Dissertations / Theses on the topic 'End stage kidney disease'
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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.
Webster, Angela Claire. "Immunosuppression and malignancy in end stage kidney disease." Thesis, The University of Sydney, 2006. http://hdl.handle.net/2123/1186.
Full textWebster, 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).
O’Lone, Emma. "Cardiovascular disease: priorities and outcomes in end stage kidney disease." Thesis, The University of Sydney, 2020. https://hdl.handle.net/2123/22326.
Full textMetcalfe, 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 textWyld, Melanie Lisa Romola. "Health outcomes and costs in Chronic and End-Stage Kidney Disease." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/20419.
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
Ju, Angela Yeo Ryeong. "Establishing Core Patient-Reported Outcome Measures for Trials in End-Stage Kidney Disease." Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/20414.
Full textGuirguis, 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 textFoote, Celine. "Improving treatment decision-making and survival in elderly patients with end-stage kidney disease." Thesis, The University of Sydney, 2014. http://hdl.handle.net/2123/13688.
Full textSaglimbene, Valeria. "Diet and health outcomes in adults with end stage kidney disease treated with haemodialysis." Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/20172.
Full textLiyanage, Thaminda. "Defining and reducing the burden of kidney disease." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/20027.
Full textShaman, Ahmed M. "Improving outcomes for patients with chronic kidney disease." Thesis, The University of Sydney, 2020. https://hdl.handle.net/2123/22328.
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 textAppiah, 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 textCass, Alan. "Social determinants of end-stage renal disease." Phd thesis, Department of Public Health and Community Medicine, 2002. http://hdl.handle.net/2123/8147.
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 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 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 textZelmer, Jennifer. "The economic burden of end-stage renal disease in Canada: present and future /." *McMaster only, 2005.
Find 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.
Smyth, Brendan Julian. "Randomised trial evidence in the delivery of haemodialysis." Thesis, University of Sydney, 2020. https://hdl.handle.net/2123/23659.
Full textByers, 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 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 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
Lau, Soo-mei Christina. "Improving quality of life of patients with end-stage renal disease : a body-mind-spirit group work approach /." Click to view the E-thesis via HKUTO, 2003. http://sunzi.lib.hku.hk/hkuto/record/B4389527X.
Full textLau, Soo-mei Christina, and 劉淑梅. "Improving quality of life of patients with end-stage renal disease: a body-mind-spirit group work approach." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B4389527X.
Full textPreece, 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 textD'souza, Nicola A. "Self-efficacy in patients undergoing home dialysis: An integrative review." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2023. https://ro.ecu.edu.au/theses/2679.
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 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
Cornec-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
Ferguson, Ryan Edward. "Predictors of end-stage renal disease." Thesis, Boston University, 2012. https://hdl.handle.net/2144/12376.
Full textChronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD) are serious threats to the public health in the United States. Medicare costs related to the treatment of these conditions are projected to reach $54 billion by 2020. Using data from the US Department of Veterans Affairs we conducted three retrospective cohort studies that examined impacts of different exposures on the incidence of CKD and ESRD. In study one, we estimated the effect of race on the rate of ESRD in a population with CKD after accounting for the competing risk of death. After accounting for the competing risks and after controlling for age, diabetes status, and the presence of hypertension, black veterans have a significantly higher rate of ESRD than do white veterans (HR: 2.32; 95% CI: 2.26, 2.39). In study two, we estimated the association between acute kidney injury (AKI) and CKD among patients with normal kidney function that were admitted to the hospital. Patients that experience AKI while hospitalized have 3.23 (95% CI: 1.46, 7.11) times the hazard of CKD than do patients that do not experience an event, after adjusting for age, CHF, diabetes, hypertension, baseline eGFR, and CAD. In study three, we compared the rate of CKD and ESRD in veterans taking an angiotensin receptor blocker (ARB) to the rate in veterans taking an angiotensin converting enzyme inhibitor. After adjusting for baseline glomerular filtration rates (eGFR), age, sex, race, hypertension and diabetes status, those veterans taking an ARB had 0.55 (95% CI: 0.53, 0.57) times the rate of kidney disease than did veterans taking an ACE. Decreased rates were seen in all dose groups and persisted in the high risk subgroups of the population. The results of the current studies highlight segments of the population that may benefit from prevention and intervention efforts and describe the comparative effectiveness of two potential pharmacologic interventions.
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 textCunningham, R. G. C. "Cardiovascular disease in an end stage renal disease population." Thesis, Queen's University Belfast, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.396856.
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