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Eligibility and Patient Barriers to Peritoneal Dialysis in Patients With Advanced Chronic Kidney Disease

Thesis Info

Author

Saleem Mohamed Abdulkarim

Department

Internal Medicine (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2019

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728049033

Similar


Introduction: The burden of chronic kidney disease is on the rise in Kenya and is a significant cause of morbidity and mortality. While definitive treatment is renal transplantation, many patients require renal replacement therapy in the form of hemodialysis or peritoneal dialysis. The predominant modality utilized in Kenya is currently hemodialysis despite peritoneal dialysis having similar survival outcomes with the potential benefit of cost-effectiveness. There is need therefore to explore why peritoneal dialysis remains underutilized and whether patient factors may be contributory to barriers that limit the uptake of peritoneal dialysis. Purpose: The main objective of this study is to determine eligibility for peritoneal dialysis of patients considered potential candidates for the modality. In addition, barriers to the same will be determined. Further, the impact of support (family support or paid assistance) on PD eligibility will be determined. Methods: This was a descriptive cross-sectional study where patients who are potentially PD candidates were consecutively recruited. A multidisciplinary team assessed these patients for PD eligibility and this was done using a standardized tool. Contraindications and barriers to the modality were recorded as was the presence or absence of support for the provision of self-care PD. Other demographic and clinical data were also recorded using a standardized questionnaire. The impact of support on peritoneal dialysis eligibility was also determined. Results/Conclusion: In this study on eligibility of patients with advanced CKD for self-care PD we found 68.9% of the patients eligible. Surgery-related abdominal scarring was the most common contraindication. Barriers to self-care PD were identified in 45.9% and physical barriers were more common than cognitive barriers. Presence of support was associated with a significant increase in PD eligibility (P<0.001%).
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خدا بھی اُن کی نظر میں ذرا ضروری نہیں


خدا کی مغفرت ہے عام ، طیبہ کی فضائوں میں
گنہگاروں کا نیک انجام ، طیبہ کی فضائوں میں

یہاں پر رحمتیں ہیں ، برکتیں ، رب کی عطائیں ہیں
سنور جاتے ہیں بگڑے کام ، طیبہ کی فضائوں میں

مقامِ گُل کا ہو ادراک کیا گلزارِ طیبہ میں
لگا ہے خار کا بھی دام ، طیبہ کی فضائوں میں

میں اپنی زندگی کی صبحِ نو قربان کر ڈالوں
اگر ہو جائے میری شام ، طیبہ کی فضائوں میں

در و دیوارِ مکّہ سے درودوں کی صدا آئے
خدا کا گونجتا ہے نام ، طیبہ کی فضائوں میں

غم و آلامِ دنیا ہے نہ عُقبیٰ کی پریشانی
دلِ عرفانؔ کو آرام ، طیبہ کی فضائوں میں

شاگرد کے خلاف تادیبی کاروائی کا دائرہ کار سنت نبوی اور فقہ اسلامی کی روشنی میں ایک تحقیقی جائزہ

Education is the development of the different aspects of human being like psychological, social and physical development etc. It is not only the provision of information but it is for the sake of guidance of students to make them beneficial human beings. A teacher inculcates good habits in students and tries to reduce or terminate bad habits in them. Therefore, the responsibility of teacher is to guide the students about good and bad along with improving their academics. But while doing so, the teacher should avoid the ways which can be harmful for the students. Therefore he (the teacher) should know how to guide the students and stop them from wrong doings. At what time what technique, he should adopt that can give benefits to students? He should be aware of the student’s psychology, their age and their abilities. Sometimes punishment is very much necessary for students to make them realize not to commit anything like this again. At this critical moment what can help the student and teacher? The Holy Prophet Muhammad (SAW), being a perfect teacher guided the Umma in this aspect. He used many skills as a teacher and taught his followers, how to guide their children and pupils. Many times the prophets would use to advise his followers on anywrong doing and that is why none of the followers repeated the same mistake. It is very important to follow the teachings of the Holy Prophet in aspect. This research paper discusses the way of handling the students in different situations.

Designing and Construction of Efficient Trickling Biofilter Systems for Wastewater Treatment

Attached growth processes for wastewater treatment have been significantly improved during recent years. Their application can be extended to sustainable municipal wastewater treatment in remote locations and in developing countries for the purpose of organic matter (BOD) removal and pathogenic decontamination. The formation of specific biofilm on support media is the essential part of attached growth processes, having peculiar mechanisms of pollutants removal. The present research work aimed to monitor the successive biofilm development and its physiological activities on polystyrene, tyre derived rubber, polypropylene and stone media, under aerobic and anaerobic conditions. These filter media were artificially colonized with biofilm by incubating it with activated sludge at 30°C±2 for nine weeks. Biofilm formation was monitored by gravimetric weight analysis, spectrophometric absorbance technique, heterotrophic plate count and scanning electron microscopy. The wet weight of polystyrene media biofilm was significantly increased from 1st till 9th week of incubation (0.56 to 1.59 g under aerobic condition). While, in case of other tested media weight of the biofilms increased till 7th week during succession and then started reduction. Relatively less growth was recorded under anaerobic condition as compared to aerobic conditions. Selected pathogenic indicators (Escherichia coli, Salmonella typhimurium, Shigella dysenteriae, Pseudomonas aeruginosa) monitored by HPC/mL considerably declined (90-99%) in the biofilms of all the media under both conditions, signifying microbial reallocation from pathogenic to beneficial microbial community. The MPN index of fecal coliforms and E. coli in the sludge also showed considerable reduction. Correspondingly the decreasing levels of COD and BOD5 (69.9─74.9%) showed signs of sludge digestion by biofilms on selected media types under both the environments. Further, changes in pH and nutrients (nitrites, nitrates, phosphates and sulphates) indicated the other key-organisms with efficient nutrient consuming capabilities in the biofilms. The surface analysis of media by SEM revealed emergence of profound bacterial growth on all media and emergence of cracks on tyre derived rubber media surface and slight deformation was further confirmed by FTIR. Further the microbial community composition in the biofilms of different packing materials was investigated using high-throughput pyrosequencing technology. Sequences of 16S rRNA gene fragments were recovered from biofilm samples of 12 laboratory scale reactors operated at different temperatures i.e., 10, 20 and 30°C for two weeks. Analysis of pyrosequencing and water physico-chemical data showed that substrate type (media vs. biofilm) and temperature conditions influence bacterial community structure and composition in experimental reactors. Greater bacterial diversity was observed in each sample (3142 operational taxonomic units), primarily due to the large number (22029) of sequences available for analysis and the identification of rare species.The number of classified sequences per sample ranged from 1016 to 2919.The results showed that there were 12 phyla and the relative abundance of phylum Proteobacteria was highest (54.06%) followed by Bacteroidetes (28.97%), Firmicutes (5.30%), Actinobacteria (3.88%) etc. in all the samples. The data set illustrated 23 genera of bacterial populations to be commonly shared by all samples, including, Rheinheimera, Rhodococcus, Aquabacterium, Trichococcus, Acidovorax, Flavobacterium, Roseateles, Aeromonas, Sediminibacterium, Hydrogenophaga, Aquimonas, etc., indicating core microbial community in the microbial populations of reactors. In the next step, study was carried out to assess selected packing media for locally designed and lab scale trickling biofilters systems and to develop a simplified model for describing the capacity of BOD removal in trickling biofilter systems. Trickling biofilters with four different media were investigated at two temperature ranges of 5-15°C and 25-35°C. The average removal of both COD and BOD5 was higher than 80% and 90% at temperature ranges of 5-15 and 25-35°C respectively. The geometric mean of fecal coliforms reduction was achieved up to4.0 log10 with polypropylene media at low temperature range of 5-15°C. While at higher temperatures range of 25-35°C reduction up to 3.97 log10 was observed with polystyrene media. A simplified model was developed and used to estimate the optimal BOD loading rates (Bvd) for designing robust trickling biofilter systems, with appropriate filter media which can be capable of treating organic loading rates of higher than 3kg BOD/m3.day. Finally, a simple, robust and a low-cost pilot scale stone media trickling biofilter system for municipal wastewater treatment was establishment at Quaid-i-Azam University, campus. The wastewater treatment efficiency of this locally designed prototype pilot scale stone media trickling biofilter was tested at 20-40.5°C for the removal of different pollution indicators (COD, BOD5, NH4-N, and pathogens). Simultaneously, the biofilms were sampled from the top and deeper layers of stone bed of the reactor for characterization. The Nitrosonoma sp. and Nitrobacter sp. were identified in the deeper layers while, 13 bacterial strains viz., Escherichia coli, Salmonella typhimurium, Shigella dysenteriae, Pseudomonas aeruginosa, Enterobacter aerogenes, Proteus vulgaris, Klebsiella pneumonia, Bacillus subtilis, Staphylococcus aureus, Micrococcus luteus, Staphylococcus epidermitus, Streptococcus lactis and Corynebacterium xerosis were identified in the top layer of the stone media bed. The results signify the COD and BOD elimination efficiency from wastewater considerably increased with passage of time from Day 1 to day 40 of operation (62.4- 98.1%; COD and 56.4 - 98.6% BOD) at flow rate of 1.2 L/min and average BOD5 loading rate of 0.063 kg BOD/m3.day.The average NH4-N levels of the influent were low (0.0024 kg NH4-N/m3.day). However, the result indicated an excellent correlation of the average consumption of 7.55 mg/L of alkalinity per mg of NH4-N removal during 40 days of reactor operation. Moreover, a significant connection between nitrification efficiency and decrease in the average pH range (7.52 to 6.62) was observed, indicating the process of nitrification. The removal of pathogenic indicators from wastewater was evaluated and an average reduction of 88.8% in the MPN index of fecal coliforms in the effluent was recorded. Overall, a significant correlation of COD, BOD5, NH4 ̄N, and pathogenic indicators removal efficiency were noticed with increase in seasonal temperature from 20 to 40.5°C.The overall results proved that pilot scale trickling biofilter has a great potential to be transferred to field scale for treating sewage for small communities in developing countries even at low temperature conditions. It will not only help to improve the public health in terms of removal of wastes and pathogens from wastewater but also treated water could be used for agriculture purposes without any hesitation.