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Analysis of drug dosage adjustments in patients with chronic kidney disease
Procházková, Jana ; Vlček, Jiří (advisor) ; Doseděl, Martin (referee)
Candidate: Jana Procházková1 Supervisor: prof. RNDr. Jiří Vlček, CSc.1 Consultant: PharmDr. Zuzana Očovská1 Title of the master thesis: Analysis of drug dosage adjustments in patients with chronic kidney disease 1 Department Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Several medications excreted by the kidneys or associated with an increased risk for adverse drug events in patient with chronic kidney disease (CKD) require dosage adjustment, cautious use or avoidance. However, a number of studies show that appropriate dosage adjustment is not provided in many cases. Our objective was to analyze appropriateness of drug dosages and contraindicated medications in patients with CKD admitted to the hospital in Hradec Králové via the department of emergency medicine. This study is an observational cross-sectional study and represents a sub-study of the previous study that examined drug-relatedness of unplanned hospital admissions to University Hospital Hradec Králové in 2018. The data were obtained from electronic medical records. The appropriateness of drug use and drug dosages was analyzed in patients with an estimated glomerular filtration rate (eGFR) between 15 and 60 mL/min/1.73 m2 based on comparison with the Summary of Product Characteristics (SmPC). The...
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Health promotion management among patients with chronic kidney disease
PUMPROVÁ, Johanka
Introduction: The bachelor thesis deals with the management of health promotion of patients with chronic kidney disease. It highlights the importance of health promotion for patients with chronic kidney disease. Aim of the work: The aim of this work is to investigate the management of health promotion of patients with chronic kidney disease. Methodology: The research part of the thesis was carried out by quantitative research using two unstructured questionnaires. The first questionnaire was designed for patients with chronic kidney disease attending a dialysis center, it included 30 questions focused on health promotion and 5 questions on demographic data. The second questionnaire developed for nurses working in the dialysis center and consisted of 20 questions, 4 of them were related to demographic data. The first questionnaire was answered by 74 respondents and the second by 32. The data that came out of the questionnaires was processed into graphs and then the research questions were answered. The results: It was found that patients support their health mostly in the areas of diet, drinking and rest. On the other hand, physical activity and participation in educational sessions is a critical area. Education on stress avoidance is the critical place for most nurses. Further, the research revealed that patient's unwillingness to listen is the biggest problem that hinders nurses from imparting health promotion information. There are only few patients who are not supported by their friends and relatives other or general nurses. Conclusion: Health promotion is very important both as a prevention of chronic kidney disease and as an effort to prevent disease progression. Engaging in leisure time physical activities, eating vegetables regularly, being supported by loved ones or finding out new information about their disease are simple actions that are not that demanding and through which the patient can promote their health.
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Adherence to treatment regime of patients with chronic kidney disease
FOUSKOVÁ, Jitka
Introduction: Chronic kidney disease in the progressing stage can significantly affect the quality of the patients' lives. It is estimated that more than 10 % of the worldwide population suffer from this disease. Proper nursing care, lifestyle modification and following proper medical treatment could significantly slow down the progression of disease. The main aim of the bachelor thesis was to find out the level of adherence to the treatment regime of patients with chronic kidney disease. Methodology: Quantitative research was chosen to process the practical part. Results were collected using a standardised questionnaire containing 50 questions to determine the attitude of haemodialysis centre patients towards adherence to dialysis plan, medication, fluid restriction and diet. Collected data was analysed and statistically processed using Microsoft Excel programme. Results: The research sample was made up by 94 respondents. The results show that 58,5 % patients undergoing haemodialysis treatment have an adherent attitude to the treatment. Keeping therapy treatment is influenced by the attitude of nursing staff. For most of the respondents, it is important to follow a treatment regime, so that their health does not deteriorate or because they realise that the condition of their kidneys requires them to follow experts' advice. Conclusion: The results of our thesis highlight the importance of nurses paying attention to patients with chronic kidney disease. Patients with whom nursing staff regularly talk about their treatment follow recommendations more conscientiously. The most frequent problem among patients is misunderstanding treatment and recommendations.
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Specifics of diet in patients with chronic kidney disease
Holakovská, Lucie ; Vachek, Jan (advisor) ; Oulehle, Kateřina (referee)
Approximately 10 % of local population is affected by chronic kidney disease. CKD is not only a major health issue but it does have socio-economic impact on society. Early diagnosis and adequate therapy helps to delay the necessity of dialysis treatment, leads to a better quality of life of patients and can lower the economic costs of the therapy. Adequate therapy and regime intervention may positively influence wide range of risk factors of CKD progression. Patients with CKD have to comply with strict dietary restrictions including reduction of proteins. When starting dialysis, proteins intake increase is necessary, because of amino acids dialysate losses. Registered dietitian (RD) aims to maintain an optimal nutritional status of the patients and to minimize complications of CKD. Patients should be educated about nutrition principles during predialysis and diet changes after initiation of dialysis treatment. This bachelor thesis aims to establish an awareness of the dialyzed patients about nutrition measures. Questionary survey was used in set of 86 patients treated on dialysis in Klatovská nemocnice. Results are presented in the form of graphs. Results of the survey says, only 19 % of patients were educated by RD and 52 % of respondents were not informed at all about the need of increased...
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Contribution of particular vasoactive systems in the development of chronic kidney disease
Drábková, Natálie ; Vaněčková, Ivana (advisor) ; Vaňourková, Zdeňka (referee)
Chronic kidney disease (CKD) is a life-threating disease which arises as a frequent consequence of diabetes and hypertension. Since it is going on silently, CKD often progresses to the end-stage renal disease. It is therefore necessary to combat this disease especially due to the fact that the world population is growing old. The aim of this work was to determine the contribution of selected vasoactive systems contributing to the maintenance of high blood pressure in the developmental and established phase of CKD. Two models of CKD were used: 5/6 nephrectomy in Ren-2 transgenic rats (TGR) and stenosis of renal artery (2K1C) in Wistar rats. We demonstrated that renin-angiotensin system does not play so important role in blood pressure maintenance in both CKD models. By contrast, a more important role has sympathetic nervous system. During both the developmental and established phase of CKD, vasoconstrictor systems prevail above vasodilator NO-synthase effects. In fact, the role of NO-dependent vasodilation gradually decreased in nephrectomized TGR rats, while it was unchanged in Wistar rats with 2K1C hypertension.
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Nutrition in patients with chronic kidney disease
Mokrejšová, Andrea ; Pejšová, Hana (advisor) ; Zakiyanov, Oskar (referee)
Nutritional therapy is very significant for dialysis patients. The basis of the diet in hemodialysis treatment is a sufficient energy intake, increased protein intake, which corresponds to the needs of the dialysis patient. It can be difficult for patients to grasp a change in their diet compared to the period of pre-dialysis treatment, constant monitoring of all dietary restrictions due to insufficient filtration capacity of the kidneys, and at the same time compiling a still varied and balanced diet. For this reason, it is more than desirable for patients to be provided with the possibility of regular nutritional education and consultation. This individual care is essential for improving the quality of the patient's life and adequate support for hemodialysis treatment. This work aims to evaluate the change in the composition of the diet of hemodialysis patients after regular nutritional education. In addition to the adjustment of eating habits, other anthropometric and laboratory parameters related to the nutritional status of dialysis patients were also monitored. Patients were divided into two groups, according to their preferences. The first monitored group recorded their meals by hand or electronically. Patients from the second control group did not record their diet, instead they tried to...
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Oxidative and carbonyl stress in kidney diseases
Kratochvílová, Markéta ; Tesař, Vladimír (advisor) ; Průša, Richard (referee) ; Zadražil, Josef (referee)
Aims: 1. Determination of AGEs (Advanced Glycation End products) in patients with various types of nephropathy. 2. Association AGEs with nutritional parameters and anemia. 3. Influence of renal parameters on sRAGE (soluble form of Receptor for Advanced Glycation End products) levels. 4. Technics and proceeding methods of the podocytes cultivation. 5. Determination of urine podocytes. Methods: We determined fluorescent AGEs by spectrofluorometry, sRAGE by Enzyme-Linked ImmunoSorbent Assay (ELISA). Podocytes were passaged and identified immunocytochemically. Podocytes in urine were specified by flow cytometry method. Results: 1. We did not find significant differences in AGEs serum levels among various types of nephropathy, even though the pathogenesis differs. 2. The albumin and prealbumin levels positively and haemoglobin levels negatively correlate with AGEs in patients with CKD grade 1-5, without necessity of dialysis. 3. Serum sRAGE levels are increased in patients with decreased renal function independently on the course of renal disease. 4. We implemented the methods and technics of podocyte cultivation. 5. Urine podocytes observation and confirmation that podocyturia relates to disease activity. Conclusion: We confirmed that AGEs serum levels depend more on renal function than the type of...
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Novel biomarkers in patients with renal disease
Zakiyanov, Oskar ; Kalousová, Marta (advisor) ; Teplan, Vladimír (referee) ; Průša, Richard (referee)
Chronic kidney disease (CKD) and acute kidney injury (AKI) are major public health problems. It is important to be able to identify those at high risk of adverse outcome, CKD progression and associated cardiovascular disease. The aim of the thesis was to study novel promising biomarkers, their relationship to kidney function, chronic inflammation and/or cardiovascular risk - placental growth factor (PlGF), pregnancy associated plasma protein A (PAPP-A), matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 9 (MMP-9), soluble receptor for advanced glycation end products (sRAGE), calcium binding protein S100A12 or extracellular newly identified RAGE binding protein (EN-RAGE), and high mobility group box protein-1 (HMGB-1) in patients with renal diseases including CKD, haemodialysis (HD), AKI patients, and healthy controls for comparison. First study revealed that PlGF is elevated in patients with decreased renal function. Second study demonstrated the association of MMP-2 and PAPP-A with proteinuria in patients with CKD. Moreover, serum MMP-2, MMP-9 and PAPP-A levels significantly differed in patients with various nephropathies. EN-RAGE levels are not elevated in patients with CKD, but are related to inflammatory status. PAPP-A, EN-RAGE and HMGB-1 levels are significantly elevated, but sRAGE and PlGF...
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Low-protein diet and physical activity in the pre-dialysis period in patients with chronic kidney disease
Pavlínová, Kristýna ; Karbanová, Miroslava (advisor) ; Zakiyanov, Oskar (referee)
Low-protein diet is one of the methods of conservative therapies or medical treatments of chronic kidney disease in predialysis. The goal of the diet is to compensate renal dysfunction together with coverage of nutritional requirement of the patient. The diet is based on reduction or food substitution of nutrients which giving rise to metabolic complications, not on reduction of food amount in general. Dietary measures focus mainly on protein reduction to 0,6-0,8 g/kg/day. Correctly prescribed nutrition should not lead to malnutririon. More further, the diet therapy is focused on reduction of sodium, potassium and phosphorus intake. Calcium intake depends on actual calcaemia of the patient. Amount of fluid intake is prescripted by a doctor, based on diuresis. The aim of nutritional therapy is to keep optimal nutritional status of the patient and minimize complications associated to chronic kidney disease. The task of the dietitan is to educate the patient in a field of prescripted diet principles and potential risks related to protein restriction. Regular physical activity should be a part of conservative therapy in case of predialysis. Regular physical activity helps to keep muscle strength, muscle mass and physical condition of the patient. The main aim of the fieldwork was to discover aspects of...
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Cardiovascular complications in patients with end-stage renal disease.
Valeriánová, Anna ; Malík, Jan (advisor) ; Zemánek, David (referee) ; Piťha, Jan (referee)
Patients with end-stage renal disease frequently suffer from cardiovascular complications. Many factors contribute to their development: hyperkinetic circulation caused by anaemia, fluid retention and by presence of dialysis arteriovenous access; metabolic changes leading to acceleration of atherosclerosis and increase of vascular stiffness and also fluctuation of blood pressure and organ perfusion during haemodialysis, that cause repeated tissue hypoxia. We performed our research on patients in chronic haemodialysis programme. The project studying long-term patency of dialysis access showed that dialysis graft patency is negatively influenced by presence of coronary artery disease and low serum concentrations of cholesterol. In our studies about tissue hypoxia we proved that haemodialysis patients suffer from hypoxia of cerebral tissue and muscle tissue of the dialysis access arm, and that the hypoxia worsens during dialysis. Factors associated with brain hypoxia are presence of heart failure, higher BNP levels and higher erythrocyte distribution width. One of the serious consequences of brain hypoxia is development of cognitive deficit. Among the negative impact of haemodialysis on the heart, we observed left atrial dysfunction, which is a consequence of long-term remodelling and cannot be...
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