The present study investigated whether vitamin E supplementation reduced oxidative stress in erythrocytes and improved vitamin E status in patients undergoing hemodialysis (HD). Plasma and erythrocyte α-tocopherol, plasma ascorbic acid, and iron status were determined in 11 regular HD patients prior to and post-dialysis, before and during oral supplementation of vitamin E, 400 IU daily for two months. HD patients were categorized into two groups according to their plasma ascorbic acid levels. We found that only the vitamin C sufficient group (>40 μM, Group I) had reliable measurements of erythrocyte α-tocopherol concentrations before vitamin E supplementation. In Group I prior to dialysis, erythrocyte α-tocopherol concentrations increased in response to vitamin E supplementation from 6.7 ± 0.7 μmol/L packed cells to 9.8 ± 0.6 (μmol/L packed cells (p<0.04). Moreover, there was a positive correlation (p<O.001) between plasma and erythrocyte α-tocopherol levels in Group I subjects. Additionally, vitamin E supplementation significantly increased hematocrits (39.9% ± 1.9% to 42.3% ±1.6%, p<0.004) post-dialysis only in Group I subjects. On the contrary, there was no change in hematocrits during vitamin E supplementation in the vitamin C deficient group (<40 μM, Group II). With respect to measures of iron status and recombinant human erythropoietin (rHuEPO) dose, no differences between before and during vitamin E supplementation were observed in two groups ofpatients. In summary, our data suggest that oral vitamin E supplementation protected erythrocytes from oxidative stress and improved vitamin E status in HD patients, but only in patients with adequate vitamin C status. / Graduation date: 2003

Dialysis patients are operated to have AV Fistula which is a joint junction of an artery and vein in the arm, operated to increase the blood flow through the dialyzer machine. AV- fistula is a type of vascular access which is a path into the body to connect/disconnect devices, but in this case, it is mainly Dialyzer. To reduce the failure rate during maturation period of AV Fistula, doctors recommend squeezing ball exercise as a necessary precaution for AV Fistula failure. Doing Squeezable interaction for about 3-4 times a day is recommended based on patient’s health condition. Hence, the proposed architecture adopts this squeezable exercise by embedding with sensor and measuring the angle at which the sensor is bent. The framework also proposes a new care coordination system having the hardware layer which has key components such as raspberry Pi, sensor which help in recording the pressure values when user presses the ball and software layer which solely focuses on data sync among the applications used by the user. It has been recorded that 53 % of patients having AV-Fistula fail because of negligence and lack of care. The maturation period is so critical and important which made us to build a gamification platform to monitor the exercise and track the activity through android application to keep users motivated and disciplined. In further chapters of the study will focus on different clinical like procedure around AV-Fistula and technical information such as different technologies used and implemented in the proposed system along with sensor circuit. This project goal is to present a way of monitoring patients and to keep track of the compliance whether the patient is active doing exercise daily. This way we are trying to present a care monitoring system for patients to help prevent AV Fistula failure. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection

<p>Syftet med föreliggande empiriska studie var att undersöka och beskriva i vilken omfattning individer behandlade med hemodialys rapporterar symtom på depression. Författarna ville även redogöra för den utsträckning antidepressiva läkemedel ordinerats samt om det existerade några könsskillnader i depressionssymtom och i ordinerad antidepressiv behandling. Studien baserades på ett bekvämlighetsurval från 11 geografiskt spridda dialysenheter i Sverige. Urvalet bestod av 222 patienter som mötte inklusionskriterierna (behärska svenska språket tillräckligt bra för att förstå frågorna i enkäten, genomgått hemodialys behandling i minst 6 månader samt vara 18 år fyllda) varav 141 patienter fullföljde undersökningen. Dessa 141 deltagare fick fylla i den förkortade versionen av CES-D formuläret, ett självskattnings instrument där den egna mentala hälsan skattas. Resultatet visade att drygt en tredjedel av hemodialyspatienterna hade depressionssymtom och endast 12 patienter av 50 med depressionssymtom var ordinerade antidepressiv behandling. Emellertid visade inte föreliggande studie några signifikanta könsskillnader gällande depressionssymtom eller i ordinerad farmakologisk behandling. Författarna drar slutsatsen att depression är vanligt bland hemodialyspatienter. Därför är det viktigt att utbilda både vårdgivare och närstående för att de ska kunna se tecken på depressionssymtom i ett tidigt skede, eftersom rätt behandling kan öka dessa patienters livskvalitet och samtidigt vara kostnadsbesparande för sjukvården</p> / <p>The aim of the present empirical study was to investigate and describe in which extent individuals treated with hemodialysis reported symptoms of depression. The authors also wanted to describe in which extent antidepressant medicine was prescribed. Also if there existed any differences between males and females in depressive symptoms and if there was any divergence in treatment with anti depressive medicals. The study was based on a convenience sample from 11 geographical spread dialys units in Sweden. The sample consisted of 222 patients whom fulfilled the inclusion criterias (they had to have a good knowledge of the Swedish language so they could understand the questionnaire, at least six months of dialysis treatment experience and be at least 18 years old) of whom 141 carried out the study. These 141 participants filled out the short version of the CES-D form, a self report form where the mental health was estimated. The result showed that one third of the hemodialysis patients had symptoms of depression and only 12 patients of 50 had treatment with antidepressant medicine. However the study did not show any significant differences between male and female regarding depressive state and treatment with anti depressive medicine. The authors conclude that depressive symptoms are common among hemodialysis patients. That is why it is important to educate nurses and relatives so they can learn how to see signs of depressive symptoms as early as possible. Right treatment could then increase hemodialysis patients quality of life and also save money for the hospitals.</p>

Syftet med föreliggande empiriska studie var att undersöka och beskriva i vilken omfattning individer behandlade med hemodialys rapporterar symtom på depression. Författarna ville även redogöra för den utsträckning antidepressiva läkemedel ordinerats samt om det existerade några könsskillnader i depressionssymtom och i ordinerad antidepressiv behandling. Studien baserades på ett bekvämlighetsurval från 11 geografiskt spridda dialysenheter i Sverige. Urvalet bestod av 222 patienter som mötte inklusionskriterierna (behärska svenska språket tillräckligt bra för att förstå frågorna i enkäten, genomgått hemodialys behandling i minst 6 månader samt vara 18 år fyllda) varav 141 patienter fullföljde undersökningen. Dessa 141 deltagare fick fylla i den förkortade versionen av CES-D formuläret, ett självskattnings instrument där den egna mentala hälsan skattas. Resultatet visade att drygt en tredjedel av hemodialyspatienterna hade depressionssymtom och endast 12 patienter av 50 med depressionssymtom var ordinerade antidepressiv behandling. Emellertid visade inte föreliggande studie några signifikanta könsskillnader gällande depressionssymtom eller i ordinerad farmakologisk behandling. Författarna drar slutsatsen att depression är vanligt bland hemodialyspatienter. Därför är det viktigt att utbilda både vårdgivare och närstående för att de ska kunna se tecken på depressionssymtom i ett tidigt skede, eftersom rätt behandling kan öka dessa patienters livskvalitet och samtidigt vara kostnadsbesparande för sjukvården / The aim of the present empirical study was to investigate and describe in which extent individuals treated with hemodialysis reported symptoms of depression. The authors also wanted to describe in which extent antidepressant medicine was prescribed. Also if there existed any differences between males and females in depressive symptoms and if there was any divergence in treatment with anti depressive medicals. The study was based on a convenience sample from 11 geographical spread dialys units in Sweden. The sample consisted of 222 patients whom fulfilled the inclusion criterias (they had to have a good knowledge of the Swedish language so they could understand the questionnaire, at least six months of dialysis treatment experience and be at least 18 years old) of whom 141 carried out the study. These 141 participants filled out the short version of the CES-D form, a self report form where the mental health was estimated. The result showed that one third of the hemodialysis patients had symptoms of depression and only 12 patients of 50 had treatment with antidepressant medicine. However the study did not show any significant differences between male and female regarding depressive state and treatment with anti depressive medicine. The authors conclude that depressive symptoms are common among hemodialysis patients. That is why it is important to educate nurses and relatives so they can learn how to see signs of depressive symptoms as early as possible. Right treatment could then increase hemodialysis patients quality of life and also save money for the hospitals.

published_or_final_version / abstract / toc / Nursing Studies / Master / Master of Nursing in Advanced Practice

Folate supplementation at a level of 15 to 35 mg per week is routinely prescribed for many chronic hemodialysis patients in B.C. In recent studies involving these levels of folate supplementation, RBC folate concentrations ranged from near the upper limit of normal to 1.5 times this upper limit. Initially there was research suggesting that high dose folate supplementation impaired zinc absorption but more recent studies refute this hypothesis. A beneficial effect of high dose folate supplementation is lowering of plasma homocysteine levels. This may be desirable since the homocysteinemia observed in chronic renal failure patients may be a factor in their commonly occurring premature vascular disease. The present study addressed folate needs on a nutritional basis but did not investigate folate's effect on homocysteine levels. The study involved chronic hemodialysis patients and was designed to: 1. assess whether patients consuming the Recommended Nutrient Intake for folate, require a folate supplement to maintain normal folate stores; 2. assess whether patients receiving a supplement of 5 mg of folate per day will have RBC folate levels exceeding the upper limit of the normal range; 3. compare serum zinc concentrations (and in some cases hair zinc levels as well) of patients receiving no zinc supplement or a 22.5 mg per day zinc supplement, to each other and to normal values; 4. assess whether a supplement of 5 mg of folate per day is associated with impaired zinc status; 5. in the event that a 5 mg per day folate supplement is associated with impaired zinc status, assess whether a supplement of 22.5 mg of zinc per day is associated with an improvement in zinc status; and 6. determine average daily energy, protein, folate and zinc intakes of patients. A 2x2 factorial quasiexperimental design was employed. The study included 21 clinically stable chronic hemodialysis patients between the ages of 25 and 69, who were receiving folate and/or zinc supplements at certain specific levels. Subjects were entered into treatment groups based on the following folate/zinc supplementation levels: no folate, no zinc; no folate, 22.5 mg zinc/day; 5 mg folate/day, no zinc; 5 mg folate/day, 22.5 mg zinc/day. Folate status was assessed using RBC folate concentration. Serum zinc concentration was measured in all subjects. Hair zinc level was determined in 6 of the zinc-supplemented subjects. A food frequency questionnaire was developed to determine dietary folate and zinc intakes. Subjects kept 3 day food records so average daily energy and protein intakes could be determined. Study results indicated no significant difference in protein intake (g/kg b.w.) or energy intake (expressed as a percent of requirement) among the four treatment groups. Differences in dietary folate intakes among the four treatment groups as well as between zinc-supplemented and non zinc-supplemented subjects, were not significant (p≤0.05). Mean dietary folate intake for all study subjects was 4.2 ug/kg b.w. RBC folate concentration was normal in both treatment groups receiving no supplemental folate. In contrast, the RBC folate concentration for both folate-supplemented groups was approximately 6.5 to 7 times the upper limit of the normal range. The difference between RBC folate concentration for folate supplemented and unsupplemented groups was highly significant (p<0.00001) and remained so when analysis of covariance was done with number of months of folate supplementation as the covariate. RBC folate levels did not differ significantly between zinc-supplemented and unsupplemented groups (p≤0.05). Differences in dietary zinc intakes among the four treatment groups as well as between zinc-supplemented and non zinc-supplemented subjects were not significant (p≤0.05). Mean dietary zinc intake for all study subjects was 9.39 mg/day. Serum zinc levels were below normal in both treatment groups receiving no supplemental zinc. The 22.5 mg zinc, no folate group had a serum zinc concentration near the lower limit of the lower range while that in the 22.5 mg zinc, 5 mg folate group was slightly below normal. When all zinc supplemented subjects were combined, serum zinc concentration was just within the normal range. Hair zinc analysis was conducted in a subgroup of 6 zinc-supplemented subjects and a group of non zinc-supplemented healthy controls. Hair zinc level was significantly higher in the zinc-supplemented subjects than in the controls (p≤O.01). In conclusion, folate supplementation does not appear to be required on a nutritional basis in clinically stable chronic hemodialysis patients not receiving medications known to affect folate status, who are consuming a diet providing a minimum of 1 g of protein per kg b.w. and 4.6 ug of folate per kg b.w. The low serum zinc concentrations observed in both zinc-supplemented and non zinc-supplemented patients may have been due to a shift of zinc from serum to other "zinc pools" in the body as reported in the literature. / Land and Food Systems, Faculty of / Graduate

Factors Influencing Women's Adaptation to Hemodialysis When Renal Transplantation is not an Option The intent of this study was to explore and describe factors that influence adaptation from the perspective of women on hemodialysis for whom renal transplantation is not an option. Phenomenology was the research design selected for this study in order to understand the experience of these women clients. Data were collected during audio-taped interviews of eight women and were analyzed concurrently with data collection to identify common themes. Two central themes emerged: the adaptation process and the theme of connectedness. The adaptation process was described as a six-phase process. Connectedness was defined as being connected to others and/or sources of life's energy. Several key factors that either facilitated or interfered with adaptation were identified for each of these two themes. Key factors that facilitated adaptation throughout the adaptation process Included a first run on dialysis, experience with adversity, emotional and instrumental support, coping behaviors such as asserting control and reframing the situation, diversions, adequate rest and confidence in health-care professionals. Factors interfering with adaptation to hemodialysis throughout the adaptation process included the gradual and ambiguous nature of renal disease, increasing dependence, reduced energy, transportation to dialysis, compromised somatic health, difficulty with assertiveness, prolonged stressors and lack of confidence in health-care professionals. Specific factors that influenced connectedness were identified. The facilitating factors identified were satisfactory relationships, nurturing others, normalizing, a harmonious atmosphere on the hemodialysis unit and pleasurable activities. Key factors interfering with adaptation related to the connectedness theme were isolation from others, unsympathetic others, ineffective communication with health-care professionals, and exclusion from activities. The findings relative to the adaptation process were discussed in the light of the literature on adapting to illness and stress. Connectedness was discussed primarily in relation to the literature exploring the socialization of women. Implications for nursing practice, education and research arising from these findings were outlined. / Applied Science, Faculty of / Nursing, School of / Graduate

Cardiovascular disease, including hypertension, accounts for almost 50% of the deaths in patients with end stage renal disease (ESRD) on hemodialysis (HD) yet hypertension remains very poorly controlled in this population. The purpose of this study was to retrospectively compare control of hypertension in hemodialysis (HD) patients when extracellular volume (ECV) was assessed and managed by clinical parameters and physical assessment data alone with control of hypertension when data from blood volume monitoring (BVM) technology was also used to assess and manage ECV in a freestanding outpatient hemodialysis unit. The main cause of hypertension in the ESRD population has been identified as increased ECV most likely secondary to increased interdialytic weight gain and failure to attain and maintain patient’s dry weight. HD nurses often employ clinical parameters along with physical examination to determine a patient’s pre, intra, and post dialytic fluid status and this approach can have a high index of error. BVM technology is being used in many hemodialysis units to assist with assessment of ECV. A comparative retrospective chart review was used to collect data for this project. A descriptive, cross-sectional design was employed to answer the question:“Are hypertensive hemodialysis patients who dialyze in a freestanding dialysis unit, where BVM technology is utilized, more likely to be normotensive as defined by a pre dialysis blood pressure of less than 140/90 and post dialysis blood pressure less than 130/80”? A pilot study was conducted to determine if the patient population and data were available in existing patient records for extrapolation. Approval for the study was obtained from the University IRB. A convenience sample was obtained from the records of patients meeting the inclusion criteria. Variables were measured and analyzed using iv descriptive statistics such as sampled paired T-test to compare pre and post BVM systolic, diastolic blood pressures, intradialytic weight gain, serum Albumin and sodium levels, and hemoglobin. A p-value of 0.05 was assigned for statistical significance. Data analysis showed there were statisticaly significant differences in the pre dialysis systolic blood pressure, post BVM, and the serum sodium pre and post BVM when the two groups were compared These statistically significant findings support a correlation between reduction in the HD patient’s ECV and improved blood pressure control. The reduction of pre-dialysis SBP was significant because many patients on hemodialysis have systolic hypertension that may or may not coexist with diastolic hypertension. The findings of this study may be used to formulate a protocol to be used in the HD units where the BVM is available. The protocol would rely on accurate nursing assessment of clinical parameters, patient verbalizations of symptoms, and the routine use of the BVM in order to continuously assess the patient’s fluid status. Future research recommendations include conducting the study in a population closer to the national sample, a study where glucose readings and /or hemoglobin A1C levels are measured to assess the impact of glucose on ECV, and which antihypertensive class of medication works best with BVM technology to effectively manage hypertension in this population.

Thesis (D. Tech. (Clinical Technology)) -- Central University of technology, Free State, 2013 / Objectives: Survival with end stage kidney disease (ESKD) is made possible by dialysis but is in turn associated with increased morbidity, mortality, and decreased quality of life (QOL). Quality of life is a frequently overlooked, yet a critical consideration in evaluating the overall medical care of ESKD patients. This study aimed to evaluate the QOL of chronic haemodialysis (HD) and peritoneal dialysis (PD) patients in multiple dialysis units in South Africa. Methods: A comparative descriptive study carried out on 100 haemodialysis (HD) (n=100) and 100 peritoneal dialysis patients (PD) (n=100) patients, evaluating factors such as demographics, duration on dialysis, medical history, clinical indicators and the patient’s understanding thereof, was performed. Quality of life was measured using the medical outcomes study 36 (SF-36). These factors, clinical scores and QOL measures were compared amongst HD and PD patients and thereafter correlated to nephrology professionals’ perspective on QOL. Results: A total of 200 (n=200) patients from 11 dialysis units were evaluated. Mean age for the HD group was 49±15 years compared to 53±14 years for the PD group (p=0.043). The HD patient group had an improved physical composite (PCS) score adjusted for age, urea, creatinine and albumin (p<0.001). The mental composite score (MCS) was improved in the PD group although not significant (p>0.05). A positive correlation was found, as PD patients had an improved symptom control score, adjusted for age (p=0.04), an improved effect of kidney disease score adjusted for albumin (p=0.000), and an improved burden QOL score adjusted for urea, creatinine and albumin (p=0.019). Age was shown to be associated to the physical functioning (p=0.01) and PCS (p=0.040), and diabetes to the emotional role (p=0.04), in QOL. An increase in the years on dialysis showed a reduced emotional well-being (p=0.028) and being on the transplant list an improved MCS (p=0.003). Participation in a pre-end stage kidney disease (PESKD) management programme showed improvement in the general health component (p=0.032), the effect (p=0.01), and the burden of kidney disease (p=0.02). Assessing patients’ knowledge on ESKD revealed the relationship of the PCS to the understanding of managing the complications associated with CKD (p=0.01) and access management (p=0.01). The understanding of diet was found to be significant to the burden of CKD (p=0.01) and the complications associated with CKD was found to be further significant to the effect and symptom QOL (p=0.01). Nephrology professionals rated the difficulty of living with kidney disease a 7.49 out of 10 score and 71% felt QOL is taken into consideration with managing ESKD patients. Conclusion: The study demonstrated differences in the adjusted QOL scores amongst HD and PD dialysis patients in the dialysis units studied. The importance of PESKD was emphasized in relation to improved QOL. Quality of life is a valid marker and important for the ongoing audit of renal services.

The effects of a monetary reward and self-monitoring on reducing interdialytic weight gain (IWG) were compared for 6 hemodialysis patients in an outpatient setting. A single-subject experimental design (A-B-BC-B-BC) was used to examine each variable individually and in combination, with alternating phases to control for possible sequencing effects. Monetary reward (50 cents - $3) was administered in a titrated manner according to standardized criteria, ranging from 3 % and 4% of patients' dry weight on weekdays and weekends, respectively, to 3.5% and 4.5% for weekdays and weekends. Self-monitoring involved recording daily fluid and diet intake. Results indicated that by the end of the treatment program, the 6 participants averaged a 14% reduction in weekday IWG and a 15.45% reduction in weekend IWG; however, due to significant variability, it cannot be concluded that the reductions are treatment effects. Four out of 6 participants reduced their average IWG for both weekends and weekdays by .75 kg (1.65 lb.). The average weekend reduction for these 4 participants was .85 kg (1.87 lbs.) while the average weekday reduction was .65 kg (1.43 lb.). All 6 participants showed reductions in weekday IWG that averaged .53 kg (1.17 lb.). However, only 2 participants demonstrated IWG reductions that could be attributable to either of the 2 treatment variables. The standardized dry weight criterion for assessing fluid adherence may have posed excessively stringent demands on participants, as only 1 of the 6 participants actually met the criterion. Future research should address the role of nonspecific treatment factors, as well as patient characteristics and responsivity to particular treatment components in an effort to identify those factors responsible for behavior change in this population.