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1.
Pan Afr Med J ; 33: 162, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565124

RESUMO

Introduction: Autodialysis is the dialysis performed by the patient himself at a local center instead of a hemodialysis center. In Morocco, the practice of hemodialysis dates back to 1970; however, an autodialysis center does not yet exist. The objective was to assess the potential medical fitness and adherence of the patients to an autodialysis program. Methods: Descriptive and analytical multicenter study conducted in March 2015 involving patients from of eight hemodialysis centers in Casablanca (Morocco). The study was conducted in two steps: 1) a transversal assessment of the medical potential to achieve autodialysis that included 556 patients; 2) a survey of the autodialysis membership that included 383 out of 556 patients who were deemed eligible for autodialysis. Results: The average age was 54.63 ± 15.16 years; the average of hemodialysis duration was 85.9 ± 78.1 months. Diabetic nephropathy (22.7%) was the predominant cause of kidney disease. The assessment of medical potential to achieve autodialysis highlighted that almost all of the patients were in good condition (93%), independent (81%), and those without major comorbidities were less than 76 years old. Regarding the potential patients' adherence to autodialysis, among the 383 patients previously deemed suited for autodialysis, 293 (76.5%) responded favorably to the proposal of self-dialysis. Conclusion: The practice of hemodialysis should be implemented in a short time in Morocco because our patients' profile is perfectly suitable to this therapeutic method especially when they are young, in good general condition, autonomous, without major comorbidities, and willing to learn.


Assuntos
Nefropatias/terapia , Diálise Renal/métodos , Autocuidado/métodos , Adulto , Idoso , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/terapia , Feminino , Humanos , Nefropatias/etiologia , Masculino , Pessoa de Meia-Idade , Marrocos , Cooperação do Paciente/estatística & dados numéricos
2.
Pan Afr Med J ; 33: 183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565143

RESUMO

Introduction: There is a great scarcity of literature in Pakistan investigating the proportion of end stage renal disease (ESRD) patients undergoing hemodialysis (HD) who meet the recommended kidney diseases outcome quality initiative (K/DOQI) guidelines for serum calcium (Ca), phosphorus (P), calcium phosphorus product (Ca x P) and parathyroid hormone (PTH) levels. Our study aimed to determine frequencies of patients who met the K/DOQI targets for these minerals at a tertiary care hospital's dialysis unit. Methods: 111 ESRD patients on maintenance HD were selected from a tertiary care hospital. Serum Ca and P were assayed on chemistry analyser. PTH was measured through electrochemiluminescence sandwich method. Data were compared with K/DOQI targets and analysed using SPSS-21. Results: The mean age of patients was 55.85 years (SD ± 13.95). Gender distribution was almost equal with 49.5% males and 50.5% females. The patients had mean corrected serum Calcium 9.12 ± 0.64 mg/dL, Phosphorus 4.57 ± 1.54 mg/dL and Parathyroid hormone 333.8 ± 278.4 pg/mL. The patients had achieved K/DOQI target ranges of Ca, P, PTH, Ca x P product and all 4 criteria in 63.1%, 47.6%, 38.7%, 84.7% and 10.8% respectively. Conclusion: Majority of patients on maintenance HD at our institution did not achieve the recommended K/DOQI target ranges. Further studies pertaining to the Asian subcontinent will prove resourceful for comparison of mineral metabolism and dialysis outcome of ESRD patients.


Assuntos
Cálcio/sangue , Falência Renal Crônica/terapia , Hormônio Paratireóideo/sangue , Fósforo/sangue , Diálise Renal/métodos , Adulto , Idoso , Estudos Transversais , Técnicas Eletroquímicas , Feminino , Humanos , Medições Luminescentes , Masculino , Pessoa de Meia-Idade , Paquistão , Guias de Prática Clínica como Assunto , Centros de Atenção Terciária
3.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1188-1193, out.-dez. 2019. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1022221

RESUMO

Objetivo: Identificar os fatores de risco/condicionantes para a falência da fístula arteriovenosa e analisar os cuidados necessários para manutenção da fístula arteriovenosa. Métodos: Estudo piloto realizado com 10 participantes com histórico de falência de fístula arteriovenosa, com dados coletados por meio de formulário e analisados por estatística descritiva, aceito pelo Comitê de Ética em Pesquisa do Hospital Universitário Pedro Ernesto, com número do CAAE nº 64150117.2.0000.5259. Resultados: A idade média foi de 57,3 anos. A hipertensão arterial foi a doença prévia mais comum encontrada entre os participantes. A hipotensão e as punções repetidas foram os fatores de risco/condicionantes com maior ocorrência. Conclusão: a maioria dos participantes possuíam baixa escolaridade e informaram ter tido alguma complicação na FAV. A hipotensão como fator condicionante para falência das FAV, permaneceu de forma frequente entre os participantes. Observou-se que grande parte já realizava tratamento dialítico prévio


Objective: The study's purpose has been to identify the risk/conditioning factors for Arteriovenous Fistula Failure (AVF), and also to analyze the care required for handling the arteriovenous fistula. Methods: It is a pilot study that was carried out with 10 participants showing a history of AVF. The data were collected through a form and analyzed by descriptive statistics. This research was accepted by the Research Ethics Committee from the Pedro Ernesto University Hospital, under the Certificado de Apresentação para Apreciação Ética (CAAE) [Certificate of Presentation for Ethical Appreciation] No. 64150117.2.0000.5259. Results: The average age was 57.3 years old. Arterial hypertension was the most common prior disease among the participants. Hypotension and repeated punctures were the most frequent risk/conditioning factors. Conclusion: A relevant percentage of the participants had little education and reported having had some complication in the AVF. Hypotension, as a conditioning factor for AVF failure, remained frequent among the participants. It was observed that a large part of the participants have undergone dialysis treatment previously


Objetivo: Identificar los factores de riesgo / condicionantes para la quiebra de la fístula arteriovenosa y analizar los cuidados necesarios para el mantenimiento de la fístula arteriovenosa. Métodos: Estudio piloto realizado con 10 participantes con historial de fallo de fístula arteriovenosa, con datos recogidos por medio de formulario y analizados por estadística descriptiva, aceptado por el Comité de Ética en Investigación del Hospital Universitario Pedro Ernesto, con número del CAAE nº 64150117.2.0000.5259 . Resultados: La edad media fue de 57,3 años. La hipertensión arterial fue la enfermedad previa más común entre los participantes. La hipotensión y las punciones repetidas fueron los factores de riesgo / condicionantes con mayor ocurrencia. Conclusión: la mayoría de los participantes tenían baja escolaridad e informaron haber tenido alguna complicación en la FAV. La hipotensión como factor condicionante para la quiebra de las FAV, permaneció de forma frecuente entre los participantes. Se observó que gran parte ya realizaba tratamiento dialítico previo


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Fatores de Risco , Fístula Arteriovenosa/complicações , Diálise Renal , Insuficiência Renal Crônica , Equipe de Assistência ao Paciente , Brasil , Fístula Arteriovenosa/prevenção & controle
4.
Isr Med Assoc J ; 21(9): 585-588, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542901

RESUMO

BACKGROUND: The potential for full rehabilitation following amputation among end-stage renal disease patients is poor. OBJECTIVES: To evaluate the functional outcomes and survival among amputees treated with hemodialysis at the end of the rehabilitation procedure. METHODS: We recruited 46 patients after lower limb amputation. Of these individuals, 19 (41.3%) were treated with dialysis and 27 (58.7%) were non-dialysis-dependent patients (NDDP). Both groups were divided into three sub-groups according to their independence with regard to activities of daily living (ADL) and their ability to walk with prostheses. RESULTS: The survival of lower limb amputees treated with dialysis was shorter compared to NDDP. Survival after amputation among the NDDP who were fully or partially independent in ADL and with regard to mobility, was longer compared to the non-mobile amputees as with the patients treated with dialysis. CONCLUSIONS: Survival was significantly longer in lower limb amputees NDDP and shorter in patients who did not achieve a certain level of functioning.


Assuntos
Atividades Cotidianas , Amputação/reabilitação , Amputados/reabilitação , Falência Renal Crônica/terapia , Diálise Renal , Amputados/estatística & dados numéricos , Membros Artificiais/estatística & dados numéricos , Feminino , Humanos , Israel , Falência Renal Crônica/complicações , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Caminhada/estatística & dados numéricos
5.
Pan Afr Med J ; 33: 91, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489069

RESUMO

Introduction: Haemodialysis (HD) which is a form of renal replacement therapy commonly prescribed for patients with chronic kidney disease (CKD). However, it is not without deleterious haemodynamic responses which may occur either during or immediately after the termination of the procedure. These may include hypotension or hypertension. Methods: This was a retrospective study that reviewed chronic kidney disease (CKD) patients on maintenance haemodialysis at the renal unit of University of Calabar Teaching Hospital, Calabar, Nigeria. In all, 71 patients were reviewed but only 64 patients had complete data for analysis. Socio-demographic, clinical and biochemical data were obtained from the records in the dialysis unit. Results: There were more males 38 (59.4%) than females 26 (40.6%) in the study. The mean age was 51.71±15.43 years and 43.04±14.03years for males and females respectively. The prevalence of intradialysis hypertension 29 (45.3%) was higher than that of intradialysis hypotension 20 (31.3%) and the commonest cause of CKD requiring haemodialysis was diabetic nephropathy. The factors associated with intradialysis hypotension were lower post-dialysis systolic blood pressure (PDSBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and less number of antihypertensive medications; while the factors associated with intradialysis hypertension were higher post-dialysis systolic blood pressure (SBP), MAP, greater number of antihypertensive medications and longer duration of haemodialysis. Conclusion: Our study shows that there are several modifiable factors associated with blood pressure fluctuations among CKD patients on maintenance haemodialysis in the renal unit of the University of Calabar Teaching Hospital, Calabar.


Assuntos
Hipertensão/epidemiologia , Hipotensão/epidemiologia , Diálise Renal/métodos , Insuficiência Renal Crônica/terapia , Adolescente , Adulto , Idoso , Anti-Hipertensivos/administração & dosagem , Pressão Sanguínea , Feminino , Hospitais de Ensino , Humanos , Hipertensão/etiologia , Hipotensão/etiologia , Masculino , Pessoa de Meia-Idade , Nigéria , Prevalência , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo , Adulto Jovem
6.
Kardiologiia ; 59(8S): 63-72, 2019 Sep 16.
Artigo em Russo | MEDLINE | ID: mdl-31526363

RESUMO

AIM: To assess the incidence of blood pressure (BP) control and various phenotypes of BP by comparing the results of office and 44-hour ambulatory brachial and central BP measurement in patients with end-stage renal disease (ESRD) on program hemodialysis (HD). MATERIALS AND METHODS: In 68 patients ESRD receiving renal replacement therapy we evaluated office peridialysis BP and performed 44-hour ambu latory monitoring (ABPM) of brachial and central BP during peridialysis period using a validated oscillometric device BPLabVasotens (OOO "Petr Telegin"). Results were considered statistically significant with p<0.05. RESULTS: The frequency of control of peripheral office BP before the HD session was 25%, after - 23.5%; control of central BP - 48.6% and 49%, respectively. According to office measurement the frequency of systolic-diastolic hypertension was 44.1%, isolated systolic hypertension - 25%, isolated diastolic hypertension - 5.9%. The values of peripheral and central office systolic BP (SBP) before and after HD were not consistent with the corresponding mean and daily SBP levels for 44 hours and for the first and second days of the interdialysis period. The frequency of true uncontrolled arterial hypertension (AH) according to peripheral ABPM was 66.5%, masked uncontrolled AH - 9%. Circadian rhythm abnormalities for 44-h peripheral BP were detected in 77%, for central - in 76%. In 97% of patients agreement between phenotypes of the daily profile of peripheral and central BP was observed. 73% of patients had a significant increase in peripheral and central SBP and pulse pressure (PP) and an increase in the proportion of non-dippers from the 1st to the 2nd day. CONCLUSION: Patients with ESRD on HD were characterized by poor control of BP control and predominance of unfavourable peripheral and central ambulatory BP phenotypes. A single measurement of clinical peripheral and central BP in the peridialysis period was not sufficient to assess the control of hypertension in this population. The 24-h BP profiles in the 1st and 2nd days of interdialysis period had significant differences.


Assuntos
Hipertensão , Falência Renal Crônica , Pressão Sanguínea , Determinação da Pressão Arterial , Monitorização Ambulatorial da Pressão Arterial , Humanos , Falência Renal Crônica/terapia , Diálise Renal
9.
Medicine (Baltimore) ; 98(36): e16812, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490367

RESUMO

Chronic kidney disease (CKD)-associated pruritus is one of the most common symptoms found in patients who undergo dialysis for CKD, leading to a compromised quality of life. This study aimed to investigate the association between CKD-associated pruritus and the quality of life in patients undergoing hemodialysis in Pakistan.A cross-sectional multicenter study was carried out from July 2016 to April 2017 in 2 tertiary care hospitals in Pakistan. Patients aged 18 years and above of both genders, undergoing hemodialysis, understood the Urdu language, and were willing to participate; were included.Of 354 recruited patients with a response rate of 100%, majority (66.1%) of the patients were males. The median (intra-quartile range [IQR]) age of patients was 42.0 [34.0-50.0] years. The prevalence of pruritus was 74%. The median [IQR] score for pruritus was 10.0 (out of possible 25) [8.0-12.0]. Multivariate linear regression revealed a statistically significant association between CKD-associated pruritus with age of patients (ß = 0.031; 95% confidence interval [CI] = 0.002-0.061; P = .038), duration of CKD (ß = -0.013; 95% CI = -0.023 --0.003; P = .014) and quality of life (ß= -0.949; 95% CI = -1.450; -0.449). The median [IQR] score for health-related quality of life was 52.00 [43.00-58.00].Prevalence of CKD-associated pruritus was reported to be 74% and it negatively affected the patient's quality of life. Patients with moderate to severe CKD-associated pruritus have poor quality of life. With an increase in intensity of pruritus, the QOL score decreased among the patients undergoing hemodialysis.


Assuntos
Prurido/epidemiologia , Prurido/etiologia , Qualidade de Vida , Insuficiência Renal Crônica/complicações , Adulto , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Prevalência , Diálise Renal/métodos , Insuficiência Renal Crônica/terapia , Índice de Gravidade de Doença , Fatores Socioeconômicos
11.
J Assoc Physicians India ; 67(8): 39-42, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31562715

RESUMO

Objectives: Continuous renal replacement therapies (CRRT) are the most favoured form of renal replacement therapies (RRT) in patients of decompensated liver cirrhosis and hepatorenal syndrome (HRS). The role of CRRT has been limited only to acute kidney injury and HRS in prior studies. We therefore aimed to evaluate the role of two different modes of CRRT- CVVHDF and CAVHDF in patients of hepatic failure and / or hepatorenal syndrome in reducing hyperbilirubinemia, uremia and fluid overload. Methods: 30 critically ill patients of hepatic failure and /or HRS were randomly divided into two groups of 15 cases each. Group A patients received continuous veno-venous hemodiafiltration (CVVHDF), whereas group B patients underwent continuous arterio-venous hemodiafiltration (CAVHDF). The inclusion criteria were hepatic failure and / or hepatorenal syndrome (HRS) with hyperbilirubinemia and fluid overload in hemodynamically unstable patients, who were unfit for conventional hemodialysis. Results: Despite hemodynamic fragility of the subjects, both the procedures were effective in achieving biochemical and clinical improvements. There was a significant fall in blood urea, serum creatinine and serum bilirubin at the end of procedures. After mean 27.32 h of CVVHDF and 27.02 h of CAVHDF, blood urea decreased to 39.54 ± 28.6 mg/dl and 45.11 ± 31.9 mg/dl in respective groups. Serum bilirubin decreased to 7.01 ± 6.4 mg/dl and 3.21 ± 1.99 mg/dl in group A and B. All the patients had gradual and steady improvement in pH and bicarbonate concentration towards normal. Urea clearance was 24.98 ± 1.09 ml/min and 22.72 ± 1.58 ml/min respectively in the two groups, whereas bilirubin clearance was 27.77 ± 1.38 ml/min and 28.74 ± 0.3 ml/min in group A and B respectively. Ultrafiltration rate had mean value of 141.66 ± 22.33 ml/h in group A and 134.26 ± 38.71 ml/h in group B. Both the modes of CRRT were well tolerated without any new episodes of hypotension secondary to the procedures and requirement of inotropes didn't change significantly. Symptomatic relief and improvement in clinical and biochemical parameters were observed in all the cases. There were no significant differences between the results of two groups. Complication rate was less and survival was 30%. Conclusion: Continuous hemodiafiltration is probably the best available modality of CRRT to treat hemodynamically unstable and critically ill patients of hepatic failure and/ or hepatorenal syndrome and it should be advocated more frequently.


Assuntos
Lesão Renal Aguda , Hemodiafiltração , Síndrome Hepatorrenal , Falência Hepática , Humanos , Diálise Renal , Terapia de Substituição Renal
12.
JAMA ; 322(10): 957-973, 2019 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-31503308

RESUMO

Importance: For-profit (vs nonprofit) dialysis facilities have historically had lower kidney transplantation rates, but it is unknown if the pattern holds for living donor and deceased donor kidney transplantation, varies by facility ownership, or has persisted over time in a nationally representative population. Objective: To determine the association between dialysis facility ownership and placement on the deceased donor kidney transplantation waiting list, receipt of a living donor kidney transplant, or receipt of a deceased donor kidney transplant. Design, Setting, and Participants: Retrospective cohort study that included 1 478 564 patients treated at 6511 US dialysis facilities. Adult patients with incident end-stage kidney disease from the US Renal Data System (2000-2016) were linked with facility ownership (Dialysis Facility Compare) and characteristics (Dialysis Facility Report). Exposures: The primary exposure was dialysis facility ownership, which was categorized as nonprofit small chains, nonprofit independent facilities, for-profit large chains (>1000 facilities), for-profit small chains (<1000 facilities), and for-profit independent facilities. Main Outcomes and Measures: Access to kidney transplantation was defined as time from initiation of dialysis to placement on the deceased donor kidney transplantation waiting list, receipt of a living donor kidney transplant, or receipt of a deceased donor kidney transplant. Cumulative incidence differences and multivariable Cox models assessed the association between dialysis facility ownership and each outcome. Results: Among 1 478 564 patients, the median age was 66 years (interquartile range, 55-76 years), with 55.3% male, and 28.1% non-Hispanic black patients. Eighty-seven percent of patients received care at a for-profit dialysis facility. A total of 109 030 patients (7.4%) received care at 435 nonprofit small chain facilities; 78 287 (5.3%) at 324 nonprofit independent facilities; 483 988 (32.7%) at 2239 facilities of large for-profit chain 1; 482 689 (32.6%) at 2082 facilities of large for-profit chain 2; 225 890 (15.3%) at 997 for-profit small chain facilities; and 98 680 (6.7%) at 434 for-profit independent facilities. During the study period, 121 680 patients (8.2%) were placed on the deceased donor waiting list, 23 762 (1.6%) received a living donor kidney transplant, and 49 290 (3.3%) received a deceased donor kidney transplant. For-profit facilities had lower 5-year cumulative incidence differences for each outcome vs nonprofit facilities (deceased donor waiting list: -13.2% [95% CI, -13.4% to -13.0%]; receipt of a living donor kidney transplant: -2.3% [95% CI, -2.4% to -2.3%]; and receipt of a deceased donor kidney transplant: -4.3% [95% CI, -4.4% to -4.2%]). Adjusted Cox analyses showed lower relative rates for each outcome among patients treated at all for-profit vs all nonprofit dialysis facilities: deceased donor waiting list (hazard ratio [HR], 0.36 [95% CI, 0.35 to 0.36]); receipt of a living donor kidney transplant (HR, 0.52 [95% CI, 0.51 to 0.54]); and receipt of a deceased donor kidney transplant (HR, 0.44 [95% CI, 0.44 to 0.45]). Conclusions and Relevance: Among US patients with end-stage kidney disease, receiving dialysis at for-profit facilities compared with nonprofit facilities was associated with a lower likelihood of accessing kidney transplantation. Further research is needed to understand the mechanisms behind this association.


Assuntos
Instituições Privadas de Saúde , Acesso aos Serviços de Saúde , Falência Renal Crônica/terapia , Transplante de Rim , Propriedade , Diálise Renal , Humanos , Doadores Vivos , Diálise Renal/economia , Estudos Retrospectivos , Estados Unidos , Listas de Espera
13.
Nephrol Nurs J ; 46(4): 375-394, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31490048

RESUMO

Adult patients on hemodialysis experience a high prevalence of poor oral health and periodontitis. The chronic inflammation associated with poor periodontal health can increase the risk of cardiovascular disease and mortality among patients on hemodialysis. A systematic review of research articles published from 2012-2018 was conducted to synthesize current literature on the subject. Forty-three articles were identified. Findings were summarized into two categories: clinical measurements and lifestyle/quality of life. We suggest the development, implementation, and evaluation of oral health nursing interventions and periodontal treatments among patients on hemodialysis.


Assuntos
Saúde Bucal/estatística & dados numéricos , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/terapia , Adulto , Humanos
14.
Nephrol Nurs J ; 46(4): 397-431, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31490049

RESUMO

Factors related to travel for transplantation were examined using data from the Scientific Registry for Transplant Recipients. Candidates who traveled abroad for a kidney transplant had higher odds of being male, Asian or Hispanic, college-educated, employed, privately insured, and a non-U.S. citizen/non-U.S. resident. Candidates with a body mass index greater than 30, a calculated panel reactive antibody (cPRA) greater than 80%, and a history of more than two years of hemodialysis or peritoneal dialysis had lower odds of traveling abroad for a kidney transplant. Geographically, candidates listed in the northeastern region of the United States (New York and Western Vermont) had the highest odds of traveling abroad for a kidney transplant. Findings of this study can be used to guide practice and education with transplant candidates, and to direct further investigation in this understudied but growing area of transplantation.


Assuntos
Transplante de Rim , Turismo Médico/estatística & dados numéricos , Transplantados/estatística & dados numéricos , Feminino , Humanos , Masculino , Sistema de Registros , Diálise Renal/estatística & dados numéricos , Fatores Socioeconômicos , Estados Unidos
15.
Nephrol Nurs J ; 46(4): 407-411, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31490050

RESUMO

The arteriovenous fistula (AVF) is the recommended hemodialysis access for pediatric patients who weight more than 20 kg and who are not expected to receive a kidney transplant for one year or longer. Whereas buttonhole cannulation of the AVF has been discouraged in adults because of the associated risk of infection, the published pediatric experience with this technique is extremely limited. A retrospective chart review of all buttonhole cannulated AVFs in a single pediatric hemodialysis unit was performed. Approximately 5,600 cannulations were performed over 215.5 patient months with no infections of the AVF or adjacent skin in 13 of 14 (93%) patients. Results from this experience provide evidence that the buttonhole cannulation technique can be successfully performed in pediatric patients on hemodialysis without an associated increased risk of infection.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Cateterismo/métodos , Diálise Renal , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo/efeitos adversos , Criança , Humanos , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento
16.
Nephrol Nurs J ; 46(4): 423-452, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31490052

RESUMO

Nurses should protect the affected extremities of patients who have a permanent arteriovenous access for hemodialysis by avoiding blood pressure measurements and venipuncture on access extremities. National recommendations include labeling the affected extremity with an alert mechanism, such as a wristband, to notify patients and staff of arteriovenous access. A policy change was enacted at an academic medical center in the Southeast to identify restricted extremities with a pink "limb alert" wristband after review of national recommendations on hemodialysis access preservation, individual facility procedures, product cost-benefit analysis, and unit and system educational methods. Keeping simplicity, nursing workload, and flexibility at the forefront of implementation, evaluation, and process revision, an overall adherence rate of 84.2% was achieved three months after implementation of the policy.


Assuntos
Derivação Arteriovenosa Cirúrgica/enfermagem , Equipamento de Proteção Individual , Diálise Renal , Centros Médicos Acadêmicos/organização & administração , Humanos , Política Organizacional , Sudeste dos Estados Unidos
17.
Pan Afr Med J ; 33: 61, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448023

RESUMO

Introduction: Mortality in patients with chronic renal failure is high compared to the general population. The objective of our study is to evaluate the predictive factors related to mortality in hemodialysis. Methods: This is a retrospective study involving 126 hemodialysis patients in the Nephrology Department of Ibn Rochd Hospital, Casablanca. Data were collected between January 2012 and January 2016. For each of our patients, we analyzed demographic, clinical, biological and anthropometric data. The Kaplan-Meier method and the log-rank test were used to evaluate and compare survival curves. To evaluate the effect of predictors of mortality, we used the proportional Cox hazard model. Results: The analysis of the results showed that the surviving patients were younger than the deceased patients (43.07±13.52 years versus 53.09±13.56 years, p=0.001). Also, the latter has a significantly lower albumin and prealbumin levels (p=0.01 and p=0.04 respectively). Overall survival was 80.2%. Cox regression analysis at age (HR=1.26, p<0.0002), inflammation (HR=1.15, p<0.03), AIP> 0.24 (HR=2.1, p<0.002) and cardiovascular disease (RR=2.91, p<0.001) were associated with global and cardiovascular mortality. Conclusion: Our study showed that the mortality rate is high in our cohort. In addition, cardiovascular diseases, under nutrition and inflammation are predictive factors for mortality. Treatment and early management of these factors are essential for reducing morbidity and mortality.


Assuntos
Doenças Cardiovasculares/mortalidade , Falência Renal Crônica/terapia , Diálise Renal/métodos , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Feminino , Humanos , Inflamação/epidemiologia , Inflamação/mortalidade , Estimativa de Kaplan-Meier , Falência Renal Crônica/mortalidade , Masculino , Desnutrição/epidemiologia , Desnutrição/mortalidade , Pessoa de Meia-Idade , Marrocos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco
18.
Pan Afr Med J ; 33: 71, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448033

RESUMO

The authors report the first case of successful peritoneal dialysis (PD) in a developing country performed about a 13-year-old adolescent followed-up for stage V chronic kidney disease (CKD) with anuria. After 3 months of hemodialysis, the parents opted for continuous ambulatory peritoneal dialysis (CAPD) as they wished to return home located 121km from Dakar. After PD catheter insertion, the plan proposed to the patient consisted 3-4 hours stasis of isotonic dialysate during the day and a night stasis of 8 hours of icodextrin for an injection volume of 1L per session. The patient and his mother were trained and assessed on the PD technique. After dialysis adequacy was tested while hospitalised, they were able to return home and continued the sessions following the same plan prescribed and while keeping in touch, by telephone, with the medical team. The technique assessment at the day hospital every 2 weeks revealed dialysis adequacy and satisfactory tolerance of PD at home after 04 months of observation. It was the first case of successful CAPD in the pediatrics unit in this context. Scaling this technique is a challenge for the pediatric nephrologist in developing countries like Senegal.


Assuntos
Hemodiálise no Domicílio/métodos , Diálise Peritoneal Ambulatorial Contínua/métodos , Insuficiência Renal Crônica/terapia , Adolescente , Países em Desenvolvimento , Soluções para Diálise/química , Humanos , Icodextrina/química , Masculino , Diálise Renal , Senegal
19.
Medicine (Baltimore) ; 98(31): e16649, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374037

RESUMO

RATIONALE: Anti-glomerular basement membrane disease (anti-GBM disease) is a rare small vessel vasculitis caused by autoantibodies directed against the glomerular and alveolar basement membranes. Anti-GBM disease is usually a monophasic illness and relapse is rare after effective treatment. This article reports a case of coexistence of recurrent anti-GBM disease and T-cell large granular lymphocytic (T-LGL) leukemia. PATIENT CONCERNS: A 37-year-old man presented with hematuria, edema, and acute kidney injury for 2 months. DIAGNOSIS: Anti-GBM disease was diagnosed by renal biopsy, in which crescentic glomerulonephritis was observed with light microscopy, strong linear immunofluorescent staining for immunoglobulin G on the GBM and positive serum anti-GBM antibody. Given this diagnosis, the patient was treated with plasmapheresis, steroids, and cyclophosphamide for 4 months. The anti-GBM antibody titer was maintained to negative level but the patient remained dialysis-dependent. One year later, the patient suffered with a relapse of anti-GBM disease, after an extensive examination, he was further diagnosed T-LGL leukemia by accident. INTERVENTIONS: The patient received cyclosporine A therapy for T-LGL leukemia. OUTCOMES: After treatment with cyclosporine A, serum anti-GBM antibody became undetectable. During the 16 months follow-up, anti-GBM titer remained normal and abnormal T-lymphocytes in the bone marrow and peripheral blood were also decreased. LESSONS: T-LGL leukemia is an indolent lymphoproliferative disorder that represents a monoclonal expansion of cytotoxic T cells, which has been reported to be accompanied by some autoimmune diseases. This is the first report of coincidence of T-LGL leukemia and anti-GBM disease, and suggests there are some relationships between these 2 diseases. Clinical physicians should exclude hematological tumors when faced with recurrent anti-GBM disease.


Assuntos
Doença Antimembrana Basal Glomerular/complicações , Leucemia Linfocítica Granular Grande/complicações , Adulto , Doença Antimembrana Basal Glomerular/terapia , Humanos , Imunossupressores/uso terapêutico , Masculino , Plasmaferese , Diálise Renal
20.
An Bras Dermatol ; 94(3): 355-357, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31365669

RESUMO

Pentavalent antimonials are the first-line drug treatment for American tegumentary leishmaniasis. We report on a patient with chronic renal failure on hemodialysis who presented with cutaneous lesions of leishmaniasis for four months. The patient was treated with intravenous meglumine under strict nephrological surveillance, but cardiotoxicity, acute pancreatitis, pancytopenia, and cardiogenic shock developed rapidly. Deficient renal clearance of meglumine antimoniate can result in severe toxicity, as observed in this case. These side effects are related to cumulative plasma levels of the drug. Therefore, second-line drugs like amphotericin B are a better choice for patients on dialysis.


Assuntos
Antiprotozoários/efeitos adversos , Leishmaniose Cutânea/complicações , Leishmaniose Cutânea/tratamento farmacológico , Antimoniato de Meglumina/efeitos adversos , Insuficiência Renal Crônica/complicações , Adulto , Anfotericina B/uso terapêutico , Antiprotozoários/uso terapêutico , Brasil , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Leishmaniose Cutânea/patologia , Masculino , Diálise Renal
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