MSc(Med), Bioethics and Health Law, Faculty of Health Sciences, University of the Witwatersrand / The current exclusion criteria for accessing renal dialysis in South African public hospitals places great emphasis on the allocation of scarce resources. The case of Soobramoney at the Constitutional Court highlighted the ethical and legal implications of providing this scarce resource. Mr. Soobramoney was denied access to renal dialysis on the basis of scarce resources and he did not qualify for care due to not meeting the criteria set for renal care. The Soobramoney case was considered mainly on the basis of scarce allocation of resources and offering treatment on an emergency basis. It was argued by the appellant that the state had an obligation to provide him with the treatment in terms of s 27(3) read with s 11 of the Constitution (para 14). This report takes a different slant and looks at the quality of life argument for increasing access to renal dialysis for those denied it based on current South African protocols. In exploring this concept one would venture to offer a definition of ‘quality of life’ according to Brown as an overall sense of well-being. This includes an individual’s satisfaction with their own lives (Brown, 2007: 72). A health related quality of life extends the definition to include the way a person’s v health affects their ability to carry out normal social and physical activities (ibid). A case is made for increasing access by developing programmes to cater for those in need of enhancing their quality of life. This is what is being motivated for in cases similar to Soobramoney, especially those with comorbid disease. The quality of life argument is based on the fact that there are indications in literature that patients with end-stage renal disease rate their own quality of life to be as important as the quality of life of the general population. Furthermore, there is no indication that the elderly live more miserable lives when they are on dialysis. The idea of respect for persons is highlighted - respect for the autonomous choices patients make concerning how they live their lives and including respect for them towards the end of their lives. Finally, I reflect on some legal issues concerned with the Soobramoney versus the Minister of Health Kwa-Zulu Natal 1997.

by Yip Mei Po. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 128-150). / Abstract and questionnaire also in Chinese. / Acknowledgements --- p.i / Abstract --- p.iii-iv / Chapter Chapter 1 --- Introduction --- p.1 / Chapter Chapter 2 --- Literature Review / End stage renal failure and dialysis therapy --- p.3 / Stress / The concept of stress --- p.4 / Lazarus' stress and coping model --- p.5 / Different approaches to stress --- p.6 / Stressors in hemodialysis patients: a convergence of chronic strains and daily hassles --- p.8 / The outcome of stressors in hemodialysis patients --- p.10 / Coping / Definition: Coping as a process --- p.12 / Problem focused and emotional focused coping --- p.12 / Functions of coping: its effectiveness --- p.14 / The use of coping methods in hemodialysis patients --- p.17 / Factors affecting coping response to illness in hemodialysis patients --- p.19 / Social Support / Approaches to social support: definitions and measurements --- p.22 / The effect of social support on adjustment to illness --- p.25 / "Social support as a coping resource in hemodialysis patients," --- p.27 / Quality of life / Quality of life as an adjustment outcome to illness --- p.28 / "The quality of life concept: dimensions, components and measurement" --- p.29 / Limitations of studies of quality of life in hemodialysis patients --- p.33 / Approaches to quality of life in hemodialysis patients --- p.34 / "The relation between stress, coping, social support and quality of life" --- p.36 / Chapter Chapter 3 --- Method / Research design --- p.38 / Research hypothesis --- p.40 / Operational definitions --- p.41 / Population --- p.42 / Sample --- p.43 / Ethical issue --- p.47 / Data collection --- p.50 / Instruments --- p.56 / Data analysis --- p.64 / Chapter Chapter 4 --- Results / Descriptives analyses --- p.66 / Correlation analyses --- p.83 / Regression analyses --- p.88 / Supplementary qualitative data --- p.90 / Chapter Chapter 5 --- Discussion and conclusion / Stressors --- p.98 / Coping --- p.104 / Social support --- p.108 / Quality of life --- p.110 / "Stress, coping, social support and quality of life" --- p.114 / Predictors of quality of life --- p.119 / Conclusions --- p.122 / Chapter Chapter 6 --- Limitation of the study --- p.124 / Implications and recommendations --- p.126 / References --- p.128 / Appendices / Chapter A. --- Table showing relationship of the use & effectiveness of eight coping styles with length of time on treatment / Chapter B. --- Descriptions of eight coping styles on the 1987 revised Jalowiec Coping Scale / Chapter C. --- A Sample of interview script / Chapter D. --- Letter of ethical approval / Chapter E. --- Letter of request for permission to conduct researchin clinical setting / Chapter F. --- Letter of request for revealing Hemodialysis Stressor Scale / Chapter G. --- Questionnaire / Chapter H. --- Consent form

Objective: Several studies have demonstrated that end-stage renal disease (ESRD) patients on dialysis are at higher risk for cerebrovascular events, especially those on hemodialysis. However, the risk of stroke in patients on peritoneal dialysis (PD) compared to those on hemodialysis (HD) remains unclear. We performed this meta-analysis to assess the risks of stroke in ESRD patients on PD compared to HD. Methods: A systematic review was conducted using MEDLINE, EMBASE, Cochrane databases from inception through January 2018 to identify studies that evaluated the risks of stroke (all types of stroke, ischemic stroke or hemorrhagic stroke) in ESRD patients on different dialysis modalities. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. Results: Fifteen cohort studies with a total of 1 289 572 ESRD patients (over 1 140 942 on HD and 122 534 on PD) were enrolled. Compared with HD, PD was associated with a significantly decreased risk of hemorrhagic stroke with pooled OR of 0.84 (95% CI: 0.76-0.92). However, there were no differences in risks of all types of stroke or ischemic stroke in those on PD compared to HD with pooled ORs of 1.06 (95% CI: 0.91-1.22) and 1.01 (95% CI: 0.80-1.18,), respectively. Conclusions: PD status is associated with 16% lower risk of hemorrhagic stroke compared to HD, but the risks of all types of stroke and hemorrhagic stroke are not statistically different in PD patients when compared to HD patients.

The kidney is an organ that plays a major role in the homeostasis of the body. The kidney has several roles such as fluid management, electrolyte balance, vitamin D production, blood pressure control, removal of wastes, red blood cell production, and pH balance. Damage to the kidney can result in severe comorbidities and even mortality. Currently, kidney disease affects over 800 million individuals today (United States Renal Data System, 2022). One of the primary methods to treat kidney disease is using dialysis as a form of renal replacement. The two current dialysis modalities are peritoneal dialysis and hemodialysis. The purpose of this thesis is to establish a background in the kidney, kidney disease, and dialysis. With this background, this thesis aims to present the advantages and disadvantages of each of the three dialysis access: arteriovenous grafts, arteriovenous fistulas, and central venous catheters. By exploring the creation methods, dialysis use, and patient perspective, this thesis has demonstrated that arteriovenous fistulas are the supreme access. However, arteriovenous grafts and central venous catheters provide important alternatives and should not be ignored.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medicine / Master / Master of Research in Medicine

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