Bakgrund: Fosfatbindande läkemedel är en viktig del i hemodialyspatienters behandling. Läkemedlet hjälper till att avlägsna fosfat ifrån kroppen, eftersom hyperfosfatemi annars ökar risken för kardiovaskulära sjukdomar. Trots den kunskapen har tidigare forskning visat att den kunskapen ibland uteblir hos hemodialyspatienter. Syfte: Syftet med studien var att undersöka hemodialyspatienters upplevelse av kunskap angående fosfatbindande läkemedel. Metod: En kvantitativ enkätundersökning på en hemodialysenhet i Mellansverige. Där svaren redovisas med deskriptiv statistik. Resultat: Studien visar på brister i hemodialyspatienters upplevelse av kunskap angående fosfatmedicinering både vad det gäller bristande information från sjukvårdspersonal men också brist på motivation att ta reda på informationen på egen hand. Dessutom visar studien på brister vad det gäller hemodialyspatienters förståelse till vikten av fosfatmedicinering. Slutsats: Studien visar att cirka hälften av hemodialyspatienterna upplever att de har kunskap för att kunna administrera fosfatbindande läkemedel på ett korrekt sätt. Men det finns fortfarande brister hos en del patienter vad det gäller kunskapen om fosfatbindande läkemedel. / Background: Phosphate-binding drugs are an important part of hemodialysis patient´s treatment because the drug helps to remove phosphate from there body, which otherwise increases the risk of cardiovascular disease. Previous research has shown that this knowledge is sometimes missing by hemodialysis patients. Objective: The aim of the study was to investigate the experience of knowledge about phosphate-binding drugs by hemodialysis patients. Method: A quantitative surveys at a hemodialysis unit in the central of Sweden. Where the answers are reported with descriptive statistics. Results: The study shows deficiencies in hemodialysis patients’ experience of knowledge about phosphate medication, both in terms of lack information from healthcare professionals, but also lack of motivation to find out their own knowledge. In addition, the study shows weaknesses regarding hemodialysis patient´s understanding of the importance of phosphate medication. Conclusion: The study shows that approximately half of the hemodialysis patients are capable to properly administer the phosphate-binding drugs. However, there are still shortcomings in some patients regarding the knowledge of phosphate-binding drugs.

A patient has two possibilities when it comes to the replacement of a function of kidneys a hemodialysis or a peritoneal dialysis. The aim of those dialysis is to remove the waste matter, water and redundant salts, which are maintained in the blood due to the dysfunction of kidneys. This thesis is focused on the evaluation of the quality of life of patients with hemodialysis and peritoneal dialysis. The thesis is divided into two parts -- a theoretical and a practical one. In the first part you can find the characteristics and the main principle of the hemodialysis and peritoneal dialysis and there is also a definition of a term the quality of life. The second part is based on a questionnaire survey dedicated to the personal perception of the quality of life of the patients with hemodialysis and peritoneal dialysis in Jindřichův Hradec and Tábor.

We accessed data on patients undergone peritoneal dialysis (PD), a technique that is underused in most countries and is not usually employed as the initial therapeutic option. The study aimed to characterize the DP program at a reference unit in the Northeast Region of Brazil. It was based on a retrospective cohort study that evaluated the clinical and socio-demographic profile, treatment history and causes of death of 565 incident patients who remained in PD for at least 30 days. Results were obtained: mean age was 54 ± 19 years when they started on PD. Males were 55%, 38% from Aracaju, 62% from Sergipe, 76% had <4 years of schooling and 88% earned <5 minimum wages as family income. Diabetic nephropathy was the main etiology (25%) and 77% were hypertensive. There was 9% of late referencing. The majority started on PD as the first dialytic procedure (53%), and (58%) as an emergency. The patients remained in PD for an average of 710.5 (± 714.2) days. PD was the initial dialysis modality for 302 patients (53%). A total of 676 peritoneal catheters were implanted, mean of 1.19 / patient. The median survival of the PD technique was 83.1 months, with a rate of 85.1% in 2 years and 61.1% in 5 years. The median survival of patients was 32.9 months for patients without DM, with a 2-year survival rate of 52.4% and a 5-year survival rate of 22.3. During the study, 353 individuals (62%) died. The etiology of renal disease was identified in 37% of the cases. The odds ratio (OR) of death of those who were referred late was 2,032 times greater than those who did conservative treatment. In conclusion, despite non favorable social indices, survival, peritonitis and complications rates were similar to those described in the literature. / Este estudo aborda a diálise peritoneal (DP), técnica que se mostra subutilizada na maioria dos países e geralmente não é oferecida como opção terapêutica inicial. Tem como objetivo caracterizar os resultados do programa de DP, avaliar frequência, etiologia e fatores associados à peritonite em pacientes sob DP em um centro de referência na região nordeste do Brasil. Avaliou a partir de um estudo de coorte retrospectivo, o perfil clínico e sociodemográfico, histórico de tratamento e causas de óbito associadas a fatores relacionados a peritonite de 565 pacientes incidentes que permaneceram em DP por pelo menos 30 dias. Foram resultados obtidos: a média de idade foi 54±19 anos quando iniciaram em DP. Sexo masculino foi 55%, sendo 38% procedentes de Aracaju, 62% residentes no interior de Sergipe, 76% com <4 anos de estudo e 88% com renda familiar <5 salários mínimos. Nefropatia diabética foi a principal etiologia (25%) e 77% eram hipertensos. Houve 9% de referenciamento tardio. A maioria iniciou em diálise por DP (53%), sendo 58% de forma emergencial. Os pacientes permaneceram em DP por, em média, 710,5 dias. Foram implantados 676 cateteres peritoneais, média de 1,19/paciente. A maioria dos pacientes (59%) não apresentou peritonite. O índice global de peritonite foi de 0,32 episódio/paciente.ano. O Staphylococus aureus foi o germe mais prevalente (23%). Houve cura da peritonite em 71% dos casos. Identificou-se maior risco de peritonite nos pacientes com histórico de infecção do sítio de saída do cateter peritoneal. A sobrevida mediana da técnica de DP foi de 83,1 meses, com taxa de 85,1% em 2 anos e de 61,1% em 5 anos. A sobrevida mediana dos pacientes foi de 32,9 meses para os pacientes sem DM, com taxa de sobrevida em 2 anos de 52,4% e em 5 anos de 22,3%. Foram a óbito 353 indivíduos (62%). A etiologia da doença renal foi identificada em 37% dos casos. A chance de risco (OR) de óbito de quem tem referenciamento tardio é 2,032 vezes maior do que quem fez tratamento conservador. Como conclusão obteve-se que a despeito dos indicadores sociais ruins da população estudada, sobrevida, taxas de peritonite e complicações se assemelharam ao descrito na literatura. / Aracaju, SE

Introdução: A Doença Renal Crônica (DRC) está associada à alta morbidade e mortalidade, com aumento progressivo nas populações mundiais. A DRC e o tratamento hemodialítico podem desencadear mudanças no estilo de vida dos pacientes como alterações em seu cotidiano, na capacidade para desempenhar atividades do seu dia a dia e no autocuidado. Objetivos: Caracterizar os pacientes atendidos nos serviços de hemodiálise de uma cidade do interior paulista quanto aos aspectos sociodemográficos, econômicos e clínicos; descrever a independência funcional utilizando o instrumento de Medida de Independência Funcional (MIF); descrever a capacidade de autocuidado utilizando a escala para avaliar as capacidades de autocuidado (ASA-A); verificar a associação da independência funcional e da capacidade do autocuidado com as variáveis sociodemográficas e clínicas e verificar correlação entre a independência funcional e a capacidade de autocuidado. Material e Método: Foi realizado um estudo transversal, populacional e descritivo com abordagem quantitativa nos três serviços de diálise do município de São José do Rio Preto-SP, nos quais foram entrevistados 214 pacientes com 18 anos ou mais de idade, residentes nesse município, em tratamento por hemodiálise e que aceitaram participar do estudo. Os instrumentos utilizados para a coleta de dados foram: Miniexame do Estado Mental (MEEM) para a avaliação do estado cognitivo; instrumento para caracterização dos dados sociodemográficos, econômicos e clínicos; a MIF e a ASA-A. Os dados foram analisados por meio do programa estatístico SAS®9.0, no qual foram gerados as análises descritivas, os testes de associação e a correlação entre as variáveis do estudo. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina de São José do Rio Preto - FAMERP. Resultados: Dos 214 pacientes, 108 eram adultos e 106 idosos, dos quais 136 eram homens e 78 mulheres. O número médio de comorbidades para cada paciente foi de 2,3, e o número médio de complicações físicas foi de 4,7 por paciente. Foram evidenciados um nível de independência completa ou modificada nessa população (média MIF total 118,38; dp12,4) e um relativo conhecimento dos pacientes referente a sua capacidade de autocuidado (média 94,53; dp12,86). A MIF se correlacionou positivamente com a ASA-A e as duas negativamente com as variáveis idade, complicações relacionadas ao tratamento hemodialítico e comorbidades. Conclusão: Os pacientes em tratamento hemodialítico apresentaram resultados satisfatórios de independência funcional e a capacidade de autocuidado. À medida que aumentam os escores de independência funcional, aumentam também os de capacidade de autocuidado. As variáveis sexo, idade, comorbidades, complicações relacionadas ao tratamento hemodialítico constituíram fatores importantes que prejudicaram a independência funcional e a capacidade de autocuidado dessa população. Os resultados deste estudo permitiram compreender aspectos referentes a essas variáveis que poderão subsidiar intervenções para a melhoria da assistência de enfermagem prestada a essa população. / Introduction: Chronic Kidney Disease (CKD) is associated with high and progressively increasing morbidity and mortality levels around the world. CKD and hemodialysis treatment can trigger changes in patients\' lifestyles, such as changes in their daily lives, in their ability to perform daily activities and in self-care. Aims: To characterize the patients attended at hemodialysis services in an interior city in São Paulo State, Brazil regarding sociodemographic, economic and clinical aspects; to describe their functional independence using the Functional Independence Measure (FIM) scale; to describe their self-care ability using the Appraisal of Self-Care Agency Scale (ASA-A); to check the association between functional independence and self-care ability and sociodemographic and clinical variables and to check for the correlation between functional independence and self-care ability. Material and Method: A cross-sectional and descriptive population study with a quantitative approach was developed at the three dialysis services in the city of São José do Rio Preto- SP, where 214 patients were interviewed, aged 18 years or older, living in this city, under hemodialysis treatment and who accepted to participate in the study. The instruments used for data collection were: Mini-Mental State Examination (MMSE) for cognitive state assessment; instrument to characterize sociodemographic, economic and clinical data; FIM and ASA-A. Data were analyzed in SAS®9.0, used to generate descriptive analyses, association tests and correlations among the study variables. Approval for the project was obtained from the Research Ethics Committee at São José do Rio Preto Medical School - FAMERP. Results: Out of 214 patients, 108 were adults and 106 elderly, with 136 men and 78 women. The average number of comorbidities for each patient was 2.3, and the mean number of physical complications was 4.7 per patients. Complete or modified independence levels were evidenced in this population (mean total FIM 118.38; sd12.4) and patients\' relative knowledge about their self-care skills (mean 94.53; sd12.86). The FIM was positively correlated with the ASA-A and both instruments were negatively correlated with age, hemodialysis treatment-related complications and comorbidities. Conclusion: Patients under hemodialysis treatment presented satisfactory functional independence and self-care ability results. Gender, age, comorbidities, hemodialysis treatment-related complications represented important factors that impaired this population\'s functional independence and self-care ability. These study results permitted understanding aspects related to these variables that can support interventions to improve nursing care delivery to this population.

A doença renal crônica (DRC) tem sido considerada um problema de saúde pública mundial. Estima-se que cerca de 17% da população adulta dos EUA apresente algum grau de comprometimento da função renal. No Brasil, um estudo realizado na cidade de Bambuí - Minas Gerais detectou-se alteração da função renal variando de 0,48% a 8,19%, sendo mais frequente nos pacientes idosos. Os pacientes que evoluem para DRC terminal necessitam de algum tipo de terapia renal substitutiva (TRS), sendo as opções disponíveis: a hemodiálise (HD), a diálise peritoneal (DP) e o transplante renal (TX renal). No caso da DP, a membrana peritoneal realiza a função de filtrar o sangue do paciente, e esta é utilizada através da implantação de um cateter na cavidade abdominal. No Brasil, segundo dados do Censo Brasileiro de Diálise (2016) existem aproximadamente 122.825 pacientes em diálise, sendo 8,6% em DP. O objetivo do estudo foi analisar a evolução dos pacientes que foram admitidos na Unidade de Diálise do HCFMRP para submeterem-se à DP nos últimos 22 anos. Os dados foram coletados dos prontuários dos pacientes atendidos no período de 1993 a 2015, de onde foram extraídas variáveis demográficas, clínicas e laboratoriais. É um estudo de coorte retrospectiva de 199 prontuários de pacientes atendidos na Unidade de Diálise do HCFMRP-USP. Os resultados demonstram que a população do estudo é em sua maioria do sexo feminino, com média de idade 57 anos. Foi encontrada a mudança de TRS para a hemodiálise como desfecho clínico mais frequente, seguida por óbito. A etiologia da DRC mais frequente foi a hipertensão arterial sistêmica (HAS), seguida por Diabetes mellitus (DM) tipo 2. Houve associação com menor média de idade de entrada em programa (48 anos), desfecho clínico óbito e maior tempo de seguimento (10 anos) com o grupo de pacientes que entraram em programa de diálise em 1993 (p<0,05). Encontramos associação do uso de medicamentos (Cloridrato de Sevelamer e Análogos da vitamina D3 com níveis categorizados de paratormônio, cálcio total e fósforo (p<0,05). CONCLUSÃO: Os pacientes que entraram em programa no período de 1993-2000 apresentaram menor média de idade e maior tempo de acompanhamento quando comparados aos demais grupos. O desfecho clínico mais frequente foi a transferência para HD, tendo como causa principal a ocorrência de peritonites. / INTRODUCTION: Chronic kidney disease (CKD) has been considered a worldwide public health problem, as well as the progressive increase of the population in renal replacement therapy (TRS). With the technological advances accumulated, the survival of patients on dialysis has increased greatly. Peritoneal dialysis (PD) is considered a safe and effective method of SRT, a challenge for the binomial patienthealth team. OBJECTIVES: To analyze the main characteristics and outcomes of patients in a PD program. METHODS: This was a retrospective cohort study of 199 patients submitted to PD in the Dialysis Unit of the HCFMRP-USP from 1993 to 2015. The primary source of data was the individual medical records. The variables were classified as: demographic, clinical and laboratorial. Statistical analyzes were performed using the Chi-square test, ANOVA and Kruskal Wallis. RESULTS: The mean age of the patients was 57 years, with a predominance of females (51.5%); the most frequent clinical outcome was the change in HRT for hemodialysis (37.2%). Type 2 diabetes mellitus (DM) was the most common cause of CKD (31,7). There was an association between lower mean age of program entry, clinical outcome and longer follow-up (10 years) in the group of patients who entered the dialysis program in the period from 1993 to 2000 (p <0.05). There was an association between the use of medications (Sevelamer\'s Hydrochloride and vitamin D3 analogues) with categorized values of parathormone, total calcium and phosphorus (p <0.05). CONCLUSION: Patients who entered the program in 1993-2000 had a lower mean age and longer follow - up when compared to the other groups. The most frequent clinical outcome was the transfer to HD, the main cause being the occurrence of peritonitis.

BACKGROUND Vascular calcification is a major risk factor for cardiovascular morbidity and mortality in patients with end stage renal disease (ESRD). In Western countries, Blacks with ESRD appear to have lesser degrees of vascular calcification compared to non-Blacks. However, there is no published data on the association of ethnic differences in vascular calcification and survival in ESRD from Sub-Saharan Africa. METHODS This study assessed the 5-year change in vascular calcification and mortality in a previously published cohort of patients with ESRD. Vascular calcification was assessed by abdominal aortic calcification score (lateral abdominal radiograph) and vascular stiffness by pulse wave velocity. RESULTS Sixty-six of the original 74 participants, studied a baseline, were identified. The median age was 46.6 years (37.6-59.2) and 57.6% were women. Abdominal aortic calcification showed no progression among Blacks [baseline range 0-5, follow up range 0-8 (p=1.00)], but a nonsignificant trend to progression among non-Blacks [baseline range 0-19, follow up range 0-22 (p=0.066)]. Black participants did not display a survival advantage (p=0.870). Overall, sepsis was the most common cause of mortality (64% of those with an identifiable cause of death). Non-Blacks had higher parathyroidectomy rates than Blacks with 9/30 cases compared to 2/36 (p=0.036). After adjustment for parathyroidectomy at follow up, the odds ratio of having abdominal vascular calcification score of ≥1 amongst non-Blacks was 8.6-fold greater compared to Blacks (p= 0.03). Central aortic systolic pressures (CASP) and pulse wave velocities (PWV) were higher in the study population than age matched normative values. At follow up, a positive correlation (r=0.3) was observed between PWV and abdominal aortic calcification (p=0.04). Elevated baseline coronary artery calcification score and FGF-23 level at baseline were not associated with a difference in mortality. CONCLUSION There was no significant progression in vascular calcification among Blacks. After adjusting for increased parathyroidectomy rates, there was a greater progression of vascular calcification amongst non-Blacks compared to Blacks highlighting possible ethnic differences in calcium phosphate metabolism in patients with ESRD. The lack of vascular calcification progression in Blacks was not however associated with improved survival, but the sample size was small.

The topic of this diploma thesis is the design of a device for dialysis, which is intended for medical institutions. During this thesis existing products were analyzed from the design and technical side. Also was achieved an understanding of the problem of existing dialysis devices. The result is a new conceptual solution with an emphasis on creating clean forms of equipment and taking into ergonomic, technical and aesthetic requirements.

Dialysis patients are often denied hospice benefits unless they forego dialysis treatments. However, many of those patients might benefit from as-needed dialysis treatments to palliate symptoms of uremia, fluid overload, etc. The current Medicare payment system precludes this "palliative dialysis" except in those few cases where the terminal diagnosis is unrelated to renal failure. As approximately three quarters of all US patients on dialysis have Medicare as their primary insurance, a of review of Medicare policy is suggested, with a goal of creating a new "palliative dialysis" category that would allow patients to receive treatments on a less regular schedule without affecting the quality statistics of the dialysis center.

Background: Complications related to peritoneal dialysis (PD) in patients with autosomal-dominant polycystic kidney disease (ADPKD), including intraperitoneal rupture of renal cyst, hernia, membrane failure and peritonitis, have been reported. However, long-term clinical outcomes of ADPKD patients on PD remain unclear. We performed this meta-analysis to assess the risks of death, technique failure and peritonitis in ADPKD patients on PD. Methods: A systematic review was conducted using MEDLINE, EMBASE and Cochrane databases from inception to October 2017 to identify studies that evaluated the outcomes of ADPKD patients on PD, including the risks of death, technique failure and peritonitis. Non-ADPKD patients on PD were used as controls. Effect estimates from the individual study were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. Results: Twelve cohort studies with a total of 14 673 patients on PD (931 ADPKD and 13 742 non-ADPKD patients) were enrolled. Compared with non-ADPKD status, ADPKD was associated with significantly decreased mortality risk with pooled odds ratio (OR) of 0.68 (95% confidence interval (CI), 0.53–0.86; I 2 = 0). There were no associations of ADPKD with the risks of technique failure of PD and peritonitis with pooled OR of 0.93 (95% CI, 0.79–1.10; I 2 = 0) and 0.88 (95% CI, 0.75–1.05; I 2 = 0), respectively. We found no publication bias as assessed by Egger's regression asymmetry test, with P = 0.90, 0.28 and 0.60 for the risks of mortality, technique failure and peritonitis in ADPKD patients on PD, respectively. Conclusion: Compared with non-ADPKD patients on PD, our study demonstrates that ADPKD patients on PD have 0.68-fold decreased mortality risk. There are no associations of ADPKD status with the risks of technique failure or peritonitis.

Purpose. The primary objective was to compare primary and secondary patency, number of percutaneous transluminal angioplasty (PTA) interventions and cost-effectiveness among PTA, deployment of a stent, or a stent graft in the treatment of failing arteriovenous dialysis grafts. The secondary objective was to compare the residual diameter at the site of dialysis shunt stenosis using sonography and digital subtraction angiography (DSA). Methods. Sixty patients were randomly assigned to either PTA, placement of a stent or stent graft. Follow-up angiography was scheduled at 3, 6, and 12 months or when requested by the physician. Residual diameter of a dialysis shunt stenosis was measured in 20 patients with significant stenosis by ultrasonography and on an angiogram from DSA. Results. During a median follow-up of 22.4 months patients with PTA, stent, or stent graft required 3.1±1.7, 2.5±1.7, or 1.7±2.1 (P=0.031) secondary PTA interventions. The primary patency rates were 0%, 18%, and 65% at 12 months and 0%, 18%, and 37% at 24 months in the PTA, stent, and stent graft group respectively (P<0.0001). The cost of the procedures was €7,900±€3,300 in PTA group, €8,500±€4,500 in stent group, and €7,500±€6,200 in stent graft group (P=0.45). The mean residual diameter measured by ultrasonography and DSA was...