Journal of Nursing Theory and Practice

[The importance of serum albumin level in patients with chronic renal disease on maintenance dialysis]

TÓTH Csitkovicsné Tünde1, SZAKÁCS Gyuláné1, KULCSÁR Imre1,2

AUGUST 30, 2017

Journal of Nursing Theory and Practice - 2017;30(04)

[The aim of the study: Evaluation of changes in serum albumin levels and their effects on mortality in chronic haemodialyzed (HD) population. Material and Methods: We analysed the serum albumin values and survival in 253 HD patients, in a retrospective observational study. Data were analyzed using Spearman-correlation, Cox-modell, endpoint analysis and Kaplan-meier analysis. Results: We did not find any significant correlation between serum albumin levels and gender or basic diseases, but the median serum albumin level was lower in patients with ages 65 years or older than in younger ones, and had decreased until observational period (5.4±3.0 years). Lower the serum albumin level the risk of mortality was higher (if the serum albumin level was <35 g/L versus >40 g/L), the HR was 5.69. Conclusions: The serum albumin level is a main indicator of the nutrition in dialyzed patients, but the target level would be different in older and younger patients. The serious malnutrition (lower serum albumin level) increases the risk of mortality in haemodialyzed patients.]


  1. B. Braun Avitum Hungary 6. sz. Dialízisközpont, Szombathely
  2. Markusovszky Egyetemi Oktatókórház, Általános Belgyógyászati Osztály, Nephrologia



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Journal of Nursing Theory and Practice

[Workplace conflicts in health care]


[Health care requires the cooperation of many professions and often comes with stressful situations. Therefore conflicts might develop among health care providers more frequently. Moreover the staff is interdependent, which might be another source of conflicts. This phenomenon not only affects the crossing parties, but also triggers emotional changes in the individuals (anger, stress and negative emotions) and has long term consequences, too (medical malpractice, fluctuation, sick leaves, discontent patients and bad reputation of the institution). All these can have financial effects, e.g. law costs. The present publication discusses the different definitions of conflicts and explains their reasons and types. This article has a special focus on health-care team conflicts, their consequences and the possible management methods.]

Journal of Nursing Theory and Practice

[The role of a weekly geriatric exercise programme in successful aging]

KOVÁCS Éva, VIRÁG Anikó, DUDÁS Flóra, ERDŐS Réka, PETRIDISZ Anna Niké, ROZS Franciska

[Objective: The aim of this retrospective study was to examine the effects of a weekly held group multicomponent exercise programme (consisting of aerobic, strengthening, flexibiliy, and balance exercises) on the functional abilities (muscle strength, walking speed, and static balance) among elderly people. Methods: Thirty eight older people were divided into two groups: the active group for those elderly who took part is the training for at least 2 years, and the inactive group for those who did not take part in the training before. The global muscle strength in the lower extremity was measured with the 5 sit-to-tand test, the walking speed was measured with the 4 meters walking test. To examine the static balance, we used the one-leg stance test. To determine the subjective well-being, a Visual Analog Scale was used. Results: The Active group was significantly better in 5 sit-to-tand test (t(36)=2,602; p=0,013; Cohen’d=0,99), and marginally significant difference was found in the 4 meters walking test (t(36)= 1,769; p=0,085; Cohen’d=0,66) to the benefit of the Active group. In the term of static balance, we could not find significant difference. Conclusions: This programme for elderly people is effective to improve the global lower limb muscle strenght and walking speed of the elderly, but not very effective in improving static balance.]

Journal of Nursing Theory and Practice

[Report of the 5th ETNA Conference]

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VITTAY Fedineczné Katalin, PERKÓ Magdolna, SÖVÉNYI Ferencné

Journal of Nursing Theory and Practice

[How to break medical bad news? The importance of the course for breaking medical bad news and an evaluation of his curriculum]


[Breaking bad news to patients is a difficult task for health care professionals and there are many unsolved issues in this area. There are several ways of delivering bad news and the quality of the communication could affect the whole life of the patient. However the wrongly delivered bit of bad news could not only cause a crisis for the recipient but will create a stressful situation for the communicator. The course created at the University of Pécs, Faculty of Health Sciences is specified to the delivery of bad news with modern communication methods, which uses video feedback method to analyse and develop the participants’ communicational attitude, thus providing potent aid for the acquisition of the proper communicational techniques, from which both the patient and the care giver can profit.]

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[Introduction: End-stage renal disease patients under dialysis have impaired immune system and are more susceptible to infection, even those infections that can be prevented by vaccination (e.g. hepatitis B). If the antibody titer (anti-HBs) remains <10 IU/ml after two consecutive vaccinations, patients are classified as non-responders. Reasons for unsuccessful vaccinations include technical, immunological (e.g. multigene haplotypes) reasons. They are often also associated with chronic diseases. Aim of the research: To re-vaccinate patients after unsuccessful intramuscular vaccination to achieve immunity. Research and sampling methods: Intracutaneous vaccination can be a viable alternative for successful immunity. 6 months after re-immunisation, anti-HBs titer>10 IU/mL indicate a successful immune response. Results: 22 haemodialysed patients received intracutaneous hepatitis B vaccination with the total dosage of 6 μg. An anti-HBs titer elevation (21-100 IU/ml) was observed in 15 cases (68.18%). In those cases, where we failed to achieve successful immunity, we identified malignancies, immunosuppression, amyloidosis, psoriasis diabetes mellitus, or coeliac disease as a possible reason. Conclusions: The rate of successful immunisations against HBV infections can be improved by means of intracutaneous vaccination. ]

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[In chronic renal failure severe cardiovascular complications develop, which are the cause of death in 50% of the patients. According to recent results, behind the accelerated atherosclerosis, malnutrition and inflammation, developing in patients with chronic renal failure, play significant role. Malnutrition and inflammation show close relationship to the serum albumin level, which is an independent predictor of mortality. Authors studied the nutritional parameters of 94 chronically hemodialysis patients. Patients had been dialysed for more than three months, for 3×4-4.5 hours weekly. Among them 36% had diabetes. According to BMI (body mass index) 42.5% of the patients was normally nourished (20-24 kg/m2), 11.7% of them had malnutrition, 28.7% was overweight, and 17.1% was mildly or moderately obese. Subjective Global Assessment (SGA), calculated by dietician, revealed, that 47.9% of the patients has normal nutritional condition, all the others had some degree of malnutrition. Serum albumin level showed close correlation with the nutritional status, also with an inflammatory marker, the CRP. Only 63.8% of the patients had higher than 40g/l serum albumin. Those, who had higher than 10 mg/l CRP value, had significantly lower serum albumin (38.7±3.4 g/l), comparing to the albumin of the patients, whose CRP was below 10 mg/l (40.5±3.9 g/l, p=0.04). Comparing anthropometrical data, there was no significant difference between diabetic and non-diabetic patients. Grouping patients by their ages, the malnutrition, defined by SGA scores and by serum albumin level, was significantly worse in patients older than 80 years, than in the younger than 50 years old subjects, which signals increased risk of mortality of the elderly patients. A case presentation demonstrates, that malnutrition can be diagnosed at early stage by appropriate nutritional assessment, and it can be corrected by timely and satisfactory energy- and nutrient-substitution, in severe cases by specially prepared nutritional supplements, and thereby the patient’s severe cardiovascular risk can be ameliorated. The successful treatment of hemodialysis patients requires change in medical practice, and close cooperation between physicians and dieticians.]

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[The authors show the data of Hungarian dialysis statistics from 2003 to 2009. The questionnaire-based data collection was made by the Dialysis Committee of the Hungarian Society of Nephrology. The number of all patients entered in the dialysis program increased by 45.2% over six years (an average of 7.5% per year) and the number of new ones increased by 51.2% (8.5% per year). The increase in number of patients treated with haemodialysis was 39% (6.5% per year) in this period. The increase in the number of patients in the peritoneal dialysis program was extremely high: 80.6% (an average of 13.4% per year). The population incidence of new dialysed patients was 332/1 million in 2003 and 483/1 million in 2009. The population point prevalence at the end of the year was 437/1 million in 2003, but 607/1 million in 2009. The penetrance of peritoneal dialysis was 12.8% in 2009. Differences exist among the regions of Hungary in the number of patients, the penetrance of peritoneal dialysis and the prevalence of renal replacement therapies. Among patients suffering in conditions which lead to end stage renal disease the proportion of patients with diabetic or hypertensive nephropathies is increasing and the proprtion of patients with glomerular or tubulointerstitial damage is decreasing. The number (and rate) of the elderly people is growing continuously year by year. The rate of patients on waiting list for renal transplantation is decreasing (the rate was 20% in 2003, but only 10.7% in 2009). There is also a slow decrease in the number of the annual renal transplantations. The mortality rate of chronically dialysed patients shows a little increase. Five dialysis centres for paediatric patients and 58 for adults have been functioning in Hungary by the end of 2009. In average 106 patients have been treated by each Hungarian dialysis centre in contrast to the optimal of 60 persons. The number of nephrologists increased between 2003 and 2007, but slightly decreased since then. The case is similar regarding nephrological nurses.]