Summary Haemodialysis in acute renal failure differs from chronic uraemia. We describe our clinical experience comparing tolerance to dialysis and dialysis efficacy of bicarbonate haemodialysis in comparison to haemofiltration. Both provide adequate treatment for ARF, Kt/v 0.6±0.1, URR 56% in bicarbonate haemodialysis compared to Kt/v 0.4±0.06, URR 60% in haemofiltration. Clinical outcome was the same in both groups, in particular the overall survival was satisfactory at about 70%. These results are likely to reflect close control of these patients by nursing staff committed to haemodialysis in acute renal failure.
We describe our clinical experience of monitoring residual renal function of patients on regular dialysis treatment as residual renal function can play an important role in the management of patients undergoing regular dialysis. With active residual renal function it is possible to delay the start of haemodialytic programmes. In managing dialysis treatments, it is important to maintain residual renal function by preventing hypotensive events. It is known that in acute renal failure intradialytic hypotension is able to reduce the recovery of renal function. Out patient follow-up plays an important role for these patients. This paper will also discuss the use of biocompatible membranes during dialysis. The outcome is that they are not associated with better maintenance of residual renal function.
Kt/v is used to estimate haemodialysis prescription and treatment adequacy and usually does not include evaluation of urea rebound. In addition urea clearance provided by the presence of residual renal function (RRF) is additive to dialytic urea clearance. Rebound is a phenomenon involving other molecules such as creatinine and phosphorus. The aim of this study was to investigate the role of RRF on post dialysis urea, creatinine and phosphorus rebounds. We investigated 7 patients with RRF (group 1) and 7 uraemic anuric patients (group 2). Urea rebound was lower in group 1 than group 2: 9.5 +/- 4% vs 18 +/- 7% (p = 0.04). Creatinine rebound and phosphorus rebound were similar in both groups 15.2 +/- 9% group 1 vs 14.6 +/- 5% group 2 (p = NS) and 16.7 +/- 7% group 1 vs 20 +/- 7% group 2 (p = NS) respectively. Our data suggest Kt/v calculated without considering rebound overestimates haemodialysis efficacy.
- This paper studies basic need satisfaction of competence, autonomy and relatedness (Deci & Ryan, 2000) and professional values in 232 subjects from the 102 Viterbo local health facility (ASL): 110 nursing students, 102 nurses and 20 nurses executives, assuming both the existence of relationships between need satisfaction and values and the career level had a significant effect on satisfaction and motivations. For this purpose the Basic Psychological Needs Scale (ad. It. Szadejko, 2003) and the Value Based Motivation Assessment Scale (Pallini and Laghi, in press) have been used. Prosociality and security resulted predominant, while competitiveness, autonomy and hedonism were scarcely represented. The growing professionalism of nurses would explain the evaluation of epistemic interest. In a statistically significant way nursing students value safety, belonging, cooperation and prosociality, nurses and nurse executives novelties and nurse executives competition. Student nurses perceive themselves as more satisfied in their psychological needs. Basic need satisfaction resulted to be closely linked with value of prosociality, cooperation and belonging.
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