Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.

Introdução: O uso de membranas de alto fluxo tornou-se comum na prática de hemodiálise convencional (HDC), hemodiafiltração (HDF) e hemofiltração (HF) devido ao elevado coeficiente de ultrafiltração e à maior permeabilidade do poro. A produção de fluido de reposição online proporciona maior facilidade na execução de HDF e HF. Estas modalidades aumentam a depuração de solutos maiores por convecção. O objetivo do estudo é comparar a eficácia de três métodos dialíticos: HDC, HDF online (HDF-OL) pós-diluição e HF online (HF-OL) pré-diluição, por meio da quantificação direta da dose de diálise pela extração de solutos. Método: Trata-se de um ensaio clínico, envolvendo 14 pacientes em hemodiálise. Os pacientes iniciaram no estudo na modalidade de HDC com prescrição de quatro horas, fluxo de sangue de 350ml/min e fluxo de dialisato de 800ml/min com dialisador novo de alto fluxo e alta eficiência. Posteriormente, os mesmos pacientes foram submetidos à uma sessão de HDF-OL pós-diluição de quatro horas, fluxo de sangue de 350ml/min, fluxo de reposição de 100ml/min e fluxo de dialisato de 700ml/min. Por último, fizeram uma sessão de HF-OL pré-diluição com mesma duração, fluxo de sangue de 350ml/min e fluxo de reposição de 100% do fluxo de sangue. Foram realizadas 42 sessões de tratamento. A extração de solutos foi avaliada por meio de dosagens plasmáticas e quantificação do efluente. Resultados: As concentrações séricas dos solutos pré-diálise não foram diferentes entre as sessões do estudo. O volume de substituição em HDF-OL foi de 20,6 ± 0,8L/sessão e em HF-OL foi de 81,8 ± 7,1L/sessão. A HDF-OL quando comparada com a HDC não apresentou diferença na extração de moléculas pequenas. Da mesma forma, a extração de ?2-microglobulina foi semelhante nas 3 modalidades: 121,1 ± 46,4 mg em HDC, 130,1 ± 46,5 mg em HDF-OL e 106,0 ± 45,0 mg em HF-OL. A perda de albumina foi significativamente maior em HDF-OL (1360,2 ± 425,0 mg) e HF-OL (1310,3 ± 201,4 mg) Vs. HDC (269,6 ± 15,3 mg) (p<0,0001). A depuração de pequenos solutos foi superior em HDF-OL. A depuração de ?2-microglobulina foi maior em HDF- OL (114,0 ± 15,7 ml/min) e HF-OL (116,1 ± 19,5 ml/min) Vs. HDC (86,5 ± 16,1 ml/min) (p<0,0001). A dose de diálise avaliada pelo singlepool, equilibrated, standard Kt/V e pela quantificação direta da diálise (DDQKt/V) não foi diferente entre HDF-OL e HDC. Na HF-OL a ausência de difusão contribuiu para menor extração e menor Kt/V de solutos pequenos (p<0,0001). Conclusão: A dose de diálise avaliada pela extração de solutos foi semelhante entre HDC e HDF-OL sendo a HF-OL menos favorável na extração de solutos pequenos / Introduction: The use of high-flux membranes became common practice in conventional hemodialysis (CHD), hemodiafiltration (HDF) and hemofiltration (HF) due to the high pore permeability and ultrafiltration coefficient. The online production of substitution volume can make easier HDF and HF execution. These modalities can increase the clearance of larger solutes by convection. The aim of this study is to compare the dialysis efficacy among three methods: CHD, online post-dilution HDF (OL-HDF), and online pre- dilution HF (OL-HF) through the direct quantification of dialysis dose by the solutes extraction. Method: This is a clinical trial involving 14 patients on hemodialysis. The patients began the study in CHD modality with a four-hour prescription, blood flow of 350ml/min and dialysate flow of 800ml/min with new high-flux and high efficiency dialyzer. Subsequently, these patients were submitted to a four-hour post-dilution OL-HDF session, with flow replacement of 100ml/min, blood flow of 350ml/min and dialysate flow of 700ml/min. Finally, patients underwent a pre-dilution OL-HF with the same duration, blood flow of 350ml/min and flow replacement of 100% of the blood flow. Forty-two sessions of treatments were performed. The solutes extraction was assessed by plasma measurements and effluent quantification Results: Pre-treatment serum concentrations of different solutes showed no statistical difference among the modalities. The substitution volume in OL- HDF was 20.6 ± 0.8L/session and in OL-HF was 81.8 ± 7.1 L/session. The OL-HDF compared to CHD showed no difference in the small solutes extraction. Similarly, ?2-microglobulin extraction was similar among the three modalities: 121.1 ± 46.4 mg in CHD, 130.1 ± 46.5 mg in OL-HDF and 106.0 ± 45.0 mg in OL-HF. Albumin loss was significantly higher in OL-HDF (1360.2 ± 425.0 mg) and OL-HF (1310.3 ± 201.4 mg) Vs. CHD (269.6 ± 15.3 mg) (p<0.0001). The small solutes clearance was greater in OL-HDF. ?2- microglobulin clearance was higher in OL-HDF (114.0 ± 15.7 ml/min) and OL- HF (116.1 ± 19.5 ml/min) Vs. CHD (86.5 ± 16.1 ml/min) (p<0.0001). The dialysis dose measured by singlepool, equilibrated, standard Kt/V and by direct dialysis quantification (DDQ Kt/V) was not different between CHD and OL-HDF. In OL-HF the absence of diffusion contributed to lower extraction and lower Kt/V of small solutes. Conclusion: The dialysis dose evaluated by extraction of solutes was similar between CHD and OL-HDF being a OL-HF less favorable in small solutes extraction

<p>Bakgrund: Antalet patienter i behov av njurtransplantation per år är cirka 400-500, varav endast cirka 350 kommer att bli transplanterade. Bristen på organ är tydligt framträdande. I väntan på transplantation behöver patienten dialysbehandling, vilket ofta upplevs vara tidskrävande och utmattande. Sjuksköterskor bör ha kunskap om patienters upplevelser i samband med väntan på transplantation för att kunna utvecklas i sin roll som sjuksköterska och få en djupare förståelse för deras situation.</p><p>Syfte: Syftet var att beskriva kroniskt njursjuka patienters upplevelser av att leva med dialysbehandling och väntan på transplantation.</p><p>Metod: Studien är en litteratursammanställning av tio kvalitativa och kvantitativa vetenskapliga artiklar inom området, vilka har granskats, analyserats och sammanställts.</p><p>Resultat: I resultatet framkom flera olika upplevelser, så som längtan efter frihet, utmattning, höga förväntningar, frustration och rädsla inför framtiden i samband med dialysbehandlingen och väntan på transplantationen.</p><p>Slutsats: Kroniskt njursjuka patienters upplever sin situation som psykiskt, fysiskt och socialt påfrestande. En av sjuksköterskans viktigaste uppgifter i samband med bemötandet av patienter under dialysbehandling är att vara tillgänglig. Med en tillgänglig och öppen inställning till patienterna blir sjuksköterskan mer mottaglig för patienternas individuella behov.</p> / <p>Background: The number in need of kidney transplants per year is approximately 400-500, of which only about 350 will be transplanted. The shortage of organs is clearly prominent. In anticipation of the transplant patient needs dialysis, which is perceived to be time consuming and exhausting. Nurses should have knowledge of patients' experiences in connection with awaiting transplantation to be able to evolve in her role as a nurse and get a deeper understanding of the patients’ situation.</p><p>Aim: The aim of this study was to describe patients’ experiences of living with chronic kidney failure with dialysis and awaiting transplantation.</p><p>Method: The study is a literature compilation of ten qualitative and quantitative scientific articles in the field. The articles have been reviewed, analyzed and compiled. Results: The results revealed several different experiences, such as yearning for freedom, fatigue, high expectations, frustration and fear for the future in connection with the dialysis treatment and awaiting transplantation.</p><p>Conclusion: Chronic kidney disease patients perceive their situation as mentally, physically and socially stressful. One of the nurse's most important tasks in connection with the treatment of patients in dialysis is to be available. With an accessible and open approach to the patient in general, a nurse becomes more responsive to patient's individual needs.</p>

Bakgrund: Antalet patienter i behov av njurtransplantation per år är cirka 400-500, varav endast cirka 350 kommer att bli transplanterade. Bristen på organ är tydligt framträdande. I väntan på transplantation behöver patienten dialysbehandling, vilket ofta upplevs vara tidskrävande och utmattande. Sjuksköterskor bör ha kunskap om patienters upplevelser i samband med väntan på transplantation för att kunna utvecklas i sin roll som sjuksköterska och få en djupare förståelse för deras situation. Syfte: Syftet var att beskriva kroniskt njursjuka patienters upplevelser av att leva med dialysbehandling och väntan på transplantation. Metod: Studien är en litteratursammanställning av tio kvalitativa och kvantitativa vetenskapliga artiklar inom området, vilka har granskats, analyserats och sammanställts. Resultat: I resultatet framkom flera olika upplevelser, så som längtan efter frihet, utmattning, höga förväntningar, frustration och rädsla inför framtiden i samband med dialysbehandlingen och väntan på transplantationen. Slutsats: Kroniskt njursjuka patienters upplever sin situation som psykiskt, fysiskt och socialt påfrestande. En av sjuksköterskans viktigaste uppgifter i samband med bemötandet av patienter under dialysbehandling är att vara tillgänglig. Med en tillgänglig och öppen inställning till patienterna blir sjuksköterskan mer mottaglig för patienternas individuella behov. / Background: The number in need of kidney transplants per year is approximately 400-500, of which only about 350 will be transplanted. The shortage of organs is clearly prominent. In anticipation of the transplant patient needs dialysis, which is perceived to be time consuming and exhausting. Nurses should have knowledge of patients' experiences in connection with awaiting transplantation to be able to evolve in her role as a nurse and get a deeper understanding of the patients’ situation. Aim: The aim of this study was to describe patients’ experiences of living with chronic kidney failure with dialysis and awaiting transplantation. Method: The study is a literature compilation of ten qualitative and quantitative scientific articles in the field. The articles have been reviewed, analyzed and compiled. Results: The results revealed several different experiences, such as yearning for freedom, fatigue, high expectations, frustration and fear for the future in connection with the dialysis treatment and awaiting transplantation. Conclusion: Chronic kidney disease patients perceive their situation as mentally, physically and socially stressful. One of the nurse's most important tasks in connection with the treatment of patients in dialysis is to be available. With an accessible and open approach to the patient in general, a nurse becomes more responsive to patient's individual needs.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

Lic.-avh. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 2 uppsatser.

Thesis (Ph. D.)--School of Nursing. University of Missouri--Kansas City, 2004. / "A dissertation in nursing." Advisor: Peggy Ward-Smith. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed feb. 27, 2006. Includes bibliographical references (leaves 124-131). Online version of the print edition.

Introdução: O uso de membranas de alto fluxo tornou-se comum na prática de hemodiálise convencional (HDC), hemodiafiltração (HDF) e hemofiltração (HF) devido ao elevado coeficiente de ultrafiltração e à maior permeabilidade do poro. A produção de fluido de reposição online proporciona maior facilidade na execução de HDF e HF. Estas modalidades aumentam a depuração de solutos maiores por convecção. O objetivo do estudo é comparar a eficácia de três métodos dialíticos: HDC, HDF online (HDF-OL) pós-diluição e HF online (HF-OL) pré-diluição, por meio da quantificação direta da dose de diálise pela extração de solutos. Método: Trata-se de um ensaio clínico, envolvendo 14 pacientes em hemodiálise. Os pacientes iniciaram no estudo na modalidade de HDC com prescrição de quatro horas, fluxo de sangue de 350ml/min e fluxo de dialisato de 800ml/min com dialisador novo de alto fluxo e alta eficiência. Posteriormente, os mesmos pacientes foram submetidos à uma sessão de HDF-OL pós-diluição de quatro horas, fluxo de sangue de 350ml/min, fluxo de reposição de 100ml/min e fluxo de dialisato de 700ml/min. Por último, fizeram uma sessão de HF-OL pré-diluição com mesma duração, fluxo de sangue de 350ml/min e fluxo de reposição de 100% do fluxo de sangue. Foram realizadas 42 sessões de tratamento. A extração de solutos foi avaliada por meio de dosagens plasmáticas e quantificação do efluente. Resultados: As concentrações séricas dos solutos pré-diálise não foram diferentes entre as sessões do estudo. O volume de substituição em HDF-OL foi de 20,6 ± 0,8L/sessão e em HF-OL foi de 81,8 ± 7,1L/sessão. A HDF-OL quando comparada com a HDC não apresentou diferença na extração de moléculas pequenas. Da mesma forma, a extração de ?2-microglobulina foi semelhante nas 3 modalidades: 121,1 ± 46,4 mg em HDC, 130,1 ± 46,5 mg em HDF-OL e 106,0 ± 45,0 mg em HF-OL. A perda de albumina foi significativamente maior em HDF-OL (1360,2 ± 425,0 mg) e HF-OL (1310,3 ± 201,4 mg) Vs. HDC (269,6 ± 15,3 mg) (p<0,0001). A depuração de pequenos solutos foi superior em HDF-OL. A depuração de ?2-microglobulina foi maior em HDF- OL (114,0 ± 15,7 ml/min) e HF-OL (116,1 ± 19,5 ml/min) Vs. HDC (86,5 ± 16,1 ml/min) (p<0,0001). A dose de diálise avaliada pelo singlepool, equilibrated, standard Kt/V e pela quantificação direta da diálise (DDQKt/V) não foi diferente entre HDF-OL e HDC. Na HF-OL a ausência de difusão contribuiu para menor extração e menor Kt/V de solutos pequenos (p<0,0001). Conclusão: A dose de diálise avaliada pela extração de solutos foi semelhante entre HDC e HDF-OL sendo a HF-OL menos favorável na extração de solutos pequenos / Introduction: The use of high-flux membranes became common practice in conventional hemodialysis (CHD), hemodiafiltration (HDF) and hemofiltration (HF) due to the high pore permeability and ultrafiltration coefficient. The online production of substitution volume can make easier HDF and HF execution. These modalities can increase the clearance of larger solutes by convection. The aim of this study is to compare the dialysis efficacy among three methods: CHD, online post-dilution HDF (OL-HDF), and online pre- dilution HF (OL-HF) through the direct quantification of dialysis dose by the solutes extraction. Method: This is a clinical trial involving 14 patients on hemodialysis. The patients began the study in CHD modality with a four-hour prescription, blood flow of 350ml/min and dialysate flow of 800ml/min with new high-flux and high efficiency dialyzer. Subsequently, these patients were submitted to a four-hour post-dilution OL-HDF session, with flow replacement of 100ml/min, blood flow of 350ml/min and dialysate flow of 700ml/min. Finally, patients underwent a pre-dilution OL-HF with the same duration, blood flow of 350ml/min and flow replacement of 100% of the blood flow. Forty-two sessions of treatments were performed. The solutes extraction was assessed by plasma measurements and effluent quantification Results: Pre-treatment serum concentrations of different solutes showed no statistical difference among the modalities. The substitution volume in OL- HDF was 20.6 ± 0.8L/session and in OL-HF was 81.8 ± 7.1 L/session. The OL-HDF compared to CHD showed no difference in the small solutes extraction. Similarly, ?2-microglobulin extraction was similar among the three modalities: 121.1 ± 46.4 mg in CHD, 130.1 ± 46.5 mg in OL-HDF and 106.0 ± 45.0 mg in OL-HF. Albumin loss was significantly higher in OL-HDF (1360.2 ± 425.0 mg) and OL-HF (1310.3 ± 201.4 mg) Vs. CHD (269.6 ± 15.3 mg) (p<0.0001). The small solutes clearance was greater in OL-HDF. ?2- microglobulin clearance was higher in OL-HDF (114.0 ± 15.7 ml/min) and OL- HF (116.1 ± 19.5 ml/min) Vs. CHD (86.5 ± 16.1 ml/min) (p<0.0001). The dialysis dose measured by singlepool, equilibrated, standard Kt/V and by direct dialysis quantification (DDQ Kt/V) was not different between CHD and OL-HDF. In OL-HF the absence of diffusion contributed to lower extraction and lower Kt/V of small solutes. Conclusion: The dialysis dose evaluated by extraction of solutes was similar between CHD and OL-HDF being a OL-HF less favorable in small solutes extraction

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-04-08T10:45:20Z No. of bitstreams: 1 alessandrabatistamarquito.pdf: 2021743 bytes, checksum: 642d2834b464172c471924679b53a3ef (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-04-24T03:45:57Z (GMT) No. of bitstreams: 1 alessandrabatistamarquito.pdf: 2021743 bytes, checksum: 642d2834b464172c471924679b53a3ef (MD5) / Made available in DSpace on 2016-04-24T03:45:57Z (GMT). No. of bitstreams: 1 alessandrabatistamarquito.pdf: 2021743 bytes, checksum: 642d2834b464172c471924679b53a3ef (MD5) Previous issue date: 2013-09-02 / INTRODUÇÃO: Nas últimas décadas, o número de pacientes com doença renal crônica (DRC) em todo mundo tem aumentado, ocasionando um grave problema de saúde pública. Os principais fatores de risco para a DRC, além de transplante renal prévio e história familiar de terapia renal substitutiva, são o diabetes mellitus (DM) e a hipertensão arterial (HAS). A essas duas condições potencialmente graves, acrescenta-se o fato de que essa população é constituída predominantemente por indivíduos da terceira idade, que utilizam diversos fármacos, necessários para a abordagem dos fatores de riscos associados à doença, bem como na tentativa de retardar a evolução da doença para estágios mais avançados. Assim, renais crônicos possuem alto risco para a ocorrência de interação medicamentosa (IM), que constitui uma causa de problema relacionado ao medicamento (PRM). Contudo, a extensão e a frequência da IM não têm sido exploradas no processo de uso dos medicamentos desse grupo de indivíduos. OBJETIVO. Identificar potenciais interações entre medicamentos prescritos a renais crônicos em tratamento conservador e fatores associados a sua ocorrência. MÉTODO. Estudo observacional transversal, com análise de 558 prescrições. O potencial interativo dos medicamentos foi traçado tendo como suporte a base de dados MICROMEDEX®, software que disponibiliza farmacopéias conhecidas internacionalmente. RESULTADOS. Houve predomínio de indivíduos do sexo masculino (54,7%), idosos (69,4%), no estágio 3 da DRC (47,5%), com sobrepeso e obesos (66,7%). As comorbidades mais prevalentes foram a hipertensão arterial sistêmica (68,5%) e o diabetes mellitus (31,9%). Interações medicamentosas potenciais foram detectadas em 74,9% das prescrições. De um total de 1364 IMs detectadas, 229 (16,8%) foram de gravidade maior e 5 (0,4%) contraindicadas, com necessidade de intervenção imediata. Interações de gravidade moderada ou menor foram identificadas respectivamente em 1049 (76,9%) e 81 (5,9%) das prescrições. Observou-se que a probabilidade de ocorrência de uma IM aumentou em 2,5 vezes para cada medicamento adicional (IC= 2,18-3,03). Obesidade, diabetes, hipertensão e estágio avançado da DRC foram fatores de risco fortemente associados para ocorrência de IM. CONCLUSÃO. A associação de medicamentos em indivíduos com DRC relacionou-se com alta prevalência de IMs potencialmente graves, especialmente nos estágios mais avançados da doença. / INTRODUCTION: Over the past three decades the incidence and prevalence of chronic kidney disease (CKD) has risen worldwide. The main risk factors for CKD are above previous kidney transplantation and a positive history of renal replacement therapy, diabetes mellitus (DM) and hypertension (HT). Furthermore, patients with CKD are predominantly over sixty and as a consequence have to take a variety of drugs to control the associated risk factors as well as to attenuate the progression of the disease. Thus, patients with CKD are at high risk for drug interactions (DI) that constitute one cause of drug related problems. However, the extent and frequency of DI is unknown in this group of individuals drug´s use process. OBJECTIVE. Identify potential interactions among drugs prescribed to patients with CKD on conservative treatment, and factors associated with their occurrence. METHODS. Observational cross-sectional study, with analysis of 558 prescriptions. Potential DIs were identified by the database MICROMEDEX®, software that provides an internationally known pharmacopoeia. RESULTS. There was a predominance of males (54.7%), seniors (69.4%), stage 3 CKD (47.5%), overweight and obese patients (66.7%). The most prevalent comorbidities were hypertension (68.5%) and diabetes mellitus (31.9%). Potential DIs were detected in 74.9% of prescriptions. Among the 1364 DIs diagnosed, 5 (0.4%) were contraindicated and 229 (16.8%) of greater severity, which need immediate intervention. Interactions of moderate and low severity were identified in 1049 (76.9%) and 81 (5.9%) prescriptions, respectively. The probability of one DI increased by 2.5 times for each additional drug (CI = 2.18 to 3.03). Obesity, hypertension, diabetes as well as advanced stage of CKD were risk factors strongly associated with DI occurrence. CONCLUSION. Drug associations in individuals with CKD were related to high prevalence of serious DIs, especially in the later stages of the disease.

Bakgrund: Kronisk njursvikt innebär att njurens funktioner gradvis minskar och blir nedsatta över tid, vilket kräver dialysbehandling i flera omgångar. Några av symtomen som kan uppstå i samband med kronisk njursvikt är bland annat klåda. Uremisk klåda kan besväras av både fysiskt och psykiskt då det bidrar till sår, ökad trötthet, försämrad livskvalitet. Lidande och obehag som orsakade av uremisk klåda kan ytterligare leda till depression och ångest. Det är därför viktigt att sjuksköterskor kan bemöta och hjälpa patienter som lider av uremisk klåda att lindra symtomen. Syfte: Syftet var att beskriva sjuksköterskors omvårdnadsåtgärder för att lindra uremisk klåda vid kronisk njursvikt Metod: Litteraturöversikten med tolv vetenskapliga artiklar. Databaserna PubMed och CINALH complete användes. Artiklarna analyserades med hjälp av Fribergs analysmodell. Resultat: I resultatet framkom fem teman; (1) Aromaterapi, (2) Termisk terapi, (3) Akupressur, (4) Krämer och (5) Övriga metoder. Dessa fem teman har visat vara effektiva för att lindra uremisk klåda. Slutsats: Sammanfattningsvis har aromaterapi, termisk terapi, akupressur, krämer och övriga omvårdnadsåtgärder visat sig verkande lindrande på uremisk klåda. Genom att tillämpa dessa omvårdnadsåtgärder kan det ytterligare bidra till bättre sömnkvalitet samt livskvalitet för patienterna som lider av uremisk klåda. Dessutom är omvårdnadsåtgärder kostnadseffektiva alternativ gentemot medicinska behandlingen. / Background: Chronic kidney failure means that the kidney's functions gradually decrease and become impaired over time, which requires dialysis treatment several rounds. Some of the symptoms that can occur in connection with chronic kidney failure is itching. Uremic itching can be troublesome both physically and psychologically as it contributes to ulcers, increased fatigue and reduced quality of life. Pain and discomfort caused by uremic pruritus can further lead to depression and anxiety. Therefore, it is necessary that nurses can address and help patients that are suffering from uremic pruritus to relieve the symptoms. Aim: The aim was to describe nurses care measure to treat pruritus in patients with chronic kidney failure. Method: The litterature review based on twelve scientific articles. The databases Pubmed and CINALH complete were used. The scientific articles were analyzed using Friberg´s model. Results: The results showed five themes; (1) Aromatherapy, (2) Thermal therapy, (3) Acupressure, (4) Creams and (5) Other methods. These five themes have been shown to be effective in relieving uremic pruritus. Conclusion: In conclusion, aromatherapy, thermal therapy, acupressure, creams and other methods have been shown to be working in treating uremic pruritus. By applying these nursing interventions can it further contribute to better quality of sleep and quality of life for patients that are suffering from uremic pruritus. Furthermore, are nursing interventions cost-effective alternatives to medical treatment.