Navegando por Palavras-chave "hemodialysis"

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    Anti-N-like and anti-form red cell antibodies in chronic hemodialysis patients
    (Marcel Dekker Inc, 2004-01-01) Fonseca, HEM; Chiba, A. K.; Junior, A. F.; Draibe, S. A.; Bordin, J. O.; Universidade Federal de São Paulo (UNIFESP)
    Allogeneic red blood cell (RBC) transfusions and the use of reusable dialyzers sterilized with formaldehyde can lead to RBC alloimmunization in chronic hemodialysis patients. the formed RBC alloantibodies have been implicated in immediate kidney allograft failure and decreased RBC survival observed in these patients. Using indirect antiglobulin test, direct antiglobulin test (DAT), and direct Polibrene(R) test (DPT), we detected an RBC alloimmunization rate of 17.2% (11/64) in transfused hemodialysis patients, and found the presence of anti-N-like and anti-Form antibodies in 5 (5.7%) and 53 (60.9%) individuals, respectively. the sensitivity rate of the DPT was significantly higher than that of the DAT in detecting anti-Form, but the DAT showed a higher specificity rate compared with the DPT. We conclude that patients treated with reusable dialyzers sterilized with formaldehyde may develop specific RBC alloantibodies that could increase the potential risk of hemolysis, decrease survival of RBCs, and increase the need of blood supply.
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    Change in hepatitis C virus genotype in hemodialysis patients after end-of-treatment response to interferon monotherapy-relapse or re-infection?
    (Wiley-Blackwell, 2008-01-01) Arrais, Teresa Cristina de Oliveira Maia [UNIFESP]; Van Dooren, Sonia; Vandamme, Anne-Mieke; Brechot, Christian; Rimlinger, Francois; Silva, Antonio Eduardo Benedito [UNIFESP]; Perez, Renata de Mello [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; Thiers, Valerie; Erasmus MC; Universidade Federal de São Paulo (UNIFESP); Katholieke Univ Leuven; Inst Pasteur; INSERM; Univ Paris Sud
    Hepatitis C virus (HCV) infection remains common among hemodialysis patients and its occurrence is related mainly to nosocomial spread. Although dialysis patients with HCV infection respond well to interferon-based therapy, relapse is frequent. This study aimed at a selected group of hemodialysis patients infected with HCV infection undergoing interferon therapy who achieved end-of-treatment virological response but became HCV-RNA positive again 6 months after end-of-treatment. It was evaluated whether de novo HCV-RNA positivity in these non-sustained responders occurred due to lack of clearance of HCV after the initial response to interferon-alpha (relapse) or due to re-infection with a new strain (re-infection). Genotyping by Inno-LiPA and by phylogenetic tree analysis using partial HCV-NS5B sequences at two evaluation points: pre-treatment (TO) and 6 months after end-of-treatment (T0). Non-sustained responders (n = 15) carried subtypes la (8 patients), 1b (4 patients), 3a (2 patients), and 4a (11 patient) before treatment. Identical subtypes were detected in 10 patients at T18. Five patients changed genotypes at T18, suggesting nosocomial re-infection. This study emphasizes the importance of epidemiologic measures to control the re-exposure of hemodialysis patients treated previously for HCV infection.
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    Clinical and laboratory characteristics of acute hepatitis C in patients with end-stage renal disease on hemodialysis
    (Lippincott Williams & Wilkins, 2008-02-01) Lemos, Lara Barros [UNIFESP]; Perez, Renata de Mello [UNIFESP]; Matos, Carla Adriana Loureiro de [UNIFESP]; Silva, Ivonete S. [UNIFESP]; Silva, Antonio Eduardo Benedito [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; Universidade Federal do Rio de Janeiro (UFRJ); Universidade Federal de São Paulo (UNIFESP)
    Background: Patients with end-stage renal disease (ESRD) undergoing hemodialysis are a risk group for hepatitis C virus (HCV) infection. The characteristics of acute hepatitis C infection in this population are not well known.Goals: To evaluate the clinical and laboratory characteristics of acute hepatitis C in ESRD patients treated with hemodialysis.Study: ESRD patients on hemodialysis with acute hepatitis C, characterized by elevated alanine aminotransferase (ALT) followed by anti-HCV seroconversion were studied.Results: Thirty-six patients (58% females, 44 +/- 12 y), with a mean time on hemodialysis of 2 years, were included. Only 2 (6%) patients had jaundice. ALT elevation was observed in all patients. Median peak ALT was 4.7 x upper limit of normal. The median interval between ALT elevation and anti-HCV seroconversion was I month (0 to 8). None of the patients with detectable HCV-RNA showed spontaneous clearance of viremia within 12 weeks of follow-up. Three (8%) patients presented ALT elevation followed by anti-HCV seroconversion with undetectable HCV-RNA.Conclusions: Acute hepatitis C is frequently asymptomatic in ESRD patients on hemodialysis and should be suspected in all patients presenting elevated ALT. Determination of HCV-RNA is important for the confirmation of infection. Anti-HCV seroconversion seems to occur early and spontaneous clearance of HCV-RNA is uncommon.
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    Cognitive-behavioral group therapy is an effective treatment for major depression in hemodialysis patients
    (Nature Publishing Group, 2009-08-01) Duarte, Priscila Silveira [UNIFESP]; Miyazaki, Maria Cristina; Blay, Sergio Luis [UNIFESP]; Sesso, Ricardo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Sch Med Sao Jose Rio Preto
    Depression is an important target of psychological assessment in patients with end-stage renal disease because it predicts their morbidity, mortality, and quality of life. We assessed the effectiveness of cognitive-behavioral therapy in chronic hemodialysis patients diagnosed with major depression by the Mini International Neuropsychiatric Interview (MINI). in a randomized trial conducted in Brazil, an intervention group of 41 patients was given 12 weekly sessions of cognitive-behavioral group therapy led by a trained psychologist over 3 months while a control group of 44 patients received the usual treatment offered in the dialysis unit. in both groups, the Beck Depression Inventory, the MINI, and the Kidney Disease and Quality of Life-Short Form questionnaires were administered at baseline, after 3 months of intervention or usual treatment, and after 9 months of follow-up. the intervention group had significant improvements, compared to the control group, in the average scores of the Beck Depression Inventory overall scale, MINI scores, and in quality-of-life dimensions that included the burden of renal disease, sleep, quality of social interaction, overall health, and the mental component summary. We conclude that cognitive-behavioral group therapy is an effective treatment of depression in chronic hemodialysis patients.
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    Comparison of nutritional and inflammatory markers in dialysis patients with reduced appetites
    (Amer Soc Clinical Nutrition, 2007-03-01) Carrero, Juan Jesus; Qureshi, Abdul Rashid; Axelsson, Jonas; Avesani, Carla Maria [UNIFESP]; Suliman, Mohammed E.; Kato, Sawako; Barany, Peter; Snaedal-Jonsdottir, Sunna; Alvestrand, Anders; Heimburger, Olof; Lindholm, Bengt; Stenvinkel, Peter; Karolinska Univ Hosp Huddinge; Universidade Federal de São Paulo (UNIFESP); Hosp La Paz
    Background: Anorexia is common in chronic kidney disease and worsens as the disease progresses. Sex hormones and inflammatory cytokines may be related to feeding behavior.Objective: We hypothesized that appetite would be related to inflammation and outcome in hemodialysis patients but that sex may account for differences in the symptoms associated with poor appetite.Design: A cross-sectional study was conducted in patients undergoing prevalent hemodialysis (n = 223; 127 M; (x) over bar +/- SD age: 66 +/- 14 y). Anthropometric markers of body composition, handgrip strength, and nutritional and inflammatory status were measured, and 3 groups according to their self-reported appetite were established. Overall mortality was assessed after 19 mo (range: 2-29 mo) of follow-up.Results: Poor appetite was associated with a longer vintage time, increased inflammation (higher serum concentrations of interleukin 6 and C-reactive protein), and a worse nutritional status (lower serum concentrations of insulin-like growth factor 1, albumin, urea, and creatinine). However, across worsening appetite scale, handgrip strength was incrementally lower in men but not in women (multivariate analysis of variance). In a multivariate logistic regression analysis (pseudo r(2) = 0.19), appetite loss was associated with sex [odds ratio (OR): 0.41; 95% CI: 0.24, 0.72], insulin-like growth factor I (3.58; 2.10, 6.32), and C-reactive protein > 10 mg/L (2.39; 1.34, 4.11). Finally, appetite loss was associated with worse clinical outcome even after adjustment for age, sex, inflammation, dialysis vintage, and comorbidity (likelihood ratio = 44.3; P < 0.0001).Conclusions: These results show a close association among appetite, malnutrition, inflammation, and outcome in patients undergoing prevalent hemodialysis. Moreover, our data suggest that uremic men may be more susceptible than are women to inflammation-induced anorexia.
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    The complexity of chronic kidney disease-mineral and bone disorder across stages of chronic kidney disease
    (Elsevier Science Inc, 2017) Graciolli, Fabiana G. [UNIFESP]; Neves, Katia R. [UNIFESP]; Barreto, Fellype; Barreto, Daniela V.; dos Reis, Luciene M. [UNIFESP]; Canziani, Maria E. [UNIFESP]; Sabbagh, Yves; Carvalho, Aluizio B. [UNIFESP]; Jorgetti, Vanda [UNIFESP]; Elias, Rosilene M. [UNIFESP]; Schiavi, Susan; Moyses, Rosa M. A.
    Chronic Kidney Disease (CKD)-Mineral and Bone Disorder (CKD-MBD) is a complex disease that is not completely understood. However, some factors secreted by the osteocytes might play an important role in its pathophysiology. Therefore, we evaluated the bone expression of proteins in a group of patients with CKD 2-3, CKD 4, and CKD 5 on dialysis and healthy individuals. We also tested several bone remodeling markers, and correlated these levels with bone biopsy findings. As expected, as serum calcium decreased, serum phosphate, alkaline phosphatase, fibroblast growth factor-23 (FGF-23), parathyroid hormone, and osteoprotegerin increased, as CKD progressed. Additionally, there was a gradual increase in bone resorption associated with a decrease in bone formation and impairment in bone mineralization. Bone expression of sclerostin and parathyroid hormone receptor-1 seemed to be increased in earlier stages of CKD, whereas FGF-23 and phosphorylated beta-catenin had increased expression in the late stages of CKD, although all these proteins were elevated relative to healthy individuals. Immunohistochemical studies showed that FGF-23 and sclerostin did not co-localize, suggesting that distinct osteocytes produce these proteins. Moreover, there was a good correlation between serum levels and bone expression of FGF-23. Thus, our studies help define the complex mechanism of bone and mineral metabolism in patients with CKD. Linkage of serum markers to bone expression of specific proteins may facilitate our understanding and management of this disease.
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    Dialysis care, cardiovascular disease, and costs in end-stage renal disease in Brazil
    (Cambridge Univ Press, 2007-12-01) Sesso, Ricardo de Castro Cintra [UNIFESP]; Silva, Camilla Barbosa da; Kowalski, Sergio Candido [UNIFESP]; Manfredi, Silvia Regina [UNIFESP]; Canziani, Maria Eugênia Fernandes [UNIFESP]; Draibe, Sergio Antonio [UNIFESP]; Elgazzar, Heba A.; Ferraz, Marcos Bosi [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Genzyme Corp
    Objectives: This study evaluates the cost of dialysis care in Brazil, including costs of ambulatory care and hospital admissions due to all causes and cardiovascular events.Methods: Data were analyzed for 200 patients with end-stage renal disease (ESRD) on chronic hemodialysis in Brazil between 2001 and 2004. Main end points were all-cause mortality, all-cause hospital admissions, and cardiovascular events. Direct costs of dialysis treatment and complications were computed from the perspective of two payers, the Ministry of Health (MoH) and private health insurance (PHI).Results: Mean number of days of hospitalization was 12 per patient-year. There were 105 cardiovascular events; the most frequent events were coronary disease (n = 59, 56 percent) and congestive heart failure (n = 26, 25 percent). The rate of cardiovascular events was 193 per 1,000 patient-years. There were 43 deaths, and the death rate was 79 per 1,000 patient-years. Median cost per hospital admission was US$ 675 and US$ 932 from the perspective of the MoH and PHI. For admissions due to cardiovascular causes, the corresponding costs were US$ 1,639 and US$ 4,499, respectively. Mean global cost per patient-year for chronic hemodialysis therapy was US$ 7,980 and US$ 13,428 from the perspective of the MoH and PHI, respectively.Conclusions: Patients on chronic hemodialysis care incur significant healthcare resources due to the costs of dialysis and complications, notably cardiovascular disease. New disease management programs aimed at reducing cardiovascular morbidity and efficient use of resources are critical to ensuring the sustainability of treatments for ESRD in Brazil.
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    Effect of end-stage renal disease and diabetes on zinc and copper status
    (Humana Press Inc, 2006-07-01) Batista, Maria Nazare; Cuppari, Lilian; Campos Pedrosa, Lucia de Fatima; Almeida, Maria Das Gracas; De Almeida, Jose Bruno; Queiroz de Medeiros, Anna Cecilia; Canziani, Maria Eugienia F.; Universidade Federal de São Paulo (UNIFESP); Univ Fed Rio Grande Norte
    The aim of this study was to compare the nutritional status of zinc and copper in patients with and without diabetes submitted to chronic hemodialysis. Thirty-three patients with type 2 diabetes (DM group), 30 nondiabetic patients (NDM group), and 20 healthy individuals (control group) were studied. Plasma, erythrocyte, and urinary zinc and plasma copper were obtained from atomic absorption spectrophotometry and ceruloplasmin by immunonephelometry. the anthropometric parameters were similar among the groups. Plasma zinc was lower and erythrocyte zinc was higher in the DM and NDM groups in relation to the control group. No difference in urinary zinc was observed comparing the groups. Plasma copper was higher in the DM group when compared to the NDM and control groups. Ceruloplasmin was similar in the three groups. Serum urea was a positive independent determinant of plasma zinc concentrations. the determinants of erythrocyte zinc were MAMC midarm muscle circumference and Kt/V dialysis adequacy. the determinants of plasma copper concentration were serum creatinine and serum glucose. the results of this study demonstrate an alteration in the distribution of zinc in patients with chronic kidney disease (CKD) independently of the presence of DM. Also, the status of copper seems not to be influenced by CKD, but only by the metabolic derangements associated with diabetes.
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    Effect of temporary catheter and late referral on hospitalization and mortality during the first year of hemodialysis treatment
    (Blackwell Publishing Inc, 2004-11-01) Goncalves, EAP; Andreoli, MCC; Watanabe, R.; Freitas, MCS; Pedrosa, A. C.; Manfredi, SR; Draibe, S. A.; Cendoroglo, M.; Canziani, MEF; Universidade Federal de São Paulo (UNIFESP)
    Late referral (LR) to dialysis therapy has been associated with poor outcomes in people with end-stage renal disease. This had been ascribed to the frequent use of temporary vascular catheters (TVCs) in LR patients. the effects of LR and TVC on the outcomes of an incident hemodialysis population (n = 101) were investigated. There was a higher incidence of vascular access infection, longer period of hospitalization, and lower survival in TVC and LR groups, compared with arteriovenous fistula and early referral (ER) groups, respectively. Late referral patients had higher number of hospitalizations than ER patients. in univariate analysis, LR (hazard ratio [HR] 10.8, P = 0.02) and albumin (HR 0.23, P < 0.0001) were associated with mortality. Late referral and body mass index were associated with the increased risk of hospitalization in univariate analysis. in multivariate analysis, LR was the only risk factor associated with hospitalization (HR 3.51, P = 0.002). in conclusion, LR was associated with increased risk of mortality and increased risk of hospitalization independently of the presence of a TVC.
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    Efficacy and tolerance of interferon-alpha in the treatment of chronic Hepatitis C in end-stage renal disease patients on hemodialysis
    (Blackwell Publishing, 2006-04-01) Rocha, C. M.; Perez, R. M.; Ferreira, A. P.; Carvalho-Filho, R. J.; Pace, F. H.; Silva, I. S.; Pestana, JOM; Lanzoni, V. P.; Silva, A. E.; Ferraz, MLG; Universidade Federal de São Paulo (UNIFESP)
    Background: Patients with end-stage renal disease (ESRD) show a high prevalence of hepatitis C, with a negative impact on the survival on hemodialysis and after renal transplantation. We evaluated the efficacy and tolerance of interferon-alpha (IFN-alpha) in HCV-infected ESRD patients on dialysis. Methods: Forty-six HCV-RNA-positive ESRD patients were studied. IFN-alpha regimen consisted of 3 million units three times a week for 12 months, and the patients were followed up for 6 months. End-of-treatment, and sustained biochemical and virological responses were evaluated and tolerance was assessed monthly. Results: A sustained virological response (SVR) was observed in 10/46 patients (22%) and in 10/29 who completed the treatment (34%). Alanine aminotransferase was elevated in 63% of the patients at the beginning of the study and returned to normal levels within the first month in all patients with SVR. Treatment was discontinued because of side effects in 11/46 patients (24%) and six patients (13%) were lost to follow-up. Conclusions: IFN-alpha monotherapy for hepatitis C in dialysis patients shows a high frequency of adverse effects. However, the SVR is high (34%) in patients who complete treatment, emphasizing the importance of careful selection and close follow-up in order to minimize and control possible side effects.
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    Erectile dysfunction in patients with chronic renal failure
    (Sociedade Brasileira de Urologia, 2007-10-01) Messina, Leonardo E. [UNIFESP]; Claro, Joaquim A. [UNIFESP]; Archimedes, Nardozza [UNIFESP]; Andrade, Enrico [UNIFESP]; Ortiz, Valdemar [UNIFESP]; Srougi, Miguel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: Determine the prevalence of erectile dysfunction in patients undergoing hemodialysis MATERIALS AND METHODS: This cross-sectional study was carried out to determine the prevalence of erectile dysfunction in a population of 58 patients in hemodialysis program. Erectile dysfunction was assessed by using the International Index of Erectile Function (IIEF). Information on demographic data, renal failure, comorbidities, laboratory tests and search for medical treatment for erectile dysfunction by means of interviews and researches in medical charts was obtained. Student t test was utilized to compare the laboratory results between group of patients with and without erectile dysfunction. The chi-square test was utilized to compare the comorbidities and the characteristics of the population studied between the groups of patients with and without erectile dysfunction. The significance level considered was 5% RESULTS: Mean patient age was 50.2 ± 14.6 years and the time of hemodialysis was 30.4 ± 28.4 months. The prevalence of erectile dysfunction was 60.3%. A progressive increase respecting the age was reported. In patients younger than 50 years, this prevalence reached 31.4% and in patients older than 50 years, this prevalence reached 68.6%. With respect to the comorbidities, hypertensive patients prevailed with 94.8% of the total, whilst diabetic patients represented 24.9%. However only the association between diabetes and erectile dysfunction was significant. Patients with erectile dysfunction presented significantly lower values for serum creatinine and Kt/V. There was no variation between the groups with reference to calcium, potassium, phosphorus, hematocrit, hemoglobin, pre- and post-dialysis urea values. There was no correlation between erectile dysfunction and time of dialysis. Amongst patients with erectile dysfunction, 8.6% sought medical care CONCLUSIONS: The prevalence of erectile dysfunction in patients in hemodialysis program was of 60.3%. Age, diabetes and hemodialysis characteristics are associated to higher incidence of erectile dysfunction.
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    Evaluation of factors associated with chronic low back pain in hemodialysis patients
    (Karger, 2008-01-01) Cristofolini, Tatiana [UNIFESP]; Draibe, Sergio [UNIFESP]; Sesso, Ricardo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background/Aims: Low back pain is a common and disabling symptom that has not been properly studied in hemodialysis patients. the aim of this study was to evaluate factors associated with chronic low back pain in these patients. Methods: We evaluated 205 patients undergoing chronic hemodialysis. Data were obtained through medical records, patient interviews and physical examination. Balance was evaluated through the Tinetti scale. the muscular strength was evaluated through the quadriceps muscle manual test and the Kendall scale graduation. Results: 74 patients (36.1%) had low back pain. They were older (p = 0.020), undergoing dialysis for a longer period (p = 0.071) and had more comorbidities than patients without lumbar pain. Among the patients with low back pain, 75.7% presented balance disorders and 59.5% muscular weakness. in multivariate analysis the factors related to low back pain were balance deficit (OR: 9.30; 95% CI: 2.77-31.20), muscular strength deficit (OR: 14.33; 95% CI: 4.55-45.19), arterial hypertension (OR: 4.51; 95% CI: 1.32-15.37), bone disease (OR: 43.39; 95% CI: 11.51-163.53) and cerebrovascular disease (OR: 20.21; 95% CI: 3.28-124.65). Conclusions: Chronic low back pain is common in hemodialysis patients and is associated with muscle weakness, balance disorders, and comorbidities. Copyright (C) 2008 S. Karger AG, Basel.
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    Fibromyalgia: Its prevalence and impact on the quality of life on a hemodialyzed population
    (Blackwell Publishing, 2008-01-01) Couto, Claudio I. [UNIFESP]; Natour, Jamil [UNIFESP]; Carvalho, Aluizio B. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Fibromyalgia syndrome (FMS) is characterized by widespread musculoskeletal pain. It has negative effects on quality of life and has been poorly investigated in specific populations. Our aim was to determine the prevalence of FMS in Brazilian hemodialysis (HD) patients and to investigate its effects on the quality of life. We investigated 311 patients on HD who were submitted to physical examination towards the classification of FMS. All subjects from FMS and control groups were submitted to laboratorial investigation and completed questionnaires of quality of life. the prevalence of FMS was 3.9%, which was close to that of the general population. Most patients were females and from non-Caucasian races. No difference between FMS and control groups was observed regarding race, dialysis adequacy, nutritional status and level of schooling. Ionized calcium was higher in the FMS group than in the control group. There was no association between FMS and secondary hyperparathyroidism. On the other hand, FMS was associated with worse quality of life, depression and anxiety. in conclusion, the prevalence of FMS in HD patients was similar to that of the general population. It was associated with decreasing quality of life in HD patients, in addition to higher degrees of depression and anxiety. No laboratory tests could identify FMS patients on HD. Fibromyalgia syndrome subsequently follows without a well-established mechanism of pathogenesis, and seems to be due to multifactorial causes. Its true impact on the quality of life of HD patients deserves more attention by nephrologists.
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    Fístula arteriovenosa safeno-femoral superficial como acesso à hemodiálise: descrição de técnica operatória e experiência clínica inicial
    (Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV), 2005-01-01) Corrêa, João Antônio; Pires, Adilson Casemiro; Kafejian, Ohannes; Miranda Jr., Fausto [UNIFESP]; Galego, Sidnei José; Yamazaki, Yumiko Regina; Fujii, Eliane Yumi; Fioretti, Alexandre César; Faculdade de Medicina do ABC; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To describe a technique for creating an arteriovenous fistula as an access to hemodialysis, evaluating its technical aspects, efficacy and complications. METHOD: From August 1998 to October 2000, 16 superficial saphenofemoral arteriovenous fistulas were performed in 15 patients. These procedures were used in patients without access options in upper limbs. The surgical technique consisted of an anteriorization and a superficialization of the saphenous vein anastomosed to the superficial femoral artery in the distal portion. The superficial saphenofemoral arteriovenous fistulas were evaluated with regard to puncture, appropriate flow, spontaneous venous pressure, dialysis adequacy and intraoperative complications. RESULTS: There were no intraoperative complications and all the fistulas could be successfully concluded. There was one early death, but the other fistulas were able to the hemodialysis in the 30th postoperative day. Fourteen fistulas were used; in the evolution, three patients were submitted to renal transplant, four presented thrombosis and two presented puncture pseudoaneurysm. CONCLUSION: Superficial saphenofemoral arteriovenous fistulas proved to be a good alternative for patients who do not have other possibilities of vascular access in upper limbs, thus allowing an effective hemodialysis treatment, with a good patency rate at medium term.
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    Gaining Efficiencies: Resources and Demand for Dialysis around the Globe
    (Wiley-Blackwell, 2009-01-01) Neil, Nancy; Walker, David R.; Sesso, Ricardo [UNIFESP]; Blackburn, Juan Carlos; Tschosik, Elizabeth A.; Sciaraffia, Vito; Garcia-Contreras, Fernando; Capsa, Dimitrie; Bhattacharyya, Samir K.; ICON Clin Res; Baxter Healthcare Corp; Universidade Federal de São Paulo (UNIFESP); Baxter Export Corp; Univ Chile; IMSS; Fundeni Clin Inst
    End-stage renal disease (ESRD) is a debilitating condition resulting in death unless treated. Treatment options are transplantation and dialysis. Alternative dialysis modalities are peritoneal dialysis (PD) and hemodialysis (HD), each of which has been shown to produce similar outcomes and survival. Nevertheless, the financial implications of each modality are different and these differences vary by country, especially in the developing world. Changes in clinically appropriate dialysis delivery leading to more efficient use of resources would increase the resources available to treat ESRD or other disabling conditions. This article outlines the relative advantages of HD and PD and uses budget impact analysis to estimate the country-specific, 5-year financial implications on total dialysis costs assuming utilization shifts from HD to PD in two high-income (UK, Singapore), three upper-middle-income (Mexico, Chile, Romania), and three lower-middle-income (Thailand, China, Colombia) countries.Peritoneal dialysis is a clinically effective dialysis option that can be significantly cost-saving compared to HD, even in developing countries.The magnitude of costs associated with treating ESRD patients globally is large and growing. PD is a clinically effective dialysis option that can be used by a majority of ESRD patients and can also be significantly cost-saving compared to HD therapy. Increasing clinically appropriate PD use would substantially reduce health-care costs and help health-care systems meet ever-tightening budget constraints.
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    Health-Related Quality of Life of Patients Recieving Hemodialysis and Peritoneal Dialysis in São Paulo, Brazil: A Longitudinal Study
    (Elsevier B.V., 2011-07-01) Abreu, Mirhelen Mendes de [UNIFESP]; Walker, David R.; Sesso, Ricardo de Castro Cintra [UNIFESP]; Ferraz, Marcos Bosi [UNIFESP]; Universidade Federal de São Carlos (UFSCar); Baxter Healthcare Corp; Universidade Federal de São Paulo (UNIFESP)
    Objectives: the aim of this study was to evaluate quality of life in patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) in São Paulo, Brazil. Methods: Inclusion criteria for this is a 1-year prospective study included being 18 years of age or older and clinically stable receiving chronic dialysis. Quality of life was measured using the SF-12 and the Kidney Disease Quality of Life questionnaires at baseline, 6 months, and 12 months. Patients who completed the surveys for all three periods were evaluated. Differences in quality of life scores were measured using univariate and multivariate regression analyses. Results: One hundred eighty-nine of 249 (76%) HD patients and 161 of 228 (71%) PD patients completed all three surveys. the PD group was older and a larger number had diabetes. PD patients consistently had higher scores than HD patients at all three measurement periods for patient satisfaction (P = 0.002, P = 0.005, and P = 0.005, respectively), encouragement/support from staff (P = 0.003, P = 0.017, and P = 0.029, respectively), and burden of kidney disease (P = 0.003, P = 0.017, and P = 0.057, respectively). the HD group had a greater percent of patients who clinically improved from baseline to 12 months compared to PD patients for sleep quality, social support, encouragement/support from staff, and overall health. Scores for other dimensions of the Kidney Disease Quality of Life and SF-12 questionnaires were not significantly different between the PD and HD groups. Conclusions: the results provide evidence that PD and HD patients have equivalent health-related quality of life in several domains, although the former performed better in some quality of life domains despite being older and having more comorbidities.
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    Hepatitis C and hemodialysis: a review
    (Brazilian Society of Infectious Diseases, 2005-08-01) Moreira, Regina Célia; Lemos, Marcilio Figueiredo; Longui, Carlos Alberto; Granato, Celso Francisco Hernandes [UNIFESP]; Adolfo Lutz Institute Virology Service Laboratory of Hepatitis; Irmandade da Santa Casa de Misericórdia de São Paulo; Faculty of Medical Sciences Santa Casa de São Paulo Molecular Medicine Laboratory; Universidade Federal de São Paulo (UNIFESP)
    Hepatitis C is a serious public health problem throughout the world; chronic renal patients are highly exposed to this infection. This could be due to a failure to identify carriers of this disease or because of a lack of truly effective biosafety measures implemented in the dialysis units. Molecular biology techniques have allowed for the understanding of this virus in detail, including its replication mechanisms. Epidemiological studies have been made throughout the world, with the goal of determining the dissemination dynamics of this agent, in addition to examining the predominance of the different genotypes, and the possible mutants that are involved. Many questions must still be answered concerning infection by Hepatitis C virus (HCV); this is especially important for immunosuppressed patients.
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    Hepatitis C in chronic kidney disease: Predialysis patients present more severe histological liver injury than hemodialysis patients?
    (Karger, 2007-01-01) Lemos, Lara B.; Perez, Renata M.; Lemos, Marcelo M.; Lanzoni, Valeria P.; Draibe, Sergio A.; Souza e Silva, Ivonete Sandra de [UNIFESP]; Silva, Antonio Eduardo B.; Ferraz, Maria Lucia G.; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Rio de Janeiro (UFRJ)
    Background: the characteristics of hepatitis C virus (HCV) infection in predialysis patients are poorly understood and they could be different from hemodialysis patients. Aims: To evaluate the demographics, laboratory and histological characteristics of chronic HCV infection in predialysis patients and to compare them with those observed in hemodialysis patients. Methods: Thirty-nine predialysis patients with chronic HCV infection were compared to HCV-infected hemodialysis patients (ratio of 1: 3) in terms of demographics, laboratory and histological characteristics. the fibrosis progression rate (FPR) was calculated as the ratio between fibrosis stage and duration of infection. Results: Predialysis patients were older (57 8 10 vs. 45 8 12 years; p < 0.001), presented a higher proportion of elevated alanine aminotransferase (71.8 vs. 41.0%; p = 0.001) and aspartate aminotransferase (64.1 vs. 26.5%; p < 0.001), a higher proportion of interface hepatitis (66.7 vs. 47%; p = 0.033) and more advanced fibrosis (71.8 vs. 16.2%; p = 0.001). Among patients with estimated duration of infection, predialysis patients presented a longer duration of infection (22 vs. 6 years; p < 0.001) and no difference in FPR was observed between groups (p = 0.692). Conclusion: Although predialysis patients with HCV infection present more severe histological injury than hemodialysis patients, this finding probably reflects a longer duration of infection with no evidence supporting that hepatitis C presents a more aggressive course in this group. Copyright (c) 2007 S. Karger AG, Basel
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    Histological evolution of hepatitis C virus infection after renal transplantation
    (Wiley-Blackwell, 2012-11-01) Oliveira Uehara, Silvia Naomi de [UNIFESP]; Emori, Christini Takemi [UNIFESP]; Pereira, Patrícia da Silva Fucuta [UNIFESP]; Perez, Renata M.; Medina Pestana, Jose Osmar; Lanzoni, Valeria Pereira; Souza e Silva, Ivonete Sandra [UNIFESP]; Benedito Silva, Antonio Eduardo [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Rio de Janeiro (UFRJ)
    Background: information regarding histological progression of hepatitis C after renal transplant (RTx) is scarce. Aims: To analyze clinical and laboratory evolution and histological progression of hepatitis C in patients evaluated before and after RTx.Methods: Twenty-two HCV-infected patients submitted to liver biopsy pre- and post-RTx were included. A semiquantitative analysis of necroinflammatory activity and fibrosis staging was performed and the two biopsies were compared.Results: Patients were mostly men (73%) with mean age of 36 +/- 9 yr. Time post-transplant was 4 +/- 2 yr and time between biopsies was 5 +/- 2 yr. An elevation of alanine aminotransferase (p = 0.041) and aspartate aminotransferase (p = 0.004) levels was observed in the post-transplant period. Fibrosis progression after renal transplantation was observed in 11 (50%) of the patients, and necroinflammatory activity worsening was observed in 7 (32%) of the patients. the histological progression occurred even among those without significant histological lesions in pre-transplant biopsy.Conclusion: the findings of this study suggest that the practice of indicating treatment in the pre-transplant phase based mainly on histological disease should be revised, because a high proportion of patients present disease progression. Because interferon cannot be used safely after RTx, treatment should be indicated for all ESRD patients with hepatitis C.
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    Impact of Compression Stockings vs. Continuous Positive Airway Pressure on Overnight Fluid Shift and Obstructive Sleep Apnea among Patients on Hemodialysis
    (Frontiers Media Sa, 2017) Silva, Bruno C.; Santos, Roberto S. S.; Drager, Luciano F.; Coelho, Fernando M. [UNIFESP]; Elias, Rosilene M.
    Introduction: Obstructive sleep apnea (OSA) is common in edematous states, notably in hemodialysis patients. In this population, overnight fluid shift can play an important role on the pathogenesis of OSA. The effect of compression stockings (CS) and continuous positive airway pressure (CPAP) on fluid shift is barely known. We compared the effects of CS and CPAP on fluid dynamics in a sample of patients with OSA in hemodialysis, through a randomized crossover study. Methods: Each participant performed polysomnography (PSG) at baseline, during CPAP titration, and after 1 week of wearing CS. Neck circumference (NC) and segmental bioelectrical impedance were done before and after PSG. Results: Fourteen patients were studied (53 9 years