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2.
Can J Cardiol ; 34(5): 665-669, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29731025

RESUMO

In this report we examine the differences between the 2017 Hypertension Canada and 2017 American College of Cardiology and American Heart Association (ACC/AHA) blood pressure (BP) guidelines regarding the proportions of individuals with a diagnosis of hypertension, BP above thresholds for treatment initiation, and BP below targets using the CARTaGENE cohort. Compared with the 2017 Canadian guidelines, the 2017 ACC/AHA guidelines would result in increases of 8.7% in hypertension diagnosis and 3.4% of individuals needing treatment, with 17.2% having a different BP target. In conclusion, implementing the 2017 ACC/AHA hypertension guidelines in Canada could result in major effects for millions of Canadians.


Assuntos
Hipertensão , Administração dos Cuidados ao Paciente , Canadá , Cardiologia/métodos , Cardiologia/normas , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/normas , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Estados Unidos , Instituições Filantrópicas de Saúde
3.
Can J Diabetes ; 42(2): 205-208, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29602409

RESUMO

Adequate blood pressure control in patients with hypertension remains the pillar of cardiovascular-event prevention. Smoking cessation, reduced dietary salt intake, physical exercise and weight loss contribute to better blood pressure control and reduced cardiovascular morbidity, but alone, they are often insufficient in doing so, and their success is highly dependent on individual patient motivation. Pharmacologic therapy, thus, remains necessary for most patients, and our conception of the optimal way of approaching this therapy has evolved over the past decade. Traditionally, monotherapy using a first-line drug was initiated and uptitrated, with the addition of other antihypertensive agents as needed. The latest Hypertension Canada guidelines, however, now recommend first-line treatment with single-pill combinations in patients without compelling indications for treatment. In this review, we discuss the evidence behind this recommendation and how single-pill combinations can improve patient care.


Assuntos
Anti-Hipertensivos/uso terapêutico , Combinação de Medicamentos , Hipertensão/tratamento farmacológico , Adulto , Gerenciamento Clínico , Humanos
4.
Can J Kidney Health Dis ; 4: 2054358117735563, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29147572

RESUMO

Background: Neutrophil-to-lymphocyte ratio (NLR) was widely studied as a prognostic marker in various medical and surgical specialties, but its significance in nephrology is not yet established. Objective: We evaluated its accuracy as an inflammation biomarker in a dialysis population. Design setting: Single-center retrospective study. Patients: The records of all 550 patients who were treated with hemodialysis (HD) or peritoneal dialysis (PD) from September 2008 to March 2011 were included. Measurements: NLR was calculated from the monthly complete blood count. Methods: Association between NLR and markers of inflammation (C-reactive protein [CRP], serum albumin, and erythropoietin resistance index [ERI]) was measured using Spearman coefficient. Results: In total, 120 patients were eligible for the correlation analyses. We found a positive correlation between NLR and CRP (all patients: r = 0.45, P < .001; HD: r = 0.47, P < .001; PD: r = 0.48, P = .13). NLR and albumin were inversely correlated (r = -0.51, P < .001). Finally, high NLR was associated with a nonsignificant increased ERI, but we have not demonstrated a direct correlation. Limitations: CRP and albumin are not measured routinely and were ordered for a specific clinical reason leading to an indication bias. Also, no relationship with clinical outcome was established. Conclusions: NLR seems to be a good inflammatory biomarker in dialysis in addition to being easily available. However, controlled studies should be conducted to properly assess and validate NLR levels that would be clinically significant and relevant, as well as its prognostic significance and utility in a clinical setting.

5.
Can J Cardiol ; 33(5): 557-576, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28449828

RESUMO

Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension. This year, we introduce 10 new guidelines. Three previous guidelines have been revised and 5 have been removed. Previous age and frailty distinctions have been removed as considerations for when to initiate antihypertensive therapy. In the presence of macrovascular target organ damage, or in those with independent cardiovascular risk factors, antihypertensive therapy should be considered for all individuals with elevated average systolic nonautomated office blood pressure (non-AOBP) readings ≥ 140 mm Hg. For individuals with diastolic hypertension (with or without systolic hypertension), fixed-dose single-pill combinations are now recommended as an initial treatment option. Preference is given to pills containing an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in combination with either a calcium channel blocker or diuretic. Whenever a diuretic is selected as monotherapy, longer-acting agents are preferred. In patients with established ischemic heart disease, caution should be exercised in lowering diastolic non-AOBP to ≤ 60 mm Hg, especially in the presence of left ventricular hypertrophy. After a hemorrhagic stroke, in the first 24 hours, systolic non-AOBP lowering to < 140 mm Hg is not recommended. Finally, guidance is now provided for screening, initial diagnosis, assessment, and treatment of renovascular hypertension arising from fibromuscular dysplasia. The specific evidence and rationale underlying each of these guidelines are discussed.


Assuntos
Anti-Hipertensivos , Determinação da Pressão Arterial/métodos , Diuréticos , Hipertensão , Adulto , Anti-Hipertensivos/classificação , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Canadá/epidemiologia , Comorbidade , Diuréticos/classificação , Diuréticos/uso terapêutico , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Masculino , Conduta do Tratamento Medicamentoso/normas , Pessoa de Meia-Idade , Medição de Risco/métodos
6.
J Transplant ; 2017: 8720283, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28386475

RESUMO

Objectives. The primary objective of this study is to evaluate the use of cinacalcet in the management of hyperparathyroidism in kidney transplant recipients. The secondary objective is to identify baseline factors that predict cinacalcet use after transplantation. Methods. In this single-center retrospective study, we conducted a chart review of all patients having been transplanted from 2003 to 2012 and having received cinacalcet up to kidney transplantation and/or thereafter. Results. Twenty-seven patients were included with a mean follow-up of 2.9 ± 2.4 years. Twenty-one were already taking cinacalcet at the time of transplantation. Cinacalcet was stopped within the first month in 12 of these patients of which 7 had to restart therapy. The main reason for restarting cinacalcet was hypercalcemia. Length of treatment was 23 ± 26 months. There were only 3 cases of mild hypocalcemia. There was no statistically significant association between baseline factors and cinacalcet status a year later. Conclusions. Discontinuing cinacalcet within the first month of kidney transplantation often leads to hypercalcemia. Cinacalcet appears to be an effective treatment of hypercalcemic hyperparathyroidism in kidney transplant recipients. Further studies are needed to evaluate safety and long-term benefits.

7.
Nephrol Dial Transplant ; 32(6): 1047-1052, 2017 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-27448671

RESUMO

Background: Erythropoiesis-stimulating agents (ESAs) are the cornerstone of the treatment for anemia in end-stage renal disease (ESRD) patients. Although a correlation has been established between ESAs and increased tumor growth among patients with cancer-related anemia, an association with a higher incidence of cancer among chronic dialysis patients remains relatively unclear. Methods: We completed a nested case-control study in a cohort of 4574 patients who began chronic dialysis treatment between 1 January 2001 and 31 December 2007 in Quebec, Canada, utilizing dialysis registry and administrative databases exclusively to extract our data. We excluded patients with a prior diagnosis of cancer. Eligible cases were identified by the time of initial cancer diagnosis obtained from either the hospital's discharge or physician billing form. We then randomly selected up to 10 controls for each case. ESA exposure was evaluated between 6 and 9 months prior to the initial cancer diagnosis. The mean weekly exposure was used to categorize ESA usage as either a low dose (<30 µg/week), moderate dose (30-70 µg/week) or high dose (>70 µg/week). We estimated the association between ESAs and the risk of developing cancer using a multivariable conditional logistic regression. Results: We identified 419 cases of cancer and 3895 matched controls during the study period. The use of ESAs was associated with a higher risk of cancer {odds ratio [OR] 1.04 [95% confidence interval (CI) 1.02-1.07]}. Specifically, patients in the high exposure group (>70 µg/week) had an increased risk of developing cancer [OR 1.77 (95% CI 1.18-2.66)] compared with patients in the unexposed group. Conclusion: High-dose ESA was associated with an increased incidence risk of new cancer diagnosis among chronic dialysis patients.


Assuntos
Hematínicos/efeitos adversos , Neoplasias/induzido quimicamente , Idoso , Estudos de Casos e Controles , Relação Dose-Resposta a Droga , Feminino , Hematínicos/uso terapêutico , Humanos , Incidência , Falência Renal Crônica/terapia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Razão de Chances , Diálise Renal , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
8.
Int Urol Nephrol ; 49(2): 325-328, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27822674

RESUMO

PURPOSE: The optimal vitamin D3 therapy for the treatment of secondary hyperparathyroidism (SHPT) in chronic hemodialysis patients is still controversial. Recent studies suggest that uremia in end-stage renal disease is associated with enzymatic hepatic dysfunction altering 25-hydroxylation of vitamin D3. The goal of our study was to compare the efficacy of calcitriol, the fully hydroxylated active form of vitamin D3, to alfacalcidol which needs 25-hydroxylation to be effective, for the treatment of SHPT in chronic hemodialysis patients. METHODS: We retrospectively reviewed 45 chronic hemodialysis patients who were switched from oral alfacalcidol to oral calcitriol for the treatment of SHPT. Parathyroid hormone (PTH), serum calcium and serum phosphorus levels were compared pre- and post-conversion using paired Student's t tests. RESULTS: The mean dose of active vitamin D3 decreased from 3.50 mcg/week at baseline to 2.86 mcg (P < 0001) after the switch from alfacalcidol to calcitriol. PTH significantly decreased from 94.4 to 82.6 pmol/L (-11.8 pmol/L, P = 0.02). The mean corrected calcium increased from 2.17 to 2.25 mmol/L (+0.08 mmol/L, P < 0.001) without any clinically significant hypercalcemia, and phosphorus levels were stable. Results were similar in a subgroup of patients (n = 17) for whom the medication was administrated during the hemodialysis session, ensuring a complete compliance. CONCLUSIONS: According to our study, calcitriol in equal dosage is more effective than alfacalcidol in lowering serum PTH level in chronic hemodialysis patients. This suggests that calcitriol may be the optimal active vitamin D3 for the treatment of SHPT in chronic hemodialysis patients.


Assuntos
Calcitriol , Substituição de Medicamentos/métodos , Hidroxicolecalciferóis , Hiperparatireoidismo Secundário , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Adulto , Idoso , Calcitriol/administração & dosagem , Calcitriol/farmacocinética , Cálcio/sangue , Canadá , Monitoramento de Medicamentos/métodos , Feminino , Humanos , Hidroxicolecalciferóis/administração & dosagem , Hidroxicolecalciferóis/farmacocinética , Hiperparatireoidismo Secundário/diagnóstico , Hiperparatireoidismo Secundário/tratamento farmacológico , Hiperparatireoidismo Secundário/etiologia , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/metabolismo , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Avaliação de Resultados da Assistência ao Paciente , Fósforo/sangue , Diálise Renal/métodos , Estudos Retrospectivos
9.
Res Rep Urol ; 8: 175-179, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27822461

RESUMO

INTRODUCTION: Retroperitoneal fibrosis (RPF) is a rare condition characterized by the presence of inflammatory and fibrous retroperitoneal tissue that often encases the ureters or abdominal organs. This study describes the clinical characteristics, diagnostic methods, and treatments and their effects on renal function. METHODS: We conducted a retrospective analysis of patients diagnosed with RPF at Maisonneuve-Rosemont Hospital. RESULTS: We identified 17 patients with RPF between 1998 and 2013. Eight patients were females (47%), and the mean age was 62±18 years. Eleven patients were idiopathic. Back pain was the most common symptom. All diagnoses were made based on the finding of a retroperitoneal mass on the computed tomography scan. Three patients had histological diagnosis of RPF and seven patients had unspecific changes on their biopsy. Twelve patients needed double-J stents, three patients had a temporary percutaneous nephrostomy, two patients had to have a nephrectomy for refractory ureteral obstruction, and one patient required hemodialysis. Ten patients with idiopathic RPF received medical treatment. In the treated group, only two patients had complete remission of the disease and five patients had improvement of their lesions. There were no deteriorations and only one relapse. Seven patients did not receive any treatment; two of them achieved complete remission, one of them deteriorated, and two of them had no changes. CONCLUSION: Most of our cases of RPF were idiopathic. Almost all treated patients received prednisone and seemed to respond, at least partially. There was a lot of heterogeneity in patient management, which makes it difficult to compare treatment effects. However, treated patients seemed to have more favorable outcomes than those who were not.

10.
Biomark Insights ; 11: 91-4, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27398022

RESUMO

OBJECTIVE: The aim of our study is to describe the changes in urinary and serum levels of novel biomarkers after gadolinium contrast administration in patients with normal renal function. METHODS: We measured four biomarkers in 28 volunteers: interleukin-18 (IL-18), N-acetyl-glucosaminidase (NAG), neutrophil gelatinase-associated lipocalin, and cystatin C. Urinary and serum samples were collected at 0, 3, and 24 hours following gadolinium administration. RESULTS: Baseline serum creatinine was 57.8 ± 34.5 µmol/L and remained stable. Urinary IL-18 levels increased significantly at three hours (10.7 vs. 7.3 ng/mg creatinine; P < 0.05). Similarly, urinary NAG levels increased significantly at three hours (3.9 vs. 2.2 IU/mg creatinine; P < 0.001). For both these markers, the difference was no longer significant at 24 hours. No statistically significant differences were observed for urinary and serum neutrophil gelatinase-associated lipocalin levels and for serum cystatin C levels. CONCLUSIONS: Urinary IL-18 and NAG levels increased transiently after administration of gadolinium-based contrast agents in patients with normal renal function.

11.
Can J Cardiol ; 32(5): 569-88, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-27118291

RESUMO

Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force provides annually updated, evidence-based recommendations to guide the diagnosis, assessment, prevention, and treatment of hypertension. This year, we present 4 new recommendations, as well as revisions to 2 previous recommendations. In the diagnosis and assessment of hypertension, automated office blood pressure, taken without patient-health provider interaction, is now recommended as the preferred method of measuring in-office blood pressure. Also, although a serum lipid panel remains part of the routine laboratory testing for patients with hypertension, fasting and nonfasting collections are now considered acceptable. For individuals with secondary hypertension arising from primary hyperaldosteronism, adrenal vein sampling is recommended for those who are candidates for potential adrenalectomy. With respect to the treatment of hypertension, a new recommendation that has been added is for increasing dietary potassium to reduce blood pressure in those who are not at high risk for hyperkalemia. Furthermore, in selected high-risk patients, intensive blood pressure reduction to a target systolic blood pressure ≤ 120 mm Hg should be considered to decrease the risk of cardiovascular events. Finally, in hypertensive individuals with uncomplicated, stable angina pectoris, either a ß-blocker or calcium channel blocker may be considered for initial therapy. The specific evidence and rationale underlying each of these recommendations are discussed. Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force will continue to provide annual updates.


Assuntos
Anti-Hipertensivos , Determinação da Pressão Arterial , Hipertensão , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial/métodos , Canadá , Medicina Baseada em Evidências , Educação em Saúde , Humanos , Hiperaldosteronismo/tratamento farmacológico , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/prevenção & controle , Medição de Risco , Fatores de Risco
12.
Perit Dial Int ; 36(1): 107-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26838993

RESUMO

The aim of our study was to evaluate the efficacy and bioavailibility of a commonly used oral furosemide dose (500 mg) compared to a 250 mg intravenous (IV) dose in PD patients with significant residual renal function (urine volume > 100 mL). We also evaluated the immediate blood pressure effect in these patients. The data were obtained from a study we performed for the homologation of a 500-mg dose of furosemide by Health Canada.


Assuntos
Diuréticos/farmacocinética , Furosemida/farmacocinética , Diálise Peritoneal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
Clin J Am Soc Nephrol ; 10(12): 2136-42, 2015 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-26576619

RESUMO

BACKGROUND AND OBJECTIVES: Hyperkalemia affects up to 10% of patients with CKD. Sodium polystyrene sulfonate has long been prescribed for this condition, although evidence is lacking on its efficacy for the treatment of mild hyperkalemia over several days. This study aimed to evaluate the efficacy of sodium polystyrene sulfonate in the treatment of mild hyperkalemia. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In total, 33 outpatients with CKD and mild hyperkalemia (5.0-5.9 mEq/L) in a single teaching hospital were included in this double-blind randomized clinical trial. We randomly assigned these patients to receive either placebo or sodium polystyrene sulfonate of 30 g orally one time per day for 7 days. The primary outcome was the comparison between study groups of the mean difference of serum potassium levels between the day after the last dose of treatment and baseline. RESULTS: The mean duration of treatment was 6.9 days. Sodium polystyrene sulfonate was superior to placebo in the reduction of serum potassium levels (mean difference between groups, -1.04 mEq/L; 95% confidence interval, -1.37 to -0.71). A higher proportion of patients in the sodium polystyrene sulfonate group attained normokalemia at the end of their treatment compared with those in the placebo group, but the difference did not reach statistical significance (73% versus 38%; P=0.07). There was a trend toward higher rates of electrolytic disturbances and an increase in gastrointestinal side effects in the group receiving sodium polystyrene sulfonate. CONCLUSIONS: Sodium polystyrene sulfonate was superior to placebo in reducing serum potassium over 7 days in patients with mild hyperkalemia and CKD.


Assuntos
Hiperpotassemia/tratamento farmacológico , Poliestirenos/uso terapêutico , Potássio/sangue , Insuficiência Renal Crônica/complicações , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Método Duplo-Cego , Regulação para Baixo , Feminino , Humanos , Hiperpotassemia/sangue , Hiperpotassemia/diagnóstico , Hiperpotassemia/etiologia , Masculino , Pessoa de Meia-Idade , Poliestirenos/efeitos adversos , Quebeque , Insuficiência Renal Crônica/diagnóstico , Fatores de Tempo , Resultado do Tratamento
15.
Int J Gen Med ; 8: 297-301, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26445558

RESUMO

Thrombotic complications figure among the most frequent causes of mortality in diabetic ketoacidosis (DKA) and hyperosmolar state. We report the case of a 55-year-old woman presenting with DKA whereby a newly discovered patent foramen ovale was found due in part to the observation of bilateral deep vein thrombosis in legs, bilateral multiple pulmonary embolisms, and left subclavian acute artery thrombosis. Diabetes is known as a hypercoagulability state, and DKA is rising as a risk factor for vascular events. The importance of prophylactic anticoagulation should be emphasized in this setting.

17.
Can J Cardiol ; 31(5): 549-68, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25936483

RESUMO

The Canadian Hypertension Education Program reviews the hypertension literature annually and provides detailed recommendations regarding hypertension diagnosis, assessment, prevention, and treatment. This report provides the updated evidence-based recommendations for 2015. This year, 4 new recommendations were added and 2 existing recommendations were modified. A revised algorithm for the diagnosis of hypertension is presented. Two major changes are proposed: (1) measurement using validated electronic (oscillometric) upper arm devices is preferred over auscultation for accurate office blood pressure measurement; (2) if the visit 1 mean blood pressure is increased but < 180/110 mm Hg, out-of-office blood pressure measurements using ambulatory blood pressure monitoring (preferably) or home blood pressure monitoring should be performed before visit 2 to rule out white coat hypertension, for which pharmacologic treatment is not recommended. A standardized ambulatory blood pressure monitoring protocol and an update on automated office blood pressure are also presented. Several other recommendations on accurate measurement of blood pressure and criteria for diagnosis of hypertension have been reorganized. Two other new recommendations refer to smoking cessation: (1) tobacco use status should be updated regularly and advice to quit smoking should be provided; and (2) advice in combination with pharmacotherapy for smoking cessation should be offered to all smokers. The following recommendations were modified: (1) renal artery stenosis should be primarily managed medically; and (2) renal artery angioplasty and stenting could be considered for patients with renal artery stenosis and complicated, uncontrolled hypertension. The rationale for these recommendation changes is discussed.


Assuntos
Determinação da Pressão Arterial/normas , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Guias de Prática Clínica como Assunto , Prevenção Primária/normas , Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial/normas , Canadá , Educação Médica Continuada/normas , Feminino , Humanos , Hipertensão/prevenção & controle , Masculino , Medição de Risco
18.
Int Urol Nephrol ; 47(7): 1165-71, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25982583

RESUMO

PURPOSE: Hyperphosphatemia and metabolic acidosis are frequently encountered in advanced chronic kidney disease (CKD) patients. Correction of metabolic acidosis in patients with advanced CKD leads to a decrease in the progression of renal impairment and improves nutritional outcomes. Lanthanum carbonate is used for control of hyperphosphatemia. This study evaluated the effect of lanthanum carbonate on metabolic acidosis in CKD IV-V patients and in patients on dialysis. METHODS: Retrospective data of patients in whom lanthanum carbonate therapy was initiated were collected from 2009 to 2013 in a single dialysis center. Of the 79 patients in whom lanthanum carbonate was introduced, 51 patients were included in the analysis. Of the 51 patients, 39 patients received chronic hemodialysis, two patients received peritoneal dialysis therapy, and 10 patients had stage IV-V CKD not on dialysis. The primary outcome was the serum bicarbonate change after the introduction of lanthanum carbonate. RESULTS: There was a significant increase in mean serum bicarbonate concentration of 2.79 mmol/L (p ≤ 0.001) compared to baseline. The increase remained in the CKD IV-V patients (2.50 mmol/L, p = 0.005) and in the patients on dialysis (2.81 mmol/L, p < 0.001). Serum bicarbonate remained higher (p > 0.05) than baseline up to 6 months after lanthanum carbonate introduction. CONCLUSION: In this study, lanthanum carbonate introduction increased serum bicarbonate concentration in a small sample of CKD IV-V patients and in patients on dialysis. Further studies are needed to confirm this effect and investigate whether the correction of metabolic acidosis by using lanthanum carbonate in CKD IV-V patients can improve clinical outcomes.


Assuntos
Acidose , Bicarbonatos/sangue , Hiperfosfatemia , Lantânio , Diálise Renal/métodos , Insuficiência Renal Crônica , Acidose/etiologia , Acidose/terapia , Canadá , Quelantes/administração & dosagem , Quelantes/efeitos adversos , Progressão da Doença , Monitoramento de Medicamentos , Feminino , Humanos , Hiperfosfatemia/tratamento farmacológico , Hiperfosfatemia/etiologia , Testes de Função Renal/métodos , Lantânio/administração & dosagem , Lantânio/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Gravidade do Paciente , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/tratamento farmacológico , Insuficiência Renal Crônica/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
19.
Clin J Am Soc Nephrol ; 10(5): 817-24, 2015 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-25818336

RESUMO

BACKGROUND AND OBJECTIVES: Peritoneal dialysis (PD) is associated with an increased risk of infection-related hospitalization (IRH) compared with hemodialysis. The objective of this study was to compare mortality and overall readmission after an IRH between PD and hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This propensity score-matched retrospective cohort study assessed patients undergoing long-term dialysis patients, derived from the Canadian Organ Replacement Register and Régie de l'assurance maladie du Québec, who had at least one IRH between January 2001 and December 2007. Patients were followed until death, kidney transplantation, or end of the study period. To estimate the probability of receiving PD versus hemodialysis, propensity scores were obtained using multivariable logistic regression. Mortality and overall readmission risks after the initial IRH were compared using a Cox survival model. RESULTS: A total of 354 pairs of patients who had at least one IRH were matched for propensity score. During follow-up (median, 1.25 years), 138 hemodialysis patients (24.7/100 patient-years; 95% confidence interval [95% CI], 20.7 to 29.1) and 130 PD patients (21.2/100 patient-years; 95% CI, 17.7 to 25.1) died; 265 hemodialysis patients (144.6/100 patient-years; 95% CI, 127.7 to 163.1) and 299 PD patients (173.2/100 patient-years; 95% CI, 154.1 to 194.0) were readmitted for any cause; and 121 hemodialysis patients (29.7/100 patient-years; 95% CI, 24.7 to 35.5) and 168 PD patients (44.7/100 patient-years; 95% CI, 38.2 to 52.0) were readmitted for an infection. Compared with hemodialysis, PD was not associated with a different mortality risk after an IRH (hazard ratio [HR], 0.87; 95% CI, 0.69 to 1.11). PD was associated with a higher risk of infection-related overall readmission compared with hemodialysis (HR, 1.44; 95% CI, 1.14 to 1.81), but not with the risk of all-cause overall readmission (HR, 1.15; 95% CI, 0.98 to 1.36). CONCLUSIONS: PD was not associated with higher mortality or all-cause overall readmission following an IRH compared with hemodialysis, but PD patients were at higher risk of infection-related overall readmission after IRH. IRHs are associated with significant mortality and overall readmissions. Evaluation of strategies to reduce infections in both hemodialysis and PD recipients are needed to improve patient care and outcomes.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Diálise Renal/efeitos adversos , Diálise Renal/mortalidade , Sepse/mortalidade , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/mortalidade , Pneumonia/microbiologia , Pneumonia/mortalidade , Pontuação de Propensão , Quebeque/epidemiologia , Diálise Renal/métodos , Estudos Retrospectivos , Fatores de Risco , Sepse/etiologia , Fatores de Tempo
20.
CMAJ Open ; 2(2): E109-14, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25077126

RESUMO

BACKGROUND: After cardiovascular disease, infection is the second leading reason for admission to hospital among patients receiving long-term dialysis. We examined whether duration of dialysis treatment influences the rate of infection-related admission to hospital. METHODS: Using provincial administrative databases for Quebec, we built a retrospective cohort of all adults receiving long-term dialysis (hemodialysis or peritoneal dialysis) between 2001 and 2007. We evaluated rates of infection-related admission to hospital according to length of time on dialysis. RESULTS: A cohort of 9822 patients (mean age 66.3 [standard deviation ± 14.7] yr; 39.7% female) were followed for a median of 2.1 (range 1.0-3.9) years. Between 2001 and 2007, infection-related hospital admissions remained stable (from 0.20 to 0.19 per person-year; p = 0.7). All-cause hospital admission rates decreased by 22.9% (from 1.53 to 1.18 per person-year; p < 0.001), and cardiovascular-related admission rates decreased by 46.7% (from 0.45 to 0.24 per person-year; p < 0.001). The rate of infection-related admission remained stable with increasing time on dialysis (p = 0.1); however, both all-cause and cardiovascular-related admission rates decreased with length of time on dialysis (p < 0.001). Standardization of hospital admission rates by age, sex or length of time on dialysis did not change trends. INTERPRETATION: We found a stable rate of infection-related hospital admission between 2001 and 2007 among patients on long-term dialysis, independent of age, sex and length of time on dialysis. A decrease in all-cause and cardiovascular-related admission rates during the same period meant that the proportion of admissions related to infection increased. Because admissions to hospital are potentially preventable, understanding the epidemiology of infection-related admissions may inform future studies on prevention of this serious outcome.

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