No description available.

Background: International guidelines provide recommendations for early chronic kidney disease care. This thesis was completed to 1) measure the quality of chronic kidney disease care and identify gaps, 2) identify reasons why patients do not receive recommended care, and 3) determine if these guideline-recommended practices are associated with better patient outcomes. Methods: Population-based cohort studies were conducted for studies 1, 3 and 4. Using consensus-based indicators, study 1 quantified the quality of care for patients with early chronic kidney disease. Study 2 was a qualitative descriptive study eliciting primary care physicians’ perceived enablers and barriers to follow-up laboratory testing to confirm chronic kidney disease. Study 3 assessed the association between non-steroidal anti-inflammatory drug (NSAID) use versus non-use and adverse clinical outcomes among older adults. Study 4 assessed whether routine serum creatinine and potassium monitoring (versus no monitoring) following angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) initiation among older adults associated with better outcomes. Results: In study 1, most recommendations were being followed; however, some care gaps were identified. For example, half of the patients with initial abnormal kidney test results did not receive follow-up tests. This finding prompted study 2, where enablers and barriers to this practice were identified. Providers were aware that they should be ordering follow-up tests and had the resources to do so. However, some providers perceived this practice as low priority. In study 3, NSAID use was associated with a higher risk of complications. In study 4, routine ACEi / ARB monitoring did not prevent adverse outcomes. Conclusions: This thesis provides a better understanding of care gaps for patients with early chronic kidney disease in Ontario, and reasons for one of these care gaps. This research also provides evidence to help strengthen guideline recommendations (NSAID avoidance) or refute them (ACEi / ARB monitoring). / Thesis / Doctor of Philosophy (PhD) / Chronic kidney disease is a medical condition where a person’s kidney function is permanently reduced. Family doctors are responsible for the care of patients with early chronic kidney disease. However, many patients may not be receiving the right treatments from their family doctors to keep their kidneys healthy. This research used Ontario healthcare data to identify care gaps for patients with early chronic kidney disease. Interviews were then done with family doctors to identify reasons for one of these care gaps; specifically, why doctors do not always repeat blood and urine tests to confirm if patients have chronic kidney disease. Finally, this research looked at whether providing certain treatments led to better patient outcomes. This information can be used to update current guidelines and to inform strategies which help patients with chronic kidney disease receive the best possible care.

Background Chronic kidney disease (CKD) is a condition characterized by gradual loss of kidney function over time. Millions of adults have CKD and those who have diabetes, hypertension, and family history of kidney failure are at highest risk of its development. Patients may develop comorbidities, such as cardiovascular disease, anemia, mineral and bone disorders, and peripheral nervous system diseases. Those with kidney failure require dialysis or kidney transplantation, as well as medications, diet therapy, restriction of fluid intake, and lifestyle modifications. The cost for such treatment represents an enormous burden on healthcare systems worldwide, costing about 8% of the Medicare budget in the U.S. Literature review findings Chronic kidney disease is now described based on internationally accepted definitions and diagnosed, when structural or functional abnormalities of the kidneys persist for more than 3 months. End-stage kidney disease is the last stage of chronic kidney disease and is associated with a decreased quality of life and life expectancy. This comprehensive literature review focuses on the effectiveness of dietary therapy in delaying the progression of CKD to end stage kidney disease (ESKD). Current evidence provides guidelines to manage ESRD with the general population. However, despite this, many clinicians do not know how to use diet as part of clinical management. Proposed methods Given the broad spectrum of different dietary therapies to decelerate progression of CKD, many providers do not utilize this information in clinical practice. A workshop hosted by registered dieticians, summarizing the most up-to-date literature on the topic of dietary interventions to slow down CKD progression would be beneficial. The workshop will measure mid-level and high-level practitioner’s knowledge on dietary therapy for CKD and assess this post-workshop. The goal is to expand the knowledge of providers and equip them with the resources necessary to educate patients on healthy dietary modifications, in order to minimize progressive CKD. Conclusions Despite the availability of dialysis and recent advancements in post-transplant care, there is a benefit to lifestyle modification. There is promising evidence that a diet low in protein, potassium, or salt and following certain diets, such as the Mediterranean diet, is beneficial in the deceleration of CKD to end stage renal disease (ESRD). A diet containing processed foods, high protein, high salt, and high potassium content has been associated with an increased risk of transition from late-stage CKD to ESRD. It is possible that these dietary recommendations may apply to prevention of CKD or ESRD. The workshop will present the most up-to-date knowledge in the area of dietary therapies for CKD. A curriculum for mid- and advanced-level health care providers will provide them with the tools necessary to provide their patients with nutrition and lifestyle management.

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

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

Thesis--Copenhagen. / Summary in Danish. Translated from Danish. Includes bibliographical references (p. 137-165).

Thesis--Copenhagen. / Summary in Danish. Translated from Danish. Includes bibliographical references (p. 137-165).

Background: There is a 3-fold risk of developing end stage kidney disease in Non-Hispanic African Americans compared to Non-Hispanic White Americans (Centers for Disease Control and Prevention, 2017). Estimated glomerular filtration rate (eGFR), one of the fundamental algorithms for coordinating treatment for kidney disease which factors in age, race, gender, and levels of creatinine, may pose an issue in this vulnerable population. Currently African Americans receive a correction factor between 1.21 and 1.16 to their eGFR to adjusting the value higher, potentially impacting appropriate kidney disease classification, and delaying beneficial interventions (National Kidney Foundation, 2020). Methods: A systematic literature search of four databases was completed. Eligibility criteria included 1) published in a peer reviewed journal, 2) English language, 3) the use of race correction in calculating eGFR, and 4) a quantitative study design. A total of 47 articles were screened with 17 selected for final review. The Johns-Hopkins Nursing Evidence - Based Practice evidence guide was then used to rate the strength and quality of the evidence. Results: Early evidence of the unreliability of race based eGFR equations emerged in 2008, and the body of evidence continues to grow. Recent studies have found eGFR calculated with no race corrections correlate best with directly measured iothalmate GFR in black patients (Zelnick et al., 2021), and that a potential 1,066,026 Black Americans may be reclassified to a more severe stage of CKD (Bragg-Gresham et al., 2021). Use of the race correction in GFR equations has been poorly supported in studies conducted in Africa and Brazil. For those with HIV, an accurate eGFR is doubly important yet all eGFR equations have marked variability. Some medical facilities have successfully updated to calculating eGFR without the racial coefficient (Shi et al., 2021). Conclusion: Nurses should be aware of the implications of using race correction in eGFR equations, educate their patients on its use, and advocate for those near threshold targets to ensure equitable and timely access to appropriate kidney disease interventions.

No description available.

O emprego do hamsters (Mesocricetus auratus) como modelo biológico experimental para a reprodução da condição de portador renal de leptospiras foi investigado em machos e fêmeas jovens com 80 a 120 g de peso vivo. Os animais foram experimentalmente infectados com estirpe patogênica do sorovar Pomona caracterizada por provocar a morte por leptospirose entre o quinto e o décimo dia pós-infecção. No segundo dia pós-infecção os animais foram tratados com estolato de eritromicina, nas concentrações de 10, 20, 40 e 80 mg/kg de peso vivo. Aos 30 dias, da infecção experimental os sobreviventes foram anestesiados com isofluorano e procedeu-se a colheita de sangue para a determinação dos indicadores da função hepática e renal (Proteínas totais, Albumina, Uréia, Creatinina, Fosfatase Alcalina, Alanina Aminotransferase, Aspartato Aminotransferase, Bilirrubinas Indireta, Bilirrubinas Direta e Bilirrubinas Totais), bem como o titulo de aglutininas pela prova de soro aglutinação microscópica. A seguir, com o aprofundamento da anestesia, os animais foram submetidos a eutanásia e necropsiados para a colheita de tecido renal e hepático destinados aos exames histopatológicos pelas colorações de Hematoxilina - Eosina e Warthin- Starry, bem como do isolamento de leptospiras por cultivo em meio de Fletcher. Houve controles do inóculo infeccioso, do tratamento com antibiótico e do sistema de manejo adotado. O número de DL 50 efetivamente empregadas no inóculo infeccioso foi de 7,11. No grupo controle do antibiótico foi constatado elevação do nível de fosfatase alcalina e degeneração vacuolares dos hepatócitos para as concentrações de 40 a 80 mg de antibiótico. Os portadores renais de leptospira foram obtidos entre os animais tratados com 40 ou 80 mg de estolato de eritromicina, independentemente do sexo; estes animais apresentaram elevação dos níveis séricos de creatinina e proteínas totais já as determinações de albumina, uréia, alanina aminotrasferase, aspartato aminotransferase, bilirrubinas direta, bilirrubinas indiretas e totais foram iguais as encontradas em animais não infectados por leptospiras e não tratados com antibióticos. As alterações histológicas encontradas nos animais portadores de leptospiras foram degeneração vacuolar em hepatócitos, sangue no espaço porta, congestão glomerular. Nos animais induzidos a condição de portadores renais de leptospiras os títulos de anticorpos aglutinantes, para o sorovar homólogo ao da infecção, expressos em logaritmo de base, 10 foram iguais ou superiores a 1,19. / The use of hamsters (Mesocricetus auratus) as experimental model for the reproduction of leptospires kidney carrier condition was investigated on youngs males and females with 80 to 120 g of living weight. The animals were experimentally infected with pathogenic strain of serovar Pomona able of causing the death by leptospirosis between the fifth and the tenth post-infection day. On the second day post-infection the animals were treated with erythromycin estolate at the concentrations of 10, 20, 40 and 80 mg/ kg of living weight. At the 30th day of experimental infection the survivors were anesthetized with isoflurane and blood sample were collected for the determination of kidney and liver functions (Total proteins, Albumin, Urea, Creatinine, Alkaline Phosphatase, Alanine Aminotransferase, Aspartate Aminotransferase, Indirect Bilirubins, Direct Bilirubins and Total Bilirubins), and the of agglutinine title by the microscopic agglutination test (MAT). The animals were killed whit the reinforcement of the anesthesis, and necropsied for the collection of kidney and liver sample for histopathologic tests by staining of Hematoxylin-Eosina and Warthin-Starry, such as the isolation of leptospiras by cultivation into Fletcher´s medium. There were controls of the infecctious inoculum, antibiotic treatment and of the management system adopted. The number of DL 50 effectively applied in the infectious inoculum was 7,11. The antibiotic controls presented elevation of the alkaline phosphatase level and vacuolar degeneration of hepatocytes at the concentrations of 40 to 80 mg of antibiotic. The leptospire\'s kidney carriers were obtained in the animals treated with 40 or 80 mg of Erythromycin Estolate, regardless of the sex; these animals showed increase in creatinine\'s and total protein serum levels but of albumin, urea, alanine aminotransferase, aspartate aminotransferase, direct bilirubins, indirect bilirubins and total bilirubins were the same as found in animals not infected by leptospires and not treated with the antibiotic. The histological changes found in the animals induced as leptospires carrier were vacuolar degeneration in hepatocytes, blood in the portal tract, and glomerular congestion. The agglutinine titles for the homologous serovar, expressed on base 10 logarithm, were at least 1.19.