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1.
J Sci Food Agric ; 100(2): 846-854, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-31646650

RESUMO

BACKGROUND: Pomegranate has antioxidant, cardioprotective and anti-inflammatory properties. We designed a crossover study aimed at determining if consumption of pomegranate juice (PJ) improves lipid profile and oxidative and inflammatory biomarkers of hemodialysis patients. Forty-one hemodialysis patients were randomly assigned to one of two groups: PJ-treated group receiving 100 mL of natural PJ immediately after their dialysis session three times a week and the control group receiving the usual care. After 8 weeks, a 4-week washout period was established and then the role of the groups was exchanged. Lipid profile, blood pressure and oxidative and inflammatory biomarkers were measured before and after each sequence. RESULTS: Based on the results of intention-to-treat analysis, triglycerides were decreased in PJ condition and increased in the controls. Conversely, high-density lipoprotein cholesterol was increased in PJ and decreased in the control group. Total and low-density lipoprotein cholesterol did not significantly change in either condition. Systolic and diastolic blood pressure significantly decreased in PJ condition. Total antioxidant capacity increased in PJ condition (P < 0.001) and decreased in the controls (P < 0.001). Conversely, malondialdehyde and interleukin-6 decreased in PJ (P < 0.001) and increased in the control group (P ≤ 0.001). The changes of these biomarkers were significantly different between the two conditions. CONCLUSIONS: Eight-week PJ consumption showed beneficial effects on blood pressure, serum triglycerides, high-density lipoprotein cholesterol, oxidative stress and inflammation in hemodialysis patients. © 2019 Society of Chemical Industry.


Assuntos
Doenças Cardiovasculares/metabolismo , Sucos de Frutas e Vegetais/análise , Insuficiência Renal Crônica/dietoterapia , Adulto , Idoso , Pressão Sanguínea , Doenças Cardiovasculares/imunologia , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Estudos Cross-Over , Feminino , Humanos , Masculino , Malondialdeído/metabolismo , Pessoa de Meia-Idade , Estresse Oxidativo , Diálise Renal , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/terapia , Triglicerídeos/metabolismo
2.
Vasc Endovascular Surg ; 54(1): 5-11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31506033

RESUMO

INTRODUCTION: High flow rates may develop in arteriovenous fistula (AVF), resulting in clinical syndromes of steal, aneurysmal fistula, or high-output cardiac failure. Various techniques with varying success have been advocated to treat this difficult problem. We present a hemodynamically validated novel banding technique. METHODS: We designed a computational fluid dynamic (CFD) model of the native high-flow AVF and tested various juxta-anastomotic venous diameters to determine the effect on AVF blood flow and pressure. We translated this principle in our banding technique, wherein adjustable banding was performed in conjunction with ultrasound-guided brachial artery flow measurement to determine the optimal band diameter. Polyurethane patch was used to fashion the adjustable band. Patient demographics, AVF flow parameters pre- and postintervention, operative intervention, and ultrasound follow-up data were collected prospectively. RESULTS: Our CFD testing demonstrated that the band diameter needed to achieve optimal distal blood pressure and preserve AVF flow depending on blood pressure, end capillary pressure, venous pressure, and vascular diameters. Five patients subsequently underwent dynamic banding of symptomatic high-flow AVF. Mean brachial artery blood flow rates pre- and postbanding were 2964 mL/min (confidence interval [CI]: 1487-4440 mL/min) and 1099 mL/min (CI: 571.7-1627 mL/min), respectively (P = .01). All patients had symptomatic improvement, and at a mean follow-up of 1 year, this benefit was sustained with no AVF thrombosis or loss. CONCLUSION: Adjustable dynamic band using ultrasound-guided brachial artery flow shows promising results in producing accurate AVF blood flow reduction with sustained efficacy in the short term for patients with symptomatic high-flow AVF.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Artéria Braquial/fisiopatologia , Hemodinâmica , Complicações Pós-Operatórias/cirurgia , Diálise Renal , Adolescente , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Artéria Braquial/diagnóstico por imagem , Simulação por Computador , Humanos , Ligadura , Pessoa de Meia-Idade , Modelos Cardiovasculares , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Fluxo Sanguíneo Regional , Reoperação , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção
3.
Vasc Endovascular Surg ; 54(1): 25-35, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31537181

RESUMO

PURPOSE: The aim of this study is to present our personal experience using covered nitinol stent-graft in the treatment of outflow tract stenosis of arteriovenous grafts (AVGs) for hemodialysis access. MATERIALS AND METHODS: Between May 2015 and October 2017, we retrospectively evaluated 36 (24 males, 12 females; mean age: 65.6 years) patients with AVGs on hemodialysis who underwent percutaneous angioplasty followed by endovascular stent-graft deployment for the treatment of stenosis of the venous outflow of the AVG. Indication for treatment included early restenosis (<3 months after previous percutaneous transluminal angioplasty [PTA]), long stenosis (stenoses >50% extending for a length >5 cm), and recoil of the stenosis after PTA performed with a noncompliant high-pressure balloon. Of 36 patients, 27 (75%) required surgical thrombectomy prior to endovascular procedure. Technical success, clinical success, primary and secondary patency, and safety were evaluated. RESULTS: Technical success was 100%, and clinical success was 94.4%. Primary patency was 94.4%, 72.2%, 63%, 45.9%, and 45.9% at 1, 3, 6, 12, and 18 months (average: 215 days, range: 9-653 days); secondary patency was 94.4% and 86.1% at 1 and 3 months; 80.4% at 6, 12, and 18 months; and 53.6% at 24 months (average: 276.8 days, range: 9-744 days). No deaths were registered. CONCLUSIONS: In selected cases, the use of stent-graft represents an effective and safe solution for the treatment of stenotic complications of the venous outflow of AVGs, even in the setting of access thrombosis.


Assuntos
Derivação Arteriovenosa Cirúrgica/instrumentação , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Oclusão de Enxerto Vascular/cirurgia , Diálise Renal , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Ligas , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Politetrafluoretileno , Desenho de Prótese , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
4.
J Clin Ethics ; 30(4): 331-337, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31851624

RESUMO

Situations in which patients lack medical decision-making (MDM) capacity raise ethical challenges, especially when the patients decline care that their surrogate decision makers and/or clinicians agree is indicated. These patients are a vulnerable population and should receive treatment that is the standard of care, in line with their the values of their authentic self, just as any other patient would. But forcing treatment on patients who refuse it, even though they lack capacity, carries medical and psychological risks to the patients and the hospital staff. It is also often impractical to force some treatments, especially in the long term. For example, independent of the ethical "should" question, how would one force hemodialysis for the rest of a patient's life, or force a surgery that requires weeks of post-operative physical therapy? In this article we present a novel algorithm that can help clinicians with ethical and practical decision making, with the goals of achieving the best outcomes for patients and reducing moral distress for their caretakers and clinicians.


Assuntos
Tomada de Decisão Clínica/ética , Tomada de Decisões , Ética Clínica , Recusa do Paciente ao Tratamento , Humanos , Competência Mental , Participação do Paciente , Diálise Renal , Recusa do Paciente ao Tratamento/ética
5.
Kardiologiia ; 59(12): 72-83, 2019 Dec 11.
Artigo em Russo | MEDLINE | ID: mdl-31849314

RESUMO

The review presents data on the prevalence of atrial fibrillation in patients on dialysis therapy. It is shown that dialysis-dependent patients with non-valve atrial fibrillation prognosis is extremely unfavorable, significantly increased risk of death due to both ischemic and hemorrhagic complications. Scales to assess the risk of thromboembolic and hemorrhagic complications in patients with atrial fibrillation on program dialysis are not validated. The lack of data from randomized clinical trials makes it much more difficult to choose anticoagulant therapy in patients with terminal stage of chronic kidney disease on dialysis who have undergone kidney transplantation. Therefore, the need for anticoagulant therapy and the choice of drugs in patients in this category should be made on the basis of a personalized multidisciplinary approach, taking into account comorbid pathology and the patient's preferences.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Administração Oral , Anticoagulantes , Humanos , Prognóstico , Diálise Renal , Acidente Vascular Cerebral/tratamento farmacológico
6.
Medicine (Baltimore) ; 98(51): e18450, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861018

RESUMO

Restless legs syndrome (RLS) increases the risks of cardiovascular disease and death in hemodialysis (HD) patients. Previous studies of risk factors for RLS in HD patients have yielded varying results. We attempted to identify risk factors for RLS in HD patients in Taiwan.This case-control study recruited 59 HD patients with RLS and 353 HD patients without RLS from the largest HD center in Taiwan during the period from April 1, 2015 through August 31, 2015. Demographic and disease characteristics, information from the International Restless Legs Syndrome Study Group (IRLSSG) diagnostic questionnaire, and IRLSSG Severity Scale scores were collected by interview. Clinical laboratory data were abstracted from medical records and then analyzed with logistic regression and Pearson correlation analysis. A P value of less than .05 was considered to indicate statistical significance.A dialysis duration of longer than 5 years (odds ratio [OR] = 2.32; 95% CI = 1.23-4.39; P = .002) and a low high-density lipoprotein cholesterol level (<40 mg/dL in men; <50 mg/dL in women) (OR = 2.73; 95% CI = 1.44-5.15; P = .009) were associated with increased risk of RLS. Among the 59 patients with RLS, 48 (81.3%) had moderate or severe symptoms (IRLSSG Severity Scale >10), and RLS severity was significantly correlated with dialysis duration (r = .26; P = .043).Among HD patients, RLS was more common among those receiving dialysis for longer than 5 years and those with a low serum high-density lipoprotein cholesterol (HDL-C) level.


Assuntos
Falência Renal Crônica/complicações , Síndrome das Pernas Inquietas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal , Síndrome das Pernas Inquietas/etiologia , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
7.
Nephrol Nurs J ; 46(6): 577-585, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31872987

RESUMO

The expert nephrology nurse is an integral part of quality care and essential for continuity of care in the renal community. A review of literature focused on the expert nephrology nurse, the need for these experts in the hemodialysis setting, and how the shortage of expert nephrology nurses may impact patient outcomes. The purpose was to synthesize the current literature to provide an understanding of the shortage of expert nephrology nurses. The review of 140 articles dated from 1984 through 2016 resulted in 65 that met the inclusion and exclusion criteria. The results of this literature review of shortage of expert nephrology nurses prompts concern for the renal community and its patients.


Assuntos
Nefrologia , Enfermeiras e Enfermeiros , Diálise Renal , Humanos , Qualidade da Assistência à Saúde
8.
Nephrol Nurs J ; 46(6): 587-590, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31872988

RESUMO

Central venous catheter (CVC) vascular access is common among patients on hemodialysis. CVC use carries a substantial risk of central line-associated bloodstream infections (CLABSIs), costly events that place patients at a high risk of mortality. Our hospital and dialysis organization developed a cooperative strategy to reduce the rate of CLABSI among hospitalized patients on hemodialysis with a CVC. The program included the use of training and reporting tools to guide hospital staff with CLABSI prevention, as well as leadership committees to oversee the process. Fourteen CLABSIs were reported in the 17-month period prior to the implementation of the program, while no new CLABSIs occurred in the 30 months following implementation of the program. This prevention program effectively reduced the frequency of CLABSIs. Broader implementation of such programs may result in better outcomes and lower costs for hospitalized patients on hemodialysis.


Assuntos
Bacteriemia , Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Cateteres Venosos Centrais , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Humanos , Diálise Renal
9.
Nephrol Nurs J ; 46(6): 591-595, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31872989

RESUMO

This article describes an example of a pilot study that was done to determine the feasibility of measuring fatigue in patients on hemodialysis several times a day for one week to track patterns of fatigue. Pilot studies are studies done on a smaller scale that use the same methods and procedures to be used in a larger study and are important in determining the feasibility of a research project. Lessons learned regarding the feasibility of this pilot study are discussed, including difficulties in participant recruitment, retention, and data collection. Suggestions to improve feasibility of studying this topic in patients on hemodialysis are examined and highlight the importance of pilot studies in designing larger scale studies.


Assuntos
Fadiga , Diálise Renal , Coleta de Dados , Estudos de Viabilidade , Humanos , Projetos Piloto
10.
Nephrol Nurs J ; 46(6): 597-603, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31872990

RESUMO

Renal replacement therapy, especially hemodialysis, can exacerbate brain injury. The excessive ultrafiltration and rapid changes in blood pressure directly impact cerebral perfusion pressure. Substances that are typically added or removed during hemodialysis treatments alter serum osmolarity, shifting fluids into or out of the intracranial cavity. This results in changes in the intracranial pressure due to shrinking or swelling of the cerebral parenchyma, which if left untreated, can result in death. This article describes a case of dialysis disequilibrium syndrome and is an example of how astute nephrology nurses can directly impact the care of critically ill neurological patients.


Assuntos
Lesão Renal Aguda , Diálise Renal , Humanos , Pressão Intracraniana , Terapia de Substituição Renal
11.
Nephrol Nurs J ; 46(6): 615-649, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31872992

RESUMO

The purpose of this study was to investigate changes in sleep quality, fatigue, mental health, and health-related quality of life (HRQoL) over a two-year period among patients undergoing peritoneal dialysis treatment at home. We further explored the extent to which sleep quality, fatigue, and mental health predicted health-related quality of life outcomes. This prospective study included 55 patients. Sleep parameters changed over two years, independently of treatment. Sleep variables at baseline, to some extent, predicted sleep quality after two years. Daytime sleepiness can be a long-term problem. Findings indicate improvements in nocturnal sleep over a two-year time period, independently of dialysis treatment. In contrast, fatigue remained unchanged over the same time period. Transplantation seems to generally benefit the outcome of HRQoL. Strategies to improve sleep and HRQoL may include systematic risk factor modification and efforts to optimise symptomatic treatment.


Assuntos
Fadiga , Diálise Peritoneal , Qualidade de Vida , Transtornos do Sono-Vigília , Humanos , Estudos Prospectivos , Diálise Renal , Sono
12.
Wiad Lek ; 72(11 cz 2): 2199-2201, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31860836

RESUMO

OBJECTIVE: Introduction: Hypertension is an overwhelming finding in chronic kidney disease (CKD), but data on hypertension prevalence in acute kidney injury (AKI) are scarce. The aim: The study aimed to assess the prevalence of hypertension in patients with AKI regarding its cause: prerenal, renal, or postrenal.. PATIENTS AND METHODS: Material and Methods: We retrospectively analyzed the medical documentation of 215 patients with AKI. RESULTS: Results: Among them, 35% required acute hemodialysis due to either clinical or biochemical indications. Prevalence of hypertension was 70%, with the highest rate in post-renal AKI (85%), followed by renal AKI (75%) and pre-renal AKI (30%). Dialyzed patients were older, had higher blood pressure, and required more hypotensive drugs. CONCLUSION: Conclusions: Hypertension is prevalent in AKI; however, it depends upon its origin. Uncontrolled hypertension, together with edema and pulmonary congestion are the indications for dialysis initiation. However, caution should be exercised during dialysis to avoid hypotensive episodes.


Assuntos
Lesão Renal Aguda , Hipertensão , Humanos , Diálise Renal , Insuficiência Renal Crônica , Estudos Retrospectivos , Fatores de Risco
13.
Wiad Lek ; 72(11 cz 2): 2202-2209, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31860837

RESUMO

OBJECTIVE: Introduction: Mineral homeostasis is achieved through a complex interplay of several feedback processes involving primarily the bone, intestine and kidney, regulated by different proteins acting on endocrine, paracrine or autocrine levels. The dysregulation of these processes in chronic renal failure, called kidney disease (CKD) - mineral and bone disorder (CKD-MBD), although apparent, is still poorly understood. The aim: The aim of the study was an analysis of potential relationships between selected biomarkers of CKD-MBD in maintenance hemodialysis (HD) patients. PATIENTS AND METHODS: Material and Methods: In the first part of this cross-sectional study, the 25(OH)D serum concentrations were measured in 115 HD vitamin D naïve patients from 5 dialysis units located in central Poland. Thereafter in 81 patients (49 men, 32 women, aged 67 ± 13 years) with vitamin deficiency (25(OH)D <20 ng/ml) serum concentrations of 25(OH)D, 1,25(OH)2D, intact parathyroid hormone (iPTH), intact FGF23, sclerostin (SCL), osteocalcin (OC), and C-terminal telopeptide of type I collagen (CTX1) were determined. RESULTS: Results: Serum levels of both 25(OH)D and 1,25(OH)2D were low (mean values 13.4±6.72 ng/ml and 12.9 ± 9.08 pmol/l, respectively). While serum 25(OH)D correlated only with a declared time spent outside (r= 0.411; p=0.000139), serum 1,25(OH)2D was related to diuresis (r= 0.289; p=0.009), and negatively to time on dialysis (r= -0.272; p=0.014) , serum phosphate (r= -0.393; p=0.000289), FGF23(r= -0.295; p=0.008), and SCL (r= -0.260; p=0.019). There was a marked dispersion of FGF-23 serum levels across the group (mean 823±5647, median 379 pg/ml) , and - as expected - they correlated highly with phosphate (r= 0.549, p=0.000), calcium (r= 0,328, p=0,003), OC (r=0.479; p=0.000), and negatively with z 1,25(OH)2D (r= -0.295, p=0.008). Mean serum SCL levels (89.2±46.7, median 81.9 pmol/l) were 3x higher than in general population, and correlated highly positively with dialysis vintage (r=0.402; p<0.001), age (r=0.356; p=0.001), as well as negatively with 1,25(OH)2D (r= -0.260; p=0.019) and CTX1 (r= -0.293; p=0.008). CONCLUSION: Conclusions: In our hemodialysis population, in addition to profoundly impaired 1,25(OH)2D synthesis, there is also a widespread prevalence of 25(OH)D deficiency. The patients have also markedly increased serum bone-secreted proteins, FGF23, and SCL, which regulate mineral and bone metabolism and are associated with the systemic side effects of uremia. All these hormones interact one with the other, creating a sophisticated cross-talk between the bone, intestine, and the kidney.


Assuntos
Deficiência de Vitamina D , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Remodelação Óssea , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo , Polônia , Diálise Renal , Vitamina D
14.
Wiad Lek ; 72(11 cz 2): 2250-2253, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31860847

RESUMO

Slow low efficiency dialysis (SLED) is a hybrid technique of renal replacement therapy. It can be performed with a mobile single-pass batch dialysis system (Genius®) or the multifunctional hemodialysis machines, with reduced dialysate flow and the extended duration of the procedure. The present article reviews the recently published data comparing SLED to continuous renal replacement modalities in critically ill patients with acute kidney injury (AKI). The technical aspects as well as the practical advantages of SLED-Genius®are discussed, and our experience of using SLED for intraoperative renal replacement therapy during liver transplantation is shortly presented.


Assuntos
Lesão Renal Aguda , Diálise Renal , Terapia de Substituição Renal , Estado Terminal , Humanos
17.
Pan Afr Med J ; 33: 321, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692795

RESUMO

Introduction: The burden of chronic kidney disease (CKD) is increasing worldwide. Few studies in low and low-middle income countries have estimated the prevalence of CKD. We aimed to estimate prevalence and factors associated with CKD among medical inpatients at the largest referral hospital in Kenya. Methods: We conducted a cross-sectional study among medical inpatients at the Kenyatta National Hospital. We used systematic sampling and collected demographic information, behavioural risk factors, medical history, underlying conditions, laboratory and imaging workup using a structured questionnaire. We estimated glomerular filtration rate (GFR) in ml/min/1.73m2 classified into 5 stages; G1 (≥ 90), G2 (60-89), G3a (45-59), G3b (30-44), G4 (15-29) and G5 (<15, or treated by dialysis/renal transplant). Ethical approval was obtained from Kenyatta National Hospital-University of Nairobi Ethics and Research Committee (KNH-UoN ERC), approval number P510/09/2017. We estimated prevalence of CKD and used logistic regression to determine factors independently associated with CKD diagnosis. Results: We interviewed 306 inpatients; median age 40.0 years (IQR 24.0), 162 (52.9%) were male, 155 (50.7%) rural residents. CKD prevalence was 118 patients (38.6%, 95% CI 33.3-44.1); median age 42.5 years (IQR 28.0), 74 (62.7%) were male, 64 (54.2%) rural residents. Respondents with CKD were older than those without (difference 4.4 years, 95% CI 3.7-8.4 years, P = 0.032). Fifty-six (47.5%) of the patients had either stage G1 or G2, 17 (14.4%) had end-stage renal disease; 64 (54.2%) had haemoglobin below 10g/dl while 33 (28.0%) had sodium levels below 135 mmol/l. ). History of unexplained anaemia (aOR 1.80, 95% CI 1.02-3.19), proteinuria (aOR 5.16, 95% CI 2.09-12.74), hematuria (aOR 7.68, 95% CI 2.37-24.86); hypertension (aOR 2.71, 95% CI 1.53-4.80) and herbal medications use (aOR 1.97, 95% CI 1.07-3.64) were independently associated with CKD. Conclusion: Burden of CKD was high among this inpatient population. Haematuria and proteinuria can aid CKD diagnosis. Public awareness on health hazards of herbal medication use is necessary.


Assuntos
Hematúria/epidemiologia , Falência Renal Crônica/epidemiologia , Proteinúria/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Adulto , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Pacientes Internados , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/diagnóstico , Fatores de Risco , Inquéritos e Questionários
18.
Rev Port Cir Cardiotorac Vasc ; 26(3): 199-204, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734971

RESUMO

BACKGROUND: Patients under dialysis have a high cardiovascular risk and they are at increased risk when submitted to cardiac surgery. AIM OF THE STUDY: to evaluate morbidity, early and late mortality, and predictive factors of mortality in patients under dialysis who underwent cardiac surgery. METHODS: A retrospective observational study was performed including all dialysis dependent patients who underwent cardiac surgery (coronary, valvular or combined procedures) in our institution between 2007 and 2014. A population of 95 consecutive patients was obtained (no exclusions). Perioperative variables and predictors of mortality were analysed and the endpoints were early and late mortality. Propensity score matching, with a control group of patients with creatinine clearance >90mL/min, was performed by logistic regression, with a 1:1 matching. Kaplan Meier curves were performed for late mortality. RESULTS: Early mortality was 9.4% (EuroSCORE II 4.1%). In univariate analysis, mean time of cardiopulmonary bypass (CPB) (p=0.016) and EuroSCORE II (p=0.02) were related with early mortality. In a multivariate analysis model, combined procedures (OR 138.09; CI95% 1.82-10498.4; p=0.03) and CCS (Canadian Cardiovascular Society) 3-4 (OR 70.951; CI 95% 1.32-3810.11; p=0.037) were predictors of mortality. In multivariable analysis, CPB time >152 min was a predictor of early mortality (p=0.001). After propensity score matching, 30 day, one year and late mortality were higher in the dialysis group. CONCLUSIONS: Early and late mortality were significantly higher in dialysis dependent patients. Predictive factors of mortality were CPB time and EuroSCORE II in univariable analysis, and CCS 3-4 and combined procedures in multivariable analysis.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Cardiopatias/cirurgia , Falência Renal Crônica/terapia , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Cardiopatias/complicações , Humanos , Falência Renal Crônica/complicações , Diálise Renal , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
19.
Rev Port Cir Cardiotorac Vasc ; 26(3): 209-212, 2019.
Artigo em Português | MEDLINE | ID: mdl-31734973

RESUMO

INTRODUCTION: True arterial aneurysms of the upper limb are rare and their treatment is intended to avoid complications as distal embolization, compression of surrounding neurovascular structures or rupture. OBJECTIVE: The purpose of this study is to review the experience of a department in the surgical treatment of true arterial aneurysms of the upper limb. METHODS: A retrospective study was performed between January 2007 and August 2017. RESULTS: From a total of eleven patients, nine were male and two were female. One of the patients had surgery twice because of two consecutive aneurysms of the upper limb. From a total of twelve cases, two were subclavian, one was axillary and nine were brachial aneurysms. Three of them had degenerative/idiopathic aetiology, one was associated to a cervical rib and seven occurred in the setting of arteriovenous fistula or kidney graft. Five patients had emergent surgery and the others had elective surgery. All of the patients were submitted to aneurysmectomy. As 30-day complications, there were two haematomas, one compartment syndrome and two early graft occlusions. Four patients needed re-intervention. During the follow-up period, all the grafts initially preserved were patent. There were no further known complications or amputation procedures. CONCLUSION: In this review most of the aneurysms were found in patients with haemodialysis vascular access or kidney grafts. Despite the need for early re-intervention in some cases, the surgical treatment of true arterial aneurysms of the upper limb is a low morbidity procedure.


Assuntos
Aneurisma/cirurgia , Falência Renal Crônica/terapia , Doença Arterial Periférica/cirurgia , Extremidade Superior/irrigação sanguínea , Aneurisma/complicações , Feminino , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/cirurgia , Transplante de Rim , Masculino , Doença Arterial Periférica/complicações , Diálise Renal , Estudos Retrospectivos , Resultado do Tratamento , Extremidade Superior/cirurgia
20.
Rev Port Cir Cardiotorac Vasc ; 26(3): 229-233, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734978

RESUMO

Creating and maintaining a functional vascular access (VA) is a critical factor in the survival of a dialysis patient. It implies a creative attitude either to maintain its functionality or to build a new one wherever possible, being it autologous or synthetic. We describe the VA history of a 59 years-old male patient, with extreme obesity, which started in 2012 with failed attempts of VA construction in both forearms until a functional brachiocephalic arteriovenous fistula (AVF) in the right upper limb was achieved. However, it required ligation due to severe venous hypertension secondary to central venous disease related to previous CVC use. As he had no good superficial conduit in the left arm we decided to harvest the arterialized right cephalic vein and implant it in the left arm, creating an autologous arteriovenous shunt between the brachial artery and axillary vein (AV). Despite initial patency, it failed irreversibly approximately one year after creation. As no more superficial veins were available in the upper limbs, a prosthetic access was the next step. We decided for a hybrid graft (HG) between the left brachial artery and the AV because of the patient's biotype and scarred axilla that impeded a safe re-intervention on the AV. This graft was used between 2015 and 2017 with multiple interventions to maintain patency. In 2017 a significant diffuse prosthesis deterioration and reduced AVF flow were noticed with no possible segmental reconstruction. We were then forced to proceed with subtotal graft substitution preserving the outflow stented segment of the HG, using an early cannulation graft to prevent CVC use. After this successful reconstruction, the patient started hemodialysis on the following day with no intercurrences registered.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Oclusão de Enxerto Vascular/cirurgia , Falência Renal Crônica/terapia , Falha de Prótese/efeitos adversos , Diálise Renal , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Oclusão de Enxerto Vascular/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
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