Este estudo transversal teve o objetivo de correlacionar as condições periodontais de pacientes renais crônicos em tratamento de hemodiálise (HD), com suas condições sistêmicas observadas em exames laboratoriais. O presente trabalho foi realizado na Clínica de Nefrologia de Rondônia NEFRON - localizada na cidade de Porto Velho Rondônia. Foram analisados os prontuários dos pacientes para a obtenção dos resultados de exames laboratoriais, como uréia (UR) pré e pós-diálise, creatinina (CREA), cálcio (Ca++), hormônio paratireoidiano (PTH) e fosfatase alcalina (FA). Realizou-se exame clínico periodontal, avaliando: índice de placa (IP), índice gengival (IG), profundidade a sondagem (PS), nível de inserção clinica (NIC) em 79 pacientes. Após o tratamento estatístico com os testes t de Student e de Mann Whitney verificou-se que o IG foi maior nos indivíduos com UR pré-normal (p = 0,0124), e houve uma diferença significante de NIC com o PTH alterado (p = 0,0388). Com relação às variáveis avaliadas observou-se que não houve diferença estatisticamente significativa entre elas. As condições periodontais encontradas nos pacientes demonstrou um perfil inflamatório leve, observado por meio do IG; o IP demonstrou uma população com moderado acúmulo de biofilme dental, mas com profundidade de sondagem média de 1,86 mm, e NIC de 2,45 mm. IG e IP foram maiores no grupo de pacientes com valores de exames laboratoriais dentro dos padrões de normalidade, mas sem diferenças estatisticamente significativas, o que demonstra serem fatores apenas locais na determinação das condições periodontais encontradas, não alterando as condições sistêmicas. A FA utilizada como marcador ósseo, apresentou valores mais elevados em pacientes com NIC > 2 mm mas sem diferença estatisticamente significante. Concluiu-se que neste grupo de pacientes as condições que caracterizam a doença renal crônica não influenciaram na condição periodontal de indivíduos submetidos ao tratamento de hemodiálise. / This transversal study whose the central hang was collect dates from periodontal conditions of patients with chronic renal disease undergoing on hemodialysis treatment (HD) with their systemic conditions observed on laboratorial exams. The present work was realizes on Nephrology Clinic of Rondônia NEFRON localized at Porto Velho city - Rondônia. It was accessed the handbooks from all patients to obtain the results of laboratorial exams, like urea (UR) before and after dialysis treatment, creatinin (CREA), calcium (Ca++), parathyroid hormone (PTH) and alkaline phosphatase (AP). It was realized clinical periodontal exam evaluating: plaque index (PI), gingival index (GI), depth on probing (DP), clinical attachment loss (CAL), on 79 patients. After the statistic treatment with tests t-Student and Mann Whitney, we observed that GI was higher in patients with normal UR before-dialysis (p = 0,0124), and occurred a significative difference of CAL with altered PTH (p = 0,0388). In relation of the evaluated parameters, it was observed no difference statistically significative between them. The periodontal conditions found in these patients demonstrated light inflammatory status, observed in GI. PI showed a group with moderate accumulation of dental biofilm, but with 1,86 mm of medium DP, and 2,45 mm of CAL. GI and PI were higher in patients group with normal values of laboratorial exams, but with no difference statistically significative, proving being only local factors on determination of periodontal conditions found, dont altering the systemic conditions. The AP, used as bone marker, presented higher values in patients with CAL > 2 mm but with no difference statistically significative. It was possible to conclude that in this group of patients the conditions that characterize the chronic renal disease dont influence on periodontal status of patients undergoing on hemodialysis treatment.

Chronic kidney disease (CKD), a reduction in kidney function, has reached pandemic proportions and imposes a major healthcare burden worldwide. A hallmark of CKD is the accumulation of several chemical compounds, called uremic toxins, which inflict systemic and renal-specific damage. Of the known uremic toxins, kynurenine (Kyn) is known to be particularly vasculotoxic and is implicated in several complications of CKD. Indoleamine 2,3-dioxygenase 1 (IDO), which catalyzes the first step in the metabolism of Tryptophan (Trp), regulates immune response to inflammatory cytokines in tissues. IDO plays a role in apoptosis and damage during acute kidney injury (AKI), a transient decrease in kidney function. During metabolism of Trp, IDO generates Kyn, a uremic solute, and therefore IDO may play a role in the brain and kidney damage due to accumulation of Kyn. The objective of the current study was to investigate the role and regulation of IDO in CKD pathology. Studies were performed to determine whether IDO is protective or pathologic and to find how IDO is regulated in the kidney during CKD. IDO in renopathology was examined using murine models of CKD. CKD was induced via a 0.2% adenine-supplemented diet (AD) model for 21 days. IDO regulation was examined using an Indoxyl Sulfate (IS)-specific solute model. Renal function in the IDO+/+ and IDO-/- AD mice was assessed through weekly measurement of blood urea nitrogen (BUN). H&E and Masson’s trichrome stains were used to assess percentages of glomerulosclerosis (GS) and immune infiltration (II), and combined interstitial fibrosis and tubular atrophy (IFTA) score in IDO+/+ and IDO-/- mice with and without CKD. IDO protein concentration in the kidneys of all mice with and without CKD and IDO+/+ IS mice was determined via immunoblotting. Patients with kidney disease suffer from neuropsychological disorders and neurocognitive decline. The effects of uremic solutes on the CNS was examined using immortalized human umbilical endothelial vein cells (HUVEC-TERT), in vitro. Cell proliferation and viability, in the presence of IS, were measured by BrdU and Alamar blue assays, respectively. In both IDO+/+ and IDO-/-, 21 days of AD results in significant deterioration of renal function. The average IFTA score and percentage of II in IDO-/- mice increased with AD compared to ND (p<0.05, p<0.001). IDO expression was seen sporadically in the glomeruli and walls of major vessels in the kidneys of 4d AD IDO+/+ mice, and in the tubules and vessel walls in the kidneys of 14d AD IDO+/+ mice. In IDO+/+ ND mice, endogenous IDO protein expression was undetectable at a signal intensity of 119.86 ± 268.01, whereas IDO+/+ AD mice showed a 370-fold higher level of IDO protein expression compared to IDO+/+ ND (p<0.001). IDO-/- AD IDO protein expression was 9.5-fold higher than in IDO-/- AD (p<0.05). IDO expression was found to be 58-fold higher in IDO+/+ mice with IS treatment (p<0.05). In the IS mice, non-significant trends toward decrease in cellular proliferation and viability with time were also observed (p=ns). IDO is upregulated at the protein level both in a CKD model and directly by the uremic solute, IS. IDO appears to be protective in the kidney during CKD, given the trend toward increased percentage of GS and II in IDO-/- compared to IDO+/+ mice with CKD, though there is little difference seen in total kidney IFTA. IDO upregulation is linked to increased apoptosis. Blocking uremic solute production would therefore prevent IDO protein upregulation and reduce apoptosis, alleviating renal damage during CKD.

A doença renal crônica (DRC) tem sido considerada um problema de saúde pública mundial. Estima-se que cerca de 17% da população adulta dos EUA apresente algum grau de comprometimento da função renal. No Brasil, um estudo realizado na cidade de Bambuí - Minas Gerais detectou-se alteração da função renal variando de 0,48% a 8,19%, sendo mais frequente nos pacientes idosos. Os pacientes que evoluem para DRC terminal necessitam de algum tipo de terapia renal substitutiva (TRS), sendo as opções disponíveis: a hemodiálise (HD), a diálise peritoneal (DP) e o transplante renal (TX renal). No caso da DP, a membrana peritoneal realiza a função de filtrar o sangue do paciente, e esta é utilizada através da implantação de um cateter na cavidade abdominal. No Brasil, segundo dados do Censo Brasileiro de Diálise (2016) existem aproximadamente 122.825 pacientes em diálise, sendo 8,6% em DP. O objetivo do estudo foi analisar a evolução dos pacientes que foram admitidos na Unidade de Diálise do HCFMRP para submeterem-se à DP nos últimos 22 anos. Os dados foram coletados dos prontuários dos pacientes atendidos no período de 1993 a 2015, de onde foram extraídas variáveis demográficas, clínicas e laboratoriais. É um estudo de coorte retrospectiva de 199 prontuários de pacientes atendidos na Unidade de Diálise do HCFMRP-USP. Os resultados demonstram que a população do estudo é em sua maioria do sexo feminino, com média de idade 57 anos. Foi encontrada a mudança de TRS para a hemodiálise como desfecho clínico mais frequente, seguida por óbito. A etiologia da DRC mais frequente foi a hipertensão arterial sistêmica (HAS), seguida por Diabetes mellitus (DM) tipo 2. Houve associação com menor média de idade de entrada em programa (48 anos), desfecho clínico óbito e maior tempo de seguimento (10 anos) com o grupo de pacientes que entraram em programa de diálise em 1993 (p<0,05). Encontramos associação do uso de medicamentos (Cloridrato de Sevelamer e Análogos da vitamina D3 com níveis categorizados de paratormônio, cálcio total e fósforo (p<0,05). CONCLUSÃO: Os pacientes que entraram em programa no período de 1993-2000 apresentaram menor média de idade e maior tempo de acompanhamento quando comparados aos demais grupos. O desfecho clínico mais frequente foi a transferência para HD, tendo como causa principal a ocorrência de peritonites. / INTRODUCTION: Chronic kidney disease (CKD) has been considered a worldwide public health problem, as well as the progressive increase of the population in renal replacement therapy (TRS). With the technological advances accumulated, the survival of patients on dialysis has increased greatly. Peritoneal dialysis (PD) is considered a safe and effective method of SRT, a challenge for the binomial patienthealth team. OBJECTIVES: To analyze the main characteristics and outcomes of patients in a PD program. METHODS: This was a retrospective cohort study of 199 patients submitted to PD in the Dialysis Unit of the HCFMRP-USP from 1993 to 2015. The primary source of data was the individual medical records. The variables were classified as: demographic, clinical and laboratorial. Statistical analyzes were performed using the Chi-square test, ANOVA and Kruskal Wallis. RESULTS: The mean age of the patients was 57 years, with a predominance of females (51.5%); the most frequent clinical outcome was the change in HRT for hemodialysis (37.2%). Type 2 diabetes mellitus (DM) was the most common cause of CKD (31,7). There was an association between lower mean age of program entry, clinical outcome and longer follow-up (10 years) in the group of patients who entered the dialysis program in the period from 1993 to 2000 (p <0.05). There was an association between the use of medications (Sevelamer\'s Hydrochloride and vitamin D3 analogues) with categorized values of parathormone, total calcium and phosphorus (p <0.05). CONCLUSION: Patients who entered the program in 1993-2000 had a lower mean age and longer follow - up when compared to the other groups. The most frequent clinical outcome was the transfer to HD, the main cause being the occurrence of peritonitis.

ABSTRACT: Hepatitis C virus (HCV) is associated with various glomerulopathies and nephrotic syndrome. However nephrotic syndrome following treatment is rare. Ledipasvir/sofosbuvir (L/S) has recently come into favor in treating HCV due to its relatively mild side effects compared to the more traditional interferon therapy. To the best of our knowledge, there are no reported cases of nephrotic syndrome following treatment with L/S. We present a case of nephrotic syndrome suspected secondary to L/S in a patient with chronic kidney disease. Increased vigilance when assessing therapeutic options in HCV patients with renal comorbidities can improve patient outcomes. A 63 year-old male patient presented to the hospital with shortness of breath, and a two-week history of bilateral lower extremity edema. Past medical history was significant for liver cirrhosis secondary to Hepatitis C genotype Ia, hepatocellular carcinoma status post liver transplantation 6 months prior to admission and Stage 3b chronic kidney disease with baseline creatinine (Cr) approximately 1.5 mg/dl. Medications included L/S for HCV and tacrolimus and prednisone for post-transplant treatment. Patient’s vitals were stable and physical exam was remarkable for facial swelling, mainly on the eyelids, decreased breath sounds bilaterally, distended abdomen with a fluid wave, and 2-3+ pitting edema up to the knees on lower extremities bilaterally. Laboratory work-up was remarkable for low albumin of 3.0 g/dl, and total protein of 5.6 g/ dl. Creatinine of 1.8 mg/dl was elevated from patient’s baseline. HCV viral load was undetectable and electrolytes, transaminases and the complete blood count were within normal limits. Subsequently, urine protein to creatinine ratio was measured because of generalized swelling and hypoproteinemia, which was found to be significantly high at 8.80, compared to 0.04 one year prior. 24-hour total urine protein was found to be 2065 mg/day. Renal ultrasonography showed no hydronephrosis and was otherwise unremarkable. Renal biopsy however, revealed changes suggestive of membranoproliferative glomerulonephritis (MPGN] most likely secondary to HCV. No immune complexes, lambda/kappa light chains, or cryogloblin were appreciated. Nephrotoxic agents such as diuretics and corticosteroids were held. Tacrolimus trough was appropriate to dose level and was continued along with L/S. As admission progressed the patient’s creatinine continued to get worse and rose up to 4.3 mg/dl with persistent proteinuria. With tacrolimus trough levels within normal limits and given L/S was the most recently initiated drug, L/S was thought to be the culprit and was thus held. The renal function began to improve gradually, and the patient was discharged in stable condition with close follow up. Follow up one month later found creatinine and renal function return to baseline and proteinuria resolved. Our case shows that Ledipasvir/sofosbuvir may possibly be related to nephrotic syndrome in HCV patients. Although further studies are needed to prove the causality our case seeks to raise clinical suspicion and increase vigilance when assessing therapeutic options in HCV patients with renal comorbidities such as chronic kidney disease.

BACKGROUND Vascular calcification is a major risk factor for cardiovascular morbidity and mortality in patients with end stage renal disease (ESRD). In Western countries, Blacks with ESRD appear to have lesser degrees of vascular calcification compared to non-Blacks. However, there is no published data on the association of ethnic differences in vascular calcification and survival in ESRD from Sub-Saharan Africa. METHODS This study assessed the 5-year change in vascular calcification and mortality in a previously published cohort of patients with ESRD. Vascular calcification was assessed by abdominal aortic calcification score (lateral abdominal radiograph) and vascular stiffness by pulse wave velocity. RESULTS Sixty-six of the original 74 participants, studied a baseline, were identified. The median age was 46.6 years (37.6-59.2) and 57.6% were women. Abdominal aortic calcification showed no progression among Blacks [baseline range 0-5, follow up range 0-8 (p=1.00)], but a nonsignificant trend to progression among non-Blacks [baseline range 0-19, follow up range 0-22 (p=0.066)]. Black participants did not display a survival advantage (p=0.870). Overall, sepsis was the most common cause of mortality (64% of those with an identifiable cause of death). Non-Blacks had higher parathyroidectomy rates than Blacks with 9/30 cases compared to 2/36 (p=0.036). After adjustment for parathyroidectomy at follow up, the odds ratio of having abdominal vascular calcification score of ≥1 amongst non-Blacks was 8.6-fold greater compared to Blacks (p= 0.03). Central aortic systolic pressures (CASP) and pulse wave velocities (PWV) were higher in the study population than age matched normative values. At follow up, a positive correlation (r=0.3) was observed between PWV and abdominal aortic calcification (p=0.04). Elevated baseline coronary artery calcification score and FGF-23 level at baseline were not associated with a difference in mortality. CONCLUSION There was no significant progression in vascular calcification among Blacks. After adjusting for increased parathyroidectomy rates, there was a greater progression of vascular calcification amongst non-Blacks compared to Blacks highlighting possible ethnic differences in calcium phosphate metabolism in patients with ESRD. The lack of vascular calcification progression in Blacks was not however associated with improved survival, but the sample size was small.

There is an epidemic of chronic kidney disease of unknown origin (CKDu) primarily affecting younger men in Central America, especially El Salvador and Nicaragua. The primary hypothesis has included heat stress and dehydration. Although medication usage is widely viewed as a likely contributor to kidney damage, the association with chronic kidney disease in Central America has not been fully explored. This study investigated medication usage, symptom presentation, and kidney function among 524 outdoor workers in agricultural and non-agricultural industries enrolled in the Mesoamerican Nephropathy Occupational Study (MANOS) led by Boston University researchers. An overview of the literature on the adverse effects of medication on renal function and thermoregulation, with a focus on medications considered in MANOS, was conducted. Medication usage and symptom presentation on both a short- and long-term timeframe were explored in relation to kidney function measured by estimated glomerular filtration rate. Long-term usage of NSAIDS and potassium supplements was significantly associated with kidney function. Neither short- or long-term uses of acetaminophen, the most commonly used medication, were associated with kidney function. While several self-reported health symptoms were significantly associated with lower kidney function in crude models, the associations’ significance levels lessened after adjusting for age, country, and industry. In contrast, symptoms of chistata (a local term for painful urination) and lower abdominal pain three months prior to data collection each significantly predicted higher kidney function. The results of this exploratory, cross-sectional study present an opportunity for further study on how medications and symptoms, related to both nephrotoxicity and heat stress, could be associated with kidney function.

Orientador: Amanda Martins Baviera / Resumo: No Brasil, o número de indivíduos com doença renal crônica (DRC) em terapia dialítica no ano de 2017 foi de aproximadamente 127 mil indivíduos; dentre estes, 92% realizavam hemodiálise (HD). A HD tem como principal objetivo a remoção dos solutos urêmicos e assim a redução dos sintomas relacionados à síndrome urêmica, melhorando a qualidade de vida do indivíduo com DRC. No entanto, aumentam as evidências de que a HD seja um fator exacerbante do estresse oxidativo, via aumento na produção de espécies reativas de oxigênio devido à ativação de leucócitos estimulada pela diálise ou pelo tipo de membrana utilizada, bem como via remoção dialítica de compostos antioxidantes solúveis em água e de baixo peso molecular. No entanto, a literatura reporta resultados contraditórios em relação às alterações em biomarcadores de lesão oxidativa e atividade antioxidante em indivíduos submetidos à HD. O objetivo deste trabalho foi avaliar as alterações na capacidade antioxidante total, nas atividades de enzimas antioxidantes e nos níveis de biomarcadores de danos oxidativos no soro de indivíduos saudáveis e de indivíduos com DRC, antes (pré-HD) e após (pós-HD) uma sessão de HD. Foram selecionados 40 indivíduos saudáveis, sem DRC ou qualquer outra patologia, doadores de sangue do Hemonúcleo Regional de Araraquara para compor o grupo controle, e 40 indivíduos com DRC que realizam HD no Centro Regional de Hemodiálise de Araraquara. Amostras de soro foram utilizadas para determinação dos marcadores ... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Orientador: José Eduardo Corrente / Resumo: Introdução: Doença renal crônica (DRC) é uma enfermidade de relevância para a saúde pública, cursando com prevalência crescente. Estudos confirmam associação da hipertensão arterial, diabetes mellitus e proteinúria com desenvolvimento da DRC, progressão e mortalidade. Intervenções nutricionais podem prevenir ou atenuar essas complicações da doença, além de manter o estado nutricional e levar à maior sobrevida e qualidade de vida aos pacientes. Objetivo: Avaliar os benefícios do aconselhamento nutricional em pacientes portadores de DRC. Metodologia: Estudo quase-experimental, controlado e em dois momentos (inicial e após três meses), com indivíduos nos estadios 3 e 4 da doença, divididos em dois grupos: controle, composto por indivíduos que nunca receberam aconselhamento nutricional por recusa, e intervenção, caracterizado por pacientes em acompanhamento com nutricionista. Foi realizada a comparação entre os parâmetros: antropometria, exames bioquímicos e avaliação do consumo alimentar através da análise dos R24h através do programa Nutrition Data System for Research. Para análise estatística, ANOVA seguido do teste de Tukey ou teste de Wald de acordo com a distribuição dos dados, adotando nível de significância de 5%. Resultados: Foram incluídos 50 pacientes, sendo: controle (n=23) e intervenção (n=27). Os grupos foram homogêneos. Observou-se diferenças em relação à pressão arterial, reduzida após aconselhamento nutricional. Não ocorreram alterações consideráveis nos bioquími... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Chronic kidney disease (CKD) is a condition of increasing prevalence, considered relevant to public health. Studies confirm an association of arterial hypertension, diabetes mellitus and proteinuria with the development of CKD, progression and mortality. Dietary interventions can prevent or mitigate these complications of the disease, in addition to maintaining nutritional status and leading to greater survival and quality of life for patients. Objective: To evaluate the benefits of nutritional counseling in patients with CKD. Methodology: Quasi-experimental study, controlled and two-stage (initial and after three months), with individuals in stages 3 and 4 of the disease, separated into two groups: control, composed of individuals who never received nutritional advice for refusal, and intervention, characterized by patients being followed up with a nutritionist. A comparison was between the parameters: anthropometry, biochemical tests and evaluation of food consumption by the analysis of R24h using the Nutrition Data System for Research program. For statistical analysis, ANOVA followed by the Tukey test or Wald test according to the data distribution, adopting a significance level of 5%. Results: 50 patients were included in the groups control (n = 23) and intervention (n = 27). The groups were homogeneous. Differences were observed in blood pressure that reduced after nutritional counseling. There were no changes in biochemicals exams, however in the evaluatio... (Complete abstract click electronic access below) / Mestre

Orientador: Maria Jaqueline Mamprim / Resumo: O diagnóstico da Leishmaniose visceral é complexo, devido à infinidade de sinais clínicos inespecíficos e por vezes os cães apresentam-se assintomáticos por longos períodos de incubação, contribuindo para a disseminação da doença. Com a finalidade de auxiliar o diagnóstico, o presente estudo tem por objetivo descrever alterações ultrassonográficas ao modo B, Doppler e elastográficos em rim e baço de cães soropositivos para LV. Foram avaliados ao exame ultrassonográfico rins de 33 animais naturalmente infectados por LV, sendo as alterações mais relevantes observadas: o aumento da ecogenicidade cortical (75,75%) e a perda da definição corticomedular (27,27%). O índice de resistividade apresentou-se elevado 0,70 e 0,71, para o rim esquerdo e direito, respectivamente. A dimetilarginina simétrica se mostrou elevada em apenas 12 animais. O escore elastográfico observado com maior frequência foi o dois, referente a tecidos de elasticidade intermediária, tendendo a macio. Também foram avaliados 36 baços de animais soropositivos, o sinal mais frequente foi a heterogeneidade do parênquima (77,77%) com áreas micronodulares hipoecogênicas (60,7%) e esplenomegalia (55,5%). O escore elastográfico esplênico mais observado foi o três, referente a tecidos de elasticidade intermediária tendendo a rígido. As alterações renais e esplênicas descritas no estudo devem ser inclusas como diagnóstico diferencial em cães provenientes de áreas endêmicas. / Abstract: The diagnosis of visceral Leishmaniasis is complex, due to the infinity of nonspecific clinical signs and dogs are often asymptomatic for long incubation periods, which may contribute to the spread of the disease. In order to help early diagnosis, the present study aims to describe sonographic mode B, Doppler and elastographic changes in kidney and spleen of VL seropositive dogs. Kidneys of 33 animals naturally infected with VL were evaluated by ultrasound examination. The most relevant changes were the increase in cortical echogenicity (75.75%) and the loss of corticomedullary definition (27.27%). The resistivity index remained high 0.70 and 0.71 for the left and right kidney respectively. Symmetric dimethylarginine was elevated in only 12 animals. The most frequently observed elastographic score was two, referring to tissues of intermediate elasticity. Thirty-six spleens from seropositive animals were also evaluated, the most frequent sign being parenchymal heterogeneity (77.77%) with hypoechogenic micronodular areas (60.7%), followed by splenomegaly (55.5%), and these changes could appear concomitant or not. The most observed splenic elastographic score was three (47.22%), referring to intermediate elasticity tissues tending to rigid. The renal and splenic changes described in the study should be included as differential diagnosis in dogs from endemic areas. / Doutor

Bakgrund: Kronisk njursjukdom drabbar mer än var 10:e människa världen över. Sjukdomen är komplex och kan ses i samband med andra sjukdomar. Individer behöver utföra en livslång och krävande egenvård av denna progressiva sjukdom. I dagens hälso- och sjukvård vårdas vanligtvis en sjukdom i taget vilket kan få vården att brista i individanpassat egenvårdsstöd. Syfte: Syftet med litteraturstudien är att beskriva erfarenheter av egenvård för individer med kronisk njursjukdom. Metod: En kvalitativ litteraturstudie baserad på åtta empiriska studier. Artiklarna hämtades från databaserna PubMed och Cinahl. Innehållsanalysen gjordes utifrån Fribergs femstegsmodell. Resultat: Två kategorier och sju underkategorier skapades utifrån resultatet. Kategorierna; 1) Hälsorelaterade värderingar och upplevelser påverkar egenvården 2) Behov av stöd för att utföra egenvård. Konklusion: Litteraturstudien visar att individer kan uppleva ångest och oro över sitt hälsotillstånd vilket försvårar utförandet av egenvård. Hälso- och sjukvården behöver ha ett personcentrerat bemötande och beakta individens beteenden och värderingar för att kunna ge en individanpassad information och ett kontinuerligt egenvårdsstöd. Därefter kan individen få en god förutsättning att ta till sig kunskap om sin hälsa. Sjuksköterskan har ett ansvar i att möta det egenvårdsbehov individen har genom att ge egenvårdsstöd för att leva ett mer hälsosamt liv. / Background: Chronic kidney disease affects more than every 10th person worldwide. The disease is complex and can be seen with other diseases. Individs need to perform a lifelong and demanding self-management of this progressive disease. In today's health care, one illness is usually cared for at a time, which can cause the care to fail in individualized self-management support. Aim: The aim of this study was to describe experiences of self-management for individs with chronic kidney disease. Methods: A qualitative literature study based on eight empirical articles. The articles were retrieved from the databases PubMed and Cinahl. The content analysis was based on Friberg's five-step model. Results: Two categories and seven subcategories were created based on the result. The two categories were: 1) Health-related values and experiences affect self-management 2) Need for support to perform self-management. Conclusion: The study shows that participants may experience anxiety about their state of health, which makes it difficult to perform self-management. Healthcare needs to have a person-centered approach and take into account the individ's behaviors and values in order to be able to provide individualized information and continuous self-management support. After that, individs can have a good chance of absorbing knowledge about their health. The nurse has a responsibility to meet the individs self-management needs by providing support to live a healthier life.