Symptoms in patients receiving dialysis are common and associated with impaired quality of life. Symptoms are a top research priority because effective therapies are lacking and even with appropriate diagnosis and treatment, residual symptoms often persist. Clinical trials in the setting of kidney disease are challenging to conduct and as a result, nephrology lags behind other specialties regarding the degree to which clinical trials inform the care of patients with kidney disease, including those receiving dialysis. The studies in this thesis inform the design of randomized controlled trials with regards to run-in periods and the treatment of symptoms in patients with kidney disease. Chapter 2 describes a meta-epidemiologic study of the frequency, setting and purposes of run-in periods in parallel randomized controlled trials of self-administered medications for chronic diseases in adults. Chapter 3 is a study within a trial of an international randomized controlled trial that compares spironolactone to placebo for the prevention of cardiovascular morbidity and mortality in dialysis. It compares the ability of a 3-week study visit in addition to a 7-week study visit during an active-run-in period to identify and exclude participants with non-adherence. Chapter 4 is a protocol for a randomized placebo controlled crossover trial of low fixed dose pharmacologic therapy for restless legs syndrome in hemodialysis that includes a placebo run-in period for adherence and tolerability. Chapter 5 is a survey of Canadian nephrologists regarding the use of cannabinoids for symptom management in patients with kidney disease and support for their use in clinical trials. / Thesis / Doctor of Philosophy (PhD)

No description available.

It is the architect's responsibility to protect the public's health, safety, and welfare. Ironically, healthcare facilities, whose programs focus on those elements, often seem to fall short of those basic design standards. The evolution of healthcare practices has brought us to a stage of design that focuses on the machine rather than the patient. This shift has created stripped, unwelcoming, and unnatural healthcare environments that have proven to negatively impact the health and well-being of facilities' patients. Dialysis treatment facilities, whose medical procedures rely so heavily on machines, are an even more extreme condition of this imbalance. In an effort to raise awareness of this problem and reinvigorate architectural design that actually promotes healthy environments, I chose to explore the idea of "design that heals". Through the conscientious integration of nature, light, and color, this project redefines the priorities of a healthcare facility and takes a holistic and sustainable approach to design that better cares for the patients and enlivens the community. The proposed program pairs a dialysis clinic with a community nutrition center which helps address the causes of kidney disease at the source. Located in an underserved Anacostia neighborhood, the people-focused building provides nutrition education, food production and healthcare services. Taking inspiration from the filtration process of dialysis, the building aims to celebrate and expose its own water circulation systems, mirroring the beautiful, yet chaotic, systems within the human body. / Master of Architecture

Chronic kidney disease (CKD) is a multifaceted health problem with both physical and psychological manifestations. Increased symptom burden is associated with higher risk of mortality, decreased treatment adherence, and impaired quality of life. Despite the recognition of the importance of symptoms, the symptoms and mental health of individuals with CKD remain poorly understood in terms of their measurement, epidemiology and associated service use. The chapters in this dissertation aim to inform these knowledge gaps. Chapter 2 focusses on the symptom burden of patients receiving maintenance hemodialysis treatment and uses exploratory analyses to identify intra-dialytic symptom clusters associated with prolonged dialysis treatment recovery time. Chapters 3 and 4 are population-based studies examining mental health and addictions service utilization in patients with CKD using administrative data in Ontario, Canada. Chapter 3 is a cross-sectional study evaluating the prevalence of individuals with a history of mental health and addiction service use by levels of kidney function. Chapter 4 is a retrospective cohort study evaluating the rates of mental health and addiction service use over time in patients with CKD. Together, these chapters provide further understanding of how symptoms of dialysis and mental health and addiction service use may be measured in this patient population. They also inform considerations for the design of future symptom management and system-level mental health strategies in CKD. / Thesis / Doctor of Philosophy (PhD)

Gao, Ni. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 133-153). / Abstracts also in Chinese. / ACKNOWLEDGEMENTS / TABLE OF CONTENT --- p.1 / LIST OF FIGURES AND TABLES --- p.4 / List of Figures --- p.4 / List of Tables --- p.5 / ABSTRACT --- p.6 / 中文摘要 --- p.9 / ABBREVIATIONS --- p.11 / Chapter CHAPTER 1 - --- BACKGROUND REVIEW AND HYPOTHESIS --- p.13 / Chapter 1.1 --- Overview of Peritoneal dialysis --- p.13 / Chapter 1.2 --- Peritoneal dialysis in Hong Kong --- p.16 / Chapter 1.3 --- Cardiovasular Disease in PD patients --- p.18 / Chapter 1.3.1 --- Arterial disease --- p.21 / Chapter 1.3.2 --- Left ventricular hypertrophy --- p.23 / Chapter 1.4 --- Malnutrition in PD patients --- p.26 / Chapter 1.5 --- Fluid overload in PD patients: a cause and a result of CVD --- p.28 / Chapter 1.5.1 --- Overview --- p.28 / Chapter 1.5.2 --- Fluid overload and residual renal function --- p.29 / Chapter 1.5.3 --- Fluid overload and hypertension --- p.30 / Chapter 1.5.4 --- Fluid overload and malnutrition --- p.32 / Chapter 1.5.5 --- Assessment of fluid status in PD patient --- p.33 / Chapter 1.6 --- Peritoneal transport as the cause of fluid overload --- p.36 / Chapter 1.6.1 --- Structure of peritoneum --- p.36 / Chapter 1.6.2 --- Structural alteration of peritoneal membrane in PD --- p.37 / Chapter 1.6.3 --- Ultrafiltration dysfunction --- p.38 / Chapter 1.6.4 --- Peritoneal transport and outcome of PD patients --- p.40 / Chapter 1.6.5 --- Fluid overload and peritoneal transport --- p.41 / Chapter 1.6.6 --- Peritoneal transport and malnutrition --- p.42 / Chapter 1.6.7 --- Assessment of peritoneal transport --- p.44 / Chapter 1.7 --- Closing the circle: Arterial stiffness as a cause of high peritoneal transport? --- p.47 / Chapter 1.7.1 --- Vascular function and anatomy --- p.47 / Chapter 1.7.2 --- Atherosclerosis --- p.49 / Chapter 1.7.3 --- Atherosclerosis and Endothelial Dysfunction --- p.50 / Chapter 1.7.4 --- Atherosclerosis and Extracellular Matrix --- p.53 / Chapter 1.7.5 --- Arterial stiffness and renal function --- p.54 / Chapter 1.7.6 --- Arterial stiffness in PD --- p.55 / Chapter 1.7.7 --- Arterial stiffness and clinical outcome --- p.55 / Chapter 1.7.8 --- Assessment of arterial stiffness --- p.57 / Chapter 1.8 --- An overall construct --- p.61 / Chapter 1.9 --- Hypothesis --- p.63 / Chapter CHAPTER 2 - --- GENERAL METHODOLOGY --- p.65 / Chapter 2.1 --- Radiographic Parameters of Intravascular Volume Status --- p.65 / Chapter 2.2 --- Pulse Wave Velocity Study --- p.69 / Chapter 2.3 --- Dialysis adequacy study --- p.72 / Chapter 2.4 --- Peritoneal equilibration test (PET) --- p.73 / Chapter 2.5 --- Assessment of nutritional status --- p.75 / Chapter CHAPTER 3 - --- Radiographic Parameters of Intravascular Volume Status as a Prognostic Marker in Chinese Peritoneal Dialysis Patients --- p.77 / Chapter 3.1 --- Introduction --- p.77 / Chapter 3.2 --- Patients and Methods --- p.78 / Chapter 3.3 --- Results --- p.81 / Chapter 3.4 --- Conclusion --- p.90 / Chapter CHAPTER 4 - --- Longitudinal Changes of Radiographic Parameters as the Prognostic Marker of Chinese Peritoneal Dialysis Patients --- p.91 / Chapter 4.1 --- Introduction --- p.91 / Chapter 4.3 --- Results --- p.95 / Chapter 4.4 --- Conclusions --- p.104 / Chapter CHAPTER 5 - --- "The Relation between Arterial Pulse Wave Velocity, Peritoneal Transport Characteristics, and Radiological Parameters of Intravascular Volume Status in Chinese peritoneal dialysis patients" --- p.105 / Chapter 5.1 --- Introduction --- p.105 / Chapter 5.2 --- Patients and Methods --- p.106 / Chapter 5.3 --- Results --- p.110 / Chapter 5.4 --- Conclusions --- p.119 / Chapter CHAPTER 6 - --- DISCUSSION --- p.120 / Chapter 6.1 --- Methodology --- p.120 / Chapter 6.2 --- Results --- p.123 / Chapter 6.3 --- Further Directions of Research --- p.131 / Chapter 6.4 --- Conclusions --- p.132 / REFERENCE --- p.133 / PUBLICATIONS RELATED TO THIS WORK --- p.154 / Index Publication --- p.154 / Abstract --- p.154

Bakgrund: Antal personer som lever med kronisk njursvikt ökar med befolkningsökningen. Peritonealdialys är en vanlig livsuppehållande behandling för patienter som lever med kronisk njursvikt som främst sköts av patienter i hemmet. För att kunna fortsätta leva med sjukdomen under kontroll kräver peritonealdialys införande av nya livsförändringar som på olika sätt kan vara påfrestande för patienterna. Syfte: Syftet var att beskriva patienters upplevelser av att leva med peritonealdialys i sin vardag. Metod: Litteraturöversikten baserades på elva vetenskapliga artiklar med kvalitativa ansatser hämtade från databaserna CINAHL complete och PsyINFO. Sökorden som användes vid artikelsökning var patient experience, living with" och "peritoneal dialysis" som vidare utökades till "perspective", "home dialysis, qualitative study och interview'' med års begränsning 2000- 2017. Resultat: Litteraturöversikten visade att patienternas upplevelser av att leva med peritonealdialys innefattade en livsförändringsprocess med upplevelser av övergång som en besvärlig vändpunkt i livet vilket började redan vid PD- initiering. De första sex månaderna var den svåraste tiden att hitta balansen och anpassa sig till ett nytt levnadssätt, under den perioden hade patienterna stora behov av stöd både från sjukvården och det egna sociala nätverket dels för att bearbeta de olika förluster och begränsningar relaterad till PD- behandlingen, dels för att upprätthålla motivationen för att fortsätta sköta sin behandling. Med tiden ökade patienterna upplevelser av oberoende självständighet i att hantera sin egenvård och deras behov av stöd minskade, stödet från sjukvården minskade till enbart rutinkontroller. Diskussion: Patienters upplevelser av att leva med PD diskuterades och analyserades utifrån Orems teori om egenvårdsbalans och tidigare forskning. Större delen av diskussionen understryker betydelse av sjukvårdpersonalens bemötande som kan såväl positivt som negativt påverka patienters upplevelser. Hur väl en patient lyckades med sin egenvård berodde mycket på bemötandet, anpassad information, typ av stöd i patientens sociala nätverk och vilka vårdinsatser patienten fick under behandlingsprocessen.

This thesis describes and evaluates an optical method utilizing ultra violet (UV) absorbance for on-line monitoring of haemodialysis treatment. Increased efficiency of haemodialysis treatment is considered to correlate to decreased morbidity and mortality when urea clearance (Kt/V) is elevated. However, further improvements have not been achieved at a higher Kt/V. The mortally rate in the haemodialysis population is still high (27% in Sweden). Urea as the clinical marker is under discussion, partly due to urea being non-toxic, but also that the uraemic syndrom is the result of a cumulative retention of innumerable involved compounds. On-line monitoring systems based on urea determination for improved dialysis efficiency have been suggested and developed in different settings over the last two decades, but have not achieved worldwide utilisation as routine clinical equipment. This thesis demonstrates that the UV-technique utilising 280, 285 and 297 nm is capable of estimating dialysis efficiency in therms of Kt/V, nutritional status in terms of protein catabolic rate (PCR), with the same characteristics as existing methods. One novel finding using UV-absorbance with high sampling rates is the on-line visualisation of the clearance process for following variations in clearance caused by clinical events and disturbances as well as during and after adjustments. The fact that the UV-absorbance technique does not measure urea directly but has high correlation to several other both UV-absorbing and not-absorbing solutes makes it suitable to reflect a more overall solute retention process. Finally, a new efficiency parameter based on the calculation of the area under UV- curve (clearance curve), is suggested to reflect the total removal of some solutes. In summary the UV-technique has the potential to be an additional tool to evaluate improvements of dialysis efficiency, which may result in decreased morbidity, longer life span and enhanced quality of life for the haemodialysis patients.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 5 uppsatser.

Thesis (M.S.)--University of Michigan, 1986.