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1.
BMJ Open ; 11(9): e050833, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34475182

RESUMO

INTRODUCTION: Diabetic foot disease is a common condition globally and is over-represented in indigenous populations. The propensity for patients with diabetic foot disease to undergo minor or major limb amputation is a concern. Diabetic foot disease and lower limb amputation are debilitating for patients and have a substantial financial impact on health services. The purpose of this multicentre study is to prospectively report the presentation, management and outcomes of diabetic foot disease, to validate existing scoring systems and assess long term outcomes for these patients particularly in relation to major limb amputation. METHODS AND ANALYSIS: This is a multisite, international, prospective observational study, being undertaken at Waikato Hospital, New Zealand (NZ); Sir Charles Gairdner Hospital, the Royal Adelaide Hospital and the Queen Elizabeth Hospital, Australia. Consecutive participants with diabetic foot disease that meet inclusion criteria and agree to participate will be recruited from multidisciplinary team diabetic foot clinic, vascular clinic, dialysis and admission to hospital. Follow-up of participants will occur at 1, 3, 6 and 12 months. At recruitment and follow-up reviews, information about service details, demographic and clinical history, wound data and discharge information will be recorded. The primary outcomes are the time to wound healing, major amputation, overall mortality and amputation-free survival at 12 months. This study started in NZ in August 2020 and will commence in Australian sites in early 2021. ETHICS AND DISSEMINATION: New Zealand Central Health and Disability Ethics Committee (20/CEN/122), Waikato DHB Research Department (RDO020044), Quality Improvement HoD Sir Charles Gairdner Hospital (39715) and the Central Adelaide Local Health Network (CALHN) Human Research Ethics Committee (13928). Results will be presented at international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12621000337875).


Assuntos
Diabetes Mellitus , Pé Diabético , Austrália/epidemiologia , Pé Diabético/epidemiologia , Pé Diabético/cirurgia , Humanos , Estudos Multicêntricos como Assunto , Nova Zelândia/epidemiologia , Estudos Observacionais como Assunto , Diálise Renal , Temefós
2.
Niger J Clin Pract ; 24(9): 1332-1337, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34531346

RESUMO

Background: Hemodialysis patients develop many physical and psychosocial symptoms associated with chronic kidney disease and its treatment. The presence of these symptoms also adversely affects an individual's activities of daily living. Aim: The aim of this study was to evaluate the symptoms seen in hemodilaysis patients and to examine the effect on daily living activities. Materials and Methods: This was a cross-sectional descriptive study carried out on 126 patients in two dialysis centers in Turkey. Patient Information Form, Dialysis Symptom Index (DSI) and Katz Activities of Daily Living Scale (KADL) were used as data collection tools. Results: The most frequent symptoms described by the patients undergoing hemodialysis were tiredness, sadness, and muscle-joint pain. The mean of the DSI was 30.03 (SD: 14.7). There was a statistically significant relationship between dialysis symptom index and disease duration and hemodialysis vintage (P < 0.05). In addition, the mean score of the Patients' KADL was 14.48 (SD: 2.55). Eighty-two (65.1%) patients maintain their daily living activities independently. On the other hand, 26.2% of the dialysis patients maintained their daily living activities as semi-dependent, while 8.7% were totally dependent on others. A statistically significant relationship was found between KADL, marital status, year of dialysis and presence of another chronic disease (P < 0.05). There was statistically significant relationship between DSI and KADL. In hemodilaysis patients, as the DSI score increased, the dependence on daily living activities increased. Conclusion: The symptoms seen in patients have a negative effect on maintaining their daily living activities. Health workers should perform symptom evaluation in patients undergoing dialysis. Thus, each patient-specific individualized care plan should be designed for effective management of these symptoms in patients. Effective symptom management will be effective in maintaining patients' daily living activities.


Assuntos
Atividades Cotidianas , Qualidade de Vida , Estudos Transversais , Fadiga , Humanos , Diálise Renal
3.
Best Pract Res Clin Anaesthesiol ; 35(3): 449-459, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34511232

RESUMO

Coronavirus disease (COVID-19) causes many deleterious effects throughout the body. Prior studies show that the incidence of acute kidney injury in COVID-19 patients could be as high as 25%. There are also autopsy reports showing evidence of viral tropism to the renal system. In this regard, COVID-19 can damage the kidneys and increase a patient's risk of requiring dialysis. Available evidence suggests that renal involvement in COVID-19 infection is not uncommon, and there has been an increased incidence of chronic kidney disease related to the pandemic. In this literature analysis, we address COVID-19 and its effects on the renal system, including the pathophysiologic mechanisms. We also address current studies on the causes of injury to the renal system, the cause of kidney failure, its effect on mortality, the impact on dialysis patients, and the impact on renal transplant patients. COVID-19 disease may have unique features in individuals on chronic dialysis and kidney transplant recipients, requiring increased vigilance in limiting viral transmission in perioperative, in-patient, and dialysis center settings.


Assuntos
COVID-19/fisiopatologia , Nefropatias/fisiopatologia , Rim/fisiopatologia , COVID-19/epidemiologia , COVID-19/terapia , Humanos , Rim/virologia , Nefropatias/epidemiologia , Nefropatias/terapia , Nefropatias/virologia , Diálise Renal/métodos , Diálise Renal/tendências , Resultado do Tratamento
4.
BMC Health Serv Res ; 21(1): 935, 2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34496853

RESUMO

BACKGROUND: Registered dietitians are rarely employed at community pharmacies in Japan, even though dietetic advice might benefit some patients. OBJECTIVE: To clarify the present status of dietetic consultation provided by registered dietitians and their collaboration with pharmacists in community pharmacies. METHODS: We conducted a cross-sectional questionnaire-based survey of pharmacists and registered dietitians who work in community pharmacies. The surveyed items were: frequency of dietetic consultation, awareness of one's knowledge and ability to conduct dietetic consultation, concerns, pharmacists' recognition of the need for nutritional support at community pharmacies, and cooperation between registered dietitians and pharmacists. RESULTS: Sixty-six registered dietitians, 53 pharmacists in pharmacies with registered dietitians/dietitians, and 110 pharmacists in pharmacies without registered dietitians/dietitians responded. The frequency of dietetic consultation regarding obesity and hypertension was significantly higher for registered dietitians than for pharmacists. The ability to conduct dietetic consultation regarding diseases/conditions such as kidney disease not requiring dialysis, hyperuricemia, gout, obesity and hypertension was also significantly higher for dietitians than pharmacists. More than 70% of pharmacists recognized the importance of nutritional support at community pharmacies, while 56.1% of registered dietitians noted that they were not able to fully utilize their occupational abilities. Registered dietitians were divided into two groups: registered dietitians who answered that they were able to utilize their occupational abilities and those that answered they were not. The former group was more likely to ask pharmacists about patients' medication for dietetic consultation and to be asked to provide dietetic consultation to patients. The latter group was more likely to find difficulty in scheduling dietetic consultation. CONCLUSION: Our results suggest that registered dietitians in community pharmacies have a greater explanatory ability than pharmacists concerning nutritional and dietary management for patients. It may be important for pharmacists to improve cooperation with registered dietitians by providing more opportunities for dietetic consultation.


Assuntos
Serviços Comunitários de Farmácia , Dietética , Nutricionistas , Farmácias , Estudos Transversais , Humanos , Farmacêuticos , Papel Profissional , Encaminhamento e Consulta , Diálise Renal , Inquéritos e Questionários
5.
Pan Afr Med J ; 39: 85, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34466187

RESUMO

End stage renal failure requires substitution therapy, including hemodialysis. Before initiation, patients and their entourage receive information on renal disease and treatment options. The purpose of this study is to assess the level of knowledge as well as the opinion of patients on haemodialysis and of their entourage on chronic kidney disease and substitution therapies. We conducted a cross-sectional descriptive study in the Department of Haemodialysis at the Sylvanus Olympio University Hospital (CHU-SO) from 29 July to 19 August 2020. The study population was composed by all the haemodialysis patients in the Department of Haemodialysis at the CHU-SO and by their accompanying persons who gave their free and informed consent. Anonymous survey was used to collect data. Data collection and statistical analysis were carried out using the Epi Info software 7.2.2.6. Eighty-one patients and 79 accompanying persons were interviewed. The average ages of patients and their accompanying persons were 49.7 years ± 13.5 and 39,6years ± 13.2 respectively. All patients knew their disease and 94% of accompanying persons were informed about their parents' disease. Hemodialysis was considered very expensive by 95.1% of patients. Patients stated that improved quality of life was the most known benefit of hemodialysis (80.2%) while 15% also thought that renal transplantation was equally effective. The majority of accompanying persons (85%) stated that hemodialysis was the best treatment. Haemodialysis education program for patients and their accompanying persons is essential to better overall management of haemodialysis patients.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Falência Renal Crônica/terapia , Qualidade de Vida , Diálise Renal , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
6.
BMJ Case Rep ; 14(9)2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493557

RESUMO

Renal transplantation is the treatment of choice for patients with end-stage renal disease. While transplantation improves the quality of life and reduces the mortality risk for most patients when compared with maintenance dialysis, it introduces significant morbidity associated with induction and maintenance immune suppression. Sirolimus, a mammalian target of rapamycin (mTOR) inhibitor, is frequently used as a second-line maintenance immunosuppressive agent in solid organ transplant recipients. Sirolimus may, however, have adverse vascular effects and has previously been shown to induce endothelial cell dysfunction and impaired nitric oxide production in vitro. Sirolimus-eluting coronary artery stents have been associated with rare reports of severe coronary artery vasospasm; however, systemic sirolimus therapy has not previously been associated with vasospastic complications.


Assuntos
Vasoespasmo Coronário , Stents Farmacológicos , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Vasoespasmo Coronário/induzido quimicamente , Vasos Coronários/diagnóstico por imagem , Humanos , Imunossupressores/efeitos adversos , Qualidade de Vida , Diálise Renal , Sirolimo/efeitos adversos , Espasmo , Resultado do Tratamento
7.
Clin Med (Lond) ; 21(5): e556-e558, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34507945

RESUMO

While all patients with chronic disease have undoubtedly been affected by the ongoing SARS-CoV-2 (COVID-19) pandemic, individuals with end-stage renal failure have suffered significant excess morbidity and mortality. Patients on haemodialysis have received extensive research and media attention into their vulnerability to the disease; however, those receiving peritoneal dialysis (PD) have been much less visible. We surveyed a selection of patients from a cohort receiving PD at a tertiary renal unit in Birmingham, UK. We devised a questionnaire looking at patients' experience of shielding, accessing both dialysis and general medical care during the pandemic, and their thoughts about the pandemic and the future. Concerning findings were apparent from this. Attending hospital was the most commonly cited reason for being unable to shield, and multiple patients experienced difficulties accessing care while unwell during this period. Worryingly, 58% of respondents indicated that they feel negatively, or feel ambivalent, about the future. Patients receiving PD have suffered significantly during the COVID-19 pandemic and face ongoing difficulties and risks while accessing medical care. It is vital that this cohort is not forgotten in the planning of renal services during the pandemic, and that special attention is paid to both their physical and mental health.


Assuntos
COVID-19 , Falência Renal Crônica , Diálise Peritoneal , Humanos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Pandemias , Diálise Peritoneal/efeitos adversos , Diálise Renal , SARS-CoV-2
8.
Zhonghua Xin Xue Guan Bing Za Zhi ; 49(9): 880-885, 2021 Sep 24.
Artigo em Chinês | MEDLINE | ID: mdl-34530595

RESUMO

Objective: To evaluate the safety and effectiveness of left atrial appendage occlusion (LAAO) in patients with atrial fibrillation and end-stage renal disease undergoing long-term hemodialysis. Methods: Six patients with AF and end-stage renal disease(ESRD)on long term hemodialysis who underwent LAAO from March 2017 to March 2021 in Beijing Anzhen Hospital were enrolled. Baseline characteristics such as age, sex, types of arrhythmia, stroke and bleeding score, and continuous dialysis time were collected. Four patients underwent LAAO, two patients underwent the combined procedure of catheter ablation and LAAO. Perioperative treatment and serious complications were recorded. Transesophageal echocardiography was repeated at 45 days and 60 days after the procedure. Telephone follow-up was conducted at 3, 6 and 12 months after the procedure, and every 6 months thereafter. Thromboembolism and major bleeding events and survival were evaluated. Results: The average age was (66.7±17.0) years old, and 5 were male (5/6). There were 4 patients with paroxysmal AF (4/6), and 2 patients with persistent AF (2/6). The mean CHA2DS2-VASc score was (4.8±1.5), and the HAS-BLED score was (3.5±1.4). The duration of hemodialysis was 2.6 (1.1, 8.3) years. Successfully Watchman implantation was achieved in all patients. There were no severe perioperative complications, and no device related thrombosis or leaks were observed by transesophageal echocardiography. During a mean of 22.0 (12.0, 32.0) months follow-up, there was no thromboembolism or major bleeding events. A total of 2 patients died, one from sudden cardiac death, and another one from heart failure. Conclusions: LAAO may be a safe and effective therapeutic option for prevention of thromboembolism in patients with atrial fibrillation and end-stage renal disease undergoing long-term hemodialysis, further studies with larger patient cohort are needed to confirm our results.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Falência Renal Crônica , Acidente Vascular Cerebral , Tromboembolia , Idoso , Idoso de 80 Anos ou mais , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Fibrilação Atrial/complicações , Fibrilação Atrial/cirurgia , Ecocardiografia Transesofagiana , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal , Resultado do Tratamento
9.
Trials ; 22(1): 626, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34526092

RESUMO

BACKGROUND AND AIM: Some parallel-group cluster-randomized trials use covariate-constrained rather than simple randomization. This is done to increase the chance of balancing the groups on cluster- and patient-level baseline characteristics. This study assessed how well two covariate-constrained randomization methods balanced baseline characteristics compared with simple randomization. METHODS: We conducted a mock 3-year cluster-randomized trial, with no active intervention, that started April 1, 2014, and ended March 31, 2017. We included a total of 11,832 patients from 72 hemodialysis centers (clusters) in Ontario, Canada. We randomly allocated the 72 clusters into two groups in a 1:1 ratio on a single date using individual- and cluster-level data available until April 1, 2013. Initially, we generated 1000 allocation schemes using simple randomization. Then, as an alternative, we performed covariate-constrained randomization based on historical data from these centers. In one analysis, we restricted on a set of 11 individual-level prognostic variables; in the other, we restricted on principal components generated using 29 baseline historical variables. We created 300,000 different allocations for the covariate-constrained randomizations, and we restricted our analysis to the 30,000 best allocations based on the smallest sum of the penalized standardized differences. We then randomly sampled 1000 schemes from the 30,000 best allocations. We summarized our results with each randomization approach as the median (25th and 75th percentile) number of balanced baseline characteristics. There were 156 baseline characteristics, and a variable was balanced when the between-group standardized difference was ≤ 10%. RESULTS: The three randomization techniques had at least 125 of 156 balanced baseline characteristics in 90% of sampled allocations. The median number of balanced baseline characteristics using simple randomization was 147 (142, 150). The corresponding value for covariate-constrained randomization using 11 prognostic characteristics was 149 (146, 151), while for principal components, the value was 150 (147, 151). CONCLUSION: In this setting with 72 clusters, constraining the randomization using historical information achieved better balance on baseline characteristics compared with simple randomization; however, the magnitude of benefit was modest.


Assuntos
Diálise Renal , Projetos de Pesquisa , Humanos , Ontário , Probabilidade , Distribuição Aleatória
10.
Isr Med Assoc J ; 23(9): 590-594, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34472237

RESUMO

BACKGROUND: Among dialysis patients, occlusive mesenteric vascular disease has rarely been reported. OBJECTIVES: To report on the experience of one center with regard to diagnosing and treating this complication. METHODS: The retrospective case-series involved six patients (3 females, 3 males; age 52-88 years; 5/6 were smokers) on chronic hemodialysis at a single center. All patients with symptoms suggestive of occlusive mesenteric disease and a subsequent angiographic intervention were included. Demographic, clinical, and laboratory data were collected from patient charts for the period before and after angioplasty and stenting of the mesenteric vessels. A Wilcoxon signed-rank test was used to compare the relevant data before and after the intervention. RESULTS: All participants had variable co-morbidities and postprandial abdominal pain, food aversion, and weight loss. CT angiography was limited due to heavy vascular calcifications. All underwent angioplasty with stenting of the superior mesenteric artery (4 patients) or the celiac artery (2 patients). All procedures were successful in resolving abdominal pain, malnutrition, and inflammation. Weight loss before was 15 ± 2 kg and weight gain after was 6 ± 2 kg. C-reactive protein decreased from 13.4 ± 5.2 mg/dl to 2.2 ± 0.4 mg/dl (P < 0.05). Serum albumin increased from 3.0 ± 0.2 g/dl to 3.9 ± 0.1 g/dl (P < 0.05). Two patients underwent a repeat procedure (4 years, 5 months, respectively). Follow-up ranged from 0.5-7 years. CONCLUSIONS: Occlusive mesenteric ischemia occurs among dialysis patients. The diagnosis requires a high degree of suspicion, and it is manageable by angiography and stenting of the most involved mesenteric artery.


Assuntos
Isquemia Mesentérica/cirurgia , Oclusão Vascular Mesentérica/cirurgia , Diálise Renal/efeitos adversos , Stents , Dor Abdominal/etiologia , Idoso , Idoso de 80 Anos ou mais , Angioplastia , Artéria Celíaca/fisiopatologia , Artéria Celíaca/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Artérias Mesentéricas/fisiopatologia , Artérias Mesentéricas/cirurgia , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/etiologia , Oclusão Vascular Mesentérica/diagnóstico , Oclusão Vascular Mesentérica/etiologia , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Mater Sci Eng C Mater Biol Appl ; 128: 112260, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34474819

RESUMO

Membranes with zeolites are encouraging for performing blood dialysis because zeolites can eliminate uremic toxins through molecular sieving. Although the addition of various pore-gen and adsorbent in the membrane can certainly impact the membrane production along with creatinine adsorption, however, it is not directed which pore-gen along with zeolite leads to better performance. The research was aimed at reducing the adsorption of protein-bound and uremic toxins by using mordenite zeolite as an adsorbent while polyethylene glycol and cellulose acetate as a pore generating agent. Membranes were cast by a phase-inversion technique which is cheap and easy to handle as compared to the electro-spinning technique. Through this strategy, the ability to adsorb creatinine and solute rejection percentage were measured and compared against the pristine PSU, when only PEG was used as a pore-modifier and when PEG along with CA was used as a pore-modifier along with a different concentration of zeolite. The experiments revealed that PEG membranes can give a better solute rejection percentage (93%) but with a low creatinine adsorption capacity that is 7654 µg/g and low bio-compatibility (PRT 392 s, HR 0.46%). However, PEG/CA membranes give maximum creatinine adsorption that is 9643 µg/g and also better bio-compatibility (PRT 490 s, HR 0.37%) but with a low BSA rejection (72%) as compared to the pristine PSU and PEG membranes. The present study finds that the concentration of mordenite zeolite affects the membrane performance because its entrapment and large pore size of the membrane decreases solute rejection but increases creatinine uptake level along with the better bio-compatibility.


Assuntos
Ultrafiltração , Zeolitas , Adsorção , Sinais (Psicologia) , Membranas Artificiais , Diálise Renal
12.
JNMA J Nepal Med Assoc ; 59(236): 336-341, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508536

RESUMO

INTRODUCTION: Occult hepatitis B infection is defined as the presence of the hepatitis B virus deoxyribonucleic acid in liver tissues and/or serum in the absence of serum hepatitis B Virus surface antigen. The prevalence of occult hepatitis B infection in end-stage renal disease patients is largely unknown. The aim of the study is to determine the prevalence of occult hepatitis B infection in the hemodialysis population starting maintenance hemodialysis. METHODS: A descriptive cross-sectional study was conducted in the department of Internal Medicine of a tertiary care hospital. Convenience sampling method was used; 50 consecutive end-stage renal disease patients, who started maintenance hemodialysis from March 2019 to March 2020, were enrolled in the study. The study was approved by the Institutional Review Committee of the hospital (reference number: 351/2019). Statistical Package for Social Sciences version 26.0 was used for statistical analysis. RESULTS: The mean age of the patients was 50.34±12.65 years, and 42 (84%) were male. About 4 (8%) patients were diagnosed having occult hepatitis B infection, 3 (6%) of them were seropositive and 1 (2%) seronegative. About 41 (82%) patients had no history of hepatitis B vaccination series before starting hemodialysis; 36 (72%) had anti-hepatitis B surface antibody titre <10 mIU/ml. About 44 (88%) patients received a blood transfusion during their hemodialysis sessions and 14 (28%) patients had a history of receiving hemodialysis at other centres. CONCLUSIONS: Our study demonstrated a high prevalence of occult hepatitis B infection among end-stage renal disease patients starting hemodialysis.


Assuntos
Hepatite B , Falência Renal Crônica , Adulto , Estudos Transversais , DNA Viral , Hepatite B/complicações , Hepatite B/diagnóstico , Hepatite B/epidemiologia , Antígenos de Superfície da Hepatite B , Vírus da Hepatite B/genética , Humanos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Diálise Renal , Centros de Atenção Terciária
13.
Artigo em Chinês | MEDLINE | ID: mdl-34521171

RESUMO

Objective: To explore the influencing factors for serum potassium >4.4 mmol/L in the morning of parathyroidectomy in hemodialysis patients with secondary hyperparathyroidism (SHPT). Methods: The clinical data of 72 patients with SHPT who received regular hemodialysis and underwent parathyroidectomy in Guangdong Provincial People's Hospital from January 2012 to December 2018 were analyzed retrospectively. There were 37 males and 35 females, aged from 25 to 69 years, and the dialysis timespan was from 0.5 to 11 years. The levels of parathyroid hormone, serum potassium and serum calcium before hemodialysis were examined one day before operation, and hemodialysis time and dewatering volume after hemodialysis without heparin were recorded, and also the level of serum potassium in the morning of parathyroidectomy was detected. The occurrences of hyperkalemia during and after operation were studied. The factors related to hyperkalemia in the morning of parathyroidectomy were evaluated by Pearson or Spearman correlation analysis, and the cut-off values of risk factors were calculated by receiver operating characteristic (ROC) curve. Results: Serum potassium >4.4 mmol/L in the morning of parathyroidectomy existed in 23 of 72 patients. Correlation analysis showed that serum potassium one day before operation ((4.93±0.56)mmol/L, r=0.656, P<0.001) and dehydration volume ((2.37±0.75)L, r=0.261, P=0.027) were positively correlated with serum potassium in the morning of parathyroidectomy((4.16±0.54)mmol/L). Serum potassium before hemodialysis one day before operation was a main predictor for serum potassium in the morning of parathyroidectomy (AUC=0.791, P<0.001). The cut-off value of serum potassium before hemodialysis one day before operation was 5.0 mmol/L. Conclusion: Serum potassium before hemodialysis one day before operation in patients with SHPT can predict serum potassium in the morning of parathyroidectomy, offering imformation for the safety of operation.


Assuntos
Hiperpotassemia , Hiperparatireoidismo Secundário , Cálcio , Feminino , Humanos , Hiperpotassemia/etiologia , Hiperparatireoidismo Secundário/complicações , Hiperparatireoidismo Secundário/cirurgia , Masculino , Hormônio Paratireóideo , Paratireoidectomia , Diálise Renal , Estudos Retrospectivos
14.
Arq Bras Cardiol ; 117(2): 385-391, 2021 08.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34495237

RESUMO

BACKGROUND: Type 1 cardiorenal syndrome is associated with higher mortality in heart failure patients. However, few studies have compared the diagnostic criteria of acute kidney injury (AKI) in this population. OBJECTIVE: To assess clinical and functional features and factors associated AKI in patients with heart failure. METHOD: Retrospective, cohort study on patients with decompensated heart failure or recent acute myocardial infarction, conducted in a tertiary hospital in a low-income region of Brazil. Clinical, laboratory and echocardiographic features were compared between patients with and without AKI according to the Acute Kidney Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The level of statistical significance was set at p < 0.05. RESULTS: Of 81 patients, 61.73% had AKI. Mean creatinine and urea levels were 1.79±1.0 mg/dL and 81.5±46.0 mg/dL, respectively, and higher in the group with AKI (p < 0.05). No evidence of a relationship between cardiac changes and reduced renal function. Chronic renal disease was associated with higher prevalence of AKI. Higher mortality was observed in patients with AKI than in patients without AKI (32.0% vs. 9.8%, p = 0.04, OR 8.187 ad 95% confidence interval 1.402-17.190, p = 0.020). CONCLUSION: In this population of patients with heart failure, AKI was highly prevalent and considered an independent risk factor for mortality. Cardiac changes were not associated with AKI, and the KDIGO and AKIN criteria showed similar performance.


Assuntos
Injúria Renal Aguda , Síndrome Cardiorrenal , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Brasil/epidemiologia , Síndrome Cardiorrenal/epidemiologia , Estudos de Coortes , Mortalidade Hospitalar , Humanos , Incidência , Rim/fisiologia , Diálise Renal , Estudos Retrospectivos , Fatores de Risco
15.
Swiss Med Wkly ; 151(33-34)2021 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-34495598

RESUMO

BACKGROUND: Patients on maintenance dialysis are at high risk for serious complications from COVID-19 infection, including death. We present an overview of local experience with dialysis unit management and reorganisation, local epidemiology and outcomes during the COVID-19 outbreak in Geneva, Switzerland, where SARS-CoV-2 incidence was one of the highest in Europe. METHODS: All SARS-CoV-2-positive outpatients on maintenance dialysis were transferred from their usual dialysis facility to the Geneva University Hospitals dialysis unit to avoid creation of new clusters of transmission. Within this unit, appropriate mitigation measures were enforced, as suggested by the institutional team for prevention and control of infectious diseases. RESULTS: From 25 February to 31 December 2020, 82 of 279 patients on maintenance dialysis tested positive for SARS-CoV-2 during two distinct waves, with an incidence rate of 73 cases per 100,000 person-days during the first wave and 342 cases per 100,000 during the second wave, approximately four- to six-fold higher than the general population. The majority of infections (55%) during both waves were traced to clusters. Most infections (62%) occurred in men. Sixteen patients (34%) died from COVID-19 related complications. Deceased patients were older and had a lower body mass index as compared with patients who survived the infection. CONCLUSION: SARS-CoV-2 is associated with high infection and fatality rates in the dialysis population. Strict mitigation measures seemed to be effective in controlling infection spread among patients on maintenance dialysis outside of clusters. Large scale epidemiological studies are needed to assess the efficacy of preventive measures in decreasing infection and mortality rates within the dialysis population.


Assuntos
COVID-19 , Pandemias , Humanos , Masculino , Diálise Renal , SARS-CoV-2 , Suíça/epidemiologia
16.
J Coll Physicians Surg Pak ; 31(9): 1040-1045, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34500518

RESUMO

OBJECTIVE: To determine patient and dialysis services-related factors associated with seroconversion of hepatitis C virus (HCV) in hemodialysis (HD) patients. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Nephrology, Mayo Hospital, King Edward Medical University (KEMU), Lahore, from January to December, 2018. METHODOLOGY: All patients on regular HD for more than three months were enrolled. All patients who seroconverted from HCV-negative to positive status three months after starting HD, were included. Patient-related factors (age, gender, blood transfusion, duration and frequency of dialysis, history of dental treatment and surgical intervention) and dialysis services-related parameters (dedicated staff, isolated room, hemodialysis machine, reverse osmosis plant, compliance of universal infection control measure) were noted. RESULTS: Out of 990 patients, 492 (49.7%) were reported as seroconverted for HCV during HD. Factors determined statistically significant for seroconversion were surgical intervention (p<0.001), history of dental procedure (p <0.001), blood transfusions (p <0.001), multiple sexual partner (p <0.001), age (p=0.035) and duration of hemodialysis (p <0.001). Factors not affecting seroconversion included frequency of dialysis (p=0.062), history of renal transplant (p =0.097) and family history of hepatitis (p=0.941). A significant negative correlation was observed between the rate of seroconversion of HCV and the score of universal infection control measures (r=-0.665, p=0.018). CONCLUSION: There was a high rate of seroconversion of HCV in HD patients. Factors responsible for seroconversion were history of surgical intervention, dental treatment, blood transfusion, multiple sexual partners, age and duration of dialysis. The dialysis centres non-compliant with universal infection control measures were having high rate of seroconversion. Key Words: Hemodialysis, Seroconversion, HCV, Blood transfusion, Dental treatment, Surgical intervention, Infection, Isolation.


Assuntos
Hepatite C , Falência Renal Crônica , Estudos Transversais , Hepacivirus , Hepatite C/epidemiologia , Humanos , Falência Renal Crônica/terapia , Prevalência , Diálise Renal , Fatores de Risco , Soroconversão
17.
J Int Med Res ; 49(9): 3000605211031063, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34496645

RESUMO

OBJECTIVE: To evaluate the role of bioimpedance-defined overhydration (BI-OH) parameters in predicting the risk of mortality and cardiovascular (CV) events in patients undergoing dialysis. METHODS: We searched multiple electronic databases for studies investigating BI-OH indicators in the prediction of mortality and CV events through 23 May 2020. We assessed the effect of BI-OH indexes using unadjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Sensitivity analysis was used for each outcome. RESULTS: We included 55 studies with 104,758 patients in the meta-analysis. Extracellular water/total body water (ECW/TBW) >0.4 (HR 5.912, 95% CI: 2.016-17.342), ECW/intracellular water (ICW) for every 0.01 increase (HR 1.041, 95% CI: 1.031-1.051), and OH/ECW >15% (HR 2.722, 95% CI: 2.005-3.439) increased the risk of mortality in patients receiving dialysis. ECW/TBW >0.4 (HR 2.679, 95% CI: 1.345-5.339) and ECW/ICW per increment of 10% (HR 1.032, 95% CI: 1.017-1.047) were associated with an increased risk of CV events in patients undergoing dialysis. A 1-degree increase in phase angle was a protective factor for both mortality (HR 0.676, 95% CI: 0.474-0.879) and CV events (HR 0.736, 95% CI: 0.589-0.920). CONCLUSIONS: BI-OH parameters might be independent predictors for mortality and CV events in patients undergoing dialysis.


Assuntos
Doenças Cardiovasculares , Desequilíbrio Hidroeletrolítico , Impedância Elétrica , Humanos , Diálise Renal/efeitos adversos , Desequilíbrio Hidroeletrolítico/etiologia
18.
Rev Esc Enferm USP ; 55: e20210156, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34516605

RESUMO

OBJECTIVE: To measure the average direct cost of procedures performed by health professionals, in a Dialysis Center, for the management of complications of vascular access for hemodialysis. METHOD: Quantitative, exploratory-descriptive case study type research. The average direct cost was calculated by multiplying the time spent by health professionals by the unit cost of direct labor, adding this to the input costs (materials/ medicines/solutions). RESULTS: The following average direct costs were obtained: US$0.72, US$2.00 and US$1.41 for "administration of easy-to-dilute, difficult-to-dilute, and undiluted antibiotics", respectively; $2.61 for "central venous catheter dressing with topical antibiotic"; $48.05 for "alteplase infusion"; US$183.68 for "insertion of central venous catheter for hemodialysis"; and $1.31 for "arteriovenous fistula puncture". CONCLUSION: Material and drug costs significantly contributed to the composition of the average total direct cost of most procedures.


Assuntos
Cateteres Venosos Centrais , Diálise Renal , Bandagens , Cateterismo , Custos e Análise de Custo , Humanos
19.
BMJ Open ; 11(9): e045832, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34475147

RESUMO

OBJECTIVES: Over the past two decades, debates on whether the profit status of dialysis facilities influences patient prognosis have been popular in the USA. Taiwan is one of the regions with the highest rate per capita of kidney replacement therapy worldwide, but no similar research has been conducted to date. This is the first study to address this issue. DESIGN: This was a nationwide retrospective cohort study based on the Taiwan Renal Registry Data System. SETTING: Patients were categorised into two groups based on the profit status (for-profit, not-for-profit (NFP)) of dialysis facilities, with 31 350 patients in each group. The patients were followed up from 2005 to 2012. PARTICIPANTS: Patients with uraemia who underwent long-term haemodialysis in private dialysis facilities and public facilities were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES: Survival analyses were performed to compare prognosis between the two groups. Adjustments to patients' basic profile, and facilities' geographical distribution, level, and length of ownership were carried out to minimise possible confounding effects. RESULTS: Analysis revealed that NFP dialysis facilities had better outcomes (HR=0.91, 95% CI (0.89 to 0.93)). A favourable effect remains with the adjustment of the facilities' level, geographical distribution (HR=0.89, 95% CI (0.86 to 0.93)) or length of ownership (HR=0.95, 95% CI (0.89 to 0.95)). Survival analysis based on the geographical distribution and level of facilities was also conducted, which showed better prognosis in medical centres in the six municipalities, whereas worse prognosis was found in local hospitals not located in these municipalities. CONCLUSION: Our findings suggest that in contemporary settings in Taiwan, treatment at NFP dialysis facilities was associated with a better prognosis. The results should be interpreted with caution since the possibility of residual confounding effects and uncertainty of casual relations exist due to the nature of observational studies.


Assuntos
Falência Renal Crônica , Diálise Renal , Estudos de Coortes , Instituições Privadas de Saúde , Humanos , Falência Renal Crônica/terapia , Propriedade , Estudos Retrospectivos
20.
BMJ Open ; 11(9): e045912, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34475148

RESUMO

INTRODUCTION: Patients with end-stage renal disease are at higher risk of cardiovascular morbidity and mortality, a risk mediated in part by increased aortic stiffness. Arterial stiffness is assessed at different anatomical locations (central elastic or peripheral muscular arteries) using a variety of mechanical biomarkers. However, little is known on the robustness of each of these mechanical biomarkers following a haemodynamic stress caused by a single haemodialysis (HD) session. METHODS AND ANALYSIS: A systematic review has been designed and reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. A targeted search strategy applicable in key databases (PubMed, Embase, the Cochrane Library, Web of Science and grey literature) is constructed to search articles and reviews from inception to 16 October 2020. Only articles of studies conducted with adults under chronic HD for kidney failure, with repeated measures of arterial stiffness metrics (pulse wave velocity, Augmentation Index, arterial distensibility or stiffness) following a before-and-after design surrounding a HD session will be selected. The screening process, data extraction and assessment of risk bias will be done by two independent pairs of reviewers. Meta-analysis will enable adjustments for potential confounders and subgroup analyses will be performed to discriminate changes in arterial stiffness metrics from elastic, muscular or global arterial territories. ETHICS AND DISSEMINATION: This study does not require ethical approval. Findings will be submitted for publication to relevant peer-reviewed journals and will be presented at profession-specific conferences. PROSPERO REGISTRATION NUMBER: CRD42020213946.


Assuntos
Falência Renal Crônica , Rigidez Vascular , Humanos , Falência Renal Crônica/terapia , Metanálise como Assunto , Análise de Onda de Pulso , Diálise Renal , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
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