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Background: South Africa [SA] has a growing burden of chronic kidney disease [CKD], with limited health resources. Cape Town offers a PD-First policy due to both limitations on haemodialysis slots and cost saving measures. This study aimed to compare health related quality of life [HRQOL] between haemodialysis [HD] and peritoneal dialysis [PD], given the lack of autonomy in modality choice and socioeconomic challenges our patients face. Methods: This cross-sectional study was performed at Groote Schuur Hospital between July 2015 and December 2016. Demographic, socio-economic variables and perception of safety were collected. HRQOL was assessed using the Kidney Disease Quality of Life-Short Form [KDQOL-SFTM] version 1.3. All data was compared between the two dialysis modalities. Results: 77 HD patients and 33 PD patients were included in the study (Total n=110). There were no significant differences in demographics. The median age was 42.5 years [IQR: 32.4-48.6] and 57.3% were female. HD patients had less pain [p=0.036], better emotional well-being [p=0.020] and better energy/fatigue score [p=0.015]. Both cohorts experienced impairment in physical health, with PD having significant limitation [p=0.05]. The only significant symptoms in the renal domain was that PD experienced more shortness of breath [p=0.0001]. Overall, patients in both groups had very poor socio-economic circumstances. Safety was a major concern with the majority reporting feeling unsafe in their homes. Conclusions: The patients in our dialysis service have very challenging social circumstances with high rates of poverty and profound safety concerns. Patients on PD scored worse in 4 HRQOL domains, possibly due to a lack of autonomy in dialysis modality choice and less frequent contact with dialysis staff to provide encouragement and support. Additional psychological and social support needs to be instituted to help improve our patient's wellbeing on PD.

There have been numerous reports of cardiovascular and pulmonary abnormalities in patients with cirrhosis and portal hypertension. The role of portal hypertension in the pathogenesis of pulmonary abnormalities in patients with liver disease has not been defined. The present study was therefore undertaken to clarify this. Pulmonary function, including exercise testing, was evaluated in two groups of patients, 11 with portal hypertension due to cirrhosis and 10 with extrahepatic portal vein thrombosis and normal liver histology. Carbon monoxide gas transfer (TLCOsb) was less than 75% of predicted values in four patients from each group. One patient from each group had clinical and catheter confirmed evidence of pulmonary hypertension. Abnormal cardiorespiratory responses to exercise occurred in three patients in the extrahepatic group. Two had associated low TLCOsb and one developed arterial desaturation on exercise. A similar pattern was seen in three patients with cirrhosis. All had low TLCOsb and one developed arterial desaturation during exercise. In the cirrhotic group however three additional patients showed reduction in Pa02 unassociated with elevated heart rate response on exercise. There was no significant correlation with the presence of autoimmune antibodies which appear to be a secondary phenomenon. Our results suggest that pulmonary hypertension is linked to the presence of portal hypertension. Reduction in arterial P02, appears to occur only in patients with liver disease, presumably on the basis of intrapulmonary shunting.

352 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (M.D. 1980) from the Dept. of Psychiatry, University of Adelaide

Thesis (Ph. D.)--Indiana University, 2006. / Includes bibliographical references. Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (Ph. D.)--Indiana University, 2006. / Includes bibliographical references.

Thesis (M.D)--Dept. of Clinical and Experimental Pharmacology, University of Adelaide, 1993. / Includes 4 published papers by the author as part of appendix 9. Includes bibliographical references (leaves 1-19 (second sequence)).

Thesis (doctoral)--Lund University, 1992. / Added t.p. with thesis statement inserted.

Thesis (doctoral)--Lund University, 1992. / Added t.p. with thesis statement inserted.

A thesis submitted to the Faculty of Medicine. University of the Witwatersrand. Johannesburg, for the Degree of Doctor of Philosophy / Abnormal cell membrane function and altered cellular cation homeostasis have been implicated in the pathogenesis of essential hypertension. The role of these factors in the aetiology of malignant hypertension is unknown. (Abbreviation abstract) / Andrew Chakane 2019