Respiratory parameters and acute kidney injury in acute respiratory distress syndrome: a causal inference study.

BACKGROUND: Assess the respiratory-related parameters associated with subsequent severe acute kidney injury in mechanically ventilated patients with acute respiratory distress syndrome (ARDS). METHODS: Retrospective cohort, analyzing a large public database-Multiparameter Intelligent Monitoring in Intensive Care-III. Adult patients with at least 48 h of mechanical ventilation (MV), under volume controlled ventilation and an oxygenation index less than 300 mmHg were included. RESULTS: A total of 1,142 patients had complete data and were included in the final analyses. According to a causal directed acyclic graph (DAG) that included respiratory system compliance (Crs), tidal volume (Vt), driving pressure (ΔP), plateau pressure (PPlat), PEEP, PaO2 and PaCO2 as possible exposures related to severe AKI, only Crs and PEEP levels had significant causal association with severe acute kidney injury (AKI) (OR 0.90, 95% CI: 0.84-0.94 for each 5-mL/cmH2O reduction in Crs; OR, 1.05 95% CI: 1.03-1.10 for each 1-cmH2O increase of PEEP). Using mediation analysis, we examined whether any mechanical ventilation, blood gas or hemodynamic parameters could explain the effects of Csr on AKI. Only PEEP mediated the significant but small effect (less than 5%) of Csr on severe AKI. The effects of PEEP, in turn, were not mediated by any other evaluated parameter. Several sensitivity analyses with (I) need of renal replacement therapy (RRT) as an alternative outcome and (II) only patients with Vt <8 mL/kg, confirmed our main findings. In trying to validate our DAG assumptions, we confirmed that only ΔP was associated with mortality but not with severe AKI. CONCLUSIONS: Crs and PEEP are the only respiratory-related variables with a direct causal association in severe AKI. No mechanical ventilator or blood gas parameter mediated the effects of Crs. Approaches reducing Vt and/or ΔP in ARDS can have limited effect on renal protection.

Perfil Epidemiológico da Hipertensão Arterial Sistêmica na população de Cajazeiras, Paraíba / Epidemiological Profile of Systemic Arterial Hypertension in the Population of Cajazeiras, Paraíba

Avaliar o perfil epidemiológico da HAS na cidadede Cajazeiras-PB. Material e Métodos: Estudo analítico,descritivo e transversal, na cidade de Cajazeiras, PB. Foramselecionados de forma aleatória alguns bairros da cidade deCajazeiras, e neste, quadras foram divididas em estratos, eos residentes dos estratos foram visitados três vezesconsecutivas, com intervalo de 2 meses. Aferiu-se a PA,medida a circunferência abdominal, a altura e o peso eaplicado um questionário referente à FR cardiovasculares atodos os participantes. Os testes do Qui-quadrado e o Exatode Fisher foram empregados na comparação de proporções.Considerou-se um nível de significância de 5% (p < 0,05).Resultados: O estudo contou com um total de 656participantes, sendo 68,43% do gênero feminino. Aprevalência global da HAS foi de 33,84%, sendo 8,38% nãodiagnosticados. Relativamente à população hipertensa,63,06% eram do gênero feminino. Do total de hipertensos,27,02% não eram diagnosticados previamente. Os principaisFR encontrados foram: sedentarismo (69,6%), antecedentesde HAS (58,4%), consumo exagerado de sal (53,7%) esobrepeso/obesidade (52,5%). Conclusão: Pode-seidentificar a alta prevalência da HAS não diagnosticada napopulação estudada (8,38%), principalmente no quecorresponde aos adultos jovens e no sexo masculino. Asbaixas taxas de controle da PA e a alta prevalência dosfatores de risco modificáveis na população também devemser ressaltadas...

To evaluate the epidemiology of hypertension inthe city of Cajazeiras, PB. Material and Methods: This wasan analytical, descriptive and cross-sectional study carriedout in the city of Cajazeiras, PB. We randomly selected somedistricts of Cajazeiras. Their blocks were divided into strataand residents of each stratum were visited three consecutivetimes within a two-month interval. We measured subjects’SAH, waist circumference, height and weight, and we applieda questionnaire relating to cardiovascular RF to allparticipants. The chi-square and Fisher exact tests wereused to compare proportions. It was considereda significance level of 5% (p <0.05). Results: This studyincluded a total of 656 participants, of which 68.43% werefemale. The overall prevalence of hypertension was 33.84%,including 8.38% of undiagnosed cases. With regard tothe hypertensive population, 63.06% were female. Of thetotal of hypertensive subjects, 27.02% had not beenpreviously diagnosed. The main RF found were:sedentarism (69.6%), history of hypertension (58.4%),excessive consumption of salt (53.7%), overweight orobesity (52.5%). Conclusion: It was identified a highprevalence of subjects with undiagnosed hypertension in thispopulation (8.38%), mainly corresponding to male youngadults. The low rate of SAH control and high prevalenceof modifiable risk factors in this population should also behighlighted...