A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Internal Medicine.Johannesburg, 2013 / Chronic Kidney disease (CKD) is emerging as a global threat to health. In sub-Saharan Africa, most patients do not receive renal replacement therapy due to lack of funds. Measures to retard the progression of CKD are important. METHOD: A retrospective review of 122 patients attending a renal clinic, over a two a year period was performed. Patients with CKD from hypertension, diabetes mellitus, tubulo-interstitial disease were inluded. Patients with CKD due to viruses, malignancies and autoimmune RESULTS: Diabetes mellitus and hypertensiion were the leading causes of CKD. BP control improved, though 765 were on ≥3 anti-hypertensives. Serum creatinine doubled in 8.2% of patients. BP, acidosis and anaemia were independent risk factors for progression of CKD. The two year renal survival rate was 82%. CONCLUSION: Renal function progressed in few patients, which would be related to low levels of proteinuria, good BP control and us of RAS blockers

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Katrol. inst. / Härtill 6 uppsatser.

Chronic renal failure patients develop a coagulopathy primarily due to reversible platelet dysfunction. This coagulopathy makes certain anaesthetic techniques and procedures such as neuraxial anaesthesia and invasive line placement possibly contra-indicated or risky. There is no evidence to suggest that the degree of platelet dysfunction is proportional to the degree of renal dysfunction. In this research project the platelet function of 39 end stage renal failure patients, who received regular dialysis and who presented to theatre for vascular access, was assessed using the thromboelastogram. A bleeding time was also performed pre-operatively. A linear regression model was used to determine if the bleeding time, plasma urea, plasma creatinine or creatinine clearance could predict maximum amplitude (and therefore clot strength) on the thromboelastogram. No such regression could be found. The clinical implication of this result is that there exists no "safe" plasma urea or creatinine, below which it is safe to perform procedures which are contra-indicated in coagulopathies. The degree of renal dysfunction did not predict the degree of platelet dysfunction. Since dialysis reverses the platelet dysfunction, the question that should be asked before performing such a procedure is not "how severe is the renal dysfunction?" but rather "has the patient been receiving regular dialysis?"

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.

Thesis (Ph.D.)--Aberdeen University, 2009. / Title from web page (viewed on Oct. 5, 2009). Includes bibliographical references.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.

Methods: All patients (5606) with at least one serum creatinine ≥130μmol/L in females and ≥150μmol/L (Index creatinine) in males during a 6 month period in 2003 were grouped according to whether they had Acute Kidney Injury (AKI), Acute on chronic renal failure (ACRF) and chronic kidney disease (CKD). 1903 patients could  not be classified. After using all available creatinine data and identifying markers of kidney damage a further group of patients with CKD were identified. Case records were examined for the presence of co-morbidity, date of death, cause of death and whether they were known to a renal physician. Results: 1225 patients were identified as having CKD out of the 1903 “Unclassified” cohort (65%). The majority of CKD patients were elderly females with Stage 3 CKD. Hypertension and ischaemic heart disease were the two most common co-morbid conditions. Only 12% of CKD patients were referred to a nephrologists. 43% of CKD patients were dead at follow-up mostly from cardiovascular causes (31^st December 2005). The presence of proteinuria was independently associated with death. The age adjusted standardised prevalence of CKD, excluding those on RRT, was 20929 per million adult population. 3.6% went on to start RRT by the end of follow-up. Conclusions: CKD is predominantly a condition of elderly females, associated with considerable morbidity and mortality. However the majority of patients die from cardiovascular disease before progressing to ESRD. Therefore these patients may be appropriately managed in primary care without the need for specialist renal input allowing targeting of the specialist renal resources to the fewer patients who require them.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

Lic.-avh. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 2 uppsatser.