Relative changes are detectable in the blood of end-stage renal disease (ESRD) patients during hemodialysis (HD) treatment using optical spectroscopy. However, the potential impacts of several confounding factors that could affect the detection of these changes have not been evaluated. The objectives of this thesis were to: 1) investigate how the variations and/or changes in acid-base and oxygen parameters during HD treatment can affect the optical signature of whole blood of ESRD patients, 2) to investigate the effect of heparin on the optical properties of whole blood and its impact on our method. Blood samples were drawn from 23 ESRD patients at 5 time points during a 4 hour HD treatment and sent for blood gas and blood spectroscopy analyses. No significant correlations were found between the changes in the blood transmittance spectra and acid-base and oxygen parameters. This indicates that the perturbations in these parameters due to HD procedures do not confound the detection of changes in the blood transmittance spectra of ESRD patients during HD treatment. Additionally, the effect of heparin in modifying the optical properties of whole blood does not confound the detection of changes in the blood of ESRD patients due to HD treatment using whole blood-based optical spectroscopy. ANOVA revealed significant (P<0.05) measurable changes in the blood transmittance spectra of ESRD patients during HD treatment. Significant spectral differences (P<0.05) were found between ESRD patients. The lack of uniform spectral characteristics across patients is

Our epidemiology research found that the incident and prevalent rates for Diabetes mellitus (DM) and Diabetic End Stage Renal Disease (DM-ESRD) were at rise in Saskatchewan between year 1980 and 2005. Combining concerns regarding the rising trends reported by research studies with the concerns of the significant health and financial burden imposed by DM-ESRD on individuals and societies, we sought to project the number of DM-ESRD patients in Saskatchewan up to year 2025 with the cost required for caring for those patients. An agent-based model (ABM) is developed to simulate DM to ESRD progression, treatments for DM-ESRD patients, and the assessments and waiting list processes preparing patients for kidney transplants. The model parameters were estimated from a wide variety of data sources. The agent based modeling approach is chosen for projections regarding the DM-ESRD situation in Saskatchewan because of its advantage in capturing heterogeneities of individual patients, ability to retain biographical information on patients, capacity to capture time-varying competing risks, better presentations features and easy integration with existing models built in either agent based or System Dynamic methods. The approach was also attractive due to its flexibility for future expansion to represent social networks. The model projects the incident and prevalent case count, cost, and person years lived for the DM-ESRD population in Saskatchewan between year 1980 and 2025. The projections captured the great challenges brought by the fast growing number of DM-ESRD patients and substantial cost associated with managing the disease. In addition to producing projection results, the research presented here demonstrates how the model can be used by policy makers to experiment and evaluate different policy/interventions in a safe context. By capturing both the individual level records and population level statistics, the model provide a wealth of data for detailed analysis, which can help health policy makers gain insights in the current and future diabetic-ESRD situation in the province, aiding in resources planning for managing the fast-growing ESRD population and the growing need for dialysis services.

Background and Purpose: Physical activity is significantly lower in the end-stage renal disease (ESRD) population compared with age-matched sedentary controls. Self-efficacy is a significant contributing factor to exercise behaviour in the healthy and various chronic disease populations; however, little information is available on self-efficacy and exercise in the ESRD population. The purpose of this study was to examine the relationship between self-efficacy and physical activity levels in individuals with ESRD and to determine factors which may contribute to this relationship. Participants: Patients (127 hemodialysis and 5 peritoneal dialysis) were recruited from the Kingston General Hospital renal units. Methods: Self-efficacy was measured using the Exercise Self-Efficacy Scale (ESES) and the Chronic Disease Self-Efficacy Scale (CDSES). Physical activity was measured using the Human Activity Profile (HAP). Responses on the HAP resulted in 2 scores: the maximum activity score (MAS) and the adjusted activity score (AAS). Contributing factors, such as age, co-morbidities, length on dialysis (vintage), medications, dialysis efficacy (Kt/V), albumin, prealbumin, total protein, protein catabolic rate (PCR) and hemoglobin (HgB) were collected from patient records. Results: The average MAS and AAS scores were 62.5±15.6 and 49.1± 21.0 (SD), respectively, which are substantively lower than those in the healthy population. Serum albumin was the sole contributing factor to physical activity such that AAS in those with lower levels of albumin (24-30g/L, 31-34 g/L) was less than those with higher levels of albumin (p<0.05). Both MAS and AAS were significantly lower in those with diabetes (n=66) compared to those without (n=66), as was the difference between MAS and AAS. Age and self-efficacy explained 51% of the variance in MAS. Age, self-efficacy and serum albumin level explained 59% of variance in AAS. Discussion and Conclusion: Individuals on dialysis have lower functional capability within their maximal energy ability at any age and this difference is more pronounced among those with diabetes. Physical activity was substantially influenced by an individual’s self-efficacy, age and serum albumin level. These findings indicate that self-efficacy must be taken into account and used to promote greater participation in physical activity in the ESRD population. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2010-04-27 09:47:12.764

No description available.

Background and aims: The overall aim of this thesis was to increase knowledge regarding the occurrence of childhood onset T1D and T2D in Sweden and in relation to that describe and elucidate important aspects on two grave complications to diabetes; end-stage renal disease (ESRD) and mortality. The two first studies included in this thesis aimed to describe and analyze the cumulative incidence of childhood onset T1D in Sweden and to assess the occurrence of undetected T2D in Swedish children. The aim with the third study was to describe the cumulative incidence of ESRD, and to analyze how ESRD risk differs with age at-onset and sex. The aim of the fourth study was to show how parental socioeconomic status (SES) affects all cause mortality in Swedish patients with childhood onset T1D. Study populations: The foundation for the studies on T1D was data from the Swedish Childhood Diabetes Registry (SCDR). When studying ESRD we also included adult onset T1D cases from the Diabetes Incidence Study in Sweden (DISS). The study on T2D was a population-based screening study where BMI was measured in 5528 school-children and hemoglobin A1c was measured in children with overweight according to international age and sex specific BMI cut-offs. To study ESRD and mortality, we linked the SCDR to various nationwide registers containing individual information on SES, mortality and ESRD. Results: The incidence rates of childhood onset T1D has continued to increase in Sweden 1977–2007. Age- and sex-specific incidence rates varied from 21.6 (95% CI 19.4–23.9) during 1978–1980 to 43.9 (95% CI 40.7– 47.3) during 2005–2007. Cumulative incidence by birth-cohorts has shifted to a younger age at-onset over the first 22 years of incidence registration. From the year 2000 there was a significant reverse in this trend (p&lt;0.01). In contrast to the increase of T1D, we found no evidence of undetected T2D among Swedish school children. Despite a relatively high incidence in T1D in Sweden there is low cumulative incidence of ESRD, 3.3% at maximum 30 years of duration. We found difference between the sexes regarding long-term risk of developing ESRD that was dependent on the age at onset of T1D. When analyzing how socioeconomic status affects mortality in different age at death groups, we found that having parents that received income support increased mortality up to three times in those who died after 18 years of age. Conclusion: The incidence of childhood onset T1D continued to increase in Sweden 1978-2007. Between the years 1978-1999 there was a shift to a younger age at-onset, but from the year 2000 there is a change in this shift indicating a possible trend break. The prevalence of T2D among Swedish children up to 12 years of age is probably very low. There is still a low cumulative incidence of T1D associated ESRD in Sweden. The risk of developing ESRD depends on age at-onset of T1D, and there is a clear difference in risk between men and woman. Excess mortality among subjects with childhood onset T1D still exists, and low parental socioeconomic status additionally increased mortality in this group.

Relative changes are detectable in the blood of end-stage renal disease (ESRD) patients during hemodialysis (HD) treatment using optical spectroscopy. However, the potential impacts of several confounding factors that could affect the detection of these changes have not been evaluated. The objectives of this thesis were to: 1) investigate how the variations and/or changes in acid-base and oxygen parameters during HD treatment can affect the optical signature of whole blood of ESRD patients, 2) to investigate the effect of heparin on the optical properties of whole blood and its impact on our method. Blood samples were drawn from 23 ESRD patients at 5 time points during a 4 hour HD treatment and sent for blood gas and blood spectroscopy analyses. No significant correlations were found between the changes in the blood transmittance spectra and acid-base and oxygen parameters. This indicates that the perturbations in these parameters due to HD procedures do not confound the detection of changes in the blood transmittance spectra of ESRD patients during HD treatment. Additionally, the effect of heparin in modifying the optical properties of whole blood does not confound the detection of changes in the blood of ESRD patients due to HD treatment using whole blood-based optical spectroscopy. ANOVA revealed significant (P<0.05) measurable changes in the blood transmittance spectra of ESRD patients during HD treatment. Significant spectral differences (P<0.05) were found between ESRD patients. The lack of uniform spectral characteristics across patients is

abstract: Health-related quality of life (HR-QOL) is a significant treatment outcome for persons with end-stage renal disease (ESRD); however, little is known about the HR-QOL of Mexican patients with ESRD. This pilot study describes relationships between demographics, sleep disorders, spirituality, mood, folk practices and dialysis modality on the HR-QOL of patients with ESRD residing in Guanajuato, Mexico. Mexican patients receiving continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD) and hemodialysis (HD) provided information on demographics, clinical health data including body mass index (BMI), and folk health practices. Measures included the Short Form (SF)-36 HR-QOL survey, Sleep Habits Questionnaire, Latin Spirituality Perspective Scale and Hospital Anxiety and Depression Scale. Data were analyzed using SAS software (V9.1). Signifi¬cance level for this pilot study was set at p<0.10. The Quality-Adjusted Life Year method was utilized to examine cost effectiveness for each dialysis modality. Demographics and clinical data showed participants (N=121) to be 59 (SD=13) years, predominantly men (55.4%), married (66.9%), Catholic (92.6%), and not currently working (78.3%). The majority were diabetic (72%) and slightly overweight (BMI M=26.1; SD=5.1). The CAPD group (n=39) demonstrated significantly lower HR-QOL scores compared to the APD (n=42) and HD (n=40) groups. Patients on HD reported higher rates and greater numbers of sleep disorders, including insomnia symptoms, non-restorative and insufficient sleep, and daytime somnolence compared to patients on CAPD and APD. Patients on CAPD reported more anxiety and depression compared to patients on HD and APD. Overall linear regression for HR-QOL found dialysis type, sleep disorders and income to be significant predictors and the model accounted for 31% of the variance. Cost analysis indicated APD as the preferred treatment because it is less costly and results in the best HR-QOL compared to the other treatment modalities. Findings provide the first SF-36 norms for Mexicans with ESRD. Sleep disorders and dialysis type greatly impinge on the HR-QOL of these patients, particularly their mental health. APD was identified as the preferred treatment based on low cost and improved HR-QOL. Results can inform clinical care and health policy for Mexican patients with ESRD. / Dissertation/Thesis / Ph.D. Nursing and Healthcare Innovation 2011

End-stage renal disease patients have a greatly increased risk of cardiovascular disease partly attributed to the elevated levels of systemic inflammation observed in uraemia. One of the key mechanisms underlying inflammation appears to be the immune dysfunction that afflicts almost every aspect of the uraemic immune system. As a consequence patients experience immunosuppression and reduced responsiveness to antigen as well as a simultaneous over-activation leading to a pro-inflammatory environment. In addition, the haemodialysis (HD) treatment itself induces a proinflammatory response but may provide an otherwise opportune time to complete supervised exercise.

This study identifies coping styles and strategies used by 40 end-stage renal disease patients over 20 years old who receive treatment in a general hospital in Peru. The instruments applied were a personal sociodemographic questionnaire and the Coping Inventory (Carver, Scheier & Weintraub, 1989). Results showed that emotion focused coping were most frequently used followed by problem focused coping. Planning, acceptance and positive reinterpretation-growth coping strategies were more frequently used by these patients, whereas mental disengagement, suppression of competing activities and behavioral disengagement were the less frequently used coping strategies. Other differences between coping styles and strategies and sociodemographic and medical variables were analyzed. / Esta investigación identifica y describe los principales estilos y estrategias de afrontamiento utilizados por un grupo de pacientes diagnosticados con insuficiencia renal crónica terminal. Participaron 40 pacientes mayores de 20 años, aceptados al programa de transplante de riñón del hospital de seguro social. Se utilizaron una encuesta personal y el Inventario sobre Estilos y Estrategias de Afrontamiento (Carver, Scheier & Weintraub, 1989). Los hallazgos indicaron que los estilos enfocados en la emoción fueron utilizados en mayor frecuencia por los participantes, seguidos por los estilos enfocados en el problema. Entre las estrategias de mayor uso se encontraron la planificación, la aceptación y la reinterpretación positiva-crecimiento, mientras que las estrategias de menor uso fueron desentendimiento conductual, supresión de actividades competentes y desentendimiento cognitivo. Se analizaron las posibles diferencias entre los estilos y estrategias de afrontamiento de acuerdo a las condiciones sociodemográficas y médicas de los participantes.

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / O elevado nÃmero de pacientes renais crÃnicos em hemodiÃlise no Brasil e a escassez de dados acerca de sua sobrevida justificam a necessidade da realizaÃÃo de estudos nesse campo. Conhecer o perfil de morbidades dessa populaÃÃo e verificar as taxas de sobrevivÃncia desses indivÃduos. Estudo observacional longitudinal retrospectivo, de seguimento de pacientes renais crÃnicos em hemodiÃlise por mais de trÃs meses, em cinco unidades de diÃlise de Fortaleza (CE). Pacientes de 18-88 anos de idade foram incluÃdos no estudo no perÃodo de janeiro/1998 a dezembro/2000 e acompanhados atà dezembro/2004. Os dados foram obtidos mediante registros em arquivos nos respectivos centros de tratamento, atravÃs de formulÃrio padronizado com informaÃÃes acerca de dados sÃcio-demogrÃficos, histÃria clÃnica, uso de medicamentos e parÃmetros laboratoriais. Na anÃlise estatÃstica foram utilizados o teste exato de Fisher, Student (t) e Wilcoxon; considerando-se o nÃvel de significÃncia p < 0,05. As curvas de sobrevida foram construÃdas pelo mÃtodo de Kaplan-meier e com teste de diferenÃa por log rank. Foram acompanhados 239 pacientes com uma mÃdia de idade de 45  16,6 anos; a maioria pertencia ao sexo masculino e era casada (56,9% e 54,0%, respectivamente). Os principais diagnÃsticos de base da doenÃa renal crÃnica em fase terminal foram: o diabetes mellitus, a hipertensÃo arterial, as glomerulonefrites e as causas indeterminadas (19,7%, 19,2%, 13,4% e 28,0%). Dentre as comorbidades, as mais freqÃentes foram: hipertensÃo arterial (64,0%), infecÃÃes (55,2%), diabetes mellitus (20,1%) e doenÃa cardÃaca (20,1%). Ao tÃrmino do estudo, 49 pacientes foram a Ãbito (20,5%). Os medicamentos mais utilizados foram os relacionados ao sistema cardiovascular (50,3%), sendo os agentes com aÃÃo no sistema renina-angiontensina (21,8%) e outros anti-hipertensivos (10,0%) os mais usados. Dos pacientes acompanhados, 81,2% usaram ferro endovenoso e 89,1%, eritropoetina recombinante humana. A sobrevida atuarial foi de 94,3%, 88,9%, 84,4%, 78,7% e 75,5%, aos 12, 24, 36, 48 e 60 meses, respectivamente. Os pacientes diabÃticos apresentaram sobrevida significantemente inferior aos nÃo-diabÃticos (p<0,001). Pacientes brancos (p=0,004), aqueles com mais de 60 anos (p<0,001) e, os que usaram uma dose de ferro inferior a 8000mg (p=0,002) tambÃm apresentaram sobrevida significantemente menor. A sobrevida atuarial foi de 94,3%, 88,9%, 84,4%, 78,7% e 75,5%, aos 12, 24, 36, 48 e 60 meses, respectivamente.