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81	Avaliação da qualidade de vida do paciente renal crônico submetido à hemodiálise e sua adesão ao tratamento farmacológico de uso diário / Evaluation of the quality of life of end-stage renal patients submitted to hemodialysis and their adhesion to daily pharmacologic treatment. Terra, Fábio de Souza 23 March 2007 (has links) Made available in DSpace on 2016-05-02T13:54:42Z (GMT). No. of bitstreams: 1 Dissertacao completa Fabio de Souza Terra.pdf: 1253899 bytes, checksum: 97e2a9b443864eee5e5db5722e7f2770 (MD5) Previous issue date: 2007-03-23 / Coordenacao de Aperfeicoamento de Pessoal de Nïvel Superior / This study evaluated the QL of end-stage renal patients submitted to hemodialysis and their adhesion to daily pharmacologic treatment knowing their life expectancy and the main complications presented during HD It is an epidemiologic descriptive tranversal and quantitative research carried out at a hemodialysis clinic of a university hospital of Alfenas State of Minas Gerais Brazil with the participation of all the 30 dialysis patients in the period of the collection of data A questionnaire was used for the obtainment of data about the participants' characterization adhesion to pharmacologic treatment and life expectation QL was analyzed through the instrument WHOQOL-bref of the World Health Organization The data were tabulated in the statistical program SPSS version 10.0 and analyzed by means of the medium score with application of the following tests Qui-square Coefficient of Correlation of Pearson Test of Wilcoxon Student s t test Cronbach s Alpha Coefficient The results showed that most of the interviewees referred that HD interfered in their professional activities and in leisure and recreation but 53.33% were calm during the permanence in the clinic The most frequent complications were the arterial hypotension vomit and dizziness All the patients take medicines mainly antihypertensives With regard to knowledge of the indication of the medicines 40% of the dialysis patients know all the drugs that they take Thirty patients informed to take the medicines daily but 16.66% have already interrupted the treatment on their own account due to adverse reactions The average scores of QL were General QL 3.26 physical domain 3.10 psychological domain 3.58 social relationships 4.19 and environment 3.54 Therefore the participants of the study classified their QL as being above "neither bad, nor good" while the domain social relationships was evaluated between "good" and "very good" The variables did not interfere in the patients' QL in other words they did not present any correlation with the domains of WHOQOL-bref Through the reproducibility it was verified that the interviewees' QL was stable between the "test" and the "retest" having satisfactory reliability while the internal consistency of WHOQOL-bref was acceptable for the facets and domains indicating a homogeneity in the appraised items The main expectation of the patients' life is receiving a renal transplantation 82.35% are in the waiting list and 47.06% encountered the refusal of their relatives in donating the organ It can be verified that the instrument WHOQOL-bref showed to be effective to evaluate QL of end-stage renal patients submitted to HD thus being a reliable instrument for such a measure Finally dialysis patients will have a better QL when they are informed about their disease and treatment when cared for in a solid supportive system and rehabilitation in order to make them capable to lead an active productive and self-sufficient life / Este estudo avaliou a QV dos nefropatas crônicos submetidos à hemodiálise e sua adesão ao tratamento farmacológico de uso diário conhecer a expectativa de vida dessa população com relação ao futuro e as principais complicações apresentadas durante a HD Trata-se de uma pesquisa epidemiológica descritiva transversal e quantitativa realizada em uma clínica de hemodiálise de um hospital universitário de Alfenas-MG com todos os 30 pacientes submetidos à HD no período da coleta de dados Utilizou-se para a coleta um questionário com dados sobre a caracterização dos participantes adesão ao tratamento farmacológico e expectativa de vida e a QV foi analisada por meio do instrumento WHOQOL-bref da Organização Mundial da Saúde Os dados foram tabulados no programa estatístico SPSS versão 10.0 e analisados por meio do escore médio com aplicação dos seguintes testes Qui-quadrado Coeficiente de Correlação de Pearson Teste de Wilcoxon Teste t de Student Coeficiente Alfa de Cronbach Os resultados mostraram que a maioria dos entrevistados referiram que a HD interferiu em suas atividades profissionais e de lazer e recreação mas 53,33% se sentem tranqüilos durante a permanência na clínica As complicações de maior ocorrência foram a hipotensão arterial vômito e tontura Todos os pacientes fazem uso de medicamentos sendo os antihipertensivos os mais utilizados Quanto ao conhecimento da indicação dos medicamentos 40% dos renais crônicos conhecem todos os fármacos que usam Os 30 pacientes estudados informaram tomar os medicamentos diariamente mas 16,66% já interromperam o uso por conta própria devido a reações adversas Os escores médios referentes à QV foram QV geral 3,26 domínio físico 3,10 psicológico 3,58 relações sociais 4,19 e meio ambiente 3,54 Assim os participantes do estudo classificaram a QV como sendo acima do nem ruim nem boa enquanto o domínio relações sociais foi avaliado entre boa e muito boa As variáveis estudadas não interferiram na QV dos pacientes ou seja elas não apresentaram correlação com os domínios do WHOQOL-bref Por meio da reprodutibilidade verificou-se que a QV dos entrevistados foi estável entre o teste e o reteste tendo uma confiabilidade satisfatória enquanto a consistência interna do WHOQOL-bref foi aceitável para as facetas e domínios indicando uma homogeneidade nos itens avaliados A principal expectativa de vida dos pacientes é a realização do transplante renal sendo que 82,35% estão na lista de espera e 47,06% se depararam com a recusa dos familiares em doar o órgão Pode-se verificar que o instrumento WHOQOL-bref mostrou-se eficaz para avaliar a QV de renais crônicos submetidos à HD sendo confiável para essa medida Por fim o paciente submetido à HD terá uma melhor QV quando ele for informado acerca de sua doença e tratamento quando existir um sólido sistema de suporte e reabilitação e ser capaz de levar uma vida ativa produtiva e autosuficiente Hemodiálise Qualidade de Vida Insuficiência Renal Crônica WHOQOL Transplante Renal Adesão ao Tratamento Uso de Medicamentos Expectativa de Vida Hemodialysis Quality of Life End-stage Renal Disease WHOQOL Renal Transplant Adhesion to Treatment Use of Medicines Expectation of Life CNPQ::CIENCIAS DA SAUDE::ENFERMAGEM
82	Velikost jednotlivých lipoproteinových částic u různých patologických stavů / The size of individual lipoproteins in various pathological conditions Dušejovská, Magdaléna January 2017 (has links) Metabolic syndrome (MS) and end-stage renal disease (ESRD) represent two clinical- pathologic states with increased risk of atherosclerotic cardiovascular complications with considerable impact on the quality of life of the patients. The knowledge about the changes in distribution of individual lipoprotein subfractions could countribute to the estimation of risk of atherosclerosis development. The studies presented in this thesis aimed at analyses of subfractions of LDL and HDL in the abovementioned pathologic states; moreover, we tried to elucidate the associations of changes in lipoprotein subfractions with clinical as well as biochemical alterations. The Study I was a placebo controlled study observing the effect of polyunsaturated fatty acids of n-3 family (PUFA n-3) administration to patients with MS who were divided to statin-treated ones (36 patients), and those without statin therapy (24 probands). The Study II comprised of 57 patients with ESRD on high volume haemodiafiltration (HV-HDF). In this Study, the parameters after 5-year follow-up were compared with baseline characteristics. Also, we included comparisons with the control group of 50 age and sex matched patients without the signs of ESRD. In Study I, we observed lowering of triacylglycerol and cholesterol content in VLDL...
83	Vliv pohybové a nutriční a nutriční intervence na fyzickou zdatnost a QŽ jedinců v prvním roce po transplantaci ledviny / The effect of physical activity and nutrition interventions on physical fitness and quality of life during the first year after kidney transplantation Švagrová, Klára January 2013 (has links) UNIVERZITA KARLOVA V PRAZE FAKULTA TĚLESNÉ VÝCHOVY A SPORTU The effect of physical activity and nutrition interventions on physical fitness and quality of life during the first year after kidney transplantation Abstract of disertation Zpracovala: Mgr. Klára Švagrová Školitel: Prof. Ing. Václav Bunc, CSc. Školící pracoviště: Laboratoř sportovní motoriky Praha, 2012 ABSTRACT Kidney transplantation is the best known treatment of chronic kidney failure. However, it is often accompanied by a number of health complications. The transplantation itself positively affects both physical fitness and quality of life during the first year after the transplant surgery which are seriously diminished when compared to the healthy population. This improvement can be even enhanced by appropriate physical activity and nutrition interventions otherwise both the physical fitness and quality of life would start declining after the first post-transplant year again. The aim of this study was to confirm a positive effect of a long-term physical activity and nutrition interventions on health-related physical fitness and health-related quality of life in a representative sample of individuals in the first year after the kidney transplantation. At the same time it was fundamental to verify that the experimental trial can be...
84	Prävention des Nierenversagens und der Nierenfibrose bei hereditären Erkrankungen der glomerulären Basalmembran (Alport-Syndrom) bei COL4A3-Knockout-Mäusen mit dem Reninantagonisten Aliskiren / Prevention of renal failure and renal fibrosis in hereditary diseases of glomerular basement membrane (Alport-Syndrome) in COL4A3 knockout mice with Aliskiren a direct renin inhibitor Theisen, Stephanie 04 June 2012 (has links) No description available. 610 Medizin, Gesundheit MED 418 Nephrologie Medicine Renininhibitor Aliskiren Col4A3-Knockout-Mäuse Alport-Syndrom Kollagen Typ IV terminalen Nierenversagens chronische Nierenerkrankungen RAAS RAAS-Blockade ACE-Hemmer AT1-Antagonisten direct renin inhibitor Aliskiren COL4A3 knockout mice Alport Syndrome collagen type IV end-stage renal failure chronic nephropathie RAAS RAAS-Blocker ACE-Inhibitors AT1-Antagonists 44 Medizin 44.88 Urologie Nephrologie
85	Χαρακτηριστικά του τρόπου ζωής των ασθενών με χρόνια νεφρική ανεπάρκεια που υποβάλλονται σε θεραπεία υποκατάστασης της νεφρικής λειτουργίας με αιμοκάθαρση, περιτοναϊκή κάθαρση, ή έχουν υποβληθεί σε επιτυχή μεταμόσχευση νεφρού Παναγοπούλου, Αλκυόνη 07 June 2010 (has links) Η εργασία αυτή αποτελεί μία από τις πρώτες που ασχολήθηκαν με τη διερεύνηση του τρόπου ζωής των ασθενών με χρόνια νεφρική ανεπάρκεια τελικού σταδίου, οι οποίοι υποβάλλονται σε μέθοδο υποκατάστασης της νεφρικής λειτουργίας με αιμοκάθαρση ή περιτοναϊκή κάθαρση ή έχουν υποβληθεί σε επιτυχή μεταμόσχευση νεφρού στον Ελλαδικό χώρο και συγκρίνει τα αποτελέσματα με τα υπάρχοντα από ανάλογες εργασίες που έχουν επιτελεστεί στην Ευρώπη και στη Βόρειο Αμερική. Στο πρώτο μέρος της διατριβής έγινε αναφορά: α) στους νεφρούς και στη λειτουργία τους και β) στη διαχρονική εξέλιξη των μεθόδων υποκατάστασης της νεφρικής λειτουργίας. Στο δεύτερο μέρος αναφέρθηκαν τα γενικά χαρακτηριστικά των ασθενών σε υποκατάσταση και στη συνέχεια τα ιδιαίτερα χαρακτηριστικά ανάλογα με την μέθοδο υποκατάστασης της νεφρικής λειτουργίας, αιμοκάθαρση ,περιτοναϊκή κάθαρση ή μεταμόσχευση Στη συνέχεια για κάθε ομάδα ασθενών προσδιορίστηκαν: α) δημογραφικά χαρακτηριστικά (ηλικία, οικογενειακή κατάσταση, τόπος κατοικίας, γραμματικές γνώσεις, χρονικό διάστημα σε υποκατάσταση) β) επαγγελματική κατάσταση γ) δραστηριότητες και φυσική κατάσταση δ) κοινωνική κατάσταση (σεξουαλική ζωή, συμμετοχή στις κοινωνικές εκδηλώσεις, ικανοποίηση από τη ζωή, τις κοινωνικές παροχές, την ιατρική και νοσηλευτική φροντίδα, σχέσεις με οικογενειακό και φιλικό περιβάλλον ) ε) ψυχολογική κατάσταση ως προς το άγχος και την κατάθλιψη και ζ) έγινε σύγκριση των αποτελεσμάτων με αυτά από ανάλογες εργασίες που έχουν επιτελεστεί στον Ευρωπαϊκό και στον βόρειο-αμερικανικό χώρο. Από τα αποτελέσματα της διατριβής προκύπτει ότι από τις διάφορες μεθόδους αντιμετώπισης της ΧΝΝ τελικού σταδίου, η νεφρική μεταμόσχευση φαίνεται να υπερέχει, συμβάλλοντας σε καλύτερο βαθμό συνολικής αποκατάστασης, αφού εξασφαλίζει βελτιωμένη φυσική κατάσταση, καλύτερη επαγγελματική αποκατάσταση και κοινωνική ευεξία. Ακολουθούν οι ασθενείς υπό ΣΦΠΚ οι οποίοι φαίνεται να έχουν καλύτερη ψυχολογική προσαρμογή με λιγότερο stress, άγχος και κατάθλιψη, μεγαλύτερη αυτονομία και ανεξαρτησία. Αυτό τους διευκολύνει για καλύτερη κοινωνική προσαρμογή με μεγαλύτερες δυνατότητες και ευκαιρίες απασχόλησης και κοινωνικής δραστηριοποίησης. Αντίστοιχα η ζωή των ασθενών υπό ΑΚ επηρεάζεται ιδιαίτερα, ο τρόπος ζωής αλλάζει δραματικά σε όλους τους παραπάνω τομείς, αν και δείχνουν να προσαρμόζονται καλύτερα στις αντίξοες συνθήκες που βιώνουν έναντι των ασθενών άλλων χωρών. Πιο αναλυτικά τα αποτελέσματα της διατριβής ήταν τα παρακάτω: - Οι ασθενείς των ομάδων ΑΚ και ΣΦΠΚ είναι κυρίως ηλικιωμένα άτομα, ενώ οι μεταμοσχευμένοι ασθενείς είναι άτομα νεαρής ηλικίας. Ως προς την οικογενειακή κατάσταση και τον τόπο κατοικίας και οι τρεις ομάδες ακολουθούν την κατανομή του γενικού πληθυσμού. Οι γραμματικές γνώσεις των ασθενών των ομάδων ΑΚ και ΣΦΠΚ είναι κυρίως επιπέδου δημοτικού σχολείου, ενώ των μεταμοσχευμένων ασθενών επιπέδου γυμνασίου. Μεγαλύτερο χρονικό διάστημα σε θεραπεία υποκατάστασης παρουσιάζουν οι μεταμοσχευμένοι ασθενείς. - Οι μεταμοσχευμένοι ασθενείς παρουσιάζουν καλύτερη επαγγελματική αποκατάσταση και ακολουθούν οι ασθενείς υπό ΣΦΠΚ, ενώ το ποσοστό των ασθενών υπό Α/Κ που εργάζεται είναι πολύ μικρό. - Προβάδισμα στις δραστηριότητες, φυσική κατάσταση έχουν και πάλι οι μεταμοσχευμένοι ασθενείς έναντι των άλλων ομάδων και ακολουθούν οι ασθενείς υπό ΣΦΠΚ. - Οι μεταμοσχευμένοι ασθενείς παρουσιάζουν καλύτερο επίπεδο κοινωνικής κατάστασης. - Σε καλύτερη ψυχολογική κατάσταση βρίσκονται οι ασθενείς υπό ΣΦΠΚ και ακολουθούν με μικρή διαφορά οι μεταμοσχευμένοι. - Αντίστοιχα αποτελέσματα δίνουν έρευνες που έχουν γίνει σε ασθενείς σε άλλες Ευρωπαϊκές και Βόρειο-Αμερικανικές χώρες αν και οι ασθενείς της παρούσας έρευνας και των τριών ομάδων δείχνουν να έχουν καλύτερους δείκτες αναφορικά με τις παραπάνω παραμέτρους και να προσαρμόζονται καλύτερα στις αντίξοες συνθήκες που βιώνουν, έναντι των ασθενών άλλων χωρών. / The present work is one of the first dealing with the study of the lifestyle of patients with end stage renal failure, under renal function substitution with haemodialysis or peritoneal dialysis or successful kidney transplantation, in Greece, and compares this data with existing results from Europe and North America. In the first part of the thesis there is a presentation of: a) the kidneys and their function and b) the evolution of renal function substitution methods through time. In the second part, the general characteristics of the included patients are reported, followed by the specific characteristics due to the renal substitution methods, haemodialysis, peritoneal dialysis or transplantation. In every group of patients the following parameters were determined: α) demographic data (age, family status, place of living, education, time in renal substitution) β) job status γ) activities and physical status δ) social status (sex life, participation in social events, satisfaction due to life, social benefits, medical and nursery care, relations with friends and relatives) ε) psychology due to stress and depression ζ) comparison of these results with other from Europe and North America. The results of this work reveal that renal transplantation preponderates all other substitution methods for renal function, since it guarantees improved physical status, better job rehabilitation and social welfare. Patients in peritoneal dialysis come next in adaptation, with lesser stress anxiety and depression, bigger autonomy and independence. They have more possibilities and opportunities to work and participate in social activities. On the contrary, the lifestyle of renal patients under dialysis is more negatively affected and their lives changes dramatically in all of the above sections; even though they seem to adapt better in the adverse conditions they are dealing with. In detail, the results of this work are: - Patients under haemodialysis (HD) or peritoneal dialysis (PD) are older people, while transplanted patients are younger. All patients follow the general population distribution, as for family status and place of living. The education level of the HD and PD patients is mostly elementary, while, most transplanted patients have a high school degree. These patients have spent longer periods under renal substitution. - Transplanted patients present better job rehabilitation, followed by patients in PD, while the percentage of working patients in HD is too small. - Transplanted patients have a better physical condition, followed by PD patents. - Transplanted patients are in a better level of social status compared with other renal patients. - Patients in PD seem to have a better psychological profile slightly higher than transplanted patients. - Similar results are presented in other studies from Europe and North America, although patients of all groups, in the present work, show better indices as for the above parameters and adapt better in adverse living conditions, compared with patients of other countries. Ποιότητα ζωής Αιμοκάθαρση Περιτοναϊκή κάθαρση Μεταμοσχεύσεις Ψυχολογία Φυσική κατάσταση 362.196 614 Quality of life Lifestyle of patients Patients with end stage renal failure Hemodialysis Peritoneal dialysis Renal transplantation Psychology Job status Physical status
86	Hémodialyse quotidienne en France : caractéristiques, trajectoires, accès à la greffe et survie des patients / Daily hemodialysis in France : characteristics, trajectories, access to renal transplantion and patients' survival Pladys, Adélaïde 05 December 2016 (has links) L’augmentation de la fréquence hebdomadaire des séances d’Hémodialyse (HD) serait la technique qui se rapprocherait le plus du rôle physiologique des reins. L’Hémodialyse quotidienne (HDQ) a été développée afin d’améliorer la qualité de vie des patients ainsi que l’épuration sanguine. Néanmoins, son association avec la survie reste controversée et son lien avec l’accès à la greffe rénale n’avait jusqu’alors jamais été étudié. Par ailleurs, les connaissances en termes de pratiques en France étaient jusqu’à aujourd’hui très faibles. Dans ce contexte, cette thèse vise à caractériser les patients français en HDQ et leurs trajectoires en plus d’analyser l’association entre l’HDQ et la transplantation rénale et la survie des patients. Une étude épidémiologique a été menée à partir du Réseau en Epidémiologie et Information en Néphrologie (REIN) où ont été inclus tous les patients âgés ≥18 ans et qui ont démarré une séance d’HDQ entre 2003 et 2012 en France. L’extraction d’un certain nombre de données biocliniques de REIN a permis de montrer que les patients français en HDQ étaient caractérisés pour présenter des profils très hétérogènes. En effet, en fonction de l’âge médian (64 ans) deux sous-groupes de patients ont pu être comparés : les âgés (moyenne d’âge : 76,6 ± 6,9 ans) en mauvaises conditions médicales et qui décédaient rapidement ; les jeunes (moyenne d’âge : 47,2 ± 12 ans) qui étaient en HDQ avant d’accéder à la greffe. Par ailleurs, en fonction des trajectoires initiales, deux sous-groupes ont également pu être comparés : patients démarrant directement par HDQ (dHDQ, n=257) ; patients démarrant par un autre traitement (cHDQ, n=496). Ensuite, cette thèse a permis de montrer qu’en France, après l’inscription sur la liste, les patients en HDQ avaient une moindre probabilité d’accéder à la greffe que les patients en HD 3x/semaine (SHR=0,74 ; IC 95%: 0,58-0,95). Par ailleurs, après ajustement sur l’âge, le sexe et les comorbidités, l’HDQ était associée avec un sur-risque de décès (HR=1,58 ; IC 95%: 1,4-1,8) en comparaison avec l’HD 3x/semaine. Ce travail de thèse a permis d’élucider nos connaissances en termes de pratiques associées avec l’HDQ bien que les raisons pour lesquelles les patients démarrent une HDQ ne sont pas connues. Nous émettons l’hypothèse que les indications pour l’HDQ en France sont probablement différentes de celles appliquées dans d’autres pays, ceci pourrait expliquer nos résultats en termes de mortalité. / An increase frequency of weekly sessions of Hemodialysis (HD) should be more physiological than a conventional HD 3x/week. Daily Hemodialysis (DHD) was developed in order to enhance patients’ quality of life in addition to blood purification. Nevertheless, its effect on survival remains controversial and the association between DHD and the access to renal transplantation has never been evaluated. Moreover, knowledges about DHD practices in France were until today very poor. In this context, the aims of this thesis was firstly, to describe profiles of French patients on DHD and their initial trajectories; secondly to analyze the association between DHD and renal transplantation, then survival in comparison with conventional HD 3x/week. An epidemiologic study has been conducted based on Renal Epidemiology and Information in Nephrology (REIN) registry. Were included all patients aged ≥18 years who initiated a DHD between 2003 and 2012 in France. Bio-clinical data analyses showed that French patients were characterized to present various profiles. Indeed, according to the median age (64 years), two sub-groups were distinguished and compared: old (mean age: 76.6 ± 6.9 years) in bad medical conditions who died rapidly; young (mean age: 47.2 ± 12 years) waiting for renal transplantation. Moreover, according to the initial trajectories, two sub-groups were also constructed: patients starting directly with DHD (dDHD, n=257); patients starting with another dialysis before switching for DHD (cDHD, n=496). Then, this thesis allowed showing that in France and after being waitlisting, patients on DHD had lower probability of being renal transplanted (SHR=0.74; 95%CI: 0.58-0.95). Then, after the adjustment on sex, age and comorbidities, DHD was associated with a higher risk of death compared to conventional HD 3sessions/week. Reasons why a patient started a DHD are unknown, but this work allows us to enhance our knowledges in terms of medical practices associated with DHD. We hypothesized that DHD indications in France might be different from other countries which could explain our results in terms of mortality. Accès à la greffe Épidémiologie Hémodialyse quotidienne Insuffisance rénale chronique terminale Inscription sur la liste d’attente Profils de patients Néphrologie Survie Access to renal transplantation Access to the renal waiting list Daily hemodialysis End stage renal disease Epidemiology Nephrology Survival
87	Economic evaluation of a new genetic risk score to prevent nephropathies in type-2 diabetic patients Guinan, Kimberly 12 1900 (has links) Un score de risque polygénique (SRP) a été mis au point pour permettre une prédiction précoce du risque de néphropathie chez les patients atteints de diabète de type-2 (DT2). Le but de cette étude était d’évaluer l’impact économique de l’implantation du SRP pour la prévention de la néphropathie chez les patients atteints du DT2, par rapport aux méthodes de dépistage habituelles au Canada. Tout d’abord, une revue systématique de la littérature a été effectuée pour examiner les évaluations économiques publiées sur le DT2 et la néphropathie. Les principales techniques de modélisation observées dans cette revue ont été utilisées pour réaliser une analyse coût-utilité à l’aide d’un modèle de Markov. Les états de santé du modèle étaient la pré-insuffisance rénale (pré-IR), l’IR et le décès. Les paramètres d’efficacité du modèle ont été basés sur les résultats de l’étude ADVANCE. Les analyses ont été menées selon une perspective du système de soins et une perspective sociétale. Sur un horizon temporel de la vie entière du patient, le SRP était une stratégie dominante par rapport aux méthodes de dépistage habituelles, selon les deux perspectives choisies. En effet, le SRP était moins coûteux et plus efficace en termes d’années de vie ajustée en fonction de la qualité, par rapport aux techniques de dépistage usuelles. Les analyses de sensibilité déterministe et probabiliste ont démontré que les résultats demeurent dominants dans la majorité des simulations. Cette évaluation économique démontre que l’adoption du SRP permettrait de réduire les coûts et d’améliorer la qualité de vie des patients. / The current screening method for diabetic nephropathy (DN) is based upon the detection of urinary albumin and the decline of estimated glomerular filtration rate, which occurs relatively late in the course of the disease. A polygenic risk score (PRS) was developed for early prediction of the risk for type 2 diabetes (T2D) patients who experience DN. The aim of this study was to assess the economic impact of the implementation of the PRS for the prevention of DN in T2D patients, compared to usual screening methods in Canada. First, a systematic literature review was conducted to examine all published economic evaluations in T2D and DN. The main trends in modelling technics obtained from this review were used to conduct a cost-utility analysis using a Markov model. Health states include pre-end-stage renal disease (Pre-ESRD), ESRD and death. Model efficacy parameters were based on prediction of outcome data by polygenic-risk testing of the ADVANCE trial. Analyses were conducted from Canadian healthcare and societal perspectives. Over a lifetime horizon, the PRS was a dominant strategy compared to usual screening methods, from both a healthcare system and societal perspective. In other words, the PRS was less expensive and more effective in terms of quality-adjusted life years compared to usual screening technics. Deterministic and probabilistic sensitivity analyses showed that results remained dominant in the majority of simulations. This economic evaluation demonstrates that the adoption of the PRS would not only be cost saving but would also help prevent ESRD and improve patients’ quality of life. Néphropathie diabétique Insuffisance rénale Diabète de type 2 Score de risque polygénique Analyse coût-utilité Modèle de Markov Diabetic nephropathy End-stage renal disease Type 2 diabetes mellitus Polygenic risk score Cost-utility analysis Markov model
88	Sexual Dimorphism of Glomerular Capillary Morphology in Rats Coker, Zackarias 01 May 2023 (has links) (PDF) Chronic kidney disease (CKD) progresses faster in males than females; however, the underlying mechanisms remain poorly understood. Sex differences in glomerular capillary morphology has been hypothesized to contribute, in part, to the increased susceptibility to hypertension-induced renal injury and CKD progression in males, but this has not been investigated. The goal of the present study was to assess glomerular capillary morphology in male vs. female rats with intact kidneys and after uninephrectomy (UNX). We hypothesized that glomerular capillary radii (RCAP) and length (LCAP) would be greater in male rats. Male (n=4) and female (n=4) with intact kidneys and UNX (n=4 males, n=4 females) provided a 0.4% NaCl diet and water ad libitum. Kidneys were perfusion-fixed, the left kidney was excised, and a 3 mm transverse section through the midline of the kidney was selected for further processing. Multiple 1 mm3 cubes were randomly excised from the left, middle, and right regions of the outer cortex, embedded in EPONTM, sectioned (1 μm), and stained with toluidine blue. Four glomeruli from each region were randomly selected for stereological analysis. Glomerular tuft volume (VG), RCAP, and LCAP were assessed. In rats with intact kidneys, no significant sex differences were observed in VG, RCAP, or LCAP. VG, RCAP, and LCAP were significant greater in both male and female rats with UNX vs. respective rats with intact kidneys. In rats with UNX, males exhibited a significantly greater VG and LCAP, but not RCAP, as compared to females despite no significant differences in relative kidney weight. These data indicate that males exhibit greater compensatory increases in LCAP following UNX. The greater capillary length may lead to reduced podocyte density, a well-known mechanism that increases the susceptibility to CKD progression. Rats Chronic Kidney Disease Glomerular Capillaries Kidneys End Stage Renal Disease Podocytes Animal Experimentation and Research Animals Animal Structures Cardiovascular System Fluid Dynamics Human and Clinical Nutrition Male Urogenital Diseases Medical Biophysics Medical Physiology Other Physiology Physics Reproductive and Urinary Physiology Urogenital System Urology
89	BIRTHWEIGHT AND SUSCEPTIBILITY TO CHRONIC DISEASE Issa Al Salmi Unknown Date (has links) The thesis examines the relationship of birthweight to risk factors and markers, such as proteinuria and glomerular filtration rate, for chronic disease in postnatal life. It made use of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). The AusDiab study is a cross sectional study where baseline data on 11,247 participants were collected in 1999-2000. Participants were recruited from a stratified sample of Australians aged ≥ 25 years, residing in 42 randomly selected urban and non-urban areas (Census Collector Districts) of the six states of Australia and the Northern Territory. The AusDiab study collected an enormous amount of clinical and laboratory data. During the 2004-05 follow-up AusDiab survey, questions about birthweight were included. Participants were asked to state their birthweight, the likely accuracy of the stated birthweight and the source of their stated birthweight. Four hundred and twelve chronic kidney disease (CKD) patients were approached, and 339 agreed to participate in the study. The patients completed the same questionnaire. Medical records were reviewed to check the diagnoses, causes of kidney trouble and SCr levels. Two control subjects, matched for gender and age, were selected for each CKD patient from participants in the AusDiab study who reported their birthweight. Among 7,157 AusDiab participants who responded to the questionnaire, 4,502 reported their birthweights, with a mean (standard deviation) of 3.4 (0.7) kg. The benefit and disadvantages of these data are discussed in chapter three. The data were analysed for the relationship between birthweight and adult body size and composition, disorders of glucose regulation, blood pressure, lipid abnormalities, cardiovascular diseases and glomerular filtration rate. Low birthweight was associated with smaller body build and lower lean mass and total body water in both females and males. In addition low birthweight was associated with central obesity and higher body fat percentage in females, even after taking into account current physical activity and socioeconomic status. Fasting plasma glucose, post load glucose and glycosylated haemoglobin were strongly and inversely correlated with birthweight. In those with low birthweight (< 2.5 kg), the risks for having impaired fasting glucose, impaired glucose tolerance, diabetes and all abnormalities combined were increased by 1.75, 2.22, 2.76 and 2.28 for females and by 1.40, 1.32, 1.98 and 1.49 for males compared to those with normal birthweight (≥ 2.5 kg), respectively. Low birthweight individuals were at higher risk for having high blood pressure ≥ 140/90 mmHg and ≥ 130/85 mmHg compared to those with normal birthweight. People with low birthweight showed a trend towards increased risk for high cholesterol (≥ 5.5 mmol/l) compared to those of normal birthweight. Females with low birthweight had increased risk for high low density lipoprotein cholesterol (≥ 3.5 mmol/l) and triglyceride levels (≥ 1.7 mmol/l) when compared to those with normal birthweight. Males with low birthweight exhibited increased risk for low levels of high density lipoprotein cholesterol (<0.9 mmol/l) than those with normal birthweight. Females with low birthweight were at least 1.39, 1.40, 2.30 and 1.47 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases respectively, compared to those ≥ 2.5 kg. Similarly, males with low birthweight were 1.76, 1.48, 3.34 and 1.70 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases compared to those ≥ 2.5 kg, respectively. The estimated glomerular filtration rate was strongly and positively associated with birthweight, with a predicted increase of 2.6 ml/min (CI 2.1, 3.2) and 3.8 (3.0, 4.5) for each kg of birthweight for females and males, respectively. The odd ratio (95% confidence interval) for low glomerular filtration rate (<61.0 ml/min for female and < 87.4 male) in people of low birthweight compared with those of normal birthweight was 2.04 (1.45, 2.88) for female and 3.4 (2.11, 5.36) for male. One hundred and eighty-nineCKD patients reported their birthweight; 106 were male. Their age was 60.3(15) years. Their birthweight was 3.27 (0.62) kg, vs 3.46 (0.6) kg for their AusDiab controls, p<0.001 and the proportions with birthweight<2.5 kg were 12.17% and 4.44%, p<0.001. Among CKD patients, 22.8%, 21.7%, 18% and 37.6% were in CKD stages 2, 3, 4 and 5 respectively. Birthweights by CKD stage and their AusDiab controls were as follows: 3.38 (0.52) vs 3.49 (0.52), p=0.251 for CKD2; 3.28 (0.54) vs 3.44 (0.54), p=0.121 for CKD3; 3.19 (0.72) vs 3.43 (0.56), p= 0.112 for CKD4 and 3.09 (0.65) vs 3.47 (0.67), p<0.001 for CKD5. The results demonstrate that in an affluent Western country with a good adult health profile, low birthweight people were predisposed to higher rates of glycaemic dysregulation, high blood pressure, dyslipidaemia, cardiovascular diseases and lower glomerular filtration rate in adult life. In all instances it would be prudent to adopt policies of intensified whole of life surveillance of lower birthweight people, anticipating this risk. The general public awareness of the effect of low birthweight on development of chronic diseases in later life is of vital importance. The general public, in addition to the awareness of people in medical practice of the role of low birthweight, will lead to a better management of this group of our population that is increasingly surviving into adulthood. birth weight birthweight birth weight and renal volume BIRTH WEIGHT QUESTIONNAIRE chronic disease Barker Hypothesis Foetal development DOHaD gestational age Anthropometric Characteristics body composition Height weight body mass index Waist Circumference hip circumference Waist-hip Ratio obesity Central Obesity Fatness Lean Body Mass Lean Mass Fat Mass body fat mass Body Fat Percentage body fatness Body Surface Area diabetes Fasting Glucose fasting insulin level glucose tolerance Impaired Fasting Glucose Impaired Glucose Tolerance Glycosylated Hemoglobin HbA1c IFG glucose control glycaemic control Metabolic Syndrome Syndrome X blood pressure Systolic Blood-pressure Diastolic Blood-pressure Systolic Hypertension high blood pressure Hypertension Dyslipidaemia Dyslipidemia Total Cholesterol Triglyceride Low Density Lipoprotein Cholesterol Ldl Cholesterol High Density Lipoprotein Hdl Cholesterol Fibrinogen angina Angina-pectoris Stroke coronary artery disease cardiovascular disease Framingham Framingham Heart Study Framingham Score coronary heart disease Glomerular Filtration glomerular filtration rate Glomerular Hyperfiltration Glomerular Injury Glomerular Number Nephrogenesis Nephron Endowment Nephron Number NKF-K/DQQI Classification Chronic Kidney Disease (ckd) Chronic Kidney Failure Kidney Failure CKD STAGES end-stage renal disease (ESRD) end-stage renal failure Cockcroft-gault MDRD formula Serum Creatinine Urinary Creatinine albuminuria Albuminuria:creatinine Ratio Kidney Development Kidney dysfunction low birth weight low birth weight Pre-term Birth AusDiab Study case control longitudinal observational study
90	BIRTHWEIGHT AND SUSCEPTIBILITY TO CHRONIC DISEASE Issa Al Salmi Unknown Date (has links) The thesis examines the relationship of birthweight to risk factors and markers, such as proteinuria and glomerular filtration rate, for chronic disease in postnatal life. It made use of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). The AusDiab study is a cross sectional study where baseline data on 11,247 participants were collected in 1999-2000. Participants were recruited from a stratified sample of Australians aged ≥ 25 years, residing in 42 randomly selected urban and non-urban areas (Census Collector Districts) of the six states of Australia and the Northern Territory. The AusDiab study collected an enormous amount of clinical and laboratory data. During the 2004-05 follow-up AusDiab survey, questions about birthweight were included. Participants were asked to state their birthweight, the likely accuracy of the stated birthweight and the source of their stated birthweight. Four hundred and twelve chronic kidney disease (CKD) patients were approached, and 339 agreed to participate in the study. The patients completed the same questionnaire. Medical records were reviewed to check the diagnoses, causes of kidney trouble and SCr levels. Two control subjects, matched for gender and age, were selected for each CKD patient from participants in the AusDiab study who reported their birthweight. Among 7,157 AusDiab participants who responded to the questionnaire, 4,502 reported their birthweights, with a mean (standard deviation) of 3.4 (0.7) kg. The benefit and disadvantages of these data are discussed in chapter three. The data were analysed for the relationship between birthweight and adult body size and composition, disorders of glucose regulation, blood pressure, lipid abnormalities, cardiovascular diseases and glomerular filtration rate. Low birthweight was associated with smaller body build and lower lean mass and total body water in both females and males. In addition low birthweight was associated with central obesity and higher body fat percentage in females, even after taking into account current physical activity and socioeconomic status. Fasting plasma glucose, post load glucose and glycosylated haemoglobin were strongly and inversely correlated with birthweight. In those with low birthweight (< 2.5 kg), the risks for having impaired fasting glucose, impaired glucose tolerance, diabetes and all abnormalities combined were increased by 1.75, 2.22, 2.76 and 2.28 for females and by 1.40, 1.32, 1.98 and 1.49 for males compared to those with normal birthweight (≥ 2.5 kg), respectively. Low birthweight individuals were at higher risk for having high blood pressure ≥ 140/90 mmHg and ≥ 130/85 mmHg compared to those with normal birthweight. People with low birthweight showed a trend towards increased risk for high cholesterol (≥ 5.5 mmol/l) compared to those of normal birthweight. Females with low birthweight had increased risk for high low density lipoprotein cholesterol (≥ 3.5 mmol/l) and triglyceride levels (≥ 1.7 mmol/l) when compared to those with normal birthweight. Males with low birthweight exhibited increased risk for low levels of high density lipoprotein cholesterol (<0.9 mmol/l) than those with normal birthweight. Females with low birthweight were at least 1.39, 1.40, 2.30 and 1.47 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases respectively, compared to those ≥ 2.5 kg. Similarly, males with low birthweight were 1.76, 1.48, 3.34 and 1.70 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases compared to those ≥ 2.5 kg, respectively. The estimated glomerular filtration rate was strongly and positively associated with birthweight, with a predicted increase of 2.6 ml/min (CI 2.1, 3.2) and 3.8 (3.0, 4.5) for each kg of birthweight for females and males, respectively. The odd ratio (95% confidence interval) for low glomerular filtration rate (<61.0 ml/min for female and < 87.4 male) in people of low birthweight compared with those of normal birthweight was 2.04 (1.45, 2.88) for female and 3.4 (2.11, 5.36) for male. One hundred and eighty-nineCKD patients reported their birthweight; 106 were male. Their age was 60.3(15) years. Their birthweight was 3.27 (0.62) kg, vs 3.46 (0.6) kg for their AusDiab controls, p<0.001 and the proportions with birthweight<2.5 kg were 12.17% and 4.44%, p<0.001. Among CKD patients, 22.8%, 21.7%, 18% and 37.6% were in CKD stages 2, 3, 4 and 5 respectively. Birthweights by CKD stage and their AusDiab controls were as follows: 3.38 (0.52) vs 3.49 (0.52), p=0.251 for CKD2; 3.28 (0.54) vs 3.44 (0.54), p=0.121 for CKD3; 3.19 (0.72) vs 3.43 (0.56), p= 0.112 for CKD4 and 3.09 (0.65) vs 3.47 (0.67), p<0.001 for CKD5. The results demonstrate that in an affluent Western country with a good adult health profile, low birthweight people were predisposed to higher rates of glycaemic dysregulation, high blood pressure, dyslipidaemia, cardiovascular diseases and lower glomerular filtration rate in adult life. In all instances it would be prudent to adopt policies of intensified whole of life surveillance of lower birthweight people, anticipating this risk. The general public awareness of the effect of low birthweight on development of chronic diseases in later life is of vital importance. The general public, in addition to the awareness of people in medical practice of the role of low birthweight, will lead to a better management of this group of our population that is increasingly surviving into adulthood. birth weight birthweight birth weight and renal volume BIRTH WEIGHT QUESTIONNAIRE chronic disease Barker Hypothesis Foetal development DOHaD gestational age Anthropometric Characteristics body composition Height weight body mass index Waist Circumference hip circumference Waist-hip Ratio obesity Central Obesity Fatness Lean Body Mass Lean Mass Fat Mass body fat mass Body Fat Percentage body fatness Body Surface Area diabetes Fasting Glucose fasting insulin level glucose tolerance Impaired Fasting Glucose Impaired Glucose Tolerance Glycosylated Hemoglobin HbA1c IFG glucose control glycaemic control Metabolic Syndrome Syndrome X blood pressure Systolic Blood-pressure Diastolic Blood-pressure Systolic Hypertension high blood pressure Hypertension Dyslipidaemia Dyslipidemia Total Cholesterol Triglyceride Low Density Lipoprotein Cholesterol Ldl Cholesterol High Density Lipoprotein Hdl Cholesterol Fibrinogen angina Angina-pectoris Stroke coronary artery disease cardiovascular disease Framingham Framingham Heart Study Framingham Score coronary heart disease Glomerular Filtration glomerular filtration rate Glomerular Hyperfiltration Glomerular Injury Glomerular Number Nephrogenesis Nephron Endowment Nephron Number NKF-K/DQQI Classification Chronic Kidney Disease (ckd) Chronic Kidney Failure Kidney Failure CKD STAGES end-stage renal disease (ESRD) end-stage renal failure Cockcroft-gault MDRD formula Serum Creatinine Urinary Creatinine albuminuria Albuminuria:creatinine Ratio Kidney Development Kidney dysfunction low birth weight low birth weight Pre-term Birth AusDiab Study case control longitudinal observational study

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