Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 54-59).

Thesis (M.S.)--University of Wisconsin. School of Nursing, 1973. / eContent provider-neutral record in process. Description based on print version record.

Introdução: A hemodiálise é um procedimento invasivo, para pacientes em falência renal onde se realiza a filtração do sangue continuamente, utilizando-se circulação extracorpórea em um filtro hemodialisador. No Brasil, a prática do reuso de hemodialisadores atinge quase 100% nos serviços de diálise. Uma das justificativas para o reuso são os limitados recursos para a assistência à saúde. No entanto, esta prática, causa questionamentos relacionados à segurança. Erros técnicos no reprocessamento, qualidade da água e alteração da integridade da membrana do hemodiliasador podem afetar a qualidade do processamento expondo os pacientes ao risco de bacteriemia e sepse. Objetivo: Avaliar a contaminação microbiana dos hemodialisadores após o número máximo de reusos permitidos, comparando os resultados conforme tipo de processamento: manual e automatizado. Método: Esta pesquisa caracterizou-se como estudo de campo, transversal, de caráter exploratório comparativo em dois serviços de diálise. A composição da amostra foi por conveniência conforme a disponibilidade destas, pelas instituições doadoras, sendo os grupos experimentais compostos por 11 hemodialisadores processados pelo método automatizado e quatro hemodialisadores processados manualmente. As amostras foram coletadas após o processamento obedecendo ao número máximo de reusos permitidos pela RDC ANVISA nº 11/2014, sendo 12 reusos para processamento manual e 20 reusos para processamento automatizado. Em Cabine de Proteção Biológica a solução salina e dialisadora foram drenadas dos compartimentos de sangue e dialisato, respectivamente, e injetados 150 mL de meio de cultura Tioglicolato de Sódio Fluido em cada compartimento. As amostras foram incubadas em estufa microbiológica por 14 dias, a temperatura de 35 ºC ±2ºC. Após esse período alíquotas do meio de cultura foram semeadas em meios de ágar sangue, anaerinsol e sabouraud, capazes de recuperar a maioria dos microrganismos aeróbios, anaeróbios, bolores e leveduras. As placas foram incubadas por 48 horas a 35 ºC ±2ºC, e procedida a identificação de gênero dos micorganismos. Realizados controles positivos com hemodialisadores contaminados intencionalmente e controles negativos, com novos esterilizados. Resultados: Das amostras submetidas ao processamento automatizado três amostras (3/11-27,3%) apresentaram crescimento microbiano no compartimento de sangue, sendo identificados dois diferentes microrganismos: de Sphingomonas paucimobilis (66,67%) e de Penicillium sp. (33,33%). Todas as amostras 11/11 (100%) apresentaram crescimento microbiano no compartimento de dialisato, sendo identificados 5 diferentes microrganismos: Sphingomonas paucimobilis (43,75%), Strenotrophomonas maltophilia (25%), Pseudomonas aeruginosa (18,75%), Acinectobacter baumannii (6,25%) e Candida sp (6,25%). Dos quatro hemodialisadores submetidos ao processamento manual, uma amostra (25%) apresentou crescimento de bacilo Gram-positivo no compartimento de sangue e uma amostra (25%) apresentou crescimento no compartimento do dialisato contaminados por três microrganismos distintos: de Bacillus sp, Rhizobium radiobacter, Burkholderia sp. Comparando os resultados da contaminação microbiana segundo os dois métodos de processamento analisados não houve diferença estatisticamente significante (p=1) para o compartimento de sangue. Para o compartimento do dialisato o método automatizado apresentou maior número amostras positivas em relação ao manual (p=0,008791). Conclusão: Os resultados demonstraram que o reuso dos hemodialisadores não é uma prática recomendada, podendo causar bacteriemia e sepse em pacientes em tratamento hemodialítico. Ressalta-se que a pesquisa foi conduzida no pior cenário após o número máximo de reusos permitidos sem determinar em qual número de reusos a contaminação aconteceu. / Introduction: Hemodialysis is an invasive procedure for patients with kidney failure in which blood is continuously filtered using a dialyzer filter through extracorporeal blood flow. In Brazil dialyzers are nearly 100% reused in dialysis facilities. One of the main justifications to reuse dialyzers is economical. However, this practice often leads to concerns related to patient safety. Technical errors in reprocessing, water quality and the membrane dialyzer degradation may lead to different risks including bacteremia and sepsis. Objective: To evaluate dialyzers regarding microbiological contamination after maximal number of reuses, comparing results in accordance with the type of reprocessing: manual and automated. Method: This research was characterized as a transversal, exploratory and comparative in two dialysis facilities. The sample was composed as convenience according to the availability of the facilities which donated the samples. The experimental groups were composed of 11 automated reprocessed dialyzers and four manually reprocessed dialyzers. The samples were collected after reprocessing in dialysis facilities according to the maximal number of reuses permited by law (12 in manual reprocessing and 20 in automated reprocessing) and prepared in Biosafety Cabinets. Saline Solution and dialysate solution were drained from both the blood and the dialysate chambers, respectively, by applying suction and filled with 150 mL of culture medium sodium thioglicolato fluid in each chamber and they were incubated at a temperature of 35 º C + or -2 ° C for 14 days. After this period, the samples were cultured in medium adequate for the growth of aerobic and anaerobic organisms as well as fungi and yeasts.The samples were incubated for 48 hours at 35 º C + or -2 ° C and identification of microorganisms was carried. Results: The analyzed samples which were automated reprocessed, 3/11(27.3%) showed microbiological growth in the blood chamber, of this total, we identified two different microorganisms: S.paucimobilis (66,67%) and Penicillium sp. (33,33%). In the dialysate chamber 11/11 (100%) of microbiological growth was identified, of this total we identified five different microorganisms: S.paucimobilis (43,75%) , S. maltophilia (25%) , P. aeruginosa (18,75%) , A. baumannii (6,25%) and Candida sp. (6,25%). The four analyzed samples which were manually reprocessed, 1/4(25%) showed microbiological growth in the blood chamber. One sample with Gram-positive Bacillus was identified in the dialysate chamber and contaminated by Bacillus sp, R. Radiobacter and Burkholderia sp. Comparing the results related to microbiological growth according to the two methods in the blood chamber, we concluded that there was no statistically significant difference (p=1) and in the dialysate chamber, there was a higher number of positive samples among those which were automated reprocessed compared to manually reprocessed (p = 0.008791) Conclusion: The results showed that dialyzers reuse is not a recommended practice and may cause bacteremia and sepsis for patients with chronical kidney disease. We highlight that this study was carried out considering the worst case scenario ,i.e. after the maximal number of reuses permitted by law, without specifying in which number of reuses the contamination occurred.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / Em meio Ãs doenÃas crÃnicas existentes està a InsuficiÃncia Renal CrÃnica (IRC), caracterizada como uma patologia de instalaÃÃo gradual, na qual o indivÃduo acometido desenvolve dependÃncia de uma terapÃutica contÃnua, a diÃlise. Esse fato causa modificaÃÃes no estilo de vida e pode repercutir na saÃde mental e qualidade de vida. O impacto causado por uma doenÃa e seu tratamento à diferente de um indivÃduo para outro, sendo necessÃrios estudos que valorizem os aspectos integrais do ser humano, de modo a se tornar subsÃdio para direcionar as aÃÃes profissionais, especialmente, as da equipe de enfermagem. Apesar das diversas inovaÃÃes tecnolÃgicas incorporadas no cuidado à pessoa com insuficiÃncia renal crÃnica em tratamento hemodialÃtico percebemos que nÃo existe um olhar diferenciado para a promoÃÃo da saÃde mental desses sujeitos e pouca Ãnfase à dada ao uso da tecnologia leve neste contexto, principalmente, quando a clientela pesquisada à o adolescente. Este estudo teve como objetivo avaliar o uso da tecnologia leve na promoÃÃo da saÃde mental e da qualidade de vida de adolescentes renais crÃnicos. Trata-se de uma investigaÃÃo convergente-assistencial realizada em uma clÃnica de diÃlise, referÃncia no atendimento de adolescentes com IRC, localizada em Fortaleza/CearÃ, no perÃodo de dezembro de 2011 a abril de 2012. Participaram oito adolescentes com diagnÃstico de IRC submetidos à hemodiÃlise. O projeto foi aprovado pelo Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ. A produÃÃo de dados foi realizada em duas fases (prà e pÃs desenvolvimento das oficinas vivenciais), compreendendo a aplicaÃÃo do questionÃrio sobre qualidade de vida (QV), entrevista semiestruturada e observaÃÃo estruturada. Os dados sobre QV foram coletados por meio de um questionÃrio WHOQOL Bref, constituÃdo de 26 perguntas que abrangem quatro domÃnios: fÃsico, psicolÃgico, relaÃÃes sociais e meio ambiente. Para realizar a anÃlise das informaÃÃes coletadas utilizamos um processo de estruturaÃÃo de Morse e Field, apresentado por Trentini e Paim. Os dados coletados por meio do WHOQOL Bref foram analisados conforme modelo estatÃstico (SPSS- Statistical Package for the Social Sciences - versÃo 15.0). Com base nos dados produzidos antes da realizaÃÃo das oficinas, emergiram quatro categorias de anÃlise: contextualizando a dinÃmica de tratamento dos adolescentes em hemodiÃlise; conhecendo os adolescentes em hemodiÃlise e a sua relaÃÃo com o adoecimento; significado da vivencia do adolescente renal crÃnico em hemodiÃlise; expectativas dos adolescentes quanto à participaÃÃo nas oficinas. Em seguida desenvolvemos as oficinas vivenciais, utilizando a tecnologia leve no cuidado de enfermagem e, posteriormente, a avaliaÃÃo da estratÃgia na percepÃÃo do adolescente. Nesta etapa foram desveladas trÃs categorias: consideraÃÃes dos adolescentes em relaÃÃo Ãs oficinas; repercussÃes na condiÃÃo vivenciada e significados dos encontros. Com base nos resultados, consideramos que a utilizaÃÃo da tecnologia leve como cuidado de enfermagem favoreceu a promoÃÃo da saÃde mental e da qualidade de vida dos adolescentes em tratamento hemodialÃtico, constituindo-se em um importante instrumental na assistÃncia desta clientela. / Amid existing chronic diseases are chronic renal failure (CRF), a disease characterized as gradual installation, in which the affected individual develops dependence on continuous therapy, dialysis. This fact leads to changes in lifestyle and can affect the mental health and quality of life. The impact of a disease and its treatment is different from one individual to another, and studies that value the integral aspects of being human, so as to make allowance for directing the actions professionals, especially the nursing staff. Despite various technological innovations incorporated in care for people with chronic renal failure on hemodialysis realize that there is a different look for the promotion of mental health of these individuals and little emphasis is given to the use of light technology in this context, especially when the clientele researched is the teenager. This study aimed to evaluate the use of soft technology in promoting mental health and quality of life of adolescents with chronic renal failure. This is a convergent-care research conducted in a dialysis clinic, reference in adolescents with IRC, located in Fortaleza / CearÃ, from December 2011 to April 2012. Participants were eight adolescents diagnosed with CRF undergoing hemodialysis. it is emphasized that the project was approved by the Ethics Committee of the Universidade Federal do CearÃ. The production data was divided into two phases (pre-and post-development workshops), subdivided in the questionnaire on quality of life (QOL), a semistructured interview and structured observation. The QOL data were collected through a questionnaire WHOQOL Bref, consisting of 26 questions covering four domains: physical, psychological, social relationships and environment. To perform the analysis of the information collected used a process of structuring Morse and Field, presented by Trentini and Paim. The data collected through the WHOQOL Bref were analyzed according to the statistical model (SPSS-Statistical Package for the Social Sciences - version 15.0). Four categories emerged from analysis of prior experiential workshops - contextualizing the dynamic treatment of adolescents on hemodialysis; knowing adolescents on hemodialysis and its relationship with the illness; meaning of the experiences of adolescents with chronic kidney disease on hemodialysis and expectations of adolescents regarding the participation in workshops . Then we develop experiential workshops, using light technology in nursing care and subsequently, evaluation of strategy on the perception of the adolescent. In this step was unveiled three categories: considerations of adolescents concerning the workshops; repercussions on condition experienced and meanings of the meetings. Based on the results, it is considered that the use of technology as a lightweight nursing care favored the promotion of mental health and quality of life of adolescents on hemodialysis, thus becoming an important instrumental in assisting this clientele.

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2016-07-14T19:52:57Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Avaliação do pH CT e FS de pac port insuf renal crônica PDF.pdf: 1534121 bytes, checksum: 8bf3ad1a647393c4291e183c75402b3e (MD5) / Made available in DSpace on 2016-07-14T19:52:57Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Avaliação do pH CT e FS de pac port insuf renal crônica PDF.pdf: 1534121 bytes, checksum: 8bf3ad1a647393c4291e183c75402b3e (MD5) Previous issue date: 2011-08-18 / O objetivo do presente trabalho foi avaliar o pH, capacidade tampão e fluxo salivar em pacientes com insuficiência renal crônica, antes e após a hemodiálise. Metodologia: estudo transversal, com 55 pacientes assim distribuídos: amostra de conveniência, composta de 32 indivíduos (18 homens, média de idade 59,5 anos, com idade variando de 28 a 87 anos e 14 mulheres, média de idade 48,2 anos, com idade variando de 30 a 83 anos) que se submetiam constantemente ao procedimento de hemodiálise em clínica particular na cidade de Maceió- AL (grupo 1) e 23 indivíduos (12 homens e 11 mulheres com média de idade de 24 e 22 anos respectivamente, com variação de 21 à 29 anos), composto por alunos do curso de odontologia do Centro universitário Cesmac e da Universidade Federal de Alagoas (grupo 2, controle). O fluxo salivar foi medido com seringa descartável de 5 mL. Para análise do pH foi utilizado pHmetro, a capacidade tampão foi avaliada através da diluição da saliva (2mL) em acido cítrico à 2% (2mL). A análise estatística foi realizada através dos testes de ANOVA, Tukey, Kruskal-Wallis e Dunn. Resultados: A hemodiálise não alterou as características do pH, fluxo e capacidade tampão da saliva. Comparando o grupo1 e o grupo 2 temos: pH com níveis semelhantes, com diferença estatística não significativa. O volume total de saliva expelida pelo grupo 1 apresentou níveis bem abaixo ao dos pacientes do grupo controle, 2,75 (± 2,32) e 7,26 (± 1,26) respectivamente. A capacidade tampão também foi menor no grupo 1. Conclusão: as características gerais da saliva (pH, capacidade tampão e volume) foram mantidas após a hemodiálise. / The aim of the present study was to evaluate the pH, buffer capacity e salivary flow rate of the patients with renal chronic failure, before and after hemodialysis. Methodology: a transverse study, total of 55 patients in this distribution: convenience sample with 32 individuals (18 males, age mean of 59,5 years, ranging 28 to 87 years and 14 females, age mean of 48,2 years, ranging 30 to 83 years) submitted the hemodialysis in a particular clinical in Maceio – AL (group 1) and 23 individuals (12 males e 11 females with age median of 24 and 22 years respectively, ranging 21 to 29 years), composed by graduation stage from CESMAC University Center and Federal University of Alagoas (group 2, control). salivary flow rate was observed the amount of aspirate salivary in a 5 ml syringe. The pH was analyzed with pHmeter and buffer capacity was verified by addiction of 2% citric acid (2 mL). Statistical analysis was verified by ANOVA, Tukey, Kruskal-Wallis and Dunn. Results: The hemodialysis don`t promoted modification on the pH, rate and buffer capacity in salivary samples. Comparing group 1 and group 2 was showed that: pH present similar level, with no statistical diference. The total salivary rate of group 1 was three times less than control group, 2,75 (± 2,32) e 7,26 (± 1,26) respectively. The buffer capacity was less in group 1. Conclusion: the general features of salivary (pH, buffer capacity and flow rate) keeping the same after hemodialysis.

Introduction: Patients with acute kidney injury (AKI) in developing countries are described in a profile of young age, with less comorbidities, with unifactorial, and with a lower mortality compared to patients in developed countries. Objective: To assess mortality in patients with acute kidney injury undergoing hemodialysis (HD) and its associated factors in a developing country setting. Methods: Retrospective study. Demographic, clinical, and mortality variables were collected from patients who presented AKI and underwent HD between January 2014 and December 2015 at a national reference hospital in Lima, Peru. Risk ratios (RR) and 95% confidence intervals (95%CI) were estimated through Poisson regressions. Results: Data from 72 patients with AKI that underwent HD were analyzed, 66.7% of them were < 64 years old, and 40.2% of all patients died undergoing HD. Crude analysis showed higher mortality among those who used vasopressors, but lower mortality among those with creatinine values > 8.9 mg/ dL. The adjusted analysis showed that having had a creatinine level of > 8.9 mg/ dL, compared to a creatinine level of < 5.2 mg/dL at the time of initiating HD, was associated with 74% less probability of death. Conclusion: Four out of every ten AKI patients undergoing HD die. Higher levels of creatinine were associated with lower probability of mortality.

INTRODUCTION: The worldwide incidence of acute kidney injury is 18% and the overall hospital mortality can rise above 50%. In Peru, there are few series about mortality of acute kidney injury in hemodialysis patients. OBJECTIVES: To identify risk factors associated to hospital mortality of acute kidney injury in hemodialysis patients. METHODS: This is a retrospective cohort of patients with acute kidney injury in hemodialysis of Hospital Nacional Edgardo Rebagliati Martins gathered between January 2013 and December 2015. The sample size was 154 patients which allowed a power of 80% and a CI of 95%. ICD-10 codes were used to identify medical records of patients with acute kidney injury (N.17) and hemodialysis (Z.49). The independent variable was oliguria, and the primary outcome was hospital mortality. Poisson regression was used for multivariate analysis. RESULTS: We identified a total of 285 patients; 212 medical records were analyzed and 44 were excluded. Out of the 168 medical records, 129 belonged to living patients and 39 to deceased ones. The overall mortality incidence was 17.2%. The principal etiologies of acute kidney injury while in hemodialysis were sepsis (39.2%), and severe dehydration (10.8%). In the adjusted model, the risk factors associated to hospital mortality of acute kidney injury while in hemodialysis were elevated serum lactate (RR 1.09), elevated serum potassium (RR 0.93), and mean arterial pressure (RR 0.97). CONCLUSIONS: Lactate is an objective parameter that can predict prognosis and contributes to a better management of acute kidney injury in hemodialysis patients. INTRODUCCIÓN: La incidencia de insuficiencia renal aguda a nivel mundial es 18% y la mortalidad intrahospitalaria puede alcanzar más del 50%. En Perú, existen escasos estudios acerca de la mortalidad en pacientes con insuficiencia renal aguda en hemodiálisis. OBJETIVOS: Identificar los factores de riesgo asociados a mortalidad intrahospitalaria en pacientes con insuficiencia renal aguda en hemodiálisis. MÉTODOS: Es una cohorte retrospectiva, en la cual se estudió a los pacientes con insuficiencia renal aguda en hemodiálisis en el Hospital Nacional Edgardo Rebagliati Martins entre enero de 2013 y diciembre de 2015. Se halló un tamaño de muestra de 154 pacientes con una potencia de 80%, y un intervalo de confianza de 95%. Se utilizaron los códigos de la Clasificación Internacional de Enfermedades-10 para identificar las historias clínicas de pacientes con insuficiencia renal aguda (N.17) y hemodiálisis (Z.49). La variable independiente fue oliguria y la variable dependiente fue mortalidad intrahospitalaria. Para el análisis multivariado, se utilizó regresión de Poisson. RESULTADOS: El universo fue de 285 pacientes. Se revisaron 212 historias clínicas y se excluyeron 44. De las 168 historias clínicas estudiadas, 129 pertenecían a pacientes vivos y 39 a fallecidos. La incidencia de mortalidad fue de 17,2%. Las principales causas de insuficiencia renal aguda en hemodiálisis fueron sepsis (39,2%) y deshidratación severa (10,8%). En el modelo ajustado, los factores de riesgo asociados a mortalidad intrahospitalaria de insuficiencia renal aguda en hemodiálisis fueron lactato (riesgo relativo 1,09), potasio (riesgo relativo 0,93), y presión arterial media (riesgo relativo 0,97). CONCLUSIONES: El lactato es un parámetro objetivo que permite predecir el pronóstico y contribuye a un mejor manejo de los pacientes con insuficiencia renal aguda en hemodiálisis.

Folate supplementation at a level of 15 to 35 mg per week is routinely prescribed for many chronic hemodialysis patients in B.C. In recent studies involving these levels of folate supplementation, RBC folate concentrations ranged from near the upper limit of normal to 1.5 times this upper limit. Initially there was research suggesting that high dose folate supplementation impaired zinc absorption but more recent studies refute this hypothesis. A beneficial effect of high dose folate supplementation is lowering of plasma homocysteine levels. This may be desirable since the homocysteinemia observed in chronic renal failure patients may be a factor in their commonly occurring premature vascular disease. The present study addressed folate needs on a nutritional basis but did not investigate folate's effect on homocysteine levels. The study involved chronic hemodialysis patients and was designed to: 1. assess whether patients consuming the Recommended Nutrient Intake for folate, require a folate supplement to maintain normal folate stores; 2. assess whether patients receiving a supplement of 5 mg of folate per day will have RBC folate levels exceeding the upper limit of the normal range; 3. compare serum zinc concentrations (and in some cases hair zinc levels as well) of patients receiving no zinc supplement or a 22.5 mg per day zinc supplement, to each other and to normal values; 4. assess whether a supplement of 5 mg of folate per day is associated with impaired zinc status; 5. in the event that a 5 mg per day folate supplement is associated with impaired zinc status, assess whether a supplement of 22.5 mg of zinc per day is associated with an improvement in zinc status; and 6. determine average daily energy, protein, folate and zinc intakes of patients. A 2x2 factorial quasiexperimental design was employed. The study included 21 clinically stable chronic hemodialysis patients between the ages of 25 and 69, who were receiving folate and/or zinc supplements at certain specific levels. Subjects were entered into treatment groups based on the following folate/zinc supplementation levels: no folate, no zinc; no folate, 22.5 mg zinc/day; 5 mg folate/day, no zinc; 5 mg folate/day, 22.5 mg zinc/day. Folate status was assessed using RBC folate concentration. Serum zinc concentration was measured in all subjects. Hair zinc level was determined in 6 of the zinc-supplemented subjects. A food frequency questionnaire was developed to determine dietary folate and zinc intakes. Subjects kept 3 day food records so average daily energy and protein intakes could be determined. Study results indicated no significant difference in protein intake (g/kg b.w.) or energy intake (expressed as a percent of requirement) among the four treatment groups. Differences in dietary folate intakes among the four treatment groups as well as between zinc-supplemented and non zinc-supplemented subjects, were not significant (p≤0.05). Mean dietary folate intake for all study subjects was 4.2 ug/kg b.w. RBC folate concentration was normal in both treatment groups receiving no supplemental folate. In contrast, the RBC folate concentration for both folate-supplemented groups was approximately 6.5 to 7 times the upper limit of the normal range. The difference between RBC folate concentration for folate supplemented and unsupplemented groups was highly significant (p<0.00001) and remained so when analysis of covariance was done with number of months of folate supplementation as the covariate. RBC folate levels did not differ significantly between zinc-supplemented and unsupplemented groups (p≤0.05). Differences in dietary zinc intakes among the four treatment groups as well as between zinc-supplemented and non zinc-supplemented subjects were not significant (p≤0.05). Mean dietary zinc intake for all study subjects was 9.39 mg/day. Serum zinc levels were below normal in both treatment groups receiving no supplemental zinc. The 22.5 mg zinc, no folate group had a serum zinc concentration near the lower limit of the lower range while that in the 22.5 mg zinc, 5 mg folate group was slightly below normal. When all zinc supplemented subjects were combined, serum zinc concentration was just within the normal range. Hair zinc analysis was conducted in a subgroup of 6 zinc-supplemented subjects and a group of non zinc-supplemented healthy controls. Hair zinc level was significantly higher in the zinc-supplemented subjects than in the controls (p≤O.01). In conclusion, folate supplementation does not appear to be required on a nutritional basis in clinically stable chronic hemodialysis patients not receiving medications known to affect folate status, who are consuming a diet providing a minimum of 1 g of protein per kg b.w. and 4.6 ug of folate per kg b.w. The low serum zinc concentrations observed in both zinc-supplemented and non zinc-supplemented patients may have been due to a shift of zinc from serum to other "zinc pools" in the body as reported in the literature. / Land and Food Systems, Faculty of / Graduate

Factors Influencing Women's Adaptation to Hemodialysis When Renal Transplantation is not an Option The intent of this study was to explore and describe factors that influence adaptation from the perspective of women on hemodialysis for whom renal transplantation is not an option. Phenomenology was the research design selected for this study in order to understand the experience of these women clients. Data were collected during audio-taped interviews of eight women and were analyzed concurrently with data collection to identify common themes. Two central themes emerged: the adaptation process and the theme of connectedness. The adaptation process was described as a six-phase process. Connectedness was defined as being connected to others and/or sources of life's energy. Several key factors that either facilitated or interfered with adaptation were identified for each of these two themes. Key factors that facilitated adaptation throughout the adaptation process Included a first run on dialysis, experience with adversity, emotional and instrumental support, coping behaviors such as asserting control and reframing the situation, diversions, adequate rest and confidence in health-care professionals. Factors interfering with adaptation to hemodialysis throughout the adaptation process included the gradual and ambiguous nature of renal disease, increasing dependence, reduced energy, transportation to dialysis, compromised somatic health, difficulty with assertiveness, prolonged stressors and lack of confidence in health-care professionals. Specific factors that influenced connectedness were identified. The facilitating factors identified were satisfactory relationships, nurturing others, normalizing, a harmonious atmosphere on the hemodialysis unit and pleasurable activities. Key factors interfering with adaptation related to the connectedness theme were isolation from others, unsympathetic others, ineffective communication with health-care professionals, and exclusion from activities. The findings relative to the adaptation process were discussed in the light of the literature on adapting to illness and stress. Connectedness was discussed primarily in relation to the literature exploring the socialization of women. Implications for nursing practice, education and research arising from these findings were outlined. / Applied Science, Faculty of / Nursing, School of / Graduate

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