A diálise peritoneal (DP) é uma técnica de reposição renal utilizada mundialmente tanto na medicina como na medicina veterinária. Na medicina veterinária, a pesquisa por técnicas minimamente invasivas para a implantação de cateteres de DP se mostra de grande valia, visto que a indicação de diálise em animais é, principalmente, para casos de injúria renal aguda e agudização da doença renal crônica, e, muitas vezes, o paciente não tem condições de aguardar a cicatrização da ferida cirúrgica para iniciar o procedimento de diálise. O objetivo desta pesquisa foi descrever a técnica de omentectomia e de implantação do cateter de Tenckhoff pelo acesso videolaparoscópico com três portais em coelhos, além de avaliar a funcionalidade do cateter. Foram utilizados oito coelhos adultos, fêmeas, da raça Nova Zelândia para a realização de implantação de cateter de Tenckhoff e omentectomia por videolaparoscopia. As medianas do Tempo Cirúrgico Total (TCT), Tempo para Omentectomia (TOm) e Tempo para implantação do Cateter de Tenckhoff (TICT) foram 65,5, 30, e 5 minutos, respectivamente. As principais complicações apresentadas pela técnica foram hemorragia e herniação pela ferida cirúrgica. Foram realizados oito procedimentos de DP em cada animal, sendo o primeiro iniciado três horas após a implantação do cateter. A principal complicação observada foi o vazamento do dialisato para o espaço subcutâneo, ocorrido em todos os animais. Com base na metodologia utilizada e nos resultados obtidos neste estudo, pode-se concluir que a técnica de omentectomia videolaparoscópica é factível em coelhos, permitindo que o procedimento seja realizado de forma segura e sem intercorrências significativas, além de permitir adequado posicionamento do cateter. / Peritoneal dialysis (PD) is a renal replacement technique used worldwide in both medicine and veterinary medicine. In veterinary medicine, the search for minimally invasive techniques for PD catheters implantation is of great value. The indication of dialysis in animals is mainly for cases of acute renal injury and exacerbation of chronic kidney disease and, the patient is often unable to wait for wound healing to begin the dialysis procedure. The objective of this research was to describe the technique of Tenckhoff catheter implantation and omentectomy by videolaparoscopic access with three portals in rabbits. In addition, to evaluating the catheter functionality. Eight female New Zealand rabbits were used to perform omentectomy and videolaparoscopic Tenckhoff catheter implantation. Median Total Surgical Time (TCT), Time for Omentectomy (TOm) and Time for Tenckhoff Catheter Implantation (TCTI) were 65.5, 30, and 5 minutes, respectively. The main complications presented by the technique were hemorrhage and herniation in the surgical wound. Eight procedures of PD were performed in each animal, the first one being started three hours after catheter implantation. The main complication observed was the leakage of the dialysate into the subcutaneous space, which occurred in all animals. Based on the methodology used and the results obtained in this study, it can be concluded that the videolaparoscopic omentectomy technique is feasible in rabbits, allowing the procedure to be performed safely and without significant intercurrences, besides allowing the adequate catheter positioning.

The presented diploma thesis deals with the study of interactions between humic acids as the main component of soil organic matter with a model organic pollutant presented by cationic surfactant Septonex (which was expected to interact positively with humic acids due to its charge) through unconventional combination of dialysis and diffusion techniques realized in diffusion cells together with isothermal titration calorimetry capable of elucidating the nature of ongoing reactions from a thermodynamic point of view. The experiments were performed with a humic acid isolated by standard isolation procedure from Leonardite (1S104H) purchased from the International Society for Humic Substances, with humic acids isolated from lignite as well as modal chernozem. The aim of the submited diploma thesis is to assess the influence of carboxyl functional groups in the structure of humic acids to interactions with Septonex. For this reason, said samples of humic acids have been modified by selective methylation of their carboxyl functional groups, which can no longer participate in interactions with ionic substances. Results from diffusion cells and isothermal titration calorimetry confirmed the assumption that Septonex interacted with all types of unmodified humic acids more than with their methylated derivatives. Despite the available literature, it was surprising that the differences in the interaction of humic acids with Septonex were not diametrically different when comparing unmodified humic acids with their methylated derivatives. The extent of these interactions was assessed through the apparent equilibrium constant Kapp determined in the diffusion (dialysis) experiments and from the course of enthalpy curves from isothermal titration calorimetry. After the experiments and their evaluation, it can be concluded that humic acids and Septonex in their interactions, due to their structures, probably apply not only electrostatic interactions, especially through available carboxyl functional groups of humic acids and positively charged hydrophilic parts of Septonex molecules, but also a significant role have a hydrophobic effect, hydrogen bonds and Van der Waals forces.

This diploma thesis is concentrated on the interactions between polyelectrolyte (hyaluronan) and cationic surfactant (CTAB). The experiments were performed in an aqueous solution and in an environment of physiological ionic strength (0,15mmoldm-3 NaCl). The determination of the surfactant concentration in solutions was based on the formation of colored complexes of CTAB and picric acid in chloroform. The concentrations of surfactant were measured by UV-VIS spectroscopy. The stability of CTAB+HyA was examined by a dialysis method. The results showed that, regardless of the environment, the presence of HyA in solution reduces the number of free molecules of CTAB which can be determined in the sample. It has been proved that there is an interaction between HyA and surfactant and that CTAB has greater affinity for HyA then for the picric acid. The stability of CTAB+HyA was determined by dialysis of 120 hours. After that time, the concentrations of the retentate and permeate were settled. The results showed that in the membrane remains a certain amount of CTAB bounded to hyaluronan. The system can be suitable for the preparation of targeted carriers of biologically active substances.

Orientador: André Luis Balbi / Resumo: Introdução: A Doença Renal Crônica (DRC) é uma condição clínica com elevada e crescente prevalência, com repercussão sistêmica, podendo cursar com hipervolemia e consequente congestão de órgãos como os pulmões. O tratamento dialítico também gera uma série de alterações nos sistemas muscular, ósseo, cardiovascular, metabólico e também respiratório. Existem muitos estudos avaliando o sistema respiratório na fase dialítica e poucos avaliam na fase pré-diaítica. Objetivo: Avaliar a função pulmonar e a força muscular respiratória de pacientes com DRC na fase pré-dialítica. Metodologia: Foram assistidos 132 pacientes e 43 avaliados no Ambulatório de Pré-Diálise do Hospital das Clínicas da Faculdade de Medicina de Botucatu, SP (HCFMB), com retornos mensais, em tratamento clínico e programação de diálise. Todos os pacientes estudados foram submetidos inicialmente à avaliação da função pulmonar através da espirometria e logo em seguida avaliação da força muscular respiratória através da manovacuometria, realizadas no laboratório de função pulmonar do HCFMB, pelo mesmo pesquisador em único dia para o mesmo paciente. Resultados: Foram incluídos no estudo 40 pacientes com média de idade de 61 ± 14 anos, sendo 60% do sexo masculino. Com relação à causa, 22 pacientes apresentaram nefropatia diabética (n=13; 32,5%) e nefropatia hipertensiva (n=9; 22,5%).Todos os resultados da espirometria (CVF, VEF1 e VEF1/CVF) foram abaixo do valor predito, com diferença estatística. A maioria dos paciente... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Chronic Kidney Disease (CKD) is a clinical condition with high and increasing prevalence, with systemic repercussions, which can develop with hypervolemia and consequent congestion of organs such as the lungs. The dialysis treatment also generates a series of changes in the muscular, bone, cardiovascular, metabolic and also respiratory systems. There are many studies evaluating the respiratory system in the dialysis phase and few assess it in the pre-dialysis phase. Objective: To evaluate pulmonary function and respiratory muscle strength in patients with pre-dialysis CKD. Methodology: 132 patients were assisted and 43 were evaluated at the Pre-Dialysis Outpatient Clinic of the Hospital das Clínicas, Faculty of Medicine of Botucatu, SP (HCFMB), with monthly returns, in clinical treatment and dialysis schedule. All patients studied were initially submitted to pulmonary function assessment using spirometry and then respiratory muscle strength was assessed using manovacuometry, performed at the HCFMB pulmonary function laboratory, by the same researcher on a single day for the same patient. Results: The study included 40 patients with a mean age of 61 ± 14 years, 60% of whom were male. Regarding the cause, 22 patients had diabetic nephropathy (n = 13; 32.5%) and hypertensive nephropathy (n = 9; 22.5%). All spirometry results (FVC, FEV1 and FEV1 / FVC) were below predicted value, with statistical difference. Most patients (37.5%) had a restrictive ventilatory disord... (Complete abstract click electronic access below) / Mestre

Die Bestimmung des Sollgewichts von Dialysepatienten stellt einen Balanceakt zwi-schen Hyper- und Hypovolämie und damit zwischen ischämischen Ereignissen durch Hypotonie und kardiovaskulären Komplikationen dar. Derzeit wird es anhand gering sensitiver bzw. unspezifischer und meist subjektiver klinischer Methoden ermittelt. Die Bioimpedanzanalyse als objektives, nicht invasives und zeitsparendes Verfahren steht zunehmend im Mittelpunkt von Studien, die der Behandlung von Dialysepatienten gewidmet sind. In dieser Arbeit wird die Untersuchung von 40 Patienten mit den Bioimpedanzanalysatoren Body Composition Monitor von Fresenius und Nutriguard-M von Data Input sowie mit klinischen Methoden beschrieben. Der Body Composition Monitor errechnet die Überwässerung des Patienten im Rahmen der Messung. Für die Berechnung der Überwässerung aus vom Nutriguard-M gemessenen Daten wurde eigens eine Formel erstellt. Obgleich hohe absolute Unterschiede zwischen den mittels der Bioimpedanzanalysatoren und der klinisch bestimmten Werte für die Überwässerung beobachtet wurden, waren positive Korrelationen der durch Bioimpedanzsanalyse gemessenen Überwässerung mit klinischen Parametern, wie dem Durchmesser der V. cava inferior, der Ausprägung von Unterschenkelödemen und dem mittleren arteriellen Blutdruck zum Nadir der Dialyse feststellbar. Verglichen wurden die Geräte nicht nur auf der Ebene der gemessenen Überwässerung, sondern auch auf den Ebenen der Rohwerte und der Anteile der Körperkompartimente am Körpergewicht. Dabei zeigten sich in Abhängigkeit des Verarbeitungsgrades der durch die Geräte gemessenen bzw. berechneten Größen sowohl geringe als auch hohe Abweichungen. Diese Erkenntnisse relativieren die Euphorie über die Möglichkeit der Anwendung der BIA in der Dialysetherapie.:1. Einleitung 2. Patienten, Material und Methoden 3. Ergebnisse 4. Diskussion 5. Zusammenfassung

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...

Durch verschiedene Modifizierungen an der Blutkontaktseite von Hohlfasermembranen sollte eine Verbesserung der Bio- und Blutkompatibilität erreicht werden. Zur Modifizierung wurden verschiedene biologisch wirksame Moleküle verwendet. Weiterhin wurden zwei Modifizerungsstrategien verfolgt. Zum einen eine Modifizierung, bei welcher das Material der Hohlfasermembran vor deren Herstellung verändert wird. Und zum anderen eine selektive Modifizierung der Blutkontaktseite nach der Herstellung der Hohlfasermembran.

Vid behandling med Peritonealdialys behöver patienten utföra ett moment där de kopplar samman sin inopererade kateter till en extern dialyspåse. Detta moment innebär stora risker för allvarliga infektioner på grund av kontaminering av känsliga delar. Mitt examensarbete syftar till att göra momentet säkrare och tryggare för patienten genom att minimera den risken. Jag ville skapa ett hjälpmedel som fortfarande engagerar patienten i kopplingsmomentet och håller ner kostnaden genom att designa kring redan befintliga dialysprodukter och undvika avancerad mekanik. Projektet tar avstamp från min tidigare erfarenhet som sjuksköterska och de observationer jag gjort rörande den här behandlingstypen / During treatment with Peritoneal dialysis the patient needs to perform a specific task of connecting their surgically placed catheter to an external bag of dialysis fluids. This specific task implicates big risks of serious infections due to contamination of sensitive parts.  My exam project aims to make this connection safer for the patient by minimizing these risks. I wanted to design a tool that aids the patient and at the same time engage them in the connection process. To keep the costs down I chose to design around already existing dialysis components and to avoid advanced mechanics. This project takes off on my previous experience as a nurse and the observations I made regarding this treatment method.

The objective of the study is to analyze the factors associated with the severity of pruritus in patients with terminal chronic kidney disease undergoing hemodialysis. The methodology used is based on a cross-sectional study in patients receiving hemodialysis at the Centro Nacional de Salud Renal. Severe pruritus was defined as a score on the visual analogue scale greater than or equal to 7, and the strength of association with the possible risk factors was assessed by calculating prevalence ratios. Regarding the results, 264 patients were included, 59.9% were male, with a mean time on hemodialysis of 10.26 ± 7.14 years. 75% experienced pruritus, of this group, 1 in 3 presented severe pruritus. Hyperphosphatemia and the use of antihistamines were associated with a higher prevalence of severe pruritus (RP 1.71, 95% CI 1.09-267 and RP 2.39, 95% CI 1.51-3.75, respectively). The positive serology for Hepatitis C Virus was described as a protective factor for presenting severe pruritus (RP 0.55, 95% CI 0.33 - 0.89). In conclusion, severe uremic pruritus is a frequent problem in patients with chronic terminal kidney disease who have hyperphosphatemia and treatment with antihistamines independently of the time they have been on hemodialysis. / Revisión por pares

A partir de l’hémodialyse, nous étudierons certains problèmes plus généralement liés à la maladie chronique mais aussi la fin de vie pour mettre en tension trois dualités : l’exactitude et la vérité, les morales déontologiques et téléologiques, et la logique d’équivalence et de surabondance. Dans la maladie chronique, nous nous intéresserons aux cas où il existe une contradiction entre le devoir thérapeutique du médecin et la volonté de la personne malade. Nous montrerons que ces refus de soin en dialyse sont sous-tendus par une tension entre l’exactitude technique des traitements proposés et la vérité éthique et existentielle de la personne. Dans la fin de vie, nous nous poserons la question de savoir quand commence l’obstination déraisonnable, comment définir sa limite, et comment limiter ou arrêter la dialyse tout en étant certain de ne pas réaliser un homicide ? Nous montrerons également que les normes, les indicateurs et les protocoles prolifèrent pour participer à une standardisation des pratiques de plus en plus hégémonique, où plusieurs moteurs sont à l’œuvre, comme la rationalité néolibérale et la gestion du risque.  Ceci aboutit à un désenchantement des soignants. Un constat apparait : l’exactitude, la technique, les morales déontologiques rabattues sous forme de protocoles et la logique d’équivalence deviennent envahissantes. A l’inverse la vérité du sujet, l’éthique, la responsabilité de l'autre vulnérable, le don d’hospitalité tendent à être précarisés. La riposte à cette dérive pourrait être la réhabilitation de la singularité du sujet et la création de métaphore vive entre exactitude technique et la vérité éthique. Enfin, nous montrerons comment lorsqu’il existe un dilemme lié à une tension entre technique et éthique, la mise en place d’une réunion d’éthique nous a permis d’apporter la réponse la plus humaine possible et de favoriser le développement d’une culture d’équipe. / From hemodialysis, we will study certain problems more generally related to chronic disease but also to the end of life bring out the tension between three dualities: the accuracy and the truth, déontological and teleological ethics, and the logics of equivalence and superabundance. In chronic illness, we will be interested in cases where there is a contradiction between the medical duty of the physician and the will of the sick person. We will show that these refusals of care in dialysis are underpinned by a tension between the technical accuracy of the proposed treatments and the ethical and existential truth of the person. In the end of life, we will ask ourselves the question of when unreasonable obstinacy begins, how to define its limit, and how to limit or stop dialysis while being sure not to perform a homicide? We will also show that norms, standards, indicators and protocols proliferate to participate in a standardization of increasingly hegemonic practices, where several drivers are at work, such as neoliberal rationality and risk management. This leads to a disenchantment of caregivers. One observation emerges: the accuracy, the technique, the déontological ethics folded in the form of protocols and the logic of equivalence become invasive. Conversely, the truth of the subject, ethics, the responsibility of the other vulnerable, the gift of hospitality tend to be precarious. The response to this drift could be the rehabilitation of the singularity of the subject and the creation of a metaphor between technical accuracy and ethical truth. Finally, we will show how, when there is a dilemma linked to a tension between technique and ethics, the setting up of an ethics meeting allowed us to provide the most humane answer possible and to foster the development of a team culture.