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2.
Medicine (Baltimore) ; 99(5): e18987, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000433

RESUMO

RATIONALE: Pituitary apoplexy (PA) and posterior reversible encephalopathy syndrome (PRES) are rare neurologic diseases that show acute neuro-ophthalmologic symptoms such as headache, decreased visual acuity, and altered consciousness. These diseases are rarely found in patients with end-stage renal disease (ESRD) on hemodialysis, and simultaneous occurrence of these 2 diseases has not been reported. PATIENT CONCERNS: The patient was a 75-year-old man with a history of hypertension, diabetes mellitus, and non-functioning pituitary macroadenoma. He had been receiving hemodialysis for ESRD for 3 months before his presentation to the emergency room. The patient complained of headache, vomiting, and dizziness that started after the previous day's hemodialysis. The patient had voluntarily discontinued his antihypertensive medication 2 weeks before presentation and had high blood pressure with marked fluctuation during hemodialysis. Complete ptosis and ophthalmoplegia on the right side suggested 3rd, 4th, and 6th cranial nerve palsies. DIAGNOSES: Magnetic resonance imaging of the brain revealed a pituitary tumor, intratumoral hemorrhage within the sella, and symmetric vasogenic edema in the subcortical white matter in the parieto-occipital lobes. Based on these findings, the patient was diagnosed with PA and PRES. INTERVENTIONS: Intravenous administration of hydrocortisone (50 mg every 6 hours after a bolus administration of 100 mg) was initiated. Although surgical decompression was recommended based on the PA score (5/10), the patient declined surgery. OUTCOMES: Headache and ocular palsy gradually improved after supportive management. The patient was discharged on the 14th day of hospitalization with no recurrence 5 months post-presentation. Current therapy includes antihypertensive agents, oral prednisolone (7.5 mg/day), and maintenance hemodialysis. LESSONS: Neurologic abnormalities developed in a patient with ESRD on hemodialysis, suggesting the importance of prompt diagnosis and treatment in similar instances.


Assuntos
Falência Renal Crônica/terapia , Apoplexia Hipofisária/etiologia , Síndrome da Leucoencefalopatia Posterior/etiologia , Diálise Renal/efeitos adversos , Idoso , Anti-Inflamatórios/uso terapêutico , Humanos , Hidrocortisona/uso terapêutico , Imagem por Ressonância Magnética , Masculino , Apoplexia Hipofisária/diagnóstico por imagem , Apoplexia Hipofisária/tratamento farmacológico , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico
3.
Medicine (Baltimore) ; 99(3): e18782, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011472

RESUMO

Hemodialysis (HD) patients had a high rate of infection transmission and mortality during the middle east respiratory syndrome coronavirus (MERS-CoV) outbreak in Saudi Arabia. A standardized guideline on isolation technique for exposed HD patients is not available. Thus, this study aimed to evaluate the effect of different isolation strategies on the prevention of secondary viral transmission and clinical outcomes among exposed HD patients.During the 2015 MERS-CoV outbreak in Korea, 116 patients in 3 HD units were incidentally exposed to individuals with confirmed MERS-CoV infection and underwent different types of isolation, which were as follows: single-room isolation (n = 54, 47%), cohort isolation (n = 46, 40%), and self-imposed quarantine (n = 16, 13%). The primary outcome was rate of secondary viral transmission. The secondary outcome measures were changes in clinical and biochemical markers during the isolation period, difference in clinical and biochemical markers according to the types of isolation practice, and effect of isolation practice on patient survival.During a mean isolation period of 15 days, no further cases of secondary transmission were detected among HD patients. Plasma hemoglobin, serum calcium, and serum albumin levels and single-pool Kt/V decreased during the isolation period but normalized thereafter. Patients who were subjected to self-imposed quarantine had higher systolic and diastolic blood pressure, lower total cholesterol level, and lower Kt/V than those who underwent single-room or cohort isolation. During the 24-month follow-up period, 12 patients died. However, none of the deaths occurred during the isolation period, and no differences were observed in patient survival rate according to different isolation strategies.Although 116 participants in 3 HD units were incidentally exposed to MERS-CoV during the 2015 outbreak in Korea, strict patient surveillance and proper isolation practice prevented secondary transmission of the virus. Thus, a renal disaster protocol, which includes proper contact surveillance and isolation practice, must be established in the future to accommodate the needs of HD patients during disasters or outbreaks.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Coronavírus da Síndrome Respiratória do Oriente Médio , Isolamento de Pacientes , Diálise Renal , Idoso , Infecções por Coronavirus/sangue , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/transmissão , Infecção Hospitalar/sangue , Infecção Hospitalar/mortalidade , Infecção Hospitalar/transmissão , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Isolamento de Pacientes/métodos , Estudos Prospectivos , Quarentena , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(3): e18773, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011469

RESUMO

Cervical epidural anesthesia (CEA) is generally not used during upper-arm vascular surgery for hemodialysis in end-stage renal disease (ESRD) patients, despite its advantages. The Quality of Recovery-40 questionnaire (QOR-40) has been validated as a tool for assessing the degree of recovery after surgery. We hypothesized that CEA could provide a better outcome on the QOR-40 than general anesthesia after upper-arm vascular surgery for hemodialysis in ESRD patients.We divided anesthetic methods into general anesthesia and CEA. The QOR-40 was administered to 70 patients on the night before surgery and at 24 hours after surgery. Additional data, including consumption of opioid analgesics, occurrence of postoperative nausea and vomiting, and scores on a numeric rating scale (NRS) were collected.The total QOR-40 scores of the two groups differed significantly (P = .024) on postoperative day 1. Opioid consumption (P = .005) and occurrence of postoperative nausea (P = .019) in the post-anesthesia care unit (PACU) were significantly lower in the CEA group, whose NRS scores were significantly lower in the PACU (P < .001) and at postoperative day 1 (P = .016).Assessment of postoperative quality of recovery after upper-arm vascular surgery in ESRD patients showed that the CEA group had significantly better total QOR-40 and NRS scores. CEA could be used as an alternative anesthetic technique for upper-arm vascular surgery for hemodialysis in ESRD patients to improve the quality of recovery.


Assuntos
Período de Recuperação da Anestesia , Anestesia Epidural/métodos , Anestesia Geral/métodos , Braço/irrigação sanguínea , Braço/cirurgia , Derivação Arteriovenosa Cirúrgica , Falência Renal Crônica/terapia , Diálise Renal , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários
5.
Medicine (Baltimore) ; 99(2): e18706, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914076

RESUMO

BACKGROUND: Warm needle acupuncture (WNA) is an integral part of the acupuncture therapy. Chronic renal failure (CRF) is a common disease, which is a type of kidney disease characterized by a slow and progressive decline in renal function. The clinical practice indicates that WNA has a therapeutic effect on CRF. Therefore, we will provide a protocol to explore the effectiveness and safety of WNA for CRF. METHODS: We will search the randomized controlled trials literatures of WNA for CRF in 5 English databases (PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials [Cochrane Library], and World Health Organization International Clinical Trials Registry Platform) and 4 Chinese databases (Chinese national knowledge infrastructure, Chinese Scientific Journal Database Information, Wanfang Database, and Chinese biomedical literature database). The renal function will be considered as the primary outcome and the secondary outcome will include curative effect, security, syndrome according to standards for assessing traditional Chinese medicine, adverse events caused by WNA, such as dizziness, nausea, vomiting, weariness, and so on. We will use EndnoteX7 software to perform the selection of the studies. And all analyses will be conducted by using RevMan software V5.3. RESULT: This study will provide a rational synthesis of current evidences for WNM on CRF. CONCLUSION: The conclusion of this study will provide evidence to judge the effectiveness and safety of WNA on CRF.Registration: PROS-PERO CRD42019144530.


Assuntos
Terapia por Acupuntura/métodos , Falência Renal Crônica/terapia , Projetos de Pesquisa , Terapia por Acupuntura/efeitos adversos , Adulto , Feminino , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
6.
Medicine (Baltimore) ; 99(1): e18576, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895804

RESUMO

A substantial limitation of dialysis fistulas is their high primary failure rate due to nonmaturation. Various studies have documented that patients with larger vein diameters exhibit reduced risks for nonmaturation. Nevertheless, some patients have small veins. Few studies have focused on patients with small veins. We hypothesize that sufficient venous dilation contributes to fistula maturation. Therefore, we studied the influence of cephalic vein dilation on fistula maturation in patients with small veins.Patients with small cephalic veins (diameter <2 mm) undergoing initial arteriovenous fistulae (AVF) operation were included. A total of 72 patients were enrolled in this study. A prospective study was performed, and the patients were followed for 6 weeks after surgery. Preoperative and postoperative duplex ultrasound mapping of veins was performed, and dilation of the cephalic vein was evaluated.The fistula maturation rate was 44.44%. Multivariate logistic regression analysis revealed a significant relationship between fistula maturation and preoperative cephalic vein dilation. Based on the results of ROC analysis, the fistula maturation rate in patients with vein dilation greater than or equal to the cut-off was 57.14% in the training data set and 54.55% in the testing data set. The independent influencing factors for fistula maturation were used to establish a combined index with logistic regression analysis. The fistula maturation rate in patients with combined indexes greater than or equal to the cut-off was 80.95% in the training data set and 77.78% in the testing data set.Our results demonstrated that preoperative venous dilation was associated with AVF maturation. For patients with small veins, venous distensibility needs to be carefully assessed before surgery, as it may be a better predictor of AVF maturation than venous diameter.


Assuntos
Braço/irrigação sanguínea , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Adulto , Idoso , Braço/diagnóstico por imagem , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Diálise Renal , Ultrassonografia
8.
Medicine (Baltimore) ; 99(4): e18760, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977867

RESUMO

RATIONALE: Peripheral arterial diseases (PADs) is defined as a systemic arterial disorders involving the lower extremity arteries, iliac, and carotid, which is developed more common in patients with chronic kidney disease (CKD) than individual with normal renal function. Concurrence of mesenteric artery disease and lower extremity artery disease (LEAD) is rare. The presence of PADs in patients receiving hemodialysis leads to a dramatic increase in risk of cardiovascular mortality. However, the early diagnosis of PADs in patient with CKD remains a challenge to nephrologists, which adds an adverse effect on prognosis. PATIENT CONCERNS: A 48-year-old man received regular hemodialysis due to end-stage renal failure caused by type 2 diabetes mellitus (T2DM) for 7 years, who was admitted into hospital for acute, severe rest pain of the right lower extremity at the first time. The computed tomography angiography showed severe, diffuse stenosis of the distal third of femoral artery. After discharged, he was readmitted into hospital for abdominal pain and the recurred right lower limb pain. A diagnostic angiography confirmed the initial occlusion of superior mesenteric artery, severe obstruction of the distal segment of femoral artery and diffuse, irregular stenosis of arteria peronea and arteria tibialis posterior. DIAGNOSIS: The patient was diagnosed as PADs including LEAD and mesenteric artery disease. INTERVENTIONS: The percutaneous transulminal angioplasty (PTA) combined with antiplatelet therapy and beraprost were performed. Moreover, the cinacalcet and lanthanum carbonate were prescribed to control calcium-phosphorus- parathyroid hormone metabolism. OUTCOMES: The patient was free of abdominal pain and partly relieved from the ache of lower limb after PTA. However, he finally succumbed to acute myocardial infarction. LESSONS: The incidence of PADs is higher in dialysis patients due to a unique set of biochemical and endocrine abnormalities. As there is a high uremic status and PADs burden in patients with hemodialysis, the short term risk of cardiovascular disesase mortality markedly increases. There is a need for nephrologists and cardiovascular physicians to identify these patients and then provide early and proper treatment.


Assuntos
Falência Renal Crônica/terapia , Doença Arterial Periférica/etiologia , Diálise Renal/efeitos adversos , Angioplastia , Diabetes Mellitus Tipo 2/complicações , Evolução Fatal , Artéria Femoral/diagnóstico por imagem , Humanos , Falência Renal Crônica/etiologia , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem
9.
Medicine (Baltimore) ; 98(51): e18450, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861018

RESUMO

Restless legs syndrome (RLS) increases the risks of cardiovascular disease and death in hemodialysis (HD) patients. Previous studies of risk factors for RLS in HD patients have yielded varying results. We attempted to identify risk factors for RLS in HD patients in Taiwan.This case-control study recruited 59 HD patients with RLS and 353 HD patients without RLS from the largest HD center in Taiwan during the period from April 1, 2015 through August 31, 2015. Demographic and disease characteristics, information from the International Restless Legs Syndrome Study Group (IRLSSG) diagnostic questionnaire, and IRLSSG Severity Scale scores were collected by interview. Clinical laboratory data were abstracted from medical records and then analyzed with logistic regression and Pearson correlation analysis. A P value of less than .05 was considered to indicate statistical significance.A dialysis duration of longer than 5 years (odds ratio [OR] = 2.32; 95% CI = 1.23-4.39; P = .002) and a low high-density lipoprotein cholesterol level (<40 mg/dL in men; <50 mg/dL in women) (OR = 2.73; 95% CI = 1.44-5.15; P = .009) were associated with increased risk of RLS. Among the 59 patients with RLS, 48 (81.3%) had moderate or severe symptoms (IRLSSG Severity Scale >10), and RLS severity was significantly correlated with dialysis duration (r = .26; P = .043).Among HD patients, RLS was more common among those receiving dialysis for longer than 5 years and those with a low serum high-density lipoprotein cholesterol (HDL-C) level.


Assuntos
Falência Renal Crônica/complicações , Síndrome das Pernas Inquietas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal , Síndrome das Pernas Inquietas/etiologia , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
10.
Rev Med Chil ; 147(6): 709-717, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859823

RESUMO

BACKGROUND: Pregnancies in women with end stage renal failure are uncommon. However, correction of anemia and improvement in dialysis techniques increases the rate of successful pregnancies. AIM: To describe a 16 years' experience treating pregnant women on hemodialysis and to analyze maternal-fetal outcomes. MATERIALS AND METHODS: Observational study of a dialysis center historical cohort in a university hospital, between 2001 and 2016. RESULTS: Thirteen pregnancies were found in 11 women aged 23 to 32 years, 77% on dialysis prior to pregnancy. Residual diuresis was 1,300 [625-1,575] mL in 24 hrs. The baseline hemoglobin was 9.0 [7.6-9.9] g/dL and 92% of patients did not use contraception. The pre-dialysis blood urea nitrogen was 34 [29-36] mg /dL. An ultrasound to confirm pregnancy was done in all. At 23 [14-25] weeks of pregnancy, dialysis hours were increased, reaching 24 [19.5-24.0] hours per week. The most common complications were severe arterial hypertension (54%), severe anemia (46%), polyhydramnios (31%) and severe intrauterine growth retardation (IUGR) (23%). The median time of pregnancy at delivery was 34 [29-34] weeks. Neonatal median hospitalization length was 4 [4-32] days, with 18% of neonatal deaths. CONCLUSIONS: Pregnancies in dialysis are no longer exceptional. Despite better maternal and fetal outcomes, morbidity and mortality remains higher than in the normal population, which makes multidisciplinary management essential.


Assuntos
Complicações na Gravidez , Resultado da Gravidez , Diálise Renal/estatística & dados numéricos , Adulto , Cesárea/estatística & dados numéricos , Feminino , Idade Gestacional , Hospitalização/estatística & dados numéricos , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Gravidez , Complicações na Gravidez/etiologia , Diálise Renal/efeitos adversos , Fatores de Risco , Fatores de Tempo , Adulto Jovem
11.
Methodist Debakey Cardiovasc J ; 15(3): 228-230, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687105

RESUMO

This column is supplied by Amita Jain, MD, and Juan Jose Olivero, MD. Dr. Jain completed an internal medicine residency at Houston Methodist Hospital in Houston, Texas, and recently joined a primary care practice in Delaware. She earned a Bachelor of Medicine and Surgery (MBBS) degree, with a distinction in microbiology, from Terna Medical College at the Maharashtra University of Health Sciences in Navi Mumbai, India. Before coming to Houston, Dr. Jain completed residency training in internal medicine and allied subspecialties at the Dr. Babasaheb Ambedkar Memorial Hospital in Byculla, Mumbai. Dr. Olivero is a nephrologist at Houston Methodist Hospital and a member of the hospital's Nephrology Training Program. He obtained his medical degree from the University of San Carlos School of Medicine in Guatemala, Central America, and completed his residency and nephrology fellowship at Baylor College of Medicine in Houston, Texas.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Ácidos Aristolóquicos/efeitos adversos , Suplementos Nutricionais/efeitos adversos , Medicamentos de Ervas Chinesas/efeitos adversos , Falência Renal Crônica/induzido quimicamente , Rim/efeitos dos fármacos , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/fisiopatologia , Lesão Renal Aguda/terapia , Progressão da Doença , Interações Ervas-Drogas , Humanos , Rim/fisiopatologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Prognóstico , Medição de Risco , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Fatores de Tempo
12.
BMJ ; 367: l5873, 2019 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-31672760

RESUMO

OBJECTIVE: To determine the global capacity (availability, accessibility, quality, and affordability) to deliver kidney replacement therapy (dialysis and transplantation) and conservative kidney management. DESIGN: International cross sectional survey. SETTING: International Society of Nephrology (ISN) survey of 182 countries from July to September 2018. PARTICIPANTS: Key stakeholders identified by ISN's national and regional leaders. MAIN OUTCOME MEASURES: Markers of national capacity to deliver core components of kidney replacement therapy and conservative kidney management. RESULTS: Responses were received from 160 (87.9%) of 182 countries, comprising 97.8% (7338.5 million of 7501.3 million) of the world's population. A wide variation was found in capacity and structures for kidney replacement therapy and conservative kidney management-namely, funding mechanisms, health workforce, service delivery, and available technologies. Information on the prevalence of treated end stage kidney disease was available in 91 (42%) of 218 countries worldwide. Estimates varied more than 800-fold from 4 to 3392 per million population. Rwanda was the only low income country to report data on the prevalence of treated disease; 5 (<10%) of 53 African countries reported these data. Of 159 countries, 102 (64%) provided public funding for kidney replacement therapy. Sixty eight (43%) of 159 countries charged no fees at the point of care delivery and 34 (21%) made some charge. Haemodialysis was reported as available in 156 (100%) of 156 countries, peritoneal dialysis in 119 (76%) of 156 countries, and kidney transplantation in 114 (74%) of 155 countries. Dialysis and kidney transplantation were available to more than 50% of patients in only 108 (70%) and 45 (29%) of 154 countries that offered these services, respectively. Conservative kidney management was available in 124 (81%) of 154 countries. Worldwide, the median number of nephrologists was 9.96 per million population, which varied with income level. CONCLUSIONS: These comprehensive data show the capacity of countries (including low income countries) to provide optimal care for patients with end stage kidney disease. They demonstrate substantial variability in the burden of such disease and capacity for kidney replacement therapy and conservative kidney management, which have implications for policy.


Assuntos
Saúde Global/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Falência Renal Crônica/terapia , Nefrologia/estatística & dados numéricos , Terapia de Substituição Renal/estatística & dados numéricos , Estudos Transversais , Países em Desenvolvimento/estatística & dados numéricos , Humanos
13.
Clin Ter ; 170(6): e454-e459, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31696909

RESUMO

AIMS: The radio-cephalic arteriovenous fistula (RCAVF) is the first choice treatment in end-stage renal disease patients. In the last few years, the hemodialysis population has shown a high percentage of elderly patients (> 65 year old) with comorbidities, mainly vascular diseases, which may adversely affect their vascular access success. The aim of this study was to evaluate the effectiveness of a loup-assisted technique to create RCAVFs in over 65 patients. PATIENTS AND METHODS: 98 consecutive patients with renal failure were prospectively observed. The patient were divided in relation to their age (> 65 year old; < 65 year old). In both groups, a microsurgical distal RCAVF was created. Statistics included the prevalence of distal RCAVF created, the incidence of immediate failure, the primary and secondary patency rate at one year. RESULTS: Distal RCAVF was created in 82.60% of patients younger than 65 years and in 73.07% of patients older than 65 years, with no statistically significant difference. The incidence of immediate failure, the primary and secondary patency at one year were not statistically significant between the two groups. CONCLUSIONS: Distal RCAVF should be the first choice vascular access even in ESRD elderly patients. The loup-assisted microsurgical fistula creation, allows to perform distal RCAVF with success, even in patients older than 65 years old, achieving similar results to younger patients.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Idoso , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Feminino , Humanos , Falência Renal Crônica/cirurgia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Diálise Renal , Resultado do Tratamento
14.
Rev Port Cir Cardiotorac Vasc ; 26(3): 199-204, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734971

RESUMO

BACKGROUND: Patients under dialysis have a high cardiovascular risk and they are at increased risk when submitted to cardiac surgery. AIM OF THE STUDY: to evaluate morbidity, early and late mortality, and predictive factors of mortality in patients under dialysis who underwent cardiac surgery. METHODS: A retrospective observational study was performed including all dialysis dependent patients who underwent cardiac surgery (coronary, valvular or combined procedures) in our institution between 2007 and 2014. A population of 95 consecutive patients was obtained (no exclusions). Perioperative variables and predictors of mortality were analysed and the endpoints were early and late mortality. Propensity score matching, with a control group of patients with creatinine clearance >90mL/min, was performed by logistic regression, with a 1:1 matching. Kaplan Meier curves were performed for late mortality. RESULTS: Early mortality was 9.4% (EuroSCORE II 4.1%). In univariate analysis, mean time of cardiopulmonary bypass (CPB) (p=0.016) and EuroSCORE II (p=0.02) were related with early mortality. In a multivariate analysis model, combined procedures (OR 138.09; CI95% 1.82-10498.4; p=0.03) and CCS (Canadian Cardiovascular Society) 3-4 (OR 70.951; CI 95% 1.32-3810.11; p=0.037) were predictors of mortality. In multivariable analysis, CPB time >152 min was a predictor of early mortality (p=0.001). After propensity score matching, 30 day, one year and late mortality were higher in the dialysis group. CONCLUSIONS: Early and late mortality were significantly higher in dialysis dependent patients. Predictive factors of mortality were CPB time and EuroSCORE II in univariable analysis, and CCS 3-4 and combined procedures in multivariable analysis.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Cardiopatias/cirurgia , Falência Renal Crônica/terapia , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Cardiopatias/complicações , Humanos , Falência Renal Crônica/complicações , Diálise Renal , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
15.
Rev Port Cir Cardiotorac Vasc ; 26(3): 209-212, 2019.
Artigo em Português | MEDLINE | ID: mdl-31734973

RESUMO

INTRODUCTION: True arterial aneurysms of the upper limb are rare and their treatment is intended to avoid complications as distal embolization, compression of surrounding neurovascular structures or rupture. OBJECTIVE: The purpose of this study is to review the experience of a department in the surgical treatment of true arterial aneurysms of the upper limb. METHODS: A retrospective study was performed between January 2007 and August 2017. RESULTS: From a total of eleven patients, nine were male and two were female. One of the patients had surgery twice because of two consecutive aneurysms of the upper limb. From a total of twelve cases, two were subclavian, one was axillary and nine were brachial aneurysms. Three of them had degenerative/idiopathic aetiology, one was associated to a cervical rib and seven occurred in the setting of arteriovenous fistula or kidney graft. Five patients had emergent surgery and the others had elective surgery. All of the patients were submitted to aneurysmectomy. As 30-day complications, there were two haematomas, one compartment syndrome and two early graft occlusions. Four patients needed re-intervention. During the follow-up period, all the grafts initially preserved were patent. There were no further known complications or amputation procedures. CONCLUSION: In this review most of the aneurysms were found in patients with haemodialysis vascular access or kidney grafts. Despite the need for early re-intervention in some cases, the surgical treatment of true arterial aneurysms of the upper limb is a low morbidity procedure.


Assuntos
Aneurisma/cirurgia , Falência Renal Crônica/terapia , Doença Arterial Periférica/cirurgia , Extremidade Superior/irrigação sanguínea , Aneurisma/complicações , Feminino , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/cirurgia , Transplante de Rim , Masculino , Doença Arterial Periférica/complicações , Diálise Renal , Estudos Retrospectivos , Resultado do Tratamento , Extremidade Superior/cirurgia
16.
Rev Port Cir Cardiotorac Vasc ; 26(3): 229-233, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734978

RESUMO

Creating and maintaining a functional vascular access (VA) is a critical factor in the survival of a dialysis patient. It implies a creative attitude either to maintain its functionality or to build a new one wherever possible, being it autologous or synthetic. We describe the VA history of a 59 years-old male patient, with extreme obesity, which started in 2012 with failed attempts of VA construction in both forearms until a functional brachiocephalic arteriovenous fistula (AVF) in the right upper limb was achieved. However, it required ligation due to severe venous hypertension secondary to central venous disease related to previous CVC use. As he had no good superficial conduit in the left arm we decided to harvest the arterialized right cephalic vein and implant it in the left arm, creating an autologous arteriovenous shunt between the brachial artery and axillary vein (AV). Despite initial patency, it failed irreversibly approximately one year after creation. As no more superficial veins were available in the upper limbs, a prosthetic access was the next step. We decided for a hybrid graft (HG) between the left brachial artery and the AV because of the patient's biotype and scarred axilla that impeded a safe re-intervention on the AV. This graft was used between 2015 and 2017 with multiple interventions to maintain patency. In 2017 a significant diffuse prosthesis deterioration and reduced AVF flow were noticed with no possible segmental reconstruction. We were then forced to proceed with subtotal graft substitution preserving the outflow stented segment of the HG, using an early cannulation graft to prevent CVC use. After this successful reconstruction, the patient started hemodialysis on the following day with no intercurrences registered.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Oclusão de Enxerto Vascular/cirurgia , Falência Renal Crônica/terapia , Falha de Prótese/efeitos adversos , Diálise Renal , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Oclusão de Enxerto Vascular/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
17.
Khirurgiia (Mosk) ; (11): 24-28, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714526

RESUMO

OBJECTIVE: To study the causes of recirculation syndrome and optimize surgical correction. MATERIAL AND METHODS: There were 2329 procedures of formation and restoration of permanent vascular access in 2109 patients for the period from 1998 to 2018. Recirculation syndrome occurred in 66 (3.1%) patients. Instrumental diagnosis of the causes of recirculation syndrome included Doppler ultrasound of permanent vascular access (100%) and angiography in accordance with indications. All patients were divided into 4 groups. The first group included 39 (59.1%) patients with native arteriovenous fistula. The second group included 12 (18.2%) patients with high arteriovenous fistula (between the brachial artery and the cephalic vein). The third group included 10 (15.1%) patients with major vein transposition. Synthetic prosthesis to create an arteriovenous fistula was used in the fourth group (n=5, 7.6%). RESULTS: In the first group, recirculation syndrome was caused by the presence of a large branch in close proximity to the arteriovenous anastomosis, its combination with significant stenosis of the anastomosis, hypoplasia of the outflow pathways of the fistulous vein. In the second group, the reasons were subclavian vein stenosis and dilated tributaries of the saphenous veins. In the third group, the main cause of recirculation syndrome was major vein stenosis in the upper third of the shoulder. In the fourth group, recirculation syndrome was caused by stenosis of the prosthetic-venous anastomosis. CONCLUSION: Recirculation syndrome in hemodialysis patients is usually caused by malfunction of permanent vascular access. Ultrasound or angiography may be successfully used to diagnose dysfunction. Effective treatment of this problem implies surgical or endovascular correction of permanent vascular access.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Constrição Patológica/complicações , Falência Renal Crônica/terapia , Diálise Renal , Derivação Arteriovenosa Cirúrgica/métodos , Humanos , Fluxo Sanguíneo Regional , Síndrome , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/patologia
18.
Medicine (Baltimore) ; 98(48): e18216, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770282

RESUMO

This study compared clinical outcomes of patient survival and arteriovenous fistula (AVF) patency between incident hemodialysis patients with and without type 2 diabetes mellitus (T2DM).Between January 2011 and December 2013, 384 consecutive incident hemodialysis patients with confirmed first upper-extremity AVF placement were divided into a T2DM group (n = 180, 46.9%) and a non-DM group (n = 204, 53.1%) and analyzed retrospectively. The primary outcome was all-cause mortality, and secondary outcome was AVF patency.Patients in the T2DM group had a higher prevalence of hypertension (P = .02), smoking (P < .01), cardiovascular disease (P < .01), history of cerebrovascular accident (CVA) (P < .01), and peripheral arterial occlusive disease (P < .01) than those in the non-DM group. On Kaplan-Meier survival analysis, the overall survival and AVF patency rates were significantly higher in the non-DM group relative to the T2DM group (both P < .01). In the adjusted model, older age (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.02-1.06; P < .01), T2DM (HR, 1.76; 95% CI, 1.12-2.77; P = .014), and history of CVA (HR, 1.76; 95% CI, 1.04-2.98; P = .04) were significantly associated with an increased risk of mortality. Older age and T2DM were independently associated with decreased primary (HR, 1.03; 95% CI, 1.02-1.04; P < .01, HR, 1.69; 95% CI, 1.22-2.33; P < .01, respectively) and secondary (HR, 1.03; 95% CI, 1.01-1.04; P < .01, HR, 2.07; 95% CI, 1.42-3.00; P < .01, respectively) AVF patency during follow-up.Compared with patients in the non-DM group, patients in the T2DM group had a higher mortality rate and worse AVF patency rates.


Assuntos
Derivação Arteriovenosa Cirúrgica , Diabetes Mellitus Tipo 2 , Falência Renal Crônica , Diálise Renal , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Comorbidade , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Diálise Renal/métodos , Diálise Renal/mortalidade , Estudos Retrospectivos , Medição de Risco , Grau de Desobstrução Vascular
19.
J Biol Regul Homeost Agents ; 33(5 Suppl. 1): 87-89, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31630720

RESUMO

End-stage renal diseases requiring chronic dialysis are rare in childhood and adolescence, but they are associated with high mortality and impaired quality of life (1, 2). The most common disease that causes chronic kidney disease (CKD) is primary glomerular disease (GD), followed by congenital abnormalities of the kidney and urinary tract, cystic, hereditary or congenital disorders and, more rarely, secondary GD. However, patients with secondary GD, urologic disorders, and metabolic diseases have greater mortality risk than patients with primary GD (3). Here, we focused on the different options of treatment available, and specifically we compared peritoneal dialysis and hemodialysis, showing pros and cons between them.


Assuntos
Falência Renal Crônica/terapia , Diálise Peritoneal , Diálise Renal , Adolescente , Criança , Humanos , Falência Renal Crônica/mortalidade , Qualidade de Vida
20.
J Biol Regul Homeost Agents ; 33(5 Suppl. 1): 91-94, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31630721

RESUMO

The natural history of children with end stage renal disease is dialysis until a transplant can be done. There are two types of dialysis: hemodialysis and peritoneal dialysis (1). Peritoneal dialysis is preferred in young children because getting the vascular access for hemodialysis is challenging (2). Catheters should be surgically placed in a paramedian or lateral abdominal region with an extremity located in Douglas' pouch.


Assuntos
Falência Renal Crônica/terapia , Ozônio/uso terapêutico , Diálise Peritoneal , Criança , Humanos
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