Predictors of Improvement in Renal Function After Heart Transplant.

OBJECTIVES: Moderate chronic renal insufficiency is often found in patients evaluated for heart transplant. Recovery of cardiac output after heart transplant might lead to improvement of renal function. In this study, our aim was to identify predictors of improvement of renal function after heart transplant. MATERIALS AND METHODS: Our study included a cohort of heart transplant patients treated from 2011 to 2016 whose main outcome was improved renal function, defined as glomerular filtration rate at 6 months after heart transplant of ≥ 10% compared with baseline (before transplant). Univariate and multivariate logistic regression was used to identify independent predictors. RESULTS: Our study included 83 patients, with 29% having improvement in renal function. Multivariate analyses identified baseline glomerular filtration rate (odds ratio of 0.95; 95% confidence interval, 0.93-0.98; P = .005), absence of hypertension (odds ratio of 4.94; 95% confidence interval, 1.37-17.8; P = .015), and elective heart transplant (odds ratio of 13.71; 95% confidence interval, 1.33-141; P = .028) as independent predictors. A scale developed with independent predictors showed good accuracy (area under the curve of 0.76). The probability for improvement in renal function was 7%, 23%, and 58% in patients with low, medium, and high scores, respectively (P < .001). CONCLUSIONS: In patients with heart transplant, baseline glomerular filtration rate, absence of hypertension, and elective heart transplant were independent predictors of improvement in renal function after heart transplant.

Predictors of renal replacement therapy after heart transplantation and its impact on long-term survival.

BACKGROUND: Renal replacement therapy (RRT) after heart transplant (HT) is associated with worse prognosis. We aimed to identify predictors of RRT and the impact of this complication on long-term survival. METHODS: Cohort study of HT patients. Univariate and multivariate competing-risk regression was performed to identify independent predictors of RRT. The cumulative incidence function was plotted for RRT. The Kaplan-Meier method was used to compare long-term survival. RESULTS: We included 103 patients. At multivariate analysis, only the emergency status of HT (short-term mechanical circulatory support as a bridge to transplant), chronic kidney disease, and low oxygen delivery were independent predictors of RRT (subhazard ratio [SHR] 4.11, 95% CI 1.84-9.14; SHR 3.17, 95% CI 1.29-7.77; SHR 2.86, 95% CI 1.14-7.19, respectively). Elective HT patients that required RRT showed a significantly reduced survival comparable to patients with emergency HT and RRT (75% ± 13% vs. 67% ± 16%). The absence of RRT implied an excellent survival in patients with an emergency status of HT and elective HT (100% vs. 93% ± 4%). CONCLUSION: The emergency status of HT, chronic kidney disease, and low oxygen delivery were independent predictors of RRT. The occurrence of RRT increases the risk of death in elective HT as much as in patients with an emergency status.

Trabalhadora e mãe: papéis, identidade, consciência política e democracia / Working mother: roles, identity, political consciousness and democracy / Madre trabajadora: papeles, la identidad, la conciencia política y la democracia / La femme travailleuse et mère: les rôles, l'identité, la conscience politique et la démocratie

Diante da complexidade da vida da mulher contemporânea, levantou-se algumas questões sobre os principais conflitos que surgem da conjunção entre trabalho e maternidade. A maior inclusão da mulher no mercado de trabalho - e sua ascensão a cargos antes exclusivamente masculinos - aponta para o reconhecimento de suas competências laborais, mas desconsidera inteiramente a peculiaridade da sua condição em relação ao trabalhador homem, que não vivencia em seu corpo as transformações impostas pela geração de uma família, e não desempenha com a mesma responsabilidade o cuidado com a prole. A partir de uma breve revisão bibliográfica sobre maternidade e trabalho feminino, observou-se a persistência de representações enaltecedoras da maternidade, que pressionam as mulheres para que sejam mães enquanto trabalham - apesar das condições adversas que tornam penosa essa conciliação - e recriminam a escolha por uma destas vivências: a maternidade exclusiva ou o trabalho como prioridade integral, que não inclua o projeto de maternidade. Apontou-se a importância desse debate para o fortalecimento das políticas trabalhistas como proposição objetiva rumo à equidade de gênero na sociedade atual.

Faced to the complexity of contemporary women's life, we raised some questions about the main conflicts of working and motherhood conjunction. The increasing inclusion of women in the market, occupying positions previously exclusive for males, highlights their work skills, but entirely ignores the individuality of women compared to the man, who had not experienced body transformations imposed by the generation of a family, and does not play the same responsibility to the offspring care. Based on a brief literature review about maternity and women's work, we noted the motherhood representation is persistent, demanding women keeping to be mothers even while working - despite the adverse conditions which make those functions painful - and censure the choice for one of those experiences: the maternity exclusively; or primary work and do not include maternity plan. It has been shown the importance of that debate to reinforce the working policies aiming equity of gender in the modern society.

Frente a la complejidad de la vida de la mujer contemporánea, planteamos algunas preguntas sobre los principales conflictos que surgen de la conjunción entre el trabajo y la maternidad. La mayor inclusión de las mujeres en el mercado laboral - y su ascenso a posiciones antes exclusivamente masculinas - puntos clave para el reconocimiento de sus habilidades al trabajo, pero ignora por completo la peculiaridad de su situación en relación al trabajador hombre, que no experimenta las transformaciones corporales impuestas por la formación de una familia y no desarrolla con la misma responsabilidad el cuidado de la prole. A partir de una breve revisión literaria de la maternidad y el trabajo de las mujeres, se ha señalado la persistencia de representaciones consolidadoras de la maternidad al presionarlas a que sean madres mientras trabajadoras - a pesar de las condiciones adversas que hacen dolorosa esta combinación - y la recriminación a la elección de uno de los roles: la maternidad exclusiva; o el trabajo como prioridad integral que no incluya el escenario del ser madre. Este trabajo apunta la importancia sobre este debate para la fortificación de las políticas laborales como proposición objetiva rumbo a la equidad de géneros en la sociedad actual.

Face à la la complexité de la vie des femmes contemporaines, quelques questions se posent sur les principaux conflits qui résultent de la conjonction entre le travail et la maternité. De nos jours, la plus grande inclusion des femmes dans le marché du travail - et leur ascension à des postes auparavant exclusivement masculins - indique la reconnaissance de leurs compétences professionnelles, mais ignore totalement la particularité de leur statut par rapport à l'homme qui travaille, qui ne subit pas dans son corps les transformations imposées pour la génération d'une famille, et ne joue pas avec la même responsabilité de prendre soin de la progéniture. A partir d'une bref analyse de la littérature sur la maternité et le travail des femmes, nous avons constaté la persistance de représentations exaltées de la maternité, qui font pression sur les femmes pour qu'elles soyent mères tout en travaillant - en dépit des conditions défavorables qui rendent pénible cette conciliation - et reprochent la femme qui choisit une de ces expériences: la maternité exclusive; ou le travail comme une priorité complète, qui ne comprend pas la concéption de la maternité. Les auteurs signalent l'importance de ce débat pour le renforcement des politiques de travail en tant que proposition objective envers l'équité des sexes dans la société actuelle.