Dissertations / Theses on the topic 'End Stage Kidney Disease (ESKD)'
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Appiah, Boateng Edward. "Decision making in end stage kidney disease (ESKD) in Ghana : exploring patient and clinician perspectives." Thesis, University of Nottingham, 2016. http://eprints.nottingham.ac.uk/37965/.
Full textBlackwell, Kara. "The impermanence of reality : a grounded theory study of the experience of transition to palliative care for people with end-stage kidney disease (ESKD)." Thesis, University of Surrey, 2017. http://epubs.surrey.ac.uk/813806/.
Full textGregory, Deborah M. "Patients' perceptions of their experiences with end-stage renal disease (ESRD) and hemodialysis treatment." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0031/MQ47421.pdf.
Full textAlarcón, Parra Carla Patricia, Chachi Jesús Ángel Marcelo, and Salas Gabriela Judy Noa. "Implementación de un centro de hemodiálisis para pacientes con ERCT en el distrito de San Martín de Porres – Lima." Master's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2021. http://hdl.handle.net/10757/657576.
Full textAt the beginning of 2020, 4,300 insured persons were registered with EsSalud diagnosed with Terminal Chronic Kidney Disease (ESRD) in the department of Lima, who have been receiving hemodialysis sessions at the National Renal Health Center (CNSR) and clinics hired for this service, as reported by the aforementioned IAFAS. On the part of those insured to the SIS, the Intangible Solidarity in Health Fund (FISSAL) reported that at the beginning of 2020, 6,268 insured have been receiving hemodialysis in private health centers in Metropolitan Lima and the different regions of the country. This project proposes to provide the outpatient hemodialysis service to patients with Terminal Chronic Kidney Disease affiliated to IAFAS EsSalud, since it has an over-demand for them that require the Hemodialysis service, and which is currently not covered even by its own offer nor by the one subcontracted to other hemodialysis centers. Our strategy is “Cost Leadership”, with a value proposition based on personalized attention with a multidisciplinary team, high quality standards and a patient-centered management model, according to the Terms of Reference (TOR) required by EsSalud. From a financial point of view, the total investment of the project is S /. 447,110.00 presenting a NPV of S /. 2,676,707.15 and an IRR is 86.1%. The main risks of the project are financial and economic, such as lack of liquidity and being hired by IAFAS EsSalud
Trabajo de investigación
Webster, Angela Claire. "Immunosuppression and malignancy in end stage kidney disease." University of Sydney, 2006. http://hdl.handle.net/2123/1186.
Full textIntroduction Kidney transplantation confers both survival and quality of life advantages over dialysis for most people with end-stage kidney disease (ESKD). The mortality rate on dialysis is 10-15% per year, compared with 2-4% per year post-transplantation. Short-term graft survival is related to control of the acute rejection process, requiring on-going immunosuppression. Most current immunosuppressive algorithms include one of the calcineurin inhibitors (CNI: cyclosporin or tacrolimus), an anti-metabolite (azathioprine or mycophenolate) and corticosteroids, with or without antibody induction agents (Ab) given briefly peri-transplantation. Despite this approach, between 15-35% of recipients undergo treatment for an episode of acute rejection (AR) within one year of transplantation. Transplantation is not without risk, and relative mortality rates for kidney recipients after the first post-transplant year remain 4-6 times that of the general population. Longer-term transplant and recipient survival are related to control of chronic allograft nephropathy (rooted in the interplay of AR, non-immunological factors, and the chronic nephrotoxicity of CNI) and limitation of the complications of chronic ESKD and long-term immunosuppression: cardiovascular disease, cancer and infection, which are responsible for 22%, 39% and 21% of deaths respectively. This thesis is presented as published works on the theme of immunosuppression and cancer after kidney transplantation. The work presented in the first chapters of this thesis has striven to identify, evaluate, synthesise and distil the entirety of evidence available of new and established immunosuppressive drug agents through systematic review of randomised trial data, with particular emphasis on quantifying harms of treatment. The final chapters use inception cohort data from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA), which is first validated then used to explore the risk of cancer in more detail than was possible from trial data alone. Interleukin 2 receptor antagonists Interleukin-2 receptor antagonists (IL2Ra, commercially available as basiliximab and daclizumab) are humanised or chimeric IgG monoclonal antibodies to the alpha subunit of the IL2 receptor present only on activated T lymphocytes, and the rationale for their use has been as induction agents peri-transplantation. Introduced in the mid-1990s, IL2Ra use has increased globally, and by 2003 38% of new kidney transplant recipients in the United States and 25% in Australasia received an IL2Ra. This study aimed to systematically identify and synthesise the evidence of effects of IL2Ra as an addition to standard therapy, or as an alternative to other induction agents. We identified 117 reports from 38 randomised trials involving 4893 participants. Where IL2Ra were compared with placebo (17 trials; 2786 patients), graft loss was not different at one (Relative Risk -RR 0.84; 0.64 to 1.10) or 3 years (RR 1.08; 0.71 to1.64). AR was reduced at 6 months (RR 0.66; 0.59 to 0.74) and at 1 year (RR 0.66; 0.59 to 0.74) but cytomegalovirus (CMV) disease (RR 0.82; CI 0.65 to 1.03) and malignancy (RR 0.67; 0.33 to1.36) were not different. Where IL2Ra were compared with other antibody therapy no significant differences in treatment effects were demonstrated, but IL2Ra had significantly fewer side effects. Given a 40% risk of rejection, 7 patients would need treatment with IL2Ra in addition to standard therapy, to prevent 1 patient having rejection, with no definite improvement in graft or patient survival. There was no apparent difference between basiliximab and daclizumab. Tacrolimus versus cyclosporin for primary immunosuppression There are pronounced global differences in CNI use; 63% of new kidney transplant recipients in the USA but only 22% in Australia receive tacrolimus as part of the initial immunosuppressive regimen. The side effects of CNI differ: tacrolimus is associated more with diabetes and neurotoxicity, but less with hypertension and dyslipidaemia than cyclosporin, with uncertainty about equivalence of nephrotoxicity or how these relate to patient and graft survival, or impact on patient compliance and quality of life. This study aimed to systematically review and synthesise the positive and negative effects of tacrolimus and cyclosporin as initial therapy for renal transplant recipients. We identified 123 reports from 30 randomised trials involving 4102 participants. At 6 months graft loss was reduced in tacrolimus-treated recipients (RR 0•56; 0•36 to 0•86), and this effect persisted for 3 years. The relative reduction in graft loss with tacrolimus diminished with higher levels of tacrolimus (P=0.04), but did not vary with cyclosporin formulation (P=0.97) or cyclosporin level (P=0.38). At 1 year, tacrolimus patients suffered less AR (RR 0•69; 0•60 to 0•79), and less steroid-resistant AR (RR 0•49; 0•37 to 0•64), but more insulin-requiring diabetes (RR 1•86; 1•11 to 3•09), tremor, headache, diarrhoea, dyspepsia and vomiting. The relative excess in diabetes increased with higher levels of tacrolimus (P=0.003). Cyclosporin-treated recipients experienced significantly more constipation and cosmetic side-effects. We demonstrated no differences in infection or malignancy. Treating 100 recipients with tacrolimus instead of cyclosporin for the 1st year post-transplantation avoids 12 suffering acute rejection and 2 losing their graft but causes an extra 5 to become insulin dependent diabetics, thus optimal drug choice may vary among patients. Target of rapamycin inhibitors for primary immunosuppression Target of rapamycin inhibitors (TOR-I) are among the newest immunosuppressive agents and have a novel mode of action but uncertain clinical role. Sirolimus is a macrocyclic lactone antibiotic and everolimus is a derivative of sirolimus. Both prevent DNA synthesis resulting in arrest of the cell cycle. Animal models suggested TOR-I would provide synergistic immunosuppression when combined with CNI, but early clinical studies demonstrated synergistic nephrotoxicity. Since then diverse trials have explored strategies that avoid this interaction and investigated other potential benefits. The aim of this study was to systematically identify and synthesise available evidence of sirolimus and everolimus when used in initial immunosuppressive regimens for kidney recipients. We identified 142 reports from 33 randomised trials involving 7114 participants, with TOR-I evaluated in four different primary immunosuppressive algorithms: as replacement for CNI, as replacement for antimetabolites, in combination with CNI at low and high dose, and with variable dose of CNI. When TOR-I replaced CNI (8 trials, 750 participants), there was no difference in AR (RR 1.03; 0.74 to 1.44), but creatinine was lower (WMD -18.31 umol/l; -30.96 to -5.67), and bone marrow more suppressed (leucopoenia RR 2.02; 1.12 to 3.66, thrombocytopenia RR 6.97; 2.97 to 16.36, anaemia RR 1.67; 1.27 to 2.20). When TOR-I replaced antimetabolites (11 trials, 3966 participants), AR and CMV were reduced (RR 0.84; 0.71 to 0.99 and RR 0.49; 0.37 to 0.65) but hypercholesterolaemia was increased (RR 1.65; 1.32 to 2.06). When low was compared to high-dose TOR-I, with equal CNI dose (10 trials, 3175 participants), AR was increased (RR 1.23; 1.06 to 1.43) but GFR higher (WMD 4.27 ml/min; 1.12 to 7.41). When low-dose TOR-I and standard-dose CNI were compared to higher-dose TOR-I and reduced CNI AR was reduced (RR 0.67; 0.52 to 0.88), but GFR also reduced (WMD -9.46 ml/min; -12.16 to -6.76). There was no significant difference in mortality, graft loss or malignancy risk demonstrated for TOR-I in any comparison. Generally surrogate endpoints for graft survival favoured TOR-I (lower risk of acute rejection and higher GFR) and surrogate endpoints for patient outcomes were worsened by TOR-I (bone marrow suppression, lipid disturbance). Long-term hard-endpoint data from methodologically robust randomised trials are still needed. Monoclonal and polyclonal antibody therapy for treating acute rejection Strategies for treating AR include pulsed steroids, an antibody (Ab) preparation, the alteration of background immunosuppression, or combinations of these options. In 2002, in the USA 61.4% of patients with AR received steroids, 20.4% received Ab and 18.2% received both. The Ab available for AR are not new: horse and rabbit derived polyclonal antibodies (ATG and ALG) have been used for 35 years, and a mouse monoclonal antibody (muromonab-CD3) became available in the late 1980s. These preparations remove the functional T-cell population from circulation, producing powerful saturation immunosuppression which is useful for AR but which may be complicated by immediate toxicity and higher rates of infection and malignancy. The aim of this study was to systematically evaluate and synthesise all evidence available to clinicians for treating AR in kidney recipients. We identified 49 reports from 21 randomised trials involving 1394 participants. Outcome measures were inconsistent and incompletely defined across trials. Fourteen trials (965 patients) compared therapies for 1st AR episodes (8 Ab versus steroid, 2 Ab versus another Ab, 4 other comparisons). In treating first rejection, Ab was better than steroid in reversing AR (RR 0.57; CI 0.38 to 0.87) and preventing graft loss (RR 0.74; CI 0.58 to 0.95) but there was no difference in preventing subsequent rejection (RR 0.67; CI 0.43 to 1.04) or death (RR 1.16; CI 0.57 to 2.33) at 1 year. Seven trials (422 patients) investigated Ab treatment of steroid-resistant rejection (4 Ab vs another Ab, 1 different doses Ab, 1 different formulation Ab, 2 other comparisons). There was no benefit of muromonab-CD3 over ATG or ALG in reversing rejection (RR 1.32; CI 0.33 to 5.28), preventing subsequent rejection (RR 0.99; CI 0.61 to 1.59), graft loss (RR 1.80; CI 0.29 to 11.23) or death (RR 0.39; CI 0.09 to 1.65). Given the clinical problem caused by AR, comparable data are sparse, and clinically important differences in outcomes between widely used interventions have not been excluded. Standardised reproducible outcome criteria are needed. Validity of cancer data in an end stage kidney disease registry Registries vary in whether the data they collect are given voluntarily or as a requirement of law, the completeness of population coverage, the breadth of data collected and whether data are assembled directly or indirectly through linkage to other databases. Data quality is crucial but difficult to measure objectively. Formal audit of ANZDATA cancer records has not previously taken place. The aim of this study was to assess agreement of records of incident cancer diagnoses held in ANZDATA (voluntary reporting system) with those reported under statute to the New South Wales (NSW) state Central Cancer Registry (CCR), to explore the strengths and weaknesses of both reporting systems, and to measure the impact of any disagreement on results of cancer analyses. From 1980-2001, 9453 residents received dialysis or transplantation in NSW. Records from ANZDATA registrants were linked to CCR using probabilistic matching and agreement between registries for patients with 1 or more cancers, all cancers and site-specific cancer was estimated using the kappa-statistic (κ). ANZDATA recorded 867 cancers in 779 (8.2%) registrants; CCR 867 cancers in 788 (8.3%), with κ =0.76. ANZDATA had sensitivity 77.3% (CI 74.2 to 80.2), specificity 98.1% (CI 97.7 to 98.3) if CCR records were regarded as the reference standard. Agreement was similar for diagnoses whilst receiving dialysis (κ =0.78) or after transplantation (κ =0.79), but varied by cancer type. Melanoma (κ =0.61) and myeloma (κ =0.47) were less good; lymphoma (κ =0.80), leukaemia (κ =0.86) and breast cancer (κ =0.85) were very good. Artefact accounted for 20.8% non-concordance but error and misclassification did occur in both registries. Cancer risk did not differ in any important way whether estimated using ANZDATA or CCR records. Quality of cancer records in ANZDATA are high, differences largely explicable, and seem unlikely to alter results of analyses. Risk of cancer after kidney transplantation Existing data on the magnitude of excess risk of cancer across different kidney recipient groups are sparse. Quantifying an individual transplant candidate’s cancer risk informs both pre-transplant counselling, treatment decisions and has implications for monitoring, screening and follow-up after transplantation. The aims of this study were firstly to establish the risk of cancer in the post-transplant population compared to that experienced by the general population, and secondly to quantify how excess risk varied within the transplanted population, seeking to establish meaningful absolute risk estimates for post-transplant cancer based on unalterable recipient characteristics known a priori at the time of transplantation. 15,183 residents of Australia and New Zealand had a transplant between 1963 and 2004, and were followed for a median of 7.2 years (130,186 person-years), with 1642 (10.8%) developing cancer. Overall, kidney recipients had 3 times the cancer risk, with risk inversely related to age (Standardised Incidence Ratio of 15 to 30 in children reducing to 2 in people > 65 years). Female recipients aged 25 -29 had rates of cancer (779.2/100,000) equivalent to women aged 55 - 59 from the general population. The risk pattern of lymphoma, colorectal and breast cancer was similar to the overall age trend, melanoma showed less variability across ages and prostate cancer showed no risk increase. Within the transplanted population cancer risk was affected by age differently for each sex (P=0.007), and was elevated for recipients with prior non-skin malignancy (Hazard Ratio: HR 1.40; 1.03 to 1.89), of white race (HR 1.36; 1.12 to 1.89), but reduced for those with diabetic ESKD (HR 0.67; 0.50 to 0.89) Rates of cancer in kidney recipients were similar to non-transplanted people 20 -30 years older, but risk differed across patient groups. Men aged 45 - 54 at transplantation with graft function at 10 years had a risk of cancer that varied from 1 in 13 (non-white, diabetic ESKD, no prior cancer) to 1 in 5 (white, prior cancer, ESKD from other causes).
Webster, Angela C. "Immunosuppression and malignancy in end stage kidney disease." Connect to full text, 2006. http://hdl.handle.net/2123/1186.
Full textTitle from title screen (viewed 21 May 2007). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Public Health, Faculty of Medicine. Includes bibliographical references. Also available in print form.
Metcalfe, Wendy. "End stage renal disease : outcomes and standards of care." Thesis, University of Aberdeen, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.251850.
Full textJassal, Sarbjit Vanita. "Kidney transplantation in elderly patients with end-stage renal disease." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0005/MQ40712.pdf.
Full textNicholas, Pauline. "Impaired cognition in end stage kidney disease: Prevalence, predictors and differences between treatment." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/203098/1/Pauline_Nicholas_Thesis.pdf.
Full textAlashek, Wiam Abdulaziz. "Epidemiology of dialysis-treated end-stage kidney disease in adults in Libya." Thesis, University of Nottingham, 2013. http://eprints.nottingham.ac.uk/28388/.
Full textTynkevich, Elena. "Muscle Wasting in Non-end Stage Chronic Kidney Disease : Determinants and Outcomes." Thesis, Paris 11, 2014. http://www.theses.fr/2014PA11T086.
Full textMainly described in patients on dialysis, muscle wasting has received little attention in early stage chronic kidney disease (CKD). We used 24-hour creatininuria to assess determinants of low muscle mass and its putative associations with CKD outcomes, using data from the NephroTest cohort, including 1429 non-dialysis patients with CKD stages 1 to 5. Kidney function was assessed with both measured (mGFR, by 51Cr-EDTA renal clearance) and estimated glomerular filtration rate (eGFR, by CKD-EPI equation). End-stage renal disease (ESRD) and pre-ESRD death were the main studied outcomes. The mean baseline creatininuria decreased from 15.3±3.1 to 12.1±3.3 mmol/24 h in men and from 9.6±1.9 to 7.6±2.5 in women, when mGFR fell from ≥ 60 to < 15 mL/min/1.73 m2. Other determinants of low creatininuria were an older age, diabetes, a lower body mass index, a lower level of proteinuria or protein intake. A fast annual decline in mGFR of 5 mL/min/1.73 m2 was linked with a 2-fold decrease in creatininuria, independent of changes in protein intake and other determinants of muscle mass. Over a median follow-up of 3.6 years, 229 patients developed ESRD and 113 patients died before ESRD. After adjustment for confounders, patients with low muscle mass showed a significantly higher risk for pre-ESRD death (HR 1.6, 95% CI 0.88-2.9), but a lower risk for ESRD (HR 0.60, 95% CI 0.39-0.91). The latter was reversed (HR 1.5, 95% CI 1.01-2.4) when mGFR was replaced by eGFR. Decrease in 24-hour creatininuria may appear early in CKD patients, is related to pre-ESRD death. The lower risk for ESRD may reflect later dialysis start due to overestimation of true GFR by eGFR in patients with low muscle mass
Guirguis, Ayman. "Studies on depression and fatigue in people with end stage kidney disease receiving haemodialysis." Thesis, University of Hertfordshire, 2017. http://hdl.handle.net/2299/19696.
Full textSood, Manish. "Longitudinal Assessment of Blood Pressure in Late Stage Chronic Kidney Disease." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/36559.
Full textBergsten, Alicia. "Molecular studies of complications in end stage renal disease : focus on expression and variations of candidate susceptibility genes /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-425-2/.
Full textGobener, Janet. "Does structured patient education increase knowledge in end stage renal disease and improve compliance with treatment regimens?" Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2009. https://ro.ecu.edu.au/theses/1875.
Full textKoufaki, Pelagia. "The effects of erythropoietin therapy and exercise rehabilitation on physiological and functional capacity of patients with end stage renal disease." Thesis, Manchester Metropolitan University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.364706.
Full textScaife, Diane. "What is the lived experience of the client with end stage renal disease on hemodialysis?" Connect to Online Resource-OhioLINK, 2006. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=mco1176378463.
Full text"In partial fulfillment of the requirements for the degree of Master of Science in Nursing." Major advisor: Jane C. Evans. Includes abstract. Document formatted into pages: v, 53 p. Title from title page of PDF document. Bibliography: pages 42-43.
Kaiser, Tiffany E. "An Appropriate Assessment of Kidney Function In Patients with End Stage Liver Disease: Role of Cystatin C." University of Cincinnati / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396532967.
Full textReston, Jonathan David. "Self-management, psychological correlates, and clinical outcomes in people on dialysis for end stage renal disease." Thesis, University of Hertfordshire, 2015. http://hdl.handle.net/2299/17108.
Full textPrieto, Roseanne. "Preventing Progression of End Stage Renal Disease: A Systematic Review of Patient-Provider Communication in Primary Care." Diss., The University of Arizona, 2016. http://hdl.handle.net/10150/612943.
Full textO'Brien-Connors, Marguerite A. "Individuals' experiences with end stage renal disease and hemodialysis treatment : implications for quality of life /." Internet access available to MUN users only, 2003. http://collections.mun.ca/u?/theses,157548.
Full textMilazi, Molly. "A bundled phosphate control intervention (4Ds) for adults with end stage kidney disease receiving haemodialysis: A cluster randomised controlled trial." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/198173/2/Molly_Milazi_Thesis.pdf.
Full textCapuano, Ermanno. "Assessment of Coronary Heart disease In Low Likelihood patients with End Stage kidney disease (ACHILLES) : comparison between Coronary Computed Tomography Angiography and Myocardial Perfusion Imaging." Thesis, Queen Mary, University of London, 2017. http://qmro.qmul.ac.uk/xmlui/handle/123456789/25810.
Full textBidii, Dempto Boniface. "An exploration into nephrology nurses' lived experiences of caring for dying patients with end stage kidney disease following withdrawal of dialysis." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31477.
Full textNilsson, Sommar Johan. "Prospective and longitudinal human studies of lead and cadmium exposure and the kidney." Doctoral thesis, Umeå universitet, Yrkes- och miljömedicin, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-67832.
Full textFör att bedöma exponering för kadmium och bly mäts ofta deras koncentrationer i blod eller urin. Dessa studerades i longitudinella data för 48 blyarbetare och 20 individer med normal miljömässig exponering. Blod- och urinprover togs var annan till var tredje månad. Kadmium- och blykoncentrationer mättes sedan i helblod, plasma och urin. Koncentrationer av bly i blod var den biomarkör som hade den största andelen av den totala variationen som kunde förklaras av skillnader mellan individer, och var därför den biomarkör med den bästa förmågan att särskilja på individer med olika medelkoncentration, både för individer med yrkesexponering och normal miljömässig exponering (91 respektive 95% av variansen berodde på vilken individ blodprovet kom ifrån). Justering för urinens utspädning av bly i urin förbättrar oftast urins användbarhet som biomarkör. För bly stämde detta bara hos dem som inte var blyarbetare. Blodkoncentrationer var också den biomarkör med störst andel av den totala variation som kunde förklaras med skillnader mellan individer för kadmium. Kadmium och bly ackumuleras i njure respektive ben och kan ha toxikologiska effekter. Det är välkänt att höga exponeringsnivåer av kadmium orsakar njurskada och även vid lägre exponeringsnivåer har studier funnit samband med markörer för njurfunktion. Exponering för bly påverkar i första hand det centrala nervsystemet. Studier har dock funnit samband mellan koncentrationer av bly i blod och njurens glomerulära filtrationshastighet. Det är oklart både om dessa associationer, vid låga exponeringsnivåer, är viktiga för hälsan och om de verkligen beror på att kadmium och bly orsakar njurskada. För att studera end-stage renal disease användes prospektiva kohorter där personer lämnat blodprov för forskning: Västerbottens interventionsprogram med prover som tagits vid Västerbottens hälsoundersökningar, MONICA-undersökningar i Norr- och Västerbotten, mammografiundersökningarna i Västerbotten och Malmö kost cancer. Sammanlagt ingick över ett hundra tusen individer i dessa kohorter. Med hjälp av det Svenska njurregistret identifierades sedan 118 personer som senare i livet fått end-stage renal disease. Dessa jämfördes med 378 kontroller. För dessa 496 personer tinades blodprovet (närmare bestämt röda blodkroppar) upp och analyserades för kadmium och bly. För att undersöka njurens förmåga till återhämtning studerades tre områden i Kina varav ett tidigare varit kraftigt kadmiumexponerat. Erytrocytkoncentrationer av bly var, utan att ta hänsyn till några andra variabler, associerat med en ökad risk för att utveckla end-stage renal disease (med oddskvoten 1.54 för en interquartile range ökning av erytrocytbly, med ett 95% konfidensintervall 1.18-2.00). Sambanden kvarstod också efter att ha tagit hänsyn till övriga variabler. För erytrocytkadmium var oddskvoten 1.15 med 95% konfidensintervall 0.99-1.34, och sambandet försvagades när hänsyn togs till andra variabler. Associationerna sågs bland män men inte bland kvinnor. Eftersom kadmium vid höga nivåer orsakar njurskada är det också av intresse att studera om påverkan på njuren går över om exponeringen minskas. Totalt följdes 412 individer upp med mätningar av markörer för njurfunktion och kadmiumkoncentrationer i blod och urin. Första undersökningen gjordes 1998, då man just hade slutat äta kadmiumförorenat ris. En andra undersökning gjordes 2006. Andelen individer med avvikande albuminvärde i urin var lägre vid uppföljningen jämfört med vid baslinjen, men ingen minskning sågs för markörer för tubulär förmåga att återta proteiner. Åttioprocent av kadmium i celler är bundet till proteinet metallotheonin, vilket skyddar mot cellskada, men har också en roll i transporten av kadmium från levern till njurarna. En tidigare studie har visat att njurens känslighet för kadmiumexponering var associerad med genetiska skillnader i detta protein. För att studera genetiska associationer studerades de 412 personerna i den kinesiska studien [då också individernas genotyper av metallotheonin-polymorfierna MT1A rs11076161 (G/A), MT2A rs10636 (G/C) och MT2A rs28366003 (A/G) bestämdes]. Genetiken spelade roll för sambandet mellan förmåga att återta proteiner och kadmium men påverkade inte förändring av njurfunktion efter att man slutat äta kadmiumförorenat ris. Kadmium- och blykoncentrationer i blod är de biomarkörer, av koncentrationer i blod, plasma och urin, med den bästa förmågan att skilja på individer med olika medelkoncentrationer. Justering för urinutspädning påverkade andelen av den totala variationen som kunde förklaras av skillnader mellan individer i stor utsträckning för individer med normal miljömässig exponering men inte bland yrkesexponerade, vilket tyder på en skillnad i hur utsöndringen går till. Associationen mellan end-stage renal disease och låg exponering för bly, uppmätta i prospektiva erytrocytprover, ger orsak till oro, men ytterligare studier behövs för att kunna utvärdera om detta är ett kausalt samband. En kadmiumrelaterad skada av den glomerulära filtrationen är reversibel efter en kraftig reducering i exponering, men detta är inte fallet för tubulär skada. De tubulära njureffekterna av kadmiumexponering kan påverkas av metallotheonin-polymorfier.
Byers, Dina Jo. "Predictors of african american women's perceived health status in the context of caring for a relative with end stage renal disease." View the abstract Download the full-text PDF version, 2008. http://etd.utmem.edu/ABSTRACTS/2008-011-Byers-index.html.
Full textTitle from title page screen (viewed on May 16, 2008 ). Research advisor: Mona N. Wicks, PhD. Document formatted into pages (vii, 87 p. : ill.). Vita. Abstract. Includes bibliographical references (p. 63-73).
Atanya, Monica. "The Effects of Acid-Base Parameters, Oxygen and Heparin on the Ability to Detect Changes in the Blood Status of End-Stage Renal Disease Patients Undergoing Hemodialysis Using Whole Blood-Based Optical Spectroscopy." Thèse, Université d'Ottawa / University of Ottawa, 2011. http://hdl.handle.net/10393/19875.
Full textMurtagh, Fliss. "Understanding and improving the quality of end-of life care for patients dying with stage 5 chronic kidney disease managed conservatively, without dialysis." Thesis, King's College London (University of London), 2009. https://kclpure.kcl.ac.uk/portal/en/theses/understanding-and-improving-the-quality-of-endof-life-care-for-patients-dying-with-stage-5-chronic-kidney-disease-managed-conservatively-without-dialysis(1a250e57-8dc4-420d-82f5-52c1f1e10e02).html.
Full textKossuth-Cabrejos, Stefano, Arquímedes M. Gavino-Gutiérrez, and Wilmer Silva-Caso. "Factors associated with the severity of pruritus in patients with terminal chronic kidney disease undergoing hemodialysis in Lima, Peru." Page Press Publications, 2020. http://hdl.handle.net/10757/655593.
Full textRevisión por pares
Preece, Cecelia. "Developing a model of care to improve the health and well-being for Indigenous people receiving renal dialysis treatment." Thesis, Queensland University of Technology, 2010. https://eprints.qut.edu.au/37644/1/Cecelia_Preece_Thesis.pdf.
Full textHoang, Lan Van. "Exploration of social support for people receiving haemodialysis therapy in Vietnam." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/205288/1/Lan%20Van_Hoang_Thesis.pdf.
Full textCornec-Le, Gall Emilie. "Polykystose rénale autosomique dominante : de la génétique moléculaire au développement d'outils pronostiques." Thesis, Brest, 2015. http://www.theses.fr/2015BRES0030.
Full textAutosomal Dominant Polycystic Kidney Disease (ADPKD) is one of the most frequent Mendelian inherited disorders, and affects approximately one individual out of 1000. ADPKD is marked by a high clinical variability, especially regarding age at end-stage renal disease (ESRD). Two genes are identified: PKD1 located on the chromosome 16 (85% of the pedigrees) and PKD2 located on the chromosome 4 (15% of the pedigrees). Substantial progress in understanding the cellular mechanisms underlying ADPKD has triggered the development of targeted therapies, and new questions are arising: which patients should be treated? When should we begin these treatments? Thanks to Genkyst cohort, which aims to include all consenting ADPKD patients from the western part of France, we first described the important allelic variability encountered in ADPKD. Secondly, we demonstrated the important influence of not only the gene involved, but also of PKD1 mutation type. Last, the analysis of clinical and genetic characteristics of 1341 patients from the Genkyst cohort allowed us to develop a prognostic algorithm, named the PROPKD score for predicting renal outcome in ADPKD. Our hope is that these works will participate in the development of individualized medicine in ADPKD, which is crucial in the context of the emerging targeted therapies
Alencar, de Pinho Natalia. "Evaluation des pratiques cliniques dans la maladie rénale chronique – apport des études observationnelles." Thesis, Université Paris-Saclay (ComUE), 2019. http://www.theses.fr/2019SACLS011/document.
Full textChronic kidney disease (CKD) affects about 10% of the adult population and is associated with high risk of end-stage kidney disease (ESKD), cardiovascular complications, and premature death. Guidelines recommend a number of measures for the prevention of CKD progression and complications, but these recommendations are often based on low evidence or expert opinion. In this thesis, we used observational data to assess clinical practices in two key areas of CKD: arteriovenous (AV) access for hemodialysis, and hypertension control in moderate to severe CKD. Using data from the French REIN registry of renal replacement therapy for ESKD, we showed that only 56% of the 53,092 adult incident patients on hemodialysis from 2005 through 2013 had an AV access (either fistulae or grafts) created at hemodialysis initiation as recommended, of which 16% were nonfunctional, requiring catheter use associated with high mortality risk. Conversion into functional AV access was associated with better outcome, but less than two out of three patients starting hemodialysis with a catheter experienced this conversion within 3 years after dialysis start. In the CKD-REIN cohort study, among 1658 patients with moderate to severe CKD, we found less hypertension control and higher systolic blood pressure to be associated with higher sodium intake assessed from spot urine, but not with lower potassium intake. Spot urinary sodium/potassium ratio did not appear to add value than sodium alone for patient monitoring. Finally, using data from the International Network of Chronic Kidney Disease cohorts (iNET-CKD), including 17 cohort studies over 4 continents (N=34,602 patients with an estimated glomerular filtration rate < 60 mL/min/1.73 m2), we highlighted a global poor hypertension control in CKD with regards to recommendations, with large variations across countries (from 27 to 61% blood pressure ≥140/90 mm Hg). These variations are partly explained by patients’ characteristics, and associated with very different antihypertensive treatment profiles. In conclusion, this thesis points out major gaps between guideline recommendations and CKD management in real life, and provide clues for the prevention of AV access-related complications and better hypertension control
Melin, Jan. "Renal Ischemia/Reperfusion Injury in Diabetes : Experimental Studies in the Rat." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2002. http://publications.uu.se/theses/91-554-5264-7/.
Full textBonilha, Martha Ribeiro. "Frequência dos genótipos HLA-A*, -B* e -DRB1* e associação com o risco de Doença Renal Terminal, em pacientes oriundos do Triangulo Mineiro, Brasil." Universidade Federal de Uberlândia, 2008. https://repositorio.ufu.br/handle/123456789/16551.
Full textA insuficiência renal, frequentemente associada com inflamação glomerular crônica e com reações de hipersensibilidade, é importante causa de morbidade e mortalidade. O objetivo deste estudo foi determinar se havia associação entre alelos HLA e doença renal crônica terminal. Foram analisados 87 pacientes com idade média de 51 anos e realizando hemodiálise há, em média, 4,5 anos. Os principais diagnósticos clínicos da insuficiência renal neste grupo foram hipertensão (38%), diabetes (25%) e glomerulopatias (23%). Como controle foram utilizados dados de tipagens de HLA de 17.541 doadores voluntários de medula óssea do registro nacional Brasileiro. A tipagem de HLA foi determinada através de kits SSO (One Lambda, Inc) e citometria de fluxo (tecnologia Luminex). Nossos resultados demonstraram que, quando comparado com a população normal, havia associação significativa de: 1) hipertensão com HLA-A*23 (p=0,014), HLA-A*30 (p<0,001) e HLAB* 41 (p=0,016); 2) diabetes com HLA-A*23 (p=0,004), HLA-A*30 (p=0,033), HLA-B*41 (p=0,023), HLA-B*81 (p=0,020), HLA-DRB1*1 (p=0,030) e HLA-DRB1*3 (p=0,013); 3) glomerulopatias com HLA-A*32 (p<0,001), HLA-B*13 (p<0,001), HLA-B*14 (p=0,004), HLA-DRB1*4 (p=0,030), HLA-DRB1*11 (p=0,008) e HLA-DRB1*15 (p<0,001). Houve associação entre a frequência de alelos e proteção contra doença renal nas seguintes situações: 1) hipertensão com HLA-A*3 e HLA-DRB1*4; 2) diabetes com HLA-DRB1*11; 3) glomerulopatias com HLA-DRB1*1 e HLA-DRB1*13. Conclusão: alelos HLA podem ser importantes marcadores do prognóstico em doença renal crônica.
Doutor em Imunologia e Parasitologia Aplicadas
Bacle, Astrid. "Perturbateurs endocriniens et patients en insuffisance rénale chronique terminale : impact des techniques d'hémodialyse sur l'exposition au Bisphénol A et à ses dérivés chlorés." Thesis, Poitiers, 2017. http://www.theses.fr/2017POIT1406/document.
Full textThe health safety conditions for the practice of hemodialysis (HD) and hemodiafiltration (HDF) do not integrate the risks associated with micropollutants such as endocrine disruptors (ED). Dialysed patients are at risk of overexposure to Bisphenol A (BPA), a well-recognized ED, due to its occurrence in medical devices used during dialysis and to the risk of accumulation due to their renal impairment.In a first step we have confirmed BPA contamination in dialyzers and demonstrated, for the first time, that the water used in HD was a significant source of BPA contamination, via dialysate production. Furthermore, we highlighted the presence of chlorinated derivatives of BPA (ClxBPA), by-products of water chlorination known to have higher oestrogenic activity than BPA, in dialysis water. Then, We have demonstrated that HDF leads to a higher risk of exposure to ED than HD, via the contamination of the liquid of substitution perfused in patient. These results will allow manufacturers to take into account the risk of contamination to these ED as well as physicians and pharmacists involved in patient care.Very few data are available regarding the clinical impact of such exposition on dialysed patient and no study has included the risk arising from ClxBPA. Therefore, we have performed exposure biomarkers using ultra-sensitive analytical methods to determine BPA and ClxBPA concentration in urine and plasma. These biomarkers will allow studying the impact of different dialysis techniques on patient exposure to these ED
Beauger, Davy. "Le retransqol : une échelle de mesure de la qualité de vie spécifique aux patients porteurs d'un greffon rénal fonctionnel. : Développement, adaptation et application." Thesis, Aix-Marseille, 2014. http://www.theses.fr/2014AIXM5057.
Full textThe inclusion of the concept of quality of life (QOL) is indicative of a profound change in the way of practicing medicine, particularly in the field of nephrology for patients with end stage renal disease (ESRD). Given the prevalence, incidence and mortality of this disease in France, it seemed important, even essential, to measure properly, appropriately and consistently, the QOL of patients with ESRD. Health related quality of life (HRQOL) is therefore an important indicator of results to evaluate the consequences of this disease, the effect of medical procedures, treatment effects, or the impact of health policies.In 2007, after a study of literature concerning the assessment of QOL's scales of patients with ESRD, it was revealed a certain lack, quantitative or qualitative, of specific questionnaires for measuring QOL for ESRD patients validated in French, especially for patients with a functioning kidney transplant.In 2008, a specific scale has been developed and validated to measure the QOL of renal transplant recipients: the ReTransQol (Renal Transplant Quality of life questionnaire). After 5 years of use and application of ReTransQol in different national studies, this tool has been improved and a new version was created: the ReTransQol V2 (or RTQ V2). After lots of analysis, this scale has currently good psychometric properties and has been validated in various populations. The RTQ V2 is also used in international studies (Brazil, Germany, Canada ...), and a cross-cultural validation of the scale is planned.The ReTransQol V2 is a specific tool to assess the HRQOL and is suitable for a routine use among renal transplant recipients
Lee, Shu-Pei, and 李書霈. "Risk Factors for Progression of Chronic Kidney Disease to End Stage Renal Disease of Taiwan Pre-ESRD Program in a Medical Center of Neihu District in Taipei." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/9xa6yw.
Full text國防醫學院
公共衛生學研究所
103
Background: Chronic kidney disease (CKD) is a large and growing problem. It is also associated with increased risk of cardiovascular disease and end-stage renal disease (ESRD), which are potentially preventable through early identification and treatment of individuals at risk. Purpose: The aim of this study is to investigate the risk factors of dialysis therapy among patients with CKD stages 1-5, enrolled in Taiwan’s pre-ESRD disease management program. Material and methods: A total of 2310 patients with CKD at stages 1 to 5 were identified from nephrology clinics at the Tri-Service General Hospital from 2006 to 2013. Prognosis records of all patients were extracted from the baseline to ESRD diagnosed.To ensure the progression of CKD, we excluded 60 patients who are hereditary kidney disease. It is a population-based study.The primaryoutcome was progression to chronic dialysis (ESRD). Predictors for this outcome were evaluated using cause-specific Coxproportional hazards models. Results: In our study, the hazard ratios of these characteristics include age, serum creatine, urea nitrogen and diabetes are significant higher between these patients of the cohort. In CKD stage 3, serum albumin, hemoglobin, diabetes and hyperlipidemia are risk factors to dialysis. In CKD stage 4, age, hemoglobin, serum creatine and diabetes are risk factors to dialysis. In CKD stage 5, serum creatine, serum calcium, diabetes and hypertention are risk factors to dialysis. Conclusion: This study identified the risk factors of CKD progressing to ESRD in this program, suggesting that a more effective pre-ESRD disease management program would be more than just a renal program. It is hoped that if implemented widely, the comprehensive protective strategy might not only delay the need for renal dialysis treatment but might actually prevent patients from ever reaching ESRD.
Chang, Mon-Yuang, and 張孟源. "Chronic Kidney Disease Management in Taiwan— Pre-End Stage Renal Disease Program." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/04681417874456846139.
Full text國立臺灣大學
會計與管理決策組
103
Since the launch of the National Health Insurance (NHI) program in Taiwan, the financial issue of healthcare has gained great importance especially under the global budget system. Any treatment plan following evidence-based medicine (EBM) should also base on a reasonable budget. Therefore, in the present work, we evaluate the economical reasonability of National Health Insurance Chronic Kidney Diseases Comprehensive Care System Plan from both microeconomic and macroeconomic perspectives in order to strike a balance between and create a win-win situation. In Chapter 3 and 5, we evaluate the cost-effectiveness of Pre-ESRD patient care and health education programs in delaying the progress of chronic kidney diseases from a macroeconomic perspective using the data from National Health Insurance Research Database. We first review the report of Dr. Shang-Zhi Huang (2014). It was reported that comparing the patients under Pay for Performance (P4P) plan with control group (non-P4P), patients in P4P(Pay for Performance) group had better clinical outcomes including survival rate (p<0.01), delayed onset of dialysis (p<0.01), and higher rate of peritoneal dialysis (p<0.01) but cost significantly more medical resources including outpatient expenditure (p<0.001) and emergency expenditure (p<0.001) after 5-year follow-up. However, in the present work, after calibrating the medical expenditure with survival curve and performing re-evaluation on the reasonability of expenditure items, we showed that the high-cost of P4P plan came from its lower mortality rate and higher rate of dialysis. Furthermore, after subtracting the cost for dialysis, the medical expenditures between 2 groups have no differences (p=0.8084). In Chapter 4, we discussed the care process of a chronic kidney disease patient under the Pre-ESRD patient care and health education programs and performed a cost analysis from the perspective of a primary-care physician. After considering the personnel cost, material cost, equipment depreciation and overhead cost, we showed that a primary-care physician participating the Pre-ESRD program could hardly strike a balance between income and expenditure. Dialysis cost about 35 billion dollars annually in Taiwan, representing 5.8% of annual health insurance global budget, and is an important resource-utilizing disease. The burden of chronic kidney diseases mainly comes from dialysis and the complications of CKD including cardiovascular diseases and diabetes. We recommended that effective management of kidney disease is the only possible way to improve the cost-effectiveness of the comprehensive medical care program for early-stage kidney disease.
FOSTER, DAVID ALAN. "ACUTE RESPIRATORY ILLNESS IN END-STAGE RENAL DISEASE PATIENTS." 1990. http://books.google.com/books?id=oFBYAAAAMAAJ.
Full textChuang, Ya-Wen, and 莊雅雯. "Risk factors associated with end-stage renal disease and fatality in patients with chronic kidney disease." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/75100298135171797219.
Full text中國醫藥大學
公共衛生學系碩士班
101
Background: The prevalence of end-stage renal disease (ESRD) in Taiwan has been the highest in the world for more than a decade since 2001. However, studies on the prognosis of chronic kidney disease (CKD) by stage are limited. This study evaluated the risk factors of ESRD and fatality for patients with stages 3, 4 and 5 of CKD. Methods: A total of 4702 patients with CKD at stages of 3-5 were identified from nephrology clinics at the Taichung Veteran General Hospital from December 6, 2001 to December 31, 2011. Prognosis records of all patients were extracted from the baseline to July 31, 2012, ESRD diagnosed, death or loss to follow-up. We used Cox models to identify risk factors associated with ESRD and deaths by stage and age, and used Kaplan-Meier method to measure the cumulative ESRD incidence and fatality for CKD patients. Results: Our study subjects consisted of 64% of male CKD patients, with 60% of patients over 65 years and 39% having diabetes. The incidence of ESRD in CKD patients at stages 3, 4, 5 were 1.95%, 10.6%, 46.7%, with fatalities of 4.56%, 6.23%, 4.69%, respectively. The elderly were at a lower risk for ESRD, but at higher risk for death, than youngers. Diabetic patients were at higher risks than non-diabetic patients for ESRD and death. Patients with hypertension or hyperlipidemia had a lowered risk for death. Conclusion: The risk of ESRD for patients with CKD increases with advanced stage. But the differences in fatality are not so acute. The elderly CKD patients are less prone to ESRD, but at an elevated risk of death.
Yu, Wan-Ling, and 游婉鈴. "The Trend of Chronic Kidney Disease Turn into End Stage Renal Dialysis:Growth Model Application." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/94746748667900943874.
Full text臺灣大學
醫療機構管理研究所
98
Objective: To explose the effect of time variables, individual features and economis status, and cross level in paients who have Chronic Kidyne Disease (CKD) to become End Stage Renal Dialysis (ESRD). Method: The study design adpated retrospective study analysis. All variables were abtained from National Health Insurance Database.Time variables meant the vaiables'' status were changed with timet hat were including time, time squared, and CCI. Individual variables were including gender, occupation, living area, salary, and the accessing of health care resource. The CKD samples were patients who the disease was confirm with ICD-9-CM code. Growth model of Hierarchical Linear analysis was used in the study, including random coefficient model, and intercept as outcome model. Result: Excluding the missing data, the CKD samples were 5931. Until 2008, 132 of them were become ESRD. In hierarchical linear analysis, discovering time variables were related to ESRD. When controlling time variables, individual variables were related to intercept as outcome model. It showed that living in south area, proverty and unstable work, and low income were related to ESRD. Conculsion: Time variables and individual variables would cause the patient who has CKD to become ESRD.
Chung, Yu-Heng, and 鍾玉衡. "HMG-CoA Reductase Inhibitors and Risk of End Stage Renal Disease in Diabetic Patients with Chronic Kidney Disease." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/97937661027893760430.
Full text國立臺灣大學
預防醫學研究所
98
Abstract Background: Diabetic patients with chronic kidney disease were at high risk of end stage renal disease. Previous studies showed that HMG-CoA reductase inhibitors (statins) could reduce proteinuria in patients with chronic kidney disease and slow the progression of renal function deterioration. In 2010, one population based cohort study in England revealed that statin increased the risk of acute renal failure. Till now, few studies investigate the effect of statin on the progression of chronic kidney disease to end stage renal disease。Therefore, our aim is try to identify whether statins could slow the progression of chronic kidney disease to end stage renal disease in diabetic patients by using big BNHI (Bureau of National Health Insurance) claim database. Materials and Methods: This is a retrospective cohort study using 2000 National Health Insurance diabetes cohort database. We identified 21719 diabetic patients with chronic kidney disease in 2002. Patients who used statin in 2002 were classified as statin user group and those who did not use statin in 2002 were classified as non-user group. The first statin prescription date in 2002 was defined as index date in statin users. We assigned a day which was chosen by the same distribution in statin users group as index date in non-users. Patients who had cancer or AIDS in 2002 were excluded. Patients who used statins or had end stage renal disease before index date were excluded, too. Total 13272 diabetic patients with chronic kidney disease were analyzed in our study. There were 1637 statin users and 11635 patients were non-users. Patients’ comorbidities and medical resource utilization were used to construct propensity score. Statin user group and non-user group are matched by propensity score. After matching for propensity score, there were 1637 statin users and non-users. Cox proportional hazard model was used to discover the hazard ratio of end stage renal disease and all cause mortality between these 2 groups. Sensitivity analysis was done by excluding patients with follow up time less than one year to test the robustness of study result. Result: End stage renal disease outcome analysis: The follow-up person-years in statin users were 3303.4 and the annual incidence rate was 0.058. The follow-up person-years in non-users were 3749.9 and the annual incidence rate was 0.041. The end stage renal disease hazard ratio between these 2 group was 1.36(1.10-1.68). Sensitivity analysis showed that the hazard ratio is 1.34 (1.07-1.68). Mortality outcome analysis: The follow-up person-years in statin users were 3447.9 and the annual incidence rate was 0.037. The follow-up person-years in non-users were 3926.6 and the annual incidence rate was 0.071. The mortality hazard ratio between these 2 group was 0.51(0.41-0.63). Sensitivity analysis showed that the hazard ratio is 0.45 (0.33-0.61). Conclusion: Our study showed that statins decrease the risk of mortality in diabetic patients with chronic kidney disease. On the other hand, the result of increasing risk of end stage renal disease in statin users needed further investigation because of residual immortal time bias.
Chang, Ching-Yi, and 張靜宜. "The Knowledge and Attitude of Living Related Kidney Transplantation among End Stage Renal Disease Patients." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/36629596695112960075.
Full text中臺科技大學
醫療暨健康產業管理系碩士班
101
Chronic kidney disease (CKD) and end-stage renal disease (ESRD) have become major health problems over the world in recent years. According to 2012 USRDS annual report, the prevalence and incidence of ESRD was ranked first and fourth respectively in Taiwan in 2010. Kidney transplantation is the most effective and efficient method for ESRD; however, only few waiting patients could obtain cadaver kidneys. Living related kidneys transplantation became a feasible method because the deficiency of cadaver kidneys and too much expenditure resulting in the argument of distributive justice. In this study, hemodialysis and peritoneal dialysis patients in a medical center located in central Taiwan were selected to explore the knowledge, attitude, and practice of living related kidneys transplantation among hemodialysis and peritoneal dialysis patients and other associated factors. Self-administered structured questionnaire was adopted in this study. Self-administered structured questionnaire contained individual patient characteristics, knowledge, attitude, and willingness to living related kidneys transplantation. All the statistics was analyzed with SPSS 18.0 software package. According to the findings, the part of living related kidney transplant knowledge was scored 75.9 points ( the full score is 100 points), which indicates the subjects lack surgical knowledge and kidney transplants legal knowledge. As for the aspect of attitude, the adequacy of obtaining the information about kidney transplantation from a living relative donor was scored the lowest. The subjects’ anxiety about the donor’s surgical risk and postoperative life is apparently higher than that about the anxiety about their own surgical risk. The subjects with different backgrounds, such as those who perform peritoneal dialysis, with education levels above college, economic independence, isolation, in possession of commercial health insurance, organ donation and transplant-related experience, waiting for donor registration, and without comorbidity in diabetes, heart disease and stroke , showed significant differences. The subjects with education levels above college, single, employment currently and willingness to accept kidney transplantation from a living relative donor scored much higher on the attitude. The female subjects, aged 40-49, who live with their families, with economic dependence, without comorbidity in hypertention, have lung disease and poor eyesight, relatives of those who are willing to donate kidney showed great anxiety. As for the female subjects, raising a child, with economic independence, diagnosed with stones comorbidity disease, and with willingness to accept kidney transplantation from a living relative donor, the result of their questionnaires scored higher as well. The finding indicates that ESRD patients’ knowledge on kidney transplantation from a living relative donor is highly related to their attitude toward it. In addition, their attitude and concerns toward it have great impact on their willingness whether to accept kidney transplantation from a living relative donor. According to the findings in this study, the suggestions are as follows:(1) Government health agencies should set up a dedicated unit to promote organ donation by living relatives, and encourage medical institutions to participate in the promotion. Besides, by legislation, the NHI should waive the copayment of predonation tests and donation surgery to reduce donors’ burdens and worries and enhance donor's social welfare measures and medical protection. Moreover, the authorities should hold more campaigns on the knowledge on kidney transplantation from a living relative donor.(2) Medical staff in dialysis units should constantly take the initiative to provide living relative kidney transplant information for the patients who received dialysis treatment for ESRD patients and their families.(3)Transplant-related health education content of the related knowledge in transplant laws, surgical risk and assessment processes can be more clearly explained and linked with the network resources and websites to major hospitals.
"Patient participation in end-stage renal disease care: a grounded theory approach." 1999. http://library.cuhk.edu.hk/record=b5889986.
Full textThesis (M.Phil.)--Chinese University of Hong Kong, 1999.
Includes bibliographical references (leaves 101-112).
Abstracts in English and Chinese.
Title Page --- p.i
Authorization Page --- p.ii
Signature Page --- p.iii
Acknowledgements --- p.iv
Table of Contents --- p.v-viii
List of Figures --- p.ix
List of Tables --- p.x
List of Append --- p.ix xi
Title Page --- p.xii
Abstract --- p.xiii
Chapter 1 --- Introduction --- p.14-15
Chapter 2 --- Literature Review --- p.16-24
Chapter 2.1 --- Introduction
Chapter 2.2 --- End-stage renal disease
Chapter 2.3 --- Continuous ambulatory peritoneal dialysis
Chapter 2.4 --- Patient participation
Chapter 2.4.1 --- Definition of participation
Chapter 2.4.2 --- Benefits of participation
Chapter 2.4.3 --- Problems of patient participation
Chapter 2.4.4 --- Application of patient participation
Chapter 2.5 --- Conclusion
Chapter 3 --- Methodology --- p.25-43
Chapter 3.1 --- Introduction
Chapter 3.2 --- Overview of grounded theory
Chapter 3.3 --- Procedures
Chapter 3.3.1 --- Data generation
Chapter - --- Sampling
Chapter - --- Data gathering
Chapter - --- Data recording
Chapter 3.3.2 --- Data analysis
Chapter - --- Open coding
Chapter - --- Constant comparative analysis
Chapter - --- Categorization
Chapter - --- Axial coding
Chapter - --- Theoretical sensitivity
Chapter - --- Memoing
Chapter 3.3.3 --- Theory construction
Chapter - --- Core category
Chapter 3.4 --- Method application
Chapter 3.4.1 --- Data collection
Chapter - --- Sampling
Chapter - --- Interview
Chapter - --- Recording
Chapter 3.4.2 --- Data analysis
Chapter - --- Open coding
Chapter - --- Constant comparative analysis
Chapter - --- Categorization and Axial coding
Chapter - --- Theoretical sensitivity
Chapter - --- Memoing
Chapter 3.4.3 --- Theoretical construction
Chapter - --- Concept formation
Chapter - --- Concept development
Chapter 3.5 --- Credibility & Trustworthiness
Chapter 3.6 --- Conclusion
Chapter 4 --- Findings --- p.44-72
Chapter 4.1 --- Introduction
Chapter 4.2 --- Core category: Integrative Restructuring
Chapter 4.3 --- Emotional Labour
Chapter 4.3.1 --- Entering the active zone
Chapter (a) --- Conditions to go into active zone
Chapter (b) --- Outcomes of emotional labour
Chapter (c) --- Strategies used for emotional labour
Chapter - --- Letting go of emotions
Chapter - --- Aligning cognitive consistency
Chapter - --- Maximizing ego
Chapter - --- Locating self
Chapter - --- Boosting power
Chapter i. --- Active control
Chapter ii. --- Building positive expectancies
Chapter iii. --- Covariance to positive expectancies
Chapter 4.3.2 --- Retreating into comfort zone
Chapter (a) --- Contexts of comfort zone
Chapter (b) --- Conditions to build comfort zone
Chapter (c) --- Strategies used within comfort zone
Chapter - --- Defending
Chapter - --- Relinquishing
Chapter - --- Anchoring
Chapter 4.3.3 --- Migrating between the two zones
Chapter (a) --- Conditions to initiate the move
Chapter (b) --- Covariance to the movement
Chapter (c) --- Strategies to make progress
Chapter 4.4 --- Conclusion
Chapter 5 --- Discussion --- p.73-92
Chapter 5.1 --- Introduction
Chapter 5.2 --- Theoretical framework
Chapter 5.3 --- Core category: Integrative Restructuring
Chapter 5.4 --- Variables affecting the move to active zone
Chapter 5.4.1 --- Preparations
Chapter 5.4.2 --- Support
Chapter (a) --- Source of support
Chapter (b) --- Context of support
Chapter (c) --- Effects of support
Chapter (i) --- Effects upon support-seekers
Chapter (ii) --- Supporter's reaction to support-giving relationship
Chapter 5.4.3 --- Commitment
Chapter (a) --- Perception of the situation
Chapter (b) --- Cultural influences
Chapter 5.4.4 --- Control
Chapter 5.5 --- Conclusion
Chapter 6 --- Concluding Chapter --- p.93-100
Chapter 6.1 --- Limitations
Chapter 6.2 --- Implications
Chapter 6.2.1 --- Practice
Chapter 6.2.2 --- Research
Chapter 6.2.3 --- Teaching
Chapter 6.2.4 --- Policy Making
Chapter 6.2.5 --- Summary
Chapter 6.3 --- Future research
Chapter 6.4 --- Reflections upon the study
Chapter 6.5 --- Conclusion
References --- p.101-112
Yap, Stanley. "Partial Nephrectomy for the Treatment of Renal Cell Carcinoma and the Risk of End Stage Renal Disease." Thesis, 2013. http://hdl.handle.net/1807/43344.
Full textSinghal, Rajni. "Prevalence, Predictors, and Outcomes Associated with Late Start of Chronic Kidney Disease Care Amongst Adults with End-stage Renal Disease." Thesis, 2011. http://hdl.handle.net/1807/31446.
Full textChih-JungTsai and 蔡芝蓉. "Proton-Pump Inhibitor Use and the Risk of Progression to End-stage Renal Disease among Chronic Kidney Disease Patients in Taiwan." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/r65smq.
Full textMartins, Pedro de Sousa. "Risk factors for mortality in end-stage kidney disease patients under online-hemadiafiltration: Three-year follow-up study." Master's thesis, 2015. https://repositorio-aberto.up.pt/handle/10216/89643.
Full textMartins, Pedro de Sousa. "Risk factors for mortality in end-stage kidney disease patients under online-hemadiafiltration: Three-year follow-up study." Dissertação, 2015. https://repositorio-aberto.up.pt/handle/10216/89643.
Full text