Background: Low protein diet is one of the treatments for patients with chronic kidney disease during the pre-dialysis period. Studies about this subject have been published for more than 20 years, but the conclusions about its effect and the most appropriate composition are not clear. A low-protein diet is recommended for some patients at the Nephrology Clinic of General University Hospital. These patients are educated and re- educated by a nutrition therapist who also controls their food intake through a food diary. Objectives: To evaluate the effect of low-protein diet on the progression of chronic kidney disease in our conditions and to compare the results with the control group. Furthermore, to evaluate the nutritional status of these patients and the influence of the diet on it. Last but not least, describe a set of patients coming to education about low-protein diet. Methods: The input data was retrospectively retrieved from the medical records of patients who attended medical checks at the Nephrology Clinic of General University Hospital between 10/2016 and 3/2018. A group of 15 patients with a low-protein diet was compared with a control group of 15 patients who did not receive low-protein diet education. The main data collected was year of birth, estimated GFR, urea, creatinine, albumin,...

Patients with end-stage renal disease frequently suffer from cardiovascular complications. Many factors contribute to their development: hyperkinetic circulation caused by anaemia, fluid retention and by presence of dialysis arteriovenous access; metabolic changes leading to acceleration of atherosclerosis and increase of vascular stiffness and also fluctuation of blood pressure and organ perfusion during haemodialysis, that cause repeated tissue hypoxia. We performed our research on patients in chronic haemodialysis programme. The project studying long-term patency of dialysis access showed that dialysis graft patency is negatively influenced by presence of coronary artery disease and low serum concentrations of cholesterol. In our studies about tissue hypoxia we proved that haemodialysis patients suffer from hypoxia of cerebral tissue and muscle tissue of the dialysis access arm, and that the hypoxia worsens during dialysis. Factors associated with brain hypoxia are presence of heart failure, higher BNP levels and higher erythrocyte distribution width. One of the serious consequences of brain hypoxia is development of cognitive deficit. Among the negative impact of haemodialysis on the heart, we observed left atrial dysfunction, which is a consequence of long-term remodelling and cannot be...

Thesis title: Kinesiophobia in patients on renal dialysis therapy - questionnaire study. The aims of the thesis: To characterise the term kinesiophobia and to evaluate the dependence of the measure of fear of movement on sociodemographic and clinical variables with the use of the Tampa Scale for Kinesiophobia questionnaire (TSK-CZ) in a group of respondents on renal dialysis therapy and a group of healthy respondents. Methods: To determine the dependence of the measure of kinesiophobia on selected variables, the TSK-CZ questionnaire was used in Fresenius Medical Care dialysis centres across towns in the Czech Republic. The reference group of individuals with no renal disease - healthy respondents - was addressed by means of the Survio.cz website. The research comprised a group of respondents on renal dialysis therapy (n = 135) and a group of healthy respondents (n = 135). The collected data was processed using statistical methods - descriptive statistics and data analysis (t-test, Chi-squared test, ANOVA, Spearman's correlation coefficient). After that, the data was transferred to tables and charts and was evaluated. Results: On the basis of the TSK-CZ questionnaire, a significant difference in the measure of fear of movement was found between the respondents on renal dialysis and the healthy ones...

Aims: The thesis deals with the biomarkers of early renal injury, namely albuminuria and neutrophil gelatinase-associated lipocalin (NGAL). The aims in the case of albuminuria were the implementation of HPLC method, comparing HPLC with immunoturbidimetric (IT) method and monitoring the relationship to the diagnosis of diabetes mellitus. The aim of urinary NGAL (and eventually other markers) examination was to verify its reliability in the prediction of acute kidney injury (AKI). Methods: We investigated albuminuria in fresh urine samples in the groups of 636 diabetics and 456 nondiabetics using the HPLC method (Agilent 1200, Agilent Technologies, USA) and immunoturbidimetrically (Cobas Integra 400, Roche Diagnostics); we studied the correlations and relationships between albuminuria and glycated hemoglobin HbA1c. We investigated urinary NGAL by chemiluminescent microparticle immunoassay (Architect i4000, Abbott) in children's groups: 1) after renal transplantation (N = 15), 2) with acute or chronic kidney disease (N = 28); and in adult patient's groups: 1) after cardiac surgery (N = 10) and 2) post angiography (N = 41). Results: Albuminuria determined by HPLC was statistically significantly higher than albuminuria determined by IT. We excluded nonspecificity of the HPLC method. Results indicate...

The main focus of our research was to compare changes in ion excretion in urine, osmolality, indicators of exercise-induced proteinuria and tubular markers before and after dynamic exercise on a bicycle ergometer. The test sample consisted of 7 healthy, physically active women aged 27.4 years ( σ = 3.82 ). For dynamic exercise we uniformly set parameters 65 % VO2max and duration of load in 50 minutes. We compared the laboratory results of urine samples taken just before the exercise with urinary samples that we have collected immediately after exercise. The results of our measurements showed a significant changes in exercise-induced urinary sodium ions, creatinine and phosphorus. Statistically insignificant changes excretion was found between markers: chlorine, urine, osmolality, and N-acetyl-beta- d-glucosaminidase. These markers, however, show a trend the significance. Statistically insignificant changes after exercise have shown excretion of urinary markers: potassium, gelatinase-associated lipocalin, neutrophil microalbuminuria and alpha-1-microglobulin. Tubular markers of kidney damage after exercise is not at the reference values, that would indicate the tubular kidney damage.

Introduction: Thanks to modern medicine people with chronic forms of the diseases can live longer than before. In this work we concerned with last stage of chronical kidney dinase, which is treated by dialysis or transplantation. Succesful renal transplantation leads to significant improvement in quality of life of patients, but after transplantation there are still some risk factors, which may influence health and physical condition of men. We can eliminace these risk factors with some non-pharmacological ways, for example with intervention program of regular physical activity and special nutrition, which can help to gain and increase patient`s physical condition. The main focus of research of this thesis was to evaluate physical condition and amount of physical aktivity of 4 groups of patients, each with another intervention, after renal transplant. We used the battery of motor tests "Senior Fitness Test Manual". Aim: Analyze, how regular physical activity, special nutrition and combination of both influence physical condition of patients after renal transplant. Methods: This research work is a part of the grant project IGA MZ CR 173 (NS-10518- 3/2009). We used 21 participants selected from patients of Nephrology Clinic TC IKEM in Prague for our solution. Physical fitness testing was performed...

Obesity is a risk factor for development of cardiovascular disease, diabetes type 2 and some cancers. Newly detected genetic risk factor for body weight is the FTO gene ("fat mass and obesity associated"). The aim of this thesis was determine 1) whether the presence of risk alleles correlate with BMI in Czech population and to determine 2) whether there is an association between variants in the FTO gene and risk of myocardial infarction/ acute coronary syndrome (MI/ ACS), 3) renal failure (ESRD), or 4) incidence of colorectal cancer (CRC). We analyzed polymorphisms rs17817449 (first intron) and rs17818902 (3rd intron) using by PCR-RFLP and then also RT PCR. We found an association of the first intron variant (but not the 3rd one) and BMI in Czech control population. We have detected an association of 1st intron SNP and BMI changes during the intervention study in obese children, but not in obese females. We found a correlation between the risk allele and increased risk of ACS (OR 1.49) in patients with MI. In patients with ESRD was detected association between the risk allele and the risk of disease (OR 1.37). We didn't confirmed the association between rs17817449 and the development of CRC. Representative selected groups of the Czech populations "MONICA" and "HAPPIE" were used as controls. One...

The issue of chronic renal failure and cannulation of permanent venous accesses in patients treated at haemodialysis centres is a topical and widespread problem of these days. According to generally accessible resources the incidence of terminal stage of renal failure, and thus the necessity to treat a patient by means of elimination methods, is very high, it reaches four individuals per thousand inhabitants according to the statistics. It is obviously a widespread nursing problem. The theoretical part of the thesis is divided into a summary and description of the present situation in chronic renal failure, particularly a brief insight into the chronic renal failure and its causes and syndromes. It also deals with the topic of the present treatment possibilities with stress on patient treatment at nephrologic outpatient clinics and in haemodialysis centres. The next chapter of the thesis describes the development from haemodialysis history up to the present advanced elimination methods. The present elimination methods bring the necessity of functional provision of venous access, particularly cannulation of AV fistulas, it is a very frequent nursing operation provided by nurses treating chronically affected patients at haemodialysis centres. This chapter is concluded by general knowledge of the techniques of cannulation of permanent venous accesses, possible occurrence of complications during the cannula penetration itself in relation to the physical phase of nursing treatment about patients with chronic renal failure. The practical part of the thesis was aimed at discovering or possible confirmation of the hypotheses discussed in the theoretical part. The practical research was based on searching for problems among dialyzed patients related to the permanent venous access, on finding the approach of nurses working at dialysis centres to cannulation of permanent accesses and on mapping the access of patients with permanent venous access to nurses with short time experience at a dialysis centre. Research questions were determined for this purpose and were processed within qualitative research into case reports upon depth interviews with nurses working at the dialysis centres of České Budějovice Hospital, Český Krumlov Hospital and Písek Hospital and their patients. The research data were processed into charts, where responses from patients and those from nurses were assessed separately. Occurrence frequency of the individual answers was particularly monitored in the individual output tables, however the responses were not processed by means of standard statistic methods because of the chosen methodology and thus a low number of respondents, but the output data served for drawing conclusions and preparing recommendations for application of nursing methods. The thesis conclusion summarizes the obtained knowledge and recommends possible procedures of solving the problems of cannulation of permanent venous accesses in patients with chronic renal failure treated at haemodialysis centres.

Sepsis and septic shock remain major cause of mortality in non-coronary intenisve care units. Prognosis of septic patiens worsens further in case of concomitant acute kidney injury. Pathophysiological pathways leading to renal dysfunction in sepsis remain unclear despite of enormous experimental and clinical research. Similarly, the role of extracorporeal blood purification techniques as an adjunctive treatment in sepsis is highly controversial. The aim of our study was to dynamically assess renal haemodynamic, microvascular and metabolic responses in a porcine clinically relevant model of septic shock. The same experimental model was used in experiments elucidating potential benefit effects of two distinct haemopurification methods on different biological responses to infectious insult.

This dissertation deals with the issue of continuous elimination methods in intensive care, and of subsequently creating teaching materials for incoming nurses. The goal was to create teaching materials for incoming nurses. These teaching materials should help incoming nurses work with a device intended for continuous elimination methods. The dissertation is divided into a theoretical and practical part. The empirical part was implemented in the form of a qualitative research, using semi-structured interviews with respondents at the Accident and Emergency Ward of Nemocnice České Budějovice a.s. at the RES 2 station. The first stage of research was implemented by conducting interviews with the respondents. These interviews were recorded in the form of detailed notes which were later transcribed in order to prevent losses of data and inaccuracies. Subsequently, categories were established and, proceeding from these categories, schemes created using the ATLAS programme. The second stage consisted of creating an instruction video and teaching materials for incoming nurses. As a part of the third stage of research, the created video and teaching materials were presented at the Accident and Emergency Ward for evaluation. Then, interviews with the original respondents were re-conducted. During these interviews, the respondents were tasked with evaluating whether the teaching materials fulfil their needs and whether they will be usable in practice. The learned information was then arranged in corresponding schemes. Two goals were set with regards to the practical part. The first goal was to determine which form of teaching materials is suitable for incoming nurses. The second goal was to establish the benefits and usability of the created materials in practice. Based on the goals, two research questions were formulated. The first research question was: Is the form of the teaching materials suitable for incoming nurses? The second research question was: What is the benefit of the created materials in practice? Based on the research, it was discovered that most of the respondents would welcome teaching materials in the form of printed leaflets; however, opinions on the option of creating a video were also heard. Therefore, an instruction video, suitably complementing the printed leaflet, was created. The third part of research implied that most of the eight interviewed respondents were satisfied with the teaching materials. Three respondents suggested supplementing the printed leaflet with additional images. All eight respondents agreed that in their opinion, the provided teaching materials would make it easier for incoming nurses to familiarize themselves with the issues discussed. The head nurse at the Accident and Emergency Ward views the created teaching materials as beneficial. She intends to continue using these materials at her ward.