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1.
Nefrologia (Engl Ed) ; 38(4): 394-400, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29426785

RESUMO

INTRODUCTION AND OBJECTIVES: Evidence for the efficacy and safety of oral anticoagulation with dicumarines in patients with atrial fibrillation (AF) on hemodialysis is controversial. The aim of our study is to evaluate the long-term prognostic implications of anticoagulation with dicumarines in a cohort of patients with non-valvular AF on a hemodialysis program due to end-stage renal disease. METHODS: Retrospective, observational study with consecutive inclusion of 74 patients with AF on hemodialysis. The inclusion period was from January 2005 to October 2016. The primary variables were all-cause mortality, non-scheduled readmissions and bleeding during follow-up. RESULTS: Mean age was 75±10 years; 66.2% were men and 43 patients (58.1%) received acenocoumarol. During a median follow-up of 2.40 years (IQR=0.88-4.15), acenocoumarol showed no survival benefit [HR=0.76, 95% CI (0.35-1.66), p=0.494]. However, anticoagulated patients were at increased risk of recurrent cardiovascular hospitalizations [IRR=3.94, 95% CI (1.06-14.69), p=0.041]. There was a trend towards an increase in repeated hospitalizations of ischemic cause in anticoagulated patients [IRR=5.80, 95% CI (0.86-39.0), p=0.071]. There was a statistical trend towards a higher risk of recurrent total bleeding in patients treated with acenocoumarol [IRR=4.43, 95% CI (0.94-20.81), p=0.059]. CONCLUSIONS: In this study, oral anticoagulation with acenocoumarol in patients with AF on hemodialysis did not increase survival. However, it was associated with an increased risk of hospitalizations of cardiovascular causes and a tendency to an increased risk of total bleeding.


Assuntos
Acenocumarol/uso terapêutico , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Diálise Renal , Idoso , Feminino , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Tempo
2.
Nefrologia ; 33(5): 675-84, 2013.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-24089159

RESUMO

OBJECTIVE: To assess the level of compliance and variability of mineral metabolism parameters over time in a sample of haemodialysis patients for the different ranges proposed (KDIGO guidelines/S.E.N recommendations) in both groups and individuals continuously. MATERIAL AND METHOD: Every four months, we collected data on calcium, phosphorus, PTH and treatment in a sample of 44 patients followed up continuously for 32 months. We established the percentages of patients who complied with the objectives set for each parameter in both ranges: optimal (KDIGO) and acceptable (S.E.N.) in each control and the percentage that individually complied with the objectives in at least 75% of the determinations. RESULTS: Compliance with the objective using the optimal range improved, although PTH did not exceed 50%. Using the acceptable range, the objective was achieved in the three parameters in over 70% and over 50% of patients achieved the three simultaneously while using the optimal range, 30% was never achieved. Individually, compliance with the optimal range was continuously achieved in 52.3% (calcium), 45.5% (phosphorus) and in only one patient in PTH, while when using the acceptable range, compliance was achieved in 84.1% (calcium) and 70.5% (phosphorus and PTH). CONCLUSIONS: The use of less stringent criteria than the KDIGO guidelines in calcium, phosphorus and PTH objectives allows patients to remain continuously within appropriate ranges with less intervention and less individual variability.


Assuntos
Cálcio/sangue , Fidelidade a Diretrizes , Falência Renal Crônica/terapia , Fósforo/sangue , Guias de Prática Clínica como Assunto , Diálise Renal , Idoso , Quelantes/uso terapêutico , Distúrbio Mineral e Ósseo na Doença Renal Crônica/sangue , Distúrbio Mineral e Ósseo na Doença Renal Crônica/etiologia , Cinacalcete , Ergocalciferóis/administração & dosagem , Ergocalciferóis/uso terapêutico , Feminino , Seguimentos , Objetivos , Humanos , Hiperparatireoidismo Secundário/sangue , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/prevenção & controle , Hiperparatireoidismo Secundário/cirurgia , Falência Renal Crônica/sangue , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Naftalenos/administração & dosagem , Naftalenos/uso terapêutico , Hormônio Paratireóideo/sangue , Paratireoidectomia , Diálise Peritoneal , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/terapia , Diálise Renal/normas , Estudos Retrospectivos
5.
Nefrologia ; 32(3): 367-73, 2012 May 14.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-22592422

RESUMO

In this paper we analyse the discrepancies that exist in the widespread prescription of metformin in patients with type 2 diabetes and the lack of guidelines concerning its prescription in the different stages of renal failure. This cross-sectional study includes 304 patients with type 2 diabetes treated with oral antidiabetic drugs (ADOs) and a glomerular filtration rate (estimated GFR) <60ml/min/1.73m2. Patients were attended in consecutive visits to primary health centres or in hospital departments of endocrinology or nephrology during 2010. We studied the frequency of metformin and other ADO prescriptions according to renal function and the department in which the patient was treated. The ADO most frequently prescribed was metformin (54.9%), followed by repaglinide (47.7%), DPP4 inhibitors (28.6%), and sulfonylureas (18.4%). However, in nephrology departments, repaglinide was more frequently prescribed than metformin (P<.001), whereas in primary health centres, the prescription of DPP4 inhibitors increased. In patients with an estimated GFR of 15-29ml/min/1.73m2, metformin (13.3%) and sulfonylureas were the least prescribed, whereas metformin was much more frequently prescribed (70.0%) when estimated GFR was 45-59ml/min/1.73m2 (P<.001). In contrast, patients with an estimated GFR of 15-29ml/min/1.73m2 were mainly prescribed repaglinide (76.7%), as opposed to patients with an estimated GFR of 45-59ml/min/1.73m2 (38.9%) (P<.001). Substantial evidence suggests that the recommendations for the use of ADO should be modified. This would lead to safely prescribing ADO in patients with an estimated GFR<60ml/min/1.73m2, and more importantly in medical practice, according to the law.


Assuntos
Conferências de Consenso como Assunto , Diabetes Mellitus Tipo 2/tratamento farmacológico , Nefropatias Diabéticas/metabolismo , Gerenciamento Clínico , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Guias de Prática Clínica como Assunto , Prática Profissional/normas , Acidose Láctica/induzido quimicamente , Acidose Láctica/etiologia , Idoso , Carbamatos/administração & dosagem , Carbamatos/uso terapêutico , Contraindicações , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/etiologia , Nefropatias Diabéticas/fisiopatologia , Uso de Medicamentos/estatística & dados numéricos , Endocrinologia , Feminino , Seguimentos , Taxa de Filtração Glomerular , Departamentos Hospitalares , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/efeitos adversos , Hipoglicemiantes/classificação , Masculino , Metformina/administração & dosagem , Metformina/efeitos adversos , Pessoa de Meia-Idade , Nefrologia , Piperidinas/administração & dosagem , Piperidinas/uso terapêutico , Atenção Primária à Saúde , Prática Profissional/legislação & jurisprudência , Sociedades Médicas , Espanha , Compostos de Sulfonilureia/administração & dosagem , Compostos de Sulfonilureia/uso terapêutico
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