Navegando por Palavras-chave "chronic"

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    Avaliacao da espessura medio-intimal em pacientes com doenca renal cronica nao dialitica: estudo prospectivo de 24 meses
    (Sociedade Brasileira de Nefrologia, 2014-03-01) Marcos, Andrea Gaspar; Watanabe, Renato; Lemos, Marcelo Montebello [UNIFESP]; Canziani, Maria Eugênia Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction:Increased carotid intima-media thickness (IMT) is considered a marker of early-onset atherosclerosis and it seems to predict cardiovascular events in general population. The prognostic value of IMT in patients with early-stage chronic kidney disease (CKD) has not been clearly established.Objective:We aimed to evaluate the association between IMT and cardiovascular (CV) events and mortality in CKD patients.Methods:A cohort of CKD patients in stage 2-4 was evaluated the occurrence of CV events and death in a 24 months follow-up. Laboratory data, carotid ultrasound and coronary computed tomography were performed at baseline.Results:A total of 117 patients (57 ± 11 years-old, 61% male) were evaluated. Mean glomerular filtration rate (eGFR) was 36 ± 17 mL/min, 96% of patients had hypertension, 23% diabetes and 27% were obese. Coronary calcification was found in 48% of the patients, with higher prevalence among CKD stage 4 (p = 0.02). The median value of IMT was 0.6 mm (0.4-0.7 mm). When compared to patients with IMT ≤ 0.6 mm, those with IMT > 0.6 mm were older (p = 0.001), had higher prevalence of male (p = 0.001) and had lower eGFR (p = 0.01). These patients also had higher prevalence of coronary calcification (p = 0.001). During the follow-up, there were no differences in the occurrence of cardiovascular events and deaths between the two groups.Conclusion:IMT in early-stage CKD patients was related to coronary calcification, but not with the occurrence of cardiovascular events or death.
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    Avaliação nutricional de crianças com doença renal crônica
    (Sociedade de Pediatria de São Paulo, 2009-06-01) Brecheret, Ana Paula [UNIFESP]; Fagundes, Ulysses [UNIFESP]; Lazaretti-Castro, Marise [UNIFESP]; Andrade, Maria Cristina de [UNIFESP]; Carvalhaes, João Tomás de Abreu [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE:Malnutrition is a frequent complication among children with renal diseases. Short stature is the main clinical sign. The aim of this study is to analyze the nutritional status of children with renal disease using anthropometry. METHODS: This cross sectional study enrolled 21 (43%) boys and 28 (57%) girls with age ranging from 5.3 to 19.5 years. They were divided in three groups based on their creatinine clearance (mL/min/1.73m²): Group 1, >37 (n=19); Group 2, between 15 and 37 (n=9) and Group 3, <15 (n=21). Weight and height were obtained in order to calculate the following indexes: Weight/age (W/A), height/age (H/A) and body mass index (BMI); then, Z scores were obtained. Malnutrition was defined as Z scores below -2. ANOVA test was used to compare groups. RESULTS: There were no differences among the groups for anthropometric data. 19 patients (38.8%) presented short-stature and 22 (44.8%) low-weight. Z scores were similar among groups relative to W/A, H/A and BMI values. W/A Z score values were: Group 1: -1.9±1.8; Group 2: -2.6±3.1 and Group 3: -2.5±1.4 (p=0.47). H/A Z scores values were: Group 1: -1.5±1.2; Group 2: -2.3±1.8 and Group 3: -2.1±1.1 (p=0.18). The calculated BMI Z scores were: Group 1: -1.2±1.4; Group 2: -1.7±3.9 and Group 3: -1.6±1.3 (p=0.82). 19 children presented short stature and 22 presented low weight. There were no differences between the studied groups. CONCLUSIONS: The sample presented high prevalence of malnutrition. Even considering the disease stage, there were no nutritional differences between the studied groups.
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    Constant Work-Rate Test to Assess the Effects of Intradialytic Aerobic Training in Mildly Impaired Patients With End-Stage Renal Disease: A Randomized Controlled Trial
    (Elsevier B.V., 2011-12-01) Reboredo, Maycon M.; Neder, J. Alberto [UNIFESP]; Pinheiro, Bruno V.; Henrique, Diane M.; Faria, Ruiter S.; Paula, Rogerio B.; Univ Fed Juiz de Fora; Fed Inst Educ Sci & Technol SE Minas Gerais; Universidade Federal de São Paulo (UNIFESP)
    Objective: To investigate if high-intensity constant work rate (CWR) would constitute a more appropriate testing strategy compared with incremental work rate (IWR) to assess the effectiveness of intradialytic aerobic training in patients with end-stage renal disease (ESRD).Design: Randomized controlled trial.Setting: Nephrology unit at the university hospital.Participants: Patients (N=28; 47.0 +/- 11.9y) under hemodialysis (4.4 +/- 4.3y) were randomly assigned to exercise and control groups.Intervention: Patients included in the exercise group underwent a moderate-intensity intradialytic aerobic training program 3 times per week for 12 weeks.Main Outcome Measures: Cardiopulmonary and perceptual responses were obtained during an IWR and a high-intensity CWR test to the limit of tolerance on a cycle ergometer.Results: Training-induced increases in peak oxygen uptake (Vo(2)peak) and time to exercise intolerance (Tlim). Mean improvement in Tlim (97.4%+/- 75.6%) was significantly higher than increases in Vo(2)peak (12%+/- 11.3%) (P<.01); in fact, while Tlim improved 50% to 200% in 9 of 12 patients, Vo(2)peak increases were typically in the 15% to 20% range. CWR test revealed lower metabolic, ventilatory, cardiovascular, and subjective stresses at isotime; in contrast, submaximal responses during the incremental work rate (at the gas exchange threshold) remained unaltered after training.Conclusions: A laboratory-based measure of endurance exercise capacity (high-intensity CWR test to Thin) was substantially more sensitive than oxygen uptake at the peak IWR test to unravel the physiologic benefits of an intradialytic aerobic training program in mildly impaired patients with ESRD.
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    Efeito do exercício resistido intradialítico em pacientes renais crônicos em hemodiálise
    (Sociedade Brasileira de Nefrologia, 2013-03-01) Ribeiro, Ronaldo [UNIFESP]; Coutinho, Gustavo L.; Iuras, Anderson; Barbosa, Ana Maria; Souza, José Adilson Camargo De; Diniz, Denise Pará [UNIFESP]; Schor, Nestor [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Instituto de Nefrologia de Taubaté; Universidade do Estado do Amazonas Escola Superior de Ciências da Saúde; Faculdade Anhanguera de Taubaté
    INTRODUCTION: Patients with chronic kidney disease (CKD) when subjected to resistance exercise (RE) show substantial improvements in many functions, especially those related to the cardiovascular system, respiratory, muscular and quality of life (QOL). There are no evaluations of the impact of exercise simple and feasible in patients with CKD associated with Diabetes Mellitus (DM) during the intradialytic period. Thus, patients with CKD and submit to the DM + RE during hemodialysis. OBJECTIVE: To study the role of resistance exercise in the treatment and quality of life in patients undergoing chronic hemodialysis (HD). METHODS: 15 patients in each group: 1: DM with CKD and RE; 2: DM + CKD sedentary; 3: CKD + RE and 4: DRC sedentary. They were evaluated during eight weeks, with RE three times a week. Parameters: Laboratory assessments, muscle strength testing (FM) and QV (SF-36). RESULTS: RE induced improvement in glucose and FM with subtle but significant changes in urea, or even in the K (p < 0.0001). It was an improvement in the impact assessment of QOL parameters (p < 0.001) with the RE, such as Functional Capacity, Physical Aspect, Reduction of Pain (in general), General Health, Vitality, Social Function, Emotional State and Mental Health. CONCLUSION: The RE program (simple and feasible) during intradialytic clinical parameters changed FM and a significant improvement in QOL assessment were observed. The impact on QOL was important for the patient, including those involving improvement in level of family and social relationships when subjected to RE.
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    Hiperhomocisteinemia na insuficiência renal crônica
    (Pontifícia Universidade Católica de Campinas, 2005-04-01) Nerbass, Fabiana Baggio [UNIFESP]; Draibe, Sergio Antonio [UNIFESP]; Cuppari, Lilian [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Homocysteine is a sulfur-containing amino acid derived from the metabolism of methionine, whose abnormal accumulation in plasma is a risk factor for vascular disease in the general population and in patients with chronic renal disease. In these patients, the prevalence of individuals with hyperhomocysteinemia is very high, even in the pre-dialysis stage of the disease. The main factor that seems to be implicated on the elevation of homocysteine levels in this population is the renal mass loss, considering that the kidney has an important role in the metabolism of such amino acid. The treatment of hyperhomocysteinemia consists on supplementation of the vitamins that are involved in the homocysteine metabolism (folate, B6 and B12.). However, for chronic renal disease patients, this treatment is not completely effective, because although it promotes reduction of homocysteine levels, the normalization is not reached in the majority of the patients. This study reviews the hyperhomocysteinemia etiology on chronic renal disease, its main determinants, its relationship with vascular diseases, and the modes of treatment.
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    Polirradiculoneuropatia desmielinizante inflamatória crônica: estudo de 18 pacientes
    (Academia Brasileira de Neurologia - ABNEURO, 1997-01-01) Calia, Leandro C.; Oliveira, Acary Souza Bulle [UNIFESP]; Gabbai, Alberto Alain [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    This is a prospective study that describes 18 patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), idiopathic type. The patients have been followed for a period of 4 to 127 months. We evaluated the clinical characteristics, the evolution, and therapeutic response. Male patients outnumbered female patients in a proporction of 1.25:1. Symptoms first appeared at an age ranging from 6 to 85. Most of the patients denied the occurrence of preceding events and a progressive evolution prevailed over relapsing evolution. All patients had both motor and sensory dysfunction associated with loss of tendon reflexes, and only three patients (16.7%) had cranial nerve involvement. The cerebrospinal fluid protein levels were increased in 88.9% of the patients and mean level was 203.4 mg/dl. Electrophysiological studies revealed demyelination in all patients and axonal damage in 94.4%. Preponderant characteristics in the sural nerve biopsy of seven patients showed demyelination and remyelination, and changes indicative of axonal damage were often present. The anti-HLA Dr antibodies were found in the sural nerve of one patient and anti-CD3 antibodies in the sural nerve of two. All patients were first treated with prednisone. The drug was mantained in reduced doses and given in alternate days to 72.2% of the patients with success. Two patients (11.1%) are asymptomatic even after the withdrawal of all medication. We administered azathioprine, associated or not with corticoid, to the four patients who had not had a satisfactory response to the prednisone treatment. By the time of the last evaluation 16 patients (88.9%) had functional improvement.
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    Relatorio do Censo Brasileiro de Dialise Cronica 2012
    (Sociedade Brasileira de Nefrologia, 2014-03-01) Sesso, Ricardo de Castro Cintra [UNIFESP]; Lopes, Antonio Alberto; Thome, Fernando Saldanha; Lugon, Jocemir Ronaldo; Watanabe, Yoshimi; Santos, Daniel Rinaldi dos; Universidade Federal de São Paulo (UNIFESP); Universidade Federal da Bahia; Universidade Federal do Rio Grande do Sul; Universidade Federal Fluminense; Hospital Sao Joao de Deus; Faculdade de Medicina do ABC
    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 chronic kidney disease patients on dialysis in July 2012.Methods:A survey based on data of dialysis units from the whole country. The data collection was performed by using a questionnaire filled out on-line by the dialysis units in Brazil.Results:255 (31.9%) of the dialysis units in the country answered the questionnaire. In July 2012, the total estimated number of patients on dialysis in the country was 97,586. The estimated prevalence and incidence rates of chronic kidney disease on maintenance dialysis were 503 and 177 patients per million population, respectively. The estimated number of new patients starting dialysis in 2012 was 34,366. The annual gross mortality rate was 18.8%. For prevalent patients, 31.9% were aged 65 years or older, 91.6% were on hemodialysis and 8.4% on peritoneal dialysis, 30,447 (31.2%) were on a waiting list of renal transplant, 28.5% were diabetics, 36.6% had serum phosphorus > 5.5 mg/dl and 34.4% hemoglobin < 11 g/dl. A venous catheter was the vascular access for 14.5% of the hemodialysis patients.Conclusion:The prevalence and incidence rates of chronic kidney disease patients on dialysis increased, while the mortality rate tended to decrease compared with 2011. The indicators of the quality of maintenance dialysis remained stable with a trend towards decrease in levels of anemia. The data highlight the importance of the census to guide chronic dialysis therapy.