É sabido que o paciente com doença renal crônica que tem um acompanhamento nefrológico precoce apresenta melhores condições clínicas e melhor prognóstico ao entrar em diálise. Porém o acompanhamento precoce pelo nefrologista melhora também o enfrentamento psíquico da doença e do tratamento? Foram estudados 39 pacientes com insuficiência renal estágio 5 no momento em que entravam em hemodiálise: 19 pacientes com acompanhamento por nefrologista 6 meses (Grupo 1) e 20 pacientes sem qualquer acompanhamento nefrológico prévio (Grupo 2). Todos os pacientes participaram de entrevista semiestruturada, composta por 17 questões abordando informações, crenças, expectativas e fantasias relacionadas à doença e ao tratamento. As respostas foram decompostas em categorias através da técnica da Análise de Conteúdo. Os dados demográficos e laboratoriais também foram coletados. A classe socioeconômica foi avaliada e classificada como baixa, média ou alta. Na análise estatística foram utilizados o teste de Fisher, do Quiquadrado, t de Student ou de Wilcoxon como apropriado e os resultados apresentados como média ± DP. O grupo 1 foi seguido por 26 ± 20 meses. Em ambos os grupos a maioria dos pacientes pertencia à classe baixa e era do sexo masculino. Os pacientes do grupo 2 eram mais jovens e apresentavam piores parâmetros laboratoriais (p <0,05). Também os aspectos psicológicos foram semelhantes nos 2 grupos: 63% dos pacientes do grupo 1 e 55% do grupo 2, disseram que tinham informações anteriores sobre a diálise; 42% no grupo 1 e 40% no grupo 2, disseram pouco entender o que o médico falava; 74% no grupo 1 e 85% no grupo 2 acreditam que seus rins voltariam a funcionar. Em ambos os grupos, 25% tinham expectativas ruins sobre voltar a trabalhar, e 60% sentiam atitudes negativas da família. O acompanhamento com o nefrologista minimiza as complicações clínicas e laboratoriais dos pacientes com insuficiência renal estágio 5, porém não é suficiente para minorar o impacto psicológico da entrada em hemodiálise. A atenção do nefrologista deve ir além dos aspectos clínicos. É necessário que o paciente seja adequadamente informado sobre sua doença e tratamento. Principalmente os pertencentes a uma classe social baixa como os estudados o apoio de uma equipe interdisciplinar pode ser de grande valia. / It is well known that patients with chronic renal failure (CRF) who are early on referred to a nephrologist have less clinical complications of the disease and a better outcome on chronic dialysis. But can early referral also improve the psychological burden of starting chronic dialysis? Thirty-nine ESRD patients initiating dialysis were studied: 19 patients had a Nephrology followup 6 months and 20 patients had no referral to nephrologist, starting dialysis on emergency situation. All patients participated in a semi-structured interview with 17 questions covering the perceived knowledge, beliefs, expectations and fantasies related to the disease and dialysis. The answers were decomposed in categories through the technique of content analysis. Demographic and laboratorial data at dialysis initiation were also collected. The socioeconomic position was evaluated and the patient was classified in one of 3 categories: low, middle or high. Categorical data were analyzed by Fishers or Chisquare statistical tests and continuous data by t or Wilcoxon tests as appropriate. The results are presented as mean ± SD. Group1 had been followed for 26 ± 20 months. In both groups the majority of patients were classified as low socioeconomic position and were males. Group 2 was younger and had worse laboratorial parameters (p<0.05). Also regarding the psychological aspects both groups were similar: 63% patients of group 1 and 55% of group 2 said they had no previous information about dialysis, and 42% in group 1 and 40% in group 2 said they didn\'t completely understand what the doctor said; 74% in group 1 and 85% in group 2 believed that their kidneys would work again; 25% in both groups had bad expectations about being able to work again , and 60% in both groups felt there was a negative attitude of the family toward them. Nephrology care of CRF patients mitigates clinical complications. However, on its own, it is not enough to minimize the psychological impact of the entering dialysis. Nephrology care must go beyond clinical care. The patients need to be well informed about the disease and treatment, especially patients like ours who came from low socioeconomic position. This kind of patients should be supported by an interdisciplinary team.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-02-03T11:32:27Z No. of bitstreams: 1 fabianerossidossantos.pdf: 1207169 bytes, checksum: 239998bfa9068a9b4676999c0ad12433 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-02-03T12:06:14Z (GMT) No. of bitstreams: 1 fabianerossidossantos.pdf: 1207169 bytes, checksum: 239998bfa9068a9b4676999c0ad12433 (MD5) / Made available in DSpace on 2017-02-03T12:06:14Z (GMT). No. of bitstreams: 1 fabianerossidossantos.pdf: 1207169 bytes, checksum: 239998bfa9068a9b4676999c0ad12433 (MD5) Previous issue date: 2007-09-13 / O impacto do diagnóstico da Doença Renal Crônica pode trazer perdas que vão além da função renal. A evolução da doença pode trazer significativas mudanças na qualidade de vida de pacientes renais crônicos, envolvendo alterações corporais, sociais e psíquicas. Grande parte dos programas de atendimento a pacientes com Doença Renal Crônica são focados em pacientes já em terapia renal substitutiva. Porém, o acompanhamento precoce destes pacientes, ainda em tratamento conservador, pode proporcionar aos profissionais de saúde intervenções que busquem retardar a entrada destes em diálise, bem como reforçar uma maior adesão ao tratamento. A abordagem de pacientes em tratamento conservador através de equipes interdisciplinares torna-se fundamental, uma vez que se destina a uma abordagem global desta população, e pode ter como conseqüência uma melhora da qualidade de vida destes pacientes. O presente estudo avaliou os efeitos da abordagem interdisciplinar na qualidade de vida de pacientes com Doença Renal Crônica em tratamento conservador. Através da avaliação da qualidade de vida pelo instrumento SF-36 e de parâmetros bioquímicos, foi realizada comparação entre um grupo de pacientes acompanhados por equipe interdisciplinar e um grupo que recebeu apenas acompanhamento médico tradicional, observando-se o impacto do acompanhamento interdisciplinar nas possíveis melhoras de aspectos físicos, sociais e emocionais. Pacientes acompanhados por equipe interdisciplinar apresentaram melhora da qualidade de vida nos domínios capacidade funcional, aspectos físicos, estado geral de saúde, vitalidade e aspectos emocionais. O grupo que recebeu acompanhamento médico tradicional não apresentou melhora da qualidade de vida em nenhum dos parâmetros. Pacientes acompanhados por equipe interdisciplinar também apresentaram mudança estatisticamente significante da anemia, cálcio e redução de peso, o que não foi observado no grupo controle. / The impact of chronic renal disease may involve losses well beyond renal function. Body, social, and psychic changes, brought about by disease evolution, may significantly impair the quality of life. A sizeable proportion of programs targeting chronic renal disease patients prioritize those on renal substitutive therapies. If these patients are followed at an earlier stage, while still on conservative treatment, health providers may implement interventions to delay dialytic therapy and enhance compliance. A global interdisciplinary approach to the care of patients on conservative treatment is fundamental, as it may lead to a better quality of life. This study assessed the effects on the quality of life of an interdisciplinary approach to the care of chronic renal disease patients on conservative treatment. Through SF-36assessed quality of life and determination of biochemical parameters, a group of patients followed by an interdisciplinary team was compared with a group receiving traditional medical care. The interdisciplinary approach was possibly accountable for the improvements in the physical, social, and emotional features. Patients followed by the interdisciplinary team had better quality of life as refers to functional capacity, physical features, general health, vitality, and emotional features. The group on traditional medical care did not present any improvement of the quality of life as refers to these parameters. Patients on interdisciplinary care also had statistically significant favorable changes in their anemia, calcium levels, and weight loss, findings not seen in the control group.

Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-09-20T11:23:05Z No. of bitstreams: 1 jaimeafonsosousanetto.pdf: 1492332 bytes, checksum: b3474331db3578ab3863a9ab3071334f (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-10-01T19:27:18Z (GMT) No. of bitstreams: 1 jaimeafonsosousanetto.pdf: 1492332 bytes, checksum: b3474331db3578ab3863a9ab3071334f (MD5) / Made available in DSpace on 2018-10-01T19:27:18Z (GMT). No. of bitstreams: 1 jaimeafonsosousanetto.pdf: 1492332 bytes, checksum: b3474331db3578ab3863a9ab3071334f (MD5) Previous issue date: 2018-07-31 / Introdução: Metade dos pacientes com insuficiência cardíaca (IC) apresentam disfunção diastólica (DD) e fração de ejeção preservada do ventrículo esquerdo (FEpVE). A hipertrofia ventricular esquerda (HVE) é a anormalidade cardíaca em pacientes com doença renal crônica (DRC). O diagnóstico por imagem da DD é tradicionalmente realizado com a ecocardiografia transtorácica (ETT), sendo o volume do átrio esquerdo indexado (IVAE) um dos principais componentes no algoritmo da avaliação da DD. A metodologia do speckle tracking através do strain longitudinal global do ventrículo esquerdo (SLGVE) e o strain atrial esquerdo (SAE), possibilitam quantificar a contratilidade miocárdica e a avaliação instantânea da função do átrio esquerdo, respectivamente. Objetivo: Avaliar, em pacientes com DRC estágios 3B a 5 (em tratamento conservador) e FEpVE, o uso do SAE na identificação da disfunção diastólica indeterminada pelo IVAE. Métodos: Estudo de caso controle que avaliou pacientes com DRC estágios 3B a 5, em tratamento conservador, e que apresentavam fração de ejeção normal através da ecocardiografia transtorácico (ETT). Os pacientes foram divididos em dois grupos, com e sem HVE. A disfunção diastólica (DD), baseado em recomendações recentes da ASE, 2016, foi avaliada inicialmente pela ETT e, posteriormente, através do SAE (valor normal de referência >23%) pelo método speckle tracking. Adicionalmente, também se avaliou o strain longitudinal global do ventrículo esquerdo (SLGVE). O diagnóstico da DRC seguiu os critérios do KDIGO de 2012. Resultados: No total, foram avaliados 114 pacientes (57 em cada grupo), com idade média de 66,3±8,65, sendo 52,7% do sexo feminino, 94% hipertensos e 46% diabéticos. A média da taxa de filtração glomerular (em mL/min/1,73 m2) nos pacientes com e sem HVE foi de 32,6±11,9 e 40,4±13,9, respectivamente. A presença da DD no grupo com HVE (24,6%) foi maior do que no grupo sem HVE. Entre os 29 pacientes com HVE e DD indeterminada pelo IVAE, o SAE reduzido foi observado em 10 casos, aumentando o percentual de DD para 42%. No grupo sem HVE e DD indeterminada (18 casos), o SEA reduzido foi observado em quatro pacientes, aumentando para 21% o DD. A relação E/e´ no ânulo mitral lateral não apresentou alteração significativa entre os grupos (10,75±3,3; 10,14±3,8; p>0,05 Conclusão: Em pacientes com DRC não dialítica, o uso do SAE potencialmente aumenta a identificação de casos indeterminados de DD. / Introduction: Half of patients with heart failure (HF) have diastolic dysfunction (DD) and preserved left ventricular ejection fraction (LVEF). Left ventricular hypertrophy (LVH) is the cardiac abnormality in patients with chronic kidney disease (CKD). DD imaging has traditionally been performed with transthoracic echocardiography (TTE), with indexed left atrium volume (VTE) being one of the main components in the DD assessment algorithm. The methodology of speckle tracking through left ventricular global longitudinal strain (SLGVE) and left atrial strain (SAE), allows quantification of myocardial contractility and the instantaneous evaluation of left atrial function, respectively. Objective: To evaluate the use of SAE in the identification of undetermined diastolic dysfunction by VTE in patients with CKD stages 3B to 5 (in conservative treatment) and FEpVE. Methods: A control case study that evaluated patients with CKD stages 3B to 5, in conservative treatment, and who presented normal ejection fraction through transthoracic echocardiography (ETT). Patients were divided into two groups, with and without LVH. Diastolic dysfunction (DD), based on recent ASE recommendations, 2016, was initially evaluated by ETT and, later, by the SAE (reference normal value> 23%) by the speckle tracking method. In addition, the overall longitudinal strain of the left ventricle (SLGLE) was also evaluated. Results: A total of 114 patients (57 in each group) were evaluated, with a mean age of 66.3 ± 8.65, of which 52.7% were female, 94 % hypertensive and 46% diabetic. The mean glomerular filtration rate (in mL / min / 1.73 m2) in patients with and without LVH was 32.6 ± 11.9 and 40.4 ± 13.9, respectively. The presence of DD in the group with LVH (24.6%) was higher than in the group without LVH. Among the 29 patients with LVH and DD undetermined by IVAE, reduced SAE was observed in 10 cases, increasing the percentage of DD to 42%. In the group without undetermined LVH and DD (18 cases), the reduced SEA was observed in four patients, increasing the DD to 21%. Conclusion: In patients with non-dialytic CKD, the use of E / e 'in the lateral mitral annulus did not present significant alteration between the groups (10.75 ± 3.3; 10.14 ± 3.8; p> 0.05 of SAE potentially increases the identification of indeterminate cases of DD.

Bakgrund: Friska njurar är en förutsättning för att kroppens övriga organ ska fungera väl. Njursvikt innebär att njurarnas funktion försämras och det finns två tillstånd, akut och kronisk. Det kroniska tillståndet utvecklas långsamt under en längre tid och i ett sent skede krävs någon form av kontinuerlig dialysbehandling för rening av blodet. Ett alternativ är hemodialysbehandling som utförs på mottagning flera gånger i veckan och kräver mycket tid av patientens vardag, vilket kan komma att påverka välbefinnandet i olika aspekter. Välbefinnande och livskvalitet beskrivs som subjektiva upplevelser och utifrån det humanistiska perspektivet kan det påverkas på fysiska, psykiska och andliga plan. Med hjälp och stöd från vårdpersonal är det ändå möjligt för patienterna att uppleva välbefinnande och livskvalitet trots kronisk sjukdom.  Syfte: Att beskriva hur välbefinnandet påverkas hos patienter med kronisk njursvikt och hemodialysbehandling. Metod: Litteraturöversikt baserat på 13 vetenskapliga artiklar från två databaser. Artiklarna granskades och analyserades efter Fribergs metod för att finna likheter och skillnader som sedan sammanställdes i fem teman. Resultat: Efter analysen identifierades fem teman som beskriver hur välbefinnandet påverkas av ett liv med kronisk njursvikt och hemodialysbehandling: begränsningar i vardagen, beroende av människor och maskiner, påverkan av symtom, känslomässig påverkan samt acceptans och hantering.  Diskussion: Metoddiskussionen utgår från litteraturöversiktens styrkor och svagheter. Resultatet diskuteras utifrån Rosemarie Rizzo Parses teori om hälsa som mänsklig tillblivelse och de tre principerna mening, rytmicitet och transcendens. / Background: Healthy kidneys are a requirement for the body's other organs to function well. Renal failure causes renal function to deteriorate and there are two conditions, acute and chronic. The chronic condition develops slowly over a long time, and in a late stage, some form of continuous dialysis treatment is required to purify the blood. One alternative is hemodialysis treatment performed in a dialysis unit several times a week a requires a lot of time from the patient's everyday life, which may affect well-being in various aspects. Well-being and quality of life are described as subjective experiences, and from the humanistic perspective it can be influenced on physical, mental and spiritual levels. With the help and support of healthcare professionals, it is still possible for patients to experience well-being and quality of life despite chronic illness.  Aim: To describe how well-being is affected among patients during chronic renal failure and hemodialysis treatment. Method: A literature review based on 13 scientific articles from two databases. The articles were reviewed and analyzed by Friberg’s method to find similarities and differences that later compiled in five themes. Results: After the analysis, five themes were identified that describes how well-being is affected by a life with chronic renal failure and hemodialysis treatment: limitations in the everyday life, dependence on humans and machines, the impact of symptoms, emotional impact and also acceptance and coping.  Discussion: The method discussion is based on the strenghts and weaknesses of the literature review. The results were discussed in relation to Rosemarie Rizzo Parse’s Humanbecoming theory and the three principles meaning, rhythmicity and transcendence.

Programa de Apoio aos Planos de Reestruturação e Expansão das Universidades Federais / Health and disease, just like the body, are social constructions; how anyone live these process and the meanings that they are going to receive are related to the culture they re in. In this context, knowing of a chronic disease case implies several emotional and psychic matters. In a Chronic Renal Failure s case (CRF) - a progressive and irreversible loss in renal function disease the patient needs to struggle against the incapacities and changes acquired through the rest of his/her life. Because of that, this dissertation s objective is to present and discuss the results of a research that sought the meanings of CRF, health/ illness and body for those patients. A clinical-qualitative research conducting was chosen, whose informers were Hospital Universitário de Santa Maria s nephrology service clinic patients, which were doing dialysis or hemodialysis. The information gathering instrument choice was a semi directed interview, which were studied through a thematic content analysis. It was found that exists in society a premise where health connected to immortality is a supreme good and must be sought and desired. Illness, on the contrary, must be countered, because it reminds of incapability, loss, body imperfection and ugliness. So, considering how patients deal with the health/ disease process and treatment matter, just like they experience it and its meaning, it is viable for this context s professionals, to provide congruent assistance. / A saúde e a doença, assim como o corpo, são construções sociais; a maneira como cada um vivencia esses processos e os significados que atribuirão aos mesmos estão relacionados à cultura na qual estão inseridos. Nesse contexto, a notícia da doença crônica traz consigo inúmeras implicações emocionais e psíquicas. No caso da Insuficiência Renal Crônica (IRC) doença em que há perda progressiva e irreversível da função dos rins o doente precisa lutar contra as incapacidades e mudanças adquiridas para o resto da vida. Por isso, esta dissertação tem como objetivo apresentar e discutir os resultados de uma pesquisa que buscou os significados que IRC, saúde/doença e corpo possuem para os pacientes. Optou-se pela realização de uma pesquisa clínico-qualitativa, cujos informantes foram os pacientes do ambulatório do Serviço de Nefrologia do Hospital Universitário de Santa Maria/RS (HUSM), que realizavam diálise ou hemodiálise. O instrumento escolhido para coleta das informações foi a entrevista semidirigida, as quais foram analisadas através de uma análise de conteúdo temática. Constatou-se que existe na sociedade a premissa de que a saúde ligada à imortalidade é um bem supremo e que deve ser desejada e procurada. A doença, ao contrário, deve ser combatida, pois ela lembra incapacidade, perda, imperfeição corporal e feiura. Portanto, ao levar-se em consideração a maneira como o processo saúde/doença e o tratamento são vistos pelos doentes, assim como a forma que eles vivenciam as experiências advindas e o significado que todo esse processo adquire para eles, acredita-se que se torne mais viável para os profissionais envolvidos nesse contexto, oferecerem o apoio necessário.

The imbalance between the oxidant species formation and the activity of antioxidants is known as oxidative stress and it is directly related to the etiology and/or the progression of chronic diseases such as chronic renal failure (CRF), atherosclerosis and cardiovascular diseases. The CRF can be the result of variety renal injuries that lead to toxic substances accumulation and metabolic disturbances in the organism. Patients with chronic renal disease on hemodialysis treatment, whose main cause of morbi-mortality is the cardiovascular diseases, are constantly under oxidative stress by the uremic condition, but overall by the hemodialysis treatment, which leads to an increase of reactive species and decrease of antioxidant defenses. Moreover, these patients also present nutritional problems and presence of other comorbity diseases as anemia, hypertension and diabetes that can contribute to increase the oxidative stress state, accented for the hyperhomocysteinemia. However, the influence of the therapeutical treatment on the oxidative stress has still several controversies. Thus, oxidative stress studies and its relationship with medicaments are very important. The aim of this study was to determine which oxidative stress markers were altered in hemodialysis patients, as well as the influence of erythropoietin, iron, vitamin B12 and folic acid on these markers and in the hematologic parameters and hyperhomocisteinemia. Plasmatic TBARS, erythrocytic GSH, ALA-D enzyme activity, methemoglobin (MHb), homocysteine (Hcy), hemoglobin (Hb) and hematocrit (Ht) of 36 hemodialysis patients (HP) and 20 controls (C) were determined with a prior consent of all subjects. The personal information of each patient was used for additional data as medicaments treatment. The results found in HP in comparison with the C had significant increase (p<0,05) for TBARS, erythrocytic GSH, MHb, and Hcy, as well as significant decrease (p<0,05) of ALA-D activity, Hb and Ht. So, it was evident the oxidative stress occur, alterations in antioxidants defense, hyperhomocysteinemia and anemia. However, significant differences in the oxidative stress markers had not been found when they were related to the use of medicaments, co-morbidities presence, life style, time of hemodialysis and accomplishment of simple activities. Thus, this work demonstrated that beyond alterations in oxidative stress markers as TBARS and GSH, it was also found alterations in the ALA-D enzyme activity and in the MHb. Moreover, it was possible to observe that some medicaments as erythropoietin, vitamin B12 and folic acid can be involved in the increase of GSH levels. / O desequilíbrio entre a formação de espécies oxidantes e a atividade dos antioxidantes é denominado estresse oxidativo e está diretamente relacionado à etiologia e/ou progressão de diversas patologias crônicas, dentre as quais a insuficiência renal crônica, aterosclerose e as doenças cardiovasculares. A insuficiência renal crônica pode ser decorrente de uma série de afecções renais que culminam em perda de funcionalidade dos rins, provocando acúmulo de várias substâncias tóxicas no organismo e diversos distúrbios metabólicos. Pacientes com doença renal crônica submetidos à hemodiálise, cuja principal causa de morbi-mortalidade são as doenças cardiovasculares, estão constantemente sob estresse oxidativo em virtude da própria condição patológica, mas, sobretudo, pelo tratamento hemodialítico, que provoca aumento na formação de espécies reativas e diminuição dos níveis de antioxidantes. Além disso, estes pacientes também apresentam problemas nutricionais e a presença de outras doenças co-mórbidas como a anemia, hipertensão e diabetes que podem contribuir para o elevado estresse oxidativo, acentuado ainda mais pela hiper-homocisteinemia. Contudo, a influência do tratamento terapêutico sobre o estresse oxidativo permanece controversa. Sendo assim, estudos do estresse oxidativo e sua interrelação com a terapia medicamentosa são muito importantes. O objetivo deste estudo foi determinar quais marcadores do estresse encontram-se alterados nos hemodialisados, bem como a influência de medicamentos como eritropoetina, ferro, vitamina B12 e ácido fólico sobre estes marcadores, sobre os parâmetros hematológicos e hiper-homocisteinemia. Para tal, foram determinadas as substâncias reativas ao ácido tiobarbitúrico (TBARS) plasmáticas, glutationa reduzida (GSH) intra-eritrocitária, atividade sangüínea da enzima ácido δ-aminolevulínico desidratase (ALA-D), metemoglobina (MHb), homocisteína (Hcy), hemoglobina (Hb) e hematócrito (Ht) de 36 pacientes hemodialisados (PH) e 20 indivíduos saudáveis (IS), mediante prévio consentimento. Os prontuários médicos de cada paciente foram utilizados para levantamento de dados adicionais como o tratamento medicamentoso. Os resultados encontrados em PH em relação aos IS demonstraram aumento estatisticamente significativo (p<0,05) de TBARS plasmático, GSH intra-eritrocitária, MHb sangüínea e de Hcy plasmática, assim como diminuição significativa (p<0,05) da atividade da enzima ALA-D sangüínea, de Hb e Ht. Dessa forma, ficou evidente a ocorrência de estresse oxidativo, alterações no sistema antioxidante, hiper-homocisteinemia e anemia. Todavia, não foram encontradas diferenças significativas nos marcadores do estresse oxidativo analisados quando relacionados ao uso de medicamentos, presença de co-morbidades, hábitos de vida, tempo de hemodiálise e capacidade de realização de atividades simples. Dessa forma, este trabalho demonstrou que, além de alterações em marcadores do estresse oxidativo como TBARS e GSH, também foram encontradas alterações na atividade da enzima ALA-D e na MHb. Ainda, pôde-se supor que alguns medicamentos como eritropoetina, vitamina B12 e ácido fólico podem estar envolvidos no aumento das concentrações de GSH.

Tryptophan is metabolised along the kynurenine pathway under the influence of tryptophan 2,3 dioxygenase and indoleamine 2,3 dioxygenase. Quinolinic acid and kynurenine, two neuroactive metabolites of the kynurenine pathway are, in chronic renal failure patients, considered as uraemic toxins. Related research is generally hampered by the non-availability of relevant analytical techniques. The primary aim of this study was, therefore, to develop and validate suitable methods for the determination of tryptophan, kynurenine and quinolinic acid. The second aim was to quantify the levels of these substances in the blood of chronic renal failure patients on renal replacement therapies and to compare the levels of haemodialysis patients to those on peritoneal dialysis. Patients’ quality of life was investigated relative to disturbances in tryptophan metabolism. Gas chromatography coupled to mass spectrometry (GC-MS) gave the best results for the analysis of tryptophan, kynurenine and quinolinic acid. A Hewlett Packard HP GC 6890 series gas chromatographer was coupled to a MS 5973 series mass spectrometer. Analytes were separated on a DB-5MS column with a nominal length of 30 metres, a diameter of 250.0 µm and film thickness of 0.10 µm. Helium was used as carrier gas, and the chromatographic analysis run time 12.5 minutes. The validation results were within the acceptance criteria for newly developed methods. The linear calibration curves constructed for all of the analytes gave r2 correlation coefficients >0.99. Other validation data such as precision, bias, accuracy and stability all fell within acceptable validation limits. In the study on chronic renal failure patients significant differences were seen between patients and controls. Tryptophan levels were 5.34 SD 5.04 µM for the haemodialysis group, 6.73 SD 3.18 µM for the peritoneal dialysis group and 28.4 SD 4.31 µM for the control group. Kynurenine levels were 4.7 SD 1.9 µM for the haemodialysis group, 2.9 SD 2.0 µM for the peritoneal dialysis group and 2.1 SD 0.6 µM for the control group. Quinolinic acid levels were 4.9 SD 2.0 µM for the haemodialysis group, 2.8 SD 2.0 µM for the peritoneal dialysis group and 0.3 SD 0.1 µM for the control group. Tryptophan was lower for the total patient group than for controls with significantly lower levels for haemodialysis versus control (p<0.05) and peritoneal dialysis versus control (p<0.05). Kynurenine levels were higher in the total patient group with significantly higher levels for the haemodialysis versus control group (p=0.0001). The patient groups had higher quinolinic acid levels with significantly higher levels for the haemodialysis versus control (p<0.05) and peritoneal dialysis versus control (p<0.05) groups. This study was the first to determine the three substances simultaneously in both haemodialysis and peritoneal dialysis patients. The study showed significant tryptophan depletion, as well as kynurenine and quinolinic acid accumulation for both groups. No significant differences were found between the patient groups other than higher kynurenine levels in the haemodialysis group. The quality of life (SF-36) was largely similar in the two patient groups. This decrease in the quality of life strongly correlated with the degree of tryptophan depletion. / Dissertation (MSc)--University of Pretoria, 2008. / Chemical Pathology / unrestricted

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Nous avons montré que malgré d'importantes améliorations survenues depuis 2001, la maladie rénale chronique reste fréquente et fortement sous-estimée chez les patients diabétiques de type 2, du fait du dosage insuffisant d'albuminurie. Nous avons également montré qu'au stade tardif, près d'un tiers des patients (30%), en particulier diabétiques de type 2 (32%), démarrent le traitement de suppléance en urgence, et que l'augmentation de l'incidence de l'insuffisance rénale chronique terminale en France, est exclusivement attribuée à la part liée au diabète type 2. Ces résultats suggèrent que davantage d'efforts de sensibilisation des patients diabétiques de type 2 et des médecins pour (i) améliorer le dépistage, (ii) renforcer le contrôle de la pression artérielle et la réduction de l'albuminurie pathologique, (iii) et une meilleure préparation des patients à la dialyse. Bien qu'il soit connu que les patients diabétiques de type 2, en particulier âgés, soient moins souvent inscrits sur la liste d'attente de greffe rénale par rapport aux patients non diabétiques, il apparaît in fine à l'issue de ce travail, qu'une fois inscrit, ce n'est pas le diabète en lui-même qui constitue un facteur de risque élevé de décès ou de retrait de liste et d'échecs post-greffe rénale, mais plutôt l'impact des comorbidités cardiovasculaires préexistantes et d'une longue durée de dialyse. Accélérer l'accès à la greffe rénale aux patients, non pas exclusivement diabétiques de type 2, mais plutôt atteints de comorbidités cardiovasculaires, en les priorisant, leur octroieraient un bénéfice certain de survie en terme de réduction du risque d'échecs en liste d'attente et post-greffe rénale. / We have shown that chronic kidney disease (CKD) is frequently seen in patients with type 2 diabetes and is likely to be underestimated because albuminuria screening remains inadequate, despite significant improvements since 2001. We also showed that at of end stage renal disease, almost a third of patients (30%), especially those with type 2 diabetes (32%), starting dialysis or kidney transplantation (KTx) on an emergency basis. The skyrocketing incidence of ESRD observed in France, especially in elderly patients, is exclusively due to an actual increase in that related to type 2 diabetes. These findings suggest that further efforts are needed to raise patients with type 2 and doctor awareness on the issue of (i) CKD screening, (ii) blood pressure and elevated albuminuria control and (iii) predialysis care. Although patients with type 2 diabetes, especially elderly, were less likely to be wait-listed for KTx than their counterparts without diabetes, ultimately, once registered, type 2 diabetes per se was not associated with death or delisting after adjustment for other factors, and death or kidney failure after KTx. Pre-existing cardiovascular comorbidities, regardless of their link to diabetes, and a long-term dialysis appear to be the major predictors of death or delisting. Improving access to KTx, not only to patients with type 2 diabetes, but also with cardiovascular comorbidities, by giving them some priorities, would enhance survival benefit by reducing the risk of failures on waiting list and after KTx.

Thesis title: Kinesiophobia in patients on renal dialysis therapy - questionnaire study. The aims of the thesis: To characterise the term kinesiophobia and to evaluate the dependence of the measure of fear of movement on sociodemographic and clinical variables with the use of the Tampa Scale for Kinesiophobia questionnaire (TSK-CZ) in a group of respondents on renal dialysis therapy and a group of healthy respondents. Methods: To determine the dependence of the measure of kinesiophobia on selected variables, the TSK-CZ questionnaire was used in Fresenius Medical Care dialysis centres across towns in the Czech Republic. The reference group of individuals with no renal disease - healthy respondents - was addressed by means of the Survio.cz website. The research comprised a group of respondents on renal dialysis therapy (n = 135) and a group of healthy respondents (n = 135). The collected data was processed using statistical methods - descriptive statistics and data analysis (t-test, Chi-squared test, ANOVA, Spearman's correlation coefficient). After that, the data was transferred to tables and charts and was evaluated. Results: On the basis of the TSK-CZ questionnaire, a significant difference in the measure of fear of movement was found between the respondents on renal dialysis and the healthy ones...