nÃo hà / O transplante renal à a terapia que oferece maior sobrevida e melhor qualidade de vida (QV) para pacientes com doenÃa renal crÃnica (DRC). Entretanto, mundialmente observa-se carÃncia de ÃrgÃos para realizaÃÃo de transplantes ocasionando grande tempo de permanÃncia dos pacientes em terapia dialÃtica. Objetivos: Identificar mudanÃa de nÃvel de QV e verificar associaÃÃo de variÃveis com nÃvel inicial e mudanÃa de QV em portadores de DRC submetidos à hemodiÃlise (HD) durante seguimento de 24 meses. Materiais e mÃtodos: A amostra foi formada pelos pacientes em HD regular na Ãnica unidade de diÃlise da regiÃo norte do CearÃ, Brasil. Foram incluÃdos maiores de 18 anos, nunca submetidos a transplante renal e com pelo menos trÃs meses sob terapia dialÃtica. Cento e sessenta e quatro pacientes foram submetidos a uma avaliaÃÃo e tiveram seus dados analisados de forma transversal. Noventa e dois foram submetidos a pelo menos duas avaliaÃÃes e foram analisados longitudinalmente. Ao serem incluÃdos no estudo os pacientes tiveram seus dados demogrÃficos, clÃnicos e laboratoriais coletados; foram classificados de acordo com grau de comorbidade pelo Ãndice de Khan; e foram submetidos ao instrumento de medida de QV SF-36. Anualmente os pacientes eram re-avaliados laboratorialmente e submetidos à nova avaliaÃÃo pelo instrumento SF-36. RegressÃo linear pelo mÃtodo stepwise foi utilizada para estimar a correlaÃÃo entre as variÃveis e o nÃvel inicial de QV. A mudanÃa de nÃvel de QV foi determinada pela anÃlise de variÃncia para medidas repetidas com uso de co-variÃveis (ANCOVA) considerando pontuaÃÃo inicial e final, e pelo cÃlculo da taxa de variaÃÃo mensal (pontuaÃÃo final menos pontuaÃÃo inicial com divisÃo do resultado pelos meses de seguimento). As variÃveis contÃnuas foram testadas quanto a sua associaÃÃo com mudanÃa de QV por regressÃo linear, e as variÃveis categÃricas pela estratificaÃÃo da amostra de acordo com a taxa de variaÃÃo mensal em trÃs grupos: melhora, piora, e sem mudanÃa. Resultados: O nÃvel de QV apresentou melhora em relaÃÃo Ãs dimensÃes Aspectos sociais (63,8 vs. 75,0; p=0,001), Aspectos emocionais (39,7 vs. 63,1; p<0,001) e SaÃde mental (63,1 vs. 69,0; p=0,009). Entre os pacientes com baixo grau de comorbidade, alÃm das dimensÃes citadas, houve melhora das dimensÃes Capacidade funcional (56,7 versus 63,5; p=0,014) e Dor (56,7 vs. 66,5; p=0,009). Idade e albumina foram as principais variÃveis correlacionadas com nÃvel inicial de QV. A idade se associou negativamente com as oito dimensÃes de QV: Capacidade funcional (r=-0,312; p<0,001), LimitaÃÃo por aspectos fÃsicos (r=-0,262; p<0,001), Dor (r=-0,157; p=0,049), Estado geral de saÃde (r=-0,232; p=0,003), Vitalidade (r=-0,298; p<0,001), Aspectos sociais (r=-0,293; p=<0,001), LimitaÃÃo por aspectos emocionais (r=-0,260; p=0,001) e SaÃde mental (r=-0,217; p=0,006). O nÃvel de albumina se correlacionou positivamente com Capacidade funcional (r=0,218; p=0,006), Dor (r=0,276; p<0,001), Estado geral de saÃde (r=0,268; p<0,001), Vitalidade (r=0,270; p<0,001) e Aspectos sociais (r=0,250; p=0,001). A idade e o nÃvel de creatinina se correlacionaram com mudanÃa do nÃvel de QV estimada pela taxa de variaÃÃo mensal. A idade se associou negativamente com Dor (r=-0,031; p=0,024), explicando 9,0% da variaÃÃo, e creatinina se correlacionou positivamente com Estado geral de saÃde (r=0,096; p=0,040), explicando 4,6% da variaÃÃo. Mais mulheres do que homens evoluÃram com piora da Capacidade Funcional [19 (50,0%) vs. 11 (21,2%); p=0,006]. ConclusÃes: Houve melhora dos aspectos mentais de qualidade de vida entre os pacientes. Essa melhora deve ser encarada como fator favorÃvel para implementaÃÃo de intervenÃÃes sobre os aspectos fÃsicos de qualidade de vida, com especial atenÃÃo aos pacientes do sexo feminino e com maior grau de comorbidade. O avanÃar da idade e nÃveis baixos dos marcadores do estado nutricional (albumina e creatinina) devem ser considerados indicadores de risco para pior nÃvel de QV. / Kidney transplantation is the therapy that offers longest lifetime and best quality of life (QL) in patients with chronic kidney disease (CKD). However, worldwide there is lack of organs to transplant, causing the need for long-term dialysis therapy. Objectives: To identify changes in QL level and verify the association between variables and initial level and changes in QL in CKD patients undergoing hemodialysis (HD) during a follow-up of 24 months. Materials and methods: The sample consisted of patients undergoing regular HD in the only renal unit in the north of Cearà state, Brazil. We included those older than 18 years who never had kidney transplant and had been under dialysis at for least three months. Hundred and sixty-four patients were submitted to one evaluation and their data composed a transversal analysis. Ninety-two were submitted at least to two evaluations and were studied by longitudinal analysis. At baseline we collected demographic, clinical and laboratory data; classified the patients according to comorbidity by the Khan index; and submitted them to the SF-36 questionnaire in order to measure QL. Every year the patients were re-evaluated with laboratory tests and submitted again to the SF-36. Linear regression by the stepwise method was used to estimate the correlation between variables and initial level of QL. Change in QL level was detected by analysis of variance using co-variables (ANCOVA), considering the initial and final scores, and by the monthly variation rate (final minus initial score divided by number of months of follow-up). Continuous variables were tested for their association with change in QL by linear regression, and the categorical variables were stratified according to monthly variation rate into three groups: improving, worsening, and no change. Results: QL level improved with respect to Social functioning (63.8 vs. 75.0; p=0.001), Role-emotional (39.7 vs. 63.1; p<0.001) and Mental health (63.1 vs. 69.0; p=0.009). Among low comorbidity patients, besides improvement in these dimensions, there was improvement in Physical functioning (56.7 vs. 63.5; p=0.014) and Bodily pain (56.7 vs. 66.5; p=0.009). Age and albumin were strong correlators due to the initial QL level. Age was negatively associated with all eight QL dimensions: Physical functioning (r=-0,312; p<0,001), Role-physical (r=-0,262; p<0,001), Bodily pain (r=-0,157; p=0,049), General health (r=-0,232; p=0,003), Vitality (r=-0,298; p<0,001), Social functioning (r=-0,293; p=<0,001), Role-emotional (r=-0,260; p=0,001) and Mental health (r=-0,217; p=0,006). Albumin was positively associated with: Physical functioning (r=0,218; p=0,006), Bodily pain (r=0,276; p<0,001), General health (r=0,268; p<0,001), Vitality (r=0,270; p<0,001) and Social functioning (r=0,250; p=0,001). Age and creatinine level were associated with changes in QL estimated by monthly variation rate. Age was negatively associated with Bodily pain (r=-0,031; p=0,024), responsible for 9.0% of its variation, and creatinine was positively correlated with General health (r=0,096; p=0,040), responsible for 4.6% in its variation. More women than men worsened in Physical functioning [19 (50.0%) vs. 11 (21.2%); p=0.006]. Conclusions: There was improvement in mental aspects of QL among the patients. This improvement should be seen as a favorable factor to implement interventions aimed at the physical aspects of QL, with special attention to women and high-grade comorbidity patients. Ageing and low level of the laboratory markers related to nutritional status (albumin and creatinine) should be considered as risk markers of poorer QL level.

Thesis (M.Sc.), Memorial University of Newfoundland, Faculty of Medicine, 1998. / Restricted until June 1999. Bibliography: leaves 123-133.

People living with renal failure experience enormous challenges, yet very little is known about life with this disease. The goal of this research was to gain an integrated understanding of the lives of people with renal failure. An understanding of life with renal failure that includes cultural, institutional and historical contexts may provide health care practitioners with the kind of information and insights necessary to improve medical practice. Thus far, medical practice has been based on a biomedical model of care that focuses almost exclusively on the physical aspects of illness. From this perspective, people with kidney disease are seen as autonomous and rational individuals. In this research, a sociocultural multiple case study approach was utilized in order to gain a situated understanding of life for four people with renal disease. This research revealed that life with renal failure is work. While it is the people living with renal failure who do the bulk of the work, friends and family also work to "live" with renal disease. Participants and their significant others learn about and become experts on life with this disease. A gap was found between practitioners' understanding of disease and participants' lived experience — resulting in many negative repercussions. Medical-based knowledge is lacking because it does not consider the three relevant sources of knowledge: practitioners, participants and participants' significant others. This research argues for a bridge between the home world and the hospital world, so that a broader community of practice is created. An account of the lived experience of people with renal failure that includes these factors can inform "best practice" because it provides a richer and more authentic picture of life with this illness. It is from this perspective that health care practitioners can begin to broaden their understanding of renal failure as it is "lived", and, so informed, can better provide the kinds of education and support that will enhance the lives of people with this illness.

Thesis (M.N.)--Memorial University of Newfoundland, 2003. / Typescript. Bibliography: leaves 176-183. Also available online.

Thesis (Ph. D.)--School of Nursing. University of Missouri--Kansas City, 2004. / "A dissertation in nursing." Advisor: Peggy Ward-Smith. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed feb. 27, 2006. Includes bibliographical references (leaves 124-131). Online version of the print edition.

People living with renal failure experience enormous challenges, yet very little is known about life with this disease. The goal of this research was to gain an integrated understanding of the lives of people with renal failure. An understanding of life with renal failure that includes cultural, institutional and historical contexts may provide health care practitioners with the kind of information and insights necessary to improve medical practice. Thus far, medical practice has been based on a biomedical model of care that focuses almost exclusively on the physical aspects of illness. From this perspective, people with kidney disease are seen as autonomous and rational individuals. In this research, a sociocultural multiple case study approach was utilized in order to gain a situated understanding of life for four people with renal disease. This research revealed that life with renal failure is work. While it is the people living with renal failure who do the bulk of the work, friends and family also work to "live" with renal disease. Participants and their significant others learn about and become experts on life with this disease. A gap was found between practitioners' understanding of disease and participants' lived experience — resulting in many negative repercussions. Medical-based knowledge is lacking because it does not consider the three relevant sources of knowledge: practitioners, participants and participants' significant others. This research argues for a bridge between the home world and the hospital world, so that a broader community of practice is created. An account of the lived experience of people with renal failure that includes these factors can inform "best practice" because it provides a richer and more authentic picture of life with this illness. It is from this perspective that health care practitioners can begin to broaden their understanding of renal failure as it is "lived", and, so informed, can better provide the kinds of education and support that will enhance the lives of people with this illness. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

The purpose of this study was to examine how chronic renal failure or cancer patients felt about their bodies during treatment. The sample was comprised of 22 subjects; 10 hemodialysis, six continuous ambulatory peritoneal dialysis (CAPD), and six chemotherapy patients. The settings included an outpatient dialysis center and an inpatient/outpatient chemotherapy treatment center. Two instruments, the Body Attitude Scale and the Body Cathexis Scale, were used to describe the patients' feelings about their bodies. Descriptive statistics were used to analyze the data. A significant difference on the Body Cathexis Scale among the subjects indicated that the chemotherapy patients had the most positive body attitude. The implications of the study for nursing are related to how nurses can provide anticipatory guidance to their clients. Both cancer and renal failure treatment require significant adaptation by the client. Therefore, appropriate nursing interventions must be instituted.

The effects of 18 milligrams elemental zinc as zinc sulfate were investigated in 24 hemodialysis patients during a double blind study. The study was conducted at two different dialysis centers in Utah. Each patient was evaluated for a 12 week period. The effects of zinc supplementation were evaluated using the parameters of serum zinc, hair zinc, dialysate zinc, and objective and subjective taste evaluation procedures. To possibly clearify the above determination in zinc status, copper determination were made of the same parameters. In addition, determinations of serum ferritin, transferrin and iron levels were made. A three day diet record was used to document the dietary intakes of calories, protein, and zinc as well as indicate the balance of food groups in the diets. Patients were evaluated biweekly throughout the study period. There were a total of six evaluations made on each participant during the investigation. Complete data were collected on six patients in the treatment group, and on ten patients in the control group. Even though the sample size was small, results were very steady and values fell within narrow ranges for most parameters examined. The mean baseline serum zinc value (n = 24) was 56 micrograms per deciliter. Patients, by this value would be classified as zinc deficient. However, the hair zinc levels were within the normal range, and no other signs or symptoms of zinc deficiency were evident in any patient, other than altered taste. There were no differences between pre and post dialysis serum zinc levels, nor were there any consistent increases in zinc levels cleared from the plasma during dialysis. There were no increases seen in the serum zinc or hair levels in response to zinc supplementation. Furthermore, there was no significant improvement in the taste acuities of the treatment group patients compared to the controls. The low serum levels maintained were probably due to the redistribution of body zinc known to occur in uremia. Most patients improved their taste test scores. This displayed the learning phenomena that was inherent in the taste testing technique. Furthermore, hemodialysis patients and the failure of many subjects to identify all four tastants (sweet, sour, bitter, and salt) correctly. Daily dietary intakes of high bioglogical value protein and zinc by the patients were less than the amounts recommended by the National Dietary Counsil and the physicians. However, the daily intakes of protein (55 grams) and zinc (7.9 milligrams) were not limited to the level where deficiency signs or symptoms of either nutrient were seen. Copper serum levels were all within the normal range. The mean baseline level for all patients was 113 micrograms per deciliter. Copper status appeared unaffected by uremia or hemodialysis. Body stores of iron, determined by serum ferritin levels, ranged from possibly indicating iron deficiency to iron overload. The body iron stores did not correlate with patients’ responses to the oral zinc supplementation.

This study investigated the hypothesis that dietary compliance among hemodialysis patients is related to their health locus of control orientation, as well as other factors. Fifty chronic hemodialysis patients were studied over a 3-month period. Among women interdialytic weight gain as a percentage of body weight (%BWG) was positively correlated with the number of weekly hemodialysis sessions and negatively related to ease of fluid compliance. Among men %BWG was positively correlated with powerful others health locus of control, family support, and hemodialysis tenure, and negatively correlated with employment. The best fitting multiple regression equation explained 26% of the variance for %BWG using ease of fluid compliance, frequency of urination, and powerful others orientation, with sex effects seen for the latter two variables. Staff perceptions of patient dietary compliance were also highly correlated with %BWG, though they never tabulated fluid gain controlled for body weight.

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