Introduktion: Med en stigande ålder på befolkningen förväntas andelen människor med njursvikt öka världen över och därmed kommer flertalet att behöva dialys för att ersätta njurarnas funktion. I och med detta kan fler komma att behöva utföra dialys i hemmet. Tidigare forskning säger att dialys i hemmet är en outnyttjad tillgång i världen och dessutom billigare än dialys i center, samtidigt som dialys i hemmet tillåter patienten att utföra mer egenvård. Som teoretisk referensram används Dorothea Orems omvårdnadsteori om egenvård.  Syfte: Detta arbete har som mål att undersöka patienternas erfarenheter av egenvård och dialysbehandling i hemmet.  Metod: För att besvara studiens syfte gjordes en deskriptiv litteraturstudie med artiklar från hela världen.  Resultat: Resultatet visade att ett genomgripande tema framkom: “Patienterna upplevde egenvården i samband med dialys i hemmet som något positivt vilket gav dem mer självständighet, ökad flexibilitet och ökad kontroll. Stöttningen ansågs också viktig för patienten”. Stöd, både från anhöriga och sjukvårdspersonal, kunde vara positivt genom att patienterna fick ökad förståelse för sin sjukdom, ökad självsäkerhet och självförtroende samt skapade trygghet. Stödet kunde också vara negativt då det kunde få patienterna att uppleva erfarenheter som rädsla, frustration och minskad självständighet. Välbefinnande kan öka vid behandling i hemmet, genom bland annat ökad frihet och ökad energi. Känslan av kontroll ökar vid egenvård och behandling i hemmet då behandlingen ofta blir till en rutin för patienten. Modifiering av egenvård är möjlig och görs ofta genom att experimentera och ändra restriktioner och egenvårdstips för att kunna leva ett normalt liv. Slutsats: Studien visar på att egenvård och dialysbehandling i hemmet ofta är positivt för patienterna, men det finns negativa aspekter som patienterna upplever. / Introduction: With an aging population, the amount of people with chronic kidney disease will increase in the world and so will the amount who will need dialysis to replace their kidney function. Consequently, more people will need access to dialysis from home. Studies show that home-dialysis is an untapped resource worldwide and provides patients with a cost effective solution. As a theoretical framework, Dorothea Orems theory of self-care will be used. Aim: The aim of the study is to investigate patients' experience of self-care and dialysis at home. Method: To answer the study's aim, a descriptive review was done by consulting academic research or articles from different areas of the world. Results: The results showed a main theme: “Patients experienced that the self-care in correlation with home-dialysis was seen as positive and gave them independence, flexibility and control. Support was also considered important”. Support with self-care had a big presence, both from healthcare and relatives. Support could be both positive and negative, while providing the patient with a better understanding of their disease, self-assurance, and safety, it was also the root of frustration and a reduction in independence. Wellbeing could improve through home-dialysis through increased freedom and energy. The feeling of control also increased through self-care and dialysis-treatment and both often became a routine. Modifications in self-care are often made through experimenting and patients' own changes of restrictions and self-care tips, made to live a normal life. Conclusion: The study shows that self-care and dialysis-treatment at home was often seen as positive by the patient, but there are negative aspects that patients also experience.

Syftet med denna studie var att undersöka hur personer med egenadministrerad peritonealdialys (PD) upplever sitt dagliga liv. Metoden var en intervjustudie där sju personer som behandlades med PD intervjuades med hjälp av en semistrukturerad intervjuguide. Materialet som analyserades med en manifest kvalitativ innehållsanalys resulterade i tre huvudkategorier: kroppsliga förändringar, upplevelser av PD-behandling samt egenvård. Resultatet visade att PD hade inverkan på olika plan i informanternas dagliga liv. Ett viktigt fynd var hur informanterna uppfattade att PD hade lett till vissa kroppsliga förändringar, exempelvis vad gäller vikt och aptit. Det mest framträdande fyndet var emellertid att PD ledde till en bundenhet, vilket orsakade en oönskad passivitet hos informanterna. Det framkom dessutom att de informanter som väntade på njurtransplantation upplevde att denna väntan ledde till mer inskränkning i det dagliga livet än vad PD gjorde. Informanterna beskrev även de positiva aspekterna av PD-behandlingen och betonade fördelen med att PD möjliggjorde en självständighet och en flexibilitet. Denna studie gav ett brett perspektiv av hur personer med PD upplever sitt dagliga liv och visade att det inte bara är de kroppsliga förändringarna som påverkar personerna utan att PD även leder till känslor av bundenhet och passivitet. / The purpose of this study was to explore how people with self-administered peritoneal dialysis (PD) experience their daily life. The method was an interview study in which seven people who were treated with PD were interviewed using a semistructured interview guide. The material was analyzed with a manifest content analysis and resulted in three main categories: bodily changes, sensations of PD treatment and self-care. The results showed that PD had an effect in different levels in the informants’ daily lives. One important finding was how the informants perceived that the PD had led to certain bodily changes for example in terms of weight and appetite. The most striking finding, however, was that the PD led to a lack of freedom causing an undesirable passivity of the informants. It also showed that respondents who were waiting for kidney transplantation felt that this anticipation led to more restriction in daily life than PD did. The informants also described the positive aspects of PD treatment and stressed advantages such as that PD allowed autonomy and flexibility. This study gave a broad perspective of how people with PD experience their daily life and showed that not only the physical changes affected them but also led to feelings of restraint and passivity.

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INFECTIOUS COMPLICATIONS IN CHRONIC RENAL FAILURE Infections represent a serious problem in chronic kidney disease (cohort and they are) associated with signifficant morbidity and mortality. The thesis originated in the nephrology division of the Department of Internal Medicine I., Charles University Teaching Hospital and Medical Faculty in Pilsen, an institution with a long standing research activity in the field. In the theoretical part of this work, a general summary of infectious complications in chronic kidney disease population is presented. The other part of this work presents results of our research dealing with pharmacoeconomical aspects of cytomegalovirus infection and finally our results in the field of influenza vaccination. The Aim of the first presented work was to evaluate the cost impact of four different strategies for prevention of cytomegalovirus infection after renal transplantation. We provide post hoc analysis of 2 randomized studies performed in our department and calculating direct CMV-related expenses using valacyclovir prophylaxis, ganciclovir prophylaxis, preemptive vlaganciclovir treatment and deferred therapy. To simulate ihe impact of varying prices of prharmacotherapy or diagnostic procedures, a sensitivity analysis was performed. With respect to our results, valacyclovir...

Bakgrund: Det finns ett stort intresse för hemdialys. Sjuksköterskan ska jobba personcentrerat och främja personers självbestämmande redan vid val av dialysmetod och vid undervisningen av hemdialys. Användningen av hemsjukvård ökar och därav behovet av kunniga sjuksköterskor inom hemdialys. Sjuksköterskan ska stötta personer i sin egenvård. Syfte: Syftet var att beskriva personers upplevelser av hur vardagslivet påverkas vid dialysbehandling i hemmet. Metod: Studiens design var en allmän litteraturstudie med induktiv ansats, utförd med strukturerad sökmetod och innehållsanalys. Resultat: Personerna upplevde ett påverkat vardagsliv med fysiska begränsningar, medikalisering av hemmet och ett försämrat psykiskt mående. Det var svårt att koordinera dialysschemat mot arbete, fritidsintressen och familjeliv. Livet med hemdialys upplevdes också som ett normaliserat liv i jämförelse med hemodialys på mottagning. Resultatet delades in i tre huvudkategorier: Fysisk påverkan, Praktisk påverkan och Psykisk påverkan. Konklusion: Personer upplevde vardagslivet som förändrat, men uppskattade att möjligheten till hemsjukvård fanns. Genom en grundlig och individanpassad utbildning kunde sjuksköterskan ge en god och trygg start på behandlingsmetoden som gav personen verktyg till att hantera sin egenvård så bra som möjligt. / Background: There’s a big interest in home dialysis. The nurse’s task is to use person-centred care and to promote people’s autonomy. This should be applied when helping people choose dialysis modalities and during the training programs. The utilisation of home care is increasing and therefore the need of nurses with home dialysis knowledge. The nurse should support people in their self-care. Aim: The aim was to describe the experiences of people’s everyday life when using home dialysis. Method: A general literature review with inductive approach. A structured search method and a content analysis were used. Results: People experienced a changed everyday life in terms of physical limitations, medicalisation of the home and a deteriorated psychological well-being. The people found difficulties coordinating the dialysis schedule with work life, family life and hobbies. Life with home dialysis were also seen as normal compared to in-centre dialysis. The result generated into three main categories: Physical impact, Practical impact and Psychological impact. Conclusions: People experienced everyday life as changed but appreciated the possibility to dialyse at home. With a thorough and individualized training, the nurse can give people a good and safe start to the treatment as well as tools to manage selfcare

Background: Intradialytic hypotension is a potential complication experienced by patients with end-stage renal disease who receive hemodialysis. This complication occurs during the dialysis treatment in 15-30% of all treatments. The multiple comorbidities that exist in hemodialysis patients predispose them to recurrent intradialytic hypotension episodes. Recurrent intradialytic hypotensive episodes can result in negative short-term and long-term clinical consequences. Short-term consequences include complications such as ischemic events (e.g., heart attacks, strokes), clotting of patient dialysis access, or heart rhythm abnormalities. Long-term consequences include end-organ damage, increased cardiovascular morbidity, and a higher mortality rate. Problem Statement: Available nursing interventions used to treat intradialytic hypotension such as decreased dialysis fluid temperature, changes in the calcium and sodium concentrations in the dialysis fluid and oral medication have limited success. Another existing technological intervention called blood volume monitoring shows greater potential success but is currently underutilized. Purpose: The purpose of this literature review is to synthesize current literature on blood volume monitoring technology used to prevent intradialytic hypotension in hemodialysis patients. Methods: A literature review was conducted analyzing pertinent research articles published in the last ten years, in addition to seminal articles. Seventeen articles were retrieved and analyzed that met criteria. Results: Fourteen of the seventeen research studies reached a consensus on the successful use of blood volume monitoring to decrease intradialytic hypotension and the related symptoms. Conclusion: Results of the literature review support the use of blood volume monitoring technology as an effective nursing intervention to prevent intradialytic hypotension in hemodialysis patients.

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<p>Reduced kidney function around the time of surgery is an important risk factor for postoperative mortality. Despite this there is limited information on how reduced kidney function prior to surgery alters prognosis, what causes sudden decrements in kidney function after surgery (known as acute kidney injury), or how they might be avoided. The studies in this thesis inform these knowledge gaps. Chapter 2 describes the results of a post hoc analysis of the interaction between preoperative estimated glomerular filtration rate, a marker of kidney function, and postoperative cardiac troponin T, a marker of heart damage, for predicting 30-day mortality in a prospective cohort study of patients undergoing noncardiac surgery. Chapter 3 uses administrative and clinical data from a single centre to inform the risk of acute kidney injury after noncardiac surgery by concentrations of preoperative hemoglobin and change in postoperative hemoglobin. Chapter 4 uses the same data to determine a definition of intraoperative hypotension that is prognostic of acute kidney injury, myocardial injury and death. Chapter 5 describes a randomized controlled trial that compares a novel therapeutic procedure called remote ischemic preconditioning to a sham procedure in patients undergoing cardiac surgery.</p> / Doctor of Philosophy (PhD)

Chronic kidney disease is an urgent public health problem in the U.S., affecting 15% of all adults, and more than 740,000 have progressed to end-stage renal disease (ESRD), requiring life-sustaining renal replacement therapy (RRT). ESRD has devastating health, quality-of-life, and economic consequences, rendering most patients unable to maintain employment and costing Medicare $36 billion in 2017. Arguably, the most disadvantaged subgroup is the subset of patients that received no or minimal pre-ESRD nephrology care, which currently accounts for one third of the total ESRD population. This subgroup suffers increased morbidity and mortality, and has limited access to kidney transplantation, the optimal RRT. Despite this subgroup representing a large minority of the ESRD patient population, there has been no U.S.-based examination of their ESRD diagnosis experiences, coping styles and strategies, and RRT decision-making preferences. Therefore, we conducted a study that compared the ESRD diagnosis experiences, coping styles and strategies, and RRT decision-making preferences among patients with varying amounts of pre-ESRD nephrology care. We also assessed nephrologists’ current practices and perspectives on the manner and timing of RRT education for patients with varying amounts of pre-ESRD care. This mixed methods study provides a comprehensive understanding of the diagnosis experiences, coping styles and strategies, and RRT decision-making preferences of patients facing sudden and unexpected ESRD diagnosis. The study contributes important knowledge about this subgroup of patients that can influence and improve health care delivery. The results of this research will inform future intervention-based investigations to improve care for patients with minimal or no pre-ESRD nephrology care. / Public Health