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.

Intra-dialytic haemodynamic instability is a common and disabling problem which may lead to morbidity and mortality though repeated organ ischaemia, but it has proven difficult to link any particular blood pressure threshold with hard patient outcomes. The relationship between blood pressure and downstream organ ischaemia during haemodialysis has not been well characterised. Previous attempts to predict and prevent intra-dialytic hypotension have had mixed results, partly due to patient and event heterogeneity. Using the brain as the indicator organ, we aimed to model the dynamic relationship between blood pressure, real-time symptoms, downstream organ ischaemia during haemodialysis, in order to identify the most physiologically grounded, prognostic definition of intra-dialytic decompensation. Following on from this, we aimed to predict the onset of intra-dialytic decompensation using personalised, probabilistic models of multivariate, continuous physiological data, ultimately working towards an early warning system for intra-dialytic adverse events. This was a prospective study of 60 prevalent haemodialysis patients who underwent extensive, continuous physiological monitoring of haemodynamic, cardiorespiratory, tissue oxygenation and dialysis machine parameters for 3-4 weeks. In addition, longitudinal cognitive function testing was performed at baseline and at 12 months. Despite their use in clinical practice, we found that blood pressure thresholds alone have a poor trade off between sensitivity and specificity for predicting downstream tissue ischaemia during haemodialysis. However, the performance of blood pressure thresholds could be improved by stratification for the presence or absence of cerebral autoregulation, and personalising thresholds according to the individual lower limit of autoregulation. For patients without autoregulation, the optimal blood pressure target was a mean arterial pressure (MAP) of 70mmHg. A key finding was that cumulative intra-dialytic exposure to cerebral ischaemia, but not to hypotension per se, corresponded to change in executive cognitive function over 12 months. Therefore we chose cerebral ischaemia as the definition of intra-dialytic decompensation for predictive modelling. We were able to demonstrate that the development of cerebral desaturation could be anticipated from earlier deviations of univariate physiological data from the expected trajectory for a given patient, but sensitivity was limited by the heterogeneity of events even within one individual. The most useful phys- iological data streams included peripheral saturation variance, cerebral saturation variance, heart rate and mean arterial pressure. Multivariate data fusion techniques using these variables created promising personalised models capable of giving an early warning of decompensation. Future work will involve the refinement and prospective testing of these models. In addition, we envisage a prospective study assessing the benefit of autoregulation-guided blood pressure targets on short term outcomes such as patient symptoms and wellbeing, as well as longer term outcomes such as cognitive function.

End-stage renal disease patients have a greatly increased risk of cardiovascular disease partly attributed to the elevated levels of systemic inflammation observed in uraemia. One of the key mechanisms underlying inflammation appears to be the immune dysfunction that afflicts almost every aspect of the uraemic immune system. As a consequence patients experience immunosuppression and reduced responsiveness to antigen as well as a simultaneous over-activation leading to a pro-inflammatory environment. In addition, the haemodialysis (HD) treatment itself induces a proinflammatory response but may provide an otherwise opportune time to complete supervised exercise.

Chronic renal failure (CRF) is a slow and gradual decline of renal function and it constitutes a major public health problem in our country. The haemodialysis treatment is the standard to which these patients are submitted. Despite increasing the survival of the patient, it is unable to fully correct the metabolic disorders. This procedure has amplified oxidative stress, which is very common among patients with CRF. These disorders added to the oxidative stress are the main factors that can trigger the development of vascular diseases. And these are the main cause of morbidity and mortality in these patients. It is also important to study the nutrition condition in these patients, related to vitamins and carotenoids, since exogenous antioxidants could potentially have a protective role against vascular diseases. In this study it was quantified the blood levels of vitamin A (retinol), vitamin E (α-and γ-tocopherol), carotenoids (lycopene, lutein, zeaxanthin, β -cryptoxanthin, α-and β -carotene),biomarkers of oxidative stress, as reduced glutathione (GSH), malondialdehyde (MDA), δ-aminolevulinate dehydratase (ALA-D), glutathione peroxidase (GPx), catalase (CAT) and superoxide dismutase (SOD), and some biochemical parameters (urea, creatinine, lipid profile : total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides and their relation) in patients with CRF submitted to the treatment of haemodialysis (HD) (n = 29) and a group of healthy subjects (control group, n = 20). The levels of retinol were significantly increased in haemodialysis patients. Among carotenoids, only the α- carotene and lycopene showed a significant decrease in patients. The plasma MDA and erythrocyte GSH levels and the activities of enzymes SOD and CAT were increased in HD, unlike the GPx and ALA-D that were reduced. The biochemical parameters urea and creatinine levels were increased, as observed in the parameters of the lipid profile (total cholesterol, LDL and triglycerides), already the HDL cholesterol was decreased. The total cholesterol / cholesterol HDL and LDL cholesterol / HDL cholesterol also known as coronary risk index were increased about three times in haemodialysis patients. Besides, the retinol showed negative correlation with the enzyme ALA-D and positive correlations with the MDA, SOD and CAT. The levels of lycopene had negative correlations with the MDA, LDL cholesterol and with LDL cholesterol / HDL cholesterol. The results obtained suggest that HD patients have some disorders for some vitamins, carotenoids and endogenous enzymes. Among the vitamins, the retinol appears in high concentrations and act as an oxidant agent / pro-oxidant. Among the carotenoids, the low concentrations of lycopene may represent an additional factor in atherogenesis, since it has antioxidant and hypocholesterolemic activity. / A insuficiência renal crônica (IRC) é uma lenta e progressiva diminuição da função renal sendo um dos principais problemas de saúde pública do nosso país. A hemodiálise é o tratamento padrão aos quais estes pacientes são submetidos. Apesar de aumentar a sobrevida do paciente, ele é incapaz de corrigir totalmente os distúrbios metabólicos. Esse procedimento acaba amplificando o estresse oxidativo muito comum em pacientes com IRC. Esses distúrbios somados ao estresse oxidativo são os principais fatores que podem desencadear o desenvolvimento de doenças vasculares e, sabe-se que estas são as principais causadoras de morbidade e mortalidade nestes pacientes. Por outro lado, é importante estudar a condição micronutricional nestes pacientes, relacionada a vitaminas e carotenóides, uma vez que, substâncias exógenas potencialmente antioxidantes poderiam exercer um papel protetor contra as doenças vasculares. Por isto, a avaliação conjunta dos níveis de algumas vitaminas, carotenóides, parâmetros do estresse oxidativo e ainda parâmetros bioquímicos em pacientes com IRC submetidos ao tratamento de hemodiálise são relevantes. Neste estudo foram quantificados os níveis sangüíneos de vitamina A (retinol), vitamina E (α-e γ- tocoferol), carotenóides (licopeno, luteína, zeaxantina, β-criptoxantina, α- e β-caroteno); biomarcadores do estresse oxidativo, como glutationa reduzida (GSH),malondialdeído (MDA), atividade das enzimas δ-aminolevulinato desidratase (ALA-D), glutationa peroxidase (GPx), catalase (CAT) e superóxido dismutase (SOD), e alguns parâmetros bioquímicos (uréia, creatinina; perfil lipídico: colesterol total, colesterol LDL, colesterol HDL e triglicerídeos e suas relações) em pacientes com IRC submetidos ao tratamento de hemodiálise (HD) (n=29) e em um grupo de indivíduos saudáveis (grupo controle; n=20). Os níveis de retinol foram significativamente aumentados nos pacientes HD. Dos carotenóides, apenas o licopeno e o α- caroteno apresentaram diminuição significativa nos pacientes. Os níveis de MDA plasmático e GSH eritrocitária e as atividades das enzimas SOD e CAT estavam aumentados nos HD; diferentemente da GPx e da ALA-D que estavam diminuídas. Em relação aos parâmetros bioquímicos, os níveis de uréia e creatinina estavam aumentados, assim como os parâmetros do perfil lipídico (colesterol total, LDL e triglicerídeos), o colesterol HDL estava diminuído. A relação colesterol total/colesterol HDL e colesterol LDL/colesterol HDL também conhecidos como índice de risco coronariano estavam aumentados cerca de três vezes nos pacientes hemodialisados. Ainda, o retinol apresentou correlação negativa com a enzima ALA-D e correlações positivas com o MDA, SOD e CAT. Os níveis de licopeno apresentaram correlações negativas com o MDA, colesterol LDL e com a relação colesterol LDL/ colesterol HDL. Através dos resultados obtidos os pacientes HD apresentam algumas desordens em relação a algumas vitaminas, carotenóides e enzimas endógenas. Dentre as vitaminas, o retinol em concentrações elevadas pode ser sugerido como um agente oxidante/pro-oxidante. Dentre os carotenóides, baixas concentrações de licopeno podem representar um fator adicional na aterogênese, pois possui tanto ação antioxidante quanto hipocolesterolêmica.

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.

Bakgrund: Kronisk njursvikt är ett tillstånd som i senare stadium kräver dialysbehandling. Hemodialys är den mest förekommande typen av dialysbehandling och den sker vanligtvis på en sjukhusavdelning. Hemodialys medför olika komplikationer och biverkningar som kan upplevas jobbiga för patienten. Utöver biverkningar får patienten också vätske- och dietrestriktioner. Dessa faktorer påverkar patiens dagliga liv. Syfte: Syftet är att beskriva patienters upplevelser av att leva med hemodialys vid kronisk njursvikt. Metod: Metoden som använts är en litteraturbaserad studie. Resultat: Resultatet presenteras genom tre huvudkategorier. Patienter beskriver skilda upplevelser av hur hemodialys påverkas kroppen, både till det positiva och negativa. Under behandling uppkommer existentiella tankar och känslor som relaterar till den egna dödligheten. Patienter beskriver att de söker stöd hos både anhöriga och hos vårdpersonal men att det kan vara svårt att diskutera existentiella tankar. Konklusion: Hemodialysbehandlingen har en begränsand effekt på patienters liv, de upplever en ökad känsla av ensamhet. En central faktor för att patienter ska kunna finna stöd är att de känner tillit och trygghet i personalen som vårdar dem. / Background: Chronic kidney disease in later stages demands dialysis-treatment. Haemodialysis is the most common type of dialysis and is usually performed at a hospital ward. Haemodialysis brings different complications and side effects that can be perceived tough for patients. Beyond the side effects the patients also receives fluid and diet restrictions. These factors affects the patient’s everyday life. Aim: The aim is to describe patients, with chronic kidney disease, experiences of living with haemodialysis. Method: The method of choice is a literature-based study. Result: The result is presented in three main categories. Patients describes different experiences of how haemodialysis affects the body, both positive and negative. During the treatment different existential thoughts and feelings related to the own mortality appears. Patients describes that they seek support with both related and health personnel but that it can be tough to talk about existential thoughts. Conclusion: Haemodialysis treatment had a limiting effect on patient’s life, they experience an increased feeling of loneliness. A central factor for patients to be able to find support was that they feel reliance and trust in health personnel.

Bakgrund: Hemodialys är en behandling som är aktuell vid kronisk njursvikt då njurarnas renande funktion ej längre fungerar och behöver ersättas. Behandlingen är tidskrävande och påverkar patienten både fysiskt och psykiskt. Patienten kan upplevda någon form av lidande och det är sjuksköterskans ansvar att främja hälsa och välbefinnande genom att förmedla kunskap och information samt att främja delaktighet och ta patientens autonomi i beaktande. Syfte: Beskriva patienters erfarenheter av sin vardag när de behandlas med hemodialys. Metod: Litteraturbaserad med grund i analys av kvalitativ forskning. Resultat: Ur analysen framkom två huvudkategorier; Hemodialysen styr vardagen och Anpassar till ett förändrat liv med sju tillhörande underkategorier. Slutsats: Restriktioner bidrog till svårigheter att hantera sin vardag. Behov av kunskap för att hantera vardagen var viktigt och sjuksköterskans bemötande påverkar patienten både positivt och negativt. Patienter erfar sin vardag olika och vissa hanterar den bra, upplever hälsa och meningsfullhet medan andra känner lidande och har ingen motivation för att kunna hantera vardagen. / Background: Haemodialysis can replace the filtration function of the kidneys when needed at end-stage renal disease. It is a treatment that causes suffering of different types and consumes a lot of time and has a physical and psychological effect. Knowledge, information, autonomy and participation are of importance for patients perceptions of wellbeing and the nurse has a supporting role. Aim: To describe patient’s experiences of their daily life when on haemodialysis. Method: Literature based with analysis of qualitative studies. Result: From the analysis two main categories emerged; Haemodialysis control daily life and Adapting to a different life, with seven subcategories. Conclusion: Restrictions in daily life was difficult to manage and the patients needed knowledge to be able to go through the day. The behaviour of the nurse had an influence on the patient, both positive and negative. Every patient experience their daily live different when on haemodialysis and some manage well and felt healthy while some suffered and felt illness and had no motivation.

Intracellular calcium is a major determinant of a wide variety of cell functions and thus of organ function. In order to get a clear picture of the intracellular calcium status it is preferable to assess the content of the various intracellular calcium pools as well as the characteristics of the transmembrane calcium movements, Le., the magnitude of the transmembrane Ca2+ flux upon stimulation and the rate of the subsequent return to baseline levels. The first aim of this study was to establish and evaluate the methods in the laboratory. The methods investigated include atomic absorption spectrometry, graphite furnace atomic absorption spectrometry and inductively coupled plasma mass spectrometry for the determination of the total cell calcium content, fluorescence spectrophotometry for the determinations of intracellular free Ca2+ and transmembrane Ca2+ movements and transmission electron microscopy for the localisation of intracellular calcium. The methods eventually identified as feasible included fluorescence spectrophotometry for the determination of intracellular free Ca2+ and transmembrane Ca2+ movements and transmission electron microscopy for the localisation of intracellular calcium. The newly developed fluorescent calcium indicator, fura-PE3, was presently shown to be the most reliable fluorescent indicator for the intracellular free Ca2+ determinations. The best method for the calcium localisation by transmission electron microscopy was an adaptation of the antimonate precipitation technique. The following objectives were set in order to contribute to the knowledge in chronic renal failure; examination of the intracellular free Ca2+ content in the neutrophils of end stage renal failure patients on maintenance haemodialysis treatment, as the result of renal failure, dialysis treatment and medication combined; examination of the characteristics of the transmembrane Ca2+ movements; investigation of the intracellular calcium distribution in the neutrophils; exploration of a possible link between the alterations in intracellular calcium status and factors known to influence the calcium status, including the lipid composition of the membrane, the oxidative status as reflected by anti-oxidant vitamin levels, as well as the levels of parathyroid hormone, and ionised serum calcium. This study involved 14 chronic renal failure patients on maintenance haemodialysis. An increase in intracellular free Ca2+, the magnitude of the transmembrane Ca2+ flux upon fMLP stimulation and an increase in the rate of the subsequent decrease in intracellular free calcium were found. In separating the patients into those receiving rHuEPO and those not receiving rHuEPO, it was seen that the significance in the increase in intracellular free Ca2+ could be ascribed to the values obtained in those patients receiving rHuEPO - despite the fact that they were the only patients receiving calcium channel blockers. No overt indications of oxidative stress could be detected by anti-oxidant vitamin levels. Nevertheless, a decrease in the content of specific membrane fatty acids occurred, supporting the previous suggestions of the presence of a mild chronic inflammatory condition in the chronic renal failure patient on maintenance haemodialysis treatment. These results suggest that factors other than those associated with uraemia, such as rHuEPO administration, might result in an increase in intracellular free Ca2+ in cells of CRF/MHT patients. The magnitude of the rHuEPD-induced increase in intracellular free Ca2+ and the effects of the various calcium channel blockers need urgent further investigation as ineffective counteraction of the rHuEPO effect, as indicated by the relative ineffectivity of Norvasc, may have serious side-effects. / Dissertation (MSc)--University of Pretoria, 2000. / Physiology / unrestricted

Aim: To compare the effects of i.v. iron sucrose and Fe chloride on the iron indices of haemodialysis patients with anaemia. Methods: One hundred and eight haemodialysis patients receiving recombinant human erythropoiesis- stimulating agent (ESA) (mean age 59.37 years) were enrolled and randomly assigned to an iron sucrose or an Fe chloride group. Iron supplements were administered at 100 mg/week during the first 4 weeks (loading dose). Ferritin and transferrin saturation (TSAT) were then measured and dose adjusted. Ninety-eight subjects completed treatment; 51 in the iron sucrose group and 47 in the Fe chloride group. Ferritin, TSAT, haematocrit (Hct), reticulocyte count, serum albumin, fractional clearance of urea (Kt/V) and intact parathyroid hormone (iPTH) were measured. Results: There was no significant difference in baseline characteristics between the groups. Significant differences between the groups were observed in both iron indices and ESA dosage. Hct at week 24 (31.1% vs 29.7%, P = 0.006) and ferritin at week 20 (731.3 vs 631.7 ng/mL, P = 0.006) in the iron sucrose group were significantly higher than in the Fe chloride group. ESA dosage used in the iron sucrose group at week 8 was significantly lower than in the Fe chloride group (244.9 vs 322.6 U/kg per month, P = 0.003), and iron sucrose group received significantly lower iron dose than the Fe chloride group at week 8 (P = 0.005). Conclusion: Although the differences in ESA dosage, ferritin and iron dosage between two groups were found during the study period while similar results were shown at the end of 24 week study. Thus, iron sucrose and Fe chloride are safe and work equally well for haemodialysis patients.

No description available.