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1.
Medicine (Baltimore) ; 99(40): e22240, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019398

RESUMO

Children with end stage renal disease (ESRD) are liable to various health disorders that possibly impair their quality of life (QoL). Low dietary intake of Omega-3 fatty acids also called marine n-3 fatty acid (n-3 FA) may be associated with health problems which are among the leading causes of impaired QoL.The objective of this study was to assess the effect of omega-3 Fatty acid (n-3 FA) supplements on quality of life among children on dialysis and to evaluate its use regarding adequacy of dialysis and inflammatory markers.A prospective cohort study was conducted on 31 hemodialysis children. Quality of life was measured for patients and an equal number of matched controls using the PedsQL Inventory where the higher the score the poorer is the quality of life. n-3FA supplementation had been given to the patients for 3 months to study its effects on QoL. Laboratory investigations like hemoglobin, lipid profile, inflammatory markers, and tests for adequacy of dialysis had been carried out.Patients had significantly higher QoL scores (42.22 ±â€Š13.31) than controls (22.70 ±â€Š1.31) (P < .001). Young ages showed higher score of physical functioning (18.23 ±â€Š4.22) than older ones (13.92 ±â€Š6.84) (P = .049). Females had significantly higher total QoL score (25.53 ±â€Š6.61) than males (20.06 ±â€Š7.09) (P = .010). The total QoL score was significantly lower post than pre administration of n-3FA (35.41 ±â€Š10.36 vs 42.22 ±â€Š13.31) (P < .001). Triglycerides and CRP were significantly lower post than pre n-3FA supplementation (160.64 ±â€Š32.55 vs 169.35 ±â€Š31.82) (P < .001) and (10.29 ±â€Š4.39 vs 11.19 ±â€Š4.83) (P = .006) respectively. Means of Kt/V and urea reduction ratio (URR) were significantly higher post (1.37 ±â€Š0.09, 70.0 ±â€Š5.99 respectively) than pre n-3FA (1.31 ±â€Š0.07 and 65.25 ±â€Š6.06 respectively) (P = .005, .001 respectively).Quality of life and adequacy of dialysis get improved after n-3FA supplementation among children on dialysis which encourages its testing for more patients to evaluate its long term effects and support its routine use.


Assuntos
Suplementos Nutricionais , Ácidos Graxos Ômega-3/administração & dosagem , Qualidade de Vida , Diálise Renal/efeitos adversos , Adolescente , Estudos de Casos e Controles , Criança , Feminino , Humanos , Falência Renal Crônica , Masculino , Estudos Prospectivos , Melhoria de Qualidade , Diálise Renal/psicologia
2.
Medicine (Baltimore) ; 99(37): e22002, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925731

RESUMO

The use of tunneled cuffed catheters (TCCs) for permanent blood access is increasing as the hemodialysis population ages. However, the higher mortality and complication rates associated with their use have been significant concerns. This single-center observational cohort study aimed to investigate clinical factors affecting mortality and complications in Japanese hemodialysis patients with a TCC.We enrolled 64 consecutive patients receiving hemodialysis through a TCC between 2012 and 2019. The primary outcome was all-cause mortality and the secondary outcome was the incidence of catheter-related complications at 2 years. Cox proportional hazards models were used to examine variables associated with these outcomes.At 2 years, death from any cause and catheter-related complications occurred in 27/64 (42%) and 23/64 (36%) patients, respectively. There were 14 bacteremia events, 7 catheter obstructions, and 8 instances of restricted blood flow. Multivariate analysis showed that systolic blood pressure (SBP) < 100 mm Hg at the time of catheter insertion was associated with higher all-cause mortality (hazard ratio, 2.59; 95% confidence interval, 1.05-6.41) and catheter-related complications (hazard ratio, 2.57; 95% confidence interval, 1.52-22.2). The Kaplan-Meier analyses also showed that patients with SBP <100 mm Hg had higher mortality (P = .001) and a higher incidence of catheter-related complications (P = .0068).SBP <100 mm Hg at the time of catheter insertion is associated with mortality and catheter-related complications in hemodialysis patients using a TCC. Further multi-center studies are required to validate our results.


Assuntos
Pressão Sanguínea , Cateteres de Demora/efeitos adversos , Causas de Morte , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Diálise Renal/instrumentação , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/etiologia , Obstrução do Cateter/etiologia , Infecções Relacionadas a Cateter/etiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/fisiopatologia , Masculino , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fluxo Sanguíneo Regional , Fatores de Risco
3.
Medicine (Baltimore) ; 99(36): e21890, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899019

RESUMO

The outcomes of carbon dioxide digital subtraction angiography (CO2-DSA) for performing percutaneous transluminal balloon angioplasty (balloon PTA) in hemodialysis patients has not been fully clarified. The purpose was to compare the outcomes of balloon PTA of hemodialysis shunts in terms of vessel patency between patients treated using CO2-DSA and conventional digital subtraction angiography using iodine contrast medium (C-DSA).We retrospectively evaluated 76 patients (38 males and 38 females, mean age: 65.0 ±â€Š14.0 years). They were under hemodialysis and treated with balloon PTA using CO2-DSA or C-DSA at our institution between 2009 and 2016. Mean duration of the follow-up period was 25.59 ±â€Š21.45 months. We compared the patency rates obtained after CO2-DSA-based balloon PTA with those after C-DSA-based balloon PTA. Secondary patency, which was defined as the duration of patency after all further endovascular interventions until surgical repair, was considered as the endpoint in this study.Overall, 19 and 57 patients underwent CO2-DSA- and C-DSA-based balloon PTA, respectively. CO2-DSA- and C-DSA-based balloon PTA produced clinical success rates of 100% and 96.5%, respectively. Blood vessel injury occurred in one patient who underwent C-DSA-based balloon PTA. No major complications occurred in CO2 group. At 24 months, the post-PTA secondary patency rates of CO2-DSA- and C-DSA-based balloon PTA were 94.1% and 93.9%, respectively (P = .9594).CO2-DSA is safe for hemodialysis patients. Compared with C-DSA, CO2-DSA-based balloon PTA produces have a similar secondary patency rate.


Assuntos
Angiografia Digital/métodos , Angioplastia com Balão/métodos , Dióxido de Carbono/administração & dosagem , Meios de Contraste/administração & dosagem , Diálise Renal/efeitos adversos , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Veia Subclávia/diagnóstico por imagem , Veia Subclávia/patologia , Grau de Desobstrução Vascular
4.
Medicine (Baltimore) ; 99(36): e21906, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899022

RESUMO

INTRODUCTION: End stage renal failure patients on hemodialysis have significant vascular calcification This is postulated to be related to sub-clinical vitamin K deficiency, which is prevalent in hemodialysis patients. Vitamin K deficiency result in the failure of the matrix GLA protein (MGP) to undergo carboxylation. MGP is a natural local inhibitor of vascular calcification and the lack of functional carboxylated MGP may contribute to increase vascular calcification. Vitamin K supplement should therefore correct this anomaly and decrease the rate or severity of vascular calcification in this population of patients on long-term maintenance hemodialysis. Our study seeks to evaluate the prevalence and the progression of vascular calcification in a cohort of maintenance hemodialysis patients. It will also evaluate the efficacy of vitamin K supplementation in reducing the progression of vascular calcification in this group of patients. METHODS: This will be a single-center randomized, prospective and open-label interventional clinical trial of end stage renal failure patients on hemodialysis. We aim to recruit 200 patients. Eligible patients will be randomized to either the standard care arm or active treatment arm. Active treatment arm patients will receive standard care plus supplementation with oral vitamin K2 isoform 360 mcg 3 times weekly for a total duration of 18 months. Primary outcome measured will be absolute difference in coronary artery calcification score at 18-month between control and intervention arms. Secondary outcomes will be to compare absolute difference in aortic valve calcification, percentage of patients with regression of coronary artery calcification of at least 10%, absolute difference in aortic and systemic arterial stiffness, mortality from any cause and major adverse cardiovascular over the same period. DISCUSSION: Evidence of successful regression or retardation of vascular calcification will support the conduct of larger and longer-term trials aimed at reducing cardiovascular disease mortality and major adverse cardiovascular events in this high-risk population using a safe and inexpensive strategy TRIAL REGISTRATION:: ClinicalTrials.gov NCT02870829. Registered on 17 August 2016 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02870829National University Hospital's Institutional Review Board (2015/01000).


Assuntos
Diálise Renal/efeitos adversos , Calcificação Vascular/prevenção & controle , Vitamina K 2/administração & dosagem , Deficiência de Vitamina K/tratamento farmacológico , Adulto , Esquema de Medicação , Feminino , Humanos , Falência Renal Crônica/terapia , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Vitamina K 2/farmacologia , Deficiência de Vitamina K/etiologia
5.
N Engl J Med ; 383(8): 733-742, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32813949

RESUMO

BACKGROUND: Standard percutaneous transluminal angioplasty is the current recommended treatment for dysfunctional hemodialysis fistulas, yet long-term outcomes of this treatment are poor. Drug-coated balloons delivering the antirestenotic agent paclitaxel may improve outcomes. METHODS: In this prospective, single-blinded, 1:1 randomized trial, we enrolled 330 participants at 29 international sites. Patients with new or restenotic lesions in native upper-extremity arteriovenous fistulas were eligible for participation. After successful high-pressure percutaneous transluminal angioplasty, participants were randomly assigned to receive treatment with a drug-coated balloon or a standard balloon. The primary effectiveness end point was target-lesion primary patency, defined as freedom from clinically driven target-lesion revascularization or access-circuit thrombosis during the 6 months after the index procedure. The primary safety end point, serious adverse events involving the arteriovenous access circuit within 30 days, was assessed in a noninferiority analysis (margin of noninferiority, 7.5 percentage points). The primary analyses included all participants with available end-point data. Additional sensitivity analyses were performed to assess the effect of missing data. RESULTS: A total of 330 participants underwent randomization; 170 were assigned to receive treatment with a drug-coated balloon, and 160 were assigned to receive treatment with a standard balloon. During the 6 months after the index procedure, target-lesion primary patency was maintained more often in participants who had been treated with a drug-coated balloon than in those who had been treated with a standard balloon (82.2% [125 of 152] vs. 59.5% [88 of 148]; difference in risk, 22.8 percentage points; 95% confidence interval [CI], 12.8 to 32.8; P<0.001). Drug-coated balloons were noninferior to standard balloons with respect to the primary safety end point (4.2% [7 of 166] and 4.4% [7 of 158], respectively; difference in risk, -0.2 percentage points; 95% CI, -5.5 to 5.0; P = 0.002 for noninferiority). Sensitivity analyses confirmed the results of the primary analyses. CONCLUSIONS: Drug-coated balloon angioplasty was superior to standard angioplasty for the treatment of stenotic lesions in dysfunctional hemodialysis arteriovenous fistulas during the 6 months after the procedure and was noninferior with respect to access circuit-related serious adverse events within 30 days. (Funded by Medtronic; IN.PACT AV Access Study ClinicalTrials.gov number, NCT03041467.).


Assuntos
Angioplastia com Balão/métodos , Derivação Arteriovenosa Cirúrgica , Fármacos Cardiovasculares/administração & dosagem , Paclitaxel/administração & dosagem , Dispositivos de Acesso Vascular/efeitos adversos , Grau de Desobstrução Vascular , Idoso , Angioplastia com Balão/instrumentação , Derivação Arteriovenosa Cirúrgica/instrumentação , Fármacos Cardiovasculares/efeitos adversos , Materiais Revestidos Biocompatíveis , Constrição Patológica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paclitaxel/efeitos adversos , Estudos Prospectivos , Diálise Renal/efeitos adversos , Método Simples-Cego , Extremidade Superior/irrigação sanguínea
6.
PLoS One ; 15(7): e0236948, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735636

RESUMO

Protein energy wasting (PEW) including muscle atrophy is a common complication in chronic hemodialysis patients. The ubiquitin proteasome system (UPS) is the main proteolytic system causing muscle atrophy in chronic kidney disease and proteasome 20S is the catalytic component of the UPS. Circulating proteasome 20S (c20S proteasome) is present in the blood and its level is related to disease severity and prognosis in several disorders. We hypothesized that c20S proteasome could be related with muscle mass, other PEW criteria and their evolution in hemodialysis patients. Stable hemodialysis patients treated at our center for more than 3 months were followed over 2 years. C20S proteasome assay was performed at baseline. Biological and clinical data were collected, muscle mass was assessed by multi-frequency bio-impedancemetry, and nutritional scores were calculated at baseline, 1 year and 2 years. Hospitalizations and mortality data were collected over the 2 years. Forty-nine patients were included. At baseline, the c20S proteasome level was 0.40[0.26-0.55] µg/ml. Low muscle mass as defined by a lean tissue index (LTI) < 10th in accordance with the International Society of Renal Nutrition and Metabolism guidelines was observed in 36% and PEW in 62%. Increased c20S proteasome levels were related with LTI at baseline (R = 0.43, p = 0.004) and with its 2 year-variation (R = -0.56, p = 0.003). Two-year survival rate was not different between higher and lower c20S proteasome values (78.9 vs 78.4%, p = 0.98 log-rank test). C20S proteasome is not a good marker for assessing nutritional status in hemodialysis patients and predicting patient outcomes.


Assuntos
Biomarcadores/sangue , Complexo de Endopeptidases do Proteassoma/sangue , Desnutrição Proteico-Calórica , Diálise Renal/efeitos adversos , Síndrome de Emaciação , Idoso , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Estado Nutricional , Avaliação de Resultados da Assistência ao Paciente , Complexo de Endopeptidases do Proteassoma/análise , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/metabolismo , Síndrome de Emaciação/diagnóstico , Síndrome de Emaciação/metabolismo
7.
Rinsho Shinkeigaku ; 60(9): 620-626, 2020 Sep 29.
Artigo em Japonês | MEDLINE | ID: mdl-32779600

RESUMO

A 72-year-old man on hemodialysis for 7 years with end-stage renal disease was admitted to our institution due to an acute headache. Physical examination revealed normal signs except for noise on the back of his neck. His head CT and brain MRI showed no abnormal findings, while his MRA demonstrated abnormal signals in the left transverse to sigmoid sinus (T-S) suggesting a left dural arteriovenous fistula. After admission, his headache persisted and left orbital numbness also occurred. His digital subtraction angiography performed on the 5th day after admission showed no vascular malformation of either the T-S or cavernous sinus (CS). However, it showed occlusion of the left brachiocephalic vein (BCV) and the origin of the left internal jugular vein (IJV) resulting in intracranial venous reflux. These findings indicated the possibility that his acute headache was caused by intracranial venous reflux and increase of intracranial pressure resulting from the occlusion of the BCV ipsilateral to a dialysis shunt. Percutaneous transluminal angioplasty (PTA) for occlusion of the left BCV was performed on the 9th day and successful dilation of the lesion with a residual stenotic ratio less than 30 percent was obtained. After the angioplasty, venous reflux to the intracranial vein was markedly reduced and his headache and orbital numbness disappeared. One day after the procedure, MRA demonstrated the disappearance of the abnormal signals of the left T-S. Twelve months after discharge, he felt discomfort in the left of his face and the re-occlusion of the left VCV was demonstrated by angiography, therefore he received re-PTA. We recommend that physicians consider occlusion of the BCV ipsilateral to a dialysis shunt and intracranial venous reflux as a cause of acute headache in patients on hemodialysis.


Assuntos
Veias Braquiocefálicas , Veias Cerebrais , Transtornos Cerebrovasculares/etiologia , Cefaleia/etiologia , Diálise Renal/efeitos adversos , Doença Aguda , Idoso , Angiografia Digital , Angioplastia , Veias Braquiocefálicas/diagnóstico por imagem , Veias Braquiocefálicas/cirurgia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/etiologia , Veias Cerebrais/diagnóstico por imagem , Transtornos Cerebrovasculares/diagnóstico por imagem , Humanos , Pressão Intracraniana , Angiografia por Ressonância Magnética , Masculino , Recidiva , Reoperação
8.
Medicine (Baltimore) ; 99(29): e21394, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702938

RESUMO

BACKGROUND: This study aims to determine the therapeutic efficacy of exercise interventions for patients undergoing hemodialysis (HD) on fatigue and health-related quality of life (HRQoL). METHODS: This review will only include randomized controlled trials (RCTs). The search strategy will be performed in 4 English databases, 4 Chinese databases, Clinical Trials.gov, and the Chinese Clinical Trial Registry. All English or Chinese RCTs, published from inception to May 31, 2020, will be sought. Two reviewers will screen, select studies, extract data, and assess quality independently. Primary outcome is fatigue assessed by questionnaire. The methodological quality including the risk of bias of the included studies will be evaluated using the Physiotherapy Evidence Database scale. Stata 12.0 software will be used for heterogeneity assessment, generating funnel-plots, data synthesis, subgroup analysis, and sensitivity analysis. RESULTS: We will provide some more practical and targeted results investigating the effect of exercise interventions for patients undergoing HD on fatigue and HRQoL in the current meta-analysis, and point out the main limitation of previous studies. CONCLUSION: The study will provide recent evidence for evaluating the therapeutic efficacy of exercise interventions for patients undergoing HD on fatigue and HRQoL. REGISTRATION NUMBER: INPLASY202050071 (DOI: 10.37766/inplasy2020.5.0071).


Assuntos
Terapia por Exercício , Fadiga/prevenção & controle , Qualidade de Vida , Diálise Renal/efeitos adversos , Terapia por Exercício/métodos , Humanos , Falência Renal Crônica/terapia , Qualidade de Vida/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Diálise Renal/métodos
9.
J Comput Assist Tomogr ; 44(4): 533-539, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697523

RESUMO

PURPOSE: The purpose of this study was to investigate the differences of gray matter volume (GMV) alteration patterns between hemodialysis with restless legs syndrome (HD-RLS) and hemodialysis without restless legs syndrome (HD-nRLS) patients using voxel-based morphometry. METHODS: Twenty-three HD-RLS patients, 27 HD-nRLS patients, and 27 age-, sex-, and education-matched healthy controls were included in this study. One-way analysis of covariance and post hoc analyses were used to assess differences in GMV, demographics, and clinical data among the 3 groups. Pearson correlation analysis was conducted between altered GMV in the HD-RLS group and clinical data. RESULTS: Compared with HD-nRLS patients, HD-RLS patients showed decreased GMV in the left primary motor cortex (false discovery rate corrected, P < 0.05). Compared with the healthy controls, both HD subgroups (ie, those with and without RLS) exhibited consistent GMV changes, including decreased GMV in the bilateral anterior cingulate and paracingulate gyrus and left middle temporal gyrus (false discovery rate corrected, P < 0.05). The GMV values in the left precentral gyrus were negatively correlated with the RLS rating scores (r = 0.2138, P = 0.0263). CONCLUSIONS: This abnormal decreased GMV in the sensorimotor cortex provides evidence for a sensory processing disorder in RLS that may be involved in the pathogenesis of RLS in HD patients.


Assuntos
Substância Cinzenta/diagnóstico por imagem , Substância Cinzenta/patologia , Diálise Renal/efeitos adversos , Síndrome das Pernas Inquietas/diagnóstico por imagem , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Córtex Motor/diagnóstico por imagem , Córtex Motor/patologia , Tamanho do Órgão , Síndrome das Pernas Inquietas/complicações
10.
J Mycol Med ; 30(3): 101009, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32620497

RESUMO

Chronic renal disease patients under chronic dialysis (CRDD) have a multifactorial immunological deterioration with an increased risk of Candida infections. Incidence of Candida infections is increasing. Choice of suitable antifungal agents is limited due to the resistance of some species to several antifungals. Aim of the present study was to identify the distribution and antifungal susceptibility patterns of oral isolated Candida species from infected and colonized patients, as well as to investigate the risk factors for oral infection in patients on dialysis. Cross-sectional study, approved by the institutional bioethics committees was performed in CRDD patients. Demographic, clinic data, and oral mucosa samples were obtained. Infection diagnosis was established clinically and confirmed with exfoliative cytology, each sample was plated on CHROMagar Candida and incubated at 36°C for 2 days. Yeast species were identified by carbohydrate assimilation ID 32C AUX system and the apiweb database. For the antifungal susceptibility test, the M44 A-3 method (CLSI) using fluconazole (FCZ), miconazole (MCZ), nystatin (NYS), and voriconazole (VCZ). Study included 119 participants, the main cause of CRD was nephropathy due to DM2 (58%), and three-fourths of the patients were under hemodialysis. Candida prevalence was 56.3% of 67 colonized or infected patients, 88 isolates were obtained. Principal identified species were C. albicans (51.1%), C. glabrata (25%), and C. tropicalis (14.8%). C. glabrata showed a reduced response to FCZ in 50% of isolates and C. albicans had a reduced response in 16% of the isolates. Antifungal agent with the least efficacious response or with the lowest susceptibility in the isolates of these patients was MCZ, followed by VCZ and FCZ, whereas NYS induced the best antifungal response.


Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Candidíase Bucal/microbiologia , Boca/microbiologia , Insuficiência Renal Crônica/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Candida/classificação , Candidíase Bucal/complicações , Candidíase Bucal/diagnóstico , Candidíase Bucal/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/microbiologia , Diabetes Mellitus Tipo 2/terapia , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/microbiologia , Nefropatias Diabéticas/terapia , Farmacorresistência Fúngica/efeitos dos fármacos , Feminino , Humanos , Masculino , México/epidemiologia , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Adulto Jovem
11.
PLoS One ; 15(7): e0236816, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32730305

RESUMO

BACKGROUND: Physical impairments are common in uraemia, as reflected by the high risk of falls of haemodialysis (HD) patients. Furthermore, these patients often suffer from malnutrition. OBJECTIVE: Up to now, it is unknown which aspects of physical performance are predominantly driven by malnutrition in HD patients. As this answer could steer different interventions, the aim of this study was to evaluate the cross-sectional relationship between nutritional status, muscle strength, exercise capacity and the risk of falls. METHODS: This study recruited HD patients between December 2016 and March 2018 from two hospital-based and five satellite dialysis units (registration number on clinicaltrial.gov: NCT03910426). The mini-nutritional assessment scale as well as objective measures of protein-energy wasting were obtained (total iron-binding capacity, total protein levels, and CRP). Physical assessment included muscle strength (quadriceps, handgrip force, and sit-to-stand test), exercise capacity (six-minute walking test) and the risk of falls (Tinetti, FICSIT, and dialysis fall index). Their interrelationship was analysed by ridge regression models. RESULTS: Out of 113 HD patients (mean age 67 years ± 16.1, 57.5% male) 36.3% were malnourished according to the mini-nutritional assessment scale and a majority had impaired quadriceps force (86.7%), six-minute walking test (92%), and an increased risk of falls (73.5%). Total protein and CRP levels were identified as relevant nutritional factors in the association with physical performance. Nutritional parameters explained 9.2% of the variance in the risk of falls and 7.6% of the variance in exercise capacity. No conclusive association was found between nutritional status and muscle strength. CONCLUSION: Protein-energy wasting is a determinant of the risk of falls and exercise capacity in patients on HD. The association between malnutrition and muscle weakness remains inconclusive.


Assuntos
Biomarcadores/análise , Caquexia/diagnóstico , Exercício Físico , Desnutrição/fisiopatologia , Força Muscular , Diálise Renal/efeitos adversos , Idoso , Caquexia/etiologia , Caquexia/metabolismo , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional
12.
Cardiovasc Pathol ; 49: 107256, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32721819

RESUMO

BACKGROUND: Heart failure is a frequently occurring complication in patients on maintenance hemodialysis (HD). However, the histological features of right ventricular endomyocardial biopsy (RVEMB) samples remain unclear. METHODS: The clinical characteristics and histological findings of consecutive patients undergoing HD with available RVEMB samples (HD group; n=28) were retrospectively compared with those of patients with dilated cardiomyopathy (n=56) and hypertensive heart disease (n=15). RESULTS: The mean myocyte diameter was significantly larger in the HD group than in the other groups (P<.001), whereas the mean percent area of fibrosis did not differ among the three groups. Immunohistochemical analysis revealed that the capillary density was significantly lower in the HD group compared with the other groups (P<.001), and it was positively associated with left ventricular ejection fraction (P=.014). The number of CD68-positive macrophages, which was significantly higher in the HD group compared with the other two groups (P<.001), was associated with cardiovascular mortality (P=.020; log-rank test). CONCLUSIONS: Myocyte hypertrophy, macrophage infiltration, and reduced capillary density were characteristic histological features of the RVEMB samples in patients undergoing HD, which may be related to the pathogenesis of cardiac dysfunction.


Assuntos
Cardiomiopatias/patologia , Cardiomiopatia Dilatada/patologia , Miocárdio/patologia , Diálise Renal , Insuficiência Renal Crônica/terapia , Adulto , Idoso , Biópsia , Capilares/patologia , Cardiomiopatias/etiologia , Cardiomiopatias/fisiopatologia , Cardiomiopatia Dilatada/fisiopatologia , Tamanho Celular , Feminino , Fibrose , Humanos , Hipertensão/complicações , Macrófagos/patologia , Masculino , Pessoa de Meia-Idade , Miócitos Cardíacos/patologia , Valor Preditivo dos Testes , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Estudos Retrospectivos , Fatores de Risco
13.
Parasitol Res ; 119(9): 3053-3059, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32638102

RESUMO

Intestinal parasitic infections (IPIs) can be a severe threat to immunocompromised patients. This is particularly true for those undergoing chemotherapy and hemodialysis. The present research is aimed at identifying intestinal parasites that might be present in immunocompromised patients. In this cross-sectional study 1040 stool samples were collected from March to September 2017. Six hundred and forty-one stool samples from immunocompromised patients (279 samples from hemodialysis patients and 362 samples from chemotherapy patients) and 399 samples from the control group were collected in Guilan province, Iran. The samples were tested by direct, formalin-ether methods for protozoa and ova of intestinal parasites and Ziehl-Neelsen staining methods for coccidian parasites such as Cryptosporidium species. The overall parasitic infection rate was highest (15%) in hemodialysis patients and 11.3% in chemotherapy patients, whereas the lowest rate was observed (7.3%) in the control group. The infectivity rates were statistically significant (P = 0.008) when compared with the control group. The parasites found were Blastocystis hominis (8.9% of the cases), Entamoeba coli (1.6%), Iodamoeba butschlii (0.8%), Endolimax nana (0.6%), Chilomastix mesnili (0.5%), Strongyloides stercoralis (0.5%), and Taenia species (0.15%), whereas Giardia lamblia was detected only in the control group. There was not a correlation between prevalence of parasites with age or education levels of the infected individuals. Results of the present study suggest that periodic stool examinations in special parasitological laboratories should be included as part of routine and general medical care.


Assuntos
Infecção Hospitalar/parasitologia , Helmintíase/parasitologia , Helmintos/isolamento & purificação , Intestinos/parasitologia , Neoplasias/parasitologia , Parasitos/isolamento & purificação , Diálise Renal/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Estudos Transversais , Fezes/parasitologia , Feminino , Helmintíase/imunologia , Helmintos/classificação , Humanos , Hospedeiro Imunocomprometido , Enteropatias Parasitárias/parasitologia , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/imunologia , Parasitos/classificação , Parasitos/genética , Prevalência , Adulto Jovem
14.
Exp Clin Transplant ; 18(3): 275-283, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-594579

RESUMO

OBJECTIVES: COVID-19 is a great threat to the modern world and significant threat to immunocompromised patients, including patients with chronic renal failure. We evaluated COVID-19 incidence among our hemodialysis patients and investigated the most probable immune mechanisms against COVID-19. MATERIALS AND METHODS: Baskent University has 21 dialysis centers across Turkey, with 2420 patients on hemodialysis and 30 on peritoneal dialysis. Among these, we retrospectively evaluated 602 patients (257 female/345 male) with chronic renal failure receiving hemodialysis as renal replacement therapy; 7 patients (1.1%) were infected with SARS-CoV-2. We retrospectively collected patient demographic characteristics, clinical data, and immunological factors affecting the clinical course of the disease. We divided patients into groups and included 2 control groups (individuals with normal renal functions): group I included COVID-19-positive patients with normal renal function, group II included COVID-19-positive hemodialysis patients, group III included COVID-19-negative hemodialysis patients, and group IV included COVID-19-negative patients with normal renal function. Lymphocyte subsets in peripheral blood and typing of human leukocyte antigens were analyzed in all groups, with killer cell immunoglobulin like receptor genes analyzed only in COVID-19-positive patients and healthy controls. RESULTS: No deaths occurred among the 7 COVID-19-positive hemodialysis patients. Group I patients were significantly older than patients in groups II and III (P = .039, P = .030, respectively) but not significantly different from group IV (P = .060). Absolute counts of natural killer cells in healthy controls were higherthan in other groups (but not significantly). ActivatedT cells were significantly increased in both COVID-19-positive groups versus COVID-19-negative groups. Groups showed significant differences in C and DQ loci with respect to distribution of alleles in both HLA classes. CONCLUSIONS: Although immunocompromised patients are at greater risk for COVID-19, we found lower COVID-19 incidence in our hemodialysis patients, which should be further investigated in in vitro and molecular studies.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/epidemiologia , Hospedeiro Imunocomprometido , Falência Renal Crônica/terapia , Infecções Oportunistas/epidemiologia , Pneumonia Viral/epidemiologia , Diálise Renal/efeitos adversos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Feminino , Antígenos HLA/imunologia , Interações Hospedeiro-Patógeno , Humanos , Incidência , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/imunologia , Células Matadoras Naturais/imunologia , Ativação Linfocitária , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/imunologia , Infecções Oportunistas/virologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Linfócitos T/imunologia , Resultado do Tratamento , Turquia/epidemiologia , Adulto Jovem
15.
Ther Apher Dial ; 24(4): 361-365, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32506762

RESUMO

In Japan, the first case of COVID-19 in dialysis patients was reported on March 1, 2020. A total of 31 cases were reported by April 10, and it increased to 95 by May 15. Thereafter, with the rapid increase in the number of COVID-19 cases in the general population since late March, there was a not surprising increase in the number of COVID-19 cases in dialysis patients. The mortality rate is 16.2% (16/99 cases) in dialysis patients, which is higher than 5.3% (874/16 532 cases) in the general population. This higher mortality rate in dialysis patients with COVID-19 might be related to their age; the majority of COVID-19 cases are aged between 70 and 90 years old in dialysis patients, compared with between 20 and 60 years old in the general population. As COVID-19 presents with severe symptoms and is associated with a high mortality rate in dialysis patients, dialysis patients who have contracted severe acute respiratory syndrome coronavirus 2 infection confirmed by polymerase chain reaction testing are required to be hospitalized under Japanese government policy. In cases of COVID-19 hospitalizations, it is essential to prevent nosocomial infection. Therefore, patients must be sufficiently instructed in infection prevention and robust measures to prevent contraction and spread of the infection must be taken at dialysis facilities.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/prevenção & controle , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Prevenção Primária/métodos , Diálise Renal/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Feminino , Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Diálise Renal/efeitos adversos , Análise de Sobrevida
16.
Medicine (Baltimore) ; 99(24): e20401, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541461

RESUMO

Depression may hamper the immune system and nutritional status, which leads to poor outcomes of treatment. It is very common in dialysis patients. There are the numbers of parameters affected by the depression of patients and available studies are not enough to define the association between biological parameters and depression in the dialysis population. The purposes of the study were to find the prevalence of depression and association of it with the biochemical abnormalities in the dialysis patients.The selected battery of tests (clinician-administered questionnaires) were applied to dialysis patients (test cohort, n = 298) and caregivers (control cohort, n = 202) for establishing depression. The demographic and clinical conditions of participants were also collected. Univariate analysis followed by multiple regression analysis was performed for demographical parameters, clinical conditions, and laboratory results for the detection of association of them with depression. The abnormal test considered as more than 2 SD of mean below the normal value. Out of all tests, at least 2 abnormal tests were considered as mild depression. More than half of abnormal parameters among all tests were considered as moderate depression and all abnormal parameters were considered as severe depression.There was a significant difference for all the test between dialysis patients and the caregivers (P < .0001 for all). The half (153 out of 298) of dialysis patients were depressive and clinically asymptomatic. 70 (23%) dialysis patients were mild depressive, 45 (15%) dialysis patients were moderate depressive, and 38 (13%) dialysis patients were severely depressive. Serum phosphate (P = .023), level of parathyroid hormone (P = .021), and urea reduction rate (P = .048) were directly associated with depression.Biochemical abnormalities (serum phosphate level, parathyroid hormone, and urea reduction rate) were independent predictors of depression in the dialysis population.Level of evidence: III.


Assuntos
Depressão/psicologia , Diálise Renal/psicologia , Uremia/terapia , Adulto , Biomarcadores/sangue , Nitrogênio da Ureia Sanguínea , Cuidadores/psicologia , Estudos de Casos e Controles , China/epidemiologia , China/etnologia , Estudos de Coortes , Depressão/sangue , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Fosfatos/sangue , Prevalência , Diálise Renal/efeitos adversos , Estudos Retrospectivos , Uremia/complicações
17.
Exp Clin Transplant ; 18(3): 275-283, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32519618

RESUMO

OBJECTIVES: COVID-19 is a great threat to the modern world and significant threat to immunocompromised patients, including patients with chronic renal failure. We evaluated COVID-19 incidence among our hemodialysis patients and investigated the most probable immune mechanisms against COVID-19. MATERIALS AND METHODS: Baskent University has 21 dialysis centers across Turkey, with 2420 patients on hemodialysis and 30 on peritoneal dialysis. Among these, we retrospectively evaluated 602 patients (257 female/345 male) with chronic renal failure receiving hemodialysis as renal replacement therapy; 7 patients (1.1%) were infected with SARS-CoV-2. We retrospectively collected patient demographic characteristics, clinical data, and immunological factors affecting the clinical course of the disease. We divided patients into groups and included 2 control groups (individuals with normal renal functions): group I included COVID-19-positive patients with normal renal function, group II included COVID-19-positive hemodialysis patients, group III included COVID-19-negative hemodialysis patients, and group IV included COVID-19-negative patients with normal renal function. Lymphocyte subsets in peripheral blood and typing of human leukocyte antigens were analyzed in all groups, with killer cell immunoglobulin like receptor genes analyzed only in COVID-19-positive patients and healthy controls. RESULTS: No deaths occurred among the 7 COVID-19-positive hemodialysis patients. Group I patients were significantly older than patients in groups II and III (P = .039, P = .030, respectively) but not significantly different from group IV (P = .060). Absolute counts of natural killer cells in healthy controls were higherthan in other groups (but not significantly). ActivatedT cells were significantly increased in both COVID-19-positive groups versus COVID-19-negative groups. Groups showed significant differences in C and DQ loci with respect to distribution of alleles in both HLA classes. CONCLUSIONS: Although immunocompromised patients are at greater risk for COVID-19, we found lower COVID-19 incidence in our hemodialysis patients, which should be further investigated in in vitro and molecular studies.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/epidemiologia , Hospedeiro Imunocomprometido , Falência Renal Crônica/terapia , Infecções Oportunistas/epidemiologia , Pneumonia Viral/epidemiologia , Diálise Renal/efeitos adversos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Feminino , Antígenos HLA/imunologia , Interações Hospedeiro-Patógeno , Humanos , Incidência , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/imunologia , Células Matadoras Naturais/imunologia , Ativação Linfocitária , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/imunologia , Infecções Oportunistas/virologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Linfócitos T/imunologia , Resultado do Tratamento , Turquia/epidemiologia , Adulto Jovem
18.
PLoS One ; 15(6): e0234376, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32569265

RESUMO

BACKGROUND: Profound healthcare challenges confront societies with an increase in prevalence of end-stage renal disease (ESRD), which is one of the leading causes of morbidity and mortality worldwide. Due to several facility and patient related factors, ESRD is significantly associated with increased morbidity and mortality attributed to infections. AIMS AND OBJECTIVE: The aim of this study was to assess systematically the characteristics of patients and risk factors associated with nosocomial infections among ESRD patients undergoing hemodialysis. METHODS: A systematic literature search was performed to identify eligible studies published during the period from inception to December 2018 pertaining to risk factors associated with nosocomial infections among hemodialysis patients. The relevant studies were generated through a computerized search on five databases (PubMed, EBSCOhost, Google Scholar, ScienceDirect and Scopus) using the Mesh Words: nosocomial infections, hospital acquired infections, healthcare associated infections, end stage renal disease, end stage renal failure, hemodialysis, and risk factors. The complete protocol has been registered under PROSPERO (CRD42019124099). RESULTS: Initially, 1411 articles were retrieved. Out of these, 24 were duplicates and hence were removed. Out of 1387 remaining articles, 1337 were removed based on irrelevant titles and/or abstracts. Subsequently, the full texts of 50 articles were reviewed and 41 studies were excluded at this stage due to lack of relevant information. Finally, nine articles were selected for this review. Longer hospital stay, longer duration on hemodialysis, multiple catheter sites, longer catheterization, age group, lower white blood cell count, history of blood transfusion, and diabetes were identified as the major risk factors for nosocomial infections among hemodialysis patients. CONCLUSION: The results of this review indicate an information gap and potential benefits of additional preventive measures to further reduce the risk of infections in hemodialysis population. Moreover, several patient-related and facility-related risk factors were consistently observed in the studies included in this review, which require optimal control measures.


Assuntos
Infecção Hospitalar/etiologia , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Infecções Relacionadas a Cateter/etiologia , Nefropatias Diabéticas/complicações , Nefropatias Diabéticas/terapia , Feminino , Hemoglobinas/metabolismo , Humanos , Falência Renal Crônica/sangue , Masculino , Fatores de Risco , Sepse/etiologia , Fatores de Tempo
19.
PLoS One ; 15(6): e0234402, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32589638

RESUMO

RATIONALE & OBJECTIVE: The prognostic significance of dialysis-dependent end-stage kidney disease on postoperative mortality is unclear. This study aims to estimate the odds of postoperative mortality in patients receiving chronic dialysis undergoing elective surgery compared to patients with normal kidney function, and to examine the influence of comorbidities on the excess mortality risk. METHODS: A systematic search of studies published up to January 2020 was conducted using MEDLINE, EMBASE and CENTRAL databases. Eligible studies reported postoperative 30-day or in-hospital mortality in chronic dialysis patients compared to patients with normal kidney function undergoing elective surgery. Two investigators independently reviewed all abstracts and performed risk of bias assessments using the Newcastle-Ottawa Scale. Quality of evidence was summarised in accordance with GRADE methodology (grading of recommendations, assessment, development and evaluation). Relative mortality risk estimates were obtained using random effects meta-analysis. Heterogeneity was explored using meta-regression. (PROSPERO CRD42017076565). RESULTS: Forty-nine studies involving 41, 822 chronic dialysis and 10, 476, 321 non-dialysis patients undergoing elective surgery were included. Patients on chronic dialysis had a greatly increased postoperative mortality odds compared to patients with normal kidney function. The excess risk ranged from OR 10.8 (95%CI 7.3-15.9) following orthopaedic surgery to OR 4.0 (95%CI 3.2-4.9) after vascular surgery. Adjustment for age and comorbidity attenuated the excess odds but remained higher for patients on chronic dialysis, irrespective of surgical discipline. Meta-regression analysis demonstrated an inverse linear relationship between excess mortality risk and study-level mean age (slope -0.06; P = 0.001) and diabetes prevalence (slope -0.02; p = 0.001). CONCLUSIONS: Patients on chronic dialysis have an increased odds for postoperative mortality following elective surgery across all surgical disciplines. This relationship is consistent among all studies, with the excess postoperative mortality attributable to end-stage kidney disease and chronic dialysis treatment may be lower among older patients with diabetes.


Assuntos
Procedimentos Cirúrgicos Eletivos/mortalidade , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Complicações Pós-Operatórias/mortalidade , Diálise Renal/efeitos adversos , Adulto , Idoso , Comorbidade , Feminino , Mortalidade Hospitalar , Humanos , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Risco
20.
Am J Physiol Renal Physiol ; 319(2): F171-F177, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32538148

RESUMO

Endothelial dysfunction (ED) contributes to the high incidence of cardiovascular events in patients undergoing hemodialysis. Syndecan-1 in the endothelial glycocalyx can be shed into the circulation, serving as a biomarker for ED. As Na+ is a trigger for glycocalyx shedding, we now tested whether hemodialysis, with higher dialysate Na+ concentrations, is associated with more syndecan-1 shedding compared with standard hemodialysis (SHD). In this crossover study in 29 patients, plasma syndecan-1 was repeatedly measured during SHD and during Hemocontrol hemodialysis (HHD), which is characterized by initially higher dialysate and plasma Na+ levels. Courses of syndecan-1 were compared with linear mixed models. Syndecan-1 shedding was assessed by area under the curve analysis. Plasma Na+ increased early after the start of SHD and HHD, with higher values during HHD (30 min: 142.3 vs. 139.9 mM, P < 0.001). Syndecan-1 increased significantly during both conditions, but the percent change was higher (42.9% vs. 19.5%) and occurred earlier (120 vs. 180 min) during HHD. Syndecan-1 levels were significantly higher at 120 min during HHD compared with SHD (P < 0.05). Overall, syndecan-1 shedding was higher during HHD compared with SHD (means: 40.4 vs. 19.0 arbitrary units, P = 0.06). Lower predialysis plasma Na+ and osmolality were associated with greater intradialytic increases in syndecan-1 levels (both groups, P = 0.001). The rise in plasma syndecan-1 levels was more pronounced and occurred earlier during hemodialysis with higher plasma Na+ levels. Although we cannot prove that the rise in plasma syndecan-1 originates from the endothelial glycocalyx, our findings are compatible with Na+-driven endothelial glycocalyx-derived syndecan-1 shedding.


Assuntos
Endotélio Vascular/efeitos dos fármacos , Sódio/sangue , Sindecana-1/sangue , Adulto , Biomarcadores/sangue , Estudos Cross-Over , Soluções para Diálise/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos
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