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1.
Nephrol Dial Transplant ; 38(6): 1528-1539, 2023 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-36610723

RESUMO

BACKGROUND: The aim of this study was to identify trends in total, deceased donor (DD) and living donor (LD) kidney transplantation (KT) rates in European countries. METHODS: The European Renal Association (ERA) Registry and the Global Observatory on Donation and Transplantation (GODT) databases were used to obtain the number of KTs in individual European countries between 2010 and 2018. General population counts were obtained from Eurostat or the national bureaus of statistics. The KT rate per million population (p.m.p.) and the average annual percentage change (APC) were calculated. RESULTS: The total KT rate in the 40 participating countries increased with 1.9% annually  [95%  confidence  interval  (CI) 1.5, 2.2] from 29.6 p.m.p. in 2010 to 34.7 p.m.p. in 2018, reflecting an increase of 3.4 p.m.p. in the DD-KT rate (from 21.6 p.m.p. to 25.0 p.m.p.; APC 1.9%; 95% CI 1.3, 2.4) and of 1.5 p.m.p. in the LD-KT rate (from 8.1 p.m.p. to 9.6 p.m.p.; APC 1.6%; 95% CI 1.0, 2.3). The trends in KT rate varied widely across European countries. An East-West gradient was observed for DD-KT rate, with Western European countries performing more KTs. In addition, most countries performed fewer LD-KTs. In 2018, Spain had the highest DD-KT rate (64.6 p.m.p.) and Turkey the highest LD-KT rate (37.0 p.m.p.). CONCLUSIONS: The total KT rate increased due to a rise in the KT rate from DDs and to a lesser extent from LDs, with large differences between individual European countries.


Assuntos
Transplante de Rim , Humanos , Doadores Vivos , Rim , Europa (Continente)/epidemiologia , Sistema de Registros
2.
Eur J Neurol ; 30(9): 2899-2911, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37326125

RESUMO

BACKGROUND: Cognitive impairment is common in patients with chronic kidney disease (CKD), and early intervention may prevent the progression of this condition. METHODS: Here, we review interventions for the complications of CKD (anemia, secondary hyperparathyroidism, metabolic acidosis, harmful effects of dialysis, the accumulation of uremic toxins) and for prevention of vascular events, interventions that may potentially be protective against cognitive impairment. Furthermore, we discuss nonpharmacological and pharmacological methods to prevent cognitive impairment and/or minimize the latter's impact on CKD patients' daily lives. RESULTS: A particular attention on kidney function assessment is suggested during work-up for cognitive impairment. Different approaches are promising to reduce cognitive burden in patients with CKD but the availabe dedicated data are scarce. CONCLUSIONS: There is a need for studies assessing the effect of interventions on the cognitive function of patients with CKD.


Assuntos
Transtornos Cognitivos , Disfunção Cognitiva , Insuficiência Renal Crônica , Humanos , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/prevenção & controle , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/prevenção & controle , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Cognição , Diálise Renal/efeitos adversos
3.
J Ren Nutr ; 33(2): 269-277, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36179957

RESUMO

OBJECTIVE: A vegetarian very low-protein diet (VLPD) supplemented with ketoanalogues of essential amino acids Ketoanalogue-supplemented very low-protein diet (sVLPD) delays dialysis initiation in patients with chronic kidney disease (CKD). In this cost-effectiveness analysis, we compare an sVLPD with a conventional low-protein diet (LPD) in patients with CKD stage 4-5 using data from Taiwan and Thailand. DESIGN AND METHODS: A Markov model simulated health outcomes and care costs in patients receiving an sVLPD (0.3-0.4 g/kg-day, vegetarian diet) supplemented with ketoanalogues (1 tablet/5 kg-day) or an LPD (0.6 g/kg-day, mixed proteins). Health state transition probability and resource cost inputs were based on published literature and local sources, respectively. RESULTS: An sVLPD increased survival and quality-adjusted life years (QALYs) at a lower cost than an LPD. Total cost of care in Taiwan was 2,262,592.30 New Taiwan dollars (NTD) (68,059.35 EUR) with an LPD and 1,096,938.20 NTD (32,996.18 EUR) with an sVLPD (difference -1,165,654.10 NTD; -35,063.17 EUR). Total cost of care in Thailand was 500,731.09 Thai baht (THB) (14,584.12 EUR) with an LPD and 421,019.22 THB (12,262.46 EUR) with an sVLPD (difference -79,711.86 THB; -2,321.66 EUR). CONCLUSION: A ketoanalogue-supplemented vegetarian sVLPD increased QALYs and lowered lifetime care costs versus an LPD in patients with predialysis CKD in Taiwan and Thailand. These data, together with the new KDOQI Guidelines for nutrition in CKD, support dietary intervention using ketoanalogue-supplemented vegetarian sVLPDs to prevent CKD progression and postpone dialysis as a cost-effective approach, with beneficial effects for patients and health care providers.


Assuntos
Dieta com Restrição de Proteínas , Insuficiência Renal Crônica , Humanos , Taiwan , Tailândia , Insuficiência Renal Crônica/terapia , Diálise Renal , Análise Custo-Benefício
4.
Kidney Int ; 100(1): 182-195, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33359055

RESUMO

The aims of this study were to determine the frequency of dialysis and kidney transplantation and to estimate the regularity of comprehensive conservative management (CCM) for patients with kidney failure in Europe. This study uses data from the ERA-EDTA Registry. Additionally, our study included supplemental data from Armenia, Germany, Hungary, Ireland, Kosovo, Luxembourg, Malta, Moldova, Montenegro, Slovenia and additional data from Israel, Italy, Slovakia using other information sources. Through an online survey, responding nephrologists estimated the frequency of CCM (i.e. planned holistic care instead of kidney replacement therapy) in 33 countries. In 2016, the overall incidence of replacement therapy for kidney failure was 132 per million population (pmp), varying from 29 (Ukraine) to 251 pmp (Greece). On 31 December 2016, the overall prevalence of kidney replacement therapy was 985 pmp, ranging from 188 (Ukraine) to 1906 pmp (Portugal). The prevalence of peritoneal dialysis (114 pmp) and home hemodialysis (28 pmp) was highest in Cyprus and Denmark respectively. The kidney transplantation rate was nearly zero in some countries and highest in Spain (64 pmp). In 28 countries with five or more responding nephrologists, the median percentage of candidates for kidney replacement therapy who were offered CCM in 2018 varied between none (Slovakia and Slovenia) and 20% (Finland) whereas the median prevalence of CCM varied between none (Slovenia) and 15% (Hungary). Thus, the substantial differences across Europe in the frequency of kidney replacement therapy and CCM indicate the need for improvement in access to various treatment options for patients with kidney failure.


Assuntos
Falência Renal Crônica , Transplante de Rim , Insuficiência Renal , Tratamento Conservador , Ácido Edético , Europa (Continente) , Alemanha , Grécia , Humanos , Irlanda , Itália , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Transplante de Rim/efeitos adversos , Portugal , Sistema de Registros , Diálise Renal/efeitos adversos , Espanha
5.
Nephrol Dial Transplant ; 37(Suppl 2): ii23-ii32, 2021 12 28.
Artigo em Inglês | MEDLINE | ID: mdl-34718757

RESUMO

Neurocognitive disorders are frequent among chronic kidney disease (CKD) patients. Identifying and characterizing cognitive impairment (CI) can help to assess the ability of adherence to CKD risk reduction strategy, identify potentially reversible causes of cognitive decline, modify pharmacotherapy, educate the patient and caregiver and provide appropriate patient and caregiver support. Numerous factors are associated with the development and progression of CI in CKD patients and various conditions can influence the results of cognitive assessment in these patients. Here we review clinical warning signs that should lead to cognitive screening; conditions frequent in CKD at risk to interfere with cognitive testing or performance, including specificities of cognitive assessment in dialysis patients or after kidney transplantation; and available tests for screening and observed cognitive patterns in CKD patients.


Assuntos
Transtornos Cognitivos , Insuficiência Renal Crônica , Cognição , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Humanos , Testes Neuropsicológicos , Diálise Renal/efeitos adversos , Diálise Renal/métodos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia
6.
Pediatr Nephrol ; 36(8): 2337-2348, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33483800

RESUMO

BACKGROUND: For 10 consecutive years, the ESPN/ERA-EDTA Registry has included data on children with stage 5 chronic kidney disease (CKD 5) receiving kidney replacement therapy (KRT) in Europe. We examined trends in incidence and prevalence of KRT and patient survival. METHODS: We included all children aged <15 years starting KRT 2007-2016 in 22 European countries participating in the ESPN/ERA-EDTA Registry since 2007. General population statistics were derived from Eurostat. Incidence and prevalence were expressed per million age-related population (pmarp) and time trends studied with JoinPoint regression. We analyzed survival trends using Cox regression. RESULTS: Incidence of children commencing KRT <15 years remained stable over the study period, varying between 5.5 and 6.6 pmarp. Incidence by treatment modality was unchanged over time: 2.0 for hemodialysis (HD) and peritoneal dialysis (PD) and 1.0 for transplantation. Prevalence increased in all age categories and overall rose 2% annually from 26.4 pmarp in 2007 to 32.1 pmarp in 2016. Kidney transplantation prevalence increased 5.1% annually 2007-2009, followed by 1.5% increase/year until 2016. Prevalence of PD steadily increased 1.4% per year over the entire period, and HD prevalence started increasing 6.1% per year from 2011 onwards. Five-year unadjusted patient survival on KRT was around 94% and similar for those initiating KRT 2007-2009 or 2010-2012 (adjusted HR: 0.98, 95% CI:0.71-1.35). CONCLUSIONS: We found a stable incidence and increasing prevalence of European children on KRT 2007-2016. Five-year patient survival was good and was unchanged over time. These data can inform patients and healthcare providers and aid health policy makers on future resource planning of pediatric KRT in Europe.


Assuntos
Terapia de Substituição Renal , Criança , Ácido Edético , Europa (Continente)/epidemiologia , Humanos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Sistema de Registros
7.
Kidney Int ; 98(6): 1540-1548, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32979369

RESUMO

The aim of this study was to investigate 28-day mortality after COVID-19 diagnosis in the European kidney replacement therapy population. In addition, we determined the role of patient characteristics, treatment factors, and country on mortality risk with the use of ERA-EDTA Registry data on patients receiving kidney replacement therapy in Europe from February 1, 2020, to April 30, 2020. Additional data on all patients with a diagnosis of COVID-19 were collected from 7 European countries encompassing 4298 patients. COVID-19-attributable mortality was calculated using propensity score-matched historic control data and after 28 days of follow-up was 20.0% (95% confidence interval 18.7%-21.4%) in 3285 patients receiving dialysis and 19.9% (17.5%-22.5%) in 1013 recipients of a transplant. We identified differences in COVID-19 mortality across countries, and an increased mortality risk in older patients receiving kidney replacement therapy and male patients receiving dialysis. In recipients of kidney transplants ≥75 years of age, 44.3% (35.7%-53.9%) did not survive COVID-19. Mortality risk was 1.28 (1.02-1.60) times higher in transplant recipients compared with matched dialysis patients. Thus, the pandemic has had a substantial effect on mortality in patients receiving kidney replacement therapy, a highly vulnerable population due to underlying chronic kidney disease and a high prevalence of multimorbidity.


Assuntos
COVID-19/mortalidade , Falência Renal Crônica/complicações , Transplante de Rim/mortalidade , Complicações Pós-Operatórias/mortalidade , Sistema de Registros , Adolescente , Adulto , Idoso , COVID-19/complicações , Criança , Pré-Escolar , Europa (Continente)/epidemiologia , Feminino , Humanos , Lactente , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Pandemias , Complicações Pós-Operatórias/virologia , Diálise Renal , Fatores de Risco , Adulto Jovem
10.
J Am Soc Nephrol ; 27(7): 2164-76, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26823552

RESUMO

Dietary protein restriction may improve determinants of CKD progression. However, the extent of improvement and effect of ketoanalogue supplementation are unclear. We conducted a prospective, randomized, controlled trial of safety and efficacy of ketoanalogue-supplemented vegetarian very low-protein diet (KD) compared with conventional low-protein diet (LPD). Primary end point was RRT initiation or >50% reduction in initial eGFR. Nondiabetic adults with stable eGFR<30 ml/min per 1.73 m(2), proteinuria <1 g/g urinary creatinine, good nutritional status, and good diet compliance entered a run-in phase on LPD. After 3 months, compliant patients were randomized to KD (0.3 g/kg vegetable proteins and 1 cps/5 kg ketoanalogues per day) or continue LPD (0.6 g/kg per day) for 15 months. Only 14% of screened patients patients were randomized, with no differences between groups. Adjusted numbers needed to treat (NNTs; 95% confidence interval) to avoid composite primary end point in intention to treat and per-protocol analyses in one patient were 4.4 (4.2 to 5.1) and 4.0 (3.9 to 4.4), respectively, for patients with eGFR<30 ml/min per 1.73 m(2) Adjusted NNT (95% confidence interval) to avoid dialysis was 22.4 (21.5 to 25.1) for patients with eGFR<30 ml/min per 1.73 m(2) but decreased to 2.7 (2.6 to 3.1) for patients with eGFR<20 ml/min per 1.73 m(2) in intention to treat analysis. Correction of metabolic abnormalities occurred only with KD. Compliance to diet was good, with no changes in nutritional parameters and no adverse reactions. Thus, this KD seems nutritionally safe and could defer dialysis initiation in some patients with CKD.


Assuntos
Aminoácidos Essenciais/uso terapêutico , Dieta com Restrição de Proteínas , Dieta Vegetariana , Suplementos Nutricionais , Insuficiência Renal Crônica/dietoterapia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Estudos Prospectivos
11.
BMC Nephrol ; 17(1): 63, 2016 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-27388899

RESUMO

BACKGROUND: Low protein diets (LPD) have long been prescribed to chronic kidney disease patients with the goals of improving metabolic abnormalities and postpone the start of maintenance dialysis. METHODS: We reviewed the recent literature addressing low protein diets supplemented with ketoacids/essential aminoacids prescribed during chronic kidney disease and their effects on metabolic, nutritional and renal parameters since 2013. RESULTS: We show new information on how to improve adherence to these diets, on metabolic improvement and delay of the dialysis needs, and preliminary data in chronic kidney disease associated pregnancy. In addition, data on incremental dialysis have been reviewed, as well as potential strategies to reverse protein energy wasting in patients undergoing maintenance dialysis. CONCLUSION: These recent data help to better identify the use of low protein diets supplemented with ketoacids/essential aminoacids during chronic kidney disease.


Assuntos
Aminoácidos/uso terapêutico , Dieta com Restrição de Proteínas , Cetoácidos/uso terapêutico , Cooperação do Paciente , Insuficiência Renal Crônica/tratamento farmacológico , Suplementos Nutricionais , Humanos , Seleção de Pacientes , Insuficiência Renal Crônica/dietoterapia
12.
Nephrol Dial Transplant ; 30(10): 1605-14, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25982327

RESUMO

Despite the potential for patient-reported outcome measures (PROMs) and experience measures (PREMs) to enhance understanding of patient experiences and outcomes they have not, to date, been widely incorporated into renal registry datasets. This report summarizes the main points learned from an ERA-EDTA QUEST-funded consensus meeting on how to routinely collect PROMs and PREMs in renal registries in Europe. In preparation for the meeting, we surveyed all European renal registries to establish current or planned efforts to collect PROMs/PREMs. A systematic review of the literature was performed. Publications reporting barriers and/or facilitators to PROMs/PREMs collection by registries were identified and a narrative synthesis undertaken. A group of renal registry representatives, PROMs/PREMs experts and patient representatives then met to (i) share any experience renal registries in Europe have in this area; (ii) establish how patient-reported data might be collected by understanding how registries currently collect routine data and how patient-reported data is collected in other settings; (iii) harmonize the future collection of patient-reported data by renal registries in Europe by agreeing upon preferred instruments and (iv) to identify the barriers to routine collection of patient-reported data in renal registries in Europe. In total, 23 of the 45 European renal registries responded to the survey. Two reported experience in collecting PROMs and three stated that they were actively exploring ways to do so. The systematic review identified 157 potentially relevant articles of which 9 met the inclusion criteria and were analysed for barriers and facilitators to routine PROM/PREM collection. Thirteen themes were identified and mapped to a three-stage framework around establishing the need, setting up and maintaining the routine collection of PROMs/PREMs. At the consensus meeting some PROMs instruments were agreed for routine renal registry collection (the generic SF-12, the disease-specific KDQOL™-36 and EQ-5D-5L to be able to derive quality-adjusted life years), but further work was felt to be needed before recommending PREMs. Routinely collecting PROMs and PREMs in renal registries is important if we are to better understand what matters to patients but it is likely to be challenging; close international collaboration will be beneficial.


Assuntos
Coleta de Dados , Avaliação de Resultados da Assistência ao Paciente , Sistema de Registros , Insuficiência Renal/terapia , Terapia de Substituição Renal , Registros Eletrônicos de Saúde , Europa (Continente) , Humanos , Satisfação do Paciente , Indicadores de Qualidade em Assistência à Saúde , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Inquéritos e Questionários
13.
J Ren Nutr ; 25(1): 67-74, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25218877

RESUMO

BACKGROUND: Periodontal disease (PDD) was associated with inflammation, malnutrition, and higher mortality in hemodialysis (HD) patients. STUDY DESIGN AND OBJECTIVE: Cross-sectional observational study, aiming to assess the prevalence of PDD and the possible relationship among PDD, inflammation, and malnutrition in HD patients. SETTINGS AND PARTICIPANTS: Single HD center, 263 patients (age: 57.4 ± 12.3 years; 60% males; HD vintage 6.6 ± 4.9 years; the primary renal diseases were mainly primary glomerular nephropathies in 34% cases, with 11% diabetic nephropathy). MEASUREMENTS: Oral health status was assessed by the Silness and Loe plaque index, loss of clinical attachment level, periodontal pocket depth according to World Health Organization recommendations, by a single examiner. Patients were stratified by periodontal pocket depth (PPD): normal oral status/mild PDD (PPD < 4 mm), moderate PDD (PPD 4-5 mm), and severe PDD (PPD ≥ 6 mm). Demographic, smoking status, hematologic, dialysis-related data and parameters of the nutritional (Subjective Global Assessment score, anthropemetrical, and biochemical) and inflammatory status were collected. RESULTS: Poor periodontal status was shown by 75% of patients, 23% of them with severe PDD. Patients with PDD were older; higher percentages of them were smokers, diabetics, had malnutrition, and inflammation. Subjects with severe PDD had higher HD vintage, lower hemoglobin, and required higher darbepoetin doses than those with healthy periodontium. Darbepoetin resistance index was higher in patients with severe PDD than in those with normal periodontium. Models of multivariable linear logistic regression for the potential promoters and for the consequences of PDD revealed smoking and HD duration as significant contributors; increased C-reactive protein was associated with severe PDD. LIMITATION: Cross-sectional observational design. CONCLUSIONS: Impaired periodontal health is highly prevalent in HD patients. PDD is more frequent in elderly diabetic smokers and in those with longer HD vintage; smoking and HD duration seems to be the most important determinants. The prevalence is higher in malnourished and in inflamed patients; inflammation seems to accompany PDD and to influence anemia response to treatment.


Assuntos
Inflamação/epidemiologia , Desnutrição/epidemiologia , Doenças Periodontais/epidemiologia , Diálise Renal , Idoso , Proteína C-Reativa/metabolismo , Estudos Transversais , Eritropoetina/administração & dosagem , Eritropoetina/análogos & derivados , Feminino , Hemoglobinas/metabolismo , Humanos , Inflamação/sangue , Nefropatias/terapia , Modelos Lineares , Modelos Logísticos , Masculino , Desnutrição/sangue , Pessoa de Meia-Idade , Análise Multivariada , Estado Nutricional , Doenças Periodontais/sangue , Prevalência
14.
Nutrients ; 16(14)2024 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-39064671

RESUMO

Low-protein diets (LPDs) seem to improve metabolic complications of advanced CKD, thus postponing kidney replacement therapy (KRT) initiation. However, the nutritional safety of LPDs remains debatable in patients with diabetic kidney disease (DKD), especially in the elderly. This is a sub-analysis of a prospective unicentric interventional study which assessed the effects of LPD in patients with advanced DKD, focusing on the feasibility and safety of LPD in elderly patients. Ninety-two patients with DKD and stable CKD stage 4+, proteinuria >3 g/g creatininuria, good nutritional status, with confirmed compliance to protein restriction, were enrolled and received LPD (0.6 g mixed proteins/kg-day) supplemented with ketoanalogues of essential amino acids for 12 months. Of the total group, 42% were elderly with a median eGFR 12.6 mL/min and a median proteinuria 5.14 g/g creatininuria. In elderly patients, proteinuria decreased by 70% compared to baseline. The rate of kidney function decline was 0.1 versus 0.5 mL/min-month before enrolment. Vascular events occurred in 15% of cases, not related to nutritional intervention, but to the severity of CKD and higher MAP. LPDs seem to be safe and effective in postponing KRT in elderly patients with advanced DKD while preserving the nutritional status.


Assuntos
Nefropatias Diabéticas , Dieta com Restrição de Proteínas , Proteinúria , Humanos , Dieta com Restrição de Proteínas/métodos , Idoso , Masculino , Feminino , Nefropatias Diabéticas/dietoterapia , Estudos Prospectivos , Proteinúria/dietoterapia , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Taxa de Filtração Glomerular , Resultado do Tratamento , Estado Nutricional , Insuficiência Renal Crônica/dietoterapia , Aminoácidos Essenciais/administração & dosagem
15.
Nutrients ; 16(11)2024 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-38892620

RESUMO

Low protein diet (LPD) seems beneficial in ameliorating the complications of chronic kidney disease (CKD), in reducing proteinuria and the decline in kidney function, thus postponing the need for kidney replacement therapy (KRT). However, this type of intervention was less investigated in diabetic kidney disease (DKD). This is a single-center, prospective, interventional study that aims to assess the efficacy of reducing proteinuria and the rate of decline in the estimated glomerular filtration rate (eGFR). Patients with advanced DKD (stable proteinuria > 3 g/g and eGFR < 30 mL/min) with a good nutritional status and accepting a LPD were evaluated for inclusion. Ninety-two of the 452 screened patients (66% males, median age 61 years, proteinuria 4.8 g/g creatininuria, eGFR 11.7 mL/min/1.73 m2) completed the study. Intervention consisted of LPD supplemented with ketoanalogues of essential amino acids (KA) along with conventional nephroprotective therapy. Efficacy parameters were the variation in proteinuria and in eGFR from baseline to the end of the study. Proteinuria decreased 3-fold, and the rate of decline in eGFR decreased 5-fold in the intervention phase. No patient initiated KRT or died. LPD supplemented with KA seems effective in safely postponing KRT by reducing proteinuria and the decline in kidney function in advanced DKD.


Assuntos
Nefropatias Diabéticas , Dieta com Restrição de Proteínas , Taxa de Filtração Glomerular , Proteinúria , Humanos , Masculino , Proteinúria/dietoterapia , Pessoa de Meia-Idade , Dieta com Restrição de Proteínas/métodos , Nefropatias Diabéticas/dietoterapia , Nefropatias Diabéticas/fisiopatologia , Feminino , Estudos Prospectivos , Idoso , Aminoácidos Essenciais/administração & dosagem , Resultado do Tratamento
16.
Semin Dial ; 26(6): 714-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24016150

RESUMO

Early versus later start of dialysis is still a matter of debate. Low-protein diets have been used for many decades to delay dialysis initiation. Protein-restricted diets (0.3-0.6 g protein/kg/day) supplemented with essential amino acids and ketoanalogues (sVLPD) can be offered, in association with pharmacological treatment, to motivated stage 4-5 chronic kidney disease (CKD) patients not having severe comorbid conditions; they probably represent 30-40% of the concerned population. A satisfactory adherence to such dietary prescription is observed in approximately 50% of the patients. While the results of the studies on the effects of this diet on the rate of progression of renal failure remain inconclusive, they are highly significant when initiation of dialysis is the primary outcome. The correction of uremic symptoms allows for initiation of dialysis treatment at a level of residual renal function lower than that usually recommended. Most of the CKD-associated complications of cardiovascular and metabolic origin, which hamper both lifespan and quality of life, are positively influenced by the diet. Lastly, with regular monitoring jointly assumed by physicians and dietitians, nutritional status is well preserved as confirmed by a very low mortality rate and by the absence of detrimental effect on the long-term outcome of patients once renal replacement therapy is initiated. On account of its feasibility, efficacy and safety, sVLPD deserves a place in the management of selected patients to safely delay the time needed for dialysis.


Assuntos
Aminoácidos Essenciais/uso terapêutico , Dieta com Restrição de Proteínas , Suplementos Nutricionais , Diálise Renal , Insuficiência Renal Crônica/terapia , Humanos , Seleção de Pacientes , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/metabolismo , Fatores de Tempo , Tempo para o Tratamento
17.
J Ren Nutr ; 23(3): 210-3, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23611549

RESUMO

Hypoproteic diets are most often discussed for patients with chronic kidney disease (CKD) who do not receive dialysis. A very low-protein diet supplemented with ketoanalogues of essential amino acids (keto-diet) proved effective in ameliorating metabolic disturbances of advanced CKD and delaying the initiation of dialysis without deleterious effects on nutritional status. Several recent studies report that the keto-diet could also slow down the rate of decline in renal function, with better outcomes after the initiation of dialysis. Results of a single-center randomized controlled trial addressing the rate of CKD progression revealed a 57% slower decline in renal function with the keto-diet compared with a conventional low-protein diet (LPD). The keto-diet allowed the safe management of selected patients with stage 4-5 CKD, delaying dialysis for almost 1 year, with a major impact on patient quality of life and health expenditures. Therefore, the keto-diet could be a link in the integrated care model. Careful selection of patients, nutritional monitoring, and dietary counseling are required.


Assuntos
Dieta com Restrição de Proteínas , Proteínas Alimentares/administração & dosagem , Suplementos Nutricionais , Progressão da Doença , Cetoácidos/administração & dosagem , Insuficiência Renal Crônica/dietoterapia , Aminoácidos Essenciais/administração & dosagem , Humanos , Estado Nutricional , Ensaios Clínicos Controlados Aleatórios como Assunto , Diálise Renal , Insuficiência Renal Crônica/fisiopatologia
18.
Oral Health Prev Dent ; 11(3): 235-42, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23878835

RESUMO

PURPOSE: To obtain a valid Romanian version of the OHIP-14 for use among Romanian adults, either in Romania or abroad. MATERIALS AND METHODS: The Romanian version of the OHIP-14 was obtained through the back translation technique and pre-tested in a pilot study. Subsequently, it was self-administered to 187 adults who also underwent a clinical examination. Cronbach alpha was used to check the internal consistency and reliability analysis and validity tests were used to determine the psychometric properties of the questionnaire. RESULTS: The Cronbach alpha coefficient obtained was 0.88. Inter-item correlation coefficients were between 0.01 and 0.74; item-total correlation values ranged between 0.25 and 0.77. There were statistically significant associations (p <= 0.001) between the respondents' self-perceived oral health (r = 0.41), the dental treatment need (r = 0.35) and the mean of the OHIP-14 total scores. Similar statistically significant associations (p <= 0.001) existed between the OHIP-14 total scores mean and the clinical data - the number of decayed (D) and of missing (M) teeth and the prosthetic treatment need - proving the construct validity of the questionnaire. The subscales 'physical pain' and 'psychological disability' have the most important impact on the overall OHIP-14 score. The subscales 'social disability' and 'handicap' seem to make the least contribution to the overall OHIP-14 score. CONCLUSION: The Romanian version of the OHIP-14 is a valid and reliable questionnaire that can be used in future studies.


Assuntos
Saúde Bucal , Perfil de Impacto da Doença , Perda de Dente/psicologia , População Urbana , Adulto , Análise de Variância , Estudos Transversais , Cultura , Índice CPO , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Qualidade de Vida , Romênia , Estatísticas não Paramétricas , Traduções
19.
Nutrients ; 15(16)2023 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-37630693

RESUMO

In chronic kidney disease (CKD), metabolic derangements resulting from the interplay between decreasing renal excretory capacity and impaired gut function contribute to accelerating disease progression and enhancing the risk of complications. To protect residual kidney function and improve quality of life in conservatively managed predialysis CKD patients, current guidelines recommend protein-restricted diets supplemented with essential amino acids (EAAs) and their ketoanalogues (KAs). In clinical studies, such an approach improved nitrogen balance and other secondary metabolic disturbances, translating to clinical benefits, mainly the delayed initiation of dialysis. There is also increasing evidence that a protein-restricted diet supplemented with KAs slows down disease progression. In the present review article, recent insights into the role of KA/EAA-supplemented protein-restricted diets in delaying CKD progression are summarized, and possible mechanistic underpinnings, such as protein carbamylation and gut dysbiosis, are elucidated. Emerging evidence suggests that lowering urea levels may reduce protein carbamylation, which might contribute to decreased morbidity and mortality. Protein restriction, alone or in combination with KA/EAA supplementation, modulates gut dysbiosis and decreases the generation of gut-derived uremic toxins associated, e.g., with cardiovascular disease, inflammation, protein energy wasting, and disease progression. Future studies are warranted to assess the effects on the gut microbiome, the generation of uremic toxins, as well as markers of carbamylation.


Assuntos
Microbiota , Carbamilação de Proteínas , Humanos , Dieta com Restrição de Proteínas , Disbiose , Qualidade de Vida , Toxinas Urêmicas , Diálise Renal , Suplementos Nutricionais , Progressão da Doença
20.
Am J Kidney Dis ; 60(6): 940-8, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22921638

RESUMO

BACKGROUND: Little is known about the criteria nephrologists use in the decision of when to start renal replacement therapy (RRT) in early referred adult patients. We evaluated opinions of European nephrologists on the decision for when to start RRT. STUDY DESIGN: European web-based survey. PREDICTORS: Patient presentations described as uncomplicated patients, patients with unfavorable clinical and unfavorable social conditions, or patients with specific clinical, social, and logistical factors. SETTING & PARTICIPANTS: Nephrologists from 11 European countries. OUTCOMES & MEASUREMENTS: We studied opinions of European nephrologists about the influence of clinical, social, and logistical factors on decision making regarding when to start RRT, reflecting practices in place in 2009. Questions included target levels of kidney function at the start of RRT and factors accelerating or postponing RRT initiation. Using linear regression, we studied determinants of target estimated glomerular filtration rate (eGFR) at the start of RRT. RESULTS: We received 433 completed surveys. The median target eGFR selected to start RRT in uncomplicated patients was 10.0 (25th-75th percentile, 8.0-10.0) mL/min/1.73 m(2). Level of excretory kidney function was considered the most important factor in decision making regarding uncomplicated patients (selected by 54% of respondents); in patients with unfavorable clinical versus social conditions, this factor was selected by 24% versus 32%, respectively. Acute clinical factors such as life-threatening hyperkalemia refractory to medical therapy (100%) and uremic pericarditis (98%) elicited a preference for an immediate start, whereas patient preference (69%) and vascular dementia (66%) postponed the start. Higher target eGFRs were reported by respondents from high- versus low-RRT-incidence countries (10.4 [95% CI, 9.9-10.9] vs 9.1 mL/min/1.73 m(2)) and from for-profit versus not-for-profit centers (10.1 [95% CI, 9.5-10.7] vs 9.5 mL/min/1.73 m(2)). LIMITATIONS: We were unable to calculate the exact response rate and examined opinions rather than practice for 433 nephrologists. CONCLUSIONS: Only for uncomplicated patients did half the nephrologists consider excretory kidney function as the most important factor. Future studies should assess the weight of each factor affecting decision making.


Assuntos
Coleta de Dados/tendências , Tomada de Decisões , Nefropatias/terapia , Nefrologia/tendências , Médicos/tendências , Terapia de Substituição Renal/tendências , Adulto , Idoso , Coleta de Dados/métodos , Europa (Continente)/epidemiologia , Feminino , Humanos , Nefropatias/epidemiologia , Nefropatias/fisiopatologia , Testes de Função Renal/métodos , Testes de Função Renal/tendências , Masculino , Pessoa de Meia-Idade , Nefrologia/métodos , Terapia de Substituição Renal/métodos
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