Thesis (Ph. D.)--University of Hong Kong, 2009. / Includes bibliographical references. Also available in print.

Thesis (M.Sc.) -- Memorial University of Newfoundland. / Typescript. Bibliography: leaves 80-86. Also available online.

Thesis (M.N) --Memorial University of Newfoundland, 1997. / Bibliography: leaves 105-112.

Made available in DSpace on 2014-06-11T19:27:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-02-25Bitstream added on 2014-06-13T18:31:42Z : No. of bitstreams: 1 antunes_aa_me_botfm.pdf: 702982 bytes, checksum: 499e260770ca22da2d95da039bd46522 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A terapia dialítica proporciona controle dos distúrbios metabólicos e remoção de toxinas urêmicas repercutindo positivamente no estado nutricional, por outro lado, o procedimento dialítico per se estimula produção de mediadores inflamatórios, induzindo catabolismo; associado a isso é freqüente o achado de sobrecarga líquida na população em diálise, fator que parece influenciar o estado inflamatório e nutricional. Na diálise peritoneal crônica a gênese e o balanço entre associações do estado de hidratação, inflamatório e nutricional não é completamente entendida. Caracterizar a amostra de pacientes em diálise peritoneal e verificar a influência do estado de hidratação e inflamatório, separadamente, sobre marcadores clínicos, nutricionais e inflamatórios. Estudo transversal que avaliou 27 pacientes em diálise peritoneal crônica quanto a parâmetros clínicos, dialíticos, laboratoriais, antropométricos e de bioimpedância elétrica (unifreqüêncial). A amostra foi estratificada quanto ao estado de hidratação pela relação entre água extracelular - AEC e água corporal total - ACT (0,47 para homens e 0,52 para mulheres); e quanto ao estado inflamatório, pela Proteína C reativa - PCR (1 mg/dl). Modelo de regressão linear múltipla foi aplicado na amostra não estratificada, para avaliar a influência de parâmetros sobre hidratação e inflamação; comparações foram realizadas por análise de covariância, Mann-Whitney, teste t de Student, Qui-quadrado ou teste exato de Fisher, considerou-se significância estatística quando p<0,05. RESULTADOS E DISCUSSÃO: Nesta casuística, sobrecarga líquida esteve presente em 100% dos pacientes, com valores de AEC/ACT de 0,51±0,05. Quanto à influência dos parâmetros no estado de hidratação, observou-se que pacientes em diálise automatizada e com maior função renal residual apresentaram menor sobrecarga líquida. / Dialytic therapy provides metabolic imbalances management and uremic toxins removal, positively reflecting on nutritional state. Otherwise, the dialytic procedure itself stimulates the production of inflammatory mediators, leading to catabolism; allied to this inflammatory state, dialytic patients frequently presents fluid overload, a factor that seems to influence both nutritional and inflammatory status. In chronic peritoneal dialysis, the genesis and the balance of hydration, nutritional and inflammatory state remains unclear. To describe chronic peritoneal dialysis patients characteristics and to verify the influence of inflammatory and nutritional state, separately, on clinical, nutritional and inflammatory markers. Crosssectional study that evaluated 27 chronic peritoneal dialysis patients according to clinical, dialytic, laboratorial, anthropometric parameters and bioelectrical impedance analysis -BIA (single-frequency BIA). The population sample was stratified according to: hydration state, by the relation between extracellular water - ECW and total body water – TBW (0.47 for men and 0.52 for women); and according to inflammatory state, by Creactive protein – CRP (1mg/dl). Multiple regression analyses was applied on the not stratified sample to evaluate the parameters influence on hydration and inflammation; comparisons were made by covariance analyses, Mann-Whitney, t test, Chi-square or Fisher exact test; values were considered significant when p<0.05. In this casuistic study, fluid overload were observed on 100 percent of the patients, with ECW/TBW values of 0.51±0.05. About the influence of the parameters on hydration state, we observed that patients under automatic peritoneal dialysis and greater residual renal function presented lower fluid overload. According to ECW/TBW, patients with higher fluid overload, compared to those with minor overload, presented lower phase... (Complete abstract click electronic access below)

Although relatively rare, encapsulating peritoneal sclerosis (EPS) is nonetheless a major concern within the renal community. Risk of developing EPS is associated with long-term peritoneal dialysis. Surgery now offers better outcomes. Research into EPS continues to focus on imaging and early detection methods, genetics, biomarkers and preventive strategies. No previous studies have examined patients' experiences of EPS, or their perception of the effect of EPS on health-related quality of life. Aims: The aim of the present study was to explore the experience of patients who have undergone surgery for EPS in one centre in the north of England. Methods: Nine participants were recruited out of a total of 18 eligible. Most participants were interviewed twice conducted on two occasions over a 12-month period. This was October 2009 to October 2010. Analysis: Interpretative data analysis was conducted, following the philosophical tradition of hermeneutics. Following the first interview a summary was sent to each participant before the second interview. Both interviews were analysed and are presented as themes. Results: EPS presents the biggest challenge these patients have had to face since developing chronic kidney disease. Three major themes were identified each with subcategories: 1. Understanding EPS -self interpretation, 'not being heard', gaps in information and knowledge, diagnosis shock and relief-confronting death 2. EPS an embodied experience- endurance, bodily awareness from others and within, struggles with eating 3. Adjustments and Transitions 'A journey of survival'- losses, support structures and their impact and locating self. Conclusions: The findings of this study highlight a number of important issues relevant to clinical practice, including lack of information and understanding of EPS, particularly its early symptoms, the extent of the surgery and the support required. At the time patients transfer from peritoneal to haemodialysis, the provision of adequate information about the risks and potential early signs of EPS may improve not only their experiences but in addition may assist its early detection.

Introducción: En pacientes con Enfermedad Renal Crónica Terminal (ERCT), la mortalidad cardiovascular está asociada a la presencia de calcificaciones vasculares. Nuestro objetivo fue determinar la asociación entre la modalidad de diálisis y la presencia de calcificación en aorta abdominal en pacientes con ERCT. Métodos: Realizamos un estudio transversal mediante el censo de los pacientes de la unidad renal del Hospital Nacional Edgardo Rebagliati Martins (HNERM), Lima-Perú. Las calcificaciones se evaluaron con radiografías simples de abdomen lateral. Comparamos la proporción de sujetos con calcificaciones según modalidad de diálisis. Calculamos razones de prevalencia mediante la regresión log-binomial. Resultados: Enrolamos 224 pacientes de los cuales 75,4% (169/224) estaban en hemodiálisis y 24.6% (55/224) en diálisis peritoneal. La edad mediana fue 57 años y el 49.1% (110-224) eran mujeres. El 31.3% (70/224) tuvo calcificaciones en aorta abdominal. La modalidad de diálisis no presentó asociación significativa con la presencia de calcificaciones. Sin embargo, la significancia presento valores límites. Los niveles altos de paratohormona estuvieron asociados en forma independiente con las calcificaciones. Conclusiones: Nuestro estudio sugiere que la diálisis peritoneal podría asociarse a una mayor presencia de calcificaciones vasculares a comparación de la hemodiálisis por ser la significancia límite debido al pequeño tamaño muestral. La evaluación rutinaria de calcificaciones a lo largo del tratamiento de soporte dialítico debe ser promovida en esta población. / Background: Presence of vascular calcifications is associated to cardiovascular mortality in patients with terminal chronic renal disease (ESRD). The aim of the present study is to determine the association between dialysis modality and the presence of vascular calcification. Methods: Vascular calcification was detected by plain lateral abdominal radiograph. We calculated the proportion of vascular calcification associated whit dialysis modality obtaining adjusted prevalence ratios from logistic regression models in this cross- sectional study. Results: We studied a total of 224 patients, 75.4 % (169/224) were on hemodialysis and 24.6% (55/224) on continuous ambulatory peritoneal dialysis. The median age was 57 years –old and 49.1% (110-224) were female. Abdominal aortic calcification was detected in 31.3% (70/224). Higher parathyroid hormone level (PTH) was an independent factor associated whit vascular calcification. Conclusions: Our study suggests that peritoneal dialysis could be associated a higher presence of vascular calcification but we did not find a significance result due to small sample. The continuous evaluation in this group of patients must be encouraged to prevent further complications. / Tesis

Background: Bone and mineral metabolism disorders are common among end-stage renal disease (ESRD) patients, which could lead to hip fracture. It is unclear whether the hip fracture risk is different among patients on hemodialysis (HD) versus peritoneal dialysis (PD). This meta-analysis was conducted to evaluate the hip fracture risk in ESRD patients on HD, when compared to PD. Methods: A literature review was conducted in EMBASE, MEDLINE, and Cochrane databases through January 31, 2018 to identify studies that appraised the rate or risk of hip fracture among patients on HD, when compared to PD. Effect estimates from the individual studies were derived and consolidated utilizing random-effect, generic inverse variance approach of DerSimonian and Laird. Results: Five cohort studies with 1 276 677 ESRD patients were enrolled. HD status was associated with a significantly higher risk of hip fracture with the pooled odds ratio (OR) of 1.61 (95% confidence interval [CI] 1.50-1.73, I2 = 10.0%), compared with PD. When the analysis was limited to studies with confounder-adjusted analysis, the pooled OR of hip fracture among HD patients was 1.57 (95% CI 1.43-1.72, I2 = 13.6%). Funnel plots and Egger's regression test demonstrated no significant publication bias in our meta-analysis. Conclusions: Among ESRD patients, HD status is associated with a 61% higher risk of hip fracture compared to PD.

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Chronic peritonitis contributes to technique failure in peritoneal dialysis (PD), an effective replacement therapy for chronic kidney failure. Staphylococcus aureus infection is one of the most common causes of peritonitis in PD. Interestingly, mice deficient in the cell surface heparan sulfate proteoglycan, syndecan-1, were reported to clear S. aureus corneal infection more effectively than wild-type mice. The objectives of this study were to examine the protein expression and role of syndecan-1 in leukocyte recruitment, chemokine presentation and S. aureus infection in the microcirculation underlying the parietal peritoneum in wild-type and syndecan-1-/- mice. Immunofluorescence intravital microscopy (IVM) of the parietal peritoneum microcirculation revealed that syndecan-1 was localized to the subendothelial region of venules and the mesothelial layer but does not regulate leukocyte recruitment and is not necessary for presentation of the chemokine MIP-2 in peritoneal venules. IVM was also used to study the effects of a conventional PD solution injected through a peritoneal catheter in a mouse PD model. After 6 weeks of dialysis, the peritoneal catheter implant increased leukocyte rolling and extravasation, fibrosis and angiogenesis in the parietal peritoneum independently from the dialysis solution treatment. Furthermore, the role of syndecan-1 was examined using a 4 week PD model. Four hours after infection with S. aureus through the dialysis catheter or intraperitoneal injection, the dialyzed syndecan-1-/- mice were more susceptible to S. aureus infection than undialyzed syndecan-1-/- controls and wild-type animals. IVM showed that in S. aureus infection, syndecan-1 was removed from the subendothelial surface of peritoneal venules but syndecan-1 deficiency did not affect leukocyte recruitment during S. aureus infection. This study indicates that syndecan-1 in the peritoneum and microcirculation is not a regulator of inflammatory responses but is crucial for providing a barrier to S. aureus infection, which may have important implications for susceptibility to S. aureus infections in PD. / Dissertation / Doctor of Philosophy (Medical Science)