Renal replacement therapy, in the form of dialysis or transplantation, is the cornerstone of management for end-stage renal disease. UK renal registry shows nearly half of those needing renal replacement therapy are treated by dialysis – predominantly by haemodialysis. Patients on renal replacement therapy have increased mortality risk compared to age matched general population. Moreover, some specific subgroups of patients on haemodialysis have increased risk of mortality than expected. The survival benefit seen in women in the general population is attenuated resulting in similar survival for men and women on haemodialysis therapy. In addition, obese individuals and those of non-Caucasian origin have better survival outcome. Though the underlying reason for these findings is not clear and is likely to be multi-factorial, it has been hypothesised that this paradox could be due to the current practice of normalising dialysis dose to total body water. A number of metabolic factors – body surface area, resting energy expenditure and total energy expenditure – have been proposed as alternative to total body water for scaling dialysis dose. There were two overarching aims of this work – one was to study the effect of declining renal function on resting and total energy expenditure and to study the influence of various energy expenditure measures on uraemic toxin generation. The second was to study the impact on survival outcome of using these alternate parameters for normalising dialysis dose and to derive dialysis dose adjustments based on these metabolic parameters. In order to study these aims, studies were designed to explore different aspects of energy expenditure measures along with a longitudinal study to examine the impact of these parameters on survival outcome. The relationship between energy metabolism, body composition and uraemic toxin generation was studied with a retrospective analysis of 166 haemodialysis patients in whom urea generation rate was used as surrogate marker of uraemic toxin generation. It was found that total energy expenditure and fat-free mass predicted uraemic toxin generation after adjustment for other relevant variables. This study provided the preliminary data which was useful in designing further studies for this work. The effect of renal function on resting and total energy expenditure was studied in 80 patients with varying stages of chronic kidney disease who were not on renal replacement therapy. Resting and total energy expenditures were measured directly using gold-standard methods. It was found that declining renal function did not have a significant influence on either of these measures. This supports the hypothesis that metabolic rate is the driving force for glomerular filtration rate and not vice-versa. The directly measured energy expenditure measures were also found to have a moderately strong relationship with urea generation rate in these patients not on renal replacement therapy. The impact of physical activity on uraemic toxin generation, and thereby dialysis requirement, was studied in a prospective cross-sectional study of 120 haemodialysis patients in whom the physical activity was measured by an accelerometer device. Results from the study showed physical activity level to be a significant predictor of uraemic toxin generation after adjustment for gender and body size differences. This study results stressed the importance of adjusting dialysis dose based on individual’s physical activity level. To study the impact of using metabolic factors as normalising parameter for scaling dialysis dose on survival outcome, a large-scale longitudinal study was conducted with 1500 maintenance haemodialysis patients recruited for the study. Dialysis dose-related parameters and survival outcomes were collected at baseline and at various time points during the follow-up period of 18 months. Study results were analysed in two parts - the theoretical basis for using these metabolic factors as scaling parameters was explored which showed that current minimum target dialysis dose risks under-dialysis in certain subgroups of patients and using these alternative parameters may provide a more equivalent dialysis dose across individuals of different body sizes and gender. With these results arguing for potential use of the alternative parameters, the impact on survival of using them were examined. It was found that all three parameters performed better than the current parameter (total body water) with regards to predicting mortality. Total energy expenditure was found to be the best parameter with the lowest hazard ratio for risk of death. The study data was also analysed to derive an algorithm for adjustment of minimum target dialysis dose based on body size and physical activity level. This newly derived minimum dose target was also shown to impact on survival with those underdialysed based on this criteria having poorer survival outcomes. To understand the impact of whole body protein turnover on resting energy expenditure and uraemic toxin generation, a cross-sectional study was conducted on 12 patients with advanced CKD – 6 each in pre-dialysis CKD and haemodialysis group. It was found that haemodialysis patients had higher rate of protein turnover compared to pre-dialysis patients. Whole body protein turnover was found to contribute significantly to resting energy expenditure and had a moderately strong relationship with urea generation rate. In the course of these studies, two questionnaire tools have been validated for use for clinical and research purposes – one is a self-report comorbidity questionnaire and the other, the Recent Physical Activity Questionnaire. The comorbidity questionnaire was developed as part of this work and was validated against Charlson Comorbidity Index. The Recent Physical Activity Questionnaire was validated for physical activity data collection and energy expenditure calculation against the gold-standard doubly labelled water method. In conclusion, it has been demonstrated that metabolic factors such as body surface area, resting energy expenditure and total energy expenditure are more closely related to uraemic toxin generation compared to total body water. It has also been demonstrated that physical activity contributes to metabolic waste production and may necessitate changes in dialysis requirement. It has been shown that these metabolic factors, when used as scaling parameter for dialysis dosing, may predict survival better than the current parameter in use. The algorithm for dialysis dose adjustment and the questionnaires validated in this work have provided novel tools for further research studies and clinical practice. The central hypothesis of this work is that some metabolic factors may be better markers of uraemic toxin generation compared to total body water. It is hypothesised that modifications in dialysis practice based on these factors may improve the quality of haemodialysis and favourably impact on survival outcome for patients with end-stage renal disease. The work presented here largely supports this hypothesis.

Intradialytic Hypotension (IDH) is the commonest complication of maintenance haemodialysis and is associated with increased morbidity and mortality. However, there is no standardised definition of IDH, making comparisons between studies difficult. This observational study with a total of 80 patients and over 600 dialysis sessions showed a poor correlation between symptoms and hypotension. Importantly, patients experienced low blood pressure without symptoms, so continuous intradialytic blood pressure monitoring is required to identify this asymptomatic group. In light of these findings, a revised definition of IDH is suggested. This study also aimed to identify predictors of IDH that could be detected in sufficient time to allow a mitigating intervention. A novel non-invasive alternative for continuous blood pressure monitoring is introduced which uses intra-fistula pressure data from the sensors sited in the extracorporeal circuit of the dialysis machine. Results show that in the majority of patients, changes in intra-fistula pressure correlate with blood pressure measurements obtained by a standard oscillometric device. To investigate whether IDH can be predicted, a photoplethysmogram (PPG) waveform was obtained from a pulse oximeter attached to the finger or ear. Continuous PPG monitoring of patients with IDH during dialysis demonstrated that some IDH episodes were predictable using the variation in the PPG baseline with respiration as a surrogate for low blood volume. Additionally, the area under the curve of the PPG waveform can be used as a surrogate for cardiac output and peripheral vascular tone, resulting in a reasonable predictor for potentially critical changes in blood pressure during dialysis. Individually, the novel metrics described here are limited in their identification of IDH in all patients affected, but in combination they may be used to develop a multi-parameter predictive model. The relative merits of personalised versus population-based models are explored and a conclusion is drawn that personalised multi-parameter data fusion modelling for haemodialysis patients would be an important area for future work.

Type 2 diabetes has reached epidemic proportions worldwide. The resulting increase in chronic and costly diabetes related complications has potentially catastrophic implications for healthcare systems, and economics and societies as a whole. One of the key pathological factors leading to type 2 diabetes is insulin resistance (IR), which is the reduced or impaired ability of the body to make use of available insulin to maintain safe glucose concentrations in the bloodstream. It is essential to understand the physiology of glucose and insulin when investigating the underlying factors contributing to chronic diseases such as diabetes and cardiovascular disease. For many years, clinicians and researchers have been working to develop and use model-based methods to increase understanding and aid therapeutic decision support. However, the majority of practicable tests cannot yield more than basic metrics that allow only a threshold-based assessment of the underlying disorder. This thesis gives an overview on several dynamic model-based methodologies with different clinical applications in assessing glycaemia via measuring effects of treatment or medication on insulin sensitivity. Other tests are clinically focused, designed to screen populations and diagnose or detect the risk of developing diabetes. Thus, it is very important to observe sensitivity metrics in various clinical and research settings. Interstitial insulin kinetics and their influence on model-based insulin sensitivity observation was analysed using data from the clinical pilot study of the dynamic insulin sensitivity and secretion (DISST) test and the glucose-insulin PK-PD models. From these inputs, a model of interstitial insulin dose-response that best links insulin action in plasma to response in blood glucose levels was developed. The critical parameters influencing interstitial insulin pharmacokinetics (PKs) are saturation in insulin receptor binding (αG) and the plasma-interstitium diffusion rate (nI). Population values for these parameters are found to be [αG, nI]=[0.05,0.055]. Critically ill patients are regularly fed via constant enteral (EN) nutrition infusions. The impact of incretin effects on endogenous insulin secretion in this cohort remains unclear. It is hypothesised that the identified SI would decrease during interruptions of EN and would increase when EN is resumed, where, for short periods around transition, the true patient SI would be assumed constant. The model-based analysis was able to elucidate incretin effects by tracking the identified model-based insulin sensitivity (SI) in a cohort of critically ill patients. Thus, changes in model-based SI given the fixed assumed endogenous secretion by the model would support the presence of an EN-related incretin effect in the population of non-diabetic, critically ill patients studied. The PD feedback-control model of Uen was designed to investigate endogenous insulin secretion amongst subjects with different metabolic states and levels of insulin resistance. The underlying effects that influence insulin secretion i.e. incretin effects were also defined by tracking the control model gain/response and the identified insulin sensitivity (SI) using intravenous (IV) bolus and oral glucose responses of insulin sensitivity tests. This new PD control model allowed the characterisation of both static (basal) and dynamic insulin responses, which defined the pancreatic β-cell glucose sensitivity parameters. However, incretin effects were unobserved during oral glucose responses as the PD control gains failed to simulate the true endogenous insulin secretion due to potentially inaccurate glucose appearance rates and low data resolution of glucose concentrations. The net effect of haemodialysis (HD) treatment on glycaemic regulation and insulin sensitivity in a critically ill cohort was investigated. It was hypothesized that the observed SI would decrease during HD due to enhanced insulin clearance compared to the model, and would be recaptured again when HD is stopped. The changes in model-based SI metric at HD transitions in a cohort of critically ill patients were evaluated. Significant changes of -29% in model-based SI was observed during HD therapy. However, there were insignificant changes when HD treatment was ended. Thus, the changes in model-based SI would thus offer a unique observation on insulin kinetics and action in this population of critically ill patients with ARF that would better inform metabolic care.

O procedimento dialítico em Unidade de Terapia Intensiva (UTI) tem evoluído muito nos últimos anos e exigido equipamentos precisos, materiais específicos e profissionais devidamente treinados. Tem havido um aumento progressivo desses procedimentos, sobretudo da Hemodiálise Veno-Venosa Contínua (CVVHD), o que tem gerado questionamentos, pois a limitação de recursos na área da saúde é um problema que atinge as organizações, gerando a necessidade de conhecer os custos da assistência prestada. Este trabalho teve como objetivos: caracterizar a clientela submetida ao tratamento dialítico com CVVHD em UTIs; levantar o tempo de duração dos procedimentos; calcular o custo de mão-de-obra dos enfermeiros e estimar o custo médio direto dos procedimentos. A pesquisa foi do tipo exploratória, descritiva, retrospectiva, documental com abordagem quantitativa. O estudo foi desenvolvido em um hospital-escola público no Município de São Paulo. A amostra constituiu-se de 93 procedimentos realizados em 50 pacientes. Para a coleta de dados, foi elaborado 1 instrumento com 2 partes: uma para o levantamento dos dados da clientela e duração do procedimento e outra para o levantamento e cálculo dos materiais, medicações e soluções utilizadas. Os resultados mostraram predominância do sexo masculino (62%), a idade média foi de 60,8 anos e o tempo de permanência na UTI foi em média 19,2 dias. A insuficiência renal aguda esteve presente em 76% dos pacientes e 24% apresentaram insuficiência renal crônica. Os principais motivos de internação na UTI foram: insuficiência respiratória (30%), rebaixamento do nível de consciência (18%), pós operatório (16%) e choque séptico (12%). A média de procedimentos foi de 1,9 por paciente e 86% evoluíram a óbito. A duração média foi de 26,6 horas variando de 1 a 80 horas. O custo total médio do procedimento foi de R$ 2.065,36 variando de R$ 733,65 a R$ 6.994,18. O custo de mão-de-obra direta do enfermeiro foi em média R$ 592,04 variando de R$ 22,50 a R$ 1.800,00 e representou 28,7% do custo total. O custo médio do material, medicação e solução foi R$ 1.473,32 com variação de R$ 711,15 a R$ 5.194,18 representando 71,3% do custo total. Houveram variações de custo em relação a quantidade de instalação/desligamento, quantidade de trocas de sistema, quantidade de trocas de dialisador capilar, tipos de soluções e anticoagulantes utilizados. Pelos resultados observa-se uma grande variabilidade dos custos desse procedimento. / Dialitic procedures performed in Intensive Care Unit ( ICU) have been showing continuous advances and consequently demanding appropriate and precision equipment, specific materials, and the most adequately trained professionals.Even though procedures as the continued veno-venous hemodialysis ( CVVHD)are routinely applied , they have been generating high financial expenditures within the healthcare system and thus affecting healthcare institutions which have to carefully assess the provided healthcare costs. The present study was intended to characterize patients submitted to dialitic treatment with CVVHD in ICUs; monitor procedure- time duration; estimate nurses´ labor wages; estim...ate the direct procedures mean costs. This investigation, of an exploratory, descriptive, retrospective and quantitative-documental nature was developed in a public teaching hospital located in the municipality of São Paulo, Brazil .Ninety-three procedures performed in 50 patients were analyzed. Data collection made use of a two-part instrument: one for the patients´data survey and procedure-duration, and the othe one , directed to analysis and cost estimatives of materials, medications, and used solutions. Findings showed the predominance of male patients ( 62%), mean age, 60.8 years, and mean ICU hospitalization time, 19.2 days; 76% of the patients presented acute renal insufficiency while 24% showed chronic renal insufficiency. Main reasons for ICU hospitalization were respiratory insufficiency ( 30%), reduced conscience level ( 18%), post-surgical referral (16%), and septic schock ( 12%). Median of procedures was of 1.9 per patient and 86% death occurrences. Mean procedure duration was 26.6 hours, ranging from 1 ( one) to 80 hours. Mean total expenditure was R$ 2.065,36, with varying amounts of R$ 733,65 to R$ 6.994,18. Direct nurses´wages was approximately R$ 592,04 which showed variations from R$22,50 to R$ 1.800,00, and represented 28.7% of total costs. Mean expenditures with material, medications, and solutions were R$1.473,32, varying from R$ 711,15 to R$ 5. 194,18, representing 71.3% of total costs. Cost variations were observed in the amount of times the equipment was set up and swithched off, number of system changes, number of capillary dialyzer changes, types of used solutions and anticoagulant administration. Viewing the described results, the high variability level involving those procedure costs could be observed.

Introduction: Haemodialysis (HD) is a treatment in which blood from the patient is lead through a tubing system into a dialysis device in a extracorporeal circuit. This circuit contains semipermeable membranes (dialyzer). Blood with uraemic toxins flows on one side, and a salt solution flows on the other side. The salt solution flushes away waste products that have passed the membrane by diffusion or convection through small pores. From there the blood returns to the patient through a tubing system that contains an air-trap and a sensor to avoid air contamination in the blood. Besides air contamination, this treatment is burdened with safety problems such as biocompatibility, electrical safety and mechanical safety. The aim of this thesis was to investigate the safety issues in haemodialysis devices regarding leakage current and air contamination during standard procedures and simulated fault conditions. Does the dialysis device constitute a risk for the patient? Methods: To determine the extent of leakage current in HD machines, measurements at the filter-coupling site were performed in vitro according to the safety standard, IEC 601-1, in 5 types of dialysis machines. To determine, in vitro, to what extent blood and priming fluid allowed leakage current to pass to the patient, leakage current were also measured in the blood lines. The blood line was filled with blood from donors or priming fluid in eight different runs. To determine if leakage current could influence biocompatibility, a Fresenius 2008C dialysis machine and 8 hemophan dialyzers were used. Blood lines contained about 400 ml heparinized blood from each of 8 different donors (in vitro). C3d was measured, in vitro, before start of a simulated dialysis and at 15, 30, 45 and 60 min. during standard dialysis procedure. Then 1.5 mA current was switched on and additional samples were drawn at 75 and 90 min. Some patients need a central dialysis catheter (CDC) for access, placed close to or within the heart. To analyze if leakage current during standard HD would influence the ECG, patients with CDC or with AV-fistula as access were investigated. To analyse if air contamination could occur without activating security alarms in the dialysis device, various modes of in vitro dialysis settings were studied, some using a dextran solution to mimic blood viscosity. Besides visual inspection an ultrasound detector for microemboli and microbubbles was also used. Results: The data showed leakage current at the filter coupling site that was significantly higher for some devices than for others. The leakage current could pass through blood and priming fluid. It exceeded the cardiac floating (CF)-safety limit (<50μA) at the top of the CDC using the test mains on applied part for saline (median 1008μA), for blood (median 610μA) and for a single fault condition using saline (median 68 μA) or blood (47 μA). The leakage current experiments showed that complement activation worsened as the leakage current increased. During standard dialysis arrhythmia could occur. Microbubbles were visible at the bottom of the air-trap and bubbles could pass the air-trap towards the venous line without triggering the alarm. During recirculation, several ml of air could be collected in an intermediate bag after the venous line. Ultrasound showed the presence of bubbles of sizes 2.5-50 μm as well as more than 50 μm silently passing to the venous line in all runs performed. In conclusion, the data showed that a leakage current in HD devices can be high enough to be a safety risk for the patient. This risk is greater if a single fault arises in the dialysis machine or another device connected to the same patient, or during mains contact to the patient. Then the current flow may be high enough to cause arrhythmia for the patient, especially when using a CDC. There is also reason for concern that micro bubble transmission may occur without inducing an alarm. These factors need to be looked over to improve safety regulations and optimize HD treatment and service schedules.

The main objective of this thesis is to contribute to the prevention and control of the cardiovascular risk, hydration state and nutritional state in dialysis patients using non-invasive electrical impedance measurements. The thesis is structured in three parts with the following objectives: 1) to establish electrical impedance reference data for healthy Cuban population, 2)to improve the diagnostic based on impedance methods in Cuban hemodialysis (HD)patients and 3) to develop the impedance methods for continuous ambulatory peritoneal dialysis patients (CAPD).Healthy population: We analyzed the impedance vector distribution using the Bioimpedance Vector Analysis (BIVA) for the three more representative race-ethnicities in Cuba. We measured 1196 healthy adult (689 M, 507 W, 18-70 yr). The 95% confidence ellipses were drawn using specific BIVA software for mean vectors of different races. Due to the close distribution of mean vectors that we found for the three race-ethnicities, we concluded that only one set of sex-specific tolerance ellipses can be used for the Cuban population.HD patients: The BIVA method was used in a sample of 74 HD patients in stable (without edema) and critical (hyper-hydrated and malnutrition) states in order to establish the relation between hyper-hydration and mortality. Stable group include 48 patients (28 M and 18 W), and critical group include 28 critical patients (16 M and 12 W). Student's t test and Hotelling's T2 test were used to analyse the separation of groups obtained by means of clinical diagnosis and those obtained by BIVA. A statistically significant difference was obtained (P < 0.05) in R/H, Xc/H and phase angle, PA. Critical patients (hyper-hydrated and malnutrition) were located below the inferior pole of the 75% tolerance ellipse, with PA lower than 4º. In conclusion, the BIVA method could be used to detect hyper-hydration state before edema appears, and to predict survival through PA. Advantages of the method are its simplicity, objectivity and that it does not require the definition of a patient dry weight.CAPD patients: Segmental impedance measurements were obtained using 9 configurations (7 longitudinal and 2 transversal) in 25 CAPD male patients.In a first study we analyzed Z, Z/H and ZBMI indexes. 23 male patients were classified according to the hydration state as normo-hydrated, group 0 (10 M) or hyper-hydrated, group 1 (13 M). Wilcoxon test was used to analyze the change in impedance produced by a PD session. Mann-Whitney U test was used to analyse the separation between groups obtained by means of clinical diagnosis and those obtained by Z, Z/H or ZBMI. Spearman correlation was used to study the correlation between impedance vectors in each segment and clinical assessment. Statistical significance was set at P < 0.05. Results show that ZBMI gives information about the specific resistivity of tissues and not about fluid and fat mass changes. BIVA separate hyper-hydrated and normo-hydrated patients. Transversal measurements in the leg region and longitudinal in the thorax region are useful to corroborate the hydration and nutritional state in CAPD patients.In a second study a new classification was performed. Group 0 has normo-hydrated patients (10 M) and group 1 includes patients (15 M) with varying degrees of hypertension, overhydration and high score on cardiovascular risk factors. Mann-Whitney U-test was used to compare the differences in clinical measurements, laboratory test, and bioimpedance measurements between groups. The Mahalanobis Distance (dM2) was calculated using a bidimensional space, using the resistance measurement, right-side (RRS/H) or thorax segment (RTH/H) and the BPmean. Hotelling's T2 test was used to analyzed difference between groups through (RTH/H, BPmean) and (RRS/H, BPmean) vectors. A statistically significant difference was obtained (P < 0.05) in both vectors. Group 1 showed a small dM2 with respect to a reference patient (a critical patient with acute lung oedema) with high BPmean and low values of RTH/H and RRS/H. Moreover, Group 0 showed a larger dM2 with respect to the reference patient with lower BPmean and higher values of RTH/H and RRS/H. All patients classified as hyper-hydrated leading to hypertension by clinical assessment were correctly classified using dM2(RTH/H, BPmean). We conclude that segmental bioimpedance of the thoracic region could be a simple, objective, non-invasive method of support to facilitate the clinical assessment in CAPD.

No description available.

Visame pasaulyje daugėja pacientų, sergančių galutiniu inkstų nepakankamumu. Daugiau negu 1 mln. tokių pacientų yra taikoma pakaitinė inkstų terapija, kuri yra gyvybę gelbstintis gydymas. Gydymas hemodializėmis išlieka dažniausia pakaitinės inkstų terapijos rūšimi visuose pasaulio regionuose. Nežiūrint per paskutinius dešimtmečius įvykusios didelės medicinos pažangos ir pagerėjusios dializių techninės bazės, vis dar išlieka didelis hemodializėmis gydomų pacientų sergamumas bei mirtingumas ir gana prasta gyvenimo kokybė. Jų išgyvenimas nėra vienodas skirtingose šalyse, nes skiriasi valstybių geografiniai, socialiniai ir ekonominiai ypatumai bei sveikatos apsaugos politika. Todėl labai svarbu kiekvienoje valstybėje nagrinėti tokių pacientų išgyvenimą ir išskirti būtent tai šaliai būdingus išgyvenimą lemiančius veiksnius, kad iš esmės būtų galima pagerinti šios didėjančios pacientų populiacijos gyvenimo prognozę ir kokybę. Daugelyje pasaulio valstybių veikia inkstų ligų registrai, renkantys duomenis ir analizuojantys įvairių lėtinių inkstų ligų stadijų dažnį, gydymo būdus, pacientų mirtingumą bei jų išgyvenimą. Lietuvoje kol kas nėra oficialaus inkstų ligų registro, todėl ilgai buvo nežinomi net pagrindiniai demografiniai sergančiųjų galutiniu inkstų nepakankamumu rodikliai. Todėl mūsų tyrimo tikslas buvo nustatyti pacientų, sergančių galutiniu inkstų nepakankamumu ir gydomų hemodializėmis, išgyvenimą bei su juo susijusius veiksnius. Į tyrimą įtraukti visi Lietuvos pacientai... [toliau žr. visą tekstą] / End-stage renal disease is highly prevalent worldwide, with more than 1 million patients undergoing renal replacement therapies, which are a life-saving treatment for such patients. Haemodialysis remains the most common treatment modality in all regions of the world. Despite many technical advances in the medical care and in the delivery of dialysis over the past years, mortality and morbidity of dialysis patients remains persistently high and their quality of life is rather poor. Survival rates differ among countries and registries. International differences in the mortality of dialysis patients are probably related to differences in population demographics, renal disease, lifestyle and socioeconomic status. Therefore, it is extremely important to investigate survival of such patients in each country and to identify characteristic risk factors in order to improve outcomes. In most countries, renal registries are responsible for end-stage renal disease data collection, analysis and reporting. There is no renal registry in Lithuania and regular information about patients on dialysis in Lithuania is not available. The aim of our study was to estimate the survival of patients on chronic haemodialysis in Lithuania and to identify associated risk factors. All patients who started chronic haemodialysis in Lithuania between 1 January, 1998, and 31 December, 2005, were enrolled. For the first time in Lithuania, survival of patients on chronic haemodialysis and associated risk factors... [to full text]

End-stage renal disease is highly prevalent worldwide, with more than 1 million patients undergoing renal replacement therapies, which are a life-saving treatment for such patients. Haemodialysis remains the most common treatment modality in all regions of the world. Despite many technical advances in the medical care and in the delivery of dialysis over the past years, mortality and morbidity of dialysis patients remains persistently high and their quality of life is rather poor. Survival rates differ among countries and registries. International differences in the mortality of dialysis patients are probably related to differences in population demographics, renal disease, lifestyle and socioeconomic status. Therefore, it is extremely important to investigate survival of such patients in each country and to identify characteristic risk factors in order to improve outcomes. In most countries, renal registries are responsible for end-stage renal disease data collection, analysis and reporting. There is no renal registry in Lithuania and regular information about patients on dialysis in Lithuania is not available. The aim of our study was to estimate the survival of patients on chronic haemodialysis in Lithuania and to identify associated risk factors. All patients who started chronic haemodialysis in Lithuania between 1 January, 1998, and 31 December, 2005, were enrolled. For the first time in Lithuania, survival of patients on chronic haemodialysis and associated risk factors... [to full text] / Visame pasaulyje daugėja pacientų, sergančių galutiniu inkstų nepakankamumu. Daugiau negu 1 mln. tokių pacientų yra taikoma pakaitinė inkstų terapija, kuri yra gyvybę gelbstintis gydymas. Gydymas hemodializėmis išlieka dažniausia pakaitinės inkstų terapijos rūšimi visuose pasaulio regionuose. Nežiūrint per paskutinius dešimtmečius įvykusios didelės medicinos pažangos ir pagerėjusios dializių techninės bazės, vis dar išlieka didelis hemodializėmis gydomų pacientų sergamumas bei mirtingumas ir gana prasta gyvenimo kokybė. Jų išgyvenimas nėra vienodas skirtingose šalyse, nes skiriasi valstybių geografiniai, socialiniai ir ekonominiai ypatumai bei sveikatos apsaugos politika. Todėl labai svarbu kiekvienoje valstybėje nagrinėti tokių pacientų išgyvenimą ir išskirti būtent tai šaliai būdingus išgyvenimą lemiančius veiksnius, kad iš esmės būtų galima pagerinti šios didėjančios pacientų populiacijos gyvenimo prognozę ir kokybę. Daugelyje pasaulio valstybių veikia inkstų ligų registrai, renkantys duomenis ir analizuojantys įvairių lėtinių inkstų ligų stadijų dažnį, gydymo būdus, pacientų mirtingumą bei jų išgyvenimą. Lietuvoje kol kas nėra oficialaus inkstų ligų registro, todėl ilgai buvo nežinomi net pagrindiniai demografiniai sergančiųjų galutiniu inkstų nepakankamumu rodikliai. Todėl mūsų tyrimo tikslas buvo nustatyti pacientų, sergančių galutiniu inkstų nepakankamumu ir gydomų hemodializėmis, išgyvenimą bei su juo susijusius veiksnius. Į tyrimą įtraukti visi Lietuvos pacientai... [toliau žr. visą tekstą]

INTRODUCTION AND AIM: Chronic renal failure patients are confronted with many challenges and often express feelings of being a burden to their families. Since the inception of haemodialysis in 1913, limited research has been conducted to explore the coping behaviours of the families of haemodialysed patients, especially in the South African context. The family’s inability to cope with the condition and treatment, may impact on their wellness as well as that of the family member on haemodialysis. In light of the limited research available on the coping behaviours of families of haemodialysed patients, this study set out to describe the coping behaviours using the mixed method. RESEARCH DESIGN AND METHOD: The study followed an explanatory mixed method approach with sequential design and was divided into two phases. Phase one addressed the first objective in identifying and describing the coping behaviours of the families using the Family Crisis Orientated Personal Scale (F–COPES) developed by McCubbin, Larsen and Olson. During phase two, the researcher conducted interviews to explore the coping behaviour identified in phase one. RESULTS: The mean scores of the subscales of the F–COPES scale ranged from 3.05 to 4.16 with reliability indices found to be within the normal range. The average mean score for the subscale “seeking spiritual support” measured highest at 4.16, followed by “mobilising the family to acquire and accept help” (M=3.94). “Acquiring social support” measured lowest at 3.05. Four categories emanated from the thematic analysis of the data from the second phase namely, challenges, coordinated care, support structures and beliefs about disease. CONCLUSION: The subscales “seeking spiritual support, mobilising the family to acquire and accept help, reframing and acquiring social support” showed concordance with the categories derived from the qualitative data analysis. Supporting evidence for “passive appraisal” as a sub–scale from the first phase and “challenges” as a category from the second phase could not be found. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2011.