Navegando por Palavras-chave "End-stage renal disease"
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- ItemAcesso aberto (Open Access)Angiotensin II antagonists: clinical experience in the treatment of hypertension, prevention of cardiovascular outcomes and renal protection in diabetic nephropathy and proteinuria(Sociedade Brasileira de Endocrinologia e Metabologia, 2006-04-01) Ribeiro, Artur Beltrame [UNIFESP]; Gavras, Haralambos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); University School of Medicine Hypertension and Atherosclerosis SectionAngiotensin II antagonists (AIIAs) were introduced to treat hypertension about 10 years ago. During this period they were evaluated not only in terms of efficacy and safety but also in several large studies with clinical outcomes. They are efficacious in all clinical forms of hypertension and are effective also in all ethnic groups. Cardiovascular and renal protection in proteinuric diabetic nephropathy beyond blood pressure reduction was proved in major clinical studies: Losartan Intervention For Endpoint reduction in hypertension study (LIFE), Reduction of Endpoint in Non-Insulin dependent Diabetes Mellitus with the AII Antagonist Losartan (RENAAL) and Irbesartan Type 2 Diabetic Nephropathy Trial (IDNT). Their blood pressure independent protective effect is also mentioned by the blockade of AT1 receptor. As a class AIIs have a tolerability profile similar to placebo.
- ItemAcesso aberto (Open Access)Cultural adaptation and validation of the Kidney Disease and Quality of Life - Short Form (KDQOL-SF 1.3) in Brazil(Associação Brasileira de Divulgação Científica, 2005-02-01) Duarte, Priscila Silveira [UNIFESP]; Ciconelli, Rozana Mesquita [UNIFESP]; Sesso, Ricardo de Castro Cintra [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The objective of the present study was to translate the Kidney Disease Quality of Life - Short Form (KDQOL-SF 1.3) questionnaire into Portuguese to adapt it culturally and validate it for the Brazilian population. The KDQOL-SF was translated into Portuguese and back-translated twice into English. Patient difficulties in understanding the questionnaire were evaluated by a panel of experts and solved. Measurement properties such as reliability and validity were determined by applying the questionnaire to 94 end-stage renal disease patients on chronic dialysis. The Nottingham Health Profile Questionnaire, the Karnofsky Performance Scale and the Kidney Disease Questionnaire were administered to test validity. Some activities included in the original instrument were considered to be incompatible with the activities usually performed by the Brazilian population and were replaced. The mean scores for the 19 components of the KDQOL-SF questionnaire in Portuguese ranged from 22 to 91. The components Social support and Dialysis staff encouragement had the highest scores (86.7 and 90.8, respectively). The test-retest reliability and the inter-observer reliability of the instrument were evaluated by the intraclass correlation coefficient. The coefficients for both reliability tests were statistically significant for all scales of the KDQOL-SF (P < 0.001), ranging from 0.492 to 0.936 for test-retest reliability and from 0.337 to 0.994 for inter-observer reliability. The Cronbach's alpha coefficient was higher than 0.80 for most of components. The Portuguese version of the KDQOL-SF questionnaire proved to be valid and reliable for the evaluation of quality of life of Brazilian patients with end-stage renal disease on chronic dialysis.
- ItemSomente MetadadadosLow estimated glomerular filtration rate and chronic kidney failure following liver transplant: A retrospective cohort study(Wichtig Editore, 2013-07-01) Narciso, Roberto Camargo [UNIFESP]; Ferraz, Leonardo Rolim; Rodrigues, Cassio Jose de Oliveira [UNIFESP]; Monte, Julio Cesar Martins [UNIFESP]; Mies, Sergio; Santos, Oscar Fernando Pavao dos [UNIFESP]; Paes, Angela Tavares; Cendoroglo Neto, Miguel [UNIFESP]; Jaber, Bertrand L.; Durao, Marcelino de Souza [UNIFESP]; Batista, Marcelo Costa [UNIFESP]; Albert Einstein Israelita Hosp HIAE; Universidade Federal de São Paulo (UNIFESP); Euryclides Jesus Zerbini Transplant Hosp Sao Paul; Tufts UnivBackground: Patients undergoing orthotropic liver transplant (LTx) often present with chronic kidney disease (CKD). Identification of patients who will progress to end-stage renal disease (ESRD) might allow not only the implementation of kidney protective measures but also simultaneous kidney transplant.Study Design: Retrospective cohort study in adults who underwent LTx at a single center. ESRD, death, and composite of ESRD or death were studied outcomes.Results: 331 patients, who underwent LTx, were followed up for 2.6 +/- 1.4 years; 31(10%) developed ESRD, 6 (2%) underwent kidney transplant after LTx and 25 (8%) remained on chronic hemodialysis. Patients with preoperative eGFR lesser than 60 ml/min per 1.73 m(2) had a 4-fold increased risk of developing ESRD after adjustment for sex, diabetes mellitus, APACHE II score, use of nephrotoxic drugs, and severe liver graft failure (HR = 3.95, 95% CI 1,73, 9.01; p = 0.001). Other independent risk factors for ESRD were preoperative diabetes mellitus and post-operative severe liver graft dysfunction.Conclusion: These findings emphasize low eGFR prior to LTx as a predictor for ESRD or death. the consideration for kidney after liver transplant as a treatment modality should be taken into account for those who develop chronic kidney failure after LTx.
- ItemSomente MetadadadosManagement of hepatitis C in patients with chronic kidney disease(Baishideng Publishing Group Inc, 2015-01-14) Carvalho-Filho, Roberto José de [UNIFESP]; Feldner, Ana Cristinade Castro Amaral [UNIFESP]; Silva, Antonio Eduardo Benedito [UNIFESP]; Ferraz, Maria Lucia G. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Hepatitis C virus (HCV) infection is highly prevalent among chronic kidney disease (CKD) subjects under hemodialysis and in kidney transplantation (KT) recipients, being an important cause of morbidity and mortality in these patients. the vast majority of HCV chronic infections in the hemodialysis setting are currently attributable to nosocomial transmission. Acute and chronic hepatitis C exhibits distinct clinical and laboratorial features, which can impact on management and treatment decisions. in hemodialysis subjects, acute infections are usually asymptomatic and anicteric; since spontaneous viral clearance is very uncommon in this context, acute infections should be treated as soon as possible. in KT recipients, the occurrence of acute hepatitis C can have a more severe course, with a rapid progression of liver fibrosis. in these patients, it is recommended to use pegylated interferon (PEG-IFN) in combination with ribavirin, with doses adjusted according to estimated glomerular filtration rate. There is no evidence suggesting that chronic hepatitis C exhibits a more aggressive course in CKD subjects under conservative management. in these subjects, indication of treatment with PEG-IFN plus ribavirin relies on the CKD stage, rate of progression of renal dysfunction and the possibility of a preemptive transplant. HCV infection has been associated with both liver disease-related deaths and cardiovascular mortality in hemodialysis patients. Among those individuals, low HCV viral loads and the phenomenon of intermittent HCV viremia are often observed, and sequential HCV RNA monitoring is needed. Despite the poor tolerability and suboptimal efficacy of antiviral therapy in CKD patients, many patients can achieve sustained virological response, which improve patient and graft outcomes. Hepatitis C eradication before KT theoretically improves survival and reduces the occurrence of chronic graft nephropathy, de novo glomerulonephritis and post-transplant diabetes mellitus.
- ItemAcesso aberto (Open Access)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.
- ItemSomente MetadadadosStrategies of the Brazilian Chronic Kidney Disease Prevention Campaign (2003-2009)(Karger, 2011-01-01) Mastroianni-Kirsztajn, Gianna [UNIFESP]; Bastos, Marcus Gomes [UNIFESP]; Burdmann, Emmanuel A.; Universidade Federal de São Paulo (UNIFESP); Univ Fed Juiz de Fora; Universidade de São Paulo (USP)In Brazil, as in the rest of the world, the prevalence of chronic kidney disease (CKD) is increasing. in order to alert the population, health professionals and authorities to this risk, in 2003, the Brazilian Society of Nephrology launched a CKD prevention campaign called 'Previna-se'. in addition, since its onset, Brazil has participated in the World Kidney Day efforts and has developed several prevention strategies. Here, we summarize the main strategies adopted in this campaign (population screening, events and meetings, distribution of educational materials, routine report of estimated glomerular filtration rate) and our initial results, sharing practical experience that could be useful in other developing countries. Copyright (C) 2010 S. Karger AG, Basel