ess of breath, bone pain, acute arthritis, swelling, delayed water excretion, and inflammation of the pericardium. Neurologic signs can also be present; these may include irritability, inability to concentrate, confusion, muscle twitching, muscle cramping, and coma. Finally, renal failure may cause hormonal abnormalities. These can alter reproductive system functioning, and may be responsible for amenorrhea, loss of libido, and impotence (Cattran, 1983, p. 229).
For the most part, renal patient care involves many different choices. The primary treatment modalities include kidney transplantation, hemodialysis, and peritoneal dialysis. These different options offer various prognoses (Kutner, 1994, p. 321). Investigators have observed that the survival rates for hemodialysis and peritoneal dialysis are similar. In addition, researchers have compared the outcomes for hemodialysis and transplantation. One recent study found that the relative risk for mortality was initially greater for transplant patients. However, about 325 days after surgery, transplant recipient mortality decreased relative to that for hemodialysis patients (Johnson, Richie, & Niblack, 1983, pp. 302-303).
Each therapeutic modality also consists of specific technical and interpersonal components. In transplantation, for example, numerous factors appear to be associated with graft survival. Hence, transplant mortality and survival rates tend to vary. At one transplant center, high risk patients (i.e., older patients, or those with diabetes, etc.) who received a cadaveric transplant had a 1-year functional graft survival of approximately 52%; for low risk patients, graft survival was about 71% (Johnson et al., 1983, pp. 302-303). However, recipients of grafts from living-related donors (LRD) generally have a more successful outcome: 2-year patient survival rates of 90% have been reported. Moreover, when patients with insulin-dependent diabetes are fact...