Introducción: En pacientes con Enfermedad Renal Crónica Terminal (ERCT), la mortalidad cardiovascular está asociada a la presencia de calcificaciones vasculares. Nuestro objetivo fue determinar la asociación entre la modalidad de diálisis y la presencia de calcificación en aorta abdominal en pacientes con ERCT. Métodos: Realizamos un estudio transversal mediante el censo de los pacientes de la unidad renal del Hospital Nacional Edgardo Rebagliati Martins (HNERM), Lima-Perú. Las calcificaciones se evaluaron con radiografías simples de abdomen lateral. Comparamos la proporción de sujetos con calcificaciones según modalidad de diálisis. Calculamos razones de prevalencia mediante la regresión log-binomial. Resultados: Enrolamos 224 pacientes de los cuales 75,4% (169/224) estaban en hemodiálisis y 24.6% (55/224) en diálisis peritoneal. La edad mediana fue 57 años y el 49.1% (110-224) eran mujeres. El 31.3% (70/224) tuvo calcificaciones en aorta abdominal. La modalidad de diálisis no presentó asociación significativa con la presencia de calcificaciones. Sin embargo, la significancia presento valores límites. Los niveles altos de paratohormona estuvieron asociados en forma independiente con las calcificaciones. Conclusiones: Nuestro estudio sugiere que la diálisis peritoneal podría asociarse a una mayor presencia de calcificaciones vasculares a comparación de la hemodiálisis por ser la significancia límite debido al pequeño tamaño muestral. La evaluación rutinaria de calcificaciones a lo largo del tratamiento de soporte dialítico debe ser promovida en esta población. / Background: Presence of vascular calcifications is associated to cardiovascular mortality in patients with terminal chronic renal disease (ESRD). The aim of the present study is to determine the association between dialysis modality and the presence of vascular calcification. Methods: Vascular calcification was detected by plain lateral abdominal radiograph. We calculated the proportion of vascular calcification associated whit dialysis modality obtaining adjusted prevalence ratios from logistic regression models in this cross- sectional study. Results: We studied a total of 224 patients, 75.4 % (169/224) were on hemodialysis and 24.6% (55/224) on continuous ambulatory peritoneal dialysis. The median age was 57 years –old and 49.1% (110-224) were female. Abdominal aortic calcification was detected in 31.3% (70/224). Higher parathyroid hormone level (PTH) was an independent factor associated whit vascular calcification. Conclusions: Our study suggests that peritoneal dialysis could be associated a higher presence of vascular calcification but we did not find a significance result due to small sample. The continuous evaluation in this group of patients must be encouraged to prevent further complications. / Tesis

Background: Bone and mineral metabolism disorders are common among end-stage renal disease (ESRD) patients, which could lead to hip fracture. It is unclear whether the hip fracture risk is different among patients on hemodialysis (HD) versus peritoneal dialysis (PD). This meta-analysis was conducted to evaluate the hip fracture risk in ESRD patients on HD, when compared to PD. Methods: A literature review was conducted in EMBASE, MEDLINE, and Cochrane databases through January 31, 2018 to identify studies that appraised the rate or risk of hip fracture among patients on HD, when compared to PD. Effect estimates from the individual studies were derived and consolidated utilizing random-effect, generic inverse variance approach of DerSimonian and Laird. Results: Five cohort studies with 1 276 677 ESRD patients were enrolled. HD status was associated with a significantly higher risk of hip fracture with the pooled odds ratio (OR) of 1.61 (95% confidence interval [CI] 1.50-1.73, I2 = 10.0%), compared with PD. When the analysis was limited to studies with confounder-adjusted analysis, the pooled OR of hip fracture among HD patients was 1.57 (95% CI 1.43-1.72, I2 = 13.6%). Funnel plots and Egger's regression test demonstrated no significant publication bias in our meta-analysis. Conclusions: Among ESRD patients, HD status is associated with a 61% higher risk of hip fracture compared to PD.

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The surgical management of renal masses involves either radical nephrectomy (RN) or partial nephrectomy (PN). The relationship between treatment choice and definitive outcomes of CKD are lacking. Our aim was to examine whether PN is associated with a lower risk of end-stage renal disease (ESRD) requiring renal replacement therapy (RRT). We performed a population-based, retrospective cohort study with data from administrative databases in the province of Ontario, Canada. We included individuals with renal cell carcinoma diagnosed between 1995 and 2010. Cox proportional hazards, propensity score, and competing risks models were used to assess the impact of treatment. PN compared to RN reduces the risk of ESRD in a modern cohort of patients (2003-2010). PN is associated with a lower risk of CKD, reduced cardiac morbidity, and improved overall survival. We provide further evidence for the benefit of PN compared to RN, particularly related to definitive outcomes of renal failure.

The surgical management of renal masses involves either radical nephrectomy (RN) or partial nephrectomy (PN). The relationship between treatment choice and definitive outcomes of CKD are lacking. Our aim was to examine whether PN is associated with a lower risk of end-stage renal disease (ESRD) requiring renal replacement therapy (RRT). We performed a population-based, retrospective cohort study with data from administrative databases in the province of Ontario, Canada. We included individuals with renal cell carcinoma diagnosed between 1995 and 2010. Cox proportional hazards, propensity score, and competing risks models were used to assess the impact of treatment. PN compared to RN reduces the risk of ESRD in a modern cohort of patients (2003-2010). PN is associated with a lower risk of CKD, reduced cardiac morbidity, and improved overall survival. We provide further evidence for the benefit of PN compared to RN, particularly related to definitive outcomes of renal failure.

It has been recognised that there is a need to get a better understanding of the user of technology in work as information technology progressively saturates users' everyday working environments. One motivating force has been a perceived need to link the design of new technology with the work actually being done. One way to do this has been to turn to ethnography as an analytic approach when studying work, and then try to relate the results to design in different ways. The main question in this thesis is precisely how technology is being used in everyday work activity. The individual papers include discussions about what the resulting analyses can do for design. The contributions from the analyses do nog guide design in any 'linear' way but can be brought to the 'design table' and serve as points of departures for design considerations.

Objective: To understand the experiences of the dialysis decision-making process from the perspective of the significant other, specifically their role, influencing factors and the supportive interventions of the interprofessional team. Method: An interpretive description qualitative study was conducted using individual interviews and results were triangulated with decisional conflict and decisional regret quantitative results. Results: Ten participants described their role as advocating, providing a positive outlook, ‘being with’ the patient, learning together, sharing opinions, and communicating about values, preferences, feasibility of options. Environmental factors that influenced decision making included unexpected life change, choosing life, and personal health problems. Factors related to implementation of the treatment modality decision were unanticipated events, relationship changes, recreational travel changes, and the caregiver role. Nursing interventions are required to realign treatment expectations. Relevance: Significant others have an important role in supporting the patient making the dialysis decision and are often instrumental in implementing the decision.

Ontario’s Chronic Disease and Prevention Framework (CDPM) is a framework aimed at improving health outcomes and reducing costs. Currently, there is a paucity of data examining diabetes management (DM) in peritoneal dialysis (PD) programs. This study, carried out in 2010-11, describes dietitians’ perspectives regarding DM in PD programs in Ontario. Purposeful sampling of dietitians employed in PD programs (n=18) resulted in a response rate of 86.6%. A web-based survey collected data on demographic characteristics of PD clients, program models, and program-specific data regarding facilitators and barriers to provision of dialysis-specific diabetes education. Statistical analysis was completed and responses to open-ended questions examined using thematic open-coding. Findings suggest three major themes: “walking the CDPM talk”, dietitians as “unrecognized CDPM champions” and “the missing pieces to the CDPM puzzle”. Results suggest that while many dietitians have embraced CDPM, their capacity to fully integrate it into their practices is limited by organizational- and system-level barriers. / UOIT

Despite the decreasing incidence of peritoneal dialysis (PD) peritonitis over time, its occurrence is still associated with adverse outcomes. This thesis focuses on determining factors associated with PD peritonitis in order to facilitate identification of patients at risk. Using data collected in a multicentre Canadian database between 1996 and 2005, the study population comprised 4,247 incident PD patients, of whom 1,605 had at least one peritonitis episode. Variables independently associated with peritonitis included age [rate ratio (RR) 1.04 per decade increase, 95% CI 1.01-1.08], Black race (RR 1.37, 95% CI 1.00-1.88) and having transferred from hemodialysis (RR 1.24, 95% CI 1.11-1.38). There was an interaction between gender and diabetes (p=0.011), with an increased peritonitis risk only among female diabetics (RR 1.27, 95% CI 1.10-1.47). Choice of continuous ambulatory PD vs. automated PD did not influence peritonitis risk. These results contribute to our understanding of peritonitis risk among PD patients.