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BACKGROUND: A new Chronic Kidney Disease Epidemiology Collaboration equation without the race variable has been recently proposed (CKD-EPIAS). This equation has neither been validated outside USA nor compared with the new European Kidney Function Consortium (EKFC) and Lund-Malmö Revised (LMREV) equations, developed in European cohorts. METHODS: Standardized creatinine and measured glomerular filtration rate (GFR) from the European EKFC cohorts (n = 13 856 including 6031 individuals in the external validation cohort), from France (n = 4429, including 964 Black Europeans), from Brazil (n = 100) and from Africa (n = 508) were used to test the performances of the equations. A matched analysis between White Europeans and Black Africans or Black Europeans was performed. RESULTS: In White Europeans (n = 9496), both the EKFC and LMREV equations outperformed CKD-EPIAS (bias of -0.6 and -3.2, respectively versus 5.0 mL/min/1.73 m², and accuracy within 30% of 86.9 and 87.4, respectively, versus 80.9%). In Black Europeans and Black Africans, the best performance was observed with the EKFC equation using a specific Q-value (= concentration of serum creatinine in healthy males and females). These results were confirmed in matched analyses, which showed that serum creatinine concentrations were different in White Europeans, Black Europeans and Black Africans for the same measured GFR, age, sex and body mass index. Creatinine differences were more relevant in males. CONCLUSION: In a European and African cohort, the performances of CKD-EPIAS remain suboptimal. The EKFC equation, using usual or dedicated population-specific Q-values, presents the best performance in the whole age range in the European and African populations included in this study.
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Insuficiencia Renal Crónica , Femenino , Humanos , Masculino , África , Brasil , Creatinina , Europa (Continente) , Tasa de Filtración Glomerular , Insuficiencia Renal Crónica/epidemiología , Población Blanca , Población NegraRESUMEN
Abstract Introduction: The guidelines recommend estimating the glomerular filtration rate using serum creatinine-based equations as a predictor of kidney disease, preferably adjusted for local population groups. Methods: Cross-sectional study that evaluated the performance of four equations used for estimating GFR compared to endogenous creatinine clearance (ClCr) in 1,281 participants. Modification of Diet equations in Renal Disease Study Group (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), CKD-EPI with adjustment for local population (CKD-EPI local) and Full Age Spectrum (FAS) in comparison with endogenous creatinine clearance (ClCr). We used the Quantile Regression to calculate the median bias, interquartile range (IQR), Bland-Altman agreement analysis and 30% margin of error (P30). Results: The mean age of participants was 52.5 ± 16.5 years with 466 women (38%), median ClCr[IQR] of 92.0 [58.0; 122.0] mL/min/1.73 m2, with 320 (25%) participants presenting ClCr < 60 mL/min/1.73 m2. The performance of the local CKD-EPI and FAS equations were superior to MDRD and CKD-EPI in relation to variability (0.92 [0.89; 0.94]) and P30 (90.5% [88.7; 92, 0]). In the group with ClCr < 60 mL/min/1.73 m2, the local CKD-EPI and FAS equations showed less variability than the CKD-EPI and MDRD (0.90 [0.86; 0.98] and 1.05 [0.97; 1.09] vs. 0.63 [0.61; 0.68] and 0.65 [0.62; 0.70], P < 0.01) and best P30 (85.5) % [81.0; 90.0], 88.0% [84.0; 92.0] vs. 52.0% (46.0; 58.0) and 53.0% [47.0; 58 .5], P < 0.01). Conclusion: Local CKD-EPI and FAS equations performed better than CKD-EPI and MDRD when compared to ClCr.
Resumo Introdução: As diretrizes recomendam a estimativa da taxa de filtração glomerular pelo uso de equações baseadas em creatinina sérica como preditor de doença renal, preferencialmente ajustadas para grupos populacionais locais. Métodos: Estudo transversal que avaliou o desempenho de quatro equações para estimativa da TFG em comparação com a depuração de creatinina endógena (DCE) em 1.281 participantes. Foram avaliadas as equações Modification of Diet in Renal Disease Study Group (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), CKD-EPI com ajuste para a população local (CKD-EPI local) e Full Age Spectrum (FAS) em comparação com a depuração de creatinina endógena (DCE). Utilizamos a Regressão Quantílica para cálculo do viés mediano, intervalo interquartil (IQR), análise de concordância de Bland-Altman e margem de erro de 30% (P30). Resultados: A idade média dos participantes era de 52,5 ± 16,5 anos com 466 mulheres (38%), mediana da DCE [IQR] de 92,0 [58,0; 122,0] mL/min/1,73 m2, com 320 (25%) participantes apresentando DCE < 60 mL/min/1,73 m2. A performance das equações CKD-EPI local e FAS foram superiores às MDRD e CKD-EPI em relação à variabilidade (0,92 [0,89; 0,94]) e P30 (90,5% [88,7; 92,0]). No grupo com DCE < 60 mL/min/1,73 m2, as equações CKD-EPI local e FAS apresentaram menor variabilidade que as CKD-EPI e MDRD (0,90 [0,86; 0,98] e 1,05 [0,97; 1,09] vs. 0,63 [0,61; 0,68] e 0,65 [0,62; 0,70], P < 0,01) e melhores P30 (85,5% [81,0; 90,0], 88,0% [84,0; 92,0] vs. 52,0% (46,0; 58,0) e 53,0% [47,0; 58,5], P < 0,01). Conclusão: As equações CKD-EPI local e FAS tiveram desempenho superior às CKD-EPI e MDRD, quando comparadas a DCE.
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INTRODUCTION: The guidelines recommend estimating the glomerular filtration rate using serum creatinine-based equations as a predictor of kidney disease, preferably adjusted for local population groups. METHODS: Cross-sectional study that evaluated the performance of four equations used for estimating GFR compared to endogenous creatinine clearance (ClCr) in 1,281 participants. Modification of Diet equations in Renal Disease Study Group (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), CKD-EPI with adjustment for local population (CKD-EPI local) and Full Age Spectrum (FAS) in comparison with endogenous creatinine clearance (ClCr). We used the Quantile Regression to calculate the median bias, interquartile range (IQR), Bland-Altman agreement analysis and 30% margin of error (P30). RESULTS: The mean age of participants was 52.5 ± 16.5 years with 466 women (38%), median ClCr[IQR] of 92.0 [58.0; 122.0] mL/min/1.73 m2, with 320 (25%) participants presenting ClCr < 60 mL/min/1.73 m2. The performance of the local CKD-EPI and FAS equations were superior to MDRD and CKD-EPI in relation to variability (0.92 [0.89; 0.94]) and P30 (90.5% [88.7; 92, 0]). In the group with ClCr < 60 mL/min/1.73 m2, the local CKD-EPI and FAS equations showed less variability than the CKD-EPI and MDRD (0.90 [0.86; 0.98] and 1.05 [0.97; 1.09] vs. 0.63 [0.61; 0.68] and 0.65 [0.62; 0.70], P < 0.01) and best P30 (85.5) % [81.0; 90.0], 88.0% [84.0; 92.0] vs. 52.0% (46.0; 58.0) and 53.0% [47.0; 58 .5], P < 0.01). CONCLUSION: Local CKD-EPI and FAS equations performed better than CKD-EPI and MDRD when compared to ClCr.
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Insuficiencia Renal Crónica , Adulto , Anciano , Creatinina , Estudios Transversales , Femenino , Tasa de Filtración Glomerular , Humanos , Persona de Mediana EdadRESUMEN
OBJECTIVES: We aimed to gather and update the evidence on the impact of exercise on late-life depression. METHOD: We conducted an umbrella review of meta-analyses of randomized controlled trials (RCTs) that assessed the effects of an exercise intervention for depression in older adults (e.g. 60+). Searches were conducted in Scopus, Web of Science, Embase, PubMed, BIREME, LILACS, SciELO, Cochrane Library for Systematic Reviews, and Opengray.eu. Methodological quality was assessed using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR 2). Data analysis was performed with RStudio (version 4.0.2) and the generic inverse-variance method was used to pool the effect sizes from the included studies. RESULTS: Twelve meta-analyses of 97 RCTs were included. The AMSTAR 2 rating was considered critically low in five studies, low in six studies, and high in one study. The effect size expressed by the standardized mean difference (SMD) varied between studies from -0.90 (95% CI = -1.51; -0.28) to -0.14 (95% CI = -0.36; 0.07) in favor of the exercise intervention. Pooling of the effect sizes produced a statistically significant moderate effect in which exercise was associated with lower levels of depression and depressive symptoms (OR = 2.24, 95% CI 1.77; 2.84). CONCLUSION: Our findings suggest that exercise produces a moderate improvement in depression and depressive symptoms in older patients. We recommend providing physical activity for older adults. KEY-POINTS: We investigated the effects of exercise interventions for depression in older adults.Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2021.1951660.
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Depresión , Terapia por Ejercicio , Anciano , Depresión/terapia , Terapia por Ejercicio/métodos , Humanos , Metaanálisis como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Revisiones Sistemáticas como AsuntoRESUMEN
Objetivos: Verificar a associação da distância da habitação em relação a sítios de reciclagem sobre habilidades cognitivas em escolares. Métodos: Estudo transversal, no qual aplicou-se a escala Wechsler Abreviada de Inteligência em 100 escolares de 6 a 14 anos. As crianças foram divididas em um grupo de estudo (expostos), cujas residências estavam situadas a menos de 100 metros de sítios de reciclagem, em um bairro da cidade de Caxias do Sul. Houve um grupo controle, cujas residências estavam a mais de 150 metros de algum sítio de reciclagem, no mesmo bairro ou adjacências. Resultados: A habitação próxima a sítios de reciclagem aumentou a chance de apresentar quociente de inteligência baixo nos escolares na análise univariada (OR 2,19; IC95% 1,213,95). No quociente de inteligência total, o escore obtido foi de 84 no grupo exposto e 95 no grupo controle (p≤0,01). Quando ajustadas para outras variáveis potencialmente prejudiciais, a escolaridade materna elevada mostrou-se um fator atenuador do impacto da distância (OR 0,28; IC95% 0,110,72). A diferença encontrada entre os escores de quociente de inteligência verbal foi de 14 pontos (p<0,01); no quociente de inteligência de execução a diferença foi de 4 pontos (p=0,04). Conclusões: A distância entre a habitação e os sítios de reciclagem de resíduos pode reduzir habilidades cognitivas em escolares, mas esse efeito parece ser atenuado pela escolaridade materna. Essa associação reforça as preocupações sobre o impacto do manejo inadequado de resíduos urbanos, podendo vir a subsidiar a criação de políticas públicas que visem diminuir exposições ambientais potencialmente danosas.
Aims: We verified the association of housing distance in relation to recycling sites on schoolchildren's cognitive abilities. Methods: This is a cross-sectional study, in which the Wechsler Abbreviated Scale of Intelligence was applied to 100 schoolchildren aged 6 to 14 years. Children were divided into a study group (exposed), whose households were located less than 100 meters from recycling sites in a neighborhood in the city of Caxias do Sul, and a control group, whose homes were located more than 150 meters from a recycling site in the same neighborhood or nearby. Results: Residences located more than 150 meters away from a recycling site can reduce the chance of low intelligence quotient in schoolchildren in the univariate analysis (OR 2.19; 95% CI 1.21-3.95). The full-scale intelligence quotient score was 84 in the exposed group and 95 in the control group (p≤0.01). When adjusted for other potentially harmful variables, higher maternal education was a mitigating factor of distance impact (OR 0.28, 95% CI 0.11-0.72). The difference found among verbal intelligence quotient scores was 14 points (p<0.01); in the performance intelligence quotient, the difference was 4 points (p=0.04). Conclusions: Living close to waste recycling sites can reduces cognitive abilities in schoolchildren, and this effect seems to be attenuated by maternal education. This association reinforces concerns about the impact of inadequate urban waste management, and may subsidize the creation of public policies that aim to reduce potentially harmful environmental exposures.
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Humanos , Niño , Adolescente , Disfunción Cognitiva , Residuos Sólidos , Crecimiento y Desarrollo , Reciclaje , Pruebas de InteligenciaRESUMEN
Abstract Objective: To evaluate the association between living near waste recycling sites and emotional or behavioral difficulties in schoolchildren. Methodology: A cross-sectional study with schoolchildren aged 6-13 years old from disadvantaged communities in a Brazilian city, divided between those who live less than 100 m away from the central point of the recycling site and those that live more than 150 m away from the site, as a control group and classified through georeferencing. The emotional and behavioral difficulties were investigated using the Strengths and Difficulties Questionnaire tool. Other variables were analyzed through logistic regression to determine their contribution to the outcomes. Results: Children living near waste recycling sites had a higher prevalence of emotional and behavioral problems than children living farther away. In the logistic regression model, no other covariates had a significant impact on the results, except for attending preschool. As expected, the families of the exposed group had lower income and lower levels of schooling, thus being characterized as a highly vulnerable population. Conclusion: The association between living near waste recycling sites and lower test performance raises concerns about the impact of inappropriate waste management in urban centers on children's health.
Resumo Objetivo: Avaliar a associação entre habitar próximo a sítios de reciclagem e dificuldades emocionais ou comportamentais em escolares. Metodologia: Estudo transversal com escolares de 6 a 13 anos de comunidades desfavorecidas em uma cidade do Brasil, divididas entre aquelas que tem sua residência situada a menos de 100 metros de distância do ponto central do sítio de reciclagem e aquelas que habitam a mais de 150 metros, como grupo controle e classificadas através de georeferenciamento. As dificuldades emocionais e comportamentais foram investigadas através do instrumento Questionário de Capacidades e Dificuldades. Outras variáveis foram analisadas através de regressão logística para determinar sua contribuição para os desfechos. Resultados: Crianças que vivem próximas a locais de reciclagem de resíduos tiveram maior prevalência de problemas emocionais e comportamentais do que as crianças que vivem mais afastadas. No modelo de regressão logística, nenhuma outra covariável apresentou impacto significativo sobre os resultados, à exceção de haver frequentado pré-escola. Como esperado, as famílias do grupo exposto apresentaram menor renda e menores níveis de escolaridade, caracterizando-se como uma população altamente vulnerável. Conclusão: A associação entre a habitação próxima a locais de reciclagem e um menor desempenho nos testes levanta preocupações sobre o impacto do manejo inadequado de resíduos nos centros urbanos sobre a saúde das crianças.
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Humanos , Niño , Adolescente , Emociones , Problema de Conducta , Brasil , Salud Infantil , Estudios TransversalesRESUMEN
Platelet-rich plasma is derived from centrifuging whole blood. There is increasing interest in the sports medicine and athlete community about providing endogenous growth factors directly to the injury site, using autologous blood products such as platelet-rich plasma. The aim of the present study is to evaluate the association between research financing, conflict of interests, level of evidence and author affiliation with the interpretation of results in articles published on platelet-rich plasma therapy in musculoskeletal ailments. A review of the current literature was performed. The outcome was classified as favorable or unfavorable. The declaration of conflict of interests and the type of funding was extracted from each article. The financing was classified as industry-sponsored; not industry-sponsored; or unidentifiable. The level of evidence was categorized from I to IV. Higher positive outcomes were observed in 134 studies with industry sponsorship compared with not industry-sponsored studies (odds ratio [OR]: 0.26; 95% confidence interval [95%CI]: 0.08-0.85; p < 0.05). Compared with level of evidence I, levels II and IV increase the probability of positive outcomes by 12.42 times ( p < 0.01) and 10.97 times ( p < 0.01) respectively. Proportionally, industry-sponsored studies are more likely to present positive results, as well as articles with a lower quality of evidence.
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Abstract Platelet-rich plasma is derived from centrifuging whole blood. There is increasing interest in the sports medicine and athlete community about providing endogenous growth factors directly to the injury site, using autologous blood products such as platelet-rich plasma. The aim of the present study is to evaluate the association between research financing, conflict of interests, level of evidence and author affiliation with the interpretation of results in articles published on platelet-rich plasma therapy in musculoskeletal ailments. A review of the current literature was performed. The outcome was classified as favorable or unfavorable. The declaration of conflict of interests and the type of funding was extracted from each article. The financing was classified as industry-sponsored; not industry-sponsored; or unidentifiable. The level of evidence was categorized from I to IV. Higher positive outcomes were observed in 134 studies with industry sponsorship compared with not industry-sponsored studies (odds ratio [OR]: 0.26; 95% confidence interval [95%CI]: 0.08-0.85; p < 0.05). Compared with level of evidence I, levels II and IV increase the probability of positive outcomes by 12.42 times (p < 0.01) and 10.97 times (p < 0.01) respectively. Proportionally, industry-sponsored studies are more likely to present positive results, as well as articles with a lower quality of evidence.
Resumo O plasma rico em plaquetas é derivado da centrifugação do sangue total. Há um interesse crescente, na medicina esportiva e na comunidade atlética, no fornecimento de fatores de crescimento endógeno diretamente ao sítio da lesão, usando componentes sanguíneos autólogos, como o plasma rico em plaquetas. O objetivo deste estudo é avaliar a associação entre financiamento de pesquisa, conflito de interesses, nível de evidência e afiliação dos autores com a interpretação dos resultados em publicações sobre terapia com plasma rico em plaquetas nas doenças osteomusculares. Foi realizada uma revisão da literatura atual. O desfecho foi classificado como favorável ou desfavorável. A declaração de conflito de interesses e o tipo de financiamento foram extraídos de cada artigo. O financiamento foi qualificado em patrocínio industrial; não patrocinado pela indústria; ou não identificável. O nível de evidência foi categorizado de I a IV. Foram obtidos os resultados positivos mais altos com 134 estudos financiados pelo setor industrial, em comparação com estudos não financiados pela indústria (razão de probabilidades [RP]: 0,26; intervalo de confiança de 95% [95%IC]: 0,08-0,85; p < 0,05). Em comparação com o nível de evidência I, os níveis II e IV aumentam a probabilidade de resultado positivo em 12,42 vezes (p < 0,01) e 10,97 vezes (p < 0,01), respectivamente. Demonstrou-se que, proporcionalmente, estudos patrocinados pela indústria têm maior probabilidade de apresentar resultados positivos, bem como artigos com menor qualidade de evidência.
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Plasma , Medicina Deportiva , Plaquetas , Financiación del Capital , Conflicto de Intereses , Enfermedades Musculoesqueléticas , Péptidos y Proteínas de Señalización Intercelular , Ética , Plasma Rico en Plaquetas , IndustriasRESUMEN
BACKGROUND: Estimating glomerular filtration rate (GFR) is important for clinical management in kidney transplantation recipients (KTR). However, very few studies have evaluated the performance of the new GFR estimating equations (Lund-Malmö Revised-LMR, and Full Age Spectrum-FAS) in KTR. METHODS: GFR was estimated (eGFR) using CKD-EPI, MDRD, LMR, and FAS equations and compared to GFR measurement (mGFR) by reference methods (inuline urinary and iohexol plasma clearance) in 395 deceased-donor KTR without corticosteroids. The equations performance was assessed using bias (mean difference of eGFR and mGFR), precision (standard deviation of the difference), accuracy (concordance correlation coefficient-CCC), and agreements (total deviation index-TDI). The area under receiver operating characteristic curves (ROC) and the likelihood ratio for a positive result were calculated. RESULTS: In the total population, the performance of the CKD-EPI, MDRD and FAS equations was significantly lower than the LMR equation regarding the mean [95%CI] difference in bias (-2.0 [-4.0; -1.5] versus 9.0 [7.5; 10.0], 5.0 [3.5; 6.0] and 10.0 [8.5; 11.0] mL/min/1.73m2, P<0.005) and TDI (17.10 [16.41; 17.88], 25.91 [24.66; 27.16], 21.23 [19.48; 23.13] and 25.84 [24.16; 27.57], respectively). Concerning the CCC, all equation had poor agreement (<0.800) without statically difference between them. However, all equations had excellent area under the ROC curve (>0.900), and LMR equation had the best ability to correctly predict KTR with mGFR<45 mL/min/1.73 m2 (positive likelihood ratio: 8.87 [5.79; 13.52]). CONCLUSION: Among a referral group of subjects KTR, LMR equation had the best mean bias and TDI, but with no significant superiority in other agreement tools. Caveat is required in the use and interpretation of PCr-based equations in this specific population.
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Algoritmos , Creatinina/sangre , Tasa de Filtración Glomerular/fisiología , Insuficiencia Renal Crónica/patología , Adulto , Anciano , Área Bajo la Curva , Femenino , Humanos , Trasplante de Riñón , Masculino , Persona de Mediana Edad , Curva ROCRESUMEN
OBJECTIVE: To evaluate the association between living near waste recycling sites and emotional or behavioral difficulties in schoolchildren. METHODOLOGY: A cross-sectional study with schoolchildren aged 6-13 years old from disadvantaged communities in a Brazilian city, divided between those who live less than 100m away from the central point of the recycling site and those that live more than 150m away from the site, as a control group and classified through georeferencing. The emotional and behavioral difficulties were investigated using the Strengths and Difficulties Questionnaire tool. Other variables were analyzed through logistic regression to determine their contribution to the outcomes. RESULTS: Children living near waste recycling sites had a higher prevalence of emotional and behavioral problems than children living farther away. In the logistic regression model, no other covariates had a significant impact on the results, except for attending preschool. As expected, the families of the exposed group had lower income and lower levels of schooling, thus being characterized as a highly vulnerable population. CONCLUSION: The association between living near waste recycling sites and lower test performance raises concerns about the impact of inappropriate waste management in urban centers on children's health.
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Emociones , Problema de Conducta , Adolescente , Brasil , Niño , Salud Infantil , Estudios Transversales , HumanosRESUMEN
INTRODUCTION: Secondary hyperoxalemia is a multifactorial disease that affects several organs and tissues in patients with native or transplanted kidneys. Plasma oxalate may increase during renal failure because it is cleared from the body by the kidneys. However, there is scarce evidence about the association between glomerular filtration rate and plasma oxalate, especially in the early stages of chronic kidney disease (CKD). METHODS: A case series focuses on the description of variations in clinical presentation. A pilot study was conducted using a cross-sectional analysis with 72 subjects. The glomerular filtration rate (GFR) and plasma oxalate levels were measured for all patients. Results: Median (IQR) GFR was 70.50 [39.0; 91.0] mL/min/1.73 m2. Plasma oxalate was < 5.0 µmol/L in all patients with a GFR > 30 mL/min/1.73m2. Among the 14 patients with severe CKD (GFR < 30 mL/min/1.73 m2) only 4 patients showed a slightly increased plasma oxalate level (between 6 and 12 µmol/L). CONCLUSION: In non-primary hyperoxaluria, plasma oxalate concentration increases when GFR < 30mL/min/1.73 m2 and, in our opinion, values greater than 5 µmol/L with a GFR > 30 mL/min/1.73 m2 are suggestive of primary hyperoxaluria. Further studies are necessary to confirm plasma oxalate increase in patients with low GFR levels (< 30mL/min/1.73 m2).
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Cromatografía Líquida de Alta Presión , Tasa de Filtración Glomerular , Yohexol/metabolismo , Oxalatos/sangre , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/fisiopatología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos PilotoRESUMEN
ABSTRACT Introduction: Secondary hyperoxalemia is a multifactorial disease that affects several organs and tissues in patients with native or transplanted kidneys. Plasma oxalate may increase during renal failure because it is cleared from the body by the kidneys. However, there is scarce evidence about the association between glomerular filtration rate and plasma oxalate, especially in the early stages of chronic kidney disease (CKD). Methods: A case series focuses on the description of variations in clinical presentation. A pilot study was conducted using a cross-sectional analysis with 72 subjects. The glomerular filtration rate (GFR) and plasma oxalate levels were measured for all patients. Results: Median (IQR) GFR was 70.50 [39.0; 91.0] mL/min/1.73 m2. Plasma oxalate was < 5.0 µmol/L in all patients with a GFR > 30 mL/min/1.73m2. Among the 14 patients with severe CKD (GFR < 30 mL/min/1.73 m2) only 4 patients showed a slightly increased plasma oxalate level (between 6 and 12 µmol/L). Conclusion: In non-primary hyperoxaluria, plasma oxalate concentration increases when GFR < 30mL/min/1.73 m2 and, in our opinion, values greater than 5 µmol/L with a GFR > 30 mL/min/1.73 m2 are suggestive of primary hyperoxaluria. Further studies are necessary to confirm plasma oxalate increase in patients with low GFR levels (< 30mL/min/1.73 m2).
RESUMO Introdução: A hiperoxalemia secundária é uma doença multifatorial que afeta vários órgãos e tecidos em pacientes com rins nativos ou transplantados. O oxalato plasmático pode aumentar durante a insuficiência renal porque é eliminado do corpo pelos rins. No entanto, há evidências escassas sobre a associação entre taxa de filtração glomerular e oxalato plasmático, especialmente nos estágios iniciais da doença renal crônica (DRC). Métodos: uma casuística centrada na descrição das variações na apresentação clínica. Foi realizado um estudo piloto a partir da análise transversal com 72 indivíduos. As taxas de filtração glomerular (TFG) e os níveis plasmáticos de oxalato foram medidos para todos os pacientes. Resultados: A TFG mediana (IIQ) foi de 70,50 [39,0; 91,0] mL/min/1,73 m2. O nível plasmático de oxalato foi < 5,0 µmol/L em todos os pacientes com TFG > 30 mL/min/1,73 m2. Entre os 14 pacientes com DRC grave (TFG < 30 mL/min/1,73 m2), apenas quatro apresentaram ligeiro aumento do nível plasmático de oxalato (entre 6 e 12 µmol/L). Conclusão: Na hiperoxalúria não primária, a concentração plasmática de oxalato aumenta quando TFG < 30 mL/min/1,73 m2 e, em nossa opinião, valores superiores a 5 µmol/L com TFG > 30 mL/min/1,73 m2 sugerem presença de hiperoxalúria primária. Estudos adicionais são necessários para confirmar o aumento do oxalato plasmático em pacientes com níveis baixos de TFG (< 30 mL/min/1,73 m2).
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Oxalatos/sangre , Yohexol/metabolismo , Cromatografía Líquida de Alta Presión , Insuficiencia Renal Crónica/fisiopatología , Insuficiencia Renal Crónica/sangre , Tasa de Filtración Glomerular , Proyectos PilotoRESUMEN
Introduction: Chronic kidney disease (CKD) is characterized by slow, progressive, and irreversible loss of kidney function. CKD has become a serious public health issue because of its increasing morbidity and mortality rates. The present study aimed to investigate factors associated with hematomas caused by arteriovenous fistula (AVF) at a Renal Replacement Therapy Unit in the state of Rio Grande do Sul, southern Brazil. Methods: In this cross-sectional study, 72 patients with CKD aged 18 years or over, presenting with AVF, and undergoing three hemodialysis sessions per week were evaluated from June 2014 to March 2015. Prevalence ratios (PRs) with 95% confidence intervals (95% CIs) were estimated for identification of risk factors associated with AVF. P-values < 0.05 were considered significant. Results: Sex, age, self-reported skin color, educational level, hypertension, diabetes, nephrotic syndrome, congestive heart failure, and hepatitis C were not associated with hematoma formation (i.e., all estimated PRs had p-values > 0.05). The single factor associated with hematomas was AVF time shorter than 60 days (PR = 2.04; 95% CI: 1.28-3.27; p < 0.01). Conclusion: AVF maturation time was associated with higher prevalence of hematomas at the cannulation site. Therefore, AVF time should be given special attention in patients undergoing renal therapy at dialysis centers. (AU)
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Fístula Arteriovenosa/complicaciones , Hematoma/complicaciones , Fallo Renal Crónico/complicaciones , Fístula Arteriovenosa/mortalidad , Hematoma/mortalidad , Fallo Renal Crónico/mortalidadRESUMEN
INTRODUCTION: Contrast induced nephropathy is the third most prevalent preventable cause of acute kidney injury in hospitalized patients. It defined as an absolute increase in serum creatinine ≥ 0.5 mg/dL and relative ≥ 25% increase. OBJECTIVE: We studied the risk factors to intravenous injection contrast nephropathy after computed tomography. METHODS: We studied 400 patients prospectively. RESULTS: The incidence of contrast induced nephropathy, with an absolute or a relative increase were 4.0% and 13.9%, respectively. Diabetes and cardiac failure were independent risk factors for CIN a relative increase de serum creatinine (O.R.: 3.5 [95% CI: 1.92-6.36], p < 0.01, 2.61 [95% CI: 1.14-6.03%], p < 0.05, respectively). CONCLUSIONS: We showed association between uses of intravenous injection contrast after computed tomography with acute injury renal, notably with diabetes and heart failure.
Asunto(s)
Lesión Renal Aguda/inducido químicamente , Medios de Contraste/efectos adversos , Tomografía Computarizada por Rayos X , Lesión Renal Aguda/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de RiesgoRESUMEN
Introduction: Contrast induced nephropathy is the third most prevalent preventable cause of acute kidney injury in hospitalized patients. It defined as an absolute increase in serum creatinine ≥ 0.5 mg/dL and relative ≥ 25% increase. Objective: We studied the risk factors to intravenous injection contrast nephropathy after computed tomography. Methods: We studied 400 patients prospectively. Results: The incidence of contrast induced nephropathy, with an absolute or a relative increase were 4.0% and 13.9%, respectively. Diabetes and cardiac failure were independent risk factors for CIN a relative increase de serum creatinine (O.R.: 3.5 [95% CI: 1.92-6.36], p < 0.01, 2.61 [95% CI: 1.14-6.03%], p < 0.05, respectively). Conclusions: We showed association between uses of intravenous injection contrast after computed tomography with acute injury renal, notably with diabetes and heart failure. .
Introdução: Nefropatia induzida por contraste é a terceira causa de lesão renal aguda em pacientes hospitalizados. Ela é definida como: um aumento absoluto da creatinina sérica ≥ 0,5 mg/dL e relativo em ≥ 25%. Objetivo: Nós estudamos os fatores de risco associados à nefropatia do contraste após tomografia computadorizada. Métodos: Analisamos prospectivamente 400 pacientes submetidos ao contraste endovenoso na tomografia computadorizada. Resultados: A incidência de nefropatia por contraste variou de 4 a 13,9%, conforme o critério de aumento da creatinina sérica. Diabetes e insuficiência cardíaca foram associados significativamente no aumento absoluto da creatinina sérica (O.R.: 3,5 [95% CI: 1,92-6,36], p < 0,01, 2,61 [95% CI: 1,14-6,03%], p < 0,05, respectivamente). Conclusão: Encontramos uma relação direta da infusão de contraste endovenoso na tomografia computadorizada e injúria renal, notadamente com diabetes e insuficiência cardíaca. .
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/epidemiología , Medios de Contraste/efectos adversos , Tomografía Computarizada por Rayos X , Incidencia , Estudios Prospectivos , Factores de RiesgoRESUMEN
OBJETIVOS: avaliar prospectivamente derrame pleuralbenignos e malignos através de comparaçäo dos resultados da citopatologia convencional com a ploidia de DNA analisada por citometria de fluxo com o objetivo de esclarecer o valor desta última na diferenciaçäo entre derrames benignos e malignos. CASUISTICA E MÉTODOS: 26 amostras de derrames pleurais de pacientes adultos foram colhidas por toracocentese e os líquidos pleurais analisados através de citopatologia convencional e análise de conteúdo de DNA por citometria de fluxo. O diagnóstico etiológico foi confirmado por exame anatomopatológico de biópsia plerais em todos os casos. Dez amostras foram excluidas por problemas técnicos, restando 16 para análise. RESULTADO: Havia 13 derrames malignos e 3 benignos. A citometria de fluxo revelou 9 exames positivos para malignidade e 7 benignos (4 falso-negativo). A citometria de fluxo revelou conteúdo de DNA euplóide nos 3 derrames benignos (valor preditivo positivo e especificadade de cem por cento) e em 8 derrames malignos (sensibilidade de 38,4 por cento, valor preditivo positivo de 27,2 por cento). A citopatologia revelou especificidade de cem por cento, sensibilidade de 69,2 por cento, valores preditivos positivo de cem por cento e negativo de 42,8 por cento, respectivamente. CONCLUSÖES: Na diferenciaçäo entre derrames benignos e malignos, a baixa sensibilidade e o valor preditivo negativo da citometria de fluxo em relaçäo à citopatologia convencional nesta amostra limitaram a utilidade do método ao achado da presença de conteúdo de DNA euplóide em derrames benignos
Asunto(s)
ADN , Citometría de Flujo , Derrame PleuralRESUMEN
os autores apresentam, a partir da conceituaçäo e da fisiopatologia da asma, uma revisäo sobre a asma na gestaçäo. Säo discutidos o quadro clínico e o tratamento da asma na gravidez