Chronic kidney disease (CKD) is a significant public health issue. The uraemic milieu is associated with profound alterations in body composition and function. Therapeutic interventions to preserve renal function and to provide adequate homeostasis to improve outcomes in all stages of chronic kidney disease may promote other unwanted functional adversities which with careful attention to individualised treatment may be modifiable. The aim of this thesis is to clearly document these disorders of body composition and function and investigate whether commonly practiced interventions can indeed have additional deleterious impact. Our work involved subjects with different levels of CKD and included: • Antihypertensive therapy and falls in older persons with CKD 3/4. • Assessment of dynamic bone function in ERF subjects treated with haemodialysis and consequences of phosphate binder medication. • Distinguishing the dominant cardiac functional abnormalities in ERF subjects treated with haemodialysis and determination of the effects of haemodialysis on camitine depletion and its functional consequences (skeletal and myocardial). Key results included: • Antihypertensive therapy in older subjects with CKD was associated with a reduction in muscle mass over time and reduced overall function but no significant falls risk was noted. • Commonly utilised measurements to determine bone turnover in ERF subjects treated with haemodialysis do not appear to correlate with dynamic collagen formation rates. • Dobutamine-atropine stress with non-invasive assessment of cardiac parameters can be used to identify the dominant functional abnormalities that predispose to intradialytic hypotension in ERF subjects. • Skeletal muscle total carnitine decreases over the first 12 months of dialysis. Change in muscle total carnitine correlated weakly with exercise capacity. Carnitine replacement did not confer any measurable cardiovascular benefit over the first 12 months of dialysis. Body composition is highly variable over time in CKD. This is seen both in subjects receiving haemodialysis and in pre-dialysis patients. The interplay of these common alterations with the effects of treatments is potentially underestimated but should always be considered in the individualisation of patient care.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:605875 |
| Date | January 2013 |
| Creators | Owen, Paul |
| Publisher | University of Nottingham |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://eprints.nottingham.ac.uk/14576/ |
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