Catherine Firanek - Academia.edu (original) (raw)

Papers by Catherine Firanek

Kidney International, Jun 1, 1996

Nephrology Nursing Journal, 2001

PubMed, Aug 10, 2016

Home dialysis offers many advantages over in-center dialysis, but peritoneal dialysis and home he... more Home dialysis offers many advantages over in-center dialysis, but peritoneal dialysis and home hemodialysis are infrequently used. To better understand why, a survey of dialysis healthcare professionals (N = 273) in the United States was conducted to assess their knowledge, perceptions, and beliefs about home dialysis modalities. Most survey respondents demonstrated a lack of knowledge about home dialysis and perceived many barriers to home therapy, which may affect patient modality choice; however, 90% of respondents stated they would choose home dialysis for themselves if they required dialysis. Additional staff education may help reduce misperceptions, address knowledge gaps, and subsequently, increase use of home modalities.

Nephrology Dialysis Transplantation, May 1, 2018

METHODS: VR gains more and more in importance concerning the medical area. So far it is used rudi... more METHODS: VR gains more and more in importance concerning the medical area. So far it is used rudimentary for training programs mainly in endoscopic and surgery topics. We developed a program in Virtual Reality to train nurses and patients each step they need for the execution of peritoneal dialysis. RESULTS: VR allows the user to feel and act like being in a different room: he puts special glasses on and then he can look around in 360 , walk, move and interact in and with his virtual environment. Thus it is a perfect technology for educational purposes. He can virtually train different procedures he needs to do peritoneal dialysis later. Several studies showed us that the learning effect is far higher when you do things rather than only read, watch or listen to them. In VR you can combine all these different methods. In our program the nurses or patients experience the whole PD-process, get instructions and guidance and can even learn from making mistakes. They can run through the program-completely or in parts-as often as it is necessary to internalize every single step. In addition to this data from the user can be generated e.g. to improve the learning effect or to document if the training has been successfully completed. CONCLUSIONS: VR-training programs are a long-desired solution for improving the quality of the execution of peritoneal dialysis and for reducing PD-related infections drastically. They give us the possibility to standardize learning processes first for the trainers and following for the patients. Patients can learn each step in their own tempo and repeat them separately as often they need to. Mistakes can be discovered, documented and stored in everyones personal digital file. Trainers can also have a look in it. We believe, that these programs will not only reduce peritonitis rates but also make the variation between the peritonitis rates in a single country smaller.

Peritoneal Dialysis International, Jun 1, 1997

American Journal of Kidney Diseases, Jul 1, 1995

We have previously found that race, level of education, and peritoneal dialysis system are factor... more We have previously found that race, level of education, and peritoneal dialysis system are factors that significantly and independently influence peritonitis rates in our patient population. We now extend these observations by assessing the pathogens responsible for peritonitis in these subgroups. Between January l,lQ81, and May 15,lQQ3,248 peritoneal dialysis patients underwent dialysis at our facilii. The rate of peritonitis by pathogen was determined in these patients using the fixed effects Poisson model. Total peritonitis rates in black patients (1.89 episodes/patient-year) were significantly greater compared with white patiints (1.11 episodes/patient-yeac P < 0.0001). Increased infection rates in black patients were significant for Sfaphy/ococcus epidennidis, Staphylococcus aufeus, and gram-negative pathogens. The level of education had a negative correlation with peritonitis rates (58 years, 2.00 episodes/patient-year; 9 to 12 years, 1.84 episodes/patient-year, and 213 years, 1.24 episodes/patient-year) with patients having 213 years of education at the start of dialysis demonstrating a significantly lower total peritonitis rate compared with patients with 9 to 12 years (P = 0.001) or 58 years (P < 0.001) of education. This was accounted for by a significant decrease in infection rates for S epidemidis, polymicrobial, and gram-negative organisms. Finally, patients on automated peritoneal dialysis had significantly lower total peritonitis rates (0.59 episodes/patient-year) compared with patients on either a connect (2.11 episodes/patientyear) or disconnect (1.48 episodes/patient-year) system. A significant decrease in infection rates for evety category of pathogen except fungal infections was found in patients on automated peritoneal dialysis in comparison to the other two systems. Overall, significant differences in S epidemidis infection rates was the single most important factor accounting for the differences in peritonitis rates observed between the various subgroups of patients evalwted. This is best demonstrated in the evaluation of the peritoneal dialysis systems in which S epidemidis infection rates were only 0.20 episodes/patient-year for automated peritoneal dialysis and 0.88 episodes/patientyear for the disconnect system compared with 0.88 episodes/patient-year for the connect system. Since S epidermidis infections generally are atbibuted to touch contamination, identifying patients at greatest risk allows the potential for intervention with closer supervision, adjustments in the peritoneal dialysis training/education approach, or a change in the peritoneal dialysis system.

Peritoneal Dialysis International, Sep 1, 1999

To determine if the previously described peritoneal equilibration test (PET)-determined solute tr... more To determine if the previously described peritoneal equilibration test (PET)-determined solute transport groups, as defined by Twardowski, fit our patient population. ♦ ♦ ♦ ♦ ♦ Design: We reviewed the 195 initial standardized PETs (on 195 patients) performed through our peritoneal dialysis program since 1989. Using the method originally defined by Twardowski using the means and standard deviations of the PET-determined dialysis/plasma ratio (D/P) of creatinine and dialysate-to-0 hour dialysate (D/D 0) glucose values, transport groupings for our patient population were determined. Comparisons were then made between patient populations. ♦ ♦ ♦ ♦ ♦ Results: The mean 4-hour D/P creatinine in our patients was 0.70 ± 0.10. This compares to a mean of 0.65 ± 0.15 as determined by Twardowski, and indicates that our patients have higher mean solute transport characteristics and tighter ranges within transport groups than previously reported. Only 2% of our patients fell into the previously described low (L) range, with 30% low average (LA), 51% high average (HA), and 17% high (H). Using our data, we would redefine the groups by a 4-hour D/P creatinine as L < 0.60, LA = 0.60-0.70, HA = 0.70-0.80, and HA > 0.80. Using these values, our population fits a Gaussian distribution with 17% L, 31% LA, 33% HA, and 19% H. ♦ ♦ ♦ ♦ ♦ Conclusion: Our patients have higher mean solute transport and tighter ranges within transport groups than previously reported. Using the previously defined PETdetermined transport groupings, low transporters are particularly underestimated. If our population data are representative of the peritoneal dialysis population as a whole, these ranges should be redefined.

Peritoneal Dialysis International, Jul 1, 2011

Peritonitis remains one of the most serious complications of peritoneal dialysis (PD) and a signi... more Peritonitis remains one of the most serious complications of peritoneal dialysis (PD) and a significant cause of transfer from the therapy. In peritonitis, analyses suggest that approximately 42% of episodes involve Staphylococcus species, organisms associated ...

American Journal of Kidney Diseases, Jul 1, 1991

American Journal of Kidney Diseases, Oct 1, 1993

Low molecular weight advanced glycosylation end products (AGEs) were evaluated for by an enzyme-l... more Low molecular weight advanced glycosylation end products (AGEs) were evaluated for by an enzyme-linked immunosorbent assay in 30 patients on continuous ambulatory peritoneal dialysis (29 patients) and continuous cyclic peritoneal dialysis (one patient). Thirteen patients were diabetic and 17 patients were nondiabetic. All patients underwent peritoneal equilibration tests and, in addition to routine chemistries, serum and dialysate were evaluated for AGEs. Serum creatinine levels were similar in the diabetic and nondiabetic patients, but serum AGE levels were significantly higher in the diabetic patients (16.2 +/- 5.3 v 8.2 +/- 2.3 U/mL; P < 0.0001). Overall, the dialysate to plasma ratio at 4 hours was 0.69 +/- 0.08 for creatinine and 0.18 +/- 0.06 for AGEs. The mass transfer area coefficient for all patients was 12.4 +/- 3.12 mL/min for creatinine and 2.03 +/- 0.93 mL/min for AGEs. The peritoneal transport of AGEs as measured by dialysate to plasma ratios at 4 hours and by mass transfer area coefficients was significantly less (P < 0.001) than that for creatinine. No significant difference in dialysate to plasma ratios or mass transfer area coefficient for creatinine or AGEs was noted between diabetic and nondiabetic patients. The peritoneal transport of AGEs is poor and leads to elevated serum levels, especially in patients with diabetes mellitus. The accumulation of AGEs may contribute to the increased cardiovascular mortality seen in patients with end stage renal disease. This is most marked in patients with diabetes mellitus.

American Journal of Kidney Diseases, Nov 1, 1991

Eight stable patients, from our institution, on continuous ambulatory peritoneal dialysis (CAPD) ... more Eight stable patients, from our institution, on continuous ambulatory peritoneal dialysis (CAPD) were entered into a multicenter, randomized, double-blind, placebo-controlled study with erythropoietin (EP]. To assess the effect of hematocrit on peritoneal solute transport, we performed peritoneal equilibration tests (PET) on each patient on a quarterly basis throughout the study. Patients on EPO had a significant increase in hematocrit at 3 (32% +/- 5%), 6 (32% +/- 2%), and 9 (38% +/- 3%) months compared with baseline (22% +/- 4%). The D/P creatinine (Cr) at 4 hours was also significantly reduced in the patients on EPO at 3 (.70 +/- .1), 6 (.66 +/- .12) months when compared with baseline (.76 +/- .11). No significant change in D/Do glucose at 4 hours or in the 4-hour ultrafiltrate (except at 9 months) was found. Based on mixed-effects regression analysis, the 4-hour D/P Cr, peritoneal Cr clearance, and Cr mass transfer area coefficient significantly decreased as hematocrit levels increased. The 4-hour D/Do glucose and the 4-hour ultrafiltrate both demonstrated a positive correlation with increasing hematocrit levels, but this did not reach statistical significance. Although larger studies are needed, it appears that increasing hematocrit levels may negatively affect peritoneal solute transport in CAPD patients as determined by PET.

Peritoneal Dialysis International, 2003

Systematic Reviews, Jan 30, 2019

Background: Previous meta-analyses have found several advantages of icodextrin compared with gluc... more Background: Previous meta-analyses have found several advantages of icodextrin compared with glucose in the application of peritoneal dialysis (PD), such as an improvement of peritoneal ultrafiltration during the long dwell and a reduction in episodes of uncontrolled fluid overload. However, the effect of icodextrin on patient-relevant outcomes remains unclear. This review aims to evaluate the benefits and harms of icodextrin in comparison with conventional glucose PD solution in patients with end-stage kidney disease receiving PD. Methods: Randomized controlled trials of icodextrin comparing with conventional glucose solution in patients with end-stage kidney disease who received PD will be deemed eligible. We will conduct systematic searches in MEDLINE, EMBASE, CENTRAL, Ichushi-Web, Chinese and Japanese databases, and in clinical trials registries (ClinicalTrials.gov, International Clinical Trials Registry Platform Search Portal (ICTRP), EU Clinical Trials Register, Japan Registries Network (JPRN), China's Clinical Trial Registry (ChiCTR)). Furthermore, we will check conference proceedings and search references from relevant studies manually. Relevant pharmaceutical companies, authors, and experts will be contacted in an effort to identify further studies. We will not apply any limitations regarding language, publication status, and publication date when searching for eligible studies. The selection of studies, data extraction, and risk of bias assessment will be carried out by two independent reviewers. Data synthesis will be performed using RevMan 5 software with either a fixed effects model or random-effects model, depending on the presence of heterogeneity. For the assessment of statistical heterogeneity, I 2 will be calculated. Sources of clinical heterogeneity will be evaluated through subgroup analyses. If there are ten or more studies included in the metaanalysis, we will investigate the publication bias using funnel plots and Egger's test. The quality of the body of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Discussion: We assume that our systematic review will be more comprehensive compared to those published previously due to contacting the relevant pharmaceutical companies and a systematic search of published and unpublished non-English studies from China, Taiwan, and Japan. Systematic review registration: PROSPERO CRD42018096951

Clinical Journal of The American Society of Nephrology, 2009

Background: The relationship between quality of life (QofL) and anemia has been the subject of re... more Background: The relationship between quality of life (QofL) and anemia has been the subject of recent debates; it has been suggested that the QofL changes associated with the treatment of anemia of chronic kidney disease (CKD) or ESRD patients should not be used in making decisions to treat anemia in CKD patients. Design, setting, participants, & measurements: This study examines the relationship between Kidney Disease Quality of Life (KDQofL) questionnaire domains and hemoglobin (Hgb) levels in 1200 patients with stage 3, 4, and 5 CKD followed in seven centers. QofL measures were compared in a stepwise fashion for hemoglobin levels of <11, 11 to <12, 12 to <13, and >13. ANOVA was used to examine the relationship between QofL scores and Hgb level, age, CKD stage, and albumin level; a history of diabetes, congestive heart failure, or myocardial infarction; use of erythropoetic-stimulating agents (ESA); and the interaction of hemoglobin level and ESA. Results: The results demonstrate that with increasing Hgb levels there is a statistically significant increase in all four physical domains, the energy/vitality domain, and the physical composite score of the SF-36, and the general health score on the kidney disease component of the questionnaire. The most dramatic improvements in these various domains occurred between the <11 and the 11 to 12 group. Conclusions: Higher Hgb levels are associated with improved QofL domains of the KDQofL questionnaire. These findings have implications for the care of CKD patients in terms of the initiation of and the Hgb target of ESA therapy.

Nephrology nursing journal : journal of the American Nephrology Nurses' Association

In the United States, the majority of patients on peritoneal dialysis (PD) use a cycler or automa... more In the United States, the majority of patients on peritoneal dialysis (PD) use a cycler or automated peritoneal dialysis (APD). The aim of this study was the identification of common features in nurse-led APD training programs that were likely to contribute to successful home dialysis. This study collected data on nurse-led APD training programs in six high-performing PD centers. A 13-point survey, which focused on training tools, topics covered methods used, and level of support at home, was administered during group face-to-face interviews with the PD training nurses. Data were reviewed for trends between centers. Training programs in all six centers focused on essential information and skill sets to begin home dialysis using APD, with simple instructions and a hands-on approach. Every center initially trained patients on continuous ambulatory PD before APD. The clinics provided ongoing education, reinforcement, and retraining of concepts and skills through discussion, quizzes, an...