Submitted in fulfillment of the Master of Technology : Biomedical and Clinical Technology, Durban University of Technology, 2014. / INTRODUCTION End stage renal disease (ESRD) occurs once 90 % of the kidney function is lost. Patients with ESRD must either undergo medical treatments, like haemodialysis, that substitute the function of the kidney, or they must have a kidney transplant. In the 1970s, haemodialysis treatment took 8 to 12 hours, three times per week. As technology advanced, dialyzers were able to handle more dialysate and higher blood flow rates hence treatment times were shortened to between three and five hours per treatment which has remained the norm until present day. One clinic in Tassin, France remained on the longer dialysis program and noticed advantages for patients who were on extended dialysis times. One of the major problems with dialysis done in the traditional sense is that it tries to provide a lot of therapy in a short period of time, and it is difficult to clear toxins and fluid in that time, Nocturnal dialysis provides a greater amount of toxin removal over a long period of time. AIMS AND OBJECTIVES The main aim of this study was to determine if nocturnal dialysis resulted in improved dialysis clearance, better overall patient health and a better quality of life. The primary objective of this study was to compare the clearance of small molecules (for example, urea, phosphate, creatinine and potassium) and large retention products (for example Parathyroid Hormone (PTH) and 2-Microglobulin) between the two haemodialysis procedures. The secondary objective was to compare the quality of life and survival of patients on both nocturnal and daytime dialysis. METHODOLOGY Thirty patients with End Stage Renal Disease (ESRD) presenting to the Sunninghill Hospital Dialysis Unit for treatment, who met the inclusion criteria, were recruited to participate in this study. Blood samples were taken for each participant at a baseline, 3 month and 6 month interval. The Kidney Disease Quality of Life Survey Questionnaire (KDQOL: SF- 36TM) was also given to each participant to complete. This survey consisted of three parts: 1) Physical Component Summary 2) Mental Component Summary and 3) Burden of Kidney Disease. This survey helped to predict the quality of life of the patients in each group. RESULTS In this study, non-significant effects of treatment were found for all small solutes individually. This study showed that there was a statistically significant increase in both dialysis adequacy and the clearance of large molecules (Parathyroid Hormone and Beta-2-Microglobulin) in the nocturnal haemodialysis group. The results of the KDQOL: SF-36 survey showed that the nocturnal dialysis patients scored higher in both the Physical Component Summary and the Mental Component Summary which means that they felt they were in better physical and mental health. The survey also showed that the nocturnal dialysis patients felt the burden of kidney disease less than those patients dialyzing during the day. CONCLUSION Firstly, dialysis adequacy as defined by the formula Kt/V, increased in the nocturnal group while it levelled off in the diurnal group. Secondly, both the Parathyroid Hormone levels and Beta-2-Microglobulin levels decreased more in the nocturnal group therefore resulting in statistically significant effects of treatment. The third and final conclusion drawn was that nocturnal haemodialysis resulted in better physical health, better mental health and a lower burden of kidney disease was felt by patients undergoing nocturnal haemodialysis.

Thesis (M. A. (PHARM.) -- University of Limpopo, 2019 / Introduction Multidisciplinary team (MDT) approach has emerged as one solution to improving chronic kidney disease (CKD) care. The MDT may include a nephrologist, physicians, nurses, dietitians, pharmacists, and social workers, all working together to deliver effective care to patients with CKD. Participation of pharmacists within the renal MDT at Polokwane hospital seems to be limited. The perceived barriers to pharmacists providing renal care services to CKD patients at Polokwane hospital could inform future strategy development, to enhance their participation. The aim of this study was to explore the role of pharmacists in renal care and develop strategies to maximise their participation in the renal multidisciplinary health care team, based on their participation at Polokwane hospital, Limpopo province. Method A qualitative study using semi-structured interviews was conducted with a purposeful sample of 8 members of the renal MDT and 9 pharmacists. The audiotaped interviews were transcribed exactly as said and analysed using thematic content analysis. Results Four themes emerged from the analysis: ‘pharmacist’s current scope of practice within the renal MDT’, ‘potential future roles of pharmacists’, ‘perceived barriers to participation of pharmacists within the renal MDT’ and ‘recommendation/Strategies to incorporate pharmacists into the MDT’. Results have shown that pharmacists have an absent role within the renal MDT. Their role is limited to just dispensing and managing stock, with no role in direct patient care. Both pharmacists and MDT members showed preference to working together during renal care. Pharmacy services suggested include medication reviews, provision of patient education and counselling, patient adherence improvement, dosage workouts, patient monitoring and education on contraindicated drugs and drug interactions. Shortage of staff, pharmacists lack of clinical skills, lack of communication and attitude of pharmacists were perceived as the major barriers to participation of pharmacists within the renal xii MDT. To overcome these barriers, it was recommended that the department of health (DoH) provide more pharmacy staff and educational opportunities in the form of workshops, to equip pharmacists clinically and broaden competency and knowledge on effective communication and coordination. In addition, it was recommended that the clinical curriculum at Universities be revised, to build solid foundation on MDT care and pharmacology and that the MDT programme be standardized through standard treatment guidelines (SOP’s), policies and drawing of job descriptions. Conclusion The role of pharmacists at Polokwane hospital is confined to just stock management and dispensing. There are promising avenues for future development of their role during patient care, which can be achieved by addressing the barriers highlighted Recommendations The expansion of the role of pharmacists within the renal MDT will require improved partnership between health care professionals, resources, legislations and guidance from formal SOPs. Having a national framework for pharmacy practice from Ministry of Health, supported by educational opportunities and a pro-active professional association would be key to incorporating pharmacists within the renal MDT.

A research project submitted in fulfilment of the requirements for the degree of Master of Arts in Psychology through the Faculty of Humanities, University of the Witwatersrand, Johannesburg, 2016 / Background Chronic Kidney Disease (CKD) is a reality faced by many around the world. There has been much physiological study around factors associated with CKD, as well as many studies surrounding the psychosocial impacts of the disease, with relatively less attention given to neuropsychological effects the disease can have on sufferers. This paper investigates the cognitive impacts as well as psychological impacts simultaneously, impacting on sufferers of End Stage Kidney Disease (ESKD). Methods Sixteen medically stable patients aged (M = 40.56, SD = 12.52) years with ESKD, were investigated. Eight of the patients were evaluated before and after six months of successful kidney transplant, using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which assessed immediate memory, visuospatial / constructional, language, and attention. They were also tested on a brief symptom inventory (BSI 18) to assess depression and anxiety in these patients. A further eight who remained on dialysis, and had not undergone renal transplant were evaluated in the same manner for comparative purposes. Results Between-group comparisons showed a statistically significant improvement in overall cognitive functioning, as well as in the specific cognitive domains of visuospatial / constructional, language and attention for participants who had undergone renal transplant surgery compared to their counterparts who had not. Results also found that there were no statistically significant differences between the levels of anxiety experienced between patients in the two groups. When assessing the differences in cognitive improvement within the transplant patient group before and after transplant, improvement in the delayed memory function of renal transplant patients post-transplant was found. Conclusion These data show improvements in delayed memory function of patients having undergone renal transplant therapy, while also highlighting a continued decline of overall cognitive functioning in patients remaining on hemodialysis therapy. / GR2017