Thesis (M.S.)--University of Michigan, 1987.

Thesis (M.S.)--University of Michigan, 1987.

Orientador: Pasqual Barretti / Resumo: Introdução: A terapia renal substitutiva por diálise peritoneal (DP) na doença renal crônica pode ser realizada manualmente pela DP ambulatorial contínua (CAPD) ou pala utilização de cicladoras automatizadas (APD). O impacto da modalidade de DP nos resultados clínicos, sobrevida do paciente, da técnica de diálise e risco de peritonite não foi avaliado por ensaios clínicos randomizados com alto número de pacientes. Estudos observacionais não mostraram de modo consistente, superioridade de um desses métodos. Objetivos: Comparar os resultados e desfechos clínicos do tratamento por CAPD e APD, em coorte de pacientes incidentes adultos e incluídos no Estudo Multicêntrico Brasileiro de Diálise Peritoneal (BRAZ-PD). Métodos: Estudo nacional de coorte prospectivo multicêntrico no qual foi incluídos pacientes incidentes com pelo menos 90 dias em DP. Os pacientes foram alocados em dois grupos, tratados exclusivamente por CAPD ou APD, utilizando-se o escore de propensão para pareamento dos mesmos, de acordo com as variáveis: idade, etnia, sexo, diabetes mellitus, índice de massa corporal, experiência do centro, biênio de início da DP, doença arterial coronária, doença arterial periférica, hipertensão arterial, presença de neoplasia maligna, tempo de escolaridade, renda familiar, tempo de acompanhamento pré-diálise e hemodiálise prévia. Os desfechos clínicos foram avaliados utilizando o modelo de risco proporcional de Cox e análise para riscos competitivos de Fine e Gray. A evolução dos ... (Resumo completo, clicar acesso eletrônico abaixo) / Doutor

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No. of bitstreams: 1 beduschi_gc_dr_bot.pdf: 2456181 bytes, checksum: 233d4c4938431e845e9e0e5cbed51438 (MD5) Previous issue date: 2017-02-24 / Introdução: A terapia renal substitutiva por diálise peritoneal (DP) na doença renal crônica pode ser realizada manualmente pela DP ambulatorial contínua (CAPD) ou pala utilização de cicladoras automatizadas (APD). O impacto da modalidade de DP nos resultados clínicos, sobrevida do paciente, da técnica de diálise e risco de peritonite não foi avaliado por ensaios clínicos randomizados com alto número de pacientes. Estudos observacionais não mostraram de modo consistente, superioridade de um desses métodos. Objetivos: Comparar os resultados e desfechos clínicos do tratamento por CAPD e APD, em coorte de pacientes incidentes adultos e incluídos no Estudo Multicêntrico Brasileiro de Diálise Peritoneal (BRAZ-PD). Métodos: Estudo nacional de coorte prospectivo multicêntrico no qual foi incluídos pacientes incidentes com pelo menos 90 dias em DP. Os pacientes foram alocados em dois grupos, tratados exclusivamente por CAPD ou APD, utilizando-se o escore de propensão para pareamento dos mesmos, de acordo com as variáveis: idade, etnia, sexo, diabetes mellitus, índice de massa corporal, experiência do centro, biênio de início da DP, doença arterial coronária, doença arterial periférica, hipertensão arterial, presença de neoplasia maligna, tempo de escolaridade, renda familiar, tempo de acompanhamento pré-diálise e hemodiálise prévia. Os desfechos clínicos foram avaliados utilizando o modelo de risco proporcional de Cox e análise para riscos competitivos de Fine e Gray. A evolução dos dados bioquímicos, hemoglobina e pressão arterial foi comparada pelo teste t ou teste de Wilcoxon. Resultados: Após o pareamento, 1445 pacientes incidentes foram incluídos em cada grupo. O risco de morte por todas as causas (SHR1.44 CI95%1.21-1.71) e por causa cardiovascular (SHR1.34 CI95%1.03-1.73) foi maior nos pacientes em CAPD, mas não observamos diferença na sobrevida da técnica e tempo para o primeiro episódio de peritonite. As médias de concentração sérica de potássio e de fósforo foram menores nos pacientes em CAPD na maioria das avalições, não se observando diferenças no controle pressórico e das demais variáveis. Conclusão: Com base em um grande estudo de coorte, randomizado e prospectivo, não foram encontradas diferenças na falência da técnica e tempo para o primeiro episódio de peritonite entre a CAPD e APD. Por outro lado, a APD se associou a maior sobrevida do paciente em comparação com CAPD. Esses achados podem influenciar a escolha da modalidade e estimular uma mais ampla utilização da APD. / Introduction: Renal substitutive therapy by peritoneal dialysis (PD) in chronic kidney disease patients can be performed manually by continuous ambulatory PD (CAPD) or using automated cyclers (APD).The impact of PD modality on patient survival, technique failure and peritonitis rates is not fully understood, and no large-scale randomized clinical trial is available. Observational studies have failed to show superiority of one of PD modalities. Objective: The aim of this study is to compare the clinical results and endpoints between CAPD and APD, in a large nation-wide PD cohort, BRAZ-PD. Methods: This is a prospective cohort study that included all incident PD patients with at least 90 days of PD recruited in the BRAZ-PD study. All patients who were treated exclusively with either CAPD or APD were matched for different covariates (age, diabetes, BMI, center-experience, coronary artery disease, cancer, literacy, hypertension, race, previous hemodialysis, gender, pre-dialysis care, family income, peripheral artery disease and year of starting PD) using a propensity score calculated with the nearest neighbor method. Clinical outcomes analyzed were overall mortality, technique failure and time to first peritonitis. For all analysis we also adjusted the curves for the presence of competing risks with the Fine and Gray analysis. Biochemical data, blood pressure and hemoglobin levels were compared by test or Wilcoxon test. Results: After the matching procedure, 1,445 patients were included in each group. General (SHR1.44 CI95%1.21-1.71) and cardiovascular mortality risk (SHR1.34 CI95%1.03-1.73) were higher in CAPD patients, but no difference was observed for technique failure nor for time till the first peritonitis episode. The mean of serum and phosphorus concentration were lower in CAPD group in the majority of measurements. Conclusion: In the first large PD cohort study with groups balanced for several covariates using propensity score matching, PD modality was not associated with differences in neither time to first peritonitis nor in technique failure. Nevertheless, patient survival was significantly better in APD patients. These findings can influence the PD modality choice and encourage a greater APD utilization.

Les études regroupées dans cette thèse montrent qu'il existe une hétérogénéité entre les centres de dialyse péritonéale dans la survenue des infections péritonéales et l’échec précoce de la méthode. Nous avons aussi montré que certaines organisations peuvent être modifiées dans l’objectif d’améliorer le devenir du patient en optimisant la ressource.Nos travaux soulignent le rôle des équipes infirmières et l’importance des visites infirmières à domicile dans la prévention des infections du liquide de dialyse péritonéale. La mise à disposition de moyens humains minimum pourrait constituer un des critères d’attribution des autorisations de traitement par dialyse donnés aux établissements de santé.Augmenter la taille des centres pourrait avoir un effet bénéfique sur la survie de la méthode en améliorant l’expérience des centres. Dans ce contexte, le regroupement d’activité entre plusieurs établissements pourrait avoir un effet positif sur la survie de la méthode.Nous avons aussi pu observer qu’il existait une disparité entre les centres dans l’utilisation de l’assistance à domicile par une infirmière pour la réalisation de la dialyse. L’attribution de l’assistance repose principalement sur l’évaluation de l’infirmière de dialyse péritonéale ce qui laisse entrevoir des possibilités de rationalisation dans son utilisation. L’utilisation et la validation d’outils permettant d’estimer la capacité d’autonomisation du patient est une recherche qui devra être conduite. / The studies grouped in this thesis show that there is a heterogeneity between the peritoneal dialysis centers in the occurrence of peritoneal infections and the early failure of the method. We have also shown that some organizations can be modified in order to improve the patient's future by optimizing the resource.Our work highlights the role of nursing teams and the importance of home nursing visits in the prevention of peritoneal dialysis fluid infections. The provision of minimum human resources could be one of the criteria for granting dialysis treatment authorizations given to health facilities.Increasing the size of the centers could have a beneficial effect on the survival of the method by improving the centers experience. In this context, group activities between several establishments could have a positive effect on the survival of the method.We also observed that there is a disparity between centers in the use of home assistance by a nurse for dialysis. The allocation of assistance is mainly based on the evaluation of the peritoneal dialysis nurse, which suggests possibilities of rationalization in its use.The use and validation of tools to estimate the patient's capacity to be treated by self-care peritoneal dialysis is a research that will need to be conducted.

The main aim of this master’s thesis is design of dialysis machine. This thesis should demonstrate author’s creative thinking and creativity. This design has to satisfy the general technical, ergonomic and design assumptions, but it should be designed with modern technology. The aim is also to show the ability to move an object from the field of functionality to the field od aesthetic, ergonimics and practicality.

The kidneys are a paired organ that has many functions in the body. They are responsible for the regulation of the internal surroundings, the excretion of metabolic products (nitrogen metabolites and foreign substances) and the secretion of certain hormones. In the theoretical part of the diploma thesis I give a brief description of the anatomy and physiology of the kidneys and a description of some renal diseases, with emphasis on acute kidney injury and chronic kidney disease. I also discuss the possibilities of kidney function replacement and the adjustment of eating habits if a patient develops any of the kidney diseases. The practical part of the diploma thesis deals with the issue of nutritional status of hospitalized patients who are indicated for dialysis therapy. The research took place at the Faculty Hospital in Královské Vinohrady, mainly at the 1st internal clinic. The research group consisted of 17 patients who completed a questionnaire and kept a prospective record of the food portions eaten. Based on the calculation of the meals list, it was found that most of the patients do not receive enough energy or basic components of nutrition. The intake of minerals, with the exception of calcium, averaged the recommended values. Blood levels of serum albumin and minerals correspond on...

Thesis (M.Sc. (Statistics)) -- University of Limpopo, 2019 / Recurrent peritonitis is a major problem of peritoneal dialysis (PD) due to its association with technique failure in the dialysis process. The literature on peritonitis focused only on investigating major risk factors associated with the first episode of peritonitis. However, this dissertation investigates factors associated to multiple episodes of peritonitis, to a maximum of 6 episodes. The correlation of recurrent episodes of a patient is considered. The univariate counting process, stratified, gap-time and marginal hazard regression models are applied to select the significant covariates to the multivariate regression hazard models. Regression coefficient for covariates are found to be statistically significant at 5% level. The application of Akaike information criterion (AIC) and Schwarz bayesian criterion (SBC) assisted to filter out the best method which is the stratified regression hazard model. The major risk factors associated with recurrent episodes of peritonitis are examined from the selected good fitting model. In conclusion, the selected model identified two independent risk factors to be significantly associated with recurrent episodes of peritonitis: marital status and glomerularfiltrationrate. Twocategoriesofmaritalstatus, divorceandwidowerare the significant factors compared to married patients (when taking married patients as the reference category). / VLIROUC Programme

This report seeks to describe the status of kidney disease and renal replacement therapy in lower-resource settings, particularly sub-Saharan Africa. Acute kidney injury and transplantation are included on a limited basis because it is impossible consider the renal replacement therapy landscape at the exclusion of either. As in the rest of the developing world, chronic kidney disease and end-stage renal disease place a sizable and rapidly growing burden on sub-Saharan Africa, and Africans face a double-burden of disease from communicable and non-communicable diseases. Meanwhile, renal replacement therapy and the subspecialty of nephrology are expanding in sub-Saharan Africa, from non-existence in many countries to a limited, tentative subsistence, largely with the support of international organizations and the dedication of local nephrologists. Hemodialysis is the most common form of renal replacement therapy in sub-Saharan Africa, but peritoneal dialysis services, particularly for acute kidney injury, are growing and renal transplants are performed in a few sub-Saharan countries. Nonetheless, in the majority of sub-Saharan Africa, maintenance dialysis is still only available to the wealthy urban few. Although peritoneal dialysis may seem more feasible in the developing world than hemodialysis for multiple reasons, it is still fraught with challenges that make widespread implementation presently unadvisable. As renal replacement therapy is costly and currently unaffordable on a large scale for most of these countries, emphasis must be on identifying at-risk populations through screening and low-cost treatment or management of risk factors to mitigate chronic kidney disease.

published_or_final_version / abstract / Medicine / Doctoral / Doctor of Philosophy