Thesis (M. Sc.)--University of Michigan. / Includes bibliographical references.

Thesis (M. Phil.)--University of Hong Kong, 1983.

Thesis (M.Phil.)--University of Hong Kong, 1983. / Also available in print.

published_or_final_version / Medicine / Master / Master of Research in Medicine

No description available.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Masters of Medicine in Paediatrics (MMed) Johannesburg, 2017 / Children with end-stage renal disease are commonly placed onto chronic peritoneal dialysis (PD) while awaiting transplant. Mechanical, infectious and metabolic complications of PD may lead to technique failure, morbidity or mortality. This study aims to describe the complications and associated risk factors in children on chronic PD. It consists of a retrospective record review of patients less than 18 years old enrolled on the chronic PD program between 1 January 2009 and 31 December 2013. Seventy one percent of the patients had one or more complications while on PD. The most common complication was peritonitis (54%) followed by catheter obstruction in 29%. Patients on automated peritoneal dialysis (APD) were significantly less likely to develop peritonitis than those on continuous ambulatory PD (OR 23.14, 95% CI 2.45 – 218.0, p = 0.002). We therefore recommend that PD patients be preferentially placed on APD. / MT2017

Cardiovascular disease is responsible for at least half of all deaths in end-stage renal disease patients on maintenance dialysis and is attributed to the very high prevalence of left ventricular hypertrophy and dysfunction, cardiac failure, coronary artery disease and other atherosclerotic complications. Apart from traditional risk factors such as smoking, hypertension, diabetes and dyslipidemia, these patients are at risk of accelerated atherosclerosis and other cardiovascular complications as a result of non-traditional risk factors such as inflammation, anemia, increased oxidative stress, hyperparathyroidism and excessive calcium phosphorus load. In recent years, there is an increasing recognition of calcification complications in patients on dialysis. However, the importance and prognostic value of calcification in patients on peritoneal dialysis is not known. Residual renal function has a significant contribution to the overall survival in patients on peritoneal dialysis but whether it is in any way related to cardiovascular death and complications in patients on peritoneal dialysis is not known. Inflammation is highly prevalent in dialysis patients and is considered to play a pathogenic role in cardiovascular disease. In this thesis, we evaluated some of these relatively novel factors that may predispose peritoneal dialysis patients to an increased risk of cardiovascular complications and mortality, including calcification, loss of residual renal function and inflammation. A number of important conclusions were drawn from these studies. First, valvular calcification is a marker of atherosclerosis and shows important associations with malnutrition and inflammation and is an important predictor of mortality and cardiovascular deaths in peritoneal dialysis patients. Second, inflammation, as denoted by either C-reactive protein or vascular cell adhesion molecule-1 shows an important association with residual renal function and cardiac hypertrophy and is associated with mortality and cardiovascular risk in peritoneal dialysis patients. Third, loss of residual renal function is an important cardiovascular risk and combines adversely with C-reactive protein and cardiac hypertrophy to increase cardiovascular mortality in peritoneal dialysis patients. Fourth, resting hypermetabolism and the malnutrition, inflammation and atherosclerosis syndrome are associated phenomena that parallel the decline of residual renal function and predict an increased mortality and cardiovascular death in peritoneal dialysis patients.

Background: End Stage Renal Disease (ESRD) is one of the commonest diseases in Hong Kong. Patient with ESRD needs to start dialysis for life maintenance. Peritoneal dialysis (PD) is the predominant dialysis modality for home dialysis patients. More than 80% of dialysis patients in Hong Kong receive PD. However, it also brings out some PD-related infectious complication such as tenckhoff exit-site infection, tenckhoff tunnel infection and PD peritonitis. These complications markedly contribute to treatment failure in PD patients. Especially PD peritonitis, it remains a leading complication of PD. Also it is a main cause of patients switch to haemodialysis (HD)and discontinue PD. Nevertheless, if the primary prevention of PD education do better, research evidences have shown that peritonitis infection rate of PD patients can be effectively reduced. It can be achieve by the utilization of effective education strategies and advanced training skills to enhance patients’ knowledge and skills of peritoneal dialysis. Purpose: This written proposal aims to identify the best evidence of PD education and to develop a guideline for this health education programme. The goal of the programme is to reduce the rate of PD-related infection for patients who started PD treatment at home after first CAPD training and education. Method: A total of 12 studies which focused on PD education and strategies for reducing PD-related infections were searched from electronic databases. Data extraction and critical appraisal were performed on these 12 studies. After the integrative review, the implementation potential was assessed. The results shown that the transferability of finding is high and it is feasible to conduct the proposed innovation. Then, the evidence-based guideline for PD education programme were developed and based on the high and medium level of evidence with grades of recommendation stated. Before implementing the proposed innovation, a communication plan was developed and targeted the various stakeholders (the administrators, nurses, patients and their relatives). The proposer would initiate the change and the programme leading group would guide and sustain the proposed innovation. The next process was planning a pilot study to examine the feasibility of the proposed innovation before implementation. Finally, different outcomes of the programme has been identified and evaluated in the evaluation plan. The methods for data analysis were formulated. Conclusion: The proposed peritoneal dialysis education programme with best evidences support is worthy to be adopted in the clinical setting for the beneficial of PD patients to reduce their PD-related infectious complications. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Thesis (M. Res.(Med.))--University of Hong Kong, 2008. / Includes bibliographical references (p. 106-130)

A research report submitted in partial fulfilment of the requirements of the Master of Medicine at the University of Witwatersrand. Johannesburg, 16 April 2018. / Background: Chronic kidney disease and end stage kidney disease are becoming a huge health challenge. The optimal treatment is renal transplantation but due to low rates of transplantation most patients who are enrolled in the chronic renal replacement programme are on dialysis. This study aimed at investigating demographic and social factors that are associated with the outcomes of peritoneal dialysis (PD). The study also investigates how co-morbidity contributed to the outcomes of PD. Methods: The study makes use of retrospective analysis of demographic data (age, marital status, residential area, race) and socioeconomic status, level of education, family support, poor access to health care system as well as co-morbidities and underlying cause of ESKD, obtained from 167 patients who were enrolled on continuous ambulatory peritoneal dialysis (CAPD) over the period of 2008 - 2012 at the Charlotte Maxeke Academic Johannesburg Hospital (CMJAH). The data analysis for the present study was conducted using STATA version 14.0. To describe the demographic characteristics of the patients, frequency tables were computed for all categorical variables. For continuous variables, the Shapiro Wilk test for normality was used to assess the distribution of the data to report the appropriate central tendency measure i.e. mean±SD or median (IQR). To assess the contribution of demographic factors to the overall outcome of CAPD, a Fisher’s exact test of comparison was used to assess the difference between the proportions for each demographic factor and CAPD outcome. The Fisher exact test was used because the proportions for each frequency table included a proportion below five (<5). To assess how the relationship of demographic and co-morbid disease affects the outcome of the treatment, a multivariate logistic regression model was fitted adjusting for co-morbid disease for each of the demographic factors. Findings and interpretation: Of 167 patients enrolled, the majority were black with low levels of education, living in townships and 56% were on subsisting on disability grants. PD failure occurred in 53.3% of patients over the study period and 46.7% were successful on PD. Of the variables tested, age was statistically significant for CAPD outcomes [Fisher exact test (p= 0.004)], indicating a significant difference in the proportion of CAPD outcomes among different age categories). The univariate and multivariate logistic regression analysis did not show significant association with CAPD outcomes. Adherence also significantly impacted on outcomes in both univariate and multivariate analyses, showing that non-compliant patients were less likely to have successful outcomes on PD. In addition, the Fisher exact test showed no significant difference in the distribution of CAPD outcome with marital status while the multivariate analysis showed that single patients were three times more likely to succeed with PD compared to married patients. These could be due to chance, because of the small sample size, and require further investigation. Conclusions: Prospective studies are needed to fully understand the extent that demographic and socioeconomic factors impact on the outcomes of PD. This will assist in formulating comprehensive recommendations and ways to improve PD utilization and outcomes. / LG2018