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1.
G Ital Nefrol ; 38(3)2021 Jun 24.
Artigo em Italiano | MEDLINE | ID: mdl-34169691

RESUMO

SARS-CoV-2 infection is responsible for the coronavirus disease 2019 (COVID-19). In the complex scenario of COVID-19, it is also possible to find patients with renal damage. The pathogenesis is multifactorial and not unique, and the clinical presentation may include urinary alterations, such as proteinuria and hematuria, accompanied with reduced renal function, or not. Acute kidney injury (AKI) is not uncommon, especially among critically ill patients hospitalized in intensive care unit. AKI is a negative prognostic factor and is associated with high in-hospital mortality. An early diagnosis of AKI and the assessment of any risk factors allow the nephrologist to implement appropriate therapeutic strategies, such as pharmacological or extracorporeal support. Still, mortality in patients with AKI during COVID-19 remains high. COVID-19 AKI is a quickly evolving field of study.


Assuntos
Injúria Renal Aguda/etiologia , COVID-19/complicações , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/terapia , Adulto , COVID-19/diagnóstico , COVID-19/tratamento farmacológico , COVID-19/epidemiologia , Tratamento Conservador , Estado Terminal , Síndrome da Liberação de Citocina/etiologia , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Pessoa de Meia-Idade , Pandemias , Diálise Renal/métodos , Terapia de Substituição Renal/métodos , Fatores de Risco
2.
Toxins (Basel) ; 13(5)2021 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-34068165

RESUMO

The stroke incidence in hemodialysis (HD) patients is high, but the associated factors remain largely unknown. This study aimed to analyze stroke incidence in HD patients and changes in risk factors. Data of 291 patients were retrospectively analyzed. The cumulative stroke incidences were 21.6% at 10 years and 31.5% at 20. Diabetic nephropathy (DN) significantly increased overall stroke (hazard ratio (HR), 2.24; 95% confidence interval (CI), 1.21-4.12; p = 0.001) and ischemic stroke (HR, 2.16; 95% CI, 1.00-4.64; p = 0.049). Patients treated with online HDF were less likely to have overall stroke (HR, 0.13; 95% CI, 0.03-0.56; p = 0.006) and ischemic stroke (HR, 0.08; 95% CI, 0.01-0.60; p = 0.014). DN (HR, 1.56; 95% CI, 1.08-2.27; p = 0.019) and age >80 years at HD initiation (20-49 years old; HR 0.13, 95% CI, 0.05-0.35, p < 0.001 and age 50-79 years; HR 0.42, 95% CI, 0.26-0.66, p < 0.001 (reference: age >80 years)) were significantly associated with stroke and/or death events. Over time, stroke risk increased in HD patients, due to the increasing number of DN. Although dialysis technology has advanced over time, these advances could not overcome other risk factors for stroke. Further increase in stroke and mortality due to aging remains a concern.


Assuntos
Nefropatias Diabéticas/complicações , Diálise Renal/métodos , Acidente Vascular Cerebral/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Nefropatias Diabéticas/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Diálise Renal/tendências , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Adulto Jovem
3.
Medicine (Baltimore) ; 100(22): e26209, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087894

RESUMO

BACKGROUND: There is no published meta-analysis comparing the effects of dialysis modality choice on cognitive functions in patients with end-stage renal disease . Therefore, we perform a protocol for systematic review and meta-analysis to evaluate cognitive function in peritoneal dialysis versus hemodialysis patients. METHODS: This protocol is conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P) statement guidelines. Related articles were identified by searching Web of Science, Embase, PubMed, Wanfang Data, Medline, Science Direct, and Cochrane Library. The risk of bias assessment of the included articles was performed by two authors independently using the tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions. All calculations were carried out with Stata 11.0 (The Cochrane Collaboration, Oxford, United Kingdom). RESULTS: The results of this systematic review and meta-analysis will be published in a peer-reviewed journal. CONCLUSION: We hypothesized that patients on peritoneal dialysis demonstrated a lower odd of cognitive dysfunction compared to those on hemodialysis. OPEN SCIENCE FRAMEWORK REGISTRATION NUMBER: 10.17605/OSF.IO/NWCZK.


Assuntos
Cognição/fisiologia , Falência Renal Crônica/psicologia , Diálise Peritoneal/psicologia , Diálise Renal/psicologia , Estudos de Casos e Controles , Comportamento de Escolha/fisiologia , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Diálise Peritoneal/métodos , Diálise Peritoneal/estatística & dados numéricos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Diálise Renal/métodos , Diálise Renal/estatística & dados numéricos
4.
Toxins (Basel) ; 13(6)2021 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-34073439

RESUMO

Chronic kidney disease (CKD) is characterized by the retention of solutes named uremic toxins, which strongly associate with high morbidity and mortality. Mounting evidence suggests that targeting uremic toxins and/or their pathways may decrease the risk of cardiovascular disease in CKD patients. Dialysis therapies have been developed to improve removal of uremic toxins. Advances in our understanding of uremic retention solutes as well as improvements in dialysis membranes and techniques (HDx, Expanded Hemodialysis) will offer the opportunity to ameliorate clinical symptoms and outcomes, facilitate personalized and targeted dialysis treatment, and improve quality of life, morbidity and mortality.


Assuntos
Diálise Renal/métodos , Insuficiência Renal Crônica/terapia , Toxinas Biológicas/metabolismo , Uremia/metabolismo , Humanos , Membranas Artificiais , Qualidade de Vida , Insuficiência Renal Crônica/psicologia , Albumina Sérica/metabolismo
5.
Medicine (Baltimore) ; 100(26): e26559, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190195

RESUMO

ABSTRACT: Although renin-angiotensin system (RAS) blockade has been shown to reduce cardiovascular disease (CVD) in the general population and high-risk subjects, their protective effect in autosomal dominant polycystic kidney disease (ADPKD) patients under dialysis was still unknown. By using the database from 1995 to 2008 Taiwan National Health Insurance Research Database (Registry for Catastrophic Illnesses), we included 387 ADPKD patients who received dialysis therapy, aged ≥ 18 year-old, and with no evidence of CVD events in 1997 and 1998. We utilized Cox proportional hazards regression analysis and propensity score matching to evaluate adjusted hazard ratios for all-cause mortality and CVD events in users (n=231) and nonusers (n = 156) of an angiotensin-converting enzymes inhibitor (ACEI) / angiotensin II receptor blocker (ARB) during the 12 years of follow-up. All study subjects were followed up for more than 3 months. There was no significant difference between the ACEI/ARB treatment group and the control group in incident CVD events except ischemic stroke and transient ischemic accident (TIA). The results remain similar between groups before and after propensity score matching. Moreover, there was no significant difference in outcomes between ACEI/ARB treatment over 50% of follow-up period and without ACEI/ARB treatment after propensity score matching. This nationwide cohort study failed to prove the protective effects of long-term ACEI or ARB on incident CVD events among APKD dialysis patients. Further larger scale, multicenter and randomized control trials are warranted to show the causal association.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Doenças Cardiovasculares , Rim Policístico Autossômico Dominante/terapia , Diálise Renal , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Rim Policístico Autossômico Dominante/epidemiologia , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/estatística & dados numéricos , Fatores de Proteção , Sistema de Registros/estatística & dados numéricos , Diálise Renal/métodos , Diálise Renal/estatística & dados numéricos , Taiwan/epidemiologia , Tempo
6.
Nefrología (Madrid) ; 41(2): 200-209, mar.-abr. 2021. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-201573

RESUMO

ANTECEDENTES Y OBJETIVO: El número de personas que inician diálisis por el fracaso del injerto aumenta cada día. La modalidad de diálisis mejor para este tipo de pacientes no está bien definida y la mayoría de ellos son derivados a hemodiálisis (HD). El objetivo de nuestro estudio es evaluar el impacto de la modalidad de diálisis sobre la morbilidad y la mortalidad en individuos trasplantados que inician este procedimiento tras el fracaso del injerto. MATERIAL Y MÉTODOS: Estudio multicéntrico retrospectivo observacional y de cohortes que compara la evolución de los pacientes que inician diálisis tras el fracaso del injerto, desde enero del año 2000 a diciembre del 2013. Un grupo lo hace en diálisis peritoneal (DP) y otro en HD. Se realizó un seguimiento a los pacientes hasta el cambio de técnica de diálisis, retrasplante o fallecimiento. Se analizaron datos antropométicos, comorbilidad, el filtrado glomerular (FG) con el que iniciaban la diálisis, la presencia de un acceso óptimo para esta, la presencia de intolerancia al injerto y el retrasplante. Estudiamos el motivo de los 10 primeros ingresos hospitalarios tras el inicio de la diálisis. Para el análisis estadístico, se tuvo en cuenta la presencia de eventos competitivos que dificultaran la aparición del evento de interés, muerte o ingreso hospitalario. RESULTADOS: Se incluyeron 175 pacientes. En DP 86 y 89 en HD. Los individuos que iniciaron DP eran más jóvenes, tenían menor comorbilidad y lo hacían con FG más bajos que los de HD. El seguimiento medio fue de 34 ± 33 meses, con una mediana de 24 (IQR siete a 50 meses), siendo mayor en los pacientes en HD que en los de DP (35 vs. 18 meses, p = < 0,001). Los factores de riesgo que influyeron en la mortalidad fueron la edad (coeficiente del sub Hazard Ratio [sHR] 1,06 (IC 95%: 1,033 a 1,106, p = 0,000), el uso no óptimo del acceso (sHR 3,00 (IC 95%: 1,507 a 5,982, p = 0,028) y el tipo de diálisis, la DP sHR[DP/HD] 0,36 (IC 95%: 0,148 a 0,890, p = 0,028). Los pacientes en DP tenían menos riesgo de un ingreso hospitalario sHR[DP/HD] 0,52 (IC 95%: 0,369 a 0,743, p = < 0,001) y menos probabilidad de desarrollar una intolerancia al injerto HR 0,307 (IC 95% 0,142 a 0,758, p = 0,009). CONCLUSIONES: Con las limitaciones de un estudio retrospectivo y no randomizado, es la primera vez a nivel nacional que se demuestra que la DP en términos de supervivencia es mejor que la HD cuando fracasa el injerto durante el primer año y medio en diálisis. La presencia de un acceso no óptimo para este procedimiento es un factor de riesgo de mortalidad independiente y modificable. La remisión precoz de los pacientes a las unidades de enfermedad renal crónica avanzada (ERCA) es fundamental para que estos elijan la técnica que más se adapte a sus circunstancias y preparar un acceso óptimo para el inicio de diálisis


BACKGROUND AND OBJECTIVE: The number of patients who start dialysis due to graft failure increases every day. The best dialysis modality for this type of patient is not well defined and most patients are referred to HD. The objective of our study is to evaluate the impact of the dialysis modality on morbidity and mortality in transplant patients who start dialysis after graft failure. MATERIAL AND METHODS: A multicentre retrospective observation and cohort study was performed to compare the evolution of patients who started dialysis after graft failure from January 2000 to December 2013. One group started on PD and the other on HD. The patients were followed until the change of dialysis technique, retransplantation or death. Anthropometric data, comorbidity, estimated glomerular filtration rate (eGFR) at start of dialysis, the presence of an optimal access for dialysis, the appearance of graft intolerance and retransplantation were analysed. We studied the causes for the first 10 hospital admissions after starting dialysis. For the statistical analysis, the presence of competitive events that hindered the observation of the event of interest, death or hospital admission was analysed. RESULTS: 175 patients were included, 86 in DP and 89 in HD. The patients who started PD were younger, had less comorbidity and started dialysis with lower eGFR than those on HD. The mean follow-up was 34 ± 33 months, with a median of 24 months (IQR 7 - 50 months), Patients on HD had longer follow-up than patients on PD (35 vs. 18 months, p = < 0.001). The mortality risk factors were age sHR 1.06 (95% CI: 1.033 - 1.106, p = 0.000), non-optimal use of access for dialysis sHR 3.00 (95% CI: 1.507 - 5.982, p = 0.028) and the dialysis modality sHR (PD / HD) 0.36 (95% CI: 0.148 - 0.890, p = 0.028). Patients on PD had a lower risk of hospital admission sHR [DP / HD] 0.52 (95% CI: 0.369-0.743, p = < 0.001) and less probability of developing graft intolerance HR 0.307 (95% CI 0.142-0.758, p = 0.009). CONCLUSIONS: With the limitations of a retrospective and non-randomized study, it is the first time nationwide that PD shows in terms of survival to be better than HD during the first year and a half after the kidney graft failure. The presence of a non-optimal access for dialysis was an independent and modifiable risk factor for mortality. Early referral of patients to advanced chronic kidney disease units is essential for the patient to choose the technique that best suits their circumstances and to prepare an optimal access for the start of dialysis


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Diálise Renal/mortalidade , Transplante de Rim/mortalidade , Rejeição de Enxerto/mortalidade , Estudos Retrospectivos , Diálise Renal/métodos , Falha de Tratamento , Comorbidade , Fatores de Risco , Estimativa de Kaplan-Meier , Fatores Etários , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/cirurgia
7.
Nutrients ; 13(5)2021 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-33923264

RESUMO

With the growing number of dialysis patients with frailty, the concept of renal rehabilitation, including exercise intervention and nutrition programs for patients with chronic kidney disease (CKD), has become popular recently. Renal rehabilitation is a comprehensive multidisciplinary program for CKD patients that is led by doctors, rehabilitation therapists, diet nutritionists, nursing specialists, social workers, pharmacists, and therapists. Many observational studies have observed better outcomes in CKD patients with more physical activity. Furthermore, recent systematic reviews have shown the beneficial effects of exercise intervention on exercise tolerance, physical ability, and quality of life in dialysis patients, though the beneficial effect on overall mortality remains unclear. Nutritional support is also fundamental to renal rehabilitation. There are various causes of skeletal muscle loss in CKD patients. To prevent muscle protein catabolism, in addition to exercise, a sufficient supply of energy, including carbohydrates, protein, iron, and vitamins, is needed. Because of decreased digestive function and energy loss due to dialysis treatment, dialysis patients are recommended to ingest 1.2-fold more protein than the regular population. Motivating patients to join in activities is also an important part of renal rehabilitation. It is essential for us to recognize the importance of renal rehabilitation to maximize patient satisfaction.


Assuntos
Terapia por Exercício/métodos , Estado Nutricional , Apoio Nutricional/métodos , Diálise Renal/métodos , Insuficiência Renal Crônica/reabilitação , Humanos , Insuficiência Renal Crônica/terapia
8.
Med Sci Monit ; 27: e930513, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33859156

RESUMO

BACKGROUND Regional citrate anticoagulation (RCA) is a recommended anticoagulation alternative for patients at high risk of bleeding while undergoing intermittent hemodialysis. Previous reports implied the risk of citrate application on bone metabolism. It is unclear whether long-term use of RCA is safe for maintenance hemodialysis patients in terms of bone metabolism. MATERIAL AND METHODS Seven patients with cerebral hemorrhage were included in the study. Blood samples were collected at baseline and 4 and 8 weeks after treatment. Spent dialysate samples were collected during each mid-week dialysis session, using the partial dialysate collection method. All patients were treated with RCA for 4 to 8 weeks, according to their clinical condition. We assessed bone metabolism-associated parameters, bone turnover markers, and magnesium loss at each dialysis session. RESULTS Serum magnesium levels were 1.24±0.13 mmol/L at baseline and significantly decreased to 1.16±0.14 mmol/L after 4 weeks of RCA treatment (P=0.025). Most patients had negative magnesium balance during citrate hemodialysis. Serum total calcium levels did not change significantly after treatment. One bone marker, N-terminal propeptide of type I procollagen (PINP), significantly decreased from 146.07±130.12 mmol/L to 92.42±79.01 mmol/L after citrate treatment (P=0.018). No significant changes were detected in other bone turnover markers. CONCLUSIONS Relatively long-term RCA treatment may decrease serum magnesium levels due to negative magnesium balance. Bone formation marker PINP seemed to decrease after treatment, while other bone turnover markers did not change significantly. Further investigation is needed to verify the effect of RCA on bone remodeling.


Assuntos
Anticoagulantes/uso terapêutico , Hemorragia Cerebral/terapia , Ácido Cítrico/uso terapêutico , Diálise Renal/métodos , Idoso , Idoso de 80 Anos ou mais , Remodelação Óssea , Cálcio/sangue , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteogênese , Fragmentos de Peptídeos/sangue , Pró-Colágeno/sangue
9.
Cardiovasc Intervent Radiol ; 44(7): 1121-1126, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33851264

RESUMO

PURPOSE: Patients undergoing long-term hemodialysis may suffer upper extremity central venous access failure and require an alternative route. This study aimed to evaluate the safety and efficacy of transrenal hemodialysis catheter insertion/replacement in patients with upper extremity central venous access failure. MATERIALS AND METHODS: A multicenter retrospective cohort study was made of transrenal hemodialysis catheter insertion/replacement performed between 2014 and 2020. The history of renal replacement therapy and central venous catheters and the technical details of transrenal hemodialysis catheter insertion/replacement, patency, removal and complications were obtained for all patients. RESULTS: Six insertion and four replacement procedures involving transrenal hemodialysis catheters were evaluated in six patients (M:F = 3:3; median age, 49.5 years). Percutaneous transrenal (right:left = 1:5) hemodialysis catheter insertion was technically successful without complication in all six patients. In two patients, the tract was not lost because the safety guidewire was still in place, so no second puncture was required. The mean procedure time was 33.0 ± 9.2 min. The mean primary patency duration was 107.3 ± 70.9 days. During the mean follow-up duration of 141.2 ± 137.1 days, four hemodialysis catheter replacement procedures were successfully performed for catheter malfunction (n = 2) and dislodgement (n = 2). Catheter removal was successfully performed in four patients after confirming normal coagulation, followed by subsequent renal replacement therapy. CONCLUSION: Percutaneous insertion/replacement of transrenal hemodialysis catheters is feasible, safe, and effective when upper extremity central venous access is exhausted, and the catheters can be maintained for a reasonable period of time. LEVEL OF EVIDENCE: Level 4, Case Series.


Assuntos
Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais , Diálise Renal/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Remoção de Dispositivo , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Extremidade Superior , Veias , Adulto Jovem
10.
Cardiovasc Intervent Radiol ; 44(7): 1039-1047, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33928408

RESUMO

OBJECTIVE: We aimed to compare the technical difficulties, complications, long-term efficacy, and risks between right- and left-sided approach transhepatic tunneled catheterization. METHODS: We retrospectively evaluated transhepatic tunneled catheter placement cases in our institution between May 2012 and November 2019. Demographic and procedural parameters were recorded. Statistical tests were used to compare the complication rates of right- and left-sided approach. Furthermore, Cox regression analyses were used to investigate the relationship between functional catheter days and included parameters. RESULTS: A total of 83 procedures were performed in 46 patients, with a female to male ratio of 1.88 and a mean age of 55.5 ± 18.2 years. Indication for catheter placement was chronic renal insufficiency and loss of central venous access through traditional routes in all cases. Median functional catheter durations were 28 days (1-382) and 55.5 days (1-780) for right-sided and left-sided access, respectively. Complication rates were similar for both sides. There was no difference between primary and revision procedures in terms of safety and efficacy outcomes. In univariate Cox regression analysis, gender was the only variable which was found to be statistically significant (HR = 2.014 (1.004-4.038)) for functional catheter days. In multivariate Cox regression model, gender and access side were included which failed to reach statistical significance. CONCLUSIONS: In our study, both right- and left-sided approaches provided similar safety and efficacy outcomes, suggesting that both techniques can be employed based on physician's preference.


Assuntos
Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais , Diálise Renal/métodos , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Medicine (Baltimore) ; 100(8): e24639, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663073

RESUMO

INTRODUCTION: The lack of individualized treatment protocols and complicated procedures are important factors limiting the use of regional citrate anticoagulation (RCA) technology in hemodialysis. This study aims to validate the safety and efficacy of a simplified individualized RCA protocol for hemodialysis. MATERIALS AND METHODS: From June 2019 to August 2019, 45 patients with active bleeding or bleeding tendency undergoing maintenance hemodialysis in the Nephrology Department of the First Affiliated Hospital of Nanchang University were randomly divided into a modified conventional RCA protocol group with a low-flux dialyzer, a simplified individualized RCA protocol group with a high-flux dialyzer, and a simplified individualized RCA protocol group with a low-flux dialyzer. RESULTS: A total of 45 patients were included in this study. The mean age of the patients was 57.38 ±â€Š19.05 years, and 78% were men. Forty-three patients completed 4 hours of hemodialysis, and the median total clotting scores in the 3 groups were 11, 12, and 12. Compared with the modified conventional RCA protocol group with a low-flux dialyzer, the 2 simplified individualized RCA protocol groups had better clotting scores for the dialyzer, arterial bubble trap, and single-pool urea clearance index (spKt/VBUN) and lower costs. Moreover, these parameters did not differ between the 2 simplified individualized RCA protocol groups. No electrolyte or acid-base imbalances or citrate poisoning was observed in any of the 3 groups. Adverse events did not differ significantly among the 3 groups. CONCLUSIONS: The simplified individualized RCA protocol is safe, effective, and easy to implement. Therefore, this protocol can be promoted for clinical practice. TRIAL REGISTRATION: This study was registered in the Chinese Clinical Study Registry under registration number ChiCTR1900023801.


Assuntos
Anticoagulantes/uso terapêutico , Ácido Cítrico/uso terapêutico , Protocolos Clínicos/normas , Diálise Renal/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Coagulação Sanguínea/efeitos dos fármacos , Gasometria , Ácido Cítrico/administração & dosagem , Ácido Cítrico/efeitos adversos , Creatinina/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
12.
Medicine (Baltimore) ; 100(8): e24882, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663116

RESUMO

INTRODUCTION: Our aim was to evaluate the safety and efficacy of low-dose mineralocorticoid receptor antagonists (MRAs) in dialysis patients. METHODS: We systematically searched PubMed, EMBASE, and Cochrane libraries for clinical trials on the use of MRAs in dialysis patients. Review Manager 5.3 software was used to analyze relevant data and evaluate the quality of evidence. RESULTS: We identified nine randomized controlled trials including 1128 chronic dialysis patients. In terms of safety, when hyperkalemia was defined as serum potassium level ≥5.5 mmol/L, low-dose MRAs were significantly associated with hyperkalemia (relative risk [RR] 1.76, 95% confidence intervals [CI] 1.07-2.89, P = .02); however, when hyperkalemia was defined as serum potassium level ≥6.0 mmol/L or serum potassium level ≥6.5 mmol/L, no significant association was observed between low-dose MRAs and hyperkalemia (RR 1.40, 95% CI 0.83-2.37, P = .20; RR 1.98, 95% CI 0.91-4.30, P = .09, respectively). Use of low-dose MRAs can reduce cardiovascular mortality by 54% compared with the control group (0.46, 95% CI 0.28-0.76, P = .003). Similarly, the RR of all-cause mortality for the low-dose MRAs group was 0.48 (95% CI 0.33-0.72, P = .0003). CONCLUSION: Low-dose MRAs may benefit dialysis patients without significantly increasing moderate to severe hyperkalemia.


Assuntos
Antagonistas de Receptores de Mineralocorticoides/administração & dosagem , Diálise Renal/métodos , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Humanos , Hiperpotassemia/induzido quimicamente , Antagonistas de Receptores de Mineralocorticoides/efeitos adversos , Antagonistas de Receptores de Mineralocorticoides/farmacologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Insuficiência Renal Crônica/terapia
13.
Semin Vasc Surg ; 34(1): 71-78, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33757639

RESUMO

End-stage kidney disease (ESKD) is a common and morbid disease that affects patients' quality and length of life, representing a large portion of health care expenditure in the United States. These patients commonly have associated diabetes and cardiovascular disease, with high rates of cardiovascular-related death. Management of ESKD requires renal replacement therapy via dialysis or transplantation. While transplantation provides the greatest improvement in survival and quality of life, the vast majority of patients are treated initially with hemodialysis. However, outcomes differ significantly among patient populations. Barriers in access to care have particularly affected at-risk populations, such as Black and Hispanic patients. These patients receive less pre-ESKD nephrology care, are less likely to initiate dialysis with a fistula, and wait longer for transplants-even in pediatric populations. Priorities for ESKD care moving into the future include increasing access to nephrology care in underprivileged populations, providing patient-centered care based on each patient's "life plan," and focusing on team-based approaches to ESKD care. This review explores ESKD from the perspective of epidemiology, costs, vascular access, patient-reported outcomes, racial disparities, and the impact of the COVID-19 crisis.


Assuntos
COVID-19/epidemiologia , Falência Renal Crônica/epidemiologia , Pandemias , Diálise Renal/métodos , Comorbidade/tendências , Saúde Global , Humanos , Falência Renal Crônica/terapia , Morbidade/tendências
14.
Elife ; 102021 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-33704068

RESUMO

End-stage kidney disease (ESKD) patients are at high risk of severe COVID-19. We measured 436 circulating proteins in serial blood samples from hospitalised and non-hospitalised ESKD patients with COVID-19 (n = 256 samples from 55 patients). Comparison to 51 non-infected patients revealed 221 differentially expressed proteins, with consistent results in a separate subcohort of 46 COVID-19 patients. Two hundred and three proteins were associated with clinical severity, including IL6, markers of monocyte recruitment (e.g. CCL2, CCL7), neutrophil activation (e.g. proteinase-3), and epithelial injury (e.g. KRT19). Machine-learning identified predictors of severity including IL18BP, CTSD, GDF15, and KRT19. Survival analysis with joint models revealed 69 predictors of death. Longitudinal modelling with linear mixed models uncovered 32 proteins displaying different temporal profiles in severe versus non-severe disease, including integrins and adhesion molecules. These data implicate epithelial damage, innate immune activation, and leucocyte-endothelial interactions in the pathology of severe COVID-19 and provide a resource for identifying drug targets.


Assuntos
COVID-19/sangue , Falência Renal Crônica/sangue , Falência Renal Crônica/virologia , Diálise Renal/métodos , Idoso , Biomarcadores/sangue , COVID-19/mortalidade , COVID-19/virologia , Feminino , Previsões , Hospitalização , Humanos , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Proteômica/métodos , Diálise Renal/mortalidade , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença
15.
Clin Nephrol ; 96(2): 90-95, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33749584

RESUMO

AIMS: Regional citrate anticoagulation (RCA) during intermittent hemodialysis (iHD) effectively prevents circuit clotting without systemic anticoagulation and is especially beneficial for patients at increased bleeding risk. The performance of RCA under different iHD modes is not well documented. MATERIALS AND METHODS: We retrospectively studied all consecutive iHD sessions with our RCA protocol during a 3-year period. We compared low-flux iHD, high-flux iHD, and online post-dilution hemodiafiltration (oHDF) with regard to flow rates, calcium changes, metabolic outcomes, and complications. We used a calcium-free dialysate, concentrated sodium citrate (0.5 M), and calcium chloride substitution (0.5 M). Several safety measures were implemented to prevent human errors. RESULTS: We performed 111 RCA treatments in 66 cases. Seven sessions were prematurely stopped due to malfunctioning vascular access or pre-existing severe hypotension. The other 104 treatments (94%) consisting of 28 low-flux iHD, 31 high-flux iHD, and 45 oHDF were completed without clotting or complications. The protocol settings were used without adaptations in 75% of low-flux iHD, 93% of high-flux iHD, and 84% of oHDF sessions. Minor adjustments of the calcium flow rate were made within the first 2 hours. We did not observe any clinically relevant differences between the three modes regarding flow rates, systemic iCa, post-filter iCa, pH, or bicarbonate levels. CONCLUSION: Our protocol was similarly suitable for low-flux iHD, high-flux iHD, and oHDF, with only minor adaptations. Clotting, relevant calcium changes, metabolic or other complications were not observed. Our protocol could serve as a template for a commercial RCA solution in iHD.


Assuntos
Anticoagulantes , Ácido Cítrico , Hemodiafiltração/métodos , Diálise Renal/métodos , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Ácido Cítrico/administração & dosagem , Ácido Cítrico/uso terapêutico , Hemorragia/prevenção & controle , Humanos , Estudos Retrospectivos
16.
Angiol. (Barcelona) ; 73(1): 29-32, ene.-feb. 2021. ilus
Artigo em Espanhol | IBECS | ID: ibc-202330

RESUMO

INTRODUCCIÓN: el agotamiento vascular es un problema sanitario significativo, sobre todo en pacientes renales que no sean aptos para otro tipo de terapia de sustitución renal (trasplante o diálisis peritoneal). Se describen distintas alternativas para estos pacientes, de acuerdo a las posibilidades. CASO CLÍNICO: exponemos el caso de una mujer de 37 años, con enfermedad renal terminal desde hace más de treinta años por esclerohialinosis focal y segmentaria de variante colapsante y agotamiento del capital venoso central. Acude a nuestro centro con infección de Splithcath III(R) (MedComp), que se retira para colocar dos catéteres venosos simples de 6 Fr a nivel del tronco innominado vía yugular interna izquierda, al fallar en una navegación más central. Se destaca que la paciente presenta una vena yugular, vena subclavia y tronco innominado derechos ocluidos, con oclusión larga en el sitio donde se colocó un stent Palmaz(R) (Genesis Medical Group) en contexto de confección de fístula protésica, que cruza completamente la vena cava superior impidiendo el paso desde las venas izquierdas. Se optó por la implantación de un catéter de larga duración a través de las celdas del stent, llevada a cabo con éxito, con síndrome de vena cava superior de resolución posterior como complicación. DISCUSIÓN: lo más significativo de esta presentación es el implante a través de las celdas de un stent de catéteres de diálisis. Hasta ahora, encontramos descrita solo la colocación endoluminal y no esta técnica. Creemos que se trata de una alternativa válida en casos puntuales, como el analizado


INTRODUCTION: exhausted vascular access in chronic renal disease patients represents a significant issue for national health systems all around. It is fundamentally worse for those patients who have already surpassed or have no indication for other methods (renal transplant, peritoneal dilalysis). Different alternatives are assessed for each of these patients according to individual history. CASE REPORT: we assess the case of a 37 year old female patient with end-stage renal disease secondary to focal esclerohialinosis. Said patient has exhausted vascular access, as a consult for infected Splithcath III(R) (MedComp) for retrieval. Two simple 6Fr standard venous catheters were placed instead through the left jugular vein, with their tips in the left innominate vein lumen for a fail in mor central navigation. Patient concomitantly presented right jugular, subclavian and innominate veins obstructed, treated with a Palmaz(R) (Genesis Medical Group) metallic stent prior to right arteriovenous graft confection. That stent was across the lumen of the superior vena Cava. We opted for the implantation of a long-lasting dialysis catheter through the cells of the mentioned stent, which was successful despite complicaciones (superior vena cava syndrome). DISCUSSION: the most relevant topic of this case is the trans-stent cell implant of dialysis catheters. Research finds evidence only of transluminal stent central vein catheters implanted. We believe it constitutes a valid alternative in special cases such as the one being exposed


Assuntos
Humanos , Feminino , Adulto , Cateteres Venosos Centrais , Cateterismo Venoso Central/instrumentação , Stents , Diálise Renal/instrumentação , Diálise Renal/métodos , Falência Renal Crônica/terapia , Resultado do Tratamento , Veias Jugulares/cirurgia
17.
Nutr. hosp ; 38(1): 94-99, ene.-feb. 2021. tab
Artigo em Inglês | IBECS | ID: ibc-198845

RESUMO

INTRODUCTION: body fat reflects important clinical impacts among hemodialysis patients; thus, simple and safe methods are required for a careful evaluation of this body compartment. OBJECTIVES: to evaluate the concordance of estimates of total body fat percentage (%BF), calculated using bioelectrical impedance analysis (BIA) and sum of four skinfolds (SSKD) measures, with those obtained using dual-energy X-ray absorptiometry (DEXA) in patients with chronic kidney disease (CKD) receiving hemodialysis. METHODS: a cross-sectional study was conducted in 317 patients undergoing hemodialysis. The %BF was evaluated using BIA, SSKD measurement, and DEXA, and stratified by sex and tertiles. The Wilcoxon test for paired samples was used to compare the %BF obtained using the different methods, and Lin's concordance correlation coefficient (CCC-L) to evaluate concordance. RESULTS: the average %BF estimated using DEXA was 29.3 ± 9.3 %, with significant differences among the three methods (p < 0.05). SSKD measurement presented a higher CCC-L concordance with DEXA, regardless of sex. After stratification of the sample in tertiles, BIA presented a higher CCC-L concordance with DEXA among the patients with CKD with a %BF above 34.4 % (third tertile). Conversely, SSKD measurement presented better concordance with DEXA for those with a %BF equal to or less than 34.4 %. CONCLUSIONS: in terms of the estimates of the %BF, SSKD measurement displayed a better concordance with DEXA


INTRODUCCIÓN: la grasa corporal refleja importantes impactos clínicos entre los pacientes en hemodiálisis; por lo tanto, se requieren métodos simples y seguros para una evaluación cuidadosa de este compartimiento del cuerpo. OBJETIVOS: evaluar la concordancia de las estimaciones del porcentaje de grasa corporal total (%GC), calculadas mediante el análisis de impedancia bioeléctrica (BIA) y la suma de las medidas de cuatro pliegues cutáneos (CPC), con las obtenidas mediante absorciometría dual energética de rayos X (DEXA) en pacientes con enfermedad renal crónica (ERC) que reciben hemodiálisis. MÉTODOS: se realizó un estudio transversal en 317 pacientes en hemodiálisis. La %GC se evaluó mediante BIA, medición de CPC y DEXA, y se estratificó por sexos y terciles. Se utilizó la prueba de Wilcoxon para muestras pareadas para comparar los %GC obtenidos con los diferentes métodos, y el coeficiente de correlación de concordancia de Lin (CCC-L) para evaluar la concordancia. RESULTADOS: el %GC promedio estimado usando DEXA fue del 29,3 ± 9,3 %, con diferencias significativas entre los tres métodos (p < 0,05). La medición de los CPC presentó una mayor concordancia de CCC-L con DEXA, independientemente del sexo. Tras la estratificación de la muestra en terciles, la BIA presentó una mayor concordancia de CCC-L con DEXA entre los pacientes con ERC con un %GC superior al 34,4 % (tercer tercil). Por el contrario, la medición de los CPC presentó una mejor concordancia con la DEXA para aquellos con un %GC igual o inferior al 34,4 %. CONCLUSIÓN: en términos de las estimaciones del %GC, la medición de los CPC mostró una mejor concordancia con la DEXA


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Pregas Cutâneas , Nefropatias/complicações , Nefropatias/dietoterapia , Diálise Renal/métodos , Avaliação Nutricional , Impedância Elétrica , Absorciometria de Fóton , Estudos Transversais
18.
Diabetes Res Clin Pract ; 173: 108694, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33571598

RESUMO

AIMS: The disposal of a glucose bolus was studied to identify glucose metabolism in patients with and without type 2 diabetes mellitus (T2DM) during their regular hemodialysis (HD) treatment. METHODS: Plasma glucose, insulin, and c-peptide concentrations were measured during a 60 min observation phase following a rapid glucose infusion (0.5 g/kg dry weight). Glucose disposition and elimination rates were determined from kinetic analysis, and insulinogenic index was calculated. Insulin resistance (RHOMA) was determined by homeostatic model assessment (HOMA). RESULTS: 35 HD patients (14 with T2DM) distinguished by a higher age (median: 70 vs. 55 y, p < 0.01) in T2DM patients were studied. Glucose kinetic data showed only small differences between patients with or without T2DM, but as RHOMA measured in all patients increased, a larger fraction of glucose was removed by the extracorporeal system (r = 0.430, p = 0.01). One hour after glucose bolus injection the glucose level was not different from that before HD also in patients with T2DM (p = 0.115). CONCLUSIONS: The larger glucose amount recovered in dialysate in patients with increasing RHOMA indicates that impaired glucose disposal could be measured during HD using a non-invasive dialysis quantification approach without blood sampling. Glucose infusion during HD is safe also in patients with T2DM.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diálise Renal/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Medicine (Baltimore) ; 100(5): e24275, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592871

RESUMO

ABSTRACT: To investigate serum level of high mobility group box protein-1 (HMGB1) and prognosis of patients with end-stage renal disease (ESRD) on hemodialysis (HD) and peritoneal dialysis (PD).This prospective cohort observational study included a total of 253 ESRD patients who came to our hospital for HD or PD from February 2013 to February 2015. Enzyme linked immunosorbent assay (ELISA) method was used to detect the serum level of HMGB1, interleukin (IL-6), IL-8, and tumor necrosis factor-alpha (TNF-α). The kidney disease quality of life short form (KDQOL-SF) and kidney disease targeted area (KDTA) was applied for evaluating the quality of life. Kaplan-Meier (K-M) curve was performed for survival time.Serum level of HMGB1 in patients on HD was higher than PD. HMGB1 levels were gradually decreased with the treatment of HD or PD. Furthermore, HMGB1 was positively correlated with IL-6 and TNF-α. Moreover, patients with higher HMGB1 had more complications than patients with lower HMGB1, but there was no difference for the survival rate. In addition, the quality of life was associated with different dialysis methods.The serum level of HMGB1 and prognosis of ESRD patients was associated with different dialysis methods.


Assuntos
Proteína HMGB1/sangue , Falência Renal Crônica , Diálise Peritoneal , Qualidade de Vida , Diálise Renal , China/epidemiologia , Correlação de Dados , Feminino , Humanos , Interleucina-6/sangue , Estimativa de Kaplan-Meier , Falência Renal Crônica/sangue , Falência Renal Crônica/mortalidade , Falência Renal Crônica/psicologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/métodos , Diálise Peritoneal/estatística & dados numéricos , Prognóstico , Estudos Prospectivos , Diálise Renal/métodos , Diálise Renal/estatística & dados numéricos , Fator de Necrose Tumoral alfa/sangue
20.
Med Sci Monit ; 27: e922753, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-33640896

RESUMO

BACKGROUND Acute kidney injury with acute renal failure is associated with severe diabetic ketoacidosis. This retrospective study was conducted at a single center in China and aimed to compare combined hemodialysis and hemoperfusion (hemodialysis+hemoperfusion) with hemoperfusion alone in 106 patients with diabetic ketoacidosis and acute renal failure. MATERIAL AND METHODS The 106 patients were divided into 2 groups according to different dialysis programs, with 53 cases in each group. Hemodialysis was performed using a single-pass 4008S FX8 HeLix-One hollow fiber hemodialyzer (Fresenius Medical Care, St. Wendel, Germany). Hemoperfusion was performed using HA130 resin adsorbents. RESULTS There were no significant differences in terms of sex, age, duration of diabetes, A1c, pH, and admission blood glucose between the 2 groups (P=0.54, 0.564, 0.53, 0.78, 0.82, 0.51). There were no significant differences in fasting blood glucose, blood urea nitrogen, osmotic pressure, and creatinine between the 2 groups before treatment (P=0.146, 0.978, 0.786, 0.983). After treatment, blood urea nitrogen and creatinine in the dual-treatment group were lower than in the control group, and the osmotic pressure was higher than that in the control group (P=0.000, 0.000, 0.000). The dual-treatment group experienced a lower prevalence of dizziness (5.7%), anemia (7.5%), bone pain (7.5%), hypertension (3.8%), and pruritus (5.7%) than the control group (P<0.05). CONCLUSIONS Compared with hemoperfusion alone, hemodialysis+hemoperfusion significantly reduced pruritus and anemia, improved renal function, and was associated with significantly fewer adverse events in patients with diabetic ketoacidosis and acute renal failure.


Assuntos
Injúria Renal Aguda/terapia , Cetoacidose Diabética/terapia , Injúria Renal Aguda/complicações , Adulto , Idoso , Nitrogênio da Ureia Sanguínea , China , Creatinina/sangue , Cetoacidose Diabética/complicações , Feminino , Hemoperfusão/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Prurido , Diálise Renal/métodos , Estudos Retrospectivos
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