Bakgrund: Njurdonation är en omfattande process där en individ, efter eget beslut eller i samråd med andra, donerar en av sina friska njurar till en mottagare i behov av den för att förbättra sin överlevnad och hälsa. Som grundutbildad sjuksköterska har man tillgång till flera olika arbetsplatser, vilket innebär att man kommer möta olika patientgrupper i sitt yrke. I omvårdnaden av en njurdonator är den personcentrerade vården en viktig grundsten. Utöver denna princip är sjuksköterskans övriga kärnkompetenser avgörande. Det är nödvändigt att kunna samarbeta i team eftersom patienten inte bara behöver sjuksköterskans stöd utan även hjälp och kontakt med andra vårdpersonal såsom läkare, specialistsjuksköterska samt psykolog och kurator. Den grundutbildade sjuksköterskan spelar rollen som navet i samarbetet, med ansvar för att säkerställa att all samverkan fungerar samtidigt och ingen aspekt av vården försummas. Därför är det av vikt att den grundutbildade sjuksköterskan har kunskap om njurdonatorers upplevelser både pre- och postoperativt. Syfte: litteraturstudiens syfte var att belysa pre- och postoperativa donationsupplevelse för donatorer som frivilligt donerar en njure. Metod: Studien genomfördes som en systematisk litteraturgenomgång med en kvalitativ metod på en grund av tio vetenskapliga peer-reviewed artiklar. Analysen av artiklarna följde en specifik modell för innehållsanalys. Resultat: Tre huvudkategorier definierar donatorernas upplevelser av den pre-och postoperativa donationsprocessen; ”Donatorernas anledningar till att donera”, ”Betydelsefullt med emotionellt stöd och förståelse” och ”Stress och komplikationer”. Konklusion: Njurdonatorers erfarenheter är övervägande positiva men präglas av intensiva känslor såsom glädje och stolthet, samtidigt som de upplever nervositet och stress inför godkännandet som donator. Tillräckligt stöd och förståelse från vårdpersonal och närstående underlättar hanteringen av den emotionella påfrestningen. För sjuksköterskor är insikten om donatorers upplevelser avgörande för att erbjuda personcentrerad vård och förbereda både vårdpersonal och donator för potentiella konsekvenser, vilket främjar högre vård- och livskvalitet för donatorn. Nyckelord: Grundutbildad sjuksköterska, Njurdonation, Njurtransplantation, upplevelser, Personcentrerad vård / Background: Kidney donation is a medical process where an individual, by their own decision or in consultation with others, donates one of their healthy kidneys to a recipient in need, aiming to improve their survival and health. As a registered nurse, one has access to various workplaces and opportunities, meaning they will encounter different types of patients in their profession. In the care of kidney donors, person-centered care stands as a crucial cornerstone. Beyond this principle, the nurse´s other core competencies are paramount. Collaborating within a team is essential since the patient requires not only the nurse´s support but also assistance and interaction with other healthcare professionals such as physicians, specialized nurses, psychologists, and counselors. The bachelor's degree nurse plays a pivotal role in this collaboration, being responsible for ensuring seamless cooperation while no aspect of care is neglected. Therefore, it is crucial for the bachelor's degree nurse to have knowledge of kidney donors´experiences both pre- and post-operatively. Aim: The aim of the literature study was to illustrate the pre-and postoperative donation experience of donors who voluntarily donate a kidney. Method: The research was conducted as an approach to a qualitative systematic literature review, drawing from ten peer-reviewed original articles. The Articles underwent analysis following a specific model for content analysis. Result: Three main categories define the donors' experiences of the pre- and post-operative donation process; “Donors’ reasons for donating”, “Meaningful with emotional support and understanding” and “Stress and complications”. Conclusion: Kidney donors` experiences are predominantly positive but are characterized by intense emotions such as joy and pride, while at the same time they experience nervousness and stress before being accepted as a donor. Sufficient support and understanding from healthcare staff and relatives facilitates the handling of the emotional strain. For nurses, the insight into donors´experiences is essential to provide person-centered care and prepare both health care professionals and donors for potential consequences, promoting higher quality of care and quality of life for the donor. Keywords: Registered nurse, experiences. kidney donation, kidney transplantation, person-centred care.

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No description available.

In 2008, El Salvador registered the world's highest mortality rate from kidney failure, with more than 2500 deaths annually in Central America's smallest country. El Salvador is the ground zero of a new form of Chronic Kidney Disease (CKD) that has become an epidemic among otherwise healthy agricultural workers and rural residents in lowland Central America in the past three decades. While the epidemic is believed to stem from some combination of agro- chemical exposure and/or dehydration, research on the disease remains embroiled in controversy, policy changes few, and medical support for affected individuals challenging. Foucaultian theorizations of 'discursive materiality' provide insights into the ways in which–even as the science remains inconclusive–understandings, discussions, and research on CKD in El Salvador are having material effects on individuals' bodies and health statuses. Based on fieldwork in El Salvador in summer 2014, this thesis uses the lens of Salvadorian CKD to explore the workings of biopower in settings of industrial agricultural production. Focusing on the Bajo Lempa region of El Salvador, in particular, the thesis examines the discourses, materialities, and practices through which CKD has "come to matter" as a medical and political phenomenon in relation to the agriculture through which affected Salvadorians make their living. Thinking through the discursive materialities of CKD alongside the production of spaces of health and agriculture, this thesis provides insights for the growing field of the political ecology of health by investigating the wider socio-political and environmental processes that make CKD management such a challenge in a Central America.

Renal replacement therapy, in the form of dialysis or transplantation, is the cornerstone of management for end-stage renal disease. UK renal registry shows nearly half of those needing renal replacement therapy are treated by dialysis – predominantly by haemodialysis. Patients on renal replacement therapy have increased mortality risk compared to age matched general population. Moreover, some specific subgroups of patients on haemodialysis have increased risk of mortality than expected. The survival benefit seen in women in the general population is attenuated resulting in similar survival for men and women on haemodialysis therapy. In addition, obese individuals and those of non-Caucasian origin have better survival outcome. Though the underlying reason for these findings is not clear and is likely to be multi-factorial, it has been hypothesised that this paradox could be due to the current practice of normalising dialysis dose to total body water. A number of metabolic factors – body surface area, resting energy expenditure and total energy expenditure – have been proposed as alternative to total body water for scaling dialysis dose. There were two overarching aims of this work – one was to study the effect of declining renal function on resting and total energy expenditure and to study the influence of various energy expenditure measures on uraemic toxin generation. The second was to study the impact on survival outcome of using these alternate parameters for normalising dialysis dose and to derive dialysis dose adjustments based on these metabolic parameters. In order to study these aims, studies were designed to explore different aspects of energy expenditure measures along with a longitudinal study to examine the impact of these parameters on survival outcome. The relationship between energy metabolism, body composition and uraemic toxin generation was studied with a retrospective analysis of 166 haemodialysis patients in whom urea generation rate was used as surrogate marker of uraemic toxin generation. It was found that total energy expenditure and fat-free mass predicted uraemic toxin generation after adjustment for other relevant variables. This study provided the preliminary data which was useful in designing further studies for this work. The effect of renal function on resting and total energy expenditure was studied in 80 patients with varying stages of chronic kidney disease who were not on renal replacement therapy. Resting and total energy expenditures were measured directly using gold-standard methods. It was found that declining renal function did not have a significant influence on either of these measures. This supports the hypothesis that metabolic rate is the driving force for glomerular filtration rate and not vice-versa. The directly measured energy expenditure measures were also found to have a moderately strong relationship with urea generation rate in these patients not on renal replacement therapy. The impact of physical activity on uraemic toxin generation, and thereby dialysis requirement, was studied in a prospective cross-sectional study of 120 haemodialysis patients in whom the physical activity was measured by an accelerometer device. Results from the study showed physical activity level to be a significant predictor of uraemic toxin generation after adjustment for gender and body size differences. This study results stressed the importance of adjusting dialysis dose based on individual’s physical activity level. To study the impact of using metabolic factors as normalising parameter for scaling dialysis dose on survival outcome, a large-scale longitudinal study was conducted with 1500 maintenance haemodialysis patients recruited for the study. Dialysis dose-related parameters and survival outcomes were collected at baseline and at various time points during the follow-up period of 18 months. Study results were analysed in two parts - the theoretical basis for using these metabolic factors as scaling parameters was explored which showed that current minimum target dialysis dose risks under-dialysis in certain subgroups of patients and using these alternative parameters may provide a more equivalent dialysis dose across individuals of different body sizes and gender. With these results arguing for potential use of the alternative parameters, the impact on survival of using them were examined. It was found that all three parameters performed better than the current parameter (total body water) with regards to predicting mortality. Total energy expenditure was found to be the best parameter with the lowest hazard ratio for risk of death. The study data was also analysed to derive an algorithm for adjustment of minimum target dialysis dose based on body size and physical activity level. This newly derived minimum dose target was also shown to impact on survival with those underdialysed based on this criteria having poorer survival outcomes. To understand the impact of whole body protein turnover on resting energy expenditure and uraemic toxin generation, a cross-sectional study was conducted on 12 patients with advanced CKD – 6 each in pre-dialysis CKD and haemodialysis group. It was found that haemodialysis patients had higher rate of protein turnover compared to pre-dialysis patients. Whole body protein turnover was found to contribute significantly to resting energy expenditure and had a moderately strong relationship with urea generation rate. In the course of these studies, two questionnaire tools have been validated for use for clinical and research purposes – one is a self-report comorbidity questionnaire and the other, the Recent Physical Activity Questionnaire. The comorbidity questionnaire was developed as part of this work and was validated against Charlson Comorbidity Index. The Recent Physical Activity Questionnaire was validated for physical activity data collection and energy expenditure calculation against the gold-standard doubly labelled water method. In conclusion, it has been demonstrated that metabolic factors such as body surface area, resting energy expenditure and total energy expenditure are more closely related to uraemic toxin generation compared to total body water. It has also been demonstrated that physical activity contributes to metabolic waste production and may necessitate changes in dialysis requirement. It has been shown that these metabolic factors, when used as scaling parameter for dialysis dosing, may predict survival better than the current parameter in use. The algorithm for dialysis dose adjustment and the questionnaires validated in this work have provided novel tools for further research studies and clinical practice. The central hypothesis of this work is that some metabolic factors may be better markers of uraemic toxin generation compared to total body water. It is hypothesised that modifications in dialysis practice based on these factors may improve the quality of haemodialysis and favourably impact on survival outcome for patients with end-stage renal disease. The work presented here largely supports this hypothesis.

Background: Chronic kidney disease (CKD) affects approximately 26 million individuals in the United States and is a top priority in the objectives for Healthy People 2020. Despite efforts to improve awareness, discussion of CKD is often minimal or ineffective in the primary care setting. This leads to a lack of patient awareness and knowledge of self-care skills to prevent or slow progression of the disease. A lack of communication of has been attributed to the provider's lack of confidence and knowledge to discuss CKD and to avoid unnecessary stress. Purpose: The purpose of the DNP project is to provide a systematic review of patient-provider communication processes used to influence self-management or behavioral change in primary care and propose a tool to enhance communication and slow progression of CKD. Methods: A systematic review was conducted following the method guidelines of the Cochrane Collaboration. Six electronic databases were searched. Inclusion criteria were adult humans, primary research studies, systematic and literature reviews, focus on communication of self-management or behavioral change strategies, primary outcomes of improving self-management and/or patient outcomes and availability of full-text online or by request. Outcomes: Of the 5765 articles initially identified, 28 studies met inclusion criteria. The studies revealed a lack of evidence directed towards CKD and communication was not directly addressed in a majority of the studies. Interventions most successful in improving patient outcomes were individualized, elicited collaboration or interaction with the patient and provider, were motivational or encouraging and aided in barrier identification and problem solving. A communication tool was developed from the evidence in order to stimulate more meaningful conversation between the patient and provider.

Hemodialysbehandling är en livsuppehållande behandling vid terminal njursvikt. Behandlingen utförs flera gånger i veckan och medför stora livsförändringar. Delaktighet är i fokus i dagens hälso- och sjukvård, vilket forskning och lagstiftning bekräftar. Syftet med denna litteraturöversikt var att beskriva upplevelsen av delaktighet hos vårdsökande personer som genomgår hemodialysbehandling på sjukhus. Metoden som valdes var litteraturöversikt med kvalitativ ansats. Nio artiklar granskades genom induktiv innehållsanalys och mynnade ut i kategorierna; hämmande maktlöshet och att känna sig säker med underkategorierna kommunikationsbrister och brister i bemötandet respektive kunskap ger trygghet och känna tillit. Resultatet visar att vårdsökande person upplever en kamp för delaktighet i sin behandling.  De som upplever att de är delaktiga beskriver ett ökat välbefinnande. Slutsatsen är att vårdpersonalen behöver utöka sin kunskap om vad som främjar delaktighet hos personer som genomgår hemodialysbehandling. / Hemodialysis is a life supporting treatment in terminal kidney failure. The treatment is given several times a week and results in major life changes. Participation is in focus in today’s healthcare, which is confirmed by current research and legislation. The aim of this literature review was to describe the experience of participation among persons undergoing in-center hemodialysis treatment. The method used was qualitative literature review. Nine articles were reviewed using inductive content analysis and two categories derived: 1. Inhibitory powerlessness with subcategories; lack of communication and deficiencies in treatment and 2. To feel secure with subcategories; knowledge gives security and to feel trust. The result shows experiences of struggle to participate in hemodialysis treatment. Persons who take active part of the treatment describe a high wellbeing. The conclusion is that healthcare professionals need to increase their knowledge in what promotes participation among persons undergoing hemodialysis treatment.

Chronic kidney disease (CKD) is associated with a complex state of immune dysfunction characterised by immune depression, which predisposes CKD patients to infections, and by immune activation resulting in inflammation, which is associated with cardiovascular disease among these patients. It has been suggested that regular moderate exercise may enhance immune function and exert anti-inflammatory effects. However, such effects are still unclear in CKD. Therefore, we investigated the effects of acute and regular (1-month and 6-months) moderate intensity aerobic exercise (walking) on measures of immunity and inflammation in pre-dialysis CKD patients. A single bout of walking exercise induced an overall immune and inflammatory response that was comparable to that observed in healthy individuals, with no indication of harmful effects to patients underlying state of immune dysfunction. Acute exercise induced a normal pattern of mobilisation of immune cells. Concerning immune cell function, acute exercise had no effect on T lymphocyte and monocyte activation, while it actually improved neutrophil responsiveness to a bacterial challenge in the recovery period. In addition, acute exercise induced a systemic anti-inflammatory environment, evidenced by the marked elevation in plasma IL-10 levels after exercise, which was most likely mediated by the observed increase in plasma IL-6 levels. Regular walking exercise exerted anti-inflammatory effects, with no apparent detrimental effects to patients immune and inflammatory status. Regular exercise led to improvements in the systemic inflammatory status (ratio of pro-inflammatory IL-6 to anti-inflammatory IL-10 cytokine levels) that were accompanied, and most likely mediated, by the observed down-regulation of T lymphocyte (only evident at 6-months) and monocyte activation. In addition, a reduction in IL-6 production in PBMC and whole blood cultures was also observed (only assessed at 1-month). Regular exercise had no effect on circulating immune cell numbers and neutrophil degranulation responses. These findings provide compelling evidence that walking exercise is safe from an immune and inflammatory perspective and has the potential to be an effective anti- inflammatory therapy in pre-dialysis CKD patients.

Bakrund: När njurarnas funktion blir nedsatt får patienten gå igenom dialys regelbundet vilket skapar lidande. Njurtransplantation är alternativ för dessa patienter. De flesta njurar som doneras är från avlidna personer eller från anhöriga men även anonyma givare förekommer. Syfte: Syftet var att belysa donatorers upplevelser av livet under och efter njurdonation. Metod: En litteraturöversikt som är byggd på tio artiklar båda kvantitativa och kvalitativa. De har kvalitetsgranskats enligt Fribergs mall för kvalitetsgranskning. Resultat: Analysen skapade fem teman, känsla av rädsla och oro, den postoperativa smärtan och återhämtningen efter njurdonationen, de psykologiska konsekvenserna av att donera en njure, upplevelsen av vården och uppföljningen samt upplevd tillfredställelse Diskussion: Donatorerna kände oro för att operationen inte skulle lyckas både för sig själv och mottagaren. Efter transplantationen återhämtade sig ofta donatorerna ganska väl och brukade oftast inte få några psykiska besvär. Donatorerna tyckte att de inte fick den medicinska uppmärksamheten som de önskade sig under vårdtiden och kände sig som ett medel av vårdpersonalen. Att få kunskap om hur donatorer upplever donationen och hälso- och sjukvårdspersonalen hjälper blivande sjuksköterskor att sätta sig i dessa patienters livsvärld och ge dem det stöd de behöver.

Κάθε χρόνο τα άτομα που υποφέρουν από κάποιας μορφής νεφρική νόσο αυξάνονται παρά τις εξελίξεις στον τομέα της ιατρικής. Έχει παρατηρηθεί ότι η νεφρική νόσος, στις περισσότερες περιπτώσεις μπορεί να εξελιχθεί σε νεφρική ανεπάρκεια, είτε με πιο αργούς είτε με πιο γρήγορους ρυθμούς. Η νεφρική ανεπάρκεια αντιμετωπίζεται είτε με αιμοκάθαρση είτε με μεταμόσχευση. Το ανοσοποιητικό σύστημα διαδραματίζει σημαντικό ρόλο τόσο στην αντιμετώπιση όσο και στη πρόοδο των διάφορων μορφών νεφρικής νόσου. Ωστόσο, οι διάφοροι λεμφοκυτταρικοί τύποι, και ιδιαίτερα αυτοί της φυσικής ανοσίας, δεν έχουν μελετηθεί ιδιαίτερα και πολλές φορές από τις λίγες μελέτες που υπάρχουν προκύπτουν αντικρουόμενα αποτελέσματα. Η μελέτη μας επικεντρώθηκε στα Τ, στα ΝΚ και στα ΝΚ-Τ λεμφοκύτταρα. Επιλέξαμε να ερευνήσουμε αρχικά και τελικά στάδια νεφρικής νόσου. Έτσι οι ασθενείς κατηγοριοποιούνται σε τρεις ομάδες: ασθενείς με σπειραμαρονεφρίτιδα (αρχικό στάδιο), ασθενείς που υποβάλλονται σε αιμοκάθαρση και μεταμοσχευμένοι ασθενείς (τελικά στάδια). Σε κάθε πείραμα γίνεται σύγκριση με μια ομάδα ελέγχου (control, που αποτελείται από υγιή άτομα). Στην περίπτωση της σπειραματονεφρίδας παρατηρήθηκαν φυσιολογικά ποσοστά των λεμφοκυτταρικών τύπων και της έκφρασης του NKG2D υποδοχέα. Παρατηρήθηκε, όμως, αυξημένη έκφραση του TNF-α. Στην περίπτωση της αιμοκάθαρσης αν και παρατηρήθηκε μειωμένο ποσοστό ΝΚ και Τ κυττάρων, βρέθηκε ότι παρουσιάζουν αυξημένη κυτταροτοξικότητα και λειτουργικότητα. Αυτό φαίνεται και από την αύξηση στην έκφραση του CD107α και από την αύξηση στη συγκέντρωση του TNF-α. Όσον αφορά τα ΝΚ-Τ κύτταρα, αν και το ποσοστό τους είναι φυσιολογικό, εμφανίζουν αυξημένη έκφραση του υποδοχέα NKG2D. Τέλος, όσον αφορά την ομάδα των μεταμοσχευμένων ασθενών, δεν παρατηρήθηκε μεταβολή στο ποσοστό των Τ και των ΝΚ-Τ κυττάρων. Όταν όμως οι ασθενείς κατηγοριοποιούνται με βάση την φαρμακευτική αγωγή, το ποσοστό των ΝΚ-Τ κυττάρων είναι αυξημένο σε ασθενείς που τους χορηγείται κυκλοσπορίνη. Επίσης, η έκφραση του υποδοχέα NKG2D είναι φυσιολογική και στις δύο κατηγορίες λεμφοκυττάρων. Από την άλλη, αν και το ποσοστό των ΝΚ κυττάρων μειώνεται, αυτά εμφανίζουν φυσιολογική λειτουργικότητα και κυτταροτοξικότητα, όπως φαίνεται από τη φυσιολογική έκφραση του NKG2D υποδοχέα, της πρωτεΐνης CD107α και του TNF-α. / Every year, people who suffer from some form of kidney disease are increasing despite advances in medicine. It has been observed that the kidney disease, in most cases might progress to renal failure, either slower or faster. The renal failure is treated either by hemodialysis or renal transplantation. The immune system plays an important role in the treatment and in the progression of various forms of renal disease. However, the various types of lymphocytes, and especially those of innate immunity have not been widely studied and often the few studies that exist result in conflicting results. Our study focused on T, NK and NK-T lymphocytes. We chose to investigate initial and final stages of renal disease. Patients were categorized into three groups: patients with glomerulonephritis (initial stage), patients on dialysis and transplanted patients (final stages). In each experiment patients were compared with a control group consisting of healthy individuals. In the case of glomerulonephritis, we observed normal percentages of the lymphocyte population examined and normal expression of the NKG2D receptor, as well as increased expression of TNF-α. In the case of hemodialysis, NK and T cell percentages were reduced, while NK cells exhibited enhanced cytotoxicity and functionality. This was shown by the increase in the expression of CD107α and by the increase in the concentration of TNF-α. Regarding the NK-T cells, although their percentage was normal, they showed increased expression of NKG2D receptor. Finally, concerning the group of transplanted patients, no change was observed in the percentage of T and NK-T cells. However, when patients were categorized based on the medication, the percentage of NK-T cells was increased in patients receiving cyclosporine. In addition, the expression of NKG2D receptor was normal on T and NK-T cells. On the other hand, although the percentage of NK cells was reduced, those cells exhibited normal functionality and cytotoxicity, as shown by the normal expression of NKG2D receptor, CD107α protein and TNF-α.