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No. of bitstreams: 1 beduschi_gc_dr_bot.pdf: 2456181 bytes, checksum: 233d4c4938431e845e9e0e5cbed51438 (MD5) Previous issue date: 2017-02-24 / Introdução: A terapia renal substitutiva por diálise peritoneal (DP) na doença renal crônica pode ser realizada manualmente pela DP ambulatorial contínua (CAPD) ou pala utilização de cicladoras automatizadas (APD). O impacto da modalidade de DP nos resultados clínicos, sobrevida do paciente, da técnica de diálise e risco de peritonite não foi avaliado por ensaios clínicos randomizados com alto número de pacientes. Estudos observacionais não mostraram de modo consistente, superioridade de um desses métodos. Objetivos: Comparar os resultados e desfechos clínicos do tratamento por CAPD e APD, em coorte de pacientes incidentes adultos e incluídos no Estudo Multicêntrico Brasileiro de Diálise Peritoneal (BRAZ-PD). Métodos: Estudo nacional de coorte prospectivo multicêntrico no qual foi incluídos pacientes incidentes com pelo menos 90 dias em DP. Os pacientes foram alocados em dois grupos, tratados exclusivamente por CAPD ou APD, utilizando-se o escore de propensão para pareamento dos mesmos, de acordo com as variáveis: idade, etnia, sexo, diabetes mellitus, índice de massa corporal, experiência do centro, biênio de início da DP, doença arterial coronária, doença arterial periférica, hipertensão arterial, presença de neoplasia maligna, tempo de escolaridade, renda familiar, tempo de acompanhamento pré-diálise e hemodiálise prévia. Os desfechos clínicos foram avaliados utilizando o modelo de risco proporcional de Cox e análise para riscos competitivos de Fine e Gray. A evolução dos dados bioquímicos, hemoglobina e pressão arterial foi comparada pelo teste t ou teste de Wilcoxon. Resultados: Após o pareamento, 1445 pacientes incidentes foram incluídos em cada grupo. O risco de morte por todas as causas (SHR1.44 CI95%1.21-1.71) e por causa cardiovascular (SHR1.34 CI95%1.03-1.73) foi maior nos pacientes em CAPD, mas não observamos diferença na sobrevida da técnica e tempo para o primeiro episódio de peritonite. As médias de concentração sérica de potássio e de fósforo foram menores nos pacientes em CAPD na maioria das avalições, não se observando diferenças no controle pressórico e das demais variáveis. Conclusão: Com base em um grande estudo de coorte, randomizado e prospectivo, não foram encontradas diferenças na falência da técnica e tempo para o primeiro episódio de peritonite entre a CAPD e APD. Por outro lado, a APD se associou a maior sobrevida do paciente em comparação com CAPD. Esses achados podem influenciar a escolha da modalidade e estimular uma mais ampla utilização da APD. / Introduction: Renal substitutive therapy by peritoneal dialysis (PD) in chronic kidney disease patients can be performed manually by continuous ambulatory PD (CAPD) or using automated cyclers (APD).The impact of PD modality on patient survival, technique failure and peritonitis rates is not fully understood, and no large-scale randomized clinical trial is available. Observational studies have failed to show superiority of one of PD modalities. Objective: The aim of this study is to compare the clinical results and endpoints between CAPD and APD, in a large nation-wide PD cohort, BRAZ-PD. Methods: This is a prospective cohort study that included all incident PD patients with at least 90 days of PD recruited in the BRAZ-PD study. All patients who were treated exclusively with either CAPD or APD were matched for different covariates (age, diabetes, BMI, center-experience, coronary artery disease, cancer, literacy, hypertension, race, previous hemodialysis, gender, pre-dialysis care, family income, peripheral artery disease and year of starting PD) using a propensity score calculated with the nearest neighbor method. Clinical outcomes analyzed were overall mortality, technique failure and time to first peritonitis. For all analysis we also adjusted the curves for the presence of competing risks with the Fine and Gray analysis. Biochemical data, blood pressure and hemoglobin levels were compared by test or Wilcoxon test. Results: After the matching procedure, 1,445 patients were included in each group. General (SHR1.44 CI95%1.21-1.71) and cardiovascular mortality risk (SHR1.34 CI95%1.03-1.73) were higher in CAPD patients, but no difference was observed for technique failure nor for time till the first peritonitis episode. The mean of serum and phosphorus concentration were lower in CAPD group in the majority of measurements. Conclusion: In the first large PD cohort study with groups balanced for several covariates using propensity score matching, PD modality was not associated with differences in neither time to first peritonitis nor in technique failure. Nevertheless, patient survival was significantly better in APD patients. These findings can influence the PD modality choice and encourage a greater APD utilization.

Les études regroupées dans cette thèse montrent qu'il existe une hétérogénéité entre les centres de dialyse péritonéale dans la survenue des infections péritonéales et l’échec précoce de la méthode. Nous avons aussi montré que certaines organisations peuvent être modifiées dans l’objectif d’améliorer le devenir du patient en optimisant la ressource.Nos travaux soulignent le rôle des équipes infirmières et l’importance des visites infirmières à domicile dans la prévention des infections du liquide de dialyse péritonéale. La mise à disposition de moyens humains minimum pourrait constituer un des critères d’attribution des autorisations de traitement par dialyse donnés aux établissements de santé.Augmenter la taille des centres pourrait avoir un effet bénéfique sur la survie de la méthode en améliorant l’expérience des centres. Dans ce contexte, le regroupement d’activité entre plusieurs établissements pourrait avoir un effet positif sur la survie de la méthode.Nous avons aussi pu observer qu’il existait une disparité entre les centres dans l’utilisation de l’assistance à domicile par une infirmière pour la réalisation de la dialyse. L’attribution de l’assistance repose principalement sur l’évaluation de l’infirmière de dialyse péritonéale ce qui laisse entrevoir des possibilités de rationalisation dans son utilisation. L’utilisation et la validation d’outils permettant d’estimer la capacité d’autonomisation du patient est une recherche qui devra être conduite. / The studies grouped in this thesis show that there is a heterogeneity between the peritoneal dialysis centers in the occurrence of peritoneal infections and the early failure of the method. We have also shown that some organizations can be modified in order to improve the patient's future by optimizing the resource.Our work highlights the role of nursing teams and the importance of home nursing visits in the prevention of peritoneal dialysis fluid infections. The provision of minimum human resources could be one of the criteria for granting dialysis treatment authorizations given to health facilities.Increasing the size of the centers could have a beneficial effect on the survival of the method by improving the centers experience. In this context, group activities between several establishments could have a positive effect on the survival of the method.We also observed that there is a disparity between centers in the use of home assistance by a nurse for dialysis. The allocation of assistance is mainly based on the evaluation of the peritoneal dialysis nurse, which suggests possibilities of rationalization in its use.The use and validation of tools to estimate the patient's capacity to be treated by self-care peritoneal dialysis is a research that will need to be conducted.

Thesis (M.Sc. (Statistics)) -- University of Limpopo, 2019 / Recurrent peritonitis is a major problem of peritoneal dialysis (PD) due to its association with technique failure in the dialysis process. The literature on peritonitis focused only on investigating major risk factors associated with the first episode of peritonitis. However, this dissertation investigates factors associated to multiple episodes of peritonitis, to a maximum of 6 episodes. The correlation of recurrent episodes of a patient is considered. The univariate counting process, stratified, gap-time and marginal hazard regression models are applied to select the significant covariates to the multivariate regression hazard models. Regression coefficient for covariates are found to be statistically significant at 5% level. The application of Akaike information criterion (AIC) and Schwarz bayesian criterion (SBC) assisted to filter out the best method which is the stratified regression hazard model. The major risk factors associated with recurrent episodes of peritonitis are examined from the selected good fitting model. In conclusion, the selected model identified two independent risk factors to be significantly associated with recurrent episodes of peritonitis: marital status and glomerularfiltrationrate. Twocategoriesofmaritalstatus, divorceandwidowerare the significant factors compared to married patients (when taking married patients as the reference category). / VLIROUC Programme

by Szeto, Cheuk Chun. / Thesis (M.D.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (p. 183-206). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

published_or_final_version / abstract / Medicine / Doctoral / Doctor of Philosophy

by Wing-cheung Pang. / Thesis (M.Sc.)--Chinese University of Hong Kong, 1988. / Bibliography: leaves 45-56.

Thesis (M. Nurs.)--University of Hong Kong, 2006.

No description available.

No description available.

Thesis (Ph. D.)--University of Hong Kong, 2007. / Also available in print.