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1.
Int Heart J ; 60(5): 1189-1191, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31447465

RESUMO

The first onset of cardiac event of long QT syndrome (LQTS) was at young age and caused by emotional or physical triggers. We presented a 64-year-old woman who experienced recurrent ventricular arrhythmia after hemodialysis initiation because of end-stage renal disease. Persistent prolonged QTc interval and diagnosis of inherited LQT2 were missed at her first 3 years of hemodialysis. The patient was beta-blocker nonresponder for ventricular arrhythmias suppression and experienced multiple ICD discharge. We reported an inherited LQT2 case with uncommon clinical manifestations and the successful experience of mexiletine use in such a patient.


Assuntos
Falência Renal Crônica/terapia , Síndrome do QT Longo/genética , Mexiletina/uso terapêutico , Diálise Renal/efeitos adversos , Taquicardia Ventricular/tratamento farmacológico , Taquicardia Ventricular/etiologia , Antiarrítmicos/uso terapêutico , Eletrocardiografia/métodos , Feminino , Seguimentos , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico , Síndrome do QT Longo/diagnóstico , Pessoa de Meia-Idade , Doenças Raras , Recidiva , Diálise Renal/métodos , Medição de Risco , Taquicardia Ventricular/diagnóstico , Resultado do Tratamento
2.
Can Assoc Radiol J ; 70(3): 300-306, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31376886

RESUMO

PURPOSE: Arteriovenous fistulas and grafts, necessary for hemodialysis, may develop stenoses due to neointimal hyperplasia, which often require percutaneous transluminal angioplasty. Patient and lesion characteristics were evaluated prior to angioplasty and were correlated with 1- and 6-month outcomes. MATERIALS AND METHODS: This was an observational study of African American hemodialysis patients who presented for angioplasty of a dysfunctional fistula or graft. Clinical outcomes were ascertained from dialysis facilities 1 month and 6 months after angioplasty. One-month clinical success was defined as dialyzer blood flows of 450 mL/min without complications or interval shunt thrombosis, interventions, or loss of access, which was rarely achieved at 6 months. Logistic regression models were used to evaluate associations of clinical variables with outcomes. RESULTS: There were 150 stenoses treated during 99 procedures performed on 82 patients. The clinical success rate at one month was 67% with no complications as a result of the percutaneous transluminal angioplasty. Success at 1 month was positively associated with use of aspirin (P = .005) and with referral for high venous pressures (P = .004). Six-month data were available for 81 procedures, with 45.7% requiring repeat angioplasty and 12.3% suffering major complications (thrombectomy, revision surgery, or access abandonment). Major complications were seen predominantly in patients who were not receiving aspirin. CONCLUSIONS: Aspirin use and high venous pressure were associated with 1-month clinical success and fewer major complications at 6 months. Future work should investigate biologic mechanisms of action of aspirin and long-term effects of use to maintain vascular access.


Assuntos
Afro-Americanos/estatística & dados numéricos , Angioplastia/métodos , Fístula Arteriovenosa/terapia , Diálise Renal/efeitos adversos , Anti-Inflamatórios não Esteroides/administração & dosagem , Fístula Arteriovenosa/etiologia , Aspirina/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
3.
Complement Ther Clin Pract ; 36: 29-33, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31383439

RESUMO

INTRODUCTION: Nausea is common side effect of hemodialysis. Nonpharmacological methods such as reflexology or other branches of integrative medicine can be used to control nausea. The aim of this study was to determine the effect of reflexology on nausea in hemodialysis patients. METHODS: This study was a double-blind randomized clinical trial conducted from March 2018 to June 2018 at the Arak Dialysis Center, Iran, in which 72 eligible hemodialysis patients were randomly assigned into intervention (n = 36) and control (n = 36) groups. Reflexology was performed on the solar plexus and soles of the feet once (30 min per session) per day for twelve days, one hour after the onset of hemodialysis in the area of nausea on the solar plexus and on the soles of the feet. RESULTS: The results showed there was no significant difference in severity of nausea (P = 0.28) between the two groups before intervention. However, after intervention the severity of nausea in the 3rd, 6th, 9th, and 12th days in the intervention group was significantly lower than the control group. CONCLUSIONS: The results showed that reflexology had a positive effect on reducing the severity of nausea in hemodialysis patients. Therefore, reflexology is recommended as part of nursing care to reduce patient suffering. Universities can train students in reflexology and managers can use the protocols to apply this method to reduce patient discomfort during hemodialysis.


Assuntos
Massagem , Náusea/etiologia , Náusea/terapia , Diálise Renal/efeitos adversos , Método Duplo-Cego , Humanos
4.
Complement Ther Clin Pract ; 36: 64-68, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31383445

RESUMO

BACKGROUND AND PURPOSE: Fatigue is a common complication of hemodialysis. This study aimed to compare the effects of aromatherapy with essential oils of lavender and orange on the fatigue of hemodialysis patients. MATERIALS AND METHODS: Ninety subjects were randomly allocated into three groups of aromatherapy with lavender essential oil, aromatherapy with orange essential oil and control. Data collection tool was the Fatigue Severity Scale. In each experimental group, subjects inhaled five drops of lavender essential oil and orange essential oil. RESULTS: The difference in the mean of fatigue before and after the intervention in each of the experimental groups was statistically significant, but this difference was not significant in the control group. Between the two groups of aromatherapy, no significant difference was observed in terms of the mean fatigue after the intervention. CONCLUSION: Aromatherapy with lavender essential oil and orange essential oil might reduce fatigue in hemodialysis patients.


Assuntos
Aromaterapia , Fadiga , Óleos Voláteis/uso terapêutico , Óleos Vegetais/uso terapêutico , Diálise Renal/efeitos adversos , Fadiga/etiologia , Fadiga/terapia , Humanos
5.
Rev Med Chil ; 147(4): 458-464, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-31344207

RESUMO

BACKGROUND: Placing central venous lines under ultrasonographic guidance reduces the complications of the procedure. AIM: To compare prevalences of complications of central venous line placements with or without ultrasonographic guidance. MATERIAL AND METHODS: Descriptive study that contemplated the comparison of two groups of patients subjected to a central venous line placement at a nephrology service for renal replacement therapy. In one group of 100 patients, the line was placed without ultrasonographic guidance between 2008 and 2012. Between 2015 and 2017 the line was placed in 138 patients using ultrasonographic guidance. The prevalences of complications with both types of procedures were recorded. RESULTS: The frequency of complications of procedures with and without ultrasonographic guidance was 0.7 and 18% respectively (prevalence ratio 0.04, 95% confidence interval 0-0.3). Ninety five percent of recorded complications were arterial puncture, followed by hematomas in 10% and pneumothorax in 5%. The higher prevalence of complications was observed in emergency line placement without ultrasonographic guidance. There was a direct association between the number of line placement attempts in a single procedure and the prevalence of complications. CONCLUSIONS: Ultrasonographic guidance is associated with a reduction in the prevalence of central venous line complications.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Diálise Renal/efeitos adversos , Adulto , Idoso , Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/métodos , Chile/epidemiologia , Estudos Transversais , Feminino , Hematoma/epidemiologia , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Prevalência , Diálise Renal/instrumentação , Diálise Renal/métodos , Distribuição por Sexo , Ultrassonografia de Intervenção/métodos
6.
J Laryngol Otol ; 133(7): 592-599, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31280727

RESUMO

BACKGROUND: Several studies have reported that the audiovestibular system is affected in patients with chronic kidney disease. OBJECTIVE: This study aimed to investigate how the audiovestibular system is affected in patients with various stages of chronic kidney disease. METHODS: Sixty participants were divided into three groups: group 1 - controls; group 2 - chronic kidney disease patients receiving conservative treatment; and group 3 - chronic kidney disease patients undergoing regular haemodialysis. Assessments included: standard and high-frequency audiometry and otoacoustic emissions testing, oculomotor tests, and combined vestibular-evoked myogenic potentials testing. RESULTS: Fifty per cent of group 2 and 60 per cent of group 3 had bilateral sensorineural hearing loss. High-frequency pure tone audiometry showed reduced detectability and higher thresholds at 12 kHz and 16 kHz in patients than in controls. Otoacoustic emissions, tracking, optokinetic and combined vestibular-evoked myogenic potential tests showed abnormal results in chronic kidney disease cases. CONCLUSION: Both the auditory and vestibular pathways are affected in different stages of chronic kidney disease. High-frequency pure tone audiometry, otoacoustic emissions and combined vestibular-evoked myogenic potentials could be performed routinely in patients with chronic kidney disease, regardless of the disease stage.


Assuntos
Perda Auditiva Neurossensorial/diagnóstico , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Adulto , Audiometria de Tons Puros , Tratamento Conservador , Estudos Transversais , Feminino , Perda Auditiva Neurossensorial/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Emissões Otoacústicas Espontâneas , Potenciais Evocados Miogênicos Vestibulares , Adulto Jovem
7.
Hypertension ; 74(3): 660-668, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31352830

RESUMO

Increased short-term blood pressure (BP) variability is associated with adverse cardiovascular outcomes in patients with hypertension. The present study investigated the long-term prognostic significance of the short-term blood pressure variability in patients on hemodialysis. A total of 149 patients (53.0% male; mean age: 54.5±15.1 years) receiving regular hemodialysis for >6 months were enrolled. They completed a 44-hour (excluding the hemodialysis session) ambulatory BP monitoring and comprehensive hemodynamic assessments, including carotid-femoral pulse wave velocity and pressure waveform decomposition (forward and backward wave amplitude). Blood pressure variability parameters, including average real variability (ARV) of systolic BP, diastolic BP, and pulse pressure (ARVp) during daytime, nighttime, and overall 44 hours were calculated. During a median follow-up of 14 years, 78 deaths (52.4%) were confirmed. In multivariable Cox regression analysis, none of the ambulatory BP parameters were predictive of mortality. In contrast, nighttime ARVp was consistently and significantly associated with all-cause mortality in multivariable Cox models adjusting for age, sex, albumin, hemodialysis treatment adequacy, and 44-hour systolic BP (continuous variable analysis, per 1-SD, hazard ratio=1.348; 95% CI, 1.029-1.767; categorical variable analysis, ≥8.5 versus <8.5 mm Hg; hazard ratio=1.825; 95% CI, 1.074-3.103). Forward wave amplitude and 44-hour systolic BP were identified as the 2 most important determinants of nighttime ARVp. Addition of nighttime ARVp to the base model significantly improved prediction of all-cause mortality (Net reclassification improvement =0.198; P=0.0012). In hemodialysis patients, increased short-term nighttime pulse pressure variability but not ambulatory BP levels were significantly predictive of long-term all-cause mortality.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/métodos , Pressão Sanguínea , Causas de Morte , Ritmo Circadiano , Hipertensão/fisiopatologia , Diálise Renal/efeitos adversos , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Hipertensão/etiologia , Hipertensão/mortalidade , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Análise de Onda de Pulso , Diálise Renal/métodos , Diálise Renal/mortalidade , Estudos Retrospectivos , Índice de Gravidade de Doença , Análise de Sobrevida , Fatores de Tempo
8.
Transplant Proc ; 51(5): 1397-1401, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31155177

RESUMO

OBJECTIVE: In dialysis patients, cinacalcet could be an effective alternative to parathyroidectomy for treating hyperparathyroidism. In the present study, we aimed to determine the characteristics of subjects with persistent hyperparathyroidism who require parathyroidectomy despite the use of cinacalcet. METHODS: Nine kidney transplant patients (7 men, 2 women; mean age 53.2 [SD, 8.9] years) who had tertiary hyperparathyroidism were reviewed in a single center. Pre- and postcinacalcet levels of calcium, phosphorous, intact parathyroid hormone (iPTH), and renal function were analyzed to evaluate the effect of cinacalcet treatment in these patients. The baseline parameters before cinacalcet treatment were compared in patients who did and did not undergo parathyroidectomy. RESULTS: Cinacalcet reduced serum calcium levels in all patients (11.48 [SD, 0.73] mg/dL to 10.20 [0.70] mg/dL; P = .008). Serum phosphorous levels significantly increased from 2.28 (SD, 0.77) mg/dL to 3.02 (SD, 0.65) mg/dL (P = .03). The iPTH levels in 7 patients decreased, while the mean level remained unchanged in total subjects. The iPTH levels increased even with cinacalcet treatment in 2 patients. In 3 patients, serum calcium levels abruptly increased after cinacalcet withdrawal. Five patients who showed persistent hypercalcemia due to hyperparathyroidism underwent parathyroidectomy. These 5 patients had significantly different characteristics compared with 4 patients who did not undergo parathyroidectomy: hypercalcemia (11.92 [SD, 0.68] mg/dL vs 10.93 [SD, 0.26] mg/dL; P = .02), hypophosphatemia (1.74 [SD, 0.36] mg/dL vs 2.95 [SD, 0.58] mg/dL; P = .03), and hyperparathyroidism (252.2 [SD, 131.4] pg/dL vs 101.5 [SD, 18.4] pg/dL; P = .02). CONCLUSION: Cinacalcet reduced hypercalcemia due to hyperparathyroidism in the transplant patients. However, patients who had pre-existing higher iPTH, hypercalcemia, and hypophosphatemia needed parathyroidectomy. Therefore, cinacalcet could be considered an alternative to parathyroidectomy in selected patients.


Assuntos
Calcimiméticos/uso terapêutico , Cinacalcete/uso terapêutico , Hiperparatireoidismo/tratamento farmacológico , Transplante de Rim , Adulto , Idoso , Feminino , Humanos , Hipercalcemia/etiologia , Hiperparatireoidismo/etiologia , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Estudos Retrospectivos
9.
J Vasc Access ; 20(5): 567-569, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31190613

RESUMO

INTRODUCTION: Vascular access for hemodialysis is a key factor in every patient dependent on this treatment. Maintaining a central venous catheter can be a good choice when all the other options have been exhausted, but unwanted and rare complications may arise from longer catheter dwell time. CASE REPORT: We describe a case of a 65-year-old woman undergoing hemodialysis treatment since 1986 after a bilateral nephrectomy due to complicated nephrolithiasis. Her last access, two Tesio® tunneled cuffed catheters implanted via the right internal jugular vein functioned correctly for 14 years without complications, and so, was not replaced in the meantime. She was referred to our hospital due to a rupture in a catheter lumen, which was corrected conservatively by creating a more proximal tunnel and excising the affected area. A few weeks later, a new rupture in the same lumen was identified, so the catheter was replaced with angiographic control. The catheter was frail, so upon its removal, the tip fractured and remained in the right ventricle, being swiftly removed by an endovascular snare without complications. DISCUSSION: This case reports two rare complications associated with catheter handling and identifies a possible technique for conservative resolution of a lumen rupture.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Falha de Equipamento , Veias Jugulares , Nefrectomia , Nefrolitíase/cirurgia , Diálise Renal/efeitos adversos , Diálise Renal/instrumentação , Idoso , Remoção de Dispositivo/métodos , Procedimentos Endovasculares , Desenho de Equipamento , Feminino , Humanos , Veias Jugulares/diagnóstico por imagem , Flebografia , Fatores de Tempo , Resultado do Tratamento
11.
Int J Infect Dis ; 85: 16-21, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31102823

RESUMO

BACKGROUND: Catheter-related bloodstream infection (CR-BSI) is one of various complications related to hemodialysis (HD). As a result of the high rate of infection, the use of lock solutions for the prevention of CR-BSI has been studied. However, adverse effects of lock solution, such as increased emergence of strains resistant to antibiotics, which is an important concern, need to be investigated further. The aim of this study was to compare the efficacy of lock solution using a combination of cefazolin and gentamicin versus taurolidine and citrate in reducing CR-BSI in patients undergoing HD and to identify any adverse effects. METHODS: A prospective observational study was performed at two dialysis centers. Patients using new tunneled central venous catheters (CVC) for HD were included. Patients with a tunneled CVC were assigned to receive either antibiotic lock solution (group 1: gentamicin 7mg/ml+cefazolin 12mg/ml+heparin 3500IU/ml) or lock solution with TauroLock-Hep500 (group 2: taurolidine citrate 4%+heparin 500 IU/ml) during the inter-dialysis period. The patients were allocated to these groups according to the hemodialysis center they were attending. RESULTS: A total of 145 CVCs were implanted in 127 patients and were followed for 15 months: 77 CVCs (65 patients) were placed in group 1 and 68 CVCs (62 patients) in group 2. There was no difference between the two groups with regard to CR-BSI (events per 1000 catheter-days: group 1=0.79, group 2=1.10; p=0.18) or exit site infection rates (events per 1000 catheter-days: group 1=2.45, group 2=1.83; p=0.37). The groups differed in ESI pathogens, with gram-positive oxacillin-resistant pathogens more frequent in group 1 (31.8% vs. 5.0%; p=0.003). The two groups were similar in mechanical complications. In the Cox regression analysis, the internal jugular vein site was a protective factor for all catheter removal complications (hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.19-0.91) and mechanical complications (HR 0.16, 95% CI 0.065-0.41); only ESI was a risk factor for all catheter removal complications (HR 1.79, 95% CI 1.04-3.07) and mechanical complications (HR 5.64, 95% CI 1.65-19.3). CONCLUSIONS: The efficacy of both lock solutions was similar in preventing infections related to tunneled CVCs for HD. However, there were more oxacillin-resistant strains in patients who received antibiotic lock solution. Further studies are required to determine the optimal drug regimen and concentrations for lock solution and the associated adverse effects.


Assuntos
Antibacterianos/uso terapêutico , Infecções Relacionadas a Cateter/prevenção & controle , Cefazolina/uso terapêutico , Ácido Cítrico/uso terapêutico , Diálise Renal/efeitos adversos , Taurina/análogos & derivados , Tiadiazinas/uso terapêutico , Adulto , Idoso , Infecções Relacionadas a Cateter/etiologia , Cateteres Venosos Centrais , Remoção de Dispositivo , Feminino , Gentamicinas/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Taurina/uso terapêutico
12.
Methodist Debakey Cardiovasc J ; 15(1): 88-89, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31049156

RESUMO

The column in this issue is supplied by Anita Shah, M.D., and Juan Jose Olivero, M.D. Dr. Shah is a first-year nephrology fellow at Baylor College of Medicine in Houston, Texas. She earned her medical degree from The University of Texas Medical Branch at Galveston and completed an internal medicine residency at Houston Methodist Hospital. Dr. Olivero is a nephrologist at Houston Methodist Hospital and a member of the hospital's Nephrology Training Program. He obtained his medical degree from the University of San Carlos School of Medicine in Guatemala, Central America, and completed his residency and nephrology fellowship at Baylor College of Medicine in Houston, Texas.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Hiperlipidemias/terapia , Hipolipemiantes/uso terapêutico , Rim/fisiopatologia , Lipídeos/sangue , Diálise Renal , Insuficiência Renal Crônica/terapia , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Humanos , Hiperlipidemias/sangue , Hiperlipidemias/diagnóstico , Hiperlipidemias/epidemiologia , Hipolipemiantes/efeitos adversos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/fisiopatologia , Fatores de Risco , Resultado do Tratamento
13.
Medicine (Baltimore) ; 98(18): e15421, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045801

RESUMO

To evaluate the effect of hemodialysis on choroidal thickness and the choroidal vascularity index (CVI) in patients with end-stage renal disease (ESRD) by using swept-source optical coherence tomography.Thirty-two eyes of 32 patients with ESRD undergoing hemodialysis were recruited prospectively. Detailed ophthalmologic examinations and swept-source optical coherence tomography were performed immediately before and after hemodialysis. Choroidal thickness maps were generated automatically by using built-in software. The CVI was calculated using binarized choroidal optical coherence tomography images. Systemic parameters such as body weight and blood pressure were also measured. The changes in systemic and ocular parameters during hemodialysis were evaluated. Subjects were divided into 2 groups (diabetes mellitus [DM] vs non-diabetes mellitus) for subgroup analysis.Total choroidal thickness showed a significant overall decrease after hemodialysis (-10.9 ±â€Š14.0, P <.001). In the subgroup analysis, total choroidal thickness significantly decreased in both patients with DM (-11.3 ±â€Š13.6, P = .004) and those without (-10.6 ±â€Š14.9, P = .020), but the reduction of choroidal thickness was observed in more subfields in patients with DM than in those without. The CVI did not significantly change after hemodialysis (P = .717). No significant systemic and ocular factors affected the changes in total choroidal thicknesses.Choroidal thickness significantly decreased after hemodialysis in most subfields regardless of the presence of DM. Peri-hemodialysis choroidal changes could be considered in the management of patients with ESRD. Swept-source optical coherence tomography can provide ample and reliable quantitative data for monitoring ocular hemodynamic changes.


Assuntos
Corioide/irrigação sanguínea , Corioide/patologia , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Adulto , Idoso , Pressão Sanguínea , Peso Corporal , Corioide/diagnóstico por imagem , Complicações do Diabetes , Feminino , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia de Coerência Óptica
15.
BMC Musculoskelet Disord ; 20(1): 209, 2019 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-31084618

RESUMO

BACKGROUND: Repair of rotator cuff tears has yielded excellent functional outcomes in recent decades; however, poor outcomes and dissatisfaction have been noted in specific groups. Spontaneous tendon rupture has been reported in patients receiving long-term hemodialysis owing to alteration of tendon structure, which might impede functional recovery after rotator cuff repair. The purpose of the present study was to compare the clinical outcomes between hemodialysis and non-hemodialysis patients after rotator cuff repair. METHODS: We retrospectively reviewed patients who underwent mini-open rotator cuff repair from Jan 2013 to Jan 2017. A total of 14 patients under chronic hemodialysis (HD) were matched to non-hemodialysis (NHD) patients at a 1:2 ratio according to age, gender, tear size, severity of fatty infiltration and history of diabetes. Pre- and post-operative functional outcome was assessed using the simple shoulder test (SST), American Shoulder and Elbow Surgeons (ASES), Shoulder Rating Scale of the University of California at Los Angeles (UCLA) and visual analog scale (VAS) scores. Clinical functional outcome at the last follow-up was adopted for comparison of the HD and NHD groups. RESULTS: A total of 42 patients were enrolled in this comparative study, with a mean age of 66.64 ± 1.68 years in the HD group and 65.71 ± 5.40 years in the NHD group. At the final clinical assessment, the post-operative functional outcome was significantly improved in both groups (p < 0.001). However, the functional outcome of the HD group was significantly inferior to that of the NHD group in terms of the SST score (6.50 ± 2.24 vs 9.39 ± 1.87, p < 0.001), ASES score (63.17 ± 15.93 vs 86.96 ± 11.43, p < 0.001), UCLA score (20.14 ± 7.71 vs 29.82 ± 5.08, p < 0.001) and VAS score (3.00 ± 0.96 vs 1.21 ± 1.03, p < 0.001). CONCLUSION: The improvement of pain and functional improvement of long-term hemodialysis patients were inferior to those of patients without hemodialysis after mini-open rotator cuff repair.


Assuntos
Artroplastia , Diálise Renal/efeitos adversos , Lesões do Manguito Rotador/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Lesões do Manguito Rotador/etiologia , Ruptura Espontânea/etiologia , Ruptura Espontânea/cirurgia , Fatores de Tempo , Resultado do Tratamento
16.
Ren Fail ; 41(1): 326-333, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31014177

RESUMO

BACKGROUND: Secondary hyperparathyroidism (SHPT) is associated with high incidences of cardiovascular disease, bone fracture, and mortality. This study was conducted to demonstrate the effectiveness of cinacalcet treatment on chronic kidney disease-mineral bone disorder (CKD-MBD) markers in chronic hemodialysis patients with severe SHPT. METHODS: In phase 1, 30 adult HD patients were randomized to cinacalcet or control groups for 12 weeks to explore the achievement of >30% reduction of iPTH. In phase 2, 45 patients were participated to further explore the effect of cinacalcet on CKD-MBD parameters for 24-week follow up and 12 additional weeks after cinacalcet discontinuation. RESULTS: In phase 1, the baseline serum iPTH levels were not different [1374 (955, 1639) pg/mL in the control group vs. 1191 (1005, 1884) pg/mL in the cinacalcet group], the percentage of patients achieving iPTH target were significantly higher in the treatment group [80% vs. 13%, p = .001]. In phase 2, the significant reductions of iPTH, FGF-23, tartrate-resistant acid phosphatase 5b, and slightly decreased size of parathyroid gland and stabilized vascular calcification were observed at 24-week follow up and markedly rebounded after discontinuation of cinacalcet. CONCLUSIONS: The effectiveness of cinacalcet were still obviously demonstrated even in chronic HD patients with severe SHPT. In addition, the improvements of bone markers and FGF-23, and stabilization of vascular calcification were observed. Therefore, cinacalcet can provide salutary effects on CKD-MBD in severe SHPT and might be an initially effective PTH-lowering therapy prior to surgical parathyroidectomy as well as an alternative treatment in the patients unsuitable for surgery. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: NCT02056730. Date of registration: February 4, 2014.


Assuntos
Calcimiméticos/uso terapêutico , Cinacalcete/uso terapêutico , Hiperparatireoidismo Secundário/tratamento farmacológico , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Adulto , Cálcio/sangue , Feminino , Fatores de Crescimento de Fibroblastos/sangue , Seguimentos , Humanos , Hiperparatireoidismo Secundário/sangue , Hiperparatireoidismo Secundário/diagnóstico , Hiperparatireoidismo Secundário/etiologia , Falência Renal Crônica/sangue , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Fósforo/sangue , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
17.
Ren Fail ; 41(1): 183-189, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30942649

RESUMO

BACKGROUND: Few centers in Brazil perform parathyroidectomy (PTX) for recalcitrant secondary hyperparathyroidism (SHPT) generating a long queue. There is little data regarding prioritize criteria besides chronological order and survival. OBJECTIVES: To determine the difference of clinical and laboratory factors between PTX patients and those who remained in the line despite the need for surgery and their survival. METHODS: A retrospective cohort study was conducted in a quaternary hospital in Brazil, where 43 patients with PTX indication due to severe SHPT were followed from 2009 to 2016. While 31 patients underwent PTX, 12 remained in the queue. Data on clinical and laboratory factors were collected for comparison and Kaplan-Meier and Cox regression survival analysis were used. RESULTS: PTX group was younger (40.9 vs. 49.3 years, p = .03), had higher PTH levels (2578 vs. 1937 pg/ml, p = .01) and higher CaxP product (62 vs. 47.5, p = .02). There were no percentage differences between groups of fractures, calciphylaxis and other complications due to SHPT. Patients who were not operated had a worst overall survival (5 y 62.2% vs. 96.7%, p = .04) with a HR for death of 8.08 (p = .07, PTX as a TVC). Other variables associated with decreased survival included a history of previous myocardial infarction (HR: 10.4, p = .01) and age per additional year (HR: 1.09, p = .02). CONCLUSIONS: Patients with severe SHPT are at increased risk of death while waiting for PTX. Clinical events like fracture were not used to prioritize patients beyond consecutive order. Therefore, optimizing priority criteria for PTX may result in improved survival in this population.


Assuntos
Hiperparatireoidismo Secundário/mortalidade , Falência Renal Crônica/terapia , Paratireoidectomia , Seleção de Pacientes , Listas de Espera/mortalidade , Adulto , Brasil/epidemiologia , Feminino , Humanos , Hiperparatireoidismo Secundário/cirurgia , Estimativa de Kaplan-Meier , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Estudos Retrospectivos
18.
Complement Ther Clin Pract ; 35: 177-182, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31003654

RESUMO

OBJECTIVE: The present study was conducted as a randomised controlled design in order to evaluate the effect of lavender oil inhalation on pain development during vascular access among patients undergoing haemodialysis. METHODS: The study was conducted involving a total of 60 patients receiving treatment at the haemodialysis unit of a public hospital. The data of study were collected using a questionnaire and a Visual Analogue Scale. Lavender oil inhalation containing a 1:10 ratio of lavender and sweet almond oil was prepared. RESULTS: The pain mean score of the intervention group was 3.8 ±â€¯0.3 prior to the application of lavender oil inhalation and decreased to 3.0 ±â€¯0.2 following the inhalation application; whereas, the pain mean score of the control group increased from 5.4 ±â€¯0.3 to 5.6 ±â€¯0.6. CONCLUSION: It was observed that applying lavender oil inhalation to patients undergoing haemodialysis did decrease pain level experienced by patients during vascular access and caused no negative effects.


Assuntos
Aromaterapia , Óleos Voláteis/uso terapêutico , Dor Processual/prevenção & controle , Óleos Vegetais/uso terapêutico , Diálise Renal/efeitos adversos , Administração por Inalação , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Processual/diagnóstico , Dor Processual/etiologia , Resultado do Tratamento
19.
J Vasc Access ; 20(1_suppl): 38-44, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31032732

RESUMO

At the second Dialysis Access Symposium held in Nagoya, Japan, a proposal was made to investigate the differences in vascular access methods used in different countries. In this article, we describe the management of vascular access in Japan. The Japanese population is rapidly aging, and the proportion of elderly patients on dialysis is also increasing. There were 325,000 dialysis patients in Japan at the end of 2015, of whom 65.1% were aged 65 years or above. The number of patients with diabetic nephropathy or nephrosclerosis as the underlying condition is also increasing, whereas the number with chronic glomerulonephritis is steadily decreasing. The Japanese health insurance system enables patients to undergo medical treatment at almost no out-of-pocket cost. Percutaneous transluminal angioplasty suffers from a severe device lag compared with other countries, but although there are limitations on permitted devices, the use of those that have been authorized is covered by medical insurance. One important point that is unique to Japan is that vascular access is performed and managed by doctors involved in dialysis across a wide range of disciplines, including nephrologists, surgeons, and urologists. This may be one factor contributing to the good survival prognosis of Japanese dialysis patients.


Assuntos
Derivação Arteriovenosa Cirúrgica , Implante de Prótese Vascular , Nefropatias/terapia , Diálise Renal , Idoso , Angioplastia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/economia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/economia , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/cirurgia , Custos de Cuidados de Saúde , Humanos , Japão/epidemiologia , Nefropatias/diagnóstico , Nefropatias/economia , Nefropatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Diálise Renal/economia , Fatores de Risco , Resultado do Tratamento , Grau de Desobstrução Vascular
20.
Arch Immunol Ther Exp (Warsz) ; 67(3): 171-177, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31028405

RESUMO

The complement system is one of the crucial pathophysiological mechanisms that directly influence the function of a transplanted kidney. Since the complement pathways' activation potential can be easily determined via their functional activity measurement, we focused on fluctuation in the cascade activity in the early post-transplant period. The aim of the study was to relate the kidney transplantation-induced complement system response to allograft outcome. Forty-two kidney recipients (aged: 53.5 [37-52], 17 females/25 males) and 24 healthy controls (aged: 40.5 [34-51], 13 females/11 males) were enrolled in the study. The functional activities of alternative, classical, and lectin pathways were determined before and in the first week after transplantation using Wielisa®-kit. We observed that the baseline functional activity of the alternative pathway (AP) was higher in chronic kidney disease patients awaiting transplantation compared to healthy controls and that its level depended on the type of dialysis. AP-functional activity was decreased following transplantation procedure and its post-transplant level was related to allograft function. The baseline and transplantation-induced functional activities of the classical and lectin pathways were not influenced by dialysis type and were not associated with transplant outcome. Moreover, our study showed that intraoperative graft surface cooling had a protective effect on AP activation. Our study confirms the influence of dialysis modality on persistent AP complement activation and supports the role of AP in an early phase after kidney transplantation and allograft outcome.


Assuntos
Via Alternativa do Complemento/imunologia , Rejeição de Enxerto/imunologia , Falência Renal Crônica/terapia , Transplante de Rim/efeitos adversos , Diálise Renal/efeitos adversos , Adulto , Idoso , Aloenxertos/imunologia , Aloenxertos/fisiopatologia , Feminino , Taxa de Filtração Glomerular , Rejeição de Enxerto/fisiopatologia , Humanos , Rim/imunologia , Rim/fisiopatologia , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Transplante Homólogo/efeitos adversos , Resultado do Tratamento
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