjective age in relation to a series of age groups.

There are also more detailed questionnaires that consider different aspects of subjective age, such as physical health, mental health, or cognitive functioning. These surveys may ask respondents to rate their perceived age in these specific areas, which can provide a more nuanced understanding of subjective age bias.

However, it’s important to note that subjective age is a complex construct that many factors, including cultural, social, and individual differences, can influence. Therefore, measuring subjective age bias is not an exact science, and the results should be interpreted with this in mind.

It’s also worth noting that subjective age and its biases can change over time, influenced by factors such as health status, life events, or changes in self-perception. Therefore, it can be beneficial to measure subjective age at multiple time points to track these changes and provide a more comprehensive picture of an individual’s subjective age bias.

The above post was seeded by an article in psypost.org on June 7, 2023, by Eric W. Dolan from Social Psychology titled “Subjective age bias Psychologists uncover a fascinating historical trend.” The article’s lead paragraph states, “Do you feel younger than your chronological age? You are not alone. Research has shown that most middle-aged and older adults feel younger than they actually are, and this phenomenon has been labeled subjective age bias. Interestingly, new research provides evidence that this effect is increasing over time. Individuals from more recent birth cohorts tend to exhibit a greater subjective age bias compared to those from earlier cohorts.”

Attribution: I was assisted in this blog post by the referenced article, ChatGPT4, Bing Illustrator for the lead graphic, Grammarly to clean up my typos, and me for the remainder. Any errors are human; any insights are divine.

Peritoneal dialysis (PD) is a life-sustaining treatment for patients with end-stage renal disease. It requires a significant level of patient involvement and self-care, making it a unique medical treatment that places a considerable amount of responsibility on the patient. One psychological concept that plays a crucial role in the successful management of PD is self-efficacy.

Self-efficacy, a term coined by psychologist Albert Bandura, refers to an individual’s belief in their ability to succeed in specific situations or accomplish a task. It’s about having confidence in the ability to exert control over one’s own motivation, behavior, and social environment. In the context of PD, self-efficacy can significantly influence a patient’s ability to manage their treatment effectively.

Patients with high self-efficacy tend to believe they can influence their health outcomes positively through their actions. They are more likely to feel confident in their ability to perform the necessary tasks associated with PD, such as maintaining sterility during exchanges, recognizing signs of infection, and managing their diet and fluid intake. This confidence can lead to better adherence to their dialysis regimen, resulting in improved health outcomes.

Moreover, self-efficacy can also influence how patients cope with the psychological challenges associated with PD. Living with a chronic illness can be emotionally taxing, leading to feelings of stress, anxiety, and depression. However, patients with high self-efficacy are often more resilient. They believe in their ability to overcome challenges and are more likely to use effective coping strategies, contributing to better mental health and overall quality of life.

So, how can we foster self-efficacy in PD patients?

1. Education: Providing comprehensive education about PD can help patients understand their treatment better and feel more confident in their ability to manage it. This includes teaching them about the mechanics of PD, potential complications, and how to respond to them.
2. Skills Training: Practical training in the tasks required for PD, such as performing exchanges and monitoring for signs of infection, can enhance patients’ confidence in their abilities.
3. Positive Feedback: Encouragement and positive feedback from healthcare providers can reinforce patients’ belief in their abilities. Celebrating small victories and progress can boost their confidence.
4. Peer Support: Connecting with other PD patients can provide a sense of community and shared understanding. Hearing about others’ experiences and successes can inspire confidence and motivation.
5. Goal Setting: Setting and achieving small, manageable goals can build self-efficacy over time. As patients see themselves successfully managing their PD, their confidence in their ability to do so will grow.

In conclusion, self-efficacy is a powerful psychological tool that can significantly impact the success of peritoneal dialysis treatment. By understanding and fostering self-efficacy, we can support PD patients in managing their treatment effectively, leading to better health outcomes and improved quality of life.

Of interest is how we go about ascertaining the degree of self-efficacy a person has and/or displays.

Self-efficacy is typically measured using self-report questionnaires. These questionnaires ask individuals to rate their confidence in their ability to perform specific tasks or behaviors. Here are some methodologies commonly used to measure self-efficacy:

1. General Self-Efficacy Scale (GSES): This is a 10-item scale designed to assess a person’s belief in their ability to handle a variety of difficult demands in life. Each item is rated on a 4-point scale.
2. Self-Efficacy for Managing Chronic Disease 6-Item Scale: This scale is specifically designed to assess self-efficacy in individuals with chronic diseases. It asks individuals to rate their confidence in doing certain activities, such as managing symptoms, following a treatment plan, and dealing with the emotional challenges of chronic disease.
3. Perceived Health Competence Scale (PHCS): This 8-item scale measures individuals’ beliefs in their ability to effectively manage their health outcomes.
4. Bandura’s Guide for Constructing Self-Efficacy Scales: Albert Bandura, the psychologist who first introduced the concept of self-efficacy, has provided guidelines for constructing self-efficacy scales. These guidelines suggest that self-efficacy scales should be tailored to the specific domain being assessed. For example, a self-efficacy scale for peritoneal dialysis might ask individuals to rate their confidence in their ability to perform specific tasks related to their dialysis treatment.
5. Disease-Specific Self-Efficacy Scales: There are also many disease-specific self-efficacy scales, such as the Arthritis Self-Efficacy Scale, the Diabetes Management Self-Efficacy Scale, and the Asthma Self-Efficacy Scale. These scales could be adapted for use with peritoneal dialysis patients.

It’s important to note that while self-report questionnaires are a common method for measuring self-efficacy, they do rely on individuals’ self-perceptions, which can be influenced by a variety of factors. Therefore, they should be used as part of a broader assessment strategy.