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Medicine (Baltimore) ; 99(31): e21460, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756167


Volume status is a key parameter for cardiovascular-related mortality in dialysis patients. Although N-terminal pro-B-type natriuretic peptide (NT-proBNP), myeloperoxidase, copeptin, and pro-adrenomedullin have been reported as volume markers, the relationship between body fluid status and volume markers in dialysis patients is uncertain. Therefore, we investigated the utility of volume status biomarkers based on body composition monitor (BCM) analyses.We enrolled pre-dialysis, hemodialysis (HD), and peritoneal dialysis (PD) patients and age- and gender-matched healthy Korean individuals (N = 80). BCM and transthoracic echocardiography were performed and NT-proBNP, myeloperoxidase, copeptin, and pro-adrenomedullin concentrations were measured. Relative hydration status (ΔHS, %) was defined in terms of the hydration status-to-extracellular water ratio with a cutoff of 15%, and hyperhydrated status was defined as ΔHS > 15%.Although there were no significant differences in total body water, extracellular water, or intracellular water among groups, mean amount of volume overload and hyperhydrated status were significantly higher in HD and PD patients compared with control and pre-dialysis patients. Mean amount of volume overload and hyperhydrated status were also significantly associated with higher NT-proBNP and pro-adrenomedullin levels in HD and PD patients, although not with myeloperoxidase or copeptin levels. Furthermore, they were significantly associated with cardiac markers (left ventricular mass index, ejection fraction, and left atrial diameter) in HD and PD patients compared with those in the control and pre-dialysis groups.On the basis of increased plasma NT-proBNP and pro-adrenomedullin concentrations, we might be able to make predictions regarding the volume overload status of dialysis patients, and thereby reduce cardiovascular-related mortality through appropriate early volume control.

Biomarcadores/sangue , Líquidos Corporais/metabolismo , Doenças Cardiovasculares/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia , Adrenomedulina/sangue , Adulto , Composição Corporal/fisiologia , Doenças Cardiovasculares/diagnóstico por imagem , Estudos de Casos e Controles , Diálise/métodos , Diálise/tendências , Ecocardiografia/métodos , Feminino , Glicopeptídeos/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Diálise Peritoneal/estatística & dados numéricos , Peroxidase/sangue , Precursores de Proteínas/sangue , Diálise Renal/estatística & dados numéricos , República da Coreia/epidemiologia , Volume Sistólico , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem
Mil Med ; 183(suppl_2): 147-152, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30189053


Acute kidney injury is a recognized complication of combat trauma. The complications associated with acute kidney injury, such as life-threatening hyperkalemia, are usually delayed in onset. In the recent conflicts, rapid evacuation of U.S. and coalition personnel generally resulted in these complications occurring at higher echelons of care where renal replacement therapies were available. In the future however, deployed providers may not have this luxury and should be prepared to temporize patients while they await transport. In this clinical practice guideline, recommendations are made for the management of patients with, or at risk for, acute kidney injury and hyperkalemia in the austere, deployed environment.

Diálise/métodos , Hiperpotassemia/terapia , Guerra , Lesão Renal Aguda/complicações , Lesão Renal Aguda/terapia , Cateterismo Venoso Central/métodos , Diálise/tendências , Gerenciamento Clínico , Hidratação/métodos , Guias como Assunto , Humanos , Hiperpotassemia/etiologia , Medicina Militar/métodos
Prog Transplant ; 28(4): 354-360, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30229693


BACKGROUND: Due to marginal efforts to increase living donor kidney transplantation, it is unclear whether interventions to improve African Americans' interest and pursuit of living donation should be tailored to address patients' exposure to or familiarity with dialysis or transplant settings. DESIGN, SETTING, AND PARTICIPANTS: We conducted a cross-sectional secondary analysis of baseline data from 3 separate randomized clinical trials among African Americans with varying degrees of experience with dialysis or transplantation (predialysis, on dialysis but not on transplant list, and on transplant wait-list) settings. METHODS: Interest in living donation was described using a 0 to 10 scale and pursuit of living donor kidney transplantation by achievement of at least 1 pursuant behavior. In multivariable logistic regression analyses, we assessed the association of knowledge, health literacy, and trust in health care with interest in or pursuit of living donation. RESULTS: Interest among the 3 study cohorts was high (predialysis, 62.9%; dialysis, 67.4%; and transplant wait-list, 74.2%). The dialysis and transplant wait-list study cohorts pursued living donation more readily than those not on dialysis (73%, 92%, and 45%, respectively). Interest and pursuit were not statistically significantly associated with knowledge, health literacy, or the 3 factors reflecting medical mistrust. CONCLUSION: Interest and pursuit of living donation were greater among study participants with greater exposure to dialysis or transplant settings. Efforts to promote patients' early interest and pursuit of living donor transplants may consider novel strategies to educate patients with less experience about the benefits of living donor kidney transplantation.

Afro-Americanos/psicologia , Diálise/tendências , Comportamentos Relacionados com a Saúde/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Transplante de Rim/psicologia , Transplante de Rim/tendências , Doadores Vivos/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Falência Renal Crônica/psicologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia
Nefrología (Madrid) ; 38(2): 114-124, mar.-abr. 2018. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-171079


Chronic kidney disease affects approximately 10% ofthe world's adult population: itis within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoinmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide (AU)

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Humanos , Feminino , Criança , Adolescente , Insuficiência Renal Crônica/epidemiologia , Disparidades nos Níveis de Saúde , Saúde da Mulher/tendências , Hipertensão/epidemiologia , Diálise/tendências , Complicações na Gravidez/prevenção & controle , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/prevenção & controle , Transplante de Rim/tendências
Arthritis Care Res (Hoboken) ; 69(9): 1377-1383, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-27813340


OBJECTIVE: There are few reports on the treatment of antineutrophil cytoplasmic antibody-associated vasculitis (AAV) in children. This study characterizes the use of cyclophosphamide, rituximab, and plasma exchange in children hospitalized with AAV in the US. METHODS: We conducted a retrospective cohort study of children hospitalized with AAV from 2004-2014 utilizing an administrative and billing database from 47 tertiary care pediatric hospitals. All patients had an International Classification of Diseases, Ninth Revision, Clinical Modification discharge code of 446.4 and ≥1 charge for glucocorticoids. Treatment receipt was determined using billing data. Mixed-effects logistic regression was used to evaluate factors associated with the likelihood of receipt of each of the 3 treatments. RESULTS: During the 11-year study period there were 1,290 admissions for 393 children. The median age at index admission was 14.6 years, and 61% were female. Dialysis or mechanical ventilation was required by 16% and 17% of the children, respectively. The median length of stay was 9 days. The percentages of children receiving cyclophosphamide, rituximab, or both were 57%, 21%, and 10%, respectively, and 22% received plasma exchange. Mechanical ventilation was associated with the receipt of cyclophosphamide and plasma exchange, but not rituximab. There was an increasing trend in the use of rituximab over time during the study period (P < 0.05), and a decreasing trend in the use of cyclophosphamide (P < 0.05). Treatment use varied significantly between hospitals, especially for plasma exchange. CONCLUSION: The treatment of children with severe AAV is shifting from cyclophosphamide to rituximab, and their need for dialysis, mechanical ventilation, and prolonged hospitalization remains common. Use of plasma exchange is highly variable.

Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/terapia , Antirreumáticos/uso terapêutico , Ciclofosfamida/uso terapêutico , Hospitalização/estatística & dados numéricos , Troca Plasmática/estatística & dados numéricos , Rituximab/uso terapêutico , Adolescente , Criança , Pré-Escolar , Terapia Combinada/tendências , Diálise/tendências , Feminino , Humanos , Imunossupressores/uso terapêutico , Tempo de Internação , Masculino , Troca Plasmática/métodos , Respiração Artificial/tendências , Estudos Retrospectivos , Estados Unidos
Enferm. nefrol ; 19(4): 307-316, oct.-dic. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-159093


Introducción: El paciente en diálisis va a sufrir una desnutrición proteico-calórica, con diferentes factores implicados en su aparición, lo cual se asocia con una elevadísima morbilidad cardiovascular y mortalidad. Se ha estimado una prevalencia de desnutrición en la población en hemodiálisis del 18-75%, siendo por tanto, un problema de especial relevancia en este tipo de pacientes. Objetivo: Realizar una revisión bibliográfica de los artículos científicos existentes sobre las variables que intervienen en la desnutrición del paciente en diálisis. Metodología: Se ha realizado una revisión bibliográfica mediante las bases de datos PubMed, Scielo, Pro-Quest. La búsqueda se ha realizado con términos Mesh, con una antigüedad no mayor de 5 años y con distintas palabras clave. Resultados: Se han revisado 19 artículos. La mayoría de los artículos fueron estudios observacionales y de revisión. Los factores que se asocian con desnutrición son la edad, pérdida de masa muscular, baja actividad física y dieta pobre en micronutrientes. Otro factor muy importante, es la inflamación. En cuanto a los métodos diagnósticos, son variados y diferentes, debido a la gran cantidad de variables que influyen en la desnutrición. Conclusiones: La desnutrición en pacientes en diálisis depende de distintas variables y no solamente de la dieta. Los factores que se asocian con desnutrición son mayor edad, pérdida de masa muscular, baja actividad física y dieta pobre en micronutrientes. Además, habría que añadir el doble papel que juega la inflamación en este proceso, pues puede ser tanto consecuencia como factor predisponente a la desnutrición (AU)

Introduction: The patient on dialysis will suffer from protein-caloric malnutrition, with different factors involved in its onset, which is associated with very high cardiovascular morbidity and mortality. A prevalence of malnutrition in the hemodialysis population of 18- 75% has been estimated, being therefore a problem of special relevance in this type of patients. Objective: A literature review of the existing scientific articles on the variables involved in malnutrition of patients on dialysis was carried out. Methods: A bibliographic review has been done using the PubMed, Scielo, ProQuest databases. The search used Mesh terms, with an age of no more than 5 years and with different keywords. Results: Nineteen articles were reviewed. Most articles were observational and review studies. The factors that are associated with malnutrition are age, loss of muscle mass, low physical activity and diet deficient in micronutrients. Another very important factor is inflammation. Regarding the diagnostic methods are varied and different, due to the large number of variables that influence malnutrition. Conclusions: Malnutrition in dialysis patients depends on different variables and not only on the diet. The factors that are associated with malnutrition are older age, loss of muscle mass, low physical activity and diet deficient in micronutrients. In addition, we should add the dual role of inflammation in this process as it can be both a consequence and a predisposing factor to malnutrition (AU)

Humanos , Masculino , Feminino , Diálise Peritoneal/métodos , Diálise Peritoneal/enfermagem , Deficiência de Proteína/complicações , Deficiência de Proteína/enfermagem , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/enfermagem , Inflamação/dietoterapia , Diálise/tendências , Desnutrição Proteico-Calórica/dietoterapia , Bibliometria , Micronutrientes/uso terapêutico , Fatores de Risco , Anorexia/complicações , Anorexia/enfermagem
Recent Pat Biotechnol ; 6(1): 32-44, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22420880


Laboratory dialysis, one of the most widely used techniques in biological research is truly a ' gateway technology' . The analogy is to that of a ' gate' of a building through which everybody has to pass, even though they may wish to go to different departments. Similarly, researchers may be working in altogether different areas but all may need to use laboratory dialysis at one stage or the other during the course of their research. Biochemists may use it to purify enzymes, an immunologist may use it to purify monoclonal antibodies from culture supernatants, a chemist may use it as a step in the crystallography process or for purification of ionic liquids, a biotechnologist may use it to study the effectiveness of enzyme immobilization and a drug discovery scientist may use it for determining drug-protein interaction. The present article reviews patents in the field of laboratory dialysis from inception till date, focusing on the various developmental and innovation related milestones during evolution of the technique. It captures the full panorama of a very interesting technique which continues to be as relevant today as it was in 1866 when the term ' dialysis' was first coined.

Diálise/história , Diálise/tendências , Patentes como Assunto/história , História do Século XIX , História do Século XX , História do Século XXI , Diálise Renal/tendências
Nephrology (Carlton) ; 16(1): 4-12, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21175971


Patients with end-stage kidney disease have significantly increased morbidity and mortality. While greater attention has been focused on advanced care planning, end-of-life decisions, conservative therapy and withdrawal from dialysis these must be supported by adequate palliative care incorporating symptom control. With the increase in the elderly, with their inherent comorbidities, accepted onto dialysis, patients, their nephrologists, families and multidisciplinary teams, are often faced with end-of-life decisions and the provision of palliative care. While dialysis may offer a better quality and quantity of life compared with conservative management, this may not always be the case; hence the patient is entitled to be well-informed of all options and potential outcomes before embarking on such therapy. They should be assured of adequate symptom control and palliative care whichever option is selected. No randomized controlled trials have been conducted in this area and only a small number of observational studies provide guidance; thus predicting which patients will have poor outcomes is problematic. Those undertaking dialysis may benefit from being fully aware of their choices between active and conservative treatment should their functional status seriously deteriorate and this should be shared with caregivers. This clarifies treatment pathways and reduces the ambiguity surrounding decision making. If conservative therapy or withdrawal from dialysis is chosen, each should be supported by palliative care. The objective of this review is to summarize published studies and evidence-based guidelines, core curricula, position statements, standards and tools in palliative care in end-stage kidney disease.

Diálise/tendências , Falência Renal Crônica/terapia , Cuidados Paliativos/normas , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Austrália , Diálise/ética , Humanos , Cuidados Paliativos/ética , Cuidados Paliativos/psicologia , Guias de Prática Clínica como Assunto
Am J Kidney Dis ; 41(1): 171-8, 2003 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-12500234


BACKGROUND: Patients on dialysis therapy are inactive, are at high risk for conditions that can be prevented or ameliorated by exercise, and often receive most of their care from their nephrologist. Exercise counseling by physicians can increase patients' levels of physical activity. The aim of the study is to determine the frequency of exercise assessment and counseling among practicing nephrologists, characteristics of nephrologists who provide exercise counseling to their dialysis patients, and barriers to exercise counseling perceived by nephrologists. METHODS: A 25-item survey regarding exercise counseling was administered to nephrologists attending the World Congress of Nephrology meeting in 2001. RESULTS: Five hundred five nephrologists completed the survey. Overall, 38% reported "almost always" or "often" assessing patient level of physical activity and counseling inactive patients to increase activity. Older (P < 0.0001), more active (P = 0.033), and women (P = 0.018) nephrologists, as well as those who provided primary care to more of their patients (P = 0.007), were more likely to provide exercise counseling. Nephrologists who do not provide routine counseling were more likely to endorse lack of time (P < 0.0001), lack of confidence in their ability to counsel patients (P < 0.0001), and lack of conviction that patients will respond as barriers to counseling (P = 0.01). In addition, noncounseling nephrologists were more likely to believe that other medical issues were more important than exercise (P = 0.01). CONCLUSION: Rates of exercise counseling among nephrologists are low, although dialysis patients are a high-risk group unlikely to receive advice about exercise from other health care providers. The low rates of counseling, particularly among younger nephrologists, could be addressed by including information about counseling in fellowship training and/or practice guidelines for the care of patients on dialysis therapy.

Aconselhamento , Diálise/métodos , Exercício Físico , Nefrologia , Padrões de Prática Médica/tendências , Adulto , Fatores Etários , Aconselhamento/tendências , Diálise/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrologia/métodos , Nefrologia/tendências , Medicina Preventiva/métodos , Medicina Preventiva/tendências , Fatores Sexuais , Inquéritos e Questionários