Perceived benefits and burdens encountered by relatives caring for person on long-term haemodialysis in Johannesburg. This study examines the perceived benefits and burdens of family members caring for persons on long term Haemodialysis. The caregiver burden scale by Elmastahl, Malmeberg and Annerstedtl (1996) was used for the purposes of the study. The participants were selected by Census (total) sampling. The sample consisted of family caregivers who were 18 years and above who were selected from three haemodialysis units in Johannesburg. Permission to conduct the study was requested and granted from all relevant authorities. One hundred and fifty questionnaires were distributed amongst the three haemodialysis units of which seventy nine participants responded to the study. Data were analysed using the statistical package STATA version 12. Demographic data and the caregiver burden scale were analysed through frequency counts, percentages and graphs were constructed from the collected data and analysed. Cross tabulations, using Fisher’s exact test were performed to determine the relationship between the demographic information and factors of the caregiver burden scale. The results are presented in the form of tables and graphs. Semi structured questionnaire with an option for elaboration were analysed using content analysis to enumerate a deeper understanding of the perceived burdens and benefits of caring for a person on Haemodialysis. Findings from the study concluded that family caregivers have encountered both benefits and burdens when caring for a person on Haemodialysis. The following factors have emerged namely demographics which include age, gender, relation to patient, highest education level, employment, ethnicity and duration of care and the factors surrounding general strain, isolation, disappointment, emotional involvement and environment. The factors, whether good or poor, are not always a predictor of perceived benefits and burdens of caring for persons on long term haemodialysis. The overall caregiver burden score, inclusive of all factors, showed a median score of 46.59% of all family caregivers’ experienced burden in caring for their relative on haemodialysis. Health education and support for the family caregivers proved to be a need in improving and reducing the caregiver burden. Caregiver health is quickly becoming a public health care issue that requires a more focused attention from health professionals, policy makers and caregivers themselves to ensure the health and safety of those dedicating their lives to the care of their relatives on haemodialysis.

Diss. (sammanfattning) Stockholm : Karol. inst., 2001. / Härtill 5 uppsatser.

1. Little work has been done on the response of regular haemodialysis patients to dynamic exercise. A systematic study of exercise capacity and the underlying mechanisms is of particular importance because these patients are encouraged to return to as normal a way of life as possible. Accordingly, a select group of healthy young male patients and a group of older males have been studied during submaximal cycling. The young male patients were compared to a closely matched sedentary control group. The 17 subjects discussed represent the fittest of 40 patients tested. 2. In both groups there was decreased work capacity associated with disproportionate tachycardia, which was not obvious at rest. Blood pressure was measured with a sphygmomanometer. During exercise there was a striking rise in the systolic blood pressure in about half the patients from currently acceptable resting levels. This occurred in the absence of any clinical circulatory overload. Mild hyperventilation and disproportionate lactic acidosis was seen towards peak exercise, probably because, in spite of the decreased work capacity, the patients were much closer to their maximum performance. However, the limiting factors were clearly circulatory and not respiratory. 3. A number of the younger male patients were more intensively studied to determine why some remained relatively 'normotensive' during exercise while others developed systolic hypertension. Total blood volume, total body water and plasma renin activity were measured at rest. It was found that the 'normotensive' patients had normal body volumes and normal to high plasma renin activity, while the hypertensive subgroup had increased volumes and normal to low plasma renin activity. Thus, in these patients the blood pressure responses to exercise were largely volume dependent, albeit at a subclinical level. 4. Cardiac output was measured at rest and during exercise. All patients developed a variable hyperkinetic circulation during exercise which was not apparent at rest. The patients were all anaemic and (xi) their cardiac output response was very like that described in patients with anaemia unassociated with renal disease. However, some patients with striking anaemia developed a less hyperkinetic circulation than others who were not so anaemic. When the body volume and the blood pressure response on exercise were considered, those patients who were normovolaemic and 'normotensive' developed a hyperkinetic circulation on exercise appropriate to their degree of anaemia. Those with subclinical volume overload and a hypertensive response to exercise developed a much less striking hyperkinetic circulation, suggesting that the blood pressure and volume excess was depressing the anticipated cardiac output response to their underlying anaemia. 5. One patient with an arteriovenous shunt was studied twice, initially when hypervolaemic with a haemoglobin of 9,1gm/100 ml and again after ultrafiltration when he was normovolaemic but his haemoglobin had risen to 12,5 gm/100 ml. On the first occasion his cardiac output response was moderately hyperkinetic but he developed increasing hypertension with a high calculated total peripheral resistance. On the second occasion his cardiac output response fell within the normal range, his blood pressure was lower but not normal and his calculated total peripheral resistance was even higher than before. Thus, the blood pressure of these volume dependent patients is due to a high total peripheral resistance, but may not simply be on the basis of 'waterlogging' of the peripheral vasculature. Some other factor, such as structural thickening, must be considered. 6. It is suggested that the combination of tachycardia and hypertension which develop on mild exertion and which may not be obvious at rest, is the most potent cause of the increased cardiovascular mortality seen in dialysis patients. Simple exercise testing will reveal those with subclinical volume overload who are most at risk. It was striking that in the two groups tested those who developed striking hypertension on exercise were usually older, between 35 and 50 years. This accelerated aging of their vascular tree would correspond with recent data showing that dialysis mortality increases with age, and is about a decade earlier than in the general population. It is suggested that a more aggressive policy be adopted towards blood pressure fluctuations and that the resting blood pressure should be kept below 140/90 mm Hg at all times, if necessary by complementing ultrafiltration with drug therapy and/or bilateral nephrectomy at an early stage. 7. Thus simple exercise testing with blood pressure recordings not only serves as a yardstick of physical rehabilitation and long-term follow-up, but may also reveal or magnify abnormalities not obvious at rest.

Nos últimos anos, em função dos resultados negativos do HEMO Study e da elevada mortalidade na população dialítica, observou-se crescente interesse nosregimes de hemodiálise diária. A dose de diálise persiste como um dos elementos fundamentais na adequação do tratamento dialítico. Comparamos as doses de diálise em hemodiálise diária (90 minutos, 6 vezes / semana), com as doses em hemodiálise convencional (240 minutos, 3 vezes / semana), através da quantificação direta da diálise, do modelo de cinética de uréia e pelo Standard Kt/V de Gotch. A comparação foi feita para diferentes solutos (uréia, creatinina, fósforo, ácido úrico e ß2-microglobulina) e diferentes taxas de ultrafiltração / The recent efforts to improve dialysis outcome and the negative results from the HEMO Study have created great interest on alternative hemodialysis (HD) regimens. Dialysis dose persist fundamental to HD adequacy. However, parameters of adequacy have not been validated to Daily HD. We compared the dialysis dose of daily, high efficiency and flux HD (90 minutes, 6 times a week) with Conventional high flux HD (240 minutes, 3 times a week) by direct dialysis quantification, urea kinetics model and Gotch's stdKt/V. The comparison was made with urea, creatinine, phosphate, uric acid and ß2-microglobulin. We, also, analyzed the effect of different ultrafiltration rates on solute removal on Daily HD

Mesenchymal stromal cells (MSC) are bone marrow-derived, non-hematopoietic progenitors that are amenable to genetic engineering, making them attractive delivery vehicles for therapeutic proteins. However, limited transplanted cell survival compromises the efficacy of MSC-based gene therapy. We hypothesized that co-implantation of insulin-like growth factor-1 (IGF-I)-overexpressing MSC (MSC-IGF) would improve MSC-based therapy of anemia by providing paracrine support to erythropoietin (EPO)-secreting MSC (MSC-EPO). Murine MSC were found to express the IGF-I receptor and be responsive to IGF-I stimulation. IGF-I also improved MSC survival in vitro. MSC were admixed in a bovine collagen matrix and implanted by subcutaneous injection in a murine model of chronic renal failure. Mice receiving MSC-EPO co-implanted with MSC-IGF experienced a greater and significantly sustained elevation in hematocrit compared to controls; heart function was also improved. Co-implantation of MSC-IGF therefore represents a promising new strategy for enhancing implanted cell survival, and improving cell-based gene therapy of renal anemia.

Nos últimos anos, em função dos resultados negativos do HEMO Study e da elevada mortalidade na população dialítica, observou-se crescente interesse nosregimes de hemodiálise diária. A dose de diálise persiste como um dos elementos fundamentais na adequação do tratamento dialítico. Comparamos as doses de diálise em hemodiálise diária (90 minutos, 6 vezes / semana), com as doses em hemodiálise convencional (240 minutos, 3 vezes / semana), através da quantificação direta da diálise, do modelo de cinética de uréia e pelo Standard Kt/V de Gotch. A comparação foi feita para diferentes solutos (uréia, creatinina, fósforo, ácido úrico e ß2-microglobulina) e diferentes taxas de ultrafiltração / The recent efforts to improve dialysis outcome and the negative results from the HEMO Study have created great interest on alternative hemodialysis (HD) regimens. Dialysis dose persist fundamental to HD adequacy. However, parameters of adequacy have not been validated to Daily HD. We compared the dialysis dose of daily, high efficiency and flux HD (90 minutes, 6 times a week) with Conventional high flux HD (240 minutes, 3 times a week) by direct dialysis quantification, urea kinetics model and Gotch's stdKt/V. The comparison was made with urea, creatinine, phosphate, uric acid and ß2-microglobulin. We, also, analyzed the effect of different ultrafiltration rates on solute removal on Daily HD

No description available.

A infecção é causa de morbimortalidade no paciente com insuficiência renal crônica (IRC), facilitada pela uremia, que leva a resposta imune insuficiente, inclusive após a vacinação. Foram avaliadas a situação vacinal e a presença de anticorpos para sarampo e varicela, de 83 crianças e adolescentes com IRC. A adesão dos pacientes às vacinas foi BCG 100%, poliomielite 98,8%, DPT 97,6%, sarampo monovalente 96,4%, tríplice viral 88%, hepatite B 68,7%. Ausência de anticorpos para sarampo e varicela ocorreu em 14,5% e 26,5% dos pacientes. A susceptibilidade ao sarampo em vacinados, predominou acima de seis anos (P < 0,00001) e à varicela (infecção natural) abaixo de sete anos (P < 0,001). O renal crônico pediátrico deve receber esquema vacinal amplo, com avaliação periódica de títulos de anticorpos / Infections are a cause of morbidity and mortality in chronic renal failure (CRF) patients, facilitated by uremia, which promotes a deficient immune response and hinders response to vaccination. We evaluated the immunization status and antibody titers against measles and varicella in 83 CRF children and adolescents. Adhesion to vaccination was 100% BCG, 98,8% poliomyelitis, 97,6% DPT, 96,4% measles, 88% MMR, 68,7% hepatitis B. Non-detectable antibodies against measles and varicella occurred in 14,5% and 26,5% patients. Susceptibility to measles, after vaccination, increased above 6 years (P < 0,00001) and to varicella (natural infection), below seven years of age (P < 0,001). Pediatric CRF patients should receive a robust immunization program with periodic antibody titer assessment

A infecção é causa de morbimortalidade no paciente com insuficiência renal crônica (IRC), facilitada pela uremia, que leva a resposta imune insuficiente, inclusive após a vacinação. Foram avaliadas a situação vacinal e a presença de anticorpos para sarampo e varicela, de 83 crianças e adolescentes com IRC. A adesão dos pacientes às vacinas foi BCG 100%, poliomielite 98,8%, DPT 97,6%, sarampo monovalente 96,4%, tríplice viral 88%, hepatite B 68,7%. Ausência de anticorpos para sarampo e varicela ocorreu em 14,5% e 26,5% dos pacientes. A susceptibilidade ao sarampo em vacinados, predominou acima de seis anos (P < 0,00001) e à varicela (infecção natural) abaixo de sete anos (P < 0,001). O renal crônico pediátrico deve receber esquema vacinal amplo, com avaliação periódica de títulos de anticorpos / Infections are a cause of morbidity and mortality in chronic renal failure (CRF) patients, facilitated by uremia, which promotes a deficient immune response and hinders response to vaccination. We evaluated the immunization status and antibody titers against measles and varicella in 83 CRF children and adolescents. Adhesion to vaccination was 100% BCG, 98,8% poliomyelitis, 97,6% DPT, 96,4% measles, 88% MMR, 68,7% hepatitis B. Non-detectable antibodies against measles and varicella occurred in 14,5% and 26,5% patients. Susceptibility to measles, after vaccination, increased above 6 years (P < 0,00001) and to varicella (natural infection), below seven years of age (P < 0,001). Pediatric CRF patients should receive a robust immunization program with periodic antibody titer assessment