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1.
Nutrients ; 13(7)2021 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-34371962

RESUMO

Low heart rate variability (HRV) is independently associated with increased risk of sudden cardiac death (SCD) and all cardiac death in haemodialysis patients. Long chain n-3 polyunsaturated fatty acids (LC n-3 PUFA) may exert anti-arrhythmic effects. This study aimed to investigate relationships between dialysis, sleep and 24 h HRV and LC n-3 PUFA status in patients who have recently commenced haemodialysis. A cross-sectional study was conducted in adults aged 40-80 with chronic kidney disease (CKD) stage 5 (n = 45, mean age 58, SD 9, 20 females and 25 males, 39% with type 2 diabetes). Pre-dialysis blood samples were taken to measure erythrocyte and plasma fatty acid composition (wt % fatty acids). Mean erythrocyte omega-3 index was not associated with HRV following adjustment for age, BMI and use of ß-blocker medication. Higher ratios of erythrocyte eicosapentaenoic acid (EPA) to docosahexaenoic acid (DHA) were associated with lower 24 h vagally-mediated beat-to-beat HRV parameters. Higher plasma EPA and docosapentaenoic acid (DPAn-3) were also associated with lower sleep-time and 24 h beat-to-beat variability. In contrast, higher plasma EPA was significantly related to higher overall and longer phase components of 24 h HRV. Further investigation is required to investigate whether patients commencing haemodialysis may have compromised conversion of EPA to DHA, which may impair vagally-mediated regulation of cardiac autonomic function, increasing risk of SCD.


Assuntos
Ácidos Graxos Ômega-3/sangue , Frequência Cardíaca , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Diálise Renal , Adulto , Idoso , Idoso de 80 Anos ou mais , Sistema Nervoso Autônomo/fisiopatologia , Estudos Transversais , Morte Súbita Cardíaca/etiologia , Diabetes Mellitus Tipo 2/complicações , Ácidos Docosa-Hexaenoicos/sangue , Ácido Eicosapentaenoico/sangue , Membrana Eritrocítica/química , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Sono
2.
Kidney Blood Press Res ; 46(4): 396-410, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34233334

RESUMO

BACKGROUND: Patients affected by chronic kidney disease are at a risk of cardiovascular morbidity and mortality. Body fluids unbalance is one of the main characteristics of this condition, as fluid overload is highly prevalent in patients affected by the cardiorenal syndrome. SUMMARY: We describe the state of the art and new insights into body volume evaluation. The mechanisms behind fluid balance are often complex, mainly because of the interplay of multiple regulatory systems. Consequently, its management may be challenging in clinical practice and even more so out-of-hospital. Availability of novel technologies offer new opportunities to improve the quality of care and patients' outcome. Development and validation of new technologies could provide new tools to reduce costs for the healthcare system, promote personalized medicine, and boost home care. Due to the current COVID-19 pandemic, a proper monitoring of chronic patients suffering from fluid unbalances is extremely relevant. Key Message: We discuss the main mechanisms responsible for fluid overload in different clinical contexts, including hemodialysis, peritoneal dialysis, and heart failure, emphasizing the potential impact provided by the implementation of the new technologies.


Assuntos
Tecnologia Biomédica/tendências , Volume Sanguíneo , Falência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia , Equilíbrio Hidroeletrolítico , COVID-19 , Humanos , Falência Renal Crônica/mortalidade , Pandemias , Insuficiência Renal Crônica/mortalidade
3.
J Ayub Med Coll Abbottabad ; 33(2): 315-318, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34137554

RESUMO

BACKGROUND: Recurrence of the primary kidney disease causing graft loss in an otherwise good functioning graft in post renal transplantation period is a well-known entity. Approximately 15% of the graft failure occurs secondary to recurrence of the primary glomerulonephritis in post renal transplant period. Regarding primary glomerulonephritis, almost 33-35% of patients suffering from primary membranous nephropathy (PMN), an organ specific auto-immune podocytopathy reach end stage renal disease (ESRD) and renal transplant is then the only treatment modality of choice for them. But, unfortunately 30-50% will experience the disease recurrence and 40-50% will end up with graft loss. The discovery of M-type anti phospholipase auto antibodies (APLA2R-ab) has changed the paradigm. Different remarkable studies are available in the literature that have concluded that APLA2R-ab titers if performed before the renal transplantation are helpful in predicting the disease recurrence and their titration in post-renal transplant period is clinically relevant to see the risk of disease recurrence and its progression, help in treatment monitoring and also to observe the treatment response in terms of complete or partial remission of the disease. Till now, there are no evidence-based guidelines available for the prevention of rPMN in post renal transplant period. The traditional treatment regimens beneficial for the management of PMN in native kidneys are associated with certain serious side effects in post renal transplant period. Rituximab, an anti-CD20 monoclonal antibody (anti CD20 mAb) has emerged as a promising treatment option for such patients. CONCLUSIONS: In conclusion an approach intending an early diagnosis of the rPMN by using the APLA2r levels in serum and its management by utilizing rituximab has proved worthy in minimizing the risk of allograft loss secondary to recurrence of PMN in post renal transplant period. However further studies are still awaited regarding the efficacy, dose and duration of the treatment.


Assuntos
Autoanticorpos/sangue , Glomerulonefrite Membranosa/fisiopatologia , Fatores Imunológicos/uso terapêutico , Falência Renal Crônica/tratamento farmacológico , Falência Renal Crônica/cirurgia , Transplante de Rim , Receptores da Fosfolipase A2/imunologia , Rituximab/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Feminino , Humanos , Falência Renal Crônica/fisiopatologia , Masculino , Recidiva
4.
Int J Mol Sci ; 22(9)2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-34062938

RESUMO

Diabetes mellitus represents a growing concern, both for public economy and global health. In fact, it can lead to insidious macrovascular and microvascular complications, impacting negatively on patients' quality of life. Diabetic patients often present diabetic kidney disease (DKD), a burdensome complication that can be silent for years. The average time of onset of kidney impairment in diabetic patients is about 7-10 years. The clinical impact of DKD is dangerous not only for the risk of progression to end-stage renal disease and therefore to renal replacement therapies, but also because of the associated increase in cardiovascular events. An early recognition of risk factors for DKD progression can be decisive in decreasing morbidity and mortality. DKD presents patient-related, clinician-related, and system-related issues. All these problems are translated into therapeutic inertia, which is defined as the failure to initiate or intensify therapy on time according to evidence-based clinical guidelines. Therapeutic inertia can be resolved by a multidisciplinary pool of healthcare experts. The timing of intensification of treatment, the transition to the best therapy, and dietetic strategies must be provided by a multidisciplinary team, driving the patients to the glycemic target and delaying or overcoming DKD-related complications. A timely nephrological evaluation can also guarantee adequate information to choose the right renal replacement therapy at the right time in case of renal impairment progression.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/terapia , Nefropatias Diabéticas/fisiopatologia , Nefropatias Diabéticas/terapia , Glicemia , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/epidemiologia , Progressão da Doença , Humanos , Rim/fisiopatologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/fisiopatologia , Qualidade de Vida , Fatores de Risco
5.
Am J Cardiol ; 151: 105-113, 2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-34049674

RESUMO

Left atrial (LA) enlargement predicts adverse cardiovascular events in patients with chronic kidney disease (CKD). The aim of our study was to evaluate the value of LA reservoir strain, a novel measure of LA function, as a prognostic marker for adverse renal outcomes. A total of 280 patients (65.8 ± 12.2years, 63% male) with stable Stage 3 and 4 CKD without prior cardiac history were evaluated with transthoracic echocardiography and prospectively followed for up to 5 years. The primary end point was progressive renal failure, which was the composite of death from renal cause, end-stage renal failure and/or doubling of serum creatinine. Over a mean follow up of 3.9 ± 2.7years, 56 patients reached the composite endpoint. By log rank test, older age, lower baseline eGFR, anemia, diabetes mellitus, higher urinary albumin/creatinine ratio, number of antihypertensive medications, higher indexed left ventricular mass, larger LA volumes, and impaired LA reservoir strain were significant predictors of the composite outcome (p <0.01 for all). Multi-variable Cox regression analysis found LA reservoir strain, eGFR, number of antihypertensive medications and urinary albumin/creatinine ratio were independent predictors for progressive renal failure (p <0.01 for all). Impaired LA reservoir strain was associated with a 2.5-fold higher risk of the composite outcome (HR 2.51, 95% CI 1.19 to 5.30, p = 0.02) and was the only echocardiographic parameter that predicted progressive renal failure independent of established clinical risk factors for end-stage renal failure. Its utility requires validation in high risk CKD patients with cardiac disease.


Assuntos
Função do Átrio Esquerdo , Átrios do Coração/diagnóstico por imagem , Falência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia , Idoso , Creatinina/sangue , Progressão da Doença , Ecocardiografia , Feminino , Seguimentos , Átrios do Coração/fisiopatologia , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/mortalidade
6.
Transplant Proc ; 53(5): 1477-1483, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34006381

RESUMO

BACKGROUND: This study aims to determine the ratio of delayed graft function in renal transplant recipients from living donors and the predictive value of hemodialysis time before transplant for delayed graft function. METHODS: We conducted a study on 116 adult patients who were diagnosed with end-stage kidney disease and were treated with hemodialysis and transplanted kidneys from living donors for 2 years (from June 2018 to June 2020). Delayed graft function event was collected for each patient. RESULTS: The recipients had a median age of 36.5 years old, in which 55.2% of them were men, 4.3% of them had the diabetic mellitus, and the median hemodialysis duration was 6 months. The ratio of positive panel-reactive antibody was 33.6% and vascular reconstruction of the donor's kidney was 16.4%. The ratio of delayed graft function was 12.2% (14 of 116 patients). Delayed graft function significantly related to positive panel-reactive antibody, long duration of hemodialysis before transplant, and vascular reconstruction of donor's kidney with P < .001. Duration of hemodialysis before kidney transplant had a predictive value for delayed graft function (area under the curve, 0.83; P < .001). CONCLUSION: Delayed graft function was not rare in renal transplant recipients from living donors. Duration of hemodialysis before kidney transplant was a good predictor for delayed graft function.


Assuntos
Função Retardada do Enxerto/etiologia , Falência Renal Crônica/terapia , Transplante de Rim/efeitos adversos , Diálise Renal/efeitos adversos , Fatores de Tempo , Adulto , Regras de Decisão Clínica , Sobrevivência de Enxerto , Humanos , Rim/fisiopatologia , Falência Renal Crônica/fisiopatologia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Diálise Renal/estatística & dados numéricos , Transplantes/fisiopatologia
7.
BMC Nephrol ; 22(1): 157, 2021 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-33910523

RESUMO

OBJECTIVE: Patients undergoing haemodialysis may experience troubling symptoms such as fatigue, anxiety, depression and sleep quality, which may affect their quality of life. The main objective of this study is to determine the prevalence of fatigue, anxiety, depression and sleep quality among patients receiving haemodialysis during the coronavirus disease 2019 (COVID-19) pandemic, and to explore the contributing predictors. METHODS: A cross-sectional and descriptive correlational design using Qualtrics software was performed. Data were collected using the Functional Assessment of Cancer Therapy-Fatigue (FACT-F), the Hospital Anxiety and Depression Scale (HADS) and the Pittsburgh Sleep Quality Index (PSQI). Logistic regression analyses were used to explore the predictors that were associated with fatigue, anxiety, depression and sleep quality. RESULTS: Of the 123 patients undergoing haemodialysis who participated, 53.7% (n = 66) reported fatigue, 43.9% (n = 54) reported anxiety, 33.3% (n = 41) reported depression and 56.9% (n = 70) reported poor sleep. Fatigue, anxiety and sleep quality (P < .05) were significantly associated with being female, and whether family members or relatives were suspected or confirmed with COVID-19. Logistic regression showed that being within the age group 31-40, having a secondary education level, anxiety, depression and sleep quality were the main predictors affecting the fatigue group. CONCLUSION: Fatigue, anxiety, depression and sleep quality are significant problems for patients receiving haemodialysis during the COVID-19 pandemic. Appropriate interventions to monitor and reduce fatigue, psychological problems and sleep quality amongst these patients are needed. This can help to strengthen preparations for responding to possible future outbreaks or pandemics of infectious diseases for patients receiving haemodialysis.


Assuntos
Ansiedade/epidemiologia , COVID-19 , Depressão/epidemiologia , Fadiga/epidemiologia , Falência Renal Crônica/terapia , Sono , Adolescente , Adulto , Fatores Etários , Escolaridade , Família , Feminino , Humanos , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/psicologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Omã/epidemiologia , Diálise Renal , Fatores de Risco , SARS-CoV-2 , Inquéritos e Questionários , Adulto Jovem
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.
Clin Rehabil ; 35(8): 1175-1184, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33827283

RESUMO

OBJECTIVE: To evaluate the effect of a 12-week breathing-based leg exercises program on quality of life under stabilizing heart rate variability and reducing fatigue in regular hemodialysis patients. DESIGN: Randomized controlled trial. SETTING: A 94-bed hemodialysis department at a medical center in northern Taiwan. PARTICIPANTS: Eighty-six patients with end-stage renal disease undergoing hemodialysis were recruited and randomly assigned to the ExBr or control groups. INTERVENTIONS: The breathing-based leg exercises program comprised abdominal breathing and low-intensity leg exercise, including leg lifts, quadriceps femoris contraction and knee flexion, and lasted for 15 minutes at one time, three times a week for 12 weeks. MAIN MEASURE: Data was collected by using the World Health Organization quality of life assessment-brief, physiological signal recorder for heart rate variability and hemodialysis-related fatigue scale at baseline and on Week 4, Week 8, and Week 12. RESULTS: Average (standard deviation) age was 53.70 (10.04) years in the ExBr group and 61.19 (10.19) years in the control group. The linear mixed model with adjusted age, creatinine, heart rate variability and fatigue revealed that the ExBr group had significantly higher quality of life than did the control group (P = 0.01), especially on Week 12 (P = 0.04). Fatigue was significantly correlated with quality of life (P < 0.001). CONCLUSION: This study supported the benefits of the continued breathing-based leg exercises during hemodialysis for at least 12 weeks, which improved the quality of life of patients with end-stage renal disease and did not affect the stability of their vital signs.


Assuntos
Exercícios Respiratórios , Terapia por Exercício , Falência Renal Crônica/terapia , Perna (Membro)/fisiologia , Qualidade de Vida , Diálise Renal , Fadiga , Humanos , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Taiwan
10.
Nutrients ; 13(4)2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33921875

RESUMO

Appetite loss is a common phenomenon in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis (HD). We aimed to (i) adapt and validate a Spanish language version of the Council on Nutrition Appetite Questionnaire (CNAQ) and (ii) to identify psychological and biological factors associated with diminished appetite. We recruited 242 patients undergoing HD from four hemodialysis centers to validate the Spanish-translated version of the CNAQ. In another set of 182 patients from three HD centers, the Appetite and Diet Assessment Tool (ADAT) was used as the gold standard to identify a cut-off value for diminished appetite in our adapted questionnaire. The Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Distorted Thoughts Scale (DTS), Dialysis Malnutrition Score (DMS), anthropometric, values and laboratory values were also measured. Seven items were preserved in the adapted appetite questionnaire, with two factors associated with flavor and gastric fullness (Cronbach's alpha = 0.758). Diminished appetite was identified with a cut-off value ≤25 points (sensitivity 73%, specificity 77%). Patients with diminished appetite had a higher proportion of females and DMS punctuation, lower plasmatic level of creatinine, blood urea nitrogen, and phosphorus. Appetite score correlated with BDI score, BAI score and DTS. Conclusions: This simple but robust appetite score adequately discriminates against patients with diminished appetite. Screening and treatment of psychological conditions may be useful to increase appetite and the nutritional status of these patients.


Assuntos
Apetite , Desnutrição/diagnóstico , Avaliação Nutricional , Diálise Renal/efeitos adversos , Inquéritos e Questionários/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antropometria , Feminino , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Masculino , Desnutrição/etiologia , Pessoa de Meia-Idade , Estado Nutricional , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Traduções , Adulto Jovem
11.
Diab Vasc Dis Res ; 18(1): 1479164120984433, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33588611

RESUMO

INTRODUCTION: We aimed to evaluate the relationship between temporal changes in renal function and long-term mortality in patients with heart failure with reduced ejection fraction (HFrEF) and identify correlates of deteriorating renal function. METHODS: A total of 381 patients with HFrEF enrolled in a prospective cohort study between 2006-2014 had eGFR measured at initial visit and at 1 year. Baseline characteristics were used in a multivariate analysis to establish variables that predict deterioration in eGFR. Follow-up data were used to assess whether declining eGFR was related to outcomes. RESULTS: Patients were grouped into tertiles based on percentage change in eGFR. In a multivariate logistic regression analysis, male sex was associated with a 1.77-fold ([95% CI 1.01-2.89]; p = 0.045) and diabetes a 1.66-fold ([95% CI 1.02-2.70]; p = 0.041) greater risk of a decline in eGFR compared to those with stable/improving eGFR. Declining eGFR was associated with a 1.4-fold greater risk of death over 10 years ([95% CI 1.08-1.86]; p = 0.01) and a 3.12-fold ([1.44-6.75]; p = 0.004) greater risk of death at 1 year from second eGFR measurement. CONCLUSIONS: In patients with HFrEF diabetes and male sex are independent predictors of a decline in eGFR at 1 year. A decline eGFR over 1 year is associated with higher long-term all-cause mortality.


Assuntos
Diabetes Mellitus/fisiopatologia , Nefropatias Diabéticas/fisiopatologia , Taxa de Filtração Glomerular , Insuficiência Cardíaca/fisiopatologia , Rim/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia , Idoso , Causas de Morte , Doença Crônica , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/mortalidade , Progressão da Doença , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Humanos , Falência Renal Crônica/mortalidade , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/mortalidade , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
12.
Mol Med Rep ; 23(4)2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33537809

RESUMO

Hypertensive nephropathy is the most common complication of hypertension, and is one of the main causes of end­stage renal disease (ESRD) in numerous countries. The basic pathological feature of hypertensive nephropathy is arteriolosclerosis followed by renal parenchymal damage. The etiology of this disease is complex, and its pathogenesis is mainly associated with renal hemodynamic changes and vascular remodeling. Despite the increased knowledge on the pathogenesis of hypertensive nephropathy, the current clinical treatment methods are still not effective in preventing the development of the disease to ESRD. Herbal medicine, which is used to relieve symptoms, can improve hypertensive nephropathy through multiple targets. Since there are few clinical studies on the treatment of hypertensive nephropathy with herbal medicine, this article aims to review the progress on the basic research on the treatment of hypertensive nephropathy with herbal medicine, including regulation of the renin angiotensin system, inhibition of sympathetic excitation, antioxidant stress and anti­inflammatory protection of endothelial cells, and improvement of obesity­associated factors. Herbal medicine with different components plays a synergistic and multi­target role in the treatment of hypertensive nephropathy. The description of the mechanism of herbal medicine in the treatment of hypertensive nephropathy will contribute towards the progress of modern medicine.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hemodinâmica/efeitos dos fármacos , Medicina Herbária , Hipertensão Renal , Falência Renal Crônica , Nefrite , Estresse Oxidativo/efeitos dos fármacos , Humanos , Hipertensão Renal/tratamento farmacológico , Hipertensão Renal/metabolismo , Hipertensão Renal/fisiopatologia , Falência Renal Crônica/tratamento farmacológico , Falência Renal Crônica/metabolismo , Falência Renal Crônica/fisiopatologia , Nefrite/tratamento farmacológico , Nefrite/metabolismo , Nefrite/fisiopatologia
13.
PLoS Med ; 18(2): e1003546, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33606673

RESUMO

BACKGROUND: Little is known about factors associated with recovery of kidney function-and return to dialysis independence-or temporal trends in recovery after starting outpatient dialysis in the United States. Understanding the characteristics of individuals who may have the potential to recover kidney function may promote better recognition of such events. The goal of this study was to determine factors associated with recovery of kidney function in children compared with adults starting dialysis in the US. METHODS AND FINDINGS: We determined factors associated with recovery of kidney function-defined as survival and discontinuation of dialysis for ≥90-day period-in children versus adults who started maintenance dialysis between 1996 and 2015 according to the United States Renal Data System (USRDS) followed through 2016 in a retrospective cohort study. We also examined temporal trends in recovery rates over the last 2 decades in this cohort. Among 1,968,253 individuals included for study, the mean age was 62.6 ± 15.8 years, and 44% were female. Overall, 4% of adults (83,302/1,953,881) and 4% of children (547/14,372) starting dialysis in the outpatient setting recovered kidney function within 1 year. Among those who recovered, the median time to recovery was 73 days (interquartile range [IQR] 43-131) in adults and 100 days (IQR 56-189) in children. Accounting for the competing risk of death, children were less likely to recover kidney function compared with adults (sub-hazard ratio [sub-HR] 0.81; 95% CI 0.74-0.89, p-value <0.001; point estimates <1 indicating increased risk for a negative outcome). Non-Hispanic black (NHB) adults were less likely to recover compared with non-Hispanic white (NHW) adults, but these racial differences were not observed in children. Of note, a steady increase in the incidence of recovery of kidney function was noted initially in adults and children between 1996 and 2010, but this trend declined thereafter. The diagnoses associated with the highest recovery rates of recovery were acute tubular necrosis (ATN) and acute interstitial nephritis (AIN) in both adults and children, where 25%-40% of patients recovered kidney function depending on the calendar year of dialysis initiation. Limitations to our study include the potential for residual confounding to be present given the observational nature of our data. CONCLUSIONS: In this study, we observed that discontinuation of outpatient dialysis due to recovery occurred in 4% of patients with end-stage kidney disease (ESKD) and was more common among those with ATN or AIN as the cause of their kidney disease. While recovery rates rose initially, they declined starting in 2010. Additional studies are needed to understand how to best recognize and promote recovery in patients whose potential to discontinue dialysis is high in the outpatient setting.


Assuntos
Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Rim/fisiopatologia , Diálise Renal , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos de Coortes , Progressão da Doença , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
14.
Prog Cardiovasc Dis ; 65: 84-88, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33587962

RESUMO

Interventional cardiologists who treat malfunctioning hemodialysis accesses play an important role in the life of patients with end-stage kidney disease (ESKD). By collaborating with interventional nephrologists who currently perform the bulk of routine access angiographic procedures, interventional cardiologists can fill an important gap in the care of ESKD patients by performing urgent or emergent procedures that fall outside the schedule of an outpatient interventional nephrology laboratory to ensure that hemodialysis patients will not miss a hemodialysis session or get a temporary catheter. This paper reviews the pathophysiology of dialysis access failure and illustrates the catheter-based approaches used by interventional cardiologists to treat malfunctioning dialysis accesses.


Assuntos
Angiografia , Derivação Arteriovenosa Cirúrgica , Procedimentos Endovasculares , Oclusão de Enxerto Vascular/terapia , Falência Renal Crônica/terapia , Radiografia Intervencionista , Diálise Renal , Trombectomia , Trombose/terapia , Angiografia/efeitos adversos , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Falência Renal Crônica/diagnóstico por imagem , Falência Renal Crônica/fisiopatologia , Valor Preditivo dos Testes , Radiografia Intervencionista/efeitos adversos , Trombectomia/efeitos adversos , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular
15.
Biomed Res Int ; 2021: 5460672, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33628787

RESUMO

Living kidney donors represent a unique population of patients. Potential donors are selected based on the belief that their preoperative fitness is likely to mitigate the risks of long- and short-term harm following uninephrectomy. Studies performed on postdonation outcomes have largely focused on mortality and the risk of end-stage renal failure, but have also investigated secondary outcomes such as cardiovascular morbidity and hypertension. It has been postulated that hypertension is a possible outcome of living kidney donation. A variety of studies have been conducted to investigate the prevalence, epidemiology, mechanisms, treatment strategies, and long-term ramifications of hypertension postdonation. These studies are heterogeneous in their population, design, methodology, and outcome measures and have presented contradicting outcomes. Additionally, the absence of a well-matched control group has made it challenging to interpret and generalise the reported findings. As such, it is not possible to definitively conclude that hypertension occurs at a higher rate among donors than the general population. This article will review the evidence of postdonation hypertension prevalence, mechanisms, treatment, and complications.


Assuntos
Hipertensão , Transplante de Rim , Doadores Vivos/estatística & dados numéricos , Nefrectomia/efeitos adversos , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Hipertensão/fisiopatologia , Hipertensão/terapia , Rim/fisiopatologia , Rim/cirurgia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/etiologia , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia
16.
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
17.
Metabolism ; 118: 154738, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33617873

RESUMO

The global nephrology community recognizes the increasing burden of kidney disease and its poor health outcomes in the general population. Given this, strategies to establish early diagnosis, improve understanding of the natural course and develop novel therapeutic interventions to slow progression and reduce complications are encouraged. Fibroblast growth factor 21 (FGF21), a member of the endocrine FGF subfamily, has emerged as a master homeostasis regulator of local and systemic lipid, glucose and energy metabolism. In addition, FGF21 should be considered an autonomic and endocrine regulator of stress responses in general. Promising results has been shown in both dysmetabolic animal models and metabolic disease patients after pharmacological administration of FGF21 analogs. The association of FGF21 with renal function has been studied for more than ten years. However, the functional role of FGF21 in the kidney is still poorly understood. This review summarizes the biological effects of FGF21 and discusses what is currently known about this hormone and chronic kidney disease, highlighting important gaps that warrant further research.


Assuntos
Fatores de Crescimento de Fibroblastos/fisiologia , Falência Renal Crônica/fisiopatologia , Animais , Nefropatias Diabéticas/fisiopatologia , Progressão da Doença , Homeostase , Humanos , Falência Renal Crônica/mortalidade
18.
Biomolecules ; 11(2)2021 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-33573220

RESUMO

Metalloproteinases (MPs) are proteolytic enzymes involved in extracellular matrix deposition, regulation of cellular signals of inflammation, proliferation, and apoptosis. Metalloproteinases are classified into three families: Matrix-MPs (MMPs), A-Disintegrin-and-Metalloprotease (ADAMs), and the A-Disintegrin-and-Metalloproteinase-with-Thrombospondin-1-like-Domains (ADAMTS). Previous studies showed that MPs are involved in the development of aortic aneurysms (AA) and, concomitantly, in the onset of chronic kidney disease (CKD). CKD has been, per se, associated with an increased risk for AA. The aim of this review is to examine the pathways that may associate MPs with CKD and AA. Several MMPs, such as MMP-2, -8, -9, and TIMP-1 have been shown to damage the AA wall and to have a toxic effect on renal tubular cells, leading to fibrosis. Similarly, ADAM10 and 17 have been shown to degrade collagen in the AA wall and to worsen kidney function via pro-inflammatory stimuli, the impairment of the Renin-Angiotensin-Aldosterone System, and the degradation of structural proteins. Moreover, MMP-2 and -9 inhibitors reduced aneurysm growth and albuminuria in experimental and human studies. It would be important, in the future, to expand research on MPs from both a prognostic, namely, to refine risk stratification in CKD patients, and a predictive perspective, likely to improve prognosis in response to targeted treatments.


Assuntos
Aneurisma Aórtico/fisiopatologia , Taxa de Filtração Glomerular , Metaloproteases/metabolismo , Insuficiência Renal Crônica/fisiopatologia , Aneurisma/fisiopatologia , Animais , Aneurisma Aórtico/complicações , Aneurisma Aórtico/enzimologia , Apoptose , Proliferação de Células , Progressão da Doença , Transição Epitelial-Mesenquimal , Matriz Extracelular/metabolismo , Fibrose , Humanos , Inflamação , Falência Renal Crônica/fisiopatologia , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 8 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Prognóstico , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/enzimologia , Sistema Renina-Angiotensina , Risco , Inibidor Tecidual de Metaloproteinase-1/metabolismo
19.
Hypertension ; 77(3): 948-959, 2021 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-33423525

RESUMO

Visit-to-visit blood pressure variability (BPV) is associated with cardiovascular events in the general population. Data are scarce in chronic kidney disease. We hypothesized that BPV would be associated with cardiovascular outcomes, death, and end-stage kidney disease (ESKD) and that diuretics would modify these associations in patients with chronic kidney disease. We studied US Veterans with nondialysis chronic kidney disease stages 1-5 and hypertension on nondiuretic antihypertensive monotherapy. At the time of second antihypertensive agent prescription, we propensity-matched for exposure to a loop or thiazide diuretic versus any other antihypertensive. BPV was defined as the coefficient of variation of systolic blood pressure over 6 months after second agent prescription. Cox proportional hazards regression measured associations of BPV with a primary cardiovascular event composite (fatal or nonfatal myocardial infarction or ischemic stroke; heart failure hospitalization). Secondary outcomes included all-cause death, each primary outcome component, end-stage kidney disease, and cardiovascular death. There were 31 394 participants in each group. BPV was associated with composite cardiovascular events, hazard ratio (95% CI) at second, third, fourth, and fifth versus first quintile: 1.79 (1.53-2.11), 2.32 (1.99-2.71), 2.60 (2.24-3.02), and 3.12 (2.68-3.62). Diuretics attenuated associations between the fourth and fifth BPV quintiles with composite events (Pinteraction=0.03 and 0.04, respectively). BPV was associated with all secondary outcomes except end-stage kidney disease, with no diuretic interactions. BPV was associated with cardiovascular events and death but not end-stage kidney disease in patients with chronic kidney disease, with attenuated associations with cardiovascular events in the diuretic-treated group at high BPV quintiles. Future studies should investigate whether other antihypertensive classes modify these risks.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Diuréticos/uso terapêutico , Hipertensão/tratamento farmacológico , Insuficiência Renal Crônica/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Estudos de Coortes , Feminino , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/prevenção & controle , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/fisiopatologia
20.
Ren Fail ; 43(1): 216-222, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33478321

RESUMO

BACKGROUND: As kidney disease progresses, patients often experience a variety of symptoms. There are very few studies reporting spectrum of predialysis patients' symptoms in peritoneal dialysis (PD) patients. Furthermore, the clinical significance of predialysis patients' symptoms for PD patients' prognosis remains unknown. METHODS: In this retrospective cohort study, patients who started PD during 1 January 2006 to 31 January 2018 were included. Patients' predialysis symptoms and clinical parameters were obtained. Both the short- and long-term patients' outcome were investigated by Cox regression and Kaplan-Meier's survival analysis to identify the relationship between clinical symptoms and patients' mortality on PD. RESULTS: A total of 898 incident PD patients were included. The anorexia (58%) was the most common predialysis symptom in the present cohort, followed by insomnia (32.7%), fatigue (27.6%), syndromes of heart failure (27.6%), and nausea (20.5%). The only symptom significantly associated with both six-months and 12-months mortality on PD was nausea (HR 2.359, 95% CI 1.377-4.040, p=.002 and HR 1.791, 95% CI 1.176-2.729, p=.007, respectively). But in the long-term, anorexia (HR 1.392, 95% CI 1.070-1.811, p=.014) was the only symptom significantly associated with patient's all-cause mortality after adjusting for other confounding factors. CONCLUSIONS: Our study demonstrated that nausea and anorexia were the most important predialysis symptoms, which was associated with patients' short- and long-term mortality on PD treatment, respectively. The results indicated that predialysis evaluation and management of symptoms of nausea and anorexia may be a possible way to improve patients' outcome on PD.


Assuntos
Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/mortalidade , Idoso , Anorexia/epidemiologia , Causas de Morte , China , Fadiga/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Análise de Sobrevida , Fatores de Tempo
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