Navegando por Palavras-chave "Dialysis"

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    Analysis of the Use of Extracorporeal Circulation on the In-Hospital Outcomes of Dialytic Patients Who Underwent Myocardial Revascularization Surgery
    (Arquivos Brasileiros Cardiologia, 2016) Miranda, Matheus [UNIFESP]; Branco, João Nelson Rodrigues [UNIFESP]; Vargas, Guilherme Flora [UNIFESP]; Hossne Junior, Nelson Americo [UNIFESP]; Yoshimoto, Michele Costa [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Pestana, Jose Osmar Medina [UNIFESP]; Buffolo, Enio [UNIFESP]
    Background: Myocardial revascularization surgery is the best treatment for dyalitic patients with multivessel coronary disease. However, the procedure still has high morbidity and mortality. The use of extracorporeal circulation (ECC) can have a negative impact on the in-hospital outcomes of these patients. Objectives: To evaluate the differences between the techniques with ECC and without ECC during the in-hospital course of dialytic patients who underwent surgical myocardial revascularization. Methods: Unicentric study on 102 consecutive, unselected dialytic patients, who underwent myocardial revascularization surgery in a tertiary university hospital from 2007 to 2014. Results: Sixty-three patients underwent surgery with ECC and 39 without ECC. A high prevalence of cardiovascular risk factors was found in both groups, without statistically significant difference between them. The group "without ECC" had greater number of revascularizations (2.4 vs. 1.7
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    Avaliação dos aspectos físicos e mentais em pacientes longevos com doença renal crônica
    (Universidade Federal de São Paulo (UNIFESP), 2017-12-21) Martini, Adriana Ferreira [UNIFESP]; Sesso, Ricardo de Castro Cintra [UNIFESP]; http://lattes.cnpq.br/1182565752545891; http://lattes.cnpq.br/1182565752545891; http://lattes.cnpq.br/4363066434428623; Universidade Federal de São Paulo (UNIFESP)
    Objetivos: Avaliar pacientes idosos longevos (≥80 anos) com doença renal crônica (DRC) em tratamento conservador (taxa de filtração glomerular ≤30 ml/min/1,73m2) em relação à qualidade de vida utilizando o questionário SF-36. Avaliar aspectos físicos e mentais usando escalas padronizadas. Estudar associações entre aspectos sóciodemográficos, suporte social, aspectos clínicos e laboratoriais, e as medidas e qualidade de vida, avaliação física, mental e depressão em comparação a idosos da comunidade.Métodos: Foram estudados 80 pacientes com DRC e 60 idosos longevos vivendo na comunidade (controles), com média de idade de 83,7 anos (DP=3,3 anos). Foram analisados aspectos físicos, cognitivos, sociais e de qualidade de vida por meio de escalas, como: SF-36, mini mental, teste de nomeação de Boston, teste sentar e levantar, TUG, ABVD, MOS, escala de depressão GDS, teste de fluência verbal categoria animais e questionário para aplicação Abep.Resultados: O grupo com doença renal crônica apresentou maior média do índice de comorbidades de Charlson (p<0,001), maior porcentagem de diabetes mellitus (p = 0,002) e de diabetes mellitus com dano de orgão alvo (p<0,001). O grupo controle apresentou médias maiores nas dimensões de capacidade funcional (p=0,007), estado de saúde geral e limitações por aspectos emocionais (p<0,001), vitalidade e limitações por aspectos físicos (p = 0,001); e na fluência verbal (teste de Boston) (p<0,001) comparativamente ao grupo com doença, que por sua vez, apresentou médias maiores nas dimensões de saúde mental, aspectos sociais (p=0,001) e maior porcentagem de indivíduos com tempo acima de 20 segundos no teste de sentar-se e levantar-se da cadeira (p = 0,002). Conclusões: Pacientes longevos com DRC estágio 4 e 5 em tratamento conservador, apresentaram uma pior avalição de sua saúde geral, função fisica e limitação por aspectos emocionais investigados pelo questionário SF-36, como também em outras medidas objetivas de desempenho físico em relação a longevos sem doença renal da comunidade. Além disso, esses pacientes têm indícios de menor desempenho cognitivo (fluência verbal) e apoio social. Entretanto outros aspectos medidos por ABVD, índices de depressão, e função emocional parecem similares a da população sem DRC. Esses achados são importantes para se conhecer o desempenho funcional físico e mental dos pacientes longevos com DRC auxiliando na tomada de decisão para se aprimorar seu tratamento
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    Chronic kidney disease in pregnancy requiring first-time dialysis
    (Elsevier B.V., 2010-10-01) Sato, Jussara L. [UNIFESP]; De Oliveira, Leandro [UNIFESP]; Kirsztajn, Gianna M. [UNIFESP]; Sass, Nelson [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To report on the treatment and outcome of pregnancy in 29 women with chronic kidney disease (CKD), 24 of whom had moderate or severe renal dysfunction. Methods: Renal dysfunction at the onset of pregnancy was stratified: serum creatinine <= 1.4 mg/dL was defined as mild; 1.5-2.5 mg/dL was defined as moderate; and >2.5 mg/dL was defined as severe renal insufficiency. Clinical complications and perinatal outcomes were evaluated. Results: the average serum creatinine level at the beginning of pregnancy was 3.32 mg/dL (range, 1.2-7.1 mg/dL), and the average urine protein level was 1.51 g in 24 hours (range, 0.1-5.6 g in 24 hours). Dialysis therapy was necessary for 1 woman with mild renal dysfunction, 4 patients with moderate renal dysfunction, and 17 patients with severe renal dysfunction. Conclusion: the use of dialysis in pregnancy among women with moderate or severe renal dysfunction proved to be useful, but many patients became dependent on dialysis. It is not known whether this was due to the interaction between pregnancy and advanced CKD. (C) 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
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    Cross-transmission of vancomycin-resistant Enterococcus in patients undergoing dialysis and kidney transplant
    (Associação Brasileira de Divulgação Científica, 2010-01-01) Fram, Dayana Souza [UNIFESP]; Castrucci, Fernanda Marques [UNIFESP]; Taminato, Monica [UNIFESP]; Godoy-Martinez, Patricio [UNIFESP]; Freitas, Maria Cecília de Santos [UNIFESP]; Belasco, Angélica Gonçalves Silva [UNIFESP]; Sesso, Ricardo de Castro Cintra [UNIFESP]; Pacheco-Silva, Alvaro [UNIFESP]; Pignatari, Antonio Carlos Campos [UNIFESP]; Barbosa, Dulce Aparecida [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidad Austral de Chile Institute of Microbiology
    The objective of this study was to investigate the occurrence of vancomycin-resistant Enterococcus (VRE) cross-transmission between two patient groups (long-term dialysis and kidney transplant patients). Molecular typing, by automated ribotyping with the RiboPrinter Microbial Characterization System (Qualicon, USA), was used to analyze VRE isolates from 31 fecal samples of 320 dialysis patients and 38 fecal samples of 280 kidney transplant patients. Clonal spread of E. faecalis and E. casseliflavus was observed intragroup, but not between the two groups of patients. In turn, transmission of E. gallinarum and E. faecium between the groups was suggested by the finding of vancomycin-resistant isolates belonging to the same ribogroup in both dialysis and transplant patients. The fact that these patients were colonized by VRE from the same ribogroup in the same health care facility provides evidence for cross-transmission and supports the adoption of stringent infection control measures to prevent dissemination of these bacteria.
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    Desenvolvimento e validação de uma equação de predição de gasto energético de repouso em pacientes com doença renal crônica
    (Universidade Federal de São Paulo (UNIFESP), 2020-05-06) Fernandes, Thais De Oliveira [UNIFESP]; Valle, Lilian Cuppari [UNIFESP]; Universidade Federal de São Paulo
    Introduction: Determination of resting energy expenditure (REE) is essential for the nutritional treatment of patients with chronic kidney disease (CKD). The equipment available for this purpose is expensive and traditional equations used, based on healthy individuals, show low accuracy to estimate the REE of these patients. There are few REE predictive equations developed for hemodialysis, but their validity has not been evaluated in our population. In addition, there are no equations in the literature developed and validated for non-dialysis dependent CKD patients (NDD-CKD). Therefore, the aim of this study was to develop and validate specific equations to estimate the REE of individuals with CKD, based on variables easily obtained in clinical practice and also to evaluate the adequacy of equations previously published in our study population. Methodology: A database comprising demographic, clinical, and body composition data, fat free mass by electrical bioimpedance (FFM.BIA) and the sum of skinfolds at four sites (FFM.Ant), and resting energy expenditure (REE) measured by indirect calorimetry (IC) of 170 NDD-CKD patients , 131 patients on hemodialysis (HD) and 58 patients in peritoneal dialysis (PD) was used to develop the equations. Two cohorts were constituted: non-dialysis dependent (NDD) and dialysis (HD and PD). A sample of 30% of patients was randomly selected, from each cohort, to compose the validation group, the remaining patients formed the group from which equations were derived, the equation group. The potential REE predictors were obtained through univariate analysis and those with the highest correlation coefficient (R) were selected. Models were constructed using multiple linear regression analysis. Data from the entire dialysis cohort were used to test the equations of Vilar et al:. REE (kcal/day) = - 2.497 x age x age factor + 0.011x height2.023 + 83.573 x body weight0.6291 + 68.171x sex factor and Byham - Gray et al.: REE (kcal/day) = 802 - ( 4.90 * age) + (10.21 * weight) - (3.25 * SCr) + 222.41 (male). For validation of all equations, the Bland-Altman analysis was performed with evaluation of the systematic and proportionality biases, intraclass correlation test (ICC) and P20 test were also applied. Results: Three equations were developed in the ND group: 1) REE (kcal / day) = 854.5 + 7.4 x weight + 179.3 x sex - 3.3 x age + 2.1 x (estimated glomerular filtration rate) eGFR + 25.6 (if DM) (R2 = 0.424); 2) REE (kcal / day) = 678.3 + 14.07 x FFM.ant + 54.8 x age – 2 x age + 2.5 x eGFR + 140.7 x (if DM) (R2= 0.449); 3) REE (kcal/day) = 668 + 17.1 x FFM.BIA - 2.7 x age - 92.7 x sex + 1.3 x eGFR - 152.3 (if DM) (R2 = 0.45) and two equations in the Dialysis group: 1) REE (kcal / day) = 957.02 - 8.08 x age + 11.07 x weight + 136.4 (if man) (R2 = 0.515); 2) REE (kcal / day) = 624.6 - 4.8 x age + 20.6 x FFM.ant - 8.65 (if man) (R2 = 0.512). In the validation step the REE estimated by the equations (eREE) was not different from the REE measured by IC (mREE), in, both NDD and Dialysis groups and neither were different among themselves. The models presented good reliability with ICC values varying from 0.59 to 0.91. On average 60% of the patients in the NDD group the eREE by the equations presented accuracy between 90 and 110%, and in the Dialysis group, the accuracy between 80 and 120% was found in 83% of the patients. The equations’ mean biases were not different from zero in all equations. In the Dialysis group, no proportionality bias was observed, while in the NDD group except for the FFM.BIA based equation the other two equations presented proportionality bias . In the Dialysis group Vilar’s equation overestimated mGER, while eREE by Byham-Gray’s equation was not different from mREE. Both equations presented systematic and proportionality biases. Conclusion: All the equations developed had good accuracy, however, equations developed in the Dialysis group presented better validation results. In the ND group, FFM.BIA based equation presented slightly better performance. The performance of Vilar’s and Byham-Gray’s REE predictive equations were considered low to moderate in the Dialysis group.
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    Efeitos do exercício físico na qualidade de vida e nas alterações fisiológicas de pacientes com doença renal crônica avançada
    (Universidade Federal de São Paulo (UNIFESP), 2017-12-13) Araújo, Cássio Luis da Silva [UNIFESP]; Medeiros, Alessandra [UNIFESP]; http://lattes.cnpq.br/0071198026371230; http://lattes.cnpq.br/2924040906282549; Universidade Federal de São Paulo (UNIFESP)
    Introdução: A doença renal crônica (DRC) é definida pela perda lenta, gradual e irreversível da função renal. Atualmente essa doença é considerada como um problema de saúde pública devido suas elevadas taxas de morbi/mortalidade tendo impacto negativo na qualidade de vida (QV). Um planejamento de exercícios é essencial nesses pacientes, já que os mesmos se apresentam em acentuada redução da capacidade funcional e física. Objetivos: Realizar uma revisão de literatura sobre os efeitos do exercício físico na qualidade de vida e nas alterações fisiológicas de pacientes com DRC avançada. Materiais e métodos: Foram realizadas buscas nas bases LILACS, SCIELO e PUBMED, a partir das seguintes palavras-chave: treinamento físico; atividade física; função renal; dialise; qualidade de vida, encontrados a partir dos Descritores em Ciências da Saúde (DeCS) e Medical Subject Headings (MeSH), sendo selecionados artigos (ensaios clínicos controlados randomizados, experimentais e revisão de literatura) nos idiomas português, inglês e espanhol, publicados entre 1997 e 2016. Resultados: Foram localizados 84 artigos, sendo 37 da base de dados PUBMED, 14 LILACS e 33 da base SCIELO. Desses artigos encontrados, 68 observaram melhora da qualidade de vida e apenas 2 não encontraram alteração da capacidade funcional e qualidade de vida dos pacientes que foram submetidos ao programa de exercício. O principal método utilizado para avaliar a qualidade de vida foi o questionário SF-36. Conclusão: Por meio de programas de exercícios físicos pode-se ter melhoras na capacidade funcional dos indivíduos com DRC. Esses exercícios exercem efeitos benéficos sobre pacientes também em hemodiálise, contudo, deve-se considerar que a DRC, desempenha amplo impacto na QV, ocasionando inúmeras alterações e constantes desafios na vida diária desses doentes. É importante ressaltar que a melhora da QV é meta comum, e que refletir sobre estas práticas com objetivo de melhorá-las é um dos caminhos para a qualidade da assistência e um objetivo a ser alcançado.
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    Effect of cholecalciferol on vitamin D-regulatory proteins in monocytes and on inflammatory markers in dialysis patients: A randomized controlled trial
    (Churchill Livingstone, 2016) Meireles, Marion Schneider [UNIFESP]; Kamimura, Maria Ayako [UNIFESP]; Dalboni, Maria Aparecida [UNIFESP]; Carvalho, José Tarcisio Giffoni de [UNIFESP]; Aoike, Danilo Takashi [UNIFESP]; Cuppari, Lilian [UNIFESP]
    Background & aims: Hypovitaminosis D and inflammation are highly prevalent among patients undergoing dialysis, and the association of both conditions with worse survival has been well recognized. Although a potential role for vitamin D in the immune system has been suggested, the effect of the treatment of hypovitaminosis D on the modulation of the inflammatory response remains unclear. The aim of this study was to investigate the effect of the restoration of the vitamin D status on the expression of vitamin D-regulatory proteins in monocytes and on circulating inflammatory markers in dialysis patients. Methods: In this randomized double-blind placebo-controlled 12-week trial, 38 patients on dialysis with serum 25-hydroxyvitamin D [25(OH)D] <20 ng/mL were randomized either to the cholecalciferol group (n = 20
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    Estudo da Fase Intra-hospitalar da Revascularizacao Cirurgica do Miocardio em Pacientes Dialiticos
    (Sociedade Brasileira de Cardiologia - SBC, 2014-03-01) Miranda, Matheus; Hossne Junior, Nelson Americo [UNIFESP]; Branco, João Nelson Rodrigues [UNIFESP]; Vargas, Guilherme Flora [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Pestana, Jose Osmar Medina [UNIFESP]; Juliano, Yara; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de Santo Amaro
    Background:Coronary artery bypass grafting currently is the best treatment for dialytic patients with multivessel coronary disease, but hospital morbidity and mortality related to procedure is still high.Objective:Evaluate results and in-hospital outcomes of coronary artery bypass grafting in dialytic patients.Methods:Retrospective unicentric study including 50 consecutive and not selected dialytic patients, who underwent coronary artery bypass grafting in a tertiary university hospital from 2007 to 2012.Results:High prevalence of cardiovascular risk factors was observed (100% hypertensive, 68% diabetic and 40% dyslipidemic). There was no intra-operative death and 60% of the procedures were performed off-pump. There were seven (14%) in-hospital deaths. Postoperative infection, previous heart failure, cardiopulmonary bypass, abnormal ventricular function and surgical re-exploration were associated with increased mortality.Conclusion:Coronary artery bypass grafting is feasible to dialytic patients although high in-hospital morbidity and mortality. It is necessary better understanding about metabolic aspects to plan adequate interventions.
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    Evaluation of quality of life, physical, and mental aspects in longevous patients with chronic kidney disease
    (Springer, 2018) Martini, Adriana [UNIFESP]; Ammirati, Adriano Luiz [UNIFESP]; Garcia, Carlos [UNIFESP]; Andrade, Carolina P. [UNIFESP]; Portela, Odete [UNIFESP]; Cendoroglo, Maysa Seabra [UNIFESP]; Sesso, Ricardo de Castro Cintra [UNIFESP]
    The diagnosis of chronic kidney disease (CKD) in elderly individuals has been increasing. The objective of this study was to evaluate physical, mental and social aspects in longevous elderly patients with CKD. Eighty patients with CKD (stage 4 and 5, not on dialysis) and 60 longevous elderly (ae 80 years) paired by gender and age living in the community were evaluated. Physical, cognitive, social and quality of life aspects were analyzed according to the following scales: Charlson comorbidity index, Medical Outcomes Study Short Form 36-Item (SF-36), Medical Outcomes Study, Boston Naming Test, verbal fluency test (animal naming), sit-to-stand test, gait speed, and the Mini-Mental state examination. Compared to the control group, the CKD group had a higher mean in the comorbidities index (3.5 +/- 1.2 vs. 1.0 +/- 1, respectively, p < 0.001). In the multivariate analysis, the CKD group presented worse performance in the SF-36 dimensions: 'physical functioning,' 'general health,' 'emotional functioning,' 'vitality,' and physical component summary. On the other hand, they presented better results for the 'mental health' dimension, in addition to lower social support, worse verbal fluency and worse results on the sit-to-stand test. Longevous patients with stage 4 or 5 CKD presented worse evaluation in several domains of physical and emotional functioning, lower social support and evidence of worse cognitive performance. These aspects should be taken into account in order to improve the care provided to these patients, improve their quality of life and prevent their morbidity.
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    Fatores de risco para infecção de corrente sanguínea em pacientes submetidos a hemodiálise e morbimortalidade relacionada
    (Universidade Federal de São Paulo (UNIFESP), 2014-05-28) Fram, Dayana Souza [UNIFESP]; Barbosa, Dulce Aparecida [UNIFESP]; http://lattes.cnpq.br/1924137485244907; http://lattes.cnpq.br/8357646821341086; Universidade Federal de São Paulo (UNIFESP)
    A infecção consiste a principal causa de morbidade e a segunda causa de mortalidade entre os pacientes em terapia renal substitutiva. Um dos principais eventos mórbidos nesta população é a internação hospitalar decorrente de infecções. Método: Fatores de risco para morbimortalidade relacionada a infecção de corrente sanguínea (ICS) em pacientes em tratamento hemodialítico foram investigados através de estudo retrospectivo ?nested? caso-controle, no período de janeiro de 2010 a junho de 2013. Os pacientes foram divididos em dois grupos: os que evoluíram para internação ou óbito por ICS (grupo 1) e pacientes que desenvolveram ICS mas não evoluíram com os mesmos desfechos (grupo 2). Os dados foram coletados através de consulta aos prontuários. Para análise estatística utilizou-se a regressão logística. Resultados: Foram incluídos 93 pacientes, 32 (grupo 1) e 61 (grupo 2). Através da regressão logística foi evidenciado que a cada ano de idade a chance de óbito ou internação por ICS aumenta 1,05 vezes (IC 95%:1,02-1,09). Pacientes com ICS causada pelo microrganismo S. aureus tem 8,67 vezes mais chance de evoluírem para óbito ou internação (IC 95%:2,5-30,06). O isolamento de microrganismos multirresistentes nas hemoculturas dos pacientes em hemodiálise aumenta a morbimortalidade em 2,75 vezes (IC 95%: 1,01-7,48). Conclusão: Medidas de controle para prevenir a disseminação de microrganismos, principalmente os multirresistentes nesta população devem ser intensificadas. Mais estudos se fazem necessários para a padronização de medidas específicas ainda não classicamente padronizadas como: coleta de culturas de vigilância, precauções de contato e descolonização.
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    Gasto energético de repouso em pacientes com doença renal crônica
    (Pontifícia Universidade Católica de Campinas, 2008-02-01) Kamimura, Maria Ayako [UNIFESP]; Avesani, Carla Maria [UNIFESP]; Draibe, Sergio Antonio [UNIFESP]; Cuppari, Lilian [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Knowledge of resting energy expenditure is of paramount importance for the determination of energy requirements and consequently for the establishment of energy recommendations of an individual. Elevated energy expenditure, if not supplied by enough food consumption, may contribute to malnutrition and higher risk of morbidity and mortality. In patients with chronic kidney disease, uremia per se and the dialysis treatment are frequently associated with several disturbances, such as metabolic acidosis, insulin resistance, secondary hyperparathyroidism and inflammation, that might in part contribute to the increase in resting energy expenditure. The present review aims to describe the studies on resting energy expenditure in patients with chronic kidney disease and the factors influencing energy expenditure in this population.
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    The impact of continuous renal replacement therapy on renal outcomes in dialysis-requiring acute kidney injury may be related to the baseline kidney function
    (Biomed Central Ltd, 2017) de Souza Oliveira, Marisa Aparecida [UNIFESP]; Claizoni dos Santos, Thais Oliveira [UNIFESP]; Martins Monte, Julio Cesar; Batista, Marcelo Costa [UNIFESP]; Pereira, Virgilio Goncalves, Jr.; Cardoso dos Santos, Bento Fortunato; Pavao Santos, Oscar Fernando [UNIFESP]; Durao, Marcelino de Souza, Jr. [UNIFESP]
    Background: Many controversies exist regarding the management of dialysis-requiring acute kidney injury (D-AKI). No clear evidence has shown that the choice of dialysis modality can change the survival rate or kidney function recovery of critically ill patients with D-AKI. Methods: We conducted a retrospective study investigating patients (>= 16 years old) admitted to an intensive care unit with D AKI from 1999 to 2012. We analyzed D AKI incidence, and outcomes, as well as the most commonly used dialysis modality over time. Outcomes were based on hospital mortality, renal function recovery (estimated glomerular filtration rate-eGFR), and the need for dialysis treatment at hospital discharge. Results: In 1,493 patients with D-AKI, sepsis was the main cause of kidney injury (56.2%). The comparison between the three study periods, (1999-2003, 2004-2008, and 2009-2012) showed an increased in incidence of D-AKI (from 2.56 to 5.17%
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    Is early virological response as predictive of the hepatitis C treatment response in dialysis patients as in non-uremic patients?
    (Elsevier B.V., 2013-01-01) Pereira, Patrícia da Silva Fucuta [UNIFESP]; Uehara, Silvia Naomi de Oliveira [UNIFESP]; Perez, Renata de Mello [UNIFESP]; Feldner, Ana Cristina de Castro Amaral [UNIFESP]; Melo, Isaura Cunha de [UNIFESP]; Souza e Silva, Ivonete Sandra de [UNIFESP]; Silva, Antonio Eduardo Benedito [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: the aim of the present study was to determine whether hepatitis C virus (HCV) RNA present at week 12 is a good predictor of the response to interferon (IFN) monotherapy in hemodialysis patients with hepatitis C.Methods: Hemodialysis patients with hepatitis C who were treated between 1997 and 2008 with IFN monotherapy for 48 weeks without dose reduction were included. the predictive value of HCV RNA at week 12 for achieving a sustained virological response (SVR) was determined.Results: Forty patients (mean age 47 +/- 9 years; 75% males and 80% with genotype 1) were included. Septal fibrosis or cirrhosis was observed in 38% of these patients. Twelve (30%) of the 40 patients achieved SVR. HCV RNA was undetectable at week 12 in 68%. the positive predictive value of HCV RNA at week 12 was 45% and the negative predictive value was 100%.Conclusions: the presence of HCV RNA at week 12 had a high negative predictive value for SVR in hemodialysis patients with chronic hepatitis C treated with IFN for 48 weeks. Therefore, if HCV RNA is detected at week 12, treatment should be discontinued due to the low probability of a sustained response. (0 2012 International Society for Infectious Diseases. Published by Elsevier B.V. All rights reserved.
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    Pentoxifylline does not alter the concentration of hepcidin in chronic kidney disease patients undergoing hemodialysis
    (Wichtig Editore, 2014-07-01) Antunes, Sandra Azevedo [UNIFESP]; Vilela, Rosana Quintella Brandão [UNIFESP]; Vaz, Jose D.; Canziani, Maria Eugenia Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Fed Alagoas; Santa Casa Misericordia Maceio
    Introduction: Anemia is a frequent condition in patients with chronic kidney disease due to a reduction in the production of erythropoietin. Patients with inflammation respond less well to treatment with erythropoietin, possibly because the increased production of hepcidin reduces the availability of iron for hematopoiesis. Some studies suggest that pentoxifylline has anti-inflammatory properties and could be used as adjuvant therapy in the treatment of anemia.Objective: the aim of this study was to analyze the effect of pentoxifylline on serum hepcidin in chronic hemodialysis patients with inflammation.Methods: 71 adult patients on hemodialysis with C-reactive protein (CRP) >= 0.5 mg/dl in screening tests; patients were randomized to the treatment group (oral pentoxifylline 400 mg/thrice-weekly) or the control group for 3 months follow-up.Results: During the study, a decrease in hemoglobin, transferrin saturation, and hepcidin was observed in both groups. However, these reductions were related to the time and not to the drug. There was no difference in the concentrations of CRP, ferritin, and albumin over time in either group.Conclusions: the use of this amount of pentoxifylline did not modify the serum levels of hepcidin in this population.
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    Predictors of quality of life among patients on dialysis in southern Brazil
    (Associacao Paulista Medicina, 2008-09-04) Bohlke, Maristela [UNIFESP]; Nunes, Diego Leite; Marini, Stela Scaglioni; Kitamura, Cleison; Andrade, Marcia; Von-Gysel, Maria Paula Ost; Univ Catolica Pelotas; Universidade Federal de São Paulo (UNIFESP); Univ Fed Rio Grande do Sul; Hosp Banco Olhos; Universidade de São Paulo (USP)
    CONTEXT AND OBJECTIVE: Quality of life (QoL) is considered important as an outcome measurement, especially for long-term diseases such as chronic renal failure. The present study searched for predictors of QoL in a sample of patients undergoing dialysis in southern Brazil.DESIGN AND SETTING: This was a cross-sectional study developed in three southern Brazilian dialysis facilities.METHODS: Health-related QoL of patients on hemodialysis or peritoneal dialysis was measured using the generic Short Form-36 (SF-36) health survey questionnaire. The results were correlated with sociodemographic, clinical and laboratory variables. The analysis was adjusted through multiple linear regression.RESULTS: A total of 140 patients were assessed: 94 on hemodialysis and 46 on peritoneal dialysis. The mean age was 54.2 +/- 15.4 years, 48% were men and 76% were white. The predictors of higher (better) physical component summary in SF-36 were: younger age (beta -0.16; 95% confidence interval, Cl: -0.27 to -0.05), shorter time on dialysis (beta -0.06; 95% Cl: -0.09 to -0.02) and lower Khan comorbidity-age index (beta 5.16; 95% Cl: 1.7-8.6). The predictors of higher mental component summary were: being employed (0 8.4; 95% Cl: 1.7-15.1), being married or having a marriage-like relationship (beta 4.56; 95% Cl: 0.9-8.2), being on peritoneal dialysis (beta 4.9; 95% Cl: 0.9-8.8) and not having high blood pressure (beta 3.9; 95% Cl: 0.3-7.6).CONCLUSIONS: Age, comorbidity and length of time on dialysis were the main predictors of physical QoL, whereas socioeconomic issues especially determined mental QoL.
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    Prevenção de infecções de corrente sanguínea relacionadas a cateter em pacientes em hemodiálise
    (Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), 2009-01-01) Fram, Dayana Souza [UNIFESP]; Taminato, Mônica [UNIFESP]; Ferreira, Daniela [UNIFESP]; Neves, Luciana [UNIFESP]; Belasco, Angélica Gonçalves Silva [UNIFESP]; Barbosa, Dulce Aparecida [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To conduct a systematic review of the literature on the prevention of catheter-related bloodstream infections in patients on hemodialysis. METHODS: A literature search was performed in Medline, Embase, Scielo, Lilacs, and Cochrane databases for articles published from 1990 to 2008. RESULTS: Two hundred ninety- three articles were retrieved. However, only 12 studies were included in this review. CONCLUSIONS: Findings suggest that health care providers use several infection control measures to prevent bloodstream infections in this patient population.
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    Relatório do censo brasileiro de diálise de 2010
    (Sociedade Brasileira de Nefrologia, 2011-12-01) Sesso, Ricardo de Castro Cintra [UNIFESP]; Lopes, Antonio Alberto; Thomé, Fernando Saldanha; Lugon, Jocemir Ronaldo; Santos, Daniel Rinaldi dos; Universidade Federal de São Paulo (UNIFESP); Universidade Federal da Bahia Faculdade de Medicina da Bahia Departamento de Medicina; Universidade Federal do Rio Grande Faculdade de Medicina Departamento de Medicina Interna; Universidade Federal Fluminense Faculdade de Medicina Departamento de Medicina Clínica; Faculdade de Medicina do ABC Departamento de Medicina
    INTRODUCTION: National chronic dialysis data are fundamental for treatment planning. OBJECTIVE: To report data of the annual survey of the Brazilian Society of Nephrology about patients with chronic renal failure who were on dialysis in 1 July, 2010. METHODS: A national survey based on data from the country's dialysis centers. Data collection was performed by using a questionnaire filled out online by the dialysis centers. RESULTS: 340 (53.3%) centers answered the questionnaire. National data were estimated for the overall dialysis population. In July 2010, the estimated total number of patients on dialysis was 92,091. The estimated prevalence and incidence rates of end-stage chronic kidney disease patients on maintenance dialysis were 483 and 100/million population, respectively. The estimated number of patients starting a dialysis program in 2010 was 18,972. The annual crude mortality rate was 17.9%. Of those on maintenance dialysis, 30.7% were aged 65 years or older, 90.6% were on hemodialysis and 9.4% on peritoneal dialysis, 35,639 (38.7%) were on a kidney transplant waiting list, 28% were diabetics, 34.5% had serum phosphorus levels > 5.5 mg/dL, and 38.5% had hemoglobin levels < 11 g/dL. Vascular access was through a venous catheter in 13.6% of the hemodialysis patients. CONCLUSIONS: The number of end-stage kidney disease patients on maintenance dialysis is increasing in Brazil. Data concerning the indicators of the quality of maintenance dialysis improved compared to the prior year, and they highlight the importance of the census to guide chronic dialysis therapy.
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    Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case-control study
    (Biomed Central Ltd, 2015-03-26) Fram, Dayana [UNIFESP]; Okuno, Meiry Fernanda Pinto [UNIFESP]; Taminato, Monica [UNIFESP]; Ponzio, Vinicius [UNIFESP]; Manfredi, Silvia Regina [UNIFESP]; Grothe, Cibele [UNIFESP]; Belasco, Angelica [UNIFESP]; Sesso, Ricardo [UNIFESP]; Barbosa, Dulce Elena [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Fdn Oswaldo Ramos
    Background: Infection is the leading cause of morbidity and the second leading cause of mortality in patients on renal replacement therapy. the rates of bloodstream infection in hemodialysis patients vary according to the type of venous access used. Gram- positive bacteria are most frequently isolated in blood cultures of hemodialysis patients. This study evaluated risk factors for the development of bloodstream infections in patients undergoing hemodialysis. Methods: Risk factors associated with bloodstream infections in patients on hemodialysis were investigated using a case- control study conducted between January 2010 and June 2013. Chronic renal disease patients on hemodialysis who presented with positive blood cultures during the study were considered as cases. Controls were hemodialysis patients from the same institution who did not present with positive blood cultures during the study period. Data were collected from medical records. Logistic regression was used for statistical analysis. Results: There were 162 patients included in the study (81 cases and 81 controls). Gram- positive bacteria were isolated with the highest frequency (72%). in initial logistic regression analysis, variables were hypertension, peritoneal dialysis with previous treatment, type and time of current venous access, type of previous venous access, previous use of antimicrobials, and previous hospitalization related to bloodstream infections. Multiple regression analysis showed that the patients who had a central venous catheter had an 11.2- fold (CI 95%: 5.17- 24.29) increased chance of developing bloodstream infections compared with patients who had an arteriovenous fistula for vascular access. Previous hospitalization increased the chance of developing bloodstream infections 6.6- fold (CI 95%: 1.9- 23.09). Conclusions: Infection prevention measures for bloodstream infections related to central venous catheter use should be intensified, as well as judicious use of this route for vascular access for hemodialysis. Reducing exposure to the hospital environment through admission could contribute to a reduction in bloodstream infections in this population.