Langzeitüberleben bei chronischer Niereninsuffizienz

Comparison of Open and Robot-Assisted Kidney Transplantation in terms of Perioperative and Postoperative Outcomes

Background

The gold standard treatment method for end-stage renal disease (ESRD) is renal transplantation (RT). RT can be done with open or minimally invasive surgical methods. We aimed to compare the outcomes between patients who underwent robot-assisted renal transplantation (RART) and open renal transplantation (ORT).

Methods

Data of the patients who underwent ORT or RART in two institutions between June 2015 and February 2020 were retrospectively reviewed. Patients who underwent live donor RT were included, and all donor nephrectomy procedures were performed by the laparoscopic technique. Demographic data, ischemia times, anastomosis times, operation times, and postoperative complications were recorded.

Results

98 patients were included in the ORT group, while 91 patients were included in the RART group. There was a significant difference between the two groups regarding mean patient age. While total ischemia time was 86.9 ± 7 minutes in the RART group, it was calculated as 71.2 ± 3.3 minutes in the ORT group, with a significant difference. The anastomosis time was significantly shorter in the ORT group than in the RART group. The incision length and duration of hospital stay were significantly shorter, visual analogue scores were significantly lower, and estimated blood loss was less in the RART group than in the ORT group.

Conclusion

Both ORT and RART are effective and safe methods for treating ESRD. According to our study, RART is associated with relatively longer ischemia times but lower complication rates and higher patient comfort.

Can robot-assisted kidney transplantation provide higher quality of life than open kidney transplantation during the early postoperative period?

PURPOSE

Purpose of this study is to investigate the quality of life (QoL) in patients with end-stage renal disease who underwent open or robot-assisted kidney transplantation (OKT and RAKT).

MATERIALS AND METHODS

Patients who underwent OKT and RAKT at Bakirkoy Sadi Konuk Training and Research Hospital between June 2016 and December 2018 constituted the target population of this study. The patient group was divided into two groups as per the surgical technique (ie, open vs. robot-assisted). Demographic data, preoperative and postoperative data of all patients were collected prospectively. The QoL of the patients was assessed preoperatively and on the postoperative 30th day.

RESULTS

Sixty-seven patients who underwent OKT and 60 patients who underwent RAKT were included. The mean patient age and BMI were calculated as 40.9 ± 11.6 years and 24.4 ± 2.9 kg/m² , respectively. Patients in the RAKT group were significantly younger than the patients in the OKT group (P = .002). There were no significant differences between the two groups in terms of gender, BMI, ASA and the ratio of premptive patients. The mean preoperative hemoglobin level was significantly higher in the OKT group than the RAKT group (P = .003). While mean total ischemia time was shorter in the "open" group, intraoperative blood loss and incision length were shorter in the RAKT group. Duration of surgical drainage and hospital stay was shorter in the "robot-assisted" group. There was no significant difference between the groups in terms of SF-36 subparameters preoperatively. The physical component scores of the QoL questionnaire revealed that postoperative impairment of quality of life in the early postoperative period was more significant in the OKT than the RAKT.

CONCLUSION

Patients who underwent RAKT have a higher QoL than the patients who were treated with OKT as per their self-reported QoL scores in the early postoperative period.

[Development of methods to evaluate nephrological screening and support measures, and lessons learned from the Styrian nephrological screening program "niere.schützen"]

Throughout the world, the incidence and prevalence of patients with chronic kidney disease have been steadily rising. In 2016, the Styrian nephrology awareness program "niere.schützen" ("Kidney Protection") was launched to early identify patients with renal insufficiency. The aim of this study was to search for existing international nephrological screening and support programs in order to identify possible evaluation parameters and concepts for niere.schützen. A search in MEDLINE® revealed five relevant international programs from four countries. These differed from one another with respect to the population to be screened, the screening method and the support measures. All the programs involved the transparent documentation of patient data, and allowed for disease monitoring, as well as the impact of specific measures on assessed parameters and variables (laboratory data, participation rates) to be determined. Depending on the data sources employed and the availability and comprehensiveness of additional documentation, three evaluation methods of different informative value were developed. The first method requires no participant labelling, while the second and third methods require the participants to be assigned to a particular program. With the third method, the documentation also needs to be conducted in line with a disease management program. Considering that the speedy implementation of the niere.schützen program is desired for political reasons, the only practical method is the first one as it does not entail patient documentation and only involves the evaluation of process parameters.

Psychological stress and strain on employees in dialysis facilities: a cross-sectional study with the Copenhagen Psychosocial Questionnaire

Background

Work in dialysis facilities involves long term contact with chronically ill patients. International comparisons make it clear that dialysis work is being concentrated, staff is being reduced and more patients are being treated. It is more than 20 years since the last German publication on job strains and job satisfaction experienced by dialysis staff was published. The present study examines the stress and strain currently experienced by the staff of German dialysis facilities.

Methods

The staff of 20 dialysis facilities were surveyed with the Copenhagen Psychosocial Questionnaire (COPSOQ). The questionnaire was extended by adding dialysis-specific questions. The data from the dialysis facilities were assessed by comparison with other professions in medical care - nurses and geriatric nurses - using data recorded in the German COPSOQ database.

Results

A total of 367 employees took part in the study, corresponding to a response rate of 55%. For almost all psychosocial aspects, the dialysis staff regarded the stress and strain as being more critical than did the geriatric nurses. There were some positive differences in comparison to hospital nursing, including less conflict between work and private life. However, there were also negative differences, such as fewer possibilities of influencing the work.

Conclusions

The results of the study show that dialysis work exhibits both positive and negative aspects in comparison with other healthcare professions. The results in the different facilities were highly variable, indicating that the deficits found in the individual scales are not inevitable consequences of working in dialysis in general, but are influenced and might be favourably altered by the individual facilities.