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1.
Angiology ; 71(3): 242-248, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31829038

RESUMO

We identified changes in renal function in patients who underwent thoracic endovascular aortic repair (TEVAR) and the factors that may influence renal function. Information on 470 consecutive patients was collected. Kidney function and contrast volume were recorded. Unpaired t test, Spearman correlation, and logistic regression were used for statistical analysis. A Kaplan-Meier curve helped clarify our follow-up findings. Mean contrast volume was 90.5 ± 21.2 mL. The change in serum creatinine was significantly correlated with (1) preexisting renal pathology (P = .033) and (2) aortic dissection (AD) involving the renal arteries (P = .019). The change in serum urea nitrogen (ΔBUN) was only significantly correlated with AD involving the renal arteries (P = .0348). Contrast volume (P = .036, odds ratio = 1.010, 95% confidence interval: 1.001-1.019) was a risk factor for contrast-induced nephropathy (CIN) after TEVAR. Survival rates and renal failure rates among no CIN, CIN, and CIN-acute kidney injury groups at longest 27 months follow-up were significantly different. Creatinine and BUN were generally elevated post-TEVAR. Contrast-induced nephropathy post-TEVAR may correlate with renal comorbidities and renal artery involvement. Contrast volume is risk factor for CIN after TEVAR. More attention needs to be paid to patient renal function during follow-up.


Assuntos
Aneurisma Dissecante/mortalidade , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/mortalidade , Implante de Prótese Vascular/mortalidade , Rim/fisiopatologia , Adulto , Idoso , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/mortalidade , Insuficiência Renal/fisiopatologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
2.
J Cardiothorac Surg ; 14(1): 191, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699143

RESUMO

BACKGROUND: Mild preoperative renal dysfunction (RD) is not rare in patients receiving isolated cardiopulmonary coronary artery bypass grafting (CCABG). However, there are not too many studies about the impact of mild preoperative RD on in-hospital and follow-up outcomes after isolated CCABG. This single-centre, retrospective propensity score matching study designed to study the impact of mild preoperative RD on in-hospital and long-term outcomes after first isolated CCABG. METHODS: After propensity score matching, 1144 patients with preoperative estimated glomerular filtration rate (eGFR) of more than 60 ml/min/1.73 m2 receiving first isolated CCABG surgery from January 2012 to December 2015 entered the study, who were divided into 2 groups: A group (eGFR ≥90 ml/min/1.73 m2, n = 572) and B group (eGFR of 60-89 ml/min/1.73 m2, n = 572). The in-hospital and long-term outcomes were recorded and analyzed. The mean follow-up time was 54.4 ± 10.7 months. Acute kidney injury (AKI) was defined and classified according to the Acute Kidney Injury Network (AKIN) criteria. RESULTS: The 2 propensity score-matched groups had similar baseline and procedure except the baseline eGFR. There were 8 patients died in A group (mortality is 1.4%) and 14 died in B group (mortality is 2.5%) during the in hospital and 30-day postoperatively(χ2 = 1.159, p = 0.282). There were totally 38 patients lost to follow-up, 18 in group A and 20 in group B. 21 patients died in group A and 37 died in group B during the follow-up, and long-term survival in group A was higher than in group B (96.2% vs 93.1%, χ2 = 4.336, p = 0.037). Comparing with group A, group B was associated with an increased rates and severity of AKI postoperatively (total AKI: 62 vs 144. AKIN stageI: 54 vs 113; AKIN stageII: 6 vs 22; AKIN stageIII: 2 vs 9, p<0.0001). During follow-up, group B also had a higher rate of new onset of dialysis (0 vs 6, χ2 = 4.432, p = 0.039). Multivariable logistic regression showed that comparing with A group, the HR for long-term mortality and new onset of dialysis in B group was 1.67 and 1.52 respectively (95%CI 1.09-2.90, p = 0.035; 95%CI 1.14-2.49, p = 0.027). CONCLUSIONS: Comparing with normal preoperative renal function, patients with mild preoperative RD had a similar in-hosptial mortality, but with an increased in-hosptial rates and severity of AKI, and with a decreased long-term survival and increased long-term new onset of dialysis.


Assuntos
Ponte de Artéria Coronária , Complicações Pós-Operatórias/etiologia , Insuficiência Renal/complicações , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Idoso , Feminino , Seguimentos , Taxa de Filtração Glomerular , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Período Pré-Operatório , Pontuação de Propensão , Diálise Renal , Insuficiência Renal/diagnóstico , Insuficiência Renal/mortalidade , Insuficiência Renal/terapia , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento
3.
PLoS Med ; 16(11): e1002955, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31693662

RESUMO

BACKGROUND: The Kidney Failure Risk Equation (KFRE) uses the 4 variables of age, sex, urine albumin-to-creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR) in individuals with chronic kidney disease (CKD) to predict the risk of end stage renal disease (ESRD), i.e., the need for dialysis or a kidney transplant, within 2 and 5 years. Currently, national guideline writers in the UK and other countries are evaluating the role of the KFRE in renal referrals from primary care to secondary care, but the KFRE has had limited external validation in primary care. The study's objectives were therefore to externally validate the KFRE's prediction of ESRD events in primary care, perform model recalibration if necessary, and assess its projected impact on referral rates to secondary care renal services. METHODS AND FINDINGS: Individuals with 2 or more Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFR values < 60 ml/min/1.73 m2 more than 90 days apart and a urine ACR or protein-to-creatinine ratio measurement between 1 December 2004 and 1 November 2016 were included in the cohort. The cohort included 35,539 (5.6%) individuals (57.5% female, mean age 75.9 years, median CKD-EPI eGFR 51 ml/min/1.73 m2, median ACR 3.2 mg/mmol) from a total adult practice population of 630,504. Overall, 176 (0.50%) and 429 (1.21%) ESRD events occurred within 2 and 5 years, respectively. Median length of follow-up was 4.7 years (IQR 2.8 to 6.6). Model discrimination was excellent for both 2-year (C-statistic 0.932, 95% CI 0.909 to 0.954) and 5-year (C-statistic 0.924, 95% 0.909 to 0.938) ESRD prediction. The KFRE overpredicted risk in lower (<20%) risk groups. Reducing the model's baseline risk improved calibration for both 2- and 5-year risk for lower risk groups, but led to some underprediction of risk in higher risk groups. Compared to current criteria, using referral criteria based on a KFRE-calculated 5-year ESRD risk of ≥5% and/or an ACR of ≥70 mg/mmol reduced the number of individuals eligible for referral who did not develop ESRD, increased the likelihood of referral eligibility in those who did develop ESRD, and referred the latter at a younger age and with a higher eGFR. The main limitation of the current study is that the cohort is from one region of the UK and therefore may not be representative of primary care CKD care in other countries. CONCLUSIONS: In this cohort, the recalibrated KFRE accurately predicted the risk of ESRD at 2 and 5 years in primary care. Its introduction into primary care for referrals to secondary care renal services may lead to a reduction in unnecessary referrals, and earlier referrals in those who go on to develop ESRD. However, further validation studies in more diverse cohorts of the clinical impact projections and suggested referral criteria are required before the latter can be clinically implemented.


Assuntos
Falência Renal Crônica/etiologia , Medição de Risco/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Albuminúria/urina , Algoritmos , Estudos de Coortes , Creatinina/urina , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Humanos , Falência Renal Crônica/mortalidade , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Prognóstico , Insuficiência Renal/mortalidade , Insuficiência Renal/fisiopatologia , Insuficiência Renal Crônica , Reprodutibilidade dos Testes , Fatores de Risco , Reino Unido/epidemiologia
4.
Ren Fail ; 41(1): 875-882, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31517550

RESUMO

Purpose: Typically, IgA nephropathy is a slowly progressive type of glomerulonephritis. High-grade proteinuria and hypertension are predictors of reduced kidney function. However, we found some normotensive patients with mild proteinuria could exhibit impaired renal function at the time of IgAN diagnosis. We therefore conduct a study to highlight the occurrence of these cases and to define their clinical characteristics and outcomes. Methods: The clinical, laboratory, pathological manifestations and outcomes of these IgAN patients were collected and were compared with normotensive IgA nephropathy patients with mild proteinuria and normal renal function. Patients were analyzed according to different pathological characteristics. Survival curves were constructed according to the Kaplan-Meier method. Results: Of all normotensive IgA nephropathy patients with mild proteinuria, 108 (10.1%) patients had impaired renal function. Ischemic sclerosis (79 patients) and fibrous crescent (25 patients) were the main pathological characteristics. Macroscopic hematuria (1.3%), prodromal infection (13.9%) and high serum IgA (11.4%) were significantly lower prevalences, but only proteinuria (26.6%) was more common in ischemic sclerosis group patients. Only hematuria were not found in ischemic sclerosis group and crescent group patients. The median follow-up were about 5 years. Patients in crescent group had a poor outcome compared with patients in ischemic sclerosis group. Conclusions: Some normotensive IgA nephropathy patients with mild proteinuria had impaired renal function at diagnosis. Ischemic sclerosis and fibrous crescent were the main pathological features in these patients. Patients in the crescent group had a worse outcome than patients in the ischemic sclerosis group.


Assuntos
Glomerulonefrite por IGA/complicações , Glomérulos Renais/fisiopatologia , Proteinúria/fisiopatologia , Insuficiência Renal/mortalidade , Adolescente , Adulto , Biópsia , Pressão Sanguínea/fisiologia , Progressão da Doença , Feminino , Seguimentos , Taxa de Filtração Glomerular , Glomerulonefrite por IGA/fisiopatologia , Glomerulonefrite por IGA/urina , Humanos , Estimativa de Kaplan-Meier , Glomérulos Renais/patologia , Masculino , Pessoa de Meia-Idade , Proteinúria/etiologia , Proteinúria/urina , Insuficiência Renal/etiologia , Insuficiência Renal/fisiopatologia , Estudos Retrospectivos , Adulto Jovem
5.
Heart Surg Forum ; 22(4): E294-E297, 2019 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-31398095

RESUMO

BACKGROUND: The aim of this study is to evaluate the negative effect of malnutrition in patients with coronary artery disease who are undergoing coronary artery bypass graft surgery. METHODS: In this study, we analyzed 149 patients, who underwent coronary artery bypass surgery. Nutritional status of the patients was classified using controlling nutritional status score (CONUT) and prognostic nutritional index (PNI). Statistical correlation between malnutrition and complication following operation was evaluated with the chi-square test. Statistical alpha significant level was accepted P < 0.05. RESULTS: There were various complications in 38 patients. Renal failure was the predominant problem in 18 of them. There was statistical significance between malnutrition and complication (P < .001). There were more complications in the controlling nutritional status score and prognostic nutritional index groups. Renal complication (P < .001), hemorrhage (P < .05), and mortality (P < .05) were high in the severe controlling nutritional status score and prognostic nutritional index groups. CONCLUSION: There are manifest correlations between the severe controlling nutritional status score and prognostic nutritional index groups and morbidity and mortality after coronary artery bypass graft surgery. We found that renal complications, hemorrhage, and mortality rate.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Desnutrição/complicações , Avaliação Nutricional , Estado Nutricional , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Distribuição de Qui-Quadrado , Ponte de Artéria Coronária/mortalidade , Feminino , Humanos , Masculino , Desnutrição/mortalidade , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Insuficiência Renal/etiologia , Insuficiência Renal/mortalidade , Adulto Jovem
6.
Saudi J Kidney Dis Transpl ; 30(4): 825-831, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464239

RESUMO

Paraprotein gap is sometimes used as a screening tool in some autoimmune diseases, cancers, and screening for latent infections. The increase in the paraprotein gap in these diseases was hypothesized to be the result of increased levels of immunoglobulins, raising the total serum protein without any changes in serum albumin. Our aim was to assess the overall survival using novel chemotherapy, bortezomib compared to traditional ones and to assess if paraprotein gap could be used as a predictor of survival. Finally, we aimed to assess factors that could predict renal response in this population.


Assuntos
Mieloma Múltiplo/sangue , Paraproteínas/metabolismo , Insuficiência Renal/sangue , Microglobulina beta-2/sangue , Idoso , Antineoplásicos/uso terapêutico , Biomarcadores/sangue , Bortezomib/uso terapêutico , Feminino , Humanos , Masculino , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/mortalidade , Inibidores de Proteassoma/uso terapêutico , Insuficiência Renal/diagnóstico , Insuficiência Renal/mortalidade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
PLoS One ; 14(5): e0216367, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31071139

RESUMO

BACKGROUND: Patients with renal impairment have altered immunity, which might cause vulnerability to specific pathogens and worsen pneumonia-related outcomes. Nonetheless, the microbiological features of pneumonia in patients with decreased renal function remain unknown. METHODS: Therefore, we conducted a retrospective cohort study enrolling adult patients hospitalized with pneumonia to assess this knowledge gap. The baseline estimated glomerular filtration rate (eGFR) and first sputum microbiology during hospitalization were used for statistical analyses. RESULTS: Overall, 1554 patients hospitalized with pneumonia (mean age, 76.1 ± 16.7) were included, and 162 patients had died at the end of hospitalization. The cutoff eGFR value predicting mortality was <55 mL/min/1.73 m2, which defined decreased renal function in this study. Patients with decreased renal function demonstrated a significantly higher risk of fungi and Staphylococcus aureus (S. aureus) infection. On the other hand, this group of patients showed significantly higher neutrophil-to-lymphocyte ratio (NLR), which associated with higher mortality. Additionally, patients with S. aureus had a significantly lower eGFR, lymphocyte count and a higher NLR. CONCLUSIONS: These findings suggested the altered immunity and vulnerability to S. aureus infection in patients with decreased renal function, which may be the underlying cause of worse outcomes of pneumonia in this group of patients.


Assuntos
Taxa de Filtração Glomerular , Mortalidade Hospitalar , Hospitalização , Pneumonia Estafilocócica , Insuficiência Renal , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Estafilocócica/microbiologia , Pneumonia Estafilocócica/mortalidade , Insuficiência Renal/microbiologia , Insuficiência Renal/mortalidade , Insuficiência Renal/fisiopatologia , Estudos Retrospectivos
9.
Braz J Cardiovasc Surg ; 34(2): 149-155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30916124

RESUMO

INTRODUCTION: Renal function is an independent risk factor for mortality among on-pump coronary bypass grafting (ONCABG) patients. This association is well known in the international literature, but there is a lack of knowledge of how admission creatinine (AC) levels modulate each cardiovascular risk factor. OBJECTIVE: The aim of this paper was to assess the effect of different AC levels on mortality among ONCABG patients. METHODS: 1,599 patients who underwent ONCABG between December 1999 and February 2006 at Hospital de Base in São José do Rio Preto/SP-Brazil were included. They were divided into quartiles according to their AC levels (QI: 0.2 ≤AC < 1.0 mg/dL; QII: 1.0 ≤ AC < 1.2 mg/dL; QIII: 1.2 ≤ AC < 1.4 mg/dL; and QIV: 1.4 ≤ AC ≤ 2.6 mg/dL). Seven risk factors were then evaluated in each stratum. RESULTS: Mortality was higher in the QIV group than QI or QII groups. Factors such as age (≥ 65 years) and cardiopulmonary bypass (CPB) time (≥ 115 minutes) in QIV, as well preoperative hospital stay (≥ 5 days) in QIII, were associated with higher mortality rates. Creatinine variation greater than or equal to 0.4 mg/dL increased mortality rates in all groups. The use of intra-aortic balloon pump and dialysis increased mortality rates in all groups except for QII. Type I neurological dysfunction increased the mortality rate in the QII and III groups. CONCLUSION: Creatinine levels play an important role in ONCABG mortality. The combination of selected risk factors and higher AC values leads to a worse prognosis. On the other hand, lower AC values were associated with a protective effect, even among elderly patients and those with a high CPB time.


Assuntos
Ponte de Artéria Coronária/mortalidade , Creatinina/sangue , Período Pré-Operatório , Idoso , Brasil , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prognóstico , Valores de Referência , Insuficiência Renal/sangue , Insuficiência Renal/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
10.
Rev. enferm. UFPE on line ; 13(3): 647-654, mar. 2019. ilus, tab
Artigo em Português | BDENF - Enfermagem | ID: biblio-1015559

RESUMO

Objetivo: descrever a epidemiologia da morbimortalidade e custos públicos pela insuficiência renal entre 2012-2017. Método: trata-se de estudo quantitativo, ecológico e descritivo, com dados do Sistema de Informações Hospitalares. Selecionou-se as cinco regiões brasileiras como população de estudo e coletou-se as variáveis sexo, faixa etária, raça/cor, valores dos serviços hospitalares, internações, óbitos e taxa de mortalidade. Analisou-se os dados por meio de estatística descritiva simples (frequências absolutas e relativas) e apresentou-se em forma de tabelas construídas por meio do software Excel. Resultados: registrou-se 507.830 internações por insuficiência renal. Evidenciou-se maior prevalência no Sudeste (45,48%), no sexo masculino (56,47%), entre 60 a 64 anos (11,10%) e autodeclarados brancos (36,81%). Notificou-se, também 64.977 óbitos e mortalidade de 12,8%, com maior taxa na região norte (13,91%). Houve impacto financeiro superior a 1,4 bilhões de reais. Conclusão: conclui-se, que a insuficiência renal aflige em maior prevalência homens idosos e brancos quando o desfecho final é o óbito, implicando em mudanças na dinâmica e orçamento familiar, incremento de custos aos sistemas de saúde e redução da qualidade de vida.(AU)


Objective: to describe the epidemiology of morbidity-mortality and public costs of kidney failure between 2012-2017. Method: this is a quantitative, ecological and descriptive study, with data from the Hospital Information System. All five Brazilian regions were selected as study population, with the collection of gender, age and race/color variables, values of hospital services, hospitalizations, deaths and mortality rate. Data were analyzed by means of descriptive statistics (absolute and relative frequencies) and presented in the form of tables constructed through Excel software. Results: there were 507.830 hospitalizations due to kidney failure. The highest values were in the Southeast (45.48%), males (56.47%), aged 60 through 64 years (11.10%) and self-reported whites (36.81%). Furthermore, there were 64,977 deaths and mortality rate of 12.8%, with the highest rates in the northern region (13.91%). There was a financial impact exceeding R$ 1.4 billion. Conclusion: kidney failure affects, in greater prevalence, elderly and white men when the outcome is death, resulting in changes in the family dynamics and budget, increased costs to health systems and reduced quality of life.(AU)


Objetivo: describir la epidemiología de la morbimortalidad y costes públicos por insuficiencia renal entre 2012-2017. Método: se trata de un estudio cuantitativo, ecológico y descriptivo, con datos del Sistema de Información Hospitalaria. Fueron seleccionadas las cinco regiones brasileñas como población de estudio y recogidas las variables sexo, edad, raza/color, valores de los servicios hospitalarios, hospitalizaciones, muertes y tasa de mortalidad. Los datos fueron analizados mediante estadística descriptiva (frecuencias absolutas y relativas) y se presentan en forma de tablas construidas mediante software Excel. Resultados: se registraron 507,830 hospitalizaciones por insuficiencia renal. Mayor prevalencia en el sureste (45.48%), el sexo masculino (56.47%), entre 60 y 64 años (11,10%) y auto-declarados blancos (36.81%). También se notificaron 64,977 muertes y tasas de mortalidad del 12,8%, con tasas más altas en la región norte (13.91%). Hubo un impacto superior a los 1.400 millones de reales. Conclusión: Se concluye que la insuficiencia renal aflige, en la mayor prevalencia, hombres ancianos y blanco cuando el resultado final es la muerte, resultando en cambios en la dinámica y el presupuesto familiar, aumento de costes para los sistemas de salud y la reducción de la calidad de vida.(AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Brasil , Saúde Pública , Insuficiência Renal , Insuficiência Renal/mortalidade , Insuficiência Renal/epidemiologia , Insuficiência Renal Crônica , Epidemiologia Descritiva , Estudos Ecológicos , Sistemas de Informação em Saúde
11.
J Card Surg ; 34(3): 110-117, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30735576

RESUMO

BACKGROUND: Dialysis-dependent patients have a higher risk of short-term morbidity and mortality following cardiac surgery. However, longitudinal survival and readmissions in this patient population after isolated coronary artery bypass grafting (CABG) are lacking in the literature. METHODS: All patients undergoing isolated CABG from 2011 to 2017 were included. Perioperative data were retrospectively extracted from a prospectively maintained cardiac surgical database with a primary focus on longitudinal mortality and readmissions. RESULTS: The total study population consisted of 6874 nondialysis-dependent patients and 174 patients with dialysis dependence. Patients in the dialysis-dependent group presented a higher risk of morbidity and mortality as reflected in the Society of Thoracic Surgeons-Predicted Risk of Morbidity and Mortality (STS-PROM) (8.4% ± 9.7% vs 2.3% ± 3.9%; P < 0.001). Operative (30-day) mortality was significantly higher in the dialysis group (8.6% vs 2.3%; P < 0.001). Unadjusted outcomes yielded 30-day (92% vs 98%; P < 0.001), 1-year (80% vs 94%; P < 0.001), and 5-year (38% vs 84%; P < 0.001) survival that was significantly worse for the dialysis group. Freedom from readmission at 30 days (93% vs 87%; P = 0.005), 1 year (78% vs 56%; P < 0.001), and 5 years (62% vs 39%; P < 0.001) was significantly better for the nondialysis cohort. Dialysis dependence was an independent predictor of mortality at 30 days (hazard ratio [HR], 3.86; 95% confidence interval [CI], 2.96, 5.03; P < 0.001), 1 year (HR, 3.20; 95% CI, 2.14, 2.79; P < 0.001), and 5 years (HR, 4.02; 95% CI, 3.07, 5.26; P < 0.001) despite risk adjustment. CONCLUSION: Dialysis-dependent patients have significantly elevated operative risk, which translates to worse short- and long-term survival following isolated CABG. The need for dialysis alone is an independent predictor of both mortality and readmission in the midterm.


Assuntos
Ponte de Artéria Coronária/mortalidade , Diálise , Idoso , Estudos de Coortes , Diálise/efeitos adversos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Insuficiência Renal/mortalidade , Risco , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
12.
Ann Transplant ; 24: 100-107, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30787265

RESUMO

BACKGROUND Preventing major adverse cardiovascular events (MACE) after kidney transplantation motivates pre-transplant cardiac evaluation that includes two-dimensional transthoracic echocardiography (TTE). The relationship of relative wall thickness (RWT) to left ventricular mass index (LVMI) in predicting post-transplant MACE is unclear. MATERIAL AND METHODS In this multi-ethnic Canadian single-center cohort study, we identified 1063 adults undergoing pre-transplant TTE within 1 year pre-transplant and with minimum 6 months of post-kidney transplant follow-up for MACE, defined as a composite of coronary revascularization, myocardial infarction, stroke, and cardiac death. Left ventricular hypertrophy (LVH, >131 g/m² in men and >100 g/m² in women) and increased RWT (>0.45) were a priori used to define normal (no LVH, normal RWT), concentric remodeling (no LVH, increased RWT), eccentric hypertrophy (LVH, normal RWT), and concentric hypertrophy (LVH, increased RWT). RESULTS There were 134 MACE over 3577 patient-years of post-transplant follow-up. Both LVH (HR 1.58, p=0.022) and high RWT (HR 1.44, p=0.041) predicted MACE in multivariate survival regression analysis independently of common pre-transplant MACE risk factors. Concentric remodeling, concentric hypertrophy, and eccentric hypertrophy all increased the risk for MACE (4.44, 5.05, and 5.55 events per 100 patient-years, respectively) versus normal echocardiography (2.71 events per 100 patient-years, all p<0.05 for difference). In Cox interactive regression analysis, LVMI and RWT were independently associated with MACE (p=0.015, p=0.025) and significantly interacted (p=0.008). CONCLUSIONS LV geometric parameters beyond LVH alone can assist post-transplant prognostication in kidney transplant candidates.


Assuntos
Doenças Cardiovasculares/etiologia , Ventrículos do Coração/diagnóstico por imagem , Transplante de Rim/efeitos adversos , Insuficiência Renal/cirurgia , Adulto , Idoso , Doenças Cardiovasculares/mortalidade , Ecocardiografia , Feminino , Humanos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Prognóstico , Insuficiência Renal/mortalidade , Fatores de Risco , Taxa de Sobrevida
13.
BMC Emerg Med ; 19(1): 11, 2019 01 22.
Artigo em Inglês | MEDLINE | ID: mdl-30669969

RESUMO

BACKGROUND: Renal failure carries high mortality even in high-resource countries. Little attention has been paid to renal failure patients presenting acutely in emergency care settings in low-to-middle income countries (LMIC). Our aim was to describe the profile, management strategies and outcome of renal failure patients presenting with indications for emergent dialysis to an urban Emergency Department (ED) in a tertiary public hospital in Tanzania. METHODS: This was a prospective cohort study of consecutive patients (age ≥ 15 yrs) presenting to the Emergency Medicine Department of Muhimbili National Hospital from September 2017 to February 2018. All patients with renal failure and complications requiring acute dialysis were included. A structured data collection sheet was used to gather demographics, clinical presentation, management strategies and outcomes. Data were summarized with descriptive statistics. Logistic regressions were performed to determine factors associated with receiving dialysis and with mortality. RESULTS: We enrolled 146 patients, median age was 49 years (IQR 32-66 years), and 110 (75.3%) were male. Shortness of breath 67 (45.9%) and reduced urine output 58 (39.7%) were the most common presenting complaints. The most common complications were hyperkalemia 77 (53%), uremic encephalopathy 66 (45%) and pulmonary edema 54 (37%). All patients were hospitalized, and 61 (42%) received dialysis. Overall mortality was 39% (57 patients); the mortality in non-dialysed patients was 53% vs. 20% (p < 0.0005) in those receiving dialysis. 54% of patients with health insurance were dialyzed, compared to 39% who paid out of pocket (adjusted OR = 0.3, 95%CI: 0.1-0.9). Patients (≥55 years) were less likely to be dialysed (adjusted OR = 0.2 [0.1-0.9]). Independent predictors of mortality were vomiting (OR = 6.2, 95%CI: 1.8-22.2), oliguria (OR = 3.4, 95%CI: 1.2-9.5), pulmonary edema (OR = 4.6, 95%CI: 1.6-14.3), creatinine level > 1200umol/L (OR = 5.0 95%CI: 1.4-18.2), and not receiving dialysis (OR = 8.0, CI: 2.7-23.5). Female sex had a lower risk of dying (OR = 0.13, CI: 0.03-0.5). CONCLUSIONS: In this ED in LIC, acute complications of renal failure created a need for ED stabilization and emergent dialysis. Overall in-hospital mortality was high; significantly higher in undialysed patients. Future studies in LICs should focus on identification of categories of patients that will do well with conservative therapy.


Assuntos
Países em Desenvolvimento , Mortalidade Hospitalar , Hospitais Urbanos , Diálise Renal , Insuficiência Renal/mortalidade , Insuficiência Renal/terapia , Adulto , Fatores Etários , Idoso , Encefalopatias/etiologia , Creatinina/sangue , Dispneia/etiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Hiperpotassemia/etiologia , Cobertura do Seguro , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Oligúria/etiologia , Estudos Prospectivos , Edema Pulmonar/etiologia , Diálise Renal/economia , Insuficiência Renal/complicações , Fatores de Risco , Fatores Sexuais , Tanzânia , Centros de Atenção Terciária , Resultado do Tratamento , Vômito/etiologia
15.
Catheter Cardiovasc Interv ; 93(2): E90-E97, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30280476

RESUMO

OBJECTIVE: This study assessed the rate of major adverse renal or cardiac events (MARCE) when iohexol is used during interventional cardiovascular procedures compared to other low osmolar contrast media (LOCMs). BACKGROUND: Interventional cardiovascular procedures are often essential for diagnosis and treatment, the risk of MARCE should be considered. METHODS: Data were derived from the Premier Hospital Database January 1, 2010 through September 30, 2015. Patient encounters with an inpatient primary interventional cardiovascular procedure with a single LOCM (iohexol, ioversol, ioxilan, ioxaglate, or iopamidol) were included. The primary outcome was a composite endpoint of MARCE, which included: renal failure with dialysis, acute kidney injury (AKI) with or without dialysis, contrast induced AKI, acute myocardial infarction, angina, stent occlusion/thrombosis, stroke, transient ischemic attack, or death. Multivariable regression analysis was performed using the hospital fixed-effects specification to assess the relationship between MARCE and iohexol compared to other LOCMs, while controlling for patient demographics, comorbid conditions and reason for hospitalization. As a sensitivity analysis, direct comparisons of iohexol were made to other LOCMs. RESULTS: A total of 458,091 inpatient encounters met inclusion criteria of which 26% used iohexol and 74% used other LOCMs. Results of multivariable modeling revealed no differences in MARCE rates between iohexol and other LOCMs. When direct comparisons of iohexol vs. ioversol and iopamidol were modeled, no differences in MARCE nor the renal component of MARCE were found. CONCLUSIONS: In this retrospective multicenter study, there were no differences in MARCE events with iohexol compared to other LOCMs during inpatient interventional cardiovascular procedures.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Cateterismo Cardíaco/efeitos adversos , Transtornos Cerebrovasculares/induzido quimicamente , Meios de Contraste/efeitos adversos , Cardiopatias/induzido quimicamente , Iohexol/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Insuficiência Renal/induzido quimicamente , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco/mortalidade , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/mortalidade , Transtornos Cerebrovasculares/terapia , Meios de Contraste/administração & dosagem , Bases de Dados Factuais , Feminino , Cardiopatias/diagnóstico , Cardiopatias/mortalidade , Cardiopatias/terapia , Humanos , Iohexol/administração & dosagem , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista/mortalidade , Diálise Renal , Insuficiência Renal/diagnóstico , Insuficiência Renal/mortalidade , Insuficiência Renal/terapia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Estados Unidos , Adulto Jovem
16.
Clin Exp Nephrol ; 23(3): 335-341, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30178236

RESUMO

BACKGROUND: Tonsillectomy performed on patients with Immunoglobulin A glomerulonephritis (IgAN) improved the clinical remission rate as defined by urinary protein. But the number of times steroid pulse therapies (SP) should be administered remained poorly understood. METHOD: Multicenter, observational, retrospective cohort study at four hospitals in the Tokyo metropolitan area between March 1981 and December 2013. We divided patients into two groups: those treated with SP three times and those treated without SP or with SP only once or twice, and we analyzed standard Cox proportional hazard model unadjusted and adjusted the confounding covariates to estimate the hazard ratio for the primary outcome, the 30% estimated decline in glomerular filtration rate, in four models: model 1, unadjusted; model 2, adjusted for age, sex, body mass index, estimated glomerular filtration rate, biopsy year, proteinuria, hematuria, Japanese historical grade, systolic blood pressure, smoking history, and diabetes as a comorbidity; model 3, adjusted for propensity score, which was estimated by multiple logistic regressions; model 4, multilevel mixed-effects parametric survival models, whose facilities comprise the second level. RESULTS: Patients that received three times SP therapy were significantly associated with better renal outcome compared with patients with less number of SP therapy (HR 0.66; 95% CI 0.37-1.17 in model 1, 0.40 (0.20-0.78) in model 2, 0.46 (0.25-0.88) in model 3, 0.36 (0.18-0.71) in model 4). CONCLUSIONS: For treatment of IgAN, SP administered three times after tonsillectomy was associated with better renal prognosis compared with SP administered only once or twice.


Assuntos
Glomerulonefrite por IGA/tratamento farmacológico , Metilprednisolona/administração & dosagem , Prednisolona/administração & dosagem , Insuficiência Renal/mortalidade , Tonsilectomia , Adulto , Feminino , Taxa de Filtração Glomerular , Glomerulonefrite por IGA/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos
17.
J Stroke Cerebrovasc Dis ; 28(2): 237-242, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30448090

RESUMO

BACKGROUND: To determine the clinical outcome for intracerebral hemorrhage (ICH) patients with pre-existing renal failure in the United States. METHODS: We analyzed the data from Nationwide Inpatient Sample (2008-2012) for all ICH patients with or without pre-existing renal failure. Patients were identified using the International Classification of Disease, Ninth Revision, Clinical Modification codes. Baseline characteristics, in-hospital complications, and exposure to invasive procedures were compared between groups. Discharge outcomes (mortality, minimal disability, and moderate-to-severe disability) were compared between the two groups, before and after adjusting for the presence of other medical comorbidities, in-hospital complications, and exposure to invasive procedures. RESULTS: Of the 328,728 patients with ICH, 36,067 (11.8%) had pre-existing renal failure as a comorbidity. There were higher rates for in-hospital complications like myocardial infarction (3.5% versus 1.9%, P ≤ .0001), sepsis (5.4% versus 3.0%, P ≤ .0001), pneumonia (7.1% versus 5.3%, P ≤ .0001), deep venous thrombosis (1.6% versus 1.2%, P = .0041), urinary tract infections (16.9% versus 15.1%, P = .0101), and gastrointestinal bleeding (0.4% versus 0.2%, P ≤ .0154), longer hospital stay (9.4 ± 14.4 versus 7.7 ± 11.4; P < .0001), and higher mean hospital charges ($86497.9 ± 131708.1 versus $69583.4 ± 110629.1; P < .0001) in patients with pre-existing renal failure . The in-hospital mortality was also higher among patients with pre-existing renal failure as comorbidity in both univariate (26.4% versus 25.3 %, P = .0010) and multivariate analysis (odds ratio [OR] = 1.124 [1.042-1.213], P = .0025). There was no statistically significant difference for in terms of moderate to severe disability between 2 groups (OR = 1.030 [0.962-1.104], P value: .3953 in multivariate analysis when analysis was limited to alive patients. CONCLUSIONS: Patients with ICH, who present with pre-existing renal failure, have higher rates of in-hospital mortality but not for disability, the difference remained significant after adjusting for the presence of other medical comorbidities, in-hospital complications or exposure to invasive procedures.


Assuntos
Hemorragia Cerebral/mortalidade , Mortalidade Hospitalar , Rim/fisiopatologia , Insuficiência Renal/mortalidade , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/terapia , Comorbidade , Bases de Dados Factuais , Avaliação da Deficiência , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Alta do Paciente , Insuficiência Renal/diagnóstico , Insuficiência Renal/fisiopatologia , Insuficiência Renal/terapia , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia
18.
Nihon Ronen Igakkai Zasshi ; 55(4): 640-649, 2018.
Artigo em Japonês | MEDLINE | ID: mdl-30542030

RESUMO

AIM: In Geriatrics Gerontology International we previously reported the efficacy of reducing diuretics to prevent falls and fractures in older adults. We have since noticed another important problem, regarding the diuretic therapy for older adults with decreased muscle and water volumes. We performed a study on renal insufficiency and diuretic therapy in an attempt to confirm the need for case control study between standard diuretic therapy administered, according to guidelines and "NY-mode" diuretic therapy, which involves the administration of the mineral-corticoid receptor inhibitor spironolactone at 12.5 mg orally every other day. METHODS: We reviewed the causes of death among 1,855 residents living at 2 atomic bomb survivors nursing homes, with a focus on the death certification and diuretic therapy status of 48 older adults who died due to renal insufficiency. We also evaluated the relationship between the estimated glomerular filtration rate of 407 residents using serum creatinine data and the level of independence in daily life of disabled older adults. RESULTS: We found that deaths due to chronic renal insufficiency were concentrated within certain period in two nursing homes examined and in patients receiving standard diuretic therapy (continuous daily loop diuretics or combination of loop diuretics with mineral-corticoid receptor inhibitor). Older adults with a relatively low level of independence in daily life showed a relatively higher estimated glomerular filtration rate, depending on their muscle volume. CONCLUSION: These results suggest the need for a case control study of standard diuretic therapy and "NY-mode" therapy among older adults with decreased muscle and water volumes to not only prevent falls and fall-related fractures but also protect the kidney from damage.


Assuntos
Diuréticos/uso terapêutico , Armas Nucleares , Casas de Saúde , Insuficiência Renal/mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Japão/epidemiologia , Masculino , Insuficiência Renal/tratamento farmacológico , Sobreviventes
19.
J Clin Hypertens (Greenwich) ; 20(11): 1624-1632, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30362656

RESUMO

Plasma homocysteine (Hcy) levels are associated with elevated blood pressure. However, the causal association between Hcy levels and the risk of hypertension remains ambiguous. Taking the study design effect into consideration, this study aimed to investigate this issue through a cross-sectional and longitudinal analysis. Data were obtained from the Beijing Health Management Cohort study, which conducted routine health check-ups from 2012 to 2017. Multivariate logistic regression was used for the cross-sectional analysis, and a quadratic inference function approach was performed for the longitudinal analysis. A total of 30 376 subjects (mean age = 50.0 years) were included in the cross-sectional analysis, and a subgroup of 3913 subjects without hypertension at baseline was included in the longitudinal analysis. After adjusting for potential confounders, the risk of hypertension increased with Hcy levels in the cross-sectional analysis using the traditional definition of hypertension (OR = 1.262, 95% CI: 1.155-1.378, Q2 vs Q1; OR = 1.458, 95% CI: 1.335-1.593, Q3 vs Q1; OR = 1.520, 95% CI: 1.388-1.664, Q4 vs Q1) and the 2017 hypertension definition (OR = 1.159, 95% CI: 1.067-1.259, Q2 vs Q1; OR = 1.328, 95% CI: 1.221-1.445, Q3 vs Q1; OR = 1.328, 95% CI: 1.217-1.449, Q4 vs Q1). The longitudinal analysis showed that hypertension risk increased in the third quartile of Hcy (OR = 1.268, 95% CI: 1.030-1.560, Q3 vs Q1). Elevated total plasma Hcy may be used as a predictive biomarker for hypertension. Attention should be paid to gender-specific mechanisms when issuing precise precautions.


Assuntos
Biomarcadores/sangue , Homocisteína/sangue , Hipertensão/sangue , Adulto , Pequim/epidemiologia , Estudos Transversais , Feminino , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Cardiopatias/mortalidade , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Insuficiência Renal/epidemiologia , Insuficiência Renal/etiologia , Insuficiência Renal/mortalidade , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade
20.
Adv Chronic Kidney Dis ; 25(5): 408-417, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30309458

RESUMO

The exact significance of kidney function deterioration during acute decompensated heart failure (ADHF) episodes is still under debate. Several studies reported a wide percentage of worsening renal function (WRF) in ADHF patients ranging from 20% to 40%. This is probably because of different populations enrolled with different baseline kidney and cardiac function, varying definition of acute kidney injury (AKI), etiology of kidney dysfunction (KD), and occurrence of transient or permanent KD over the observational period. Current cardiorenal syndrome classification does not distinguish among the mechanisms leading to cardiac and renal deterioration. Cardiorenal syndrome type 1 (CRS-1) is the result of a combination of neurohormonal activation, fluid imbalance, arterial underfilling, increased renal and abdominal pressure, and aggressive decongestive treatment. A more complete mechanistic approach to CRS-1 should include evaluation of baseline kidney function, timing, course and magnitude of KD, and introduction of specific biomarkers able to identify early kidney damage. Therefore, clinical and laboratory parameters may yield a different combination among predisposing, precipitating, and amplifying factors that may influence cardiorenal syndrome development. Thus, CRS-1 is a heterogeneous syndrome that needs to be better defined and categorized taking into account clinical status, renal condition, and treatment. The application of universal definitions for WRF/AKI definition would be the first step to achieve a clear classification.


Assuntos
Síndrome Cardiorrenal/classificação , Síndrome Cardiorrenal/fisiopatologia , Progressão da Doença , Insuficiência Cardíaca/fisiopatologia , Insuficiência Renal/fisiopatologia , Síndrome Cardiorrenal/mortalidade , Feminino , Insuficiência Cardíaca/mortalidade , Testes de Função Cardíaca , Humanos , Testes de Função Renal , Masculino , Prognóstico , Insuficiência Renal/mortalidade , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida
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