End stage renal failure refers to an irreversible kidney dysfunction in which the kidneys fail to remove toxins from the blood stream. Haemodialysis is an effective treatment modality to sustain the lives of patients with end stage renal failure by removing waste products like urea, creatinine, and excess fluid. It involves a challenging regimen including dietary restrictions to ensure long-term survival. Failure to adhere with the regimen can result in fatal consequences. Renal patient discomfort related to non-adherence is commonly seen in clinical settings; however, there is currently no evidence-based fluid or dietary education program available to haemodialysis patients. This dissertation aims to identify and evaluate current evidence for the effectiveness of dietary and fluid control programs in the treatment of haemodialysis patients, to assess the transferability and feasibility of implementing a nurse-led education program regarding dietary and fluid control in haemodialysis patients, and to develop an evidence-based, nurse-led fluid and dietary control program for haemodialysis patients. Four electronic bibliographical databases including PubMed, Cochrane library, PsycInfo and CINAHL and two searching engines including Google scholar and ProQuest were used to identify studies that examined the effectiveness of educational programs or interventions on fluid or dietary control for patients on haemodialysis. Forty-five unique studies were identified as potentially relevant. Eleven of those studies met the selection criteria and were evaluated in this dissertation. Appraisal instrument was used to evaluate the quality of the selected studies. Six studies and three studies showed statistically significant in reduction of serum phosphate level and interdialytic weight gain respectively after educational intervention. Critical evaluation of the available studies led to an evidence-based, nurse-led, fluid and dietary control program for haemodialysis patients that followed the guideline development process of the Scottish Intercollegiate Guideline Network. Comparison on the similarity of patient characteristics, staff competence, and organizational settings of the evaluated studies were similar to those of the target unit. Therefore, the proposed program may be transferable and feasible. Furthermore, a cost-benefit analysis showed that the benefit of the fluid and dietary control program to patients outweighs the cost needed to implement the program. This dissertation outlines a proposed twenty-week program including marketing of the program, training of staff in the targeted renal unit, pilot testing, and application of the proposed program. Evaluation of the program will focus on three categories: patient outcome, health care provider outcome, and organization outcome. Clinical effectiveness of the program is defined by an overall reduction in patients’ mean interdialytic weight gain and mean serum phosphate level, improvement in knowledge test scores by patients, satisfactory nurses’ attendance rate in the renal training sessions, high nurse satisfaction with the educational program, and reduction of admission rate related to non-adherence. / published_or_final_version / Nursing Studies / Master / Master of Nursing

This research examines Hemodialysis patients' psycho-social characteristics and predictors of quality of life and compliance at a small rural hospital. Sixty-four patients from the hemodialysis unit at Renfrew Victoria Hospital in Renfrew, Ontario, and a satellite unit at St. Francis Memorial Hospital in Barry's Bay, Ontario, were assessed using the Social Work Patient Profile, Perceived Quality of Life and Compliance Indices. Bivariate correlation and multiple regressions were conducted on psychosocial, physical and mental health variables to determine if they correlated, and could be predictors of, social worker and nurses' perceptions of patients' quality of life and compliance. / Findings support multiple correlations between variables. Younger age, recreation, family support, self driving to dialysis, dementia, diabetes as the cause of chronic kidney failure (CKF), and other as the cause of CKF were significant individual predictors of social work quality of life score. Significant individual predictors for the nurses' quality of life scores were dementia, glomeruloneph, compliance, level of education, and polycystic kidney disease as the cause of CKF. The statistically significant risk factors for nurses' quality of life were lower levels of education and dementia. The four psychosocial variables that predicted compliance to treatment, suggested that there was increased compliance for patients who had recreation and family support, and increased risk factors with age and lower levels of education.

No description available.

This study assessed the psychological problems associated with hemodialysis and included an investigation of the differences and similarities between (1) dialysis patients' and medical staff's perceptions of patients' problems, and (2) the problems of hemodialysis patients and spinal cord injury patients. Data were collected from 31 adult hemodialysis patients, 34 dialysis medical staff and 32 spinal cord injury patients at the Miami, Florida Veterans Administration Medical Center. The scaling technique of magnitude estimation was used to measure patients' and staff's perceptions of the relative seriousness of various illness-related problems. Depression and anxiety in hemodialysis patients and spinal cord injury patients were measured by standardized self-report inventories. Among the most significant findings were that: (1) Dialysis patients judged problems concerning lifestyle changes (e.g., inability to travel and work) and loss of body function (e.g., reduced levels of physical activity) to be more serious or emotionally distressing than other problems they experienced. (2) Dialysis patients and medical staff differed significantly in their perceptions of the seriousness of most problems associated with hemodialysis; moreover, there was less agreement between patients and physicians than between patients and other types of staff (e.g., nurses and technicians). (3) There were no significant differences between dialysis patients and spinal cord injury patients in their scaled problem judgments. (4) Depression in hemodialysis patients and spinal cord injury patients was greater than for the general population, with the majority of both patient groups meeting criteria for diagnosis of clinical depression. In addition, although dialysis patients and spinal cord injury patients did not differ significantly in their total mean depression scores, dialysis patients endorsed somatic components of depression more frequently and/or with greater intensity than spinal cord injury patients did. (5) Anxiety in dialysis patients was not greater than for the general population and was significantly less than for spinal cord injury patients. (6) Depression and anxiety were positively related to most problems for hemodialysis patients, while anxiety, but not depression, was significantly associated with most problems for spinal cord injury patients. A major contribution of this study is the comparison, for the first time, of patients' and medical staff's scaled problem judgments.

This study examines the relationships between three aspects of adjustment to hemodialysis (i.e. activity levels, mood states and severity of symptoms) and four demographic variables (i.e. age, occupation, education and length of time on dialysis). The sample consisted of 37 patients on hemodialysis. Activity levels, mood states and severity of symptoms were measured by the activity inventory, profile of mood states and symptom questionnaire, respectively. A personal history questionnaire was employed to assess the demographic variables. The data was analyzed using the Pearson Product-Moment Correlation Method with a one-tailed test of significance. Activity levels were found to be negatively correlated with age at a statistically significant level, but were not significantly correlated with occupation, education or length of time on dialysis. Total mood disturbance was not significantly correlated with any of the demographic variables. Total severity of symptoms were negatively correlated with education at a statistically significant level, but no significant correlations were discovered between this aspect of adjustment and the other demographic variables. A few supplemental findings were also deemed important. Total severity of symptoms were both negatively correlated with activity levels and positively correlated with mood states at statistically significant levels. However, mood states and activity levels were not significantly correlated. Finally, a significant positive correlation was found between education and occupational level. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

Thesis (M.Tech.: Clinical Technology)- Dept. of Clinical Technology, Durban University of Technology, 2008. xviii, 160 leaves.

Thesis (M.S.)--University of Michigan, 1981.

Thesis (M.S.)--University of Michigan, 1981.

Thesis (M.Tech.: Clinical Technology)- Dept. of Clinical Technology, Durban University of Technology, 2008. xviii, 160 leaves. / Anaemia being one of the most severe complications of end stage renal disease is presently being managed with treatment by recombinant erythropoietin (RHuEPO). Recombinant erythropoietin (RHuEPO) produced by recombinant human DNA technology (RHuEPO) is becoming a standard part of therapy in chronic renal failure. In such patients anaemia is a leading cause of morbidity and mortality. Haemodialysis patients have grown dependent on RHuEPO therapy due their anaemia. The assessment of native erythropoietin levels and the detection of antibody levels in blood in the study were carried out to assist in the clear target of the treatment of anaemia. Haemoglobin levels were monitored over a trial period of six months during the RHuEPO therapy. Ferritin, transferrin saturation (T Sats %) and transferrin levels were monitored accordingly. Monitoring of erythropoietin levels in haemodialysis patients has been one of the first done in our population group in South Africa. Forty haemodialysis patients on RHuEPO therapy and ten haemodialysis patients not on RHuEPO therapy and ten healthy individuals from the Haemodialysis unit at Addington Hospital, Durban, South Africa were recruited to participate in the trial. Blood samples were collected then were centrifuged at 5 degrees celsius. Plasma was isolated, stored and subsequently used in enzyme linked immunosorbent assay (ELISA). Two ELISA were set up, one to measure EPO level and another for anti EPO antibodies. The dilutions of 1:50 were selected to detect the presence of antibodies. These have all been done in duplicates. Optical density of each sample was measured using a microplate reader at 450nm. The haemodialysis patients receiving RHuEPO presented with higher EPO levels as compared to the haemodialysis patients not receiving RHuEPO and the healthy individuals. However, in the study the HB levels were not increased over the trial period with higher RHuEPO doses. Higher doses of RHuEPO therapy showed no clear increase in haemoglobin levels. From a total of forty patients, twelve patients (35%) in the months of August and eight (25%) in the month of November were tested positive for antibodies to RHuEPO. Using statistical analysis, no correlation was observed between the antibody levels and the erythropoietin levels. However, we did not test whether the antibodies found were neutralizing or not. Bioassays for EPO may be used for that purpose.

Submitted in partial fulfillment of the requirements for the degree of Doctor In Technology (Clinical Technology), Durban University of Technology, Durban, South Africa, 2016. / Erythropoietin (EPO) is widely used in patients with chronic renal failure and is a necessity. However, due to the cost implications and the medical complications in our population it is imperative to review the factors affecting the process of erythropoiesis and the analysis of cell proliferation and cell viability in the bioassay. Complications such as hypertension and risk of worsening a malignancy cannot be ignored. We had previously analysed variations of erythropoietin levels in haemodialysis patients over a six month period. This study aims to evaluate erythropoiesis in conjunction with various laboratory, demographic, clinical parameters and inflammatory markers, in the population of haemodialysis patients. EPO, antibody level and antibody activity were analysed in the population groups as EPO responsive and EPO sensitive patients. This is a prospective, experimental and controlled study. Fifty nine patients were randomly selected from haemodialysis units of Addington and King Edward VIII Hospitals following an informed consent and 15 healthy individuals were also selected as controls. Demographic parameters (age, sex), clinical parameters (weight, height, skin folding, EPO doses and blood pressures (BP) were recorded. Pre-dialysis serum was used to measure laboratory markers (haemoglobin, transferrin, ferritin, albumin, ESR, C reactive protein, creatinine and urea). EPO levels and antibody levels were measured by ELISA, the optical density of each well was determined within fifteen minutes using the microplate reader set at 450 nm. All results were statistically analysed using SPSS statistical package version 21 (IBMR). Patients requiring very high doses of EPO to reach Hb of 11g/dL, and they remained anaemic after at least three months of adequate EPO doses were considered to be EPO resistant. Those who responded to the usual EPO doses were labelled EPO sensitive. The bioassay was used to quantify cell proliferation and cell viability in the presence of EPO. The UT 7 cells were cultured in medium, in the presence of serum from the EPO resistant, EPO sensitive patients and the healthy, control subjects. Luminescence was read with the Glorunner Microplate Luminometer and was recorded in relative light units (RLU). The analysis revealed: a non-significant positive correlation between haemoglobin and erythropoietin levels. However, a strong negative correlation was found between CRP and albumin level (R= -0.591; (p=0.001), which was not significant. No correlation was found between haemoglobin or erythropoietin levels and CRP or albumin. There was a positive correlation with systolic and diastolic blood pressures and mean arterial pressures which was statistically significant (p <0.05). EPO dosages and Hb levels were correlated significantly (p < 0.05). No correlation of EPO levels and Hb; age and Hb was found to be significant (p = 0.08). The UT 7 cells cultured in serum in medium alone with RHuEPO containing cells were statistically significant (p <0.01)). Reduction of ATP stimulation between medium and serum was observed. However, mean arterial pressures had a significant association with EPO resistance (p = 0.041) odd ratio- 1.066. In conclusion, EPO level is not a useful tool for the monitoring of its use as it does not correlate with EPO goal of red blood production in our patients. The neutralizing antibodies did not correlate with any of our variables contributing to erythropoiesis, and are therefore not confirmed as playing a major role in erythropoiesis. From the analysis of our results the key contributing factors of EPO doses, malnutrition and age were more significant in erythropoiesis. However the higher doses of EPO significantly increased the blood pressures and the mean arterial pressures (MAP). The analysis of the bioassay showed lack of difference between EPO responsive and EPO sensitive patients. This observation warrants further studies to clarify the role of serum of haemodialysis patients in erythropoiesis. / D