RESUMO
Brain natriuretic peptide (BNP) is elevated in hemodialysis (HD) patients and predicts increased mortality. Intra- and interdialytic changes in BNP have not been fully described. End-stage renal disease (ESRD) patients were prospectively recruited at three dialysis centers. At five visits, over a 6-week period, pre- and postdialysis BNP levels were measured. Pre- and postdialysis weights, blood pressure, fluid removed/given and demographic/medical information were recorded. Mean pre- and post-HD BNP (log-transformed) was not significantly different and did not correlate with fluid removed. Both pre- and post-HD BNP significantly decreased across the dialysis week (Pre-HD: intercept = 2.69, slope = -0.097, t = -6.7, P < 0.001) and across the five sessions (slope = -0.046, t = -2.47, P = 0.01). Interdialytic BNP changes are not related to fluid removed. Chronic volume overload and increased left ventricular wall tension likely account for the BNP decrease across dialysis weeks and may be related to higher death rates among HD patients at the beginning of the week.
Assuntos
Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Natriuréticos/sangue , Peptídeo Natriurético Encefálico/sangue , Diálise Renal/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-IdadeAssuntos
Meios de Contraste/farmacocinética , Angiografia Coronária , Ácidos Tri-Iodobenzoicos/farmacocinética , Adulto , Idoso , Doença Crônica , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Nefropatias/fisiopatologia , Masculino , Taxa de Depuração Metabólica/fisiologia , Pessoa de Meia-Idade , Fatores de TempoRESUMO
This article surveyed attending physicians on their work hours, sleep schedule, daytime sleepiness, and the perceived relation of these factors to patient safety, quality of care, and personal well-being. Physicians answered demographic and workload questions and attitudinal questions regarding work-hour limitations; the Epworth Sleepiness Scale (ESS) was used to measure subjective sleepiness, and an 18-item Impact Questionnaire was also used. Of 180 participants, 41 (23%) attending physicians manifested abnormal ESS scores (11 or greater). Private practice- and surgically-based subspecialties had higher ESS scores. Reduced sleep, but not hours worked, was associated with increased sleepiness. Sleepy physicians were more likely to associate sleep loss with medical errors and driving impairment. Sleepiness may be attenuated by education regarding consequences of insufficient sleep and institution of effective countermeasures.