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3.
Dermatol Ther ; 34(4): e15015, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34080277

RESUMO

Chronic kidney disease (CKD) is a common medical problem with well-known dermatologic manifestations, some of which highly disturb the patients' quality of life. This cross-sectional study was designed to identify the prevalence and type of cutaneous involvement in CKD patients. The skin manifestations of 49 patients with CKD undergoing hemodialysis at Akhavan Hospital in Kashan, Iran, were recorded over 2 months. Diabetes (35%) was the most common cause of chronic renal failure in the patients, and the most common skin manifestations were xerosis (95.9%), uremic pigmentation (89.8%), scleral discoloration (87.8%), dental discoloration (85.2% among the patients with natural teeth), dry mouth (65.3%), varicosity (61.2%), pruritus (57.1%), skin atrophy (49%), lentigo (46.9%), subungual hyperkeratosis (42.9%), half and half nail dystrophy (34.7%), and purpura (26.5%). Mucocutaneous involvement has a very high prevalence in CKD patients undergoing hemodialysis, and some of the cases are medically and cosmetically disturbing; therefore, with better knowledge about the type and prevalence of these involvements, the consequences can be better predicted and managed. Further studies are recommended to be conducted on the association between these signs and CKD grade, and clinical trials are also required for establishing the treatment options available for these signs and then assessing the patients' quality of life as a primary outcome measure.


Assuntos
Falência Renal Crônica , Dermatopatias , Estudos Transversais , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Qualidade de Vida , Diálise Renal/efeitos adversos , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Dermatopatias/etiologia
4.
J Nephrol ; 34(4): 985-989, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34061336

RESUMO

The health crisis induced by the pandemic of coronavirus 2019 disease (COVID-19) has had a major impact on dialysis patients in France. The incidence of infection with acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first wave of the COVID-19 epidemic was 3.3% among dialysis patients-13 times higher than in the general population. The corresponding mortality rate was high, reaching 21%. As of 19th April, 2021, the cumulative prevalence of SARS-CoV-2 infection in French dialysis patients was 14%. Convergent scientific data from France, Italy, the United Kingdom and Canada show that home dialysis reduces the risk of SARS-CoV-2 infection by a factor of at least two. Unfortunately, home dialysis in France is not sufficiently developed: the proportion of dialysis patients being treated at home is only 7%. The obstacles to the provision of home care for patients with end-stage kidney disease in France include (i) an unfavourable pricing policy for home haemodialysis and nurse visits for assisted peritoneal dialysis (PD), (ii) insufficient training in home dialysis for nephrologists, (iii) the small number of administrative authorizations for home dialysis programs, and (iv) a lack of structured, objective information on renal replacement therapies for patients with advanced chronic kidney disease (CKD). We propose a number of pragmatic initiatives that could be simultaneously enacted to improve the situation in three areas: (i) the provision of objective information on renal replacement therapies for patients with advanced CKD, (ii) wider authorization of home dialysis networks and (iii) price increases in favour of home dialysis procedures.


Assuntos
COVID-19 , Falência Renal Crônica , Hemodiálise no Domicílio , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Pandemias , Diálise Renal/efeitos adversos , SARS-CoV-2
5.
Medicine (Baltimore) ; 100(21): e26050, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032732

RESUMO

ABSTRACT: To investigate the clinicopathological features and outcomes of primary IgA nephropathy with nephrotic-range proteinuria in Chinese children. Patients with biopsy-proven IgA nephropathy and nephrotic-range proteinuria between January 2011 and December 2017 were included, and their proteinuria and renal function were followed up. A total of 90 patients were enrolled, and 21.1% (19/90) of them had decreased renal function at diagnosis. Complete remission, partial remission, and no response of proteinuria occurred in 88.6% (70/79), 10.1% (8/79), and 1.3% (1/79), respectively, of the 79 patients who were followed up for 6 to 104 months. 73.7% (14/19) of the patients with decreased renal function at diagnosis recovered to normal level while 26.3% (5/19) of them did not recover or progressed to end-stage renal disease. Two patients with normal renal function at diagnosis progressed to renal insufficiency during follow-up period. By multivariate analysis, the risk for renal function deterioration was significantly higher in the partial remission and no response groups than in the complete remission group. Remission of proteinuria was important for improving renal prognosis in children with IgA nephropathy and nephrotic-range proteinuria. The outcomes for pediatric patients appeared to be better than that reported in adults.


Assuntos
Glomerulonefrite por IGA/tratamento farmacológico , Glucocorticoides/uso terapêutico , Imunossupressores/uso terapêutico , Falência Renal Crônica/epidemiologia , Proteinúria/epidemiologia , Adolescente , Biópsia , Criança , Pré-Escolar , China/epidemiologia , Quimioterapia Combinada/métodos , Feminino , Seguimentos , Mesângio Glomerular/patologia , Glomerulonefrite por IGA/complicações , Glomerulonefrite por IGA/imunologia , Glomerulonefrite por IGA/patologia , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/imunologia , Falência Renal Crônica/urina , Masculino , Proteinúria/diagnóstico , Proteinúria/imunologia , Proteinúria/urina , Indução de Remissão/métodos , Estudos Retrospectivos , Resultado do Tratamento
6.
J Nephrol ; 34(4): 999-1006, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34050905

RESUMO

INTRODUCTION: In this observational study, we describe the change in the clinical profile and outcome of Corona Virus Disease 2019 (COVID-19) over the course of the outbreak, among patients requiring dialysis, including chronic haemodialysis therapy. METHODS: This is a single-centre prospective observational study of patients with COVID-19 (as confirmed by RT-PCR) and renal failure requiring haemodialysis. Their clinical profiles and outcomes were analysed, vis-à-vis the changing disease severity. FINDINGS: A total of 483 patients were included, of whom 416 had end-stage renal disease and were on maintenance haemodialysis. Patients who were symptomatic at presentation had significantly higher levels of Neutrophil-lymphocyte ratio (NLR) (p < 0.001), C-reactive protein (CRP) (p < 0.001), lactate dehydrogenase (LDH) (p < 0.001), higher degrees of lung involvement (p < 0.001) and required more respiratory support (p < 0.001). The overall mortality observed was 18.8%. In the late phases of the outbreak, there was a significant increase in disease severity without a statistically significant increase in mortality. Predictors of mortality on univariate analysis were age, diabetes mellitus, acute on chronic kidney disease, presence of symptoms on admission, NLR, CRP, LDH, computed tomography (CT) chest grades 3 and 4, and need for respiratory support; however, only age and the renal syndrome of acute on chronic kidney disease retained significance on multivariate analysis (p0.003 and p0.019, respectively). CONCLUSION: Among patients on haemodialysis, higher mortality was observed in patients who were older, and among those with acute on chronic kidney disease. In the late phase of the outbreak, there was a statistically significant increase in disease severity without a corresponding increase in mortality.


Assuntos
COVID-19 , Falência Renal Crônica , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , SARS-CoV-2 , Índice de Gravidade de Doença
7.
Isr Med Assoc J ; 23(4): 245-250, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33899358

RESUMO

BACKGROUND: Hypomagnesemia (serum magnesium level < 1.7 mg/dl) occurs more frequently in patients with type 2 diabetes mellitus (T2DM).Serum magnesium levels are not routinely tested in hospitalized patients, including in hospitalized patients with T2DM. OBJECTIVES: To evaluate the prevalence of hypomagnesemia among hospitalized T2DM patients treated with proton pump inhibitors (PPIs) and/or diuretics. METHODS: A total of 263 T2DM patients hospitalized in general departments were included in the study and were further divided into four groups: group 1 (patients not treated with PPIs or diuretics), group 2 (patients treated with PPIs), group 3 (patients treated with diuretics), and group 4 (patients treated with both PPIs and diuretics).  Blood and urine samples were taken during the first 24 hours of admission. Electrocardiogram was performed on admission. RESULTS: Of the 263 T2DM patients, 58 (22.1%) had hypomagnesemia (serum magnesium level < 1.7 mg/dl). Patients in group 2 had the lowest mean serum magnesium level (1.79 mg/dl ± 0.27). Relatively more patients with hypomagnesemia were found in group 2 compared to the other groups, although a statistically significant difference was not observed. Significantly more patients in group 3 and 4 had chronic renal failure. Patients with hypomagnesemia had significantly lower serum calcium levels. CONCLUSIONS: Hospitalized T2DM patients under PPI therapy are at risk for hypomagnesemia and hypocalcemia.


Assuntos
Cálcio/sangue , Diabetes Mellitus Tipo 2 , Falência Renal Crônica , Magnésio/sangue , Doenças Metabólicas , Idoso , Comorbidade , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Diuréticos/administração & dosagem , Diuréticos/efeitos adversos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Israel/epidemiologia , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Masculino , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/epidemiologia , Doenças Metabólicas/etiologia , Doenças Metabólicas/metabolismo , Pessoa de Meia-Idade , Prevalência , Inibidores da Bomba de Prótons/administração & dosagem , Inibidores da Bomba de Prótons/efeitos adversos
8.
Toxins (Basel) ; 13(4)2021 04 19.
Artigo em Inglês | MEDLINE | ID: mdl-33921862

RESUMO

The retention of uremic toxins and their pathological effects occurs in the advanced phases of chronic kidney disease (CKD), mainly in stage 5, when the implementation of conventional thrice-weekly hemodialysis is the prevalent and life-saving treatment. However, the start of hemodialysis is associated with both an acceleration of the loss of residual kidney function (RKF) and the shift to an increased intake of proteins, which are precursors of uremic toxins. In this phase, hemodialysis treatment is the only way to remove toxins from the body, but it can be largely inefficient in the case of high molecular weight and/or protein-bound molecules. Instead, even very low levels of RKF are crucial for uremic toxins excretion, which in most cases are protein-derived waste products generated by the intestinal microbiota. Protection of RKF can be obtained even in patients with end-stage kidney disease (ESKD) by a gradual and soft shift to kidney replacement therapy (KRT), for example by combining a once-a-week hemodialysis program with a low or very low-protein diet on the extra-dialysis days. This approach could represent a tailored strategy aimed at limiting the retention of both inorganic and organic toxins. In this paper, we discuss the combination of upstream (i.e., reduced production) and downstream (i.e., increased removal) strategies to reduce the concentration of uremic toxins in patients with ESKD during the transition phase from pure conservative management to full hemodialysis treatment.


Assuntos
Dieta com Restrição de Proteínas , Falência Renal Crônica/terapia , Diálise Renal , Toxinas Biológicas/sangue , Uremia/terapia , Biomarcadores/sangue , Terapia Combinada , Dieta com Restrição de Proteínas/efeitos adversos , Progressão da Doença , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Diálise Renal/efeitos adversos , Resultado do Tratamento , Uremia/sangue , Uremia/diagnóstico , Uremia/fisiopatologia
9.
Photodiagnosis Photodyn Ther ; 34: 102313, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33915311

RESUMO

PURPOSE: Chronic renal failure (CRF) is a disease with a high morbidity rate that can develop into uraemia, resulting in a series of complications, such as dyspnoea, mental disorders, hypertension, and heart failure. CRF may be controlled clinically by drug intervention. Therefore, early diagnosis and control of the disease are of great significance for the treatment and prevention of chronic renal failure. Based on the complexity of CRF diagnosis, this study aims to explore a new rapid and noninvasive diagnostic method. METHODS: In this experiment, the serum Raman spectra of samples from 47 patients with CRF and 53 normal subjects were obtained. In this study, Serum Raman spectra of healthy and CRF patients were identified by a Convolutional Neural Network (CNN) and compared with the results of identified by an Improved AlexNet. In addition, different amplitude of noise were added to the spectral data of the samples to explore the influence of a small random noise on the experimental results. RESULTS: A CNN and an Improved AlexNet was used to classify the spectra, and the accuracy was 79.44 % and 95.22 % respectively. And the addition of noise did not significantly interfere with the classification accuracy. CONCLUSION: The accuracy of CNN of this study can be as high as 95.22 %, which greatly improves its accuracy and reliability, compared to 89.7 % in the previous study. The results of this study show that the combination of serum Raman spectrum and CNN can be used in the diagnosis of CRF, and small random noise will not cause serious interference to the data analysis results.


Assuntos
Falência Renal Crônica , Fotoquimioterapia , Humanos , Falência Renal Crônica/diagnóstico , Redes Neurais de Computação , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes , Reprodutibilidade dos Testes , Análise Espectral Raman
10.
Toxins (Basel) ; 13(4)2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33807387

RESUMO

Optical monitoring of spent dialysate has been used to estimate the removal of water-soluble low molecular weight as well as protein-bound uremic toxins from the blood of end stage kidney disease (ESKD) patients. The aim of this work was to develop an optical method to estimate the removal of ß2-microglobulin (ß2M), a marker of middle molecule (MM) uremic toxins, during hemodialysis (HD) treatment. Ultraviolet (UV) and fluorescence spectra of dialysate samples were recorded from 88 dialysis sessions of 22 ESKD patients, receiving four different settings of dialysis treatments. Stepwise regression was used to obtain the best model for the assessment of ß2M concentration in the spent dialysate. The correlation coefficient 0.958 and an accuracy of 0.000 ± 0.304 mg/L was achieved between laboratory and optically estimated ß2M concentrations in spent dialysate for the entire cohort. Optically and laboratory estimated reduction ratio (RR) and total removed solute (TRS) of ß2M were not statistically different (p > 0.35). Dialytic elimination of MM uremic toxin ß2M can be followed optically during dialysis treatment of ESKD patients. The main contributors to the optical signal of the MM fraction in the spent dialysate were provisionally identified as tryptophan (Trp) in small peptides and proteins, and advanced glycation end-products.


Assuntos
Soluções para Hemodiálise/análise , Falência Renal Crônica/terapia , Diálise Renal , Toxinas Biológicas/sangue , Uremia/terapia , Microglobulina beta-2/sangue , Adulto , Idoso , Biomarcadores/sangue , Feminino , Produtos Finais de Glicação Avançada/sangue , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Ligação Proteica , Espectrometria de Fluorescência , Espectrofotometria Ultravioleta , Resultado do Tratamento , Triptofano/sangue , Uremia/sangue , Uremia/diagnóstico
11.
J Cardiovasc Magn Reson ; 23(1): 23, 2021 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-33691727

RESUMO

BACKGROUND: Secondary hyperparathyroidism is a common complication of end-stage renal disease (ESRD), which may be associated with cardiovascular diseases. Thus, this study aimed to explore myocardial damage using non-contrast cardiovascular magnetic resonance (CMR) in ESRD patients undergoing hemodialysis and further investigate its relationship with parathyroid hormone (PTH) toxicity. METHODS: Seventy-two adult ESRD patients receiving regular hemodialysis and 30 healthy subjects underwent CMR examination. Continuous CMR cine sections from the mitral valve level to the left ventricular (LV) apex in the short-axis plane, cine series of vertical two-chamber long-axis plane, and horizontal four-chamber plane were acquired. Native T1 mapping was obtained using modified Look-Locker inversion recovery (MOLLI) sequences. Native T1 values and myocardial strain were analyzed.  Immunoreactive parathyroid hormone (iPTH) was obtained from all enrolled patients. RESULTS: Forty (55.6%) hemodialysis ESRD patients were found to have increased iPTH levels. LV ejection fraction (LVEF) of both ESRD patients with targeted and increased iPTH levels was decreased compared with healthy subjects (55.9 ± 12.0% vs. 65.0 ± 4.5%; 51.7 ± 12.8 vs. 65.0 ± 4.5%, both P < 0.05). The mean peak radial strain (PRS), peak circumferential strain (PCS), and peak longitudinal strain (PLS) were lowest in ESRD patients with increased iPTH; however, no significant difference was observed among these three groups. Segmentally, from base to apex, the native T1 of ESRD patients with increased iPTH levels tended to be higher than those with targeted iPTH and healthy subjects (all P < 0.05). In ESRD patients with targeted iPTH, both native T1 of basal and middle segments were significantly higher than normal subjects (basal, 1304 ± 41 ms vs. 1238 ± 36 ms, P = 0.001; middle, 1300 ± 43 ms vs. 1242 ± 50 ms, P < 0.001). Comparing global native T1 values in the three groups, ESRD patients with targeted and increased iPTH level showed increased native T1 (1305 ± 41 ms vs. 1251 ± 49 ms, P = 0.001; 1334 ± 40 ms vs. 1251 ± 49 ms, P < 0.001, respectively). Native T1 values of the basal segment and global native T1 were moderately associated with iPTH (r = 0.4, P < 0.001; r = 0.5, P < 0.001). Multiple linear regression analysis showed that global native T1 values (beta = 1.0, P = 0.01) were independently associated with iPTH. CONCLUSIONS: Elevated iPTH level was associated with and was an independent risk factor for myocardial damage in ESRD patients undergoing maintenance hemodialysis. TRIAL REGISTRATION: Chinese Clinical Trial Registry ( http://www.chictr.org.cn/index.aspx ) ChiCTR-DND-17012976, 13/12/2017, retrospectively registered.


Assuntos
Cardiopatias/diagnóstico por imagem , Hiperparatireoidismo Secundário/sangue , Falência Renal Crônica/terapia , Imagem Cinética por Ressonância Magnética , Miocárdio/patologia , Hormônio Paratireóideo/sangue , Diálise Renal , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Cardiopatias/etiologia , Cardiopatias/patologia , Cardiopatias/fisiopatologia , Humanos , Hiperparatireoidismo Secundário/diagnóstico , Hiperparatireoidismo Secundário/etiologia , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Diálise Renal/efeitos adversos , Medição de Risco , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Regulação para Cima , Função Ventricular Esquerda
12.
J Stroke Cerebrovasc Dis ; 30(5): 105686, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33735668

RESUMO

OBJECTIVES: End-stage renal disease (ESRD) is one of the most critical risk factors of intracerebral hemorrhage (ICH). We aimed to investigate the effects of maintenance hemodialysis on hematoma volume, edema volume, and prognosis in patients with comorbid ESRD and ICH. MATERIALS AND METHODS: Patients with comorbid ESRD and ICH were divided into two groups based on whether receiving maintenance hemodialysis. Hematoma and perihemorrhagic edema (PHE) volumes and relative edema ratio after admission were assessed on head computed tomography scans. RESULTS: During the initial diagnosis, the dialysis group had lower PHE volume (16.41 vs 35.90 mL, P = 0.010), total volume of hematoma and edema (31.58 vs 54.58 mL, P = 0.013), and relative edema ratio (0.57 vs 0.92, P = 0.033) than the non-dialysis group. In addition, the peak PHE volume (36.68 vs 84.30 mL, P < 0.001), peak total volume of hematoma and edema (53.45 vs 127.69 mL, P = 0.011), and peak relative edema ratio (1.12 vs 1.92, P = 0.001) within one week after onset were lower in the dialysis group than in the non-dialysis group. The dialysis group had a higher in-hospital mortality rate than the non-dialysis group (40% vs 10%, P = 0.007). At 1-year follow-up, the two groups had similar 1-year-mortality rates and modified Rankin Scale. CONCLUSIONS: Hemodialysis can prevent the enlargement of edema and reduce PHE volume shortly after onset. Although dialyzed patients had a higher in-hospital mortality rate, hemodialysis did not affect 1-year survival rate and functional neurologic scales.


Assuntos
Edema Encefálico/prevenção & controle , Hemorragia Cerebral/terapia , Falência Renal Crônica/terapia , Diálise Renal , Idoso , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Edema Encefálico/mortalidade , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/mortalidade , China , Comorbidade , Feminino , Mortalidade Hospitalar , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Diálise Renal/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
Toxins (Basel) ; 13(3)2021 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-33668249

RESUMO

Peritoneal dialysis (PD) is a feasible and effective renal replacement therapy (RRT) thanks to the dialytic properties of the peritoneal membrane (PM). Preservation of PM integrity and transport function is the key to the success of PD therapy, particularly in the long term, since the prolonged exposure to unphysiological hypertonic glucose-based PD solutions in current use is detrimental to the PM, with progressive loss of peritoneal ultrafiltration capacity causing technique failure. Moreover, absorbing too much glucose intraperitoneally from the dialysate may give rise to a number of systemic metabolic effects. Here we report the preliminary results of the first clinical experience based on the use in continuous ambulatory PD (CAPD) patients of novel PD solutions obtained through partly replacing the glucose load with other osmotically active metabolites, such as L-carnitine and xylitol. Ten CAPD patients were treated for four weeks with the new solutions. There was good tolerance to the experimental PD solutions, and no adverse safety signals were observed. Parameters of dialysis efficiency including creatinine clearance and urea Kt/V proved to be stable as well as fluid status, diuresis, and total peritoneal ultrafiltration. The promising tolerance and local/systemic advantages of using L-carnitine and xylitol in the PD solution merit further research.


Assuntos
Carnitina/uso terapêutico , Soluções para Diálise/uso terapêutico , Falência Renal Crônica/terapia , Diálise Peritoneal Ambulatorial Contínua , Xilitol/uso terapêutico , Adulto , Idoso , Carnitina/efeitos adversos , Soluções para Diálise/efeitos adversos , Feminino , Glucose/uso terapêutico , Humanos , Itália , Falência Renal Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Xilitol/efeitos adversos
14.
Photodiagnosis Photodyn Ther ; 34: 102241, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33662617

RESUMO

In this study, 60 samples taken from patients with thyroid dysfunction, 40 samples taken from patients with chronic renal failure (CRF) and 60 samples taken from healthy people were classified. We used partial least squares (PLS) to extract features to reduce the dimension of the spectral data to discriminate among the different samples. The Decision Trees (DT), Extreme Learning Machine (ELM), Probabilistic Neural Network (PNN), Back Propagation Neural Network (BPNN) and Learning Vector Quantization (LVQ) algorithms were used to build classification models and compare the results. The PLS-PNN algorithm distinguished between patients with thyroid dysfunction and patients with chronic renal failure with up to a 96.67 % accuracy rate, the PLS-BP algorithm distinguished between patients with chronic renal failure and healthy people with up to a 98.33 % accuracy rate, and the PLS-PNN algorithm and the PLS-DT algorithm distinguished between healthy people and patients with chronic renal failure with up to a 100 % accuracy rate. The results showed that serum Raman spectroscopy can be used in conjunction with classification algorithms to rapidly and accurately diagnose and distinguish between thyroid dysfunction and chronic renal failure.


Assuntos
Falência Renal Crônica , Fotoquimioterapia , Algoritmos , Humanos , Falência Renal Crônica/diagnóstico , Análise dos Mínimos Quadrados , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes , Análise Espectral Raman , Glândula Tireoide
16.
Vasc Endovascular Surg ; 55(5): 524-528, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33596777

RESUMO

Ilio-femoral deep vein thrombosis (DVT) is rare in patients with lower limb arterio-venous grafts due to a state of high blood flow. May-Thurner syndrome (MTS) is an anomaly where the left common iliac vein is compressed by the right common iliac artery. We present a rare case of ilio-femoral deep vein thrombosis in a patient with May-Thurner Syndrome and an underlying arteriovenous graft in-situ who presented with acute lower limb swelling. The patient underwent catheter-directed thrombolysis, pharmaco-mechanical thrombectomy, venoplasty and iliac vein stenting. Follow-up surveillance duplex ultrasound showed patency of the iliac vein stent and arteriovenous graft at 1-year postoperatively.


Assuntos
Angioplastia com Balão , Derivação Arteriovenosa Cirúrgica , Veia Ilíaca , Falência Renal Crônica/terapia , Extremidade Inferior/irrigação sanguínea , Síndrome de May-Thurner/complicações , Trombectomia , Terapia Trombolítica , Trombose Venosa/etiologia , Idoso , Angioplastia com Balão/instrumentação , Humanos , Veia Ilíaca/diagnóstico por imagem , Falência Renal Crônica/diagnóstico , Masculino , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome de May-Thurner/terapia , Diálise Renal , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia
17.
J Nephrol ; 34(3): 781-790, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33555578

RESUMO

BACKGROUND: The prevalence and severity of anemia differ between diabetic and non-diabetic patients. We investigated whether the effect of hemoglobin (Hb) on patient outcome was affected by the presence or absence of diabetes among Japanese patients receiving chronic hemodialysis (HD). METHODS: We enrolled 149,308 patients from a nationwide dialysis registry in Japan at the end of 2012 (mean age, 67.6 ± 12.3 years; male, 61.7%; diabetes, 43.5%; median dialysis duration, 65 months) who underwent three HD sessions weekly. One-year all-cause and cardiovascular (CV) mortality were assessed using Cox regression analysis and competing-risks regression analysis. We used multiple imputation to deal with missing covariate data. RESULTS: Baseline Hb and serum ferritin levels were independently associated with all-cause and CV mortality. In non-diabetic patients, a significantly higher risk for all-cause mortality compared to the reference group (10 to 11 g/dL) was observed in patients with Hb < 8 g/dL (hazard ratio (HR): 1.266; 95% confidence interval (CI) 1.097-1.460) and 8 to 9 g/dL(HR: 1.153; 95% CI 1.030-1.290). On the other hand, diabetic HD patients in the same Hb category group did not have increased risk of all-cause mortality. CONCLUSIONS: We found that non-diabetic HD patients had an increased risk of all-cause mortality if they had lower Hb levels, whereas the effect of Hb levels on mortality was attenuated in diabetic HD patients. These data suggest that the association between Hb levels and mortality rate could be different between diabetic and non-diabetic HD patients.


Assuntos
Anemia , Diabetes Mellitus , Falência Renal Crônica , Idoso , Anemia/diagnóstico , Anemia/epidemiologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Hemoglobinas/análise , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/terapia , Masculino , Diálise Renal/efeitos adversos
19.
Kidney Blood Press Res ; 46(1): 84-94, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33592619

RESUMO

INTRODUCTION: Living donor kidney transplant (LDKT) is one of the best therapeutic options for end-stage kidney disease (ESKD). Guidelines identify different estimated glomerular filtration rate (eGFR) thresholds to determine the eligibility of donors. The aim of our study was to evaluate whether pretransplant donor eGFR was associated with kidney function in the recipient. METHODS: We retrospectively studied LDKT recipients who received a kidney graft between September 1, 2005, and June 30, 2016 in the same transplant center in France and that had eGFR data available at 3, 12, 24, and 36 months posttransplant. RESULTS: We studied 90 donor-recipient pairs. The average age at time of transplant was 51.47 ± 10.95 for donors and 43.04 ± 13.52 years for recipients. Donors' average eGFR was 91.99 ± 15.37 mL/min/1.73 m2. Donor's age and eGFR were significantly correlated (p < 0.0001, r2 0.023). Donor's age and eGFR significantly correlated with recipient's eGFR at 3, 12, and 24 months posttransplant (age: p < 0.001 at all intervals; eGFR p = 0.001, 0.003, and 0.016, respectively); at 36 months, only donor's age significantly correlated with recipient's eGFR. BMI, gender match, and year of kidney transplant did not correlate with graft function. In the multivariable analyses, donor's eGFR and donor's age were found to be associated with graft function; correlation with eGFR was lost at 36 months; and donor's age retained a strong correlation with graft function at all intervals (p < 0.001). CONCLUSIONS: Donor's eGFR and age are strong predictors of recipient's kidney function at 3 years. We suggest that donor's eGFR should be clinically balanced with other determinants of kidney function and in particular with age.


Assuntos
Falência Renal Crônica/terapia , Transplante de Rim , Rim/fisiologia , Doadores Vivos , Adulto , Taxa de Filtração Glomerular , Sobrevivência de Enxerto , Humanos , Rim/fisiopatologia , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Transplante de Rim/métodos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
20.
Kidney Int ; 99(6): 1408-1417, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33607178

RESUMO

Intradialytic hypotension (IDH) is a common complication of hemodialysis, but there is no data about the time of onset during treatment. Here we describe the incidence of IDH throughout hemodialysis and associations of time of hypotension with clinical parameters and survival by analyzing data from 21 dialysis clinics in the United States to include 785682 treatments from 4348 patients. IDH was defined as a systolic blood pressure of 90 mmHg or under while IDH incidence was calculated in 30-minute intervals throughout the hemodialysis session. Associations of time of IDH with clinical and treatment parameters were explored using logistic regression and with survival using Cox-regression. Sensitivity analysis considered further IDH definitions. IDH occurred in 12% of sessions at a median time interval of 120-149 minutes. There was no notable change in IDH incidence across hemodialysis intervals (range: 2.6-3.2 episodes per 100 session-intervals). Relative blood volume and ultrafiltration volume did not notably associate with IDH in the first 90 minutes but did thereafter. Associations between central venous but not arterial oxygen saturation and IDH were present throughout hemodialysis. Patients prone to IDH early as compared to late in a session had worse survival. Sensitivity analyses suggested IDH definition affects time of onset but other analyses were comparable. Thus, our study highlights the incidence of IDH during the early part of hemodialysis which, when compared to later episodes, associates with clinical parameters and mortality.


Assuntos
Hipotensão , Falência Renal Crônica , Pressão Sanguínea , Volume Sanguíneo , Humanos , Hipotensão/diagnóstico , Hipotensão/epidemiologia , Hipotensão/etiologia , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Ultrafiltração
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