No description available.

L-carnitine is an endogenous compound that has important roles in fatty acid oxidation. Patients with end-stage renal disease (ESRD) who are undergoing haemodialysis may develop a secondary L-carnitine deficiency. Following oral administration of L-carnitine, enterobacteria generate ??-butyrobetaine and trimethylamine with the latter substance extensively N-oxygenated in the liver, to form trimethylamine-N-oxide. Given that patients with ESRD have qualitatively different and higher bacterial populations in the small intestine as compared with healthy subjects, increased formation of trimethylamine and accumulation of trimethylamine-N-oxide would be expected. The clinical significance of these amines is related to their potential to form the carcinogen N-nitrosodimethylamine, contribution to neurological toxicity and "uraemic breath". / The pharmacokinetics of oral L-carnitine display clear non-linearity above a dose of 0.5 g three times a day with an associated increase in plasma concentrations of trimethylamine and trimethylamine-N-oxide. Oral administration of L-carnitine to patients with ESRD undergoing haemodialysis increased plasma concentrations of this substance to levels seen in individuals with normal kidney function and evidence was provided for the accumulation of trimethylamine-N-oxide. / Thesis (PhD)--University of South Australia, 2006.

L-carnitine is an endogenous compound that has important roles in fatty acid oxidation. Patients with end-stage renal disease (ESRD) who are undergoing haemodialysis may develop a secondary L-carnitine deficiency. Following oral administration of L-carnitine, enterobacteria generate ??-butyrobetaine and trimethylamine with the latter substance extensively N-oxygenated in the liver, to form trimethylamine-N-oxide. Given that patients with ESRD have qualitatively different and higher bacterial populations in the small intestine as compared with healthy subjects, increased formation of trimethylamine and accumulation of trimethylamine-N-oxide would be expected. The clinical significance of these amines is related to their potential to form the carcinogen N-nitrosodimethylamine, contribution to neurological toxicity and "uraemic breath". / The pharmacokinetics of oral L-carnitine display clear non-linearity above a dose of 0.5 g three times a day with an associated increase in plasma concentrations of trimethylamine and trimethylamine-N-oxide. Oral administration of L-carnitine to patients with ESRD undergoing haemodialysis increased plasma concentrations of this substance to levels seen in individuals with normal kidney function and evidence was provided for the accumulation of trimethylamine-N-oxide. / Thesis (PhD)--University of South Australia, 2006.

Diss. Linköping : Univ., 2002.

Thesis (Ph.D.)--Flinders University, School of Nursing and Midwifery. / Typescript bound. Includes bibliographical references: (leaves 234-259) Also available in an electronic version.

No description available.

No description available.

Submitted in fulfillment of the Master of Technology : Biomedical and Clinical Technology, Durban University of Technology, 2014. / INTRODUCTION End stage renal disease (ESRD) occurs once 90 % of the kidney function is lost. Patients with ESRD must either undergo medical treatments, like haemodialysis, that substitute the function of the kidney, or they must have a kidney transplant. In the 1970s, haemodialysis treatment took 8 to 12 hours, three times per week. As technology advanced, dialyzers were able to handle more dialysate and higher blood flow rates hence treatment times were shortened to between three and five hours per treatment which has remained the norm until present day. One clinic in Tassin, France remained on the longer dialysis program and noticed advantages for patients who were on extended dialysis times. One of the major problems with dialysis done in the traditional sense is that it tries to provide a lot of therapy in a short period of time, and it is difficult to clear toxins and fluid in that time, Nocturnal dialysis provides a greater amount of toxin removal over a long period of time. AIMS AND OBJECTIVES The main aim of this study was to determine if nocturnal dialysis resulted in improved dialysis clearance, better overall patient health and a better quality of life. The primary objective of this study was to compare the clearance of small molecules (for example, urea, phosphate, creatinine and potassium) and large retention products (for example Parathyroid Hormone (PTH) and 2-Microglobulin) between the two haemodialysis procedures. The secondary objective was to compare the quality of life and survival of patients on both nocturnal and daytime dialysis. METHODOLOGY Thirty patients with End Stage Renal Disease (ESRD) presenting to the Sunninghill Hospital Dialysis Unit for treatment, who met the inclusion criteria, were recruited to participate in this study. Blood samples were taken for each participant at a baseline, 3 month and 6 month interval. The Kidney Disease Quality of Life Survey Questionnaire (KDQOL: SF- 36TM) was also given to each participant to complete. This survey consisted of three parts: 1) Physical Component Summary 2) Mental Component Summary and 3) Burden of Kidney Disease. This survey helped to predict the quality of life of the patients in each group. RESULTS In this study, non-significant effects of treatment were found for all small solutes individually. This study showed that there was a statistically significant increase in both dialysis adequacy and the clearance of large molecules (Parathyroid Hormone and Beta-2-Microglobulin) in the nocturnal haemodialysis group. The results of the KDQOL: SF-36 survey showed that the nocturnal dialysis patients scored higher in both the Physical Component Summary and the Mental Component Summary which means that they felt they were in better physical and mental health. The survey also showed that the nocturnal dialysis patients felt the burden of kidney disease less than those patients dialyzing during the day. CONCLUSION Firstly, dialysis adequacy as defined by the formula Kt/V, increased in the nocturnal group while it levelled off in the diurnal group. Secondly, both the Parathyroid Hormone levels and Beta-2-Microglobulin levels decreased more in the nocturnal group therefore resulting in statistically significant effects of treatment. The third and final conclusion drawn was that nocturnal haemodialysis resulted in better physical health, better mental health and a lower burden of kidney disease was felt by patients undergoing nocturnal haemodialysis.

Typescript. / Digitized by Kansas Correctional Industries

Submitted in partial fulfillment of the requirements for the degree of Masters in Technology: Clinical Technology, Durban University of Technology, 2009. / Exercise assessment, counseling and training are not widely offered to patients with chronic kidney disease. Haemodialysis patient’s participation in exercise and an adequate assessment of exercise effects on haemodialysis outcome are needed so that more interventions can be developed to improve the well being of those patients with chronic kidney disease. Exercise is not routinely advocated in patients with end-stage renal disease receiving maintenance haemodialysis. Lack of widespread awareness of exercise in haemodialysis literature may be contributing to these shortcomings in clinical practice. Purpose of the study This study was aimed to establish the effect of exercise during haemodialysis on pedal oedema and solute removal. This is the first time that such a study was undertaken in dialysis units in South Africa. Methodolgy In a quasi-experimental design, thirty-four end-stage renal failure patients on three times weekly haemodialysis program from Bloemfontein and Newcastle MediClinic Renal Units participation in the study. Ethical approval for the study was obtained from Durban University of Technology Ethics Committee. Seventeen patients were in the intervention group (aged between 25 and 60) and seventeen in the control group (aged between 18 and 60). The intervention group did not exercise for the first three months of the study in order to establish a baseline period. Thereafter, exercising took place from the fourth to the ninth month. Patients pedaled on an exercise cushion for fifteen minutes every hour to achieve a total of sixty minutes of exercise over a four-hour dialysis session. Patients in the control group did not pedal on the exercise cushion during the nine-month study period. Pre and post haemodialysis measurements of creatinine, urea and potassium using the Alkaline Picrate, Urease and Ion Selective Electrode methods respectively were done for each patient monthly over the nine month period. Oedema of the lower limb was evaluated by measuring the right and left ankle circumference, in centimeters before and after dialysis. Urea Kt/V was also measured before and after haemodialysis for each patient over the study period. Results Statistical analysis of results showed a significant 30% reduction in urea levels and a 46% reduction in creatinine levels in the intervention group at the end of the nine month period, a 12% reduction in the potassium levels in the intervention group which was 4% more than the control group. The urea Kt/V in the intervention group showed a 9% greater reduction than the control group. There was a significant improvement in oedema of 45% of the right ankle for the first three months of exercise and thereafter there was a an increase in ankle size in the last three months which was a 13% reduction in oedema compared to baseline. There was a significant improvement in oedema of 60% of the left ankle for the first five months of exercise and thereafter there was an increase in ankle size in the last month which showed a 25% reduction compared to baseline. The reason for the increase in ankle size in both ankles in the last three months in inconclusive and future investigation is recommended. Conclusion The results of this study demonstrated benefits of exercise during haemodialysis on solute removal and oedema perhaps due to the acute increases in blood flow and therefore increasing perfusion of skeletal muscles.