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1.
J Nephrol ; 2020 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-32440840

RESUMO

The most common cause of liver disease worldwide is now non-alcoholic fatty liver disease (NAFLD). NAFLD refers to a spectrum of disease ranging from steatosis to non-alcoholic steatohepatitis, causing cirrhosis, and ultimately hepatocellular carcinoma. However, the impact of NAFLD is not limited to the liver. NAFLD has extra-hepatic consequences, most notably, cardiovascular and renal disease. NAFLD and chronic kidney disease share pathogenic mechanisms including insulin resistance, lipotoxicity, inflammation and oxidative stress. Not surprisingly, there has been a recent surge in efforts to manage NAFLD in an integrated way that not only protects the liver but also delays comorbidities such as chronic kidney disease. This concept of simultaneously addressing the main disease target and comorbidities is key to improve outcomes, as recently demonstrated by clinical trials of SGLT2 inhibitors and GLP1 receptor agonists in diabetes. HIF activators, already marketed in China, also have the potential to protect both liver and kidney, as suggested by preclinical data. This review concisely discusses efforts at identifying common pathogenic pathways between NAFLD and chronic kidney disease with an emphasis on potential paradigm shifts in diagnostic workup and therapeutic management.

2.
Curr Vasc Pharmacol ; 2020 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-32096744

RESUMO

Volume overload is the most common complication in end-stage renal disease (ESRD) patients, being directly related to numerous complications including resistant hypertension, cardiac hypertrophy, congestive heart failure or arterial stiffness, among others. Therefore, volume overload is now considered an important risk factor for hard outcomes, like all-cause or cardiovascular mortality. Relying solely on clinical examination for assessing volume overload in ESRD patients lacks sensitivity and specificity. Numerous efforts have been made to identify new methods that could objectively assess volume status; however, each of them has important limitations. This review aims to discuss the most frequently used of these methods (biomarkers, inferior vena cava assessment, lung ultrasonography, bioimpedance analysis and blood volume monitoring) and to compare the advantage of each method vs the overall/clinical strategy.

3.
Angiology ; 71(4): 315-323, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32000517

RESUMO

Several trials have been completed in patients with heart failure (HF) treated with uric acid (UA)-lowering agents with inconsistent results. We aimed to investigate whether lowering UA would have an effect on mortality and cardiovascular (CV) events in patients with HF in a systematic review and meta-analysis. The primary outcome measures were all-cause mortality, CV mortality, CV events, and CV hospitalization in patients with HF. We included 11 studies in our final analysis. Overall, allopurinol treatment was associated with a significant increase in the risk for all-cause mortality (hazard ratio [HR]: 1.24, 95% confidence interval [CI]: 1.04-1.49, P = .02). The trial heterogeneity is high (heterogeneity χ2 = 37.3, I2 = 73%, P < .001). With regard to CV mortality, allopurinol treatment was associated with a 42% increased risk of CV mortality (HR: 1.42, 95% CI: 1.11-1.81, P = .005). There was a trend toward increased CV hospitalization in the same group (HR: 1.21, 95% CI: 0.95-1.53, P = .12). Uric acid-lowering treatments increase all-cause and CV mortality but did not increase CV hospitalization significantly in this study.


Assuntos
Inibidores Enzimáticos/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Xantina Oxidase/antagonistas & inibidores , Alopurinol/uso terapêutico , Febuxostat/uso terapêutico , Insuficiência Cardíaca/mortalidade , Humanos , Oxipurinol/uso terapêutico , Ácido Úrico
4.
Int Urol Nephrol ; 52(3): 541-547, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32008199

RESUMO

BACKGROUND AND OBJECTIVES: Contrast-induced nephropathy (CIN) is a relatively common complication following primary coronary angiography (CAG) or percutaneous coronary intervention (PCI), especially in at-risk patients. The goal of this study is to evaluate the role of pre-procedural serum osmolarity as a risk factor for CIN in patients undergoing elective CAG for stable coronary artery disease (CAD). MATERIALS AND METHODS: A total of 356 stable CAD patients scheduled to undergo CAG or PCI were included in this two-center study. Serum osmolarity was calculated on admission. CIN was defined according to the KDIGO criteria. RESULTS: There were 45 (12.6%) patients who developed CIN 48-72 h after CAG or PCI. CIN patients had a higher prevalence of diabetes (51.1% in those with CIN vs 24.4% in those without CIN, p < 0.001), higher serum glucose (129 mg/dL in those with CIN vs 108 mg/dL in those without CIN, p < 0.001), blood urea nitrogen (22.4 mg/dL in those with CIN vs 19.0 mg/dL in those without CIN, p = 0.01) and serum osmolarity (294.2 mOsm in those with CIN vs 290.1 mOsm in those without CIN, p < 0.001) levels, had received a higher dose of contrast (250 mL in those with CIN vs 200 mL in those without CIN, p = 0.03) but had lower hemoglobin (12.9 g/dL in those with CIN vs 13.6 g/dL in those without CIN, p = 0.04) level. In multivariate analysis, serum osmolarity [odds ratio (OR) 1.11; 95% confidence interval (CI) 1.04-1.18 for each mOsm/L increase; p = 0.001], diabetes (OR 2.43, 95% CI 1.26-4.71; p = 0.01), C-reactive protein (OR 1.04, 95% CI 1.01-1.08 for each mg/dL increase; p = 0.02) and contrast volume (OR 34.66, 95% CI 1.25-962.22 for each L increase; p = 0.04) remained as independent predictors of CIN. Serum sodium, glucose and blood urea nitrogen contributed to the excess serum osmolarity of CIN patients. CONCLUSION: Serum osmolarity is a cheap and widely available marker that can reliably predict CIN after CAG or PCI. Future research should focus on determining a clinically optimal cutoff for serum osmolarity that would warrant preventive interventions. Furthermore, later research may investigate the role of serum osmolarity not only as a risk factor but also as a pathogenetic mechanism underlying CIN.

5.
J Nephrol ; 33(3): 583-590, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31916229

RESUMO

INTRODUCTION: Since inflammation alters vascular permeability, including vascular permeability in the lung, we hypothesized that it can be an amplifier of lung congestion in a category of patients at high risk for pulmonary oedema like end stage kidney disease (ESKD) patients. OBJECTIVE AND METHODS: We investigated the effect modification by systemic inflammation (serum CRP) on the relationship between a surrogate of the filling pressure of the LV [left atrial volume indexed to the body surface area (LAVI)] and lung water in a series of 220 ESKD patients. Lung water was quantified by the number of ultrasound B lines (US-B) on lung US. Six-hundred and three recordings were performed during a 2-year follow up. Longitudinal data analysis was made by the Mixed Linear Model. RESULTS: At baseline, 88 had absent, 101 had mild to moderate lung congestion and 31 severe congestion. The number of US B lines associated with LAVI (r = 0.23, P < 0.001) and serum CRP was a robust modifier of this relationship (P < 0.001). Similarly, in fully adjusted longitudinal analyses US-B lines associated with simultaneous estimates of LAVI (P = 0.002) and again CRP was a strong modifier of this relationship in adjusted analyses (P ≤ 0.01). Overall, at comparable LAVI levels, lung congestion was more pronounced in inflamed than in non-inflamed patients. CONCLUSION: In ESKD systemic inflammation is a modifier of the relationship between LAVI, an integrate measure of LV filling pressure, and lung water. For any given pressure, lung water is increased with higher CRP levels, likely reflecting a higher permeability of the alveolar-capillary barrier.

6.
Kidney Blood Press Res ; 45(1): 131-141, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31865342

RESUMO

BACKGROUND: Hyperuricemia may cause acute kidney injury by activating inflammatory, pro-oxidative and vasoconstrictive pathways. In addition, radiocontrast causes an acute uricosuria, potentially leading to crystal formation. We therefore aimed to investigate the effect of urine acidity and urine uric acid level on the development of contrast-induced nephropathy (CIN) in patients undergoing elective coronary angiography. METHODS: We enrolled 175 patients who underwent elective coronary angiography. CIN was defined as a >25% increase in the serum creatinine levels relative to basal values 48-72 h after contrast use. Prior to coronary angiography and 48-72 h later, serum uric acid, urea, creatinine, bicarbonate levels, and spot uric acid to creatinine ratio (UACR) were measured. RESULTS: Of the 175 subjects included, 29 (16.6%) developed CIN. Those who developed CIN had a higher prevalence of diabetes, higher UACR (0.60 vs. 0.44, p = 0.014), higher contrast volume, and lower serum sodium level. With univariate analysis of a logistic regression model, the risk of CIN was found to be associated with diabetes (p = 0.0016, OR = 3.8 [95% CI: 1.7-8.7]), urine UACR (p = 0.0027, OR = 9.6 [95% CI: 2.2-42.2]), serum sodium (p = 0.0079, OR = 0.8 [95% CI: 0.77-0.96]), and contrast volume (p = 0.0385, OR = 1.8 [95% CI: 1.03-3.09]). In a multiple logistic regression model with stepwise method of selection, diabetes (p = 0.0120, OR = 3.2 [95% CI: 1.3-8.1]) and UACR (p = 0.0163, OR = 6.9 [95% CI: 1.4-33.4]) were the 2 risk factors finally identified. CONCLUSIONS: We have demonstrated that higher urine UACR is associated with the development of CIN in patients undergoing elective coronary angiography.

7.
Int Urol Nephrol ; 51(10): 1805-1813, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31385176

RESUMO

BACKGROUND: The treatment of most glomerulonephritides is still based on a combination of an oral corticosteroid and an alkylating agent, with favorable outcomes, but with serious side effects. The objective of this study was to reduce the cumulative corticosteroid dose in patients with high risk of corticosteroid-related adverse events by replacing daily oral corticosteroids with intravenous (iv) methylprednisolone pulses, associated with monthly pulse i.v. cyclophosphamide (according to KDIGO guidelines) in patients with glomerulonephritis. METHODS: This was a retrospective cohort study conducted at a single nephrology centre. In the course of a 6-month run-in phase, all the patients received non-immunosuppressive pathogenic treatment. High-risk patients, who still had urinary protein excretion of at least 3.5 g per day at the end of these 6 months, received a combination of corticosteroids and cyclophosphamide. Patients were divided in two groups: group 1 (23 patients)-included patients with high risk of corticosteroid-related adverse events received monthly methylprednisolone 1 g/day, 3 days and i.v. cyclophosphamide for 6 months, and group 2 (84 patients)-received oral corticosteroids (as per KDIGO recommended dose) and i.v. cyclophosphamide. The primary outcome-time to a combined end-point of doubling of serum creatinine, ESRD, need for chronic renal replacement therapy or death; secondary outcomes: complete remission [proteinuria < 0.3 g per 24 h (urinary protein-creatinine rate < 300 mg/g [< 30 mg/mmol]]; partial remission (proteinuria > 0.3 but < 3.5 g per 24 h or a decrease in proteinuria by at least 50% from the initial value) and adverse events. RESULTS: At 6 months, there was no difference in the primary composite end-point: 8.7% patients from the group 1 and 20.2% patients from the group 2 (P = 0.199) reached this end-point. Similar data were also recorded at 12 months. Secondary end-points were also similar between treatment groups. More patients receiving oral corticosteroids experienced infections, but without statistical significance. CONCLUSION: Our data indicate that low i.v. dose corticosteroids and cyclophosphamide administered monthly in patients with high risk of corticosteroid-related adverse events and primary glomerulonephritis are equally effective, with fewer metabolic disorders and infections.


Assuntos
Ciclofosfamida/administração & dosagem , Glomerulonefrite/tratamento farmacológico , Glucocorticoides/administração & dosagem , Imunossupressores/administração & dosagem , Metilprednisolona/administração & dosagem , Administração Intravenosa , Adulto , Estudos de Coortes , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
J Clin Monit Comput ; 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31201590

RESUMO

Water retention and intercompartmental redistribution occur frequently in association with adverse postoperative outcomes, yet the available strategies for non-invasive assessment are limited. One such approach for evaluating body water composition in various circumstances is bio-electrical impedance analysis (BIA). This study aims to appraise the usefulness of the Body Composition Monitor (BCM, Fresenius Medical Care, Germany) in assessing body fluid composition and intercompartmental shifts before and after open major abdominal surgery. This prospective, clinician blinded observational study enrolled all the patients scheduled consecutively for elective major open abdominal surgery during a 1-year period starting from January 1st, 2016. BIA parameters-total body water (TBW), extracellular water (ECW), intracellular water (ICW), absolute fluid overload (AFO), and relative fluid overload (RFO) were measured before and after surgery. The results were compared with fluid balance and outcome parameters such as organ dysfunction, ICU-and hospital length of stay (-LOS). The study population included 71 patients aged 60.2 ± 12 of whom 60.6% men and with a BMI of 26.3 ± 5.1 kg/m2. Postoperative acute kidney injury, respiratory dysfunction, and infections occurred in 14.0%, 19.7% and 28.1% of cases, respectively. The median LOS in ICU was 20 h and the hospital-LOS was 10 days. Positive intraoperative fluid balance (2.4 ± 1.0 L) resulted in a significant increase of TBW (1.4 ± 2.4 L) and of ECW (1.4 ± 1.2 L). Intraoperative fluid balance significantly correlated with TBW change (r = 0.23, p = 0.04) and with AFO change (r = 0.31, p < 0.01). A significant correlation was found between pre- and postoperative AFO and RFO on one hand, and ICU-LOS on the other. BIA may be a useful tool for the perioperative assessment of volume status.

9.
Trials ; 20(1): 236, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023358

RESUMO

BACKGROUND: In routine intensive care unit (ICU) practice, fluids are often administered without a safety limit, which may lead to fluid overload and decreased survival. Recently, B-lines score (BLS) has been validated as a lung ultrasound (LUS) quantification of pulmonary congestion. This suggests that LUS may provide a safety threshold to conduct fluid therapy and to avoid overhydration. However, there is no randomized study to test the utility of LUS in guiding fluid management in ICU patients by using a pre-specified BLS cut-off value as a threshold for fluid removal. METHODS: LUS Guided Fluid Management Protocol for the Critically Ill Patient is a prospective, multi-centre, randomized controlled trial. Five hundred ICU patients will be randomly assigned in a 1:1 ratio, to protocolized LUS-based fluid management or usual care. The trial intervention will start on ICU admission and will consist in daily assessment of BLS and triggered evacuation of excessive fluids with loop diuretics (Furosemide) when BLS ≥ 15. If rebalancing volume status with diuretics fails, forced evacuation by ultrafiltration will be used. The main endpoint is death from all causes at 28 days from randomization. The secondary outcomes are presence and time-course evolution of organ dysfunctions, ICU- and hospital length of stay, all-cause mortality at 90 days, and health economics data. DISCUSSION: If study results will show that LUS guided fluid management protocol improves outcome in ICU patients, it will be the base for other studies to refine this protocol or track those categories of critically ill patients to whom it may bring maximum benefits. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03393065 . Registered on 8 January 2018.


Assuntos
Cuidados Críticos/métodos , Estado Terminal/terapia , Hidratação/métodos , Pulmão/diagnóstico por imagem , Ultrassonografia , Estado Terminal/mortalidade , Hidratação/efeitos adversos , Hidratação/mortalidade , Nível de Saúde , Humanos , Unidades de Terapia Intensiva , Estudos Multicêntricos como Assunto , Valor Preditivo dos Testes , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Romênia , Fatores de Tempo , Resultado do Tratamento
10.
Nephrol Dial Transplant ; 34(8): 1385-1393, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30624712

RESUMO

BACKGROUND: Both baseline fluid overload (FO) and fluid depletion are associated with increased mortality risk and cardiovascular complications in haemodialysis patients. Fluid status may vary substantially over time, and this variability could also be associated with poor outcomes. METHODS: In our retrospective cohort study, including 4114 haemodialysis patients from 34 Romanian dialysis units, we investigated both all-cause and cardiovascular mortality risk according to baseline pre- and post-dialysis volume status, changes in pre- and post-dialysis fluid status during follow-up (time-varying survival analysis), pre-post changes in volume status during dialysis and pre-dialysis fluid status variability during the first 6 months of evaluation. RESULTS: According to their pre-dialysis fluid status, patients were stratified in the following groups: normovolaemic with an absolute FO (AFO) compartment between -1.1 and 1.1 L, fluid depletion with an AFO below -1.1 L, moderate FO with an AFO compartment >1.1 but <2.5 L and severe FO with the AFO compartment >2.5 L. Baseline pre-dialysis FO and fluid depletion patients had a significantly elevated risk of all-cause mortality risk {hazard ratio [HR] 1.53 [95% confidence interval (CI) 1.22-1.93], HR 2.04 (95% CI 1.59-2.60) and HR 1.88 (95% CI 1.07-3.39) for moderate FO, severe FO and fluid depletion, respectively}. In contrast, post-dialysis fluid depletion was associated with better survival [HR 0.71 (95% CI 0.57-0.89)]. Similar results were found when using changes in pre- or post-dialysis fluid status during follow-up (time-varying values): FO patients had an increased risk of all-cause [moderate FO: HR 1.39 (95% CI 1.11-1.75); severe FO: HR 2.29 (95% CI 2.01-3.31] and cardiovascular (CV) mortality [moderate FO: HR 1.34 (95% CI 1.05-1.70); severe FO: HR 2.34 (95% CI 1.67-3.28)] as compared with normohydrated patients. Using pre-post changes in volume status during dialysis, we categorized the patients into six groups: Group 1, AFO <-1.1 L pre- and post-dialysis; Group 2, AFO between -1.1 and 1.1 L pre-dialysis and <-1.1 L post-dialysis (the reference group); Group 3, AFO between -1.1 and 1.1 L pre- and post-dialysis; Group 4, AFO >1.1 L pre-dialysis and <-1.1 L post-dialysis; Group 5, AFO >1.1 L pre-dialysis and between -1.1 and 1.1 L post-dialysis; Group 6, AFO >1.1 L pre- and post-dialysis. Using the baseline values, only patients in Groups 1, 5 and 6 maintained an increased risk for all-cause mortality as compared with the reference group. Additionally, CV mortality risk was significantly higher for patients in Groups 5 and 6. When we applied the time-varying analysis, patients in Groups 1, 5 and 6 had a significantly higher risk for both all-cause and CV mortality risk. In the last approach, the highest risk for the all-cause mortality outcome was observed for patients with high-amplitude fluctuation during the first 6 months of evaluation [HR 2.75 (95% CI 1.29-5.84)]. CONCLUSION: We reconfirm the association between baseline pre- and post-dialysis volume status and mortality in dialysis patients; additionally, we showed that greater fluid status variability is independently associated with higher mortality.

11.
J Clin Hypertens (Greenwich) ; 20(11): 1587-1594, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30295011

RESUMO

Accumulating evidence indicates that higher levels of salt intake are associated with higher blood pressure levels. The aim of our analysis was to test the hypothesis that the effect of urinary sodium excretion (UNaV) on systolic blood pressure (SBP) is mediated through estimated glomerular filtration rate (eGFR) and arterial stiffness and also to test the direction of the relationship between eGFR and arterial stiffness, in both hypertensive and normotensive patients. We assessed the potential for connection between UNaV and SBP and mediators (eGFR and pulse wave velocity [PWV]) of this relationship using structural equation models of data from 1599 adults ≥18 years of age and without chronic kidney disease who participated in the Third Epidemiologic Study concerning the Prevalence of Arterial Hypertension and Cardiovascular Risk in Romania (SEPHAR III). In hypertensive patients, the indirect effect, mediated through PWV, of UNaV on SBP was 23.9% and 27.7% of the total effect of UNaV on SBP, while in normotensive patients the contribution of PWV to the total effect of UNaV on SBP was slightly lower (15.9% and 18.3% of the total effect of UNaV on SBP). Taken together, our findings support the conclusion that UNaV influences SBP, both directly and indirectly, through the effect on PWV.


Assuntos
Hipertensão/fisiopatologia , Cloreto de Sódio na Dieta/efeitos adversos , Sódio/efeitos adversos , Rigidez Vascular/fisiologia , Adulto , Idoso , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Doenças Cardiovasculares/epidemiologia , Sistema Cardiovascular/fisiopatologia , Taxa de Filtração Glomerular , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Pessoa de Meia-Idade , Análise de Onda de Pulso/métodos , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/fisiopatologia , Fatores de Risco , Romênia/epidemiologia , Sódio/administração & dosagem , Sódio/urina , Cloreto de Sódio na Dieta/administração & dosagem , Sístole
12.
J Clin Hypertens (Greenwich) ; 20(10): 1447-1454, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30232829

RESUMO

It is classically thought that it is the amount of salt that is critical for driving acute blood pressure responses. However, recent studies suggest that blood pressure responses, at least acutely, may relate to changes in serum osmolality. Here, we test the hypothesis that acute blood pressure responses to salt can be altered by concomitant water loading. Ten healthy patients free of any disease and medication underwent 4 interventions each a week apart in which they took 300 mL of lentil soup with no salt (visit 1), lentil soup with 3 g salt (visit 2), or lentil soup with 3 g salt and 500 mL water (visit 3) or 750 mL water (visit 4). At each visit, hourly blood measurements and blood pressure measurements (baseline, 1st, 2nd, 3rd, and 4th hour) were performed and plasma osmolarity, sodium and copeptin levels were measured. Patients receiving the 3 g salt showed a 6 mOsm/L change in osmolality with a 2.5 mmol/L change in plasma sodium and 10 mm Hg rise in systolic blood pressure at 2 hours. When the same patients drank salty soup with water, the changes in plasma osmolarity, plasma sodium, and blood pressure were prevented. The ability to raise blood pressure acutely with salt appears dependent on changes in plasma osmolality rather than the amount of salt. Our findings suggest that concurrent intake of water must be considered when evaluating the role of salt in blood pressure.


Assuntos
Pressão Sanguínea/fisiologia , Ingestão de Alimentos/fisiologia , Concentração Osmolar , Cloreto de Sódio na Dieta/efeitos adversos , Determinação da Pressão Arterial/métodos , Índice de Massa Corporal , Cloretos/sangue , Feminino , Aromatizantes/efeitos adversos , Aromatizantes/farmacologia , Glicopeptídeos/sangue , Humanos , Masculino , Período Pós-Prandial , Sódio/sangue , Cloreto de Sódio na Dieta/administração & dosagem , Cloreto de Sódio na Dieta/farmacologia , Sístole
13.
Int Urol Nephrol ; 50(8): 1489-1495, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29974404

RESUMO

PURPOSE: The objective of this study is to investigate the impact of the temporary loop ileostomy on renal function and also to assess the factors associated with the change in renal function observed between the index surgery (the moment of the radical surgical procedure) and the closure of the ileostomy (the moment of the secondary surgical act of suppression of the ileostomy). METHODS: A total of 69 rectal cancer patients from a single referral surgical unit who had a loop ileostomy during low anterior resection of the rectum were included in this study. Serum creatinine levels were evaluated, and estimated glomerular filtration rate (eGFR) was calculated prior to index surgery and closure of the ileostomy. RESULTS: During this time interval, there was a significant decrease in eGFR levels (mean difference - 4.5 mL/min/1.73 m2, 95% CI - 7.8 to - 1.3 mL/min/1.73 m2), and also a significant increase in the serum creatinine values (mean difference 0.07, 95% CI 0.02-0.12 mg/dL). The eGFR decrease was more pronounced in diabetic patients, in those with a baseline Charlson Comorbidity Index score ≥ 1 or in those that received chemotherapy. In a multivariable regression analysis, the use of neoadjuvant chemotherapy was the only variable significantly associated with the change in eGFR levels between the two surgical interventions. CONCLUSION: Renal function impairment is an important event that the surgeon has to take into consideration when deciding upon opting for a loop ileostomy to temporarily defunction a colorectal anastomosis.


Assuntos
Taxa de Filtração Glomerular/fisiologia , Ileostomia/efeitos adversos , Rim/fisiopatologia , Complicações Pós-Operatórias/epidemiologia , Neoplasias Retais/cirurgia , Reto/cirurgia , Anastomose Cirúrgica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Romênia/epidemiologia , Taxa de Sobrevida/tendências , Fatores de Tempo
14.
Obes Surg ; 28(12): 3815-3833, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30054877

RESUMO

BACKGROUND/OBJECTIVE: Although promising, data regarding the renal impact and safety of bariatric surgery (BS) are insufficient. We aimed at investigating the benefits and harms of BS for weight loss on kidney function. METHODS: A systematic review and meta-analysis of observational studies reporting data about the impact of BS (any techniques) on serum/plasma creatinine, creatinine clearance, glomerular filtration rate (GFR), proteinuria, nephrolithiasis, and need for renal replacement therapy (RRT)) was performed. Obese adults (non-chronic kidney disease (CKD), CKD or transplanted patients) that underwent BS for weight loss were included. After searching MEDLINE (inception to August 2017), the Cochrane Library (Issue 10-12, October 2017), and the websiteclinicaltrials.gov (August 2017), data were extracted and summarized using a random-effects model. RESULTS: The final analysis included 23 cohort studies, comprising 3015 participants. Compared with renal function before treatment, BS significantly decreased serum creatinine level (mean difference (MD), - 0.08 mg dl-1; 95% confidence interval (CI), - 0.10 to - 0.06); p < 0.001) and proteinuria (MD, - 0.04 g 24 h-1; 95% CI, - 0.06 to - 0.02; p < 0.001) in the overall group. GFR significantly improved 6 months or more after BS both in the hyperfiltration and CKD subgroups. Renal function also tended to improve in renal transplant patients. Data on nephrolithiasis and the need for RRT were scarce or not reported. CONCLUSIONS: BS apparently has positive effects on kidney function and tends to normalize GFR across different categories of renal impairment (hyperfiltration and CKD patients).


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Insuficiência Renal Crônica , Humanos , Rim/fisiologia , Testes de Função Renal , Obesidade Mórbida/complicações , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia
17.
Blood Purif ; 46(1): 34-47, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29649794

RESUMO

Volume overload is an important, may be the foremost, independent prognostic factor determining the outcome of hemodialysis patients. Therefore, it is crucial to measure fluid status of these patients and avoid volume overload. This review aims to evaluate volume overload, its effects on patients with renal diseases and current methodologies measuring volume status in the body. These techniques will be first classified as clinical evaluation and non-clinical and/or instrumental techniques, which includes biomarkers, ultrasonography, relative blood volume monitoring, bioimpedance, echocardiography, pulmonary artery catheterization, esophageal and/or suprasternal Doppler, and blood viscosity. Advantages and limitations of these different techniques will be reviewed extensively by comparing each other. At last, insights gained from this review can highlight the future prospects in this active area of research.


Assuntos
Volume Sanguíneo , Diálise Renal/métodos , Desequilíbrio Hidroeletrolítico/diagnóstico , Impedância Elétrica , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Ultrassonografia , Desequilíbrio Hidroeletrolítico/diagnóstico por imagem
18.
Int Urol Nephrol ; 50(5): 885-904, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29344881

RESUMO

The prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) is increasing steadily. CKD does not only relate to morbidity and mortality but also has impact on quality of life, depression and malnutrition. Such patients often have significantly decreased physical activity. Recent evidence suggests that low physical activity is associated with morbidity, mortality, muscle atrophy, quality of life impairment, cardiovascular outcomes and depression. Based on this, it is now recommended to regularly improve the physical activity of these patients. Furthermore, studies have shown the beneficial effects of various exercise programs with respect to outcomes such as low physical activity muscle atrophy, quality of life, cardiovascular outcomes and depression. Despite these encouraging findings, the subject is still under debate, with various aspects still unknown. In this review, we tried to critically summarize the existing studies, to explore mechanisms and describe future perspectives regarding physical activity in CKD/ESRD patients.


Assuntos
Exercício Físico/fisiologia , Qualidade de Vida , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/psicologia , Pressão Sanguínea , Composição Corporal , Cognição , Depressão/etiologia , Exercício Físico/psicologia , Teste de Esforço , Humanos , Força Muscular
19.
Cerebrovasc Dis ; 45(1-2): 33-41, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29316564

RESUMO

BACKGROUND: Although chronic kidney disease (CKD) is an independent risk factor for stroke, official recommendations for the primary prevention of stroke in CKD are generally lacking. SUMMARY: We searched PubMed and ISI Web of Science for randomised controlled trials, observational studies, reviews, meta-analyses and guidelines referring to measures of stroke prevention or to the treatment of stroke-associated risk factors (cardiovascular disease in general and atrial fibrillation (AF), arterial hypertension or carotid artery disease in particular) among the CKD population. The use of oral anticoagulation in AF appears safe in non-end stage CKD, but it should be individualized and preferably based on thromboembolic and bleeding stratification algorithms. Non-vitamin K antagonist oral anticoagulants with definite dose adjustment are generally preferred over vitamin K antagonists in mild and moderate CKD and their indications have started being extended to severe CKD and dialysis also. Aspirin, but not clopidogrel, has limited indications for reducing the risk for atherothrombotic events in CKD due to its increased bleeding risk. Carotid endarterectomy has shown promising results for stroke risk reduction in CKD patients with high-grade symptomatic carotid stenosis. The medical treatment of arterial hypertension in CKD often fails to efficiently lower blood pressure values, but recent data regarding the use of interventional procedures such as renal denervation, baroreflex activation therapy or renal artery stenting are encouraging. Key Messages: In the absence of clear guidelines and protocols, primary prevention of stroke in CKD patients remains a subtle art in the hands of the clinicians. Nevertheless, refraining CKD patients from standard therapies often worsens their prognosis.


Assuntos
Anticoagulantes/administração & dosagem , Procedimentos Endovasculares , Inibidores da Agregação de Plaquetas/administração & dosagem , Prevenção Primária/métodos , Insuficiência Renal Crônica/terapia , Acidente Vascular Cerebral/prevenção & controle , Idoso , Anticoagulantes/efeitos adversos , Tomada de Decisão Clínica , Comorbidade , Procedimentos Endovasculares/efeitos adversos , Medicina Baseada em Evidências , Feminino , Hemorragia/induzido quimicamente , Humanos , Rim/fisiopatologia , Masculino , Seleção de Pacientes , Inibidores da Agregação de Plaquetas/efeitos adversos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/fisiopatologia , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
20.
Am J Kidney Dis ; 71(3): 412-422, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29274919

RESUMO

Adequate assessment of fluid status is an imperative objective in the management of all types of patients in cardiology, intensive care, and especially nephrology. Fluid overload is one of the most common modifiable risk factors directly associated with hypertension, heart failure, left ventricular hypertrophy, and eventually, higher morbidity and mortality risk in these categories of patients. Different methods are commonly used to determine fluid status (eg, clinical assessment, natriuretic peptide concentrations, echocardiography, inferior vena cava measurements, or bioimpedance analysis). In recent years, lung ultrasonography (LUS), through the assessment of extravascular lung water, has received growing attention in clinical research. This article summarizes available studies that compare LUS with other methods for fluid status assessment in patients with kidney diseases. At the same time, it also presents the association of LUS with different outcomes (physical functioning, mortality, and cardiovascular events) in the same population. It appears that this simple bedside noninvasive technique has significant clinical potential in nephrology.


Assuntos
Insuficiência Cardíaca/terapia , Falência Renal Crônica/terapia , Edema Pulmonar/diagnóstico por imagem , Diálise Renal/efeitos adversos , Ultrassonografia Doppler/métodos , Desequilíbrio Hidroeletrolítico/diagnóstico por imagem , Idoso , Ecocardiografia Doppler/métodos , Feminino , Seguimentos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/metabolismo , Edema Pulmonar/etiologia , Edema Pulmonar/mortalidade , Diálise Renal/métodos , Medição de Risco , Taxa de Sobrevida , Resultado do Tratamento , Desequilíbrio Hidroeletrolítico/etiologia
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