Stress within healthcare environments can be the result of uncertainty, illness, or the environment itself. In order to promote better health outcomes for dialysis users, scientific literature advocates stress reduction within healthcare environments. Dialysis patients are subject to numerous stressors, including the threat of potential losses and lifestyle change. Studies have revealed that patients who suffer from chronic illness perceive different levels of quality of life than those who are considered healthy and because of these lifestyle changes they employ various coping mechanisms when dealing with stress. There is a rising movement to mitigate stress through the use of holistic healing, an approach that addresses a person’s mental, emotional, physical, and spiritual elements to create a total healing environment. In accordance with this growing movement, the intent of this practicum is to create an outpatient centre for Manitoba’s dialysis patients that increases their perceived quality of life. The inquiry process began by questioning dialysis patients and conducting observational research at the Winnipeg Health Sciences Centre. Literature and precedent reviews were conducted, and the design programme was developed. The result of this research-based design proposal is an outpatient hemodialysis centre located within the Winnipeg Health Sciences Centre that helps mitigate stress while patients attempt to cope with lifestyle changes. The resulting design is one that is warm, welcoming, home-like and comfortable, which is supported by the theories explained in the literature review. This environment provides a greater sense of control, creates positive distractions and allows spiritually evoking opportunities to take place for all users of this new facility.

Patient-related barriers may reduce the effectiveness of screening for depression. This study aimed to explore perceived barriers to participation in a Screening Program for Depression by hemodialysis patients. In a cross-sectional study of hemodialysis patients, the Perceived Barriers to Psychological Treatment questionnaire was used to measure barriers to the Screening Program. Of 160 participants, 73.1% perceived at least one barrier (95% CI, 66.2% to 80.0%). The most common barriers were concerns about the side effects of antidepressant medications (40%), concerns about having more medications (32%), feeling that the problem is not severe enough (23%), and perceiving no risk of depression (23%). A high depression score was an independent predictor of barriers related to perceiving no benefit of the Screening Program and psychological, social, and practical barriers. We believe that patient-related barriers need to be addressed before implementing any case identification and treatment program for depression.

Thesis (doctoral)--Lund University, 1995. / Added t.p. with thesis statement inserted.

Thesis (doctoral)--Lund University, 1995. / Added t.p. with thesis statement inserted.

Thesis (M.Tech.: Clinical Technology)- Dept. of Clinical Technology, Durban University of Technology, 2008. xviii, 160 leaves. / Anaemia being one of the most severe complications of end stage renal disease is presently being managed with treatment by recombinant erythropoietin (RHuEPO). Recombinant erythropoietin (RHuEPO) produced by recombinant human DNA technology (RHuEPO) is becoming a standard part of therapy in chronic renal failure. In such patients anaemia is a leading cause of morbidity and mortality. Haemodialysis patients have grown dependent on RHuEPO therapy due their anaemia. The assessment of native erythropoietin levels and the detection of antibody levels in blood in the study were carried out to assist in the clear target of the treatment of anaemia. Haemoglobin levels were monitored over a trial period of six months during the RHuEPO therapy. Ferritin, transferrin saturation (T Sats %) and transferrin levels were monitored accordingly. Monitoring of erythropoietin levels in haemodialysis patients has been one of the first done in our population group in South Africa. Forty haemodialysis patients on RHuEPO therapy and ten haemodialysis patients not on RHuEPO therapy and ten healthy individuals from the Haemodialysis unit at Addington Hospital, Durban, South Africa were recruited to participate in the trial. Blood samples were collected then were centrifuged at 5 degrees celsius. Plasma was isolated, stored and subsequently used in enzyme linked immunosorbent assay (ELISA). Two ELISA were set up, one to measure EPO level and another for anti EPO antibodies. The dilutions of 1:50 were selected to detect the presence of antibodies. These have all been done in duplicates. Optical density of each sample was measured using a microplate reader at 450nm. The haemodialysis patients receiving RHuEPO presented with higher EPO levels as compared to the haemodialysis patients not receiving RHuEPO and the healthy individuals. However, in the study the HB levels were not increased over the trial period with higher RHuEPO doses. Higher doses of RHuEPO therapy showed no clear increase in haemoglobin levels. From a total of forty patients, twelve patients (35%) in the months of August and eight (25%) in the month of November were tested positive for antibodies to RHuEPO. Using statistical analysis, no correlation was observed between the antibody levels and the erythropoietin levels. However, we did not test whether the antibodies found were neutralizing or not. Bioassays for EPO may be used for that purpose.

Made available in DSpace on 2016-05-17T16:51:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-11-30. Added 1 bitstream(s) on 2016-05-17T16:55:50Z : No. of bitstreams: 1 000863713_20171130.pdf: 826002 bytes, checksum: 97ca1ec4e89c4d115097e7a1bed80027 (MD5) Bitstreams deleted on 2017-12-01T14:40:48Z: 000863713_20171130.pdf,. Added 1 bitstream(s) on 2017-12-01T14:41:33Z : No. of bitstreams: 1 000863713.pdf: 1578984 bytes, checksum: 0146de305ae1f1f381ad8943c453bd0d (MD5) / O acesso à água de qualidade, livre de microrganismos patogênicos e de subprodutos potencialmente nocivos ao homem é um desafio constante do ser humano. Dentre os diversos microrganismos patogênicos, a presença daqueles pertencentes ao Reino Fungi tem chamado a atenção, principalmente em águas de hemodiálise, devido às consequências que a presença destes e de suas respectivas micotoxinas podem ocasionar a um paciente imunocomprometido. O presente trabalho teve como objetivo investigar a potencialidade de fotoânodos do tipo W/WO3 em sistemas de desinfecção fotoeletrocatalítica de águas contaminadas por Candida parapsilosis. Para isto, foram sintetizados eletrodos de trióxido de tungstênio usando anodização oxidativa através do crescimento eletroquímico de filmes de WO3 sobre W como substrato. O eletrodo proposto mostrou a formação de um filme homogêneo com nanoporos ao redor de 100nm, conforme a imagem de FEGSEM e apresentou um band gap em torno de 2,5 eV calculado a partir do gráfico de Tauc pelo método Kubelka-Munk. O material construído é fotoativo e A curva de Iph vs E sob radiação UV em NaCl 0,1 molL-1 revelou uma fotocorrente igual a 19 mA. Estudos da degradação de C. parapsilosis em NaCl 0,1 molL-1, pH 7, potencial igual a 1,5V e irradiação UV-Vis e Vis, condições previamente otimizadas, mostraram a morte das leveduras em 30 segundos de tratamento. Não foi verificada a formação significativa de cloro ativo nas condições empregadas assim como não há formação de íons clorato e perclorato durante a degradação fotoeletrocatalítica. Para as medidas fotoeletrocatalíticas realizadas no dialisato, verificou-se a morte microbiana em torno de 5 minutos e remoção de carbono orgânico total em torno de 73% e 45% para as soluções ácidas e básicas respectivamente. / The access to quality water, free of pathogenic microorganisms and potentially harmful to the community is a constant challenge of being human. Among the various pathogenic microorganisms, the presence of those belonging to the kingdom Fungi has drawn attention, especially in hemodialysis water, due to the consequences that the presence of these and their respective mycotoxins causes to an immunocompromised patient. The aim of this study was to investigate the capability of W/WO3 as photoanode in disinfection systems using photoelectrocatalysis in water contaminated by Candida parapsilosis. For this, tungsten trioxide was synthesized using electrodes via electrochemical anodization by the growth of WO3 films in tungsten foil as a substrate. The prepared electrode was characterized morphologically and electrochemically and was subsequently applied in a photoelectrochemical system. The FEMSEM image showed a formation of a homogeneous film in the surface foil with nanopores around 100 nm. There was obtained a band gap of 2.5 eV calculated from Tauc's plot of the Kubelka-Munk method and photocurrent observed in NaCl 0.1 molL-1 was equal to 19 mA. Studies of C. parapsilosis degradation in NaCl 0.1 molL-1, pH 7, the potential equal to 1.5V and irradiating UV-Vis and Vis, previously optimized conditions, showed the death of yeast at 30 seconds of treatment. There was no significant formation of active chlorine under the conditions employed just as there is formation of chlorate and perchlorate ions during photoelectrocatalytic degradation. For photoelectrocatalytics measurements in the dialysate, there was microbial death in about 5 minutes and removal of total organic carbon at around 73% and 45% for acidic and basic solutions, respectively.

Made available in DSpace on 2014-06-11T19:28:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-02-23Bitstream added on 2014-06-13T19:16:04Z : No. of bitstreams: 1 montanha_la_me_botfm.pdf: 512315 bytes, checksum: 07667b0129d624f39611f9893cdc115a (MD5) / O tratamento dialítico, especificamente a hemodiálise, é a modalidade mais usada na atualidade. Ela envolve procedimentos especializados de alto risco pelas possibilidades dos efeitos terapêuticos colaterais. O estudo teve como objetivo descrever as características epidemiológicas dos 130 pacientes atendidos no Serviço de Hemodiálise do Hospital das Clínicas da Faculdade de Medicina da UNESP-Botucatu-SP. A população foi composta pelos pacientes em programa regular de hemodiálise. Os dados foram coletados no período de abril a julho de 2011. Utilizou-se como instrumento um questionário com 30 perguntas, fechadas e abertas, bem como o banco de dados eletrônico (Data Rim) e os prontuáriosportfólio existentes no serviço. A coleta de dados foi realizada pelo pesquisador após autorização do Comitê de Ética, com o parecer nº 82/11 CEP-FMB. Os dados foram analisados pela estatística descritiva. Para os 130 pacientes, verificou-se que: o gênero predominante foi o masculino (66 pacientes - 50,77%); a faixa etária estava acima de 60 anos (42,31%); a renda familiar da maioria dos pacientes estava na faixa de até três salários mínimos (76,93%); os 59 aposentados representaram índice igual a 45,38%. Os pacientes que disseram residir na zona urbana foram 91,54%; a ocupação de origem em serviços agropecuários em geral foi indicada por 47 pacientes (36,16%). Dentre as doenças de base, a nefropatia diabética (43,07%) foi seguida pela nefropatia hipertensiva (26,14%). Quanto aos fatores de risco para doença renal (DR), o tabagismo apresentou-se com importante índice (50,77%). Como doenças primárias, teve-se a glomerulonefrite (30,00%) e, como doenças sistêmicas associadas à DR, verificaram-se a hipertensão arterial sistêmica (HAS) (80,77%) e diabetes mellitus (DM) (45,38%). Quanto às doenças do trato urinário... / Dialytic therapy, and hemodialysis in particular, is the most frequently used treatment modality at present. It involves high-risk specialized procedures due to the possibility of therapy side effects. This study aimed at describing the epidemiological characteristics of the 130 patients assisted at the Hemodialysis Service of the Botucatu School of Medicine University Hospital - UNESP - SP. The population consisted of the patients undergoing the regular hemodialysis program. Data were collected from April to July, 2011. A questionnaire with 30 open and closed questions, an electronic database (Data Rim) and medical portfolio-charts existing in the service were used for data collection, which was performed by the researcher after authorization from the Research Ethics Committee, according to authorization letter no. 82/11 CEP-FMB. The data were analyzed by descriptive statistics. For the 130 patients, it was observed that: they were predominantly males (66 patients - 50.77%); the age range was above 60 years (42.31%); most patients’ family income was in the range of up to three minimum salaries (76.93%); 59 pensioners represented a percentage of 45.38%. The patients who reported to live in the urban area comprised 91.54%; an original occupation in general agricultural and cattleraising jobs was reported by 47 patients (36.16%). Among base diseases, diabetic nephropathy (43.07%) was followed by hypertensive nephropathy (26.14%). As regards risk factors for kidney failure (KF), smoking showed an important rate (50.77%). Glomerulonephritis (30.00%) was found as a primary disease, and systemic arterial hypertension (SAH) (80.77%) and diabetes mellitus (DM) (45.38%) were observed as a systemic diseases associated with KF. Concerning urinary-tract diseases, nephrolithiasis (11.54%) was recorded. Of the 130 patients undergoing... (Complete abstract click electronic access below)

Made available in DSpace on 2014-06-11T19:24:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2003Bitstream added on 2014-06-13T20:28:10Z : No. of bitstreams: 1 brant_jrac_me_botfmvz.pdf: 709608 bytes, checksum: c83a8fba5a9def3cde2a2a989d66dac5 (MD5) / Durante a realização das sessões de hemodiálise (HD) observam-se alterações relacionadas à coagulação, pelo contato do sangue do paciente com os circuitos extracorpóreos. Essas alterações podem ser decorrentes da ativação dos mecanismos intrínsecos da cascata de coagulação sangüínea, que resultam na formação de trombos. No modelo hemodialítico, utilizam-se substâncias anticoagulantes com a finalidade de prevenir a formação destes trombos. A substância padrão utilizada para anticoagulação em HD é a heparina sódica. As heparina de baixo peso molecular (HBPM) são fragmentos da heparina sódica com muitas vantagens. Exibe uma biodisponibilidade maior, possui menor ligação com proteínas plasmáticas e meia vida superior, resultando desta maneira, menor risco de sangramento. O objetivo principal desta pesquisa foi comparar e avaliar a heparina sódica com HBPM em cães submetidos à HD. Utilizou-se 14 cães que foram divididos em 2 grupos. O primeiro grupo, foi utilizada a heparina sódica e o segundo grupo a HBPM. Para avaliação do sistema hemostático dos animais foram colhidas amostras de sangue durante o período de 3 horas em 4 momentos distintos (M1, M2 e M3) e 24 horas (M4) após o término das sessões de hemodiálise para a realização de provas de coagulação como: tempo de tromboplastina parcial ativada (TTPA), tempo de protombina (TP), tempo de coagulação ativada (TCA), prova Anti-Xa e hemograma completo. Neste estudo a dose padronizada de heparina foi de 100UI/Kg/IV/Bolus com repetição de o da dose 60 e 120 minutos após o inicio, e 125 U anti-Xa/Kg/IV/Bolus com repetição de ? da dose após 90 minutos para HBPM. De acordo com os resultados obtidos nesta pesquisa pode-se concluir que não existiram diferenças estatisticamente significantes quando se utiliza a heparina sódica e HBPM como substâncias anticoagulantes... . / Coagulation disturbances, with thrombus formation, are common in hemodialysis due to activation of the intrinsic mechanism of the coagulation cascade. Anticoagulant substances are used for preventing thrombus formation. Heparin is the standard substance used for this purpose. However, heparin has troublesome pharmacokinetics, its clearance is dose dependent, it is highly protein bound and a minimum or threshold level is necessary to achieve an antithrombotic effect. Low molecular weight heparins are depolymerized preparations of heparin with multiple advantages over heparin. They exhibit less binding to cells and proteins and have superior bioavailability, a longer plasma half life and more predictable dose-response characteristics and carry a lower risk of hemorrhage and the immune mediated thrombocytopenia is less common. This research was planned to compare the effect of the low molecular weight heparin with the standard heparin in dogs submitted do hemodialysis. 14 dogs divided in two groups were studied.Group 1 used heparin 50 UI/Kg/IV Bolus with o of the initial dose repeated at 60 and 120 minutes after the beginning of the experiment. Group 2 used Low molecular weight heparin (Nadroparin) 125 U anti aX/kg//IV with a 1/3 of the initial dose repeated 90 minutes after the beginning of the experiment.Blood samples were drawn at 3 hours interval called (M1, M2,M3) and at 24 hours (M4) after ending the hemodialysis session.The coagulation system of the dogs was evaluated by the aPTT, PTT, aCT, aX and hemogram. The patency of the dialytic system was also evaluated. Our results showed no statistically significant differences between the two heparins, and the dose of the low-molecular-weight heparin was standardized for hemodialysis in dogs.

Orientador: Magda Cristina Queiroz Dell'Acqua / Banca: Luis Cuadrado Martin / Banca: Heloísa Cristina Quatrini Carvalho Passos Guimarães / Resumo: O tratamento dialítico, especificamente a hemodiálise, é a modalidade mais usada na atualidade. Ela envolve procedimentos especializados de alto risco pelas possibilidades dos efeitos terapêuticos colaterais. O estudo teve como objetivo descrever as características epidemiológicas dos 130 pacientes atendidos no Serviço de Hemodiálise do Hospital das Clínicas da Faculdade de Medicina da UNESP-Botucatu-SP. A população foi composta pelos pacientes em programa regular de hemodiálise. Os dados foram coletados no período de abril a julho de 2011. Utilizou-se como instrumento um questionário com 30 perguntas, fechadas e abertas, bem como o banco de dados eletrônico (Data Rim) e os prontuáriosportfólio existentes no serviço. A coleta de dados foi realizada pelo pesquisador após autorização do Comitê de Ética, com o parecer nº 82/11 CEP-FMB. Os dados foram analisados pela estatística descritiva. Para os 130 pacientes, verificou-se que: o gênero predominante foi o masculino (66 pacientes - 50,77%); a faixa etária estava acima de 60 anos (42,31%); a renda familiar da maioria dos pacientes estava na faixa de até três salários mínimos (76,93%); os 59 aposentados representaram índice igual a 45,38%. Os pacientes que disseram residir na zona urbana foram 91,54%; a ocupação de origem em serviços agropecuários em geral foi indicada por 47 pacientes (36,16%). Dentre as doenças de base, a nefropatia diabética (43,07%) foi seguida pela nefropatia hipertensiva (26,14%). Quanto aos fatores de risco para doença renal (DR), o tabagismo apresentou-se com importante índice (50,77%). Como doenças primárias, teve-se a glomerulonefrite (30,00%) e, como doenças sistêmicas associadas à DR, verificaram-se a hipertensão arterial sistêmica (HAS) (80,77%) e diabetes mellitus (DM) (45,38%). Quanto às doenças do trato urinário... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Dialytic therapy, and hemodialysis in particular, is the most frequently used treatment modality at present. It involves high-risk specialized procedures due to the possibility of therapy side effects. This study aimed at describing the epidemiological characteristics of the 130 patients assisted at the Hemodialysis Service of the Botucatu School of Medicine University Hospital - UNESP - SP. The population consisted of the patients undergoing the regular hemodialysis program. Data were collected from April to July, 2011. A questionnaire with 30 open and closed questions, an electronic database (Data Rim) and medical portfolio-charts existing in the service were used for data collection, which was performed by the researcher after authorization from the Research Ethics Committee, according to authorization letter no. 82/11 CEP-FMB. The data were analyzed by descriptive statistics. For the 130 patients, it was observed that: they were predominantly males (66 patients - 50.77%); the age range was above 60 years (42.31%); most patients' family income was in the range of up to three minimum salaries (76.93%); 59 pensioners represented a percentage of 45.38%. The patients who reported to live in the urban area comprised 91.54%; an original occupation in general agricultural and cattleraising jobs was reported by 47 patients (36.16%). Among base diseases, diabetic nephropathy (43.07%) was followed by hypertensive nephropathy (26.14%). As regards risk factors for kidney failure (KF), smoking showed an important rate (50.77%). Glomerulonephritis (30.00%) was found as a primary disease, and systemic arterial hypertension (SAH) (80.77%) and diabetes mellitus (DM) (45.38%) were observed as a systemic diseases associated with KF. Concerning urinary-tract diseases, nephrolithiasis (11.54%) was recorded. Of the 130 patients undergoing... (Complete abstract click electronic access below) / Mestre

nÃo hà / O transplante renal à a terapia que oferece maior sobrevida e melhor qualidade de vida (QV) para pacientes com doenÃa renal crÃnica (DRC). Entretanto, mundialmente observa-se carÃncia de ÃrgÃos para realizaÃÃo de transplantes ocasionando grande tempo de permanÃncia dos pacientes em terapia dialÃtica. Objetivos: Identificar mudanÃa de nÃvel de QV e verificar associaÃÃo de variÃveis com nÃvel inicial e mudanÃa de QV em portadores de DRC submetidos à hemodiÃlise (HD) durante seguimento de 24 meses. Materiais e mÃtodos: A amostra foi formada pelos pacientes em HD regular na Ãnica unidade de diÃlise da regiÃo norte do CearÃ, Brasil. Foram incluÃdos maiores de 18 anos, nunca submetidos a transplante renal e com pelo menos trÃs meses sob terapia dialÃtica. Cento e sessenta e quatro pacientes foram submetidos a uma avaliaÃÃo e tiveram seus dados analisados de forma transversal. Noventa e dois foram submetidos a pelo menos duas avaliaÃÃes e foram analisados longitudinalmente. Ao serem incluÃdos no estudo os pacientes tiveram seus dados demogrÃficos, clÃnicos e laboratoriais coletados; foram classificados de acordo com grau de comorbidade pelo Ãndice de Khan; e foram submetidos ao instrumento de medida de QV SF-36. Anualmente os pacientes eram re-avaliados laboratorialmente e submetidos à nova avaliaÃÃo pelo instrumento SF-36. RegressÃo linear pelo mÃtodo stepwise foi utilizada para estimar a correlaÃÃo entre as variÃveis e o nÃvel inicial de QV. A mudanÃa de nÃvel de QV foi determinada pela anÃlise de variÃncia para medidas repetidas com uso de co-variÃveis (ANCOVA) considerando pontuaÃÃo inicial e final, e pelo cÃlculo da taxa de variaÃÃo mensal (pontuaÃÃo final menos pontuaÃÃo inicial com divisÃo do resultado pelos meses de seguimento). As variÃveis contÃnuas foram testadas quanto a sua associaÃÃo com mudanÃa de QV por regressÃo linear, e as variÃveis categÃricas pela estratificaÃÃo da amostra de acordo com a taxa de variaÃÃo mensal em trÃs grupos: melhora, piora, e sem mudanÃa. Resultados: O nÃvel de QV apresentou melhora em relaÃÃo Ãs dimensÃes Aspectos sociais (63,8 vs. 75,0; p=0,001), Aspectos emocionais (39,7 vs. 63,1; p<0,001) e SaÃde mental (63,1 vs. 69,0; p=0,009). Entre os pacientes com baixo grau de comorbidade, alÃm das dimensÃes citadas, houve melhora das dimensÃes Capacidade funcional (56,7 versus 63,5; p=0,014) e Dor (56,7 vs. 66,5; p=0,009). Idade e albumina foram as principais variÃveis correlacionadas com nÃvel inicial de QV. A idade se associou negativamente com as oito dimensÃes de QV: Capacidade funcional (r=-0,312; p<0,001), LimitaÃÃo por aspectos fÃsicos (r=-0,262; p<0,001), Dor (r=-0,157; p=0,049), Estado geral de saÃde (r=-0,232; p=0,003), Vitalidade (r=-0,298; p<0,001), Aspectos sociais (r=-0,293; p=<0,001), LimitaÃÃo por aspectos emocionais (r=-0,260; p=0,001) e SaÃde mental (r=-0,217; p=0,006). O nÃvel de albumina se correlacionou positivamente com Capacidade funcional (r=0,218; p=0,006), Dor (r=0,276; p<0,001), Estado geral de saÃde (r=0,268; p<0,001), Vitalidade (r=0,270; p<0,001) e Aspectos sociais (r=0,250; p=0,001). A idade e o nÃvel de creatinina se correlacionaram com mudanÃa do nÃvel de QV estimada pela taxa de variaÃÃo mensal. A idade se associou negativamente com Dor (r=-0,031; p=0,024), explicando 9,0% da variaÃÃo, e creatinina se correlacionou positivamente com Estado geral de saÃde (r=0,096; p=0,040), explicando 4,6% da variaÃÃo. Mais mulheres do que homens evoluÃram com piora da Capacidade Funcional [19 (50,0%) vs. 11 (21,2%); p=0,006]. ConclusÃes: Houve melhora dos aspectos mentais de qualidade de vida entre os pacientes. Essa melhora deve ser encarada como fator favorÃvel para implementaÃÃo de intervenÃÃes sobre os aspectos fÃsicos de qualidade de vida, com especial atenÃÃo aos pacientes do sexo feminino e com maior grau de comorbidade. O avanÃar da idade e nÃveis baixos dos marcadores do estado nutricional (albumina e creatinina) devem ser considerados indicadores de risco para pior nÃvel de QV. / Kidney transplantation is the therapy that offers longest lifetime and best quality of life (QL) in patients with chronic kidney disease (CKD). However, worldwide there is lack of organs to transplant, causing the need for long-term dialysis therapy. Objectives: To identify changes in QL level and verify the association between variables and initial level and changes in QL in CKD patients undergoing hemodialysis (HD) during a follow-up of 24 months. Materials and methods: The sample consisted of patients undergoing regular HD in the only renal unit in the north of Cearà state, Brazil. We included those older than 18 years who never had kidney transplant and had been under dialysis at for least three months. Hundred and sixty-four patients were submitted to one evaluation and their data composed a transversal analysis. Ninety-two were submitted at least to two evaluations and were studied by longitudinal analysis. At baseline we collected demographic, clinical and laboratory data; classified the patients according to comorbidity by the Khan index; and submitted them to the SF-36 questionnaire in order to measure QL. Every year the patients were re-evaluated with laboratory tests and submitted again to the SF-36. Linear regression by the stepwise method was used to estimate the correlation between variables and initial level of QL. Change in QL level was detected by analysis of variance using co-variables (ANCOVA), considering the initial and final scores, and by the monthly variation rate (final minus initial score divided by number of months of follow-up). Continuous variables were tested for their association with change in QL by linear regression, and the categorical variables were stratified according to monthly variation rate into three groups: improving, worsening, and no change. Results: QL level improved with respect to Social functioning (63.8 vs. 75.0; p=0.001), Role-emotional (39.7 vs. 63.1; p<0.001) and Mental health (63.1 vs. 69.0; p=0.009). Among low comorbidity patients, besides improvement in these dimensions, there was improvement in Physical functioning (56.7 vs. 63.5; p=0.014) and Bodily pain (56.7 vs. 66.5; p=0.009). Age and albumin were strong correlators due to the initial QL level. Age was negatively associated with all eight QL dimensions: Physical functioning (r=-0,312; p<0,001), Role-physical (r=-0,262; p<0,001), Bodily pain (r=-0,157; p=0,049), General health (r=-0,232; p=0,003), Vitality (r=-0,298; p<0,001), Social functioning (r=-0,293; p=<0,001), Role-emotional (r=-0,260; p=0,001) and Mental health (r=-0,217; p=0,006). Albumin was positively associated with: Physical functioning (r=0,218; p=0,006), Bodily pain (r=0,276; p<0,001), General health (r=0,268; p<0,001), Vitality (r=0,270; p<0,001) and Social functioning (r=0,250; p=0,001). Age and creatinine level were associated with changes in QL estimated by monthly variation rate. Age was negatively associated with Bodily pain (r=-0,031; p=0,024), responsible for 9.0% of its variation, and creatinine was positively correlated with General health (r=0,096; p=0,040), responsible for 4.6% in its variation. More women than men worsened in Physical functioning [19 (50.0%) vs. 11 (21.2%); p=0.006]. Conclusions: There was improvement in mental aspects of QL among the patients. This improvement should be seen as a favorable factor to implement interventions aimed at the physical aspects of QL, with special attention to women and high-grade comorbidity patients. Ageing and low level of the laboratory markers related to nutritional status (albumin and creatinine) should be considered as risk markers of poorer QL level.