The purpose of this retrospective study was to determine the effectiveness of an innovative unit-wide phosphorus football contest and nutrition education intervention directed at improving the serum phosphorus levels and calcium-phosphorus products of patients undergoing routine hemodialysis. Patients at the Clarian Health Partners dialysis center located at 2140 North Capitol Avenue in Indianapolis, Indiana participated in the "National Fosphorus League Phootball" contest, a theme game that allowed patients to join a team and compete against other teams in the dialysis center over a four month time period from September 2005 to December 2005. Additional nutrition education was also provided to all the hemodialysis patients during the months of the phosphorus football contest. Identical patient information from September 2004 to December 2004 was also collected for baseline comparison of serum phosphorus levels and calcium-phosphorus products when only routine education and instruction was provided.Pearson Chi-Square analyses and a series of three-way ANOVAs were performed on the data collected. Overall, it was determined that patients who participated in the phosphorus football contest and received Vitamin D therapy were potentially two times likely to have serum phosphorus levels and calcium-phosphorus products in the goal ranges. / Department of Family and Consumer Sciences

Patients with end-stage renal disease undergoing hemodialysis have a high incidence of oxidative stress-related diseases. This study evaluated oxidative stress and inflammatory markers in patients undergoing hemodialysis before and during vitamin E supplementation. Blood samples were obtained before and after dialysis during two separate dialysis sessions to establish baseline measurements. For the next two months, subjects consumed 400 IU RRR-α-tocopherol daily. At one month and two months of supplementation, blood samples were also obtained before and after dialysis. Circulating concentrations of α- and γ-tocopherols and their metabolites (carboxyethyl-hydroxychromans, α- and γ-CEHCs), vitamin C, and uric acid were determined by HPLC with electrochemical detection. C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were measured using standard clinical assays. F₂-isoprostanes were evaluated using an enzyme immunoassay. Dietary vitamins E and C were assessed using two 24-hour recalls. In response to vitamin E supplementation, plasma α-tocopherol concentrations increased from 18 ± 1.7 μM to 31 ± 5.4 μM (p<0.0001), while γ-tocopherol concentrations decreased from 2.8 ±1.0 μM to 1.7 ± 0.6 μM (p=0.001). Additionally, serum vitamin E metabolites increased, α-CEHCs from 68 ± 20 pmol/ml to 771 ± 161 (p<0.0001) and γ-CEHC from 837 ± 161.8 pmol/ml to 1136 ± 225.9 (p=0.0083). Both CEHCs are well above reported normal values (p<0.0001). Dietary antioxidants (vitamins E and C) were low in most subjects; thus, plasma ascorbic acid levels were low in most subjects, but high in a few, resulting a wide range of responses (88 ± 84 μM). Nonetheless, ascorbic acid concentrations decreased significantly after dialysis to 33 ± 34 μM (p=0.0124), but were unaffected by vitamin E supplementation. Indeed, many parameters decreased significantly by dialysis but were unchanged by vitamin E supplementation, including plasma concentrations of uric acid and TNF-α. Both IL-6 and F₂-isoprostane concentrations were elevated in the subjects but were unaffected by either vitamin E supplementation or dialysis. CRP increased significantly after dialysis (p=0.0161, ANOVA main effect), but in the vitamin E supplemented subjects CRP concentrations were slightly lower before dialysis , but increased following dialysis (p=0.0041, ANOVA interaction). Taken together, the data suggest that there is a complex relationship between chronic inflammation and oxidative stress. Longer supplementation with vitamin E might be necessary in order to observe beneficial effects. / Graduation date: 2003

Made available in DSpace on 2015-05-14T16:53:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-09-01Bitstream added on 2015-05-14T16:58:56Z : No. of bitstreams: 1 000829061.pdf: 954808 bytes, checksum: 4db24b81e97a0d9789f7fab459997db1 (MD5) / Introdução: O hipercatabolismo é a alteração nutricional mais importante em pacientes com lesão renal aguda (LRA). Balanço nitrogenado (BN) e aparecimento de nitrogênio uréico (UNA) são medidas que permitem estimar a extensão do catabolismo na LRA. Objetivos: descrever e classificar o catabolismo de pacientes com LRA em Hemodiálise (HD) e Diálise Peritoneal de Alto Volume (DPAV) e analisar se BN e UNA são marcadores precoces de infecção e mortalidade nestes pacientes. Metodologia: Estudo tipo coorte prospectiva que avaliou pacientes com LRA dialítica internados no Hospital das Clínicas da Faculdade de Medicina de Botucatu, de março de 2011 a dezembro de 2012. Foi utilizado protocolo de estudo composto por dados clínicos, avaliação nutricional, parâmetros de catabolismo (redução de pelo menos 2g/dia no BN ou aumento de 2g/dia no UNA) e avaliação da presença de quadro infeccioso (presença de febre, leucócitos acima de 12.000/mm³ ou PCR>10mg/dl). Todos os pacientes foram acompanhados em conjunto com a equipe médica até a alta nefrológica hospitalar (na presença de recuperação parcial ou completa da função renal) ou óbito. Este estudo obteve aprovação do Comitê de Ética em Pesquisa da Instituição. Os resultados foram descritos como mediana ou média e desvio padrão. Para comparação das características clínicas, nutricionais e de catabolismo utilizou-se Teste t, Mann-Whitney ou Teste Qui-quadrado. Para a associação do BN e UNA com mortalidade e infecção foi utilizado teste t ou Mann-Whitney e curvas de Kaplan-Meyer, respectivamente. Utilizou-se como nível de significância estatística p<0,05. Resultados: Foram incluídos 124 pacientes, sendo 96 em HD e 28 em DPAV. Os pacientes apresentaram mediana de idade de 63 anos, prevalência de internação em UTI de 85,5%, Índice de Severidade da LRA (ATN-ISS) de 64,85% e taxa de mortalidade de 56,5%. Pacientes em HD e em DPAV apresentaram prevalência ... / Introduction: Hypercatabolism is the most important nutritional alteration in patients with acute kidney injury (AKI). Nitrogen balance (NB) and ureic nitrogen appearance (UNA) are measures that allow to estimate the extent of catabolism in AKI. Objectives: To describe and classify the catabolism of AKI patients on hemodialysis (HD) and high volume peritoneal dialysis (HVPD) and to examine whether NB and UNA are early markers of infection and mortality in these patients. Methodology: Prospective cohort study that evaluated AKI patients requiring dialysis at the Clinical Hospital of Botucatu Medicine College, from March 2011 to December 2012. The protocol study was performed using clinical and nutritional datas and parameters of catabolism. (such as reduction of at least 2g/day in NB or increased 2g/day in UNA) and assessment of presence of infection (fever, leukocytes above 12.000/mm ³ or CRP> 10mg/dl). All patients were followed by the medical staff since admission on unit nephrology until partial or complete recovery of renal function or death. This study was approved by the Ethics Committee of Research. Results are expressed as median or mean and standard deviation. To compare the clinical, nutritional and catabolism characteristics, t test, Mann-Whitney or chi-square were used. To investigate the association of NB and UNA with mortality and infection, t test or Mann-Whitney test and Kaplan-Meyer were used, respectively. The statistical significance level was p <0.05. Results: 124 patients were included, 96 in HD and 28 in HVPD. Patients had a median age of 63 years, prevalence of admission in ICU of 85.5%, AKI Severity Index (ATN-ISS) of 64.85% and mortality rate of 56.5%. HD and HVPD patients showed severe catabolism with NB median of -8.74 gN/day (-14.74;3.93 gN/day) vs. -7.36 gN/day (-13.46;-1.56 gN/day), p=0,73)], respectively. Measures of UNA were [16.74 gN/day (10.38 – 22.76 gN/day) vs. 12.97 gN/day (10.53 – 17.14), ...

Orientador: André Luis Balbi / Banca: Lilian Cuppari / Banca: Aline de Araújo Antunes / Banca: Silvia Papini / Resumo: Introdução: O hipercatabolismo é a alteração nutricional mais importante em pacientes com lesão renal aguda (LRA). Balanço nitrogenado (BN) e aparecimento de nitrogênio uréico (UNA) são medidas que permitem estimar a extensão do catabolismo na LRA. Objetivos: descrever e classificar o catabolismo de pacientes com LRA em Hemodiálise (HD) e Diálise Peritoneal de Alto Volume (DPAV) e analisar se BN e UNA são marcadores precoces de infecção e mortalidade nestes pacientes. Metodologia: Estudo tipo coorte prospectiva que avaliou pacientes com LRA dialítica internados no Hospital das Clínicas da Faculdade de Medicina de Botucatu, de março de 2011 a dezembro de 2012. Foi utilizado protocolo de estudo composto por dados clínicos, avaliação nutricional, parâmetros de catabolismo (redução de pelo menos 2g/dia no BN ou aumento de 2g/dia no UNA) e avaliação da presença de quadro infeccioso (presença de febre, leucócitos acima de 12.000/mm³ ou PCR>10mg/dl). Todos os pacientes foram acompanhados em conjunto com a equipe médica até a alta nefrológica hospitalar (na presença de recuperação parcial ou completa da função renal) ou óbito. Este estudo obteve aprovação do Comitê de Ética em Pesquisa da Instituição. Os resultados foram descritos como mediana ou média e desvio padrão. Para comparação das características clínicas, nutricionais e de catabolismo utilizou-se Teste t, Mann-Whitney ou Teste Qui-quadrado. Para a associação do BN e UNA com mortalidade e infecção foi utilizado teste t ou Mann-Whitney e curvas de Kaplan-Meyer, respectivamente. Utilizou-se como nível de significância estatística p<0,05. Resultados: Foram incluídos 124 pacientes, sendo 96 em HD e 28 em DPAV. Os pacientes apresentaram mediana de idade de 63 anos, prevalência de internação em UTI de 85,5%, Índice de Severidade da LRA (ATN-ISS) de 64,85% e taxa de mortalidade de 56,5%. Pacientes em HD e em DPAV apresentaram prevalência ... / Abstract: Introduction: Hypercatabolism is the most important nutritional alteration in patients with acute kidney injury (AKI). Nitrogen balance (NB) and ureic nitrogen appearance (UNA) are measures that allow to estimate the extent of catabolism in AKI. Objectives: To describe and classify the catabolism of AKI patients on hemodialysis (HD) and high volume peritoneal dialysis (HVPD) and to examine whether NB and UNA are early markers of infection and mortality in these patients. Methodology: Prospective cohort study that evaluated AKI patients requiring dialysis at the Clinical Hospital of Botucatu Medicine College, from March 2011 to December 2012. The protocol study was performed using clinical and nutritional datas and parameters of catabolism. (such as reduction of at least 2g/day in NB or increased 2g/day in UNA) and assessment of presence of infection (fever, leukocytes above 12.000/mm ³ or CRP> 10mg/dl). All patients were followed by the medical staff since admission on unit nephrology until partial or complete recovery of renal function or death. This study was approved by the Ethics Committee of Research. Results are expressed as median or mean and standard deviation. To compare the clinical, nutritional and catabolism characteristics, t test, Mann-Whitney or chi-square were used. To investigate the association of NB and UNA with mortality and infection, t test or Mann-Whitney test and Kaplan-Meyer were used, respectively. The statistical significance level was p <0.05. Results: 124 patients were included, 96 in HD and 28 in HVPD. Patients had a median age of 63 years, prevalence of admission in ICU of 85.5%, AKI Severity Index (ATN-ISS) of 64.85% and mortality rate of 56.5%. HD and HVPD patients showed severe catabolism with NB median of -8.74 gN/day (-14.74;3.93 gN/day) vs. -7.36 gN/day (-13.46;-1.56 gN/day), p=0,73)], respectively. Measures of UNA were [16.74 gN/day (10.38 - 22.76 gN/day) vs. 12.97 gN/day (10.53 - 17.14), ... / Doutor

Growth failure is a major problem in children with chronic renal failure (CRF). A number of factors have been suggested as explanations for this impaired growth including renal osteodystrophy, age of onset of chronic renal failure, degree of azotemia and nutritional status. As children with CRF are frequently unable to maintain sufficient nutrient intakes for optimal growth, the nutritional status of these individuals must obviously have a major, if as yet poorly understood, role in the observed growth failure. Therefore, a nutritional, physical and biochemical study was conducted to assess the nutritional status of seven children undergoing maintenance hemodialysis. To evaluate the adequacy of dietary intake, fourteen day food records were obtained from each of the participants and average nutrient intakes were compared to the recommended daily nutrient intake of the Canadian Dietary Standard (CDS) (1975). To assess the physical status of the children, height, height velocity, weight, per cent body fat, and bone age were determined. As abnormalities of taste sensitivity are known to influence dietary patterns, salivary flow rates, salivary urea concentrations, and taste detection and recognition thresholds for sweet, sour, salt and bitter were determined pre and post dialysis. Biochemical investigations included the determination of pre and post dialysis plasma amino acid concentrations following a standardized fast of five hours, and the quantification of the amounts of amino acids lost into dialysate during a complete hemodialysis treatment. The mean caloric intake of 54% ±11 of the CDS is inadequate for optimal growth. The mean protein intake was 1.09 ±.16 grams of protein per kilogram of body weight. The first and second limiting amino acids were histidine and threonine, respectively. Nutritional deficiencies of certain water soluble vitamins (riboflavin, niacin and pyridoxine) existed for some of the children. The mean zinc, magnesium and copper intakes were 45% ±8, 51% ±19 and 54% ±32 of the CDS, respectively. Growth (as measured by body height and weight) was found to be retarded one to two standard deviations from normal in the children studied. Per cent body fat estimations were within normal limits, but bone age was frequently below chronological age. Taste sensitivity was impaired as shown by elevated pre dialysis sweet and bitter recognition thresholds (p<.01). This reduced taste acuity was improved post dialysis (p<.005), but did not reach normal values. Pre and post dialysis, salivary flow rates were reduced (p<.0005) and salivary urea concentrations elevated (p<.0005) when compared to normal. Pre dialysis, plasma concentrations of taurine, a-amino-butyric acid, valine, cystine, leucine, tyrosine and tryptophan were decreased from normal levels (p<.025), and aspartic acid, proline, glycine, citrulline, ornithine, histidine, arginine, asparagine, 3-methylhistidine and hydroxyproline were elevated above normal (p<.005). The presence of subclinical protein calorie malnutrition (PCM) was indicated by a depressed plasma essential to nonessential amino acid ratio, a depressed plasma valine to glycine ratio, and an elevated plasma phenylalanine to tyrosine ratio as compared to normal. The detection of 3-methylhistidine and hydroxyproline in plasma provides additional indications of PCM. The mean amount of total amino acid lost into dialysate was 4.7 ±.9 grams. Histidine, threonine, lysine and valine were the essential amino acids lost in the largest amounts. In conclusion, growth is retarded in children with CRF and may be due to the accumulation of metabolic end products which depress appetite and/or delay the natural rate of growth events Suboptimal nutriture, as evidenced by the presence of PCM, is a major factor in the growth retardation of these individuals. / Land and Food Systems, Faculty of / Graduate

Text in English with abstracts in English and isiZulu / Poor adherence to their prescribed diet, medications and treatment contributes to increased mortality and morbidity in patients with end-stage renal disease. These patients must change their diet when receiving dialysis treatment, but cultural beliefs and practices can affect their adherence to the prescribed diet. The purpose of this qualitative, descriptive, exploratory study was to improve health education on prescribed diet adherence to patients living on haemodialysis at a haemodialysis unit in eThekwini Municipality. Data from a sample of 20 patients was collected using semi-structured interviews and analysed using qualitative content analysis. The findings revealed that haemodialysis patients’ prescribed diet adherence was influenced by cultural and religious views, and by family support. Food availability, patients’ geographical location and patients’ financial means hindered their adherence to their prescribed diet. A multi-disciplinary health care team including nurses, should be sensitive to patients’ different cultural beliefs and practices when providing health education. / Ukungabambeleli endleleni emisiwe yokudla, amakhambi nasekwelashweni kunomthelela ekwandiseni izimpawu zesifo sezinso esingapheli (ESRD) futhi kwandisa isibalo sabantu ababulawa yilesisifo. Iziguli ezinalesisifo zidinga ukushitsha indlela yokuphila, iziphuzo kanye nokulandela indlela emisiwe yokudla kakhulukazi mabe ngaphansi kokwelashwa ngokuhlanzwa kwegazi ngomshini (dialysis). Izinkolelo zamasiko nendlela zokuphila ezihambisana namasiko kwenze imfundiso nge ezempilo maqondana nendlela emisiwe yokudla yaba lukhuni. Inhloso yalolucwaningo bekuwukwandisa ulwazi nemfundiso ngezempilo mayelana nokulandela indlela emisiwe yokudla kwiziguli izithola ukulashwa ngokuhlanzwa kwegazi ngomshini (haemodialysis) esikhungweni esikuMasipala weTheku. Kusetshenziwe indlela yokwenza ucwaningo esezingeni elifanele, Imininingwano eqoqiwe eqembini (sample) leziguli ezingamashumi amabili (20) ezithola ukwelashwange haemodialyisis. Imininigwane iqoqwe kusetshenziswa izingxoxo ezihleliwe. Imigomo elawula ukuhlaziya ilandeliwe yonke ngenkathi kwenziwe lolucwaningo. Lolucwaningo luveze ukuthi indlela yokudla emisiwe yeziguli ezikwi dialysis iphazanyiswa imobono yamasiko, inkolo kanye nokusekelwa nokuzimbandakanya kwamalungu omndeni. Izinselelo ezinjengokutholakala, indawo isiguli esihlala kuyo nezinkinga zemali zivimbela ukubambelela endleleni emisiwe yokudla. Abasebenzi bezempilo kumele banakekele indima edlalwa izinkolelo namasiko uma befundisa ngezempilo ezigulini eziphethwe izinso. / Nursing Science / M.A. (Nursing Science)