Programa de Apoio aos Planos de Reestruturação e Expansão das Universidades Federais / Health and disease, just like the body, are social constructions; how anyone live these process and the meanings that they are going to receive are related to the culture they re in. In this context, knowing of a chronic disease case implies several emotional and psychic matters. In a Chronic Renal Failure s case (CRF) - a progressive and irreversible loss in renal function disease the patient needs to struggle against the incapacities and changes acquired through the rest of his/her life. Because of that, this dissertation s objective is to present and discuss the results of a research that sought the meanings of CRF, health/ illness and body for those patients. A clinical-qualitative research conducting was chosen, whose informers were Hospital Universitário de Santa Maria s nephrology service clinic patients, which were doing dialysis or hemodialysis. The information gathering instrument choice was a semi directed interview, which were studied through a thematic content analysis. It was found that exists in society a premise where health connected to immortality is a supreme good and must be sought and desired. Illness, on the contrary, must be countered, because it reminds of incapability, loss, body imperfection and ugliness. So, considering how patients deal with the health/ disease process and treatment matter, just like they experience it and its meaning, it is viable for this context s professionals, to provide congruent assistance. / A saúde e a doença, assim como o corpo, são construções sociais; a maneira como cada um vivencia esses processos e os significados que atribuirão aos mesmos estão relacionados à cultura na qual estão inseridos. Nesse contexto, a notícia da doença crônica traz consigo inúmeras implicações emocionais e psíquicas. No caso da Insuficiência Renal Crônica (IRC) doença em que há perda progressiva e irreversível da função dos rins o doente precisa lutar contra as incapacidades e mudanças adquiridas para o resto da vida. Por isso, esta dissertação tem como objetivo apresentar e discutir os resultados de uma pesquisa que buscou os significados que IRC, saúde/doença e corpo possuem para os pacientes. Optou-se pela realização de uma pesquisa clínico-qualitativa, cujos informantes foram os pacientes do ambulatório do Serviço de Nefrologia do Hospital Universitário de Santa Maria/RS (HUSM), que realizavam diálise ou hemodiálise. O instrumento escolhido para coleta das informações foi a entrevista semidirigida, as quais foram analisadas através de uma análise de conteúdo temática. Constatou-se que existe na sociedade a premissa de que a saúde ligada à imortalidade é um bem supremo e que deve ser desejada e procurada. A doença, ao contrário, deve ser combatida, pois ela lembra incapacidade, perda, imperfeição corporal e feiura. Portanto, ao levar-se em consideração a maneira como o processo saúde/doença e o tratamento são vistos pelos doentes, assim como a forma que eles vivenciam as experiências advindas e o significado que todo esse processo adquire para eles, acredita-se que se torne mais viável para os profissionais envolvidos nesse contexto, oferecerem o apoio necessário.

The imbalance between the oxidant species formation and the activity of antioxidants is known as oxidative stress and it is directly related to the etiology and/or the progression of chronic diseases such as chronic renal failure (CRF), atherosclerosis and cardiovascular diseases. The CRF can be the result of variety renal injuries that lead to toxic substances accumulation and metabolic disturbances in the organism. Patients with chronic renal disease on hemodialysis treatment, whose main cause of morbi-mortality is the cardiovascular diseases, are constantly under oxidative stress by the uremic condition, but overall by the hemodialysis treatment, which leads to an increase of reactive species and decrease of antioxidant defenses. Moreover, these patients also present nutritional problems and presence of other comorbity diseases as anemia, hypertension and diabetes that can contribute to increase the oxidative stress state, accented for the hyperhomocysteinemia. However, the influence of the therapeutical treatment on the oxidative stress has still several controversies. Thus, oxidative stress studies and its relationship with medicaments are very important. The aim of this study was to determine which oxidative stress markers were altered in hemodialysis patients, as well as the influence of erythropoietin, iron, vitamin B12 and folic acid on these markers and in the hematologic parameters and hyperhomocisteinemia. Plasmatic TBARS, erythrocytic GSH, ALA-D enzyme activity, methemoglobin (MHb), homocysteine (Hcy), hemoglobin (Hb) and hematocrit (Ht) of 36 hemodialysis patients (HP) and 20 controls (C) were determined with a prior consent of all subjects. The personal information of each patient was used for additional data as medicaments treatment. The results found in HP in comparison with the C had significant increase (p<0,05) for TBARS, erythrocytic GSH, MHb, and Hcy, as well as significant decrease (p<0,05) of ALA-D activity, Hb and Ht. So, it was evident the oxidative stress occur, alterations in antioxidants defense, hyperhomocysteinemia and anemia. However, significant differences in the oxidative stress markers had not been found when they were related to the use of medicaments, co-morbidities presence, life style, time of hemodialysis and accomplishment of simple activities. Thus, this work demonstrated that beyond alterations in oxidative stress markers as TBARS and GSH, it was also found alterations in the ALA-D enzyme activity and in the MHb. Moreover, it was possible to observe that some medicaments as erythropoietin, vitamin B12 and folic acid can be involved in the increase of GSH levels. / O desequilíbrio entre a formação de espécies oxidantes e a atividade dos antioxidantes é denominado estresse oxidativo e está diretamente relacionado à etiologia e/ou progressão de diversas patologias crônicas, dentre as quais a insuficiência renal crônica, aterosclerose e as doenças cardiovasculares. A insuficiência renal crônica pode ser decorrente de uma série de afecções renais que culminam em perda de funcionalidade dos rins, provocando acúmulo de várias substâncias tóxicas no organismo e diversos distúrbios metabólicos. Pacientes com doença renal crônica submetidos à hemodiálise, cuja principal causa de morbi-mortalidade são as doenças cardiovasculares, estão constantemente sob estresse oxidativo em virtude da própria condição patológica, mas, sobretudo, pelo tratamento hemodialítico, que provoca aumento na formação de espécies reativas e diminuição dos níveis de antioxidantes. Além disso, estes pacientes também apresentam problemas nutricionais e a presença de outras doenças co-mórbidas como a anemia, hipertensão e diabetes que podem contribuir para o elevado estresse oxidativo, acentuado ainda mais pela hiper-homocisteinemia. Contudo, a influência do tratamento terapêutico sobre o estresse oxidativo permanece controversa. Sendo assim, estudos do estresse oxidativo e sua interrelação com a terapia medicamentosa são muito importantes. O objetivo deste estudo foi determinar quais marcadores do estresse encontram-se alterados nos hemodialisados, bem como a influência de medicamentos como eritropoetina, ferro, vitamina B12 e ácido fólico sobre estes marcadores, sobre os parâmetros hematológicos e hiper-homocisteinemia. Para tal, foram determinadas as substâncias reativas ao ácido tiobarbitúrico (TBARS) plasmáticas, glutationa reduzida (GSH) intra-eritrocitária, atividade sangüínea da enzima ácido δ-aminolevulínico desidratase (ALA-D), metemoglobina (MHb), homocisteína (Hcy), hemoglobina (Hb) e hematócrito (Ht) de 36 pacientes hemodialisados (PH) e 20 indivíduos saudáveis (IS), mediante prévio consentimento. Os prontuários médicos de cada paciente foram utilizados para levantamento de dados adicionais como o tratamento medicamentoso. Os resultados encontrados em PH em relação aos IS demonstraram aumento estatisticamente significativo (p<0,05) de TBARS plasmático, GSH intra-eritrocitária, MHb sangüínea e de Hcy plasmática, assim como diminuição significativa (p<0,05) da atividade da enzima ALA-D sangüínea, de Hb e Ht. Dessa forma, ficou evidente a ocorrência de estresse oxidativo, alterações no sistema antioxidante, hiper-homocisteinemia e anemia. Todavia, não foram encontradas diferenças significativas nos marcadores do estresse oxidativo analisados quando relacionados ao uso de medicamentos, presença de co-morbidades, hábitos de vida, tempo de hemodiálise e capacidade de realização de atividades simples. Dessa forma, este trabalho demonstrou que, além de alterações em marcadores do estresse oxidativo como TBARS e GSH, também foram encontradas alterações na atividade da enzima ALA-D e na MHb. Ainda, pôde-se supor que alguns medicamentos como eritropoetina, vitamina B12 e ácido fólico podem estar envolvidos no aumento das concentrações de GSH.

Tryptophan is metabolised along the kynurenine pathway under the influence of tryptophan 2,3 dioxygenase and indoleamine 2,3 dioxygenase. Quinolinic acid and kynurenine, two neuroactive metabolites of the kynurenine pathway are, in chronic renal failure patients, considered as uraemic toxins. Related research is generally hampered by the non-availability of relevant analytical techniques. The primary aim of this study was, therefore, to develop and validate suitable methods for the determination of tryptophan, kynurenine and quinolinic acid. The second aim was to quantify the levels of these substances in the blood of chronic renal failure patients on renal replacement therapies and to compare the levels of haemodialysis patients to those on peritoneal dialysis. Patients’ quality of life was investigated relative to disturbances in tryptophan metabolism. Gas chromatography coupled to mass spectrometry (GC-MS) gave the best results for the analysis of tryptophan, kynurenine and quinolinic acid. A Hewlett Packard HP GC 6890 series gas chromatographer was coupled to a MS 5973 series mass spectrometer. Analytes were separated on a DB-5MS column with a nominal length of 30 metres, a diameter of 250.0 µm and film thickness of 0.10 µm. Helium was used as carrier gas, and the chromatographic analysis run time 12.5 minutes. The validation results were within the acceptance criteria for newly developed methods. The linear calibration curves constructed for all of the analytes gave r2 correlation coefficients >0.99. Other validation data such as precision, bias, accuracy and stability all fell within acceptable validation limits. In the study on chronic renal failure patients significant differences were seen between patients and controls. Tryptophan levels were 5.34 SD 5.04 µM for the haemodialysis group, 6.73 SD 3.18 µM for the peritoneal dialysis group and 28.4 SD 4.31 µM for the control group. Kynurenine levels were 4.7 SD 1.9 µM for the haemodialysis group, 2.9 SD 2.0 µM for the peritoneal dialysis group and 2.1 SD 0.6 µM for the control group. Quinolinic acid levels were 4.9 SD 2.0 µM for the haemodialysis group, 2.8 SD 2.0 µM for the peritoneal dialysis group and 0.3 SD 0.1 µM for the control group. Tryptophan was lower for the total patient group than for controls with significantly lower levels for haemodialysis versus control (p<0.05) and peritoneal dialysis versus control (p<0.05). Kynurenine levels were higher in the total patient group with significantly higher levels for the haemodialysis versus control group (p=0.0001). The patient groups had higher quinolinic acid levels with significantly higher levels for the haemodialysis versus control (p<0.05) and peritoneal dialysis versus control (p<0.05) groups. This study was the first to determine the three substances simultaneously in both haemodialysis and peritoneal dialysis patients. The study showed significant tryptophan depletion, as well as kynurenine and quinolinic acid accumulation for both groups. No significant differences were found between the patient groups other than higher kynurenine levels in the haemodialysis group. The quality of life (SF-36) was largely similar in the two patient groups. This decrease in the quality of life strongly correlated with the degree of tryptophan depletion. / Dissertation (MSc)--University of Pretoria, 2008. / Chemical Pathology / unrestricted

No description available.

The objective of the study is to analyze the factors associated with the severity of pruritus in patients with terminal chronic kidney disease undergoing hemodialysis. The methodology used is based on a cross-sectional study in patients receiving hemodialysis at the Centro Nacional de Salud Renal. Severe pruritus was defined as a score on the visual analogue scale greater than or equal to 7, and the strength of association with the possible risk factors was assessed by calculating prevalence ratios. Regarding the results, 264 patients were included, 59.9% were male, with a mean time on hemodialysis of 10.26 ± 7.14 years. 75% experienced pruritus, of this group, 1 in 3 presented severe pruritus. Hyperphosphatemia and the use of antihistamines were associated with a higher prevalence of severe pruritus (RP 1.71, 95% CI 1.09-267 and RP 2.39, 95% CI 1.51-3.75, respectively). The positive serology for Hepatitis C Virus was described as a protective factor for presenting severe pruritus (RP 0.55, 95% CI 0.33 - 0.89). In conclusion, severe uremic pruritus is a frequent problem in patients with chronic terminal kidney disease who have hyperphosphatemia and treatment with antihistamines independently of the time they have been on hemodialysis. / Revisión por pares

Thesis (M. A. (PHARM.) -- University of Limpopo, 2019 / Introduction Multidisciplinary team (MDT) approach has emerged as one solution to improving chronic kidney disease (CKD) care. The MDT may include a nephrologist, physicians, nurses, dietitians, pharmacists, and social workers, all working together to deliver effective care to patients with CKD. Participation of pharmacists within the renal MDT at Polokwane hospital seems to be limited. The perceived barriers to pharmacists providing renal care services to CKD patients at Polokwane hospital could inform future strategy development, to enhance their participation. The aim of this study was to explore the role of pharmacists in renal care and develop strategies to maximise their participation in the renal multidisciplinary health care team, based on their participation at Polokwane hospital, Limpopo province. Method A qualitative study using semi-structured interviews was conducted with a purposeful sample of 8 members of the renal MDT and 9 pharmacists. The audiotaped interviews were transcribed exactly as said and analysed using thematic content analysis. Results Four themes emerged from the analysis: ‘pharmacist’s current scope of practice within the renal MDT’, ‘potential future roles of pharmacists’, ‘perceived barriers to participation of pharmacists within the renal MDT’ and ‘recommendation/Strategies to incorporate pharmacists into the MDT’. Results have shown that pharmacists have an absent role within the renal MDT. Their role is limited to just dispensing and managing stock, with no role in direct patient care. Both pharmacists and MDT members showed preference to working together during renal care. Pharmacy services suggested include medication reviews, provision of patient education and counselling, patient adherence improvement, dosage workouts, patient monitoring and education on contraindicated drugs and drug interactions. Shortage of staff, pharmacists lack of clinical skills, lack of communication and attitude of pharmacists were perceived as the major barriers to participation of pharmacists within the renal xii MDT. To overcome these barriers, it was recommended that the department of health (DoH) provide more pharmacy staff and educational opportunities in the form of workshops, to equip pharmacists clinically and broaden competency and knowledge on effective communication and coordination. In addition, it was recommended that the clinical curriculum at Universities be revised, to build solid foundation on MDT care and pharmacology and that the MDT programme be standardized through standard treatment guidelines (SOP’s), policies and drawing of job descriptions. Conclusion The role of pharmacists at Polokwane hospital is confined to just stock management and dispensing. There are promising avenues for future development of their role during patient care, which can be achieved by addressing the barriers highlighted Recommendations The expansion of the role of pharmacists within the renal MDT will require improved partnership between health care professionals, resources, legislations and guidance from formal SOPs. Having a national framework for pharmacy practice from Ministry of Health, supported by educational opportunities and a pro-active professional association would be key to incorporating pharmacists within the renal MDT.

A research project submitted in fulfilment of the requirements for the degree of Master of Arts in Psychology through the Faculty of Humanities, University of the Witwatersrand, Johannesburg, 2016 / Background Chronic Kidney Disease (CKD) is a reality faced by many around the world. There has been much physiological study around factors associated with CKD, as well as many studies surrounding the psychosocial impacts of the disease, with relatively less attention given to neuropsychological effects the disease can have on sufferers. This paper investigates the cognitive impacts as well as psychological impacts simultaneously, impacting on sufferers of End Stage Kidney Disease (ESKD). Methods Sixteen medically stable patients aged (M = 40.56, SD = 12.52) years with ESKD, were investigated. Eight of the patients were evaluated before and after six months of successful kidney transplant, using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which assessed immediate memory, visuospatial / constructional, language, and attention. They were also tested on a brief symptom inventory (BSI 18) to assess depression and anxiety in these patients. A further eight who remained on dialysis, and had not undergone renal transplant were evaluated in the same manner for comparative purposes. Results Between-group comparisons showed a statistically significant improvement in overall cognitive functioning, as well as in the specific cognitive domains of visuospatial / constructional, language and attention for participants who had undergone renal transplant surgery compared to their counterparts who had not. Results also found that there were no statistically significant differences between the levels of anxiety experienced between patients in the two groups. When assessing the differences in cognitive improvement within the transplant patient group before and after transplant, improvement in the delayed memory function of renal transplant patients post-transplant was found. Conclusion These data show improvements in delayed memory function of patients having undergone renal transplant therapy, while also highlighting a continued decline of overall cognitive functioning in patients remaining on hemodialysis therapy. / GR2017

Thesis (M.Sc. (Statistics)) -- University of Limpopo, 2020 / Peritoneal Dialysis (PD) is a process of replacing kidney function which cleans waste from the blood and remove extra fluid from the body. In most cases, the process of PD is slowed down by a peritoneal membrane infection called peritonitis. Despite recent advancements in treatments and prevention, peritonitis still remains the leading complication which results in high morbidity and technique failure among PD patients. Using a prospective peritonitis dataset of 159 kidney patients who were on PD from 2008 to 2015 in Pietersburg Provincial Hospital, the aim of this study was to identify potential social, demographic and biological risk factors that contribute to the first episode of peritonitis. Both semi-parametric (Cox PH) and parametric (Accelerated Failure Time: Weibull, exponential, loglogistic, and gamma) survival models were fitted to the peritonitis dataset. Akaike Information Criterion (AIC) was applied to select models which best fit to the peritonitis data. Accordingly, log-logistic Accelerated Failure Time (AFT) model was found to be a working model that best fit to the data. A total of 96 (60.38%) peritonitis cases were recorded over the follow-up period with majority of peritonitis infection coming from females (65.4%) and rural dwellers (65.7%) with (62.6%) of black Africans showing higher risk of developing peritonitis. The multivariate log-logistic AFT model revealed that availability of water (p-value=0.018), electricity (p-value=0.018), dwelling (p-value=0.008), haemoglobin status (p-value=0.002) and duration on PD (p-value=0.001) are significant risk factors for the development of peritonitis. Therefore, patients with no water and electricity, coming from rural background with low level of haemoglobin and shorter duration on PD are associii ated with high risk or hazard of developing peritonitis for the first time.

Thrombotic microangiopathies (TMA) are disorders characterized by microangiopathic hemolytic anemia, thrombocytopenia, and microthrombi leading to organ dysfunction. Atypical hemolytic uremic syndrome (aHUS) is a rare subtype of TMA mediated by complement dysregulation. We present a case of a 59-year-old female who presented with acute kidney injury and mild thrombocytopenia but with normal hemoglobin. We highlight the importance of prompt diagnosis of aHUS and initiating appropriate treatment with eculizumab.

This research examines the relationship between health literacy among End Stage Renal Disease (ESRD) patients and its relevance for communication between patients and providers. The study was conducted among dialysis services providers at the Good Samaritan Dialysis Center and dialysis patients receiving care at the Center. Data collection techniques included individual interviews, surveys, and the Short Test of Functional Health Literacy in Adults (S-TOFHLA), which measured the health literacy level of the participants. The results of the study show that a large majority of the patients have "adequate" health literacy, which contradicts the provider's perceptions of the patient's ability to comprehend health information. Provider's perspectives are shaped by their training and work environment. The study suggests that structural barriers and communication issues impede effective patient-provider interactions. This issue is especially serious for those chronic disease patients who have limited self-management skills. / Graduation date: 2012