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Malta LMDA, Lugon JR, Santos AASMDD, Machado LM. Morphometric magnetic resonance imaging study of the quadriceps tendon in hemodialysis patients: comparison with non-dialyzed controls. Radiol Bras 2022; 55:293-298. [PMID: 36320376 PMCID: PMC9620849 DOI: 10.1590/0100-3984.2021.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/15/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the knees of individuals with renal failure who are on
hemodialysis, using magnetic resonance imaging (MRI), comparing them with
those of a group of individuals with normal renal function. Materials and Methods This was a cross-sectional, observational, controlled study conducted between
August 2018 and February 2020. The cases consisted of 15 patients who had
been on hemodialysis for ≥ 5 years and did not have a quadriceps
tendon rupture. The controls consisted of 15 individuals with normal renal
function who were matched (1:1) to the cases for sex, age, and physical
activity level. The subjects in both groups underwent MRI of the right knee
only. Results The mean ages of the cases and controls were 50 ± 15 years and 49
± 14 years, respectively. The median time on hemodialysis was 11
years (range, 10-14 years). Serum levels of parathyroid hormone, ferritin,
alkaline phosphatase, phosphorus, and creatinine were higher among the cases
than among the controls, whereas serum albumin and hemoglobin were lower
(p < 0.05 for all). The MRI study showed a
hyperintense signal in the quadriceps tendon in 11 of the cases and in three
of the controls (p = 0.009). Knee joint effusion was
observed in nine of the cases and in three of the controls
(p < 0.05). The thickness, length, and width of the
tendon did not differ between the groups. A hyperintense signal in the
tendon was not associated with the time on hemodialysis; nor with the levels
of intact parathyroid hormone, hemoglobin, or alkaline phosphatase. Conclusion Patients on chronic hemodialysis, even those without a tendon rupture, show a
hyperintense signal in the quadriceps tendon on MRI.
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Pain in Hemodialysis Patients: Prevalence, Intensity, Location, and Functional Interference in Daily Activities. Healthcare (Basel) 2021; 9:healthcare9101375. [PMID: 34683055 PMCID: PMC8544358 DOI: 10.3390/healthcare9101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 11/24/2022] Open
Abstract
Although pain is a frequent complaint of patients with chronic kidney disease who undergo hemodialysis, few studies have assessed the functional interference of pain in activities of daily living (ADLs). Hence, the aim of this study was to evaluate the prevalence, location, intensity, and functional interference of pain in ADLs of chronic kidney disease patients undergoing hemodialysis and to estimate the association of specific pain sites with severe functional interference by pain in ADLs. This cross-sectional study included patients with chronic kidney disease undergoing hemodialysis. The prevalence, intensity, and functional interference of pain in ADLs were assessed using the brief pain inventory. Poisson regression was used to calculate the prevalence ratio. A total of 65 patients participated in the study. The overall prevalence of pain was 89.23%; the prevalence of headache was 18.46% and that of pain in the trunk was 55.38%, upper limbs was 35.38%, and lower limbs was 60.00%. The prevalence of moderate and severe pain at the time of hemodialysis was 13.85% and 21.54%, respectively. A high prevalence of severe functional interference of pain in general activity (61.54%), mobility (56.92%), and disposition (55.38%) was observed. Pain is a frequent complaint in patients undergoing hemodialysis, mainly musculoskeletal and intradialytic, and it interferes with ADLs and incapacitates the patient. Pain was highly prevalent in the upper and lower limbs and the trunk. Furthermore, a higher prevalence of severe pain at the time of hemodialysis and functional interference of pain, mainly in general activity, mobility, and disposition, were observed.
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Neves PDMDM, Sesso RDCC, Thomé FS, Lugon JR, Nascimento MM. Brazilian dialysis survey 2019. J Bras Nefrol 2021; 43:217-227. [PMID: 33513218 PMCID: PMC8257289 DOI: 10.1590/2175-8239-jbn-2020-0161] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/02/2020] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION National data on chronic dialysis treatment are essential for the development of health policies that aim to improve the treatment of patients. OBJECTIVE To present data from the Brazilian Dialysis Survey 2019, promoted by the Brazilian Society of Nephrology. METHODS Data collection from dialysis units in the country through a completed online questionnaire for 2019. RESULTS 314 (39%) centers responded the questionnaire. In July 2019, the estimated total number of patients on dialysis was 139,691. Estimates of the prevalence and incidence rates of patients undergoing dialysis treatment per million of the population (pmp) were 665 and 218, respectively, with mean annual increases of 25 pmp and 14 pmp for prevalence and incidence, respectively. The annual gross mortality rate was 18.2%. Of the prevalent patients, 93.2% were on hemodialysis and 6.8% on peritoneal dialysis; and 33,015 (23.6%) on the waiting list for transplantation. 55% of THE centers offered treatment with peritoneal dialysis. Venous catheters were used as access in 24.8% of THE patients on hemodialysis. 17% of the patients had K ≥ 6.0mEq/L; 2.5% required red blood cell transfusion in July 2019 and 10.8% of the patients had serum levels of 25-OH vitamin D < 20 ng/mL. CONCLUSION The absolute number of patients, the incidence and prevalence rates in dialysis in the country continue to increase, as well as the percentage of patients using venous catheter as dialysis access. There was an increase in the number of patients on the list for transplantation and a tendency to reduce gross mortality.
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Neves PDMDM, Sesso RDCC, Thomé FS, Lugon JR, Nasicmento MM. Brazilian Dialysis Census: analysis of data from the 2009-2018 decade. J Bras Nefrol 2020; 42:191-200. [PMID: 32459279 PMCID: PMC7427641 DOI: 10.1590/2175-8239-jbn-2019-0234] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 01/30/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION National data on chronic dialysis treatment are essential for the development of health policies that aim to improve patient treatment. OBJECTIVE To present data from the Brazilian Society of Nephrology on patients with chronic dialysis for kidney disease in July 2018, making a comparative analysis of the past 10 years. METHODS Data collection from dialysis units, with filling in an online questionnaire for 2018. Data from 2009, 2013 and 2018 were compared. RESULTS 288 (36.6%) centers answered the questionnaire. In July 2018, the estimated total number of patients on dialysis was 133,464. Estimates of the prevalence and incidence rates of patients undergoing dialysis treatment per million of the population (pmp) were 640 and 204, respectively, with average annual increases of 23.5 pmp and 6 pmp for prevalence and incidence, respectively. The annual gross mortality rate was 19.5%. Of the prevalent patients, 92.3% were on hemodialysis and 7.7% on peritoneal dialysis, with 29,545 (22.1%) on the waiting list for transplantation. Median bicarbonate concentration in the hemodialysis bath was 32 mEq/L. Venous catheters were used as access in 23.6% of the hemodialysis patients. The prevalence rate of positive serology for hepatitis C showed a progressive reduction (3.2%). CONCLUSION The absolute number of patients and rates of incidence and prevalence in dialysis in the country increased substantially in the period, although there are considerable differences in rates by state. There has been a persistent increase in the use of venous catheters as an access for dialysis; and reduction in the number of patients with positive serology for hepatitis C.
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Bacci MR, Cabral LS, L. da Veiga G, da C.A. Alves B, Murad N, Fonseca FL. The Impact of Inflammatory Profile on Selenium Levels in Hemodialysis Patients. Antiinflamm Antiallergy Agents Med Chem 2020; 19:42-49. [PMID: 30666918 PMCID: PMC7460750 DOI: 10.2174/1871523018666190121165902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/06/2019] [Accepted: 01/14/2019] [Indexed: 11/22/2022]
Abstract
Introduction: Hemodialysis stands out as an eligible treatment for patients with chronic kidney disease. The subsequent inflammatory process resulting from this disease and hemodialysis per se is exacerbated in this therapy. Selenium (Se) is an essential trace element that can participate in the inhibition of pro-oxidant and pro-inflammatory processes and could be considered a measurement that indicates the progression of chronic kidney disease and inflammation. Objectives: The present study investigated selenemia in hemodialysis patients of the ABC region of São Paulo and aimed to establish the correlation between an inflammatory marker and selenemia in this conditions disease. Methods: This is an observational cross-sectional study of the Faculdade de Medicina do ABC in patients submitted to hemodialysis three times a week for at least six months. The eligible group composed of 21 patients, who filled out forms and underwent biochemical tests (colorimetric enzyme methods, flow cytometer, turbidimetric method and mass spectrometry). Results: The study population showed, women (70%), men (30%) with a mean age of 47 ± 17 years, Caucasians (36%) and non-Caucasian (64%), hypertensive (68%), smokers (53%) and non-smokers (64%). There was a hegemonic prevalence of systolic arterial hypertension (SAH) 68.1% in relation to diabetes mellitus (DM) (50%). Pre and post hemodialysis (HD) selenemia showed statistical significance, which did not occur with C-reactive protein. There was a predominance of females in our sample; the pre- and post-HD selenemia were within the normal range of the reference values; there was a statistically significant correlation between pre and post-HD selenemia; there was no correlation with statistical significance between values of pre and post-HD C-reactive protein. Conclusion: Our data showed that there was no direct relationship between pre- and post-HD inflammation and pre- and post-HD selenemia.
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Affiliation(s)
- Marcelo R. Bacci
- Clinical Analysis Department, Faculdade de Medicina ABC, FMABC Santo Andre, Brazil
| | - Lívia S.S. Cabral
- Clinical Analysis Department, Faculdade de Medicina ABC, FMABC Santo Andre, Brazil
| | - Glaucia L. da Veiga
- Clinical Analysis Department, Faculdade de Medicina ABC, FMABC Santo Andre, Brazil
| | | | - Neif Murad
- Clinical Analysis Department, Faculdade de Medicina ABC, FMABC Santo Andre, Brazil
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Functional and Respiratory Capacity of Patients with Chronic Kidney Disease Undergoing Cycle Ergometer Training during Hemodialysis Sessions: A Randomized Clinical Trial. Int J Nephrol 2019; 2019:7857824. [PMID: 30805216 PMCID: PMC6360580 DOI: 10.1155/2019/7857824] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/03/2018] [Accepted: 12/18/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose Exercise is recommended for patients undergoing hemodialysis, to reduce the decrease in functional capacity secondary to the progression of chronic kidney disease. A cycle ergometer can be easily added to an exercise routine during hemodialysis sessions. The purpose of this article was to assess the results of a training protocol with the cycle ergometer during hemodialysis sessions on the respiratory function and functional capacity of patients with chronic kidney disease on hemodialysis. Method In this randomized clinical trial (NCT no. 02834026), 39 patients undergoing hemodialysis were randomly allocated into two groups: the treatment group (TG, n = 20), who underwent a cycle ergometer protocol training, and the control group (GC, n = 19), not trained. The TG attended 24 training sessions, three times a week, during the intradialytic period. Training intensity was aimed at keeping the heart rate between 50 and 70% of its maximum. All participants were evaluated before and after the eight consecutive weeks of follow-up and had biochemicals data, anthropometric, functional, and respiratory outcomes evaluated. Results A significant difference was observed between groups in forced vital capacity, forced expiratory volume in the first second, peak expiratory flow, maximal inspiratory and expiratory pressure, and Borg score and distance covered in the six-minute walk test. Improvement was also observed in biochemical and Kt/V test results for the TG. Conclusion The systematic training regimen with a cycle ergometer resulted in benefits in the respiratory function and functional capacity in patients with chronic kidney disease undergoing hemodialysis.
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Cordeiro VM, Martins BCT, Teles SA, Martins RMB, Cruvinel KPDS, Matos MADD, Luz JA, Barreto RADSS, Teles JA, Santos NC, Caetano KAA, Carneiro MADS. Decline in hepatitis B and C prevalence among hemodialysis patients in Tocantins, Northern Brazil. Rev Inst Med Trop Sao Paulo 2018; 60:e36. [PMID: 30066804 PMCID: PMC6069268 DOI: 10.1590/s1678-9946201860036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/15/2018] [Indexed: 11/21/2022] Open
Abstract
Infection control measures have been responsible for a decline in the prevalence
of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in
hemodialysis patients. In Brazil, these measures have been in place since 1996.
The aim of this study was to evaluate the current HBV and HCV epidemiology among
hemodialysis patients in the State of Tocantins comparing them with those found
14 years ago. There was a significant decline in hepatitis B surface antigen
(HBsAg) and anti-HCV prevalence from 4% and 13% in 2001 to 0.8% and 2.8% in
2014-2015, respectively (p < 0.05). Variables related to hemodialysis
environment such as working shift and length of time on hemodialysis treatment
were no longer associated to HCV and HBV exposure in 2014-2015. A high
prevalence of self-reported hepatitis B vaccination was observed in both
periods, but only 30% of the individuals showed serological profile of effective
previous immunization, suggesting a low compliance with surveillance of
hepatitis B immunization in hemodialysis centers. The significant decline in
viral hepatitis B and C prevalence in hemodialysis patients in Tocantins
underscores the importance of infection control measures, but the low frequency
of protective serological profile after immunization against hepatitis B points
to the need for greater vigilance of the patients’ vaccination.
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Affiliation(s)
| | | | - Sheila Araujo Teles
- Universidade Federal de Goiás, Faculdade de Enfermagem, Goiânia, Goiás, Brazil
| | | | | | | | - Jonio Arruda Luz
- Hospital de Doenças Tropicais de Araguaína, Serviço de Fígado e Hepatites, Araguaína, Tocantins, Brazil
| | | | - Juliana Araujo Teles
- Hospital Naval Marcilio Dias, Clínica Médica, Rio de Janeiro, Rio de Janeiro, Brazil
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HEPATIC ENZYMES CHANGES IN CHRONIC KIDNEY DISEASE PATIENTS- A NEED FOR MODIFIED REFERENCE VALUES. ACTA ACUST UNITED AC 2018. [DOI: 10.14260/jemds/2018/439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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9
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Discrimination model applied to urinalysis of patients with diabetes and hypertension aiming at diagnosis of chronic kidney disease by Raman spectroscopy. Lasers Med Sci 2017; 32:1605-1613. [DOI: 10.1007/s10103-017-2288-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
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Stumm EMF, Kirchner RM, Guido LDA, Benetti ERR, Belasco AGS, Sesso RDCC, Barbosa DA. Educational nursing intervention to reduce the hyperphosphatemia in patients on hemodialysis. Rev Bras Enferm 2017; 70:31-38. [PMID: 28226039 DOI: 10.1590/0034-7167-2016-0015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 08/16/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: to evaluate the effectiveness of an educational nursing intervention to reduce hyperphosphataemia in chronic renal patients on hemodialysis. Method: quasi-experimental study with 63 hyperphosphatemic patients on hemodialysis. The intervention consisted of developing and providing a printed and illustrated manual to patients containing information on disease control. The participant was asked to complete a daily checklist with the aim to reinforce aspects provided in the manual. Laboratory tests and itching intensity were analyzed at the beginning of the study, and at 30 and 60 days after the educational intervention. Results: the mean age of participants was 58±13.1 years, with a treatment time of 51.1±44.7 months. A reduction in serum phosphorus values of 7.06 ± 1.43 to 5.80 ± 1.53 (p <0.001) and the intensity of itching after the intervention was observed. Conclusion: the educational nursing intervention was effective in reducing phosphate and decreasing itching in hyperphosphatemic patients.
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Affiliation(s)
- Eniva Miladi Fernandes Stumm
- Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Departamento de Ciências da Saúde, Curso de Enfermagem. Ijuí-RS, Brasil
| | - Rosane Maria Kirchner
- Universidade Federal de Santa Maria, Centro de Educação Superior Norte. Palmeira das Missões-RS, Brasil
| | - Laura de Azevedo Guido
- Universidade Federal de Santa Maria, Centro de Ciências da Saúde, Departamento de Enfermagem. Santa Maria-RS, Brasil
| | | | | | | | - Dulce Aparecida Barbosa
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem. São Paulo-SP, Brasil
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Hurst H, Figueiredo AE. The Needs of Older Patients for Peritoneal Dialysis: Training and Support at Home. Perit Dial Int 2016; 35:625-9. [PMID: 26702002 DOI: 10.3747/pdi.2014.00337] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chronic kidney disease (CKD) in all its stages has become an important problem for older patients, stage 3 - 5 is expected to happen in 25 to 30% of the population, and a higher prevalence can be found in residential care and nursing homes, affecting the demand for patient education. Although older patients are able and keen to learn, there are specific needs that must be addressed. The focus of this paper is to review the demands to train and maintain older patients on peritoneal dialysis (PD) at home.
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Affiliation(s)
- Helen Hurst
- Renal, Manchester Royal Infirmary, Manchester, UK
| | - Ana E Figueiredo
- Pontificia Universidade Catolica do Rio Grande do Sul, FAENFI, Brazil
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12
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Abud ACF, Kusumota L, dos Santos MA, Rodrigues FFL, Damasceno MMC, Zanetti ML. Peritonitis and catheter exit-site infection in patients on peritoneal dialysis at home. Rev Lat Am Enfermagem 2015; 23:902-9. [PMID: 26487141 PMCID: PMC4660413 DOI: 10.1590/0104-1169.0413.2630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 05/03/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the complications related to peritonitis and catheter exit-site infections, in patients on peritoneal dialysis at home. METHOD quantitative and cross-sectional study, carried out with 90 patients on peritoneal dialysis at home, in a municipality in the Northeast region of Brazil. For data collection, it was used two structured scripts and consultation on medical records. Descriptive analysis and comparison tests among independent groups were used, considering p<0.05 as level of statistical significance. RESULTS by comparing the frequency of peritonitis and the length of treatment, it was found that patients over two years of peritoneal dialysis were more likely to develop peritonitis (X²=6.39; p=0.01). The number of episodes of peritoneal catheter exit-site infection showed association with the length of treatment (U=224,000; p=0.015). CONCLUSION peritonitis and catheter exit-site infection are associated with the length of treatment.
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Affiliation(s)
- Ana Cristina Freire Abud
- PhD, Adjunct Professor, Centro de Ciências Biológicas e da Saúde,
Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Luciana Kusumota
- PhD, Associate Professor, Escola de Enfermagem de Ribeirão Preto,
Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research
Development, Ribeirão Preto, SP, Brazil
| | - Manoel Antônio dos Santos
- PhD, Associate Professor, Faculdade de Filosofia, Ciências e Letras de
Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP,
Brazil
| | - Flávia Fernanda Luchetti Rodrigues
- Doctoral student, Escola de Enfermagem de Ribeirão Preto, Universidade
de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão
Preto, SP, Brazil
| | - Marta Maria Coelho Damasceno
- PhD, Adjunct Professor, Faculdade de Farmácia, Odontologia e Enfermagem,
Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Maria Lúcia Zanetti
- PhD, Associate Professor, Escola de Enfermagem de Ribeirão Preto,
Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research
Development, Ribeirão Preto, SP, Brazil
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Konstantyner T, Sesso R, de Camargo MF, de Santis Feltran L, Koch-Nogueira PC. Pediatric Chronic Dialysis in Brazil: Epidemiology and Regional Inequalities. PLoS One 2015; 10:e0135649. [PMID: 26285019 PMCID: PMC4540415 DOI: 10.1371/journal.pone.0135649] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 07/23/2015] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION There are few reports in the literature estimating the epidemiologic characteristics of pediatric chronic dialysis. These patients have impaired physical growth, high number of comorbidities and great need for continuous attention of specialized services with high demand for complex and costly procedures. OBJECTIVE The aim of this study was to estimate the incidence and prevalence rates and describe the characteristics of children and adolescents undergoing chronic dialysis treatment in a Brazilian demographic health survey. MATERIALS AND METHODS A cross-sectional study was performed in a representative sample of dialysis centers (nc = 239) that was established from the 2011 Brazilian Nephrology Society Census (Nc = 708). We collected data encompassing the five Brazilian macro-regions. We analyzed the data from all patients under 19 years of age. The sample population consisted of 643 children and adolescents who were on chronic dialysis program anytime in 2012. Data collection was carried out in the dialysis services by means of patients' records reviews and personal interviews with the centers' leaders. RESULTS We estimated that there were a total of 1,283 pediatric patients on chronic dialysis treatment in Brazil, resulting in a prevalence of 20.0 cases per million age-related population (pmarp) (95% CI: 14.8-25.3) and an incidence of 6.6 cases pmarp in 2012 (95% CI: 4.8-8.4). The South region had the highest prevalence and incidence rates of patients under dialysis therapy, 27.7 (95% CI: 7.3-48.1) and 11.0 (95% CI: 2.8-19.3) cases pmarp, respectively; the lowest prevalence and incidence rates were found in the North-Midwest region, 13.8 (95% CI: 6.2-21.4), and in the Northeast region, 3.8 (95% CI: 1.4-6.3) cases pmarp, respectively. CONCLUSION Brazil has an overall low prevalence of children on chronic dialysis treatment, figuring near the rates from others countries with same socioeconomic profile. There are substantial differences among regions related to pediatric chronic dialysis treatment. Joint strategies aiming to reduce inequities and improving access to treatment and adequacy of services across the Brazilian regions are necessary to provide an appropriate care setting for this population group.
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Affiliation(s)
- Tulio Konstantyner
- Sociedade Hospital Samaritano, Sao Paulo, Brazil
- Pediatric Division, Federal Univesity of Sao Paulo, Sao Paulo, Brazil
| | - Ricardo Sesso
- Sociedade Hospital Samaritano, Sao Paulo, Brazil
- Nephrology Division, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Paulo Cesar Koch-Nogueira
- Sociedade Hospital Samaritano, Sao Paulo, Brazil
- Pediatric Division, Federal Univesity of Sao Paulo, Sao Paulo, Brazil
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14
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Carreira MAMDQ, Nogueira AB, Pena FM, Kiuchi MG, Rodrigues RC, Rodrigues RDR, Matos JPSD, Lugon JR. Heart Rate Variability Correlates to Functional Aerobic Impairment in Hemodialysis Patients. Arq Bras Cardiol 2015; 104:493-500. [PMID: 26131705 PMCID: PMC4484682 DOI: 10.5935/abc.20150039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 01/19/2015] [Indexed: 11/20/2022] Open
Abstract
Background Autonomic dysfunction (AD) is highly prevalent in hemodialysis (HD) patients and
has been implicated in their increased risk of cardiovascular mortality. Objective To correlate heart rate variability (HRV) during exercise treadmill test (ETT)
with the values obtained when measuring functional aerobic impairment (FAI) in HD
patients and controls. Methods Cross-sectional study involving HD patients and a control group. Clinical
examination, blood sampling, transthoracic echocardiogram, 24-hour Holter, and ETT
were performed. A symptom-limited ramp treadmill protocol with active recovery was
employed. Heart rate variability was evaluated in time domain at exercise and
recovery periods. Results Forty-one HD patients and 41 controls concluded the study. HD patients had higher
FAI and lower HRV than controls (p<0.001 for both). A correlation was found
between exercise HRV (SDNN) and FAI in both groups. This association was
independent of age, sex, smoking, body mass index, diabetes, and clonidine or
beta-blocker use, but not of hemoglobin levels. Conclusion No association was found between FAI and HRV on 24-hour Holter or at the recovery
period of ETT. Of note, exercise HRV was inversely correlated with FAI in HD
patients and controls.
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Affiliation(s)
| | - André Barros Nogueira
- Department of Cardiology, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | - Felipe Montes Pena
- Department of Cardiology, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | - Marcio Galindo Kiuchi
- Department of Cardiology, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Jocemir Ronaldo Lugon
- Department of Nephrology, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
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15
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Carreira MAMQ, Nogueira AB, Pena FM, Kiuchi MG, Rodrigues RC, Rodrigues RR, Matos JPS, Lugon JR. Detection of autonomic dysfunction in hemodialysis patients using the exercise treadmill test: the role of the chronotropic index, heart rate recovery, and R-R variability. PLoS One 2015; 10:e0128123. [PMID: 26042678 PMCID: PMC4456158 DOI: 10.1371/journal.pone.0128123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 04/22/2015] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To evaluate the ability of different parameters of exercise treadmill test to detect autonomic dysfunction in hemodialysis patients. METHODS Cross-sectional study involving hemodialysis patients and a control group. Clinical examination, blood sampling, echocardiogram, 24-hour Holter, and exercise treadmill test were performed. A ramp treadmill protocol symptom-limited with active recovery was employed. RESULTS Forty-one hemodialysis patients and 41 controls concluded the study. There was significant difference between hemodialysis patients and controls in autonomic function parameters in 24h-Holter and exercise treadmill test. Probability of having autonomic dysfunction in hemodialysis patients compared to controls was 29.7 at the exercise treadmill test and 13.0 in the 24-hour Holter. Chronotropic index, heart rate recovery at the 1st min, and SDNN at exercise were used to develop an autonomic dysfunction score to grade autonomic dysfunction, in which, 83% of hemodialysis patients reached a scoring ≥2 in contrast to 20% of controls. Hemodialysis was independently associated with either altered chronotropic index or autonomic dysfunction scoring ≥2 in every tested model (OR=50.1, P=0.003; and OR=270.9, P=0.002, respectively, model 5). CONCLUSION The exercise treadmill test was feasible and useful to diagnose of the autonomic dysfunction in hemodialysis patients. Chronotropic index and autonomic dysfunction scoring ≥2 were the most effective parameters to differentiate between hemodialysis patients and controls suggesting that these variables portrays the best ability to detect autonomic dysfunction in this setting.
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Affiliation(s)
- Maria Angela M. Q. Carreira
- Department of Medicine, Cardiology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - André B. Nogueira
- Department of Medicine, Cardiology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Felipe M. Pena
- Department of Medicine, Cardiology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Marcio G. Kiuchi
- Department of Medicine, Nephrology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Ronaldo C. Rodrigues
- Department of Medicine, Cardiology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Rodrigo R. Rodrigues
- Department of Medicine, Cardiology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
- Department of Medicine, Nephrology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Jorge P. S. Matos
- Department of Medicine, Nephrology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Jocemir R. Lugon
- Department of Medicine, Nephrology Division, Medical School, Universidade Federal Fluminense, Rio de Janeiro, Brazil
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Togoe EB, Silva IS, Cury JL, Souza AS, Borges JHS, Saturnino KC. Animal model of chronic kidney disease using a unilateral technique of renal ischemia and reperfusion in White New Zealand rabbits. Acta Cir Bras 2015; 29:651-7. [PMID: 25317997 DOI: 10.1590/s0102-8650201400160005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/22/2014] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To establish a model of chronic kidney disease in White New Zealand rabbits, using an exclusive unilateral technique of renal ischemia and reperfusion. METHODS Twenty males White New Zealand rabbits were used. All animals were subjected to the following: pre-surgical blood collection (1st collection) for creatinine and urea serum analysis, left renal ischemia and reperfusion surgery technique, another blood sample was collected after 6 weeks post surgery (2nd collection), the last blood sample (3rd collection) blood sample was taken 11 weeks post surgery (pre-euthanasia), euthanasia and withdrawal of right and left kidney for histopathological analysis. RESULTS The creatinine levels after surgery was statistically significant higher in the 3rd collection, regarding the 1st and 2nd collection (p<0.05). A significant statistic increase for urea was showed only in the 2nd collection (p<0.05) when compared to the 1st and 3rd collections. Histopathological analysis showed bilateral lesions in the renal tissue, consistent to the process of ischemia and reperfusion. CONCLUSION This exclusive unilateral technique of renal ischemia and reperfusion without nephrectomy in White New Zealand rabbits, showed effectiveness in getting an animal model of chronic kidney disease.
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de Freitas JS, Costa PS, Costa LR, Naghettini AV. Evaluation of clinical and laboratory variables associated with anemia in pediatric patients on hemodialysis. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2014.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Freitas JSD, Costa PS, Costa LR, Naghettini AV. Evaluation of clinical and laboratory variables associated with anemia in pediatric patients on hemodialysis. J Pediatr (Rio J) 2015; 91:87-92. [PMID: 25240161 DOI: 10.1016/j.jped.2014.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/21/2014] [Accepted: 05/28/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To identify the occurrence of anemia in pediatric patients on hemodialysis and the association between hemoglobin levels and anemia in CKD-related variables. METHODS This was a retrospective study. Patients aged up to 18 years with chronic kidney disease undergoing hemodialysis at this service between January of 2009 and December of 2010 were selected. Clinical and laboratory data were obtained from medical records. Statistical analysis was performed with chi-squared test, Student's t-test and general estimating equations (GEE) using SPSS 20.0, assuming a significance level of 5%. RESULTS A total of 357 medical records depicting the monthly evolution of 29 patients were analyzed. The most common etiology for chronic kidney disease was malformations of the genitourinary tract (28%). Hemoglobin showed a mean (standard deviation) value of 9.20 (1.8) g/dL, with the occurrence of anemia in 65.3% of cases. Anemia was associated with hospitalization; antibiotic use; transfusion; use of intravenous iron hydroxide; low values of creatinine, hematocrit, and albumin; and high values of ferritin, aluminum, and equilibrated Kt/V (p<0.05). The odds ratio for anemia with the use of intravenous iron hydroxide was 0.36 (95% CI: 0.25 to 0.89), i.e., a 2.78-fold higher chance of developing anemia without the use of this medication. CONCLUSIONS Anemia predominated in children and adolescents with chronic kidney disease; intravenous iron hydroxide use was a protective factor.
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Malta LMA, Gameiro VS, Sampaio EA, Gouveia ME, Lugon JR. Quadriceps tendon rupture in maintenance haemodialysis patients: results of surgical treatment and analysis of risk factors. Injury 2014; 45:1970-3. [PMID: 25441174 DOI: 10.1016/j.injury.2014.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 09/14/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Reports of spontaneous quadriceps ruptures in end-stage renal disease (ESRD) patients are scarce, and the assessment of risk factors for tendon rupture is poorly addressed in the majority of the studies. The purpose of the present study is to report a series of patients on haemodialysis with spontaneous quadriceps tendon ruptures operated at our institution. The results of the surgical treatment are described and the potential risk factors associated with the rupture are analyzed. METHODS Our study consisted of retrospective analysis of patient's charts. Clinical and laboratory findings of the operated group were compared to the ones of a control group of haemodialysis patients matched by age, gender, and time on haemodialysis, but without tendon rupture. RESULTS Between 1998 and 2010, six ESRD patients with 11 spontaneous ruptures of the quadriceps tendon were treated at our institution. On postoperative evaluation all patients were able to walk without crutches after six months of follow-up, and there were no new ruptures. Positive serology for Hepatitis C was present in two cases (33%) but in none of the controls (p = 0.034). Mean serum levels of intact parathormone (iPTH) and alkaline phosphatase were both higher in cases (p = 0.013 and p = 0.034, respectively). In contrast, mean serum levels of albumin, ferritin and haemoglobin were all lower in cases (p = 0.008, p = 0.043 and p = 0.016, respectively). CONCLUSION Reconstructive surgery is a good way to restore knee function in ESRD patients with quadriceps tendon ruptures. Our cases exhibited higher levels of iPTH and alkaline phosphatase than control patients, reinforcing the role of secondary hyperparathyroidism in tendon weakening. They also had a higher frequency of hepatitis C and lower levels of albumin and haemoglobin compared to controls, possibly implicating chronic inflammation as a potential risk factor for tendon rupture.
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Rusa SG, Peripato GI, Pavarini SCI, Inouye K, Zazzetta MS, Orlandi FDS. Quality of life/spirituality, religion and personal beliefs of adult and elderly chronic kidney patients under hemodialysis. Rev Lat Am Enfermagem 2014; 22:911-7. [PMID: 25591085 PMCID: PMC4309224 DOI: 10.1590/0104-1169.3595.2495] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 07/08/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to assess the quality of life of chronic kidney patients undergoing hemodialysis, using the WHOQOL-bref and WHOQOL-SRPB. METHOD a descriptive and cross-sectional study was undertaken at a kidney replacement therapy service in the interior of the state of SP. The 110 subjects who complied with the inclusion criteria answered the Subject Characterization Instrument, the WHOQOL-bref and WHOQOL-SRPB. RESULTS most of the respondents were male (67.27%), with a mean age of 55.65 years, Catholic (55.45%), with unfinished primary education (33.64%) and without formal occupation (79.08%). The WHOQOL-bref domains with the highest and lowest mean score were, respectively, "psychological" (µ=74.20) and "physical" (µ=61.14). The WHOQOL-SRPB domains with the highest and lowest mean score were, respectively, "completeness and integration" (µ=4.00) and "faith" (µ=4.40). CONCLUSIONS the respondents showed high quality of life scores, specifically in the dimensions related to spirituality, religion and personal beliefs. Losses were evidenced in the physical domain of quality of life, possibly due to the changes resulting from the chronic kidney disease and hemodialysis treatment.
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Affiliation(s)
- Suzana Gabriela Rusa
- Undergraduate student in Gerontology, Universidade Federal de São
Carlos, São Carlos, SP, Brazil
| | | | | | - Keika Inouye
- PhD, Adjunct Professor, Universidade Federal de São Carlos, São Carlos,
SP, Brazil
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21
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Pieralisi N, Godoy J, Yamada S, Santana R, Svidzinski T. Oral lesions and colonization by yeasts in hemodialysis patients. J Oral Pathol Med 2014; 44:585-90. [DOI: 10.1111/jop.12277] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Neli Pieralisi
- Department of Dentistry; State University of Maringá; Paraná Brazil
| | - Janine Godoy
- Section of Medical Mycology; Department of Clinical Analysis; State University of Maringá; Paraná Brazil
| | - Sergio Yamada
- University Hospital of Maringá; State University of Maringá; Paraná Brazil
| | - Rosangela Santana
- Department of Statistics; State University of Maringá; Paraná Brazil
| | - Terezinha Svidzinski
- Section of Medical Mycology; Department of Clinical Analysis; State University of Maringá; Paraná Brazil
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Paula Santos U, Zanetta DMT, Terra-Filho M, Burdmann EA. Burnt sugarcane harvesting is associated with acute renal dysfunction. Kidney Int 2014; 87:792-9. [PMID: 25229334 DOI: 10.1038/ki.2014.306] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 07/10/2014] [Accepted: 07/24/2014] [Indexed: 12/18/2022]
Abstract
Sugarcane harvesting has been associated with an epidemic of chronic kidney disease in Central America mainly affecting previously healthy young workers. Repeated episodes of acute kidney dysfunction are hypothesized to be one of the possible mechanisms for this phenomenon. Therefore, this exploratory study aimed to assess the acute effects of burnt sugarcane harvesting on renal function among 28 healthy non-African Brazilian workers. Urine and blood samples were collected at the beginning and at the end of the harvesting season and before and at the end of a harvesting workday. All individuals decreased their estimated glomerular filtration rate by ∼20% at the end of the daily shift, and 18.5% presented with serum creatinine increases consistent with acute kidney injury. Those changes were associated with increased serum creatine phosphokinase (a known marker for exertional rhabdomyolysis) and oxidative stress-associated malondialdehyde levels, increased peripheral blood white cell counts, decreased urinary and serum sodium, decreased calculated fractional sodium excretion, and increased urine density. Thus, burnt sugarcane harvesting caused acute renal dysfunction in previously healthy workers. This was associated with a combination of dehydration, systemic inflammation, oxidative stress, and rhabdomyolysis.
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Affiliation(s)
- Ubiratan Paula Santos
- Pulmonary Division, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Dirce Maria T Zanetta
- Department of Epidemiology, University of São Paulo Public Health School, São Paulo, Brazil
| | - Mário Terra-Filho
- Pulmonary Division, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Emmanuel A Burdmann
- Medical Investigation Laboratory 12 (LIM-12), Division of Nephrology, University of São Paulo Medical School, São Paulo, Brazil
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Frazão CMFDQ, de Sá JD, de Paiva MDGMN, Lira ALBDC, Lopes MVDO, Enders BC. Association Between Nursing Diagnoses and Socioeconomic/Clinical Characteristics of Patients on Hemodialysis. Int J Nurs Knowl 2014; 26:135-40. [PMID: 25163351 DOI: 10.1111/2047-3095.12051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To analyze the association between nursing diagnoses and socioeconomic/clinical characteristics of patients on hemodialysis. METHODS Cross-sectional study conducted by means of interview and physical examination of 178 patients consecutively selected. FINDINGS Nursing diagnoses within the NANDA-I domains of health promotion, nutrition, activity/rest, perception/cognition, sexuality, safety/protection, and comfort presented statistically significant association with the socioeconomic/clinical data of age, education, sex, marital status, and duration of the chronic renal disease and hemodialysis. CONCLUSION The nursing diagnoses in this population may be influenced by the socioeconomic/clinical data. IMPLICATIONS FOR NURSING PRACTICE The results suggest an opportunity for improved nursing intervention in this community.
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Affiliation(s)
| | | | | | | | | | - Bertha Cruz Enders
- Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Picon PD, Pribbernow SCM, Prompt CA, Schacher SC, Antunes VVH, Mentz BP, Oliveira FL, Souza CMBD, Schacher FC. Randomized double-blind clinical trial of a new human epoetin versus a commercially available formula for anemia control in patients on hemodialysis. Clinics (Sao Paulo) 2014; 69:547-53. [PMID: 25141114 PMCID: PMC4129558 DOI: 10.6061/clinics/2014(08)08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 12/20/2013] [Accepted: 03/17/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Anemia is a common complication among chronic kidney disease patients on hemodialysis, occurring mostly due to erythropoietin deficiency. This randomized noninferiority trial sought to compare the efficacy and safety of a new epoetin formulation developed by Bio-Manguinhos, a biologics manufacturer affiliated with the Brazilian government, with those of a commercially available product currently used in Brazil (a biosimilar epoetin formulation). METHODS The sample size needed to enable demonstration of noninferiority with a statistical power of 85% for a between-group difference in hemoglobin levels of no more than 1.5 g/dL was calculated. In total, 74 patients were randomly assigned to receive the epoetin formulation from Bio-Manguinhos (n = 36) or the biosimilar epoetin formulation (n = 38) in a double-blind fashion. The inclusion criteria were current epoetin therapy and stable hemoglobin levels for at least 3 months prior to the study. The primary and secondary outcomes were mean monthly hemoglobin levels and safety, respectively. The dose was calculated according to international criteria and adjusted monthly in both groups according to hemoglobin levels and at the assistant physicians' discretion. Iron storage was estimated at baseline and once monthly. Clinicaltrials.gov: NCT01184495. RESULTS The study was conducted for 6 months after randomization. The mean baseline hemoglobin levels were 10.9±1.2 and 10.96±1.2 g/dL (p = 0.89) in the Bio-Manguinhos epoetin and biosimilar epoetin groups, respectively. During the study period, there was no significant change in hemoglobin levels in either group (p = 0.055, ANOVA). The epoetin from Bio-Manguinhos was slightly superior in the last 3 months of follow-up. The adverse event profiles of the two formulations were also similar. CONCLUSIONS The epoetin formulations tested in this study are equivalent in efficacy and safety.
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Affiliation(s)
- Paulo D Picon
- Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | | | - Carlos A Prompt
- Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Suzana C Schacher
- Centro de Diálise e Transplantes de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Bianca P Mentz
- Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Fabiane L Oliveira
- Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | | | - Fernando C Schacher
- Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
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de Moura L, Prestes IV, Duncan BB, Thome FS, Schmidt MI. Dialysis for end stage renal disease financed through the Brazilian National Health System, 2000 to 2012. BMC Nephrol 2014; 15:111. [PMID: 25008169 PMCID: PMC4099158 DOI: 10.1186/1471-2369-15-111] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/03/2014] [Indexed: 11/10/2022] Open
Abstract
Background Chronic kidney disease has become a public health problem worldwide. Its terminal stage requires renal replacement therapy – dialysis or transplantation – for the maintenance of life, resulting in high economic and social costs. Though the number of patients with end-stage renal disease treated by dialysis in Brazil is among the highest in the world, current estimates of incidence and prevalence are imprecise. Our aim is to describe incidence and prevalence trends and the epidemiologic profile of end-stage renal disease patients receiving publically-financed dialysis in Brazil between 2000 and 2012. Methods We internally linked records of the High Complexity Procedure Authorization/Renal Replacement Therapy (APAC/TRS) system so as to permit analyses of incidence and prevalence of dialysis over the period 2000-2012. We characterized temporal variations in the incidence and prevalence using Joinpoint regression. Results Over the period, 280,667 patients received publically-financed dialysis, 57.2% of these being male. The underlying disease causes listed were hypertension (20.8%), diabetes (12.0%) and glomerulonephritis (7.7%); for 42.3%, no specific cause was recorded. Hemodialysis was the therapeutic modality in 90.1%. Over this period, prevalence increased 47%, rising 3.6% (95% CI 3.2% - 4.0%)/year. Incidence increased 20%, or 1.8% (1.1% – 2.5%)/year. Incidence increased in both sexes, in all regions of the country and particularly in older age groups. Conclusions Incidence and prevalence of end-stage renal disease receiving publically-financed dialysis treatment has increased notably. The linkage approach developed will permit continuous future monitoring of these indicators.
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Affiliation(s)
- Lenildo de Moura
- Post-Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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Burmeister JE, Mosmann CB, Costa VB, Saraiva RT, Grandi RR, Bastos JP, Gonçalves LF, Rosito GA. Prevalence of cardiovascular risk factors in hemodialysis patients - The CORDIAL study. Arq Bras Cardiol 2014; 102:473-80. [PMID: 24759948 PMCID: PMC4051450 DOI: 10.5935/abc.20140048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 11/11/2013] [Accepted: 11/29/2013] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There are scarce epidemiological data on cardiovascular risk profile of chronic hemodialysis patients in Brazil. OBJECTIVE The CORDIAL study was designed to evaluate cardiovascular risk factors and follow up a hemodialysis population in a Brazilian metropolitan city. METHODS All patients undergoing regular hemodialysis for chronic renal failure in all fifteen nephrology centers of Porto Alegre were considered for inclusion in the baseline phase of the CORDIAL study. Clinical, laboratory and demographic data were obtained in medical records and in structured individual interviews performed in all patients by trained researchers. RESULTS A total of 1215 patients were included (97.3% of all hemodialysis patients in the city of Porto Alegre). Their average age was 58.3 years old, 59.5% were male and 62.8% were white. The prevalence of cardiovascular risk factors observed was 87.5% for hypertension, 84.7% for dyslipidemia, 73.1% for sedentary lifestyle, 53.7% for tobacco use, and 35.8% for diabetes. In a multivariate adjusted analysis, we found that sedentary lifestyle (p = 0.032, PR 1.08 - 95%CI: 1.01-1.15), dyslipidemia (p = 0.019, PR 1.08 - 95%CI: 1.01-1.14), and obesity (p < 0.001, PR 1.96 - 95%CI: 1.45-2.63) were more frequent in women; and hypertension (p = 0.018, PR 1.06 - 95%CI: 1.01-1.11) and tobacco use (p = 0.006, PR 2.7 - 95%CI: 1.79-4.17) were more often found among patients under 65 years old. Sedentary lifestyle was independently associated with time in dialysis less than 12 months (p < 0.001, PR 1.23 - 95% CI: 1.14-1.33). CONCLUSION Hemodialysis patients in this southern metropolitan Brazilian city have a high prevalence of cardiovascular risk factors resembling many northern countries.
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Affiliation(s)
- Jayme Eduardo Burmeister
- Universidade Federal de Ciências da Saúde de Porto Alegre
- Programa de Pós-graduação em Ciências da Saúde,
Porto Alegre, RS - Brazil
- Universidade Luterana do Brasil - Curso de Medicina, Porto Alegre, RS -
Brazil
| | | | - Veridiana Borges Costa
- Universidade Federal de Ciências da Saúde de Porto Alegre
- Faculdade de Medicina, Porto Alegre, RS - Brazil
| | | | - Renata Rech Grandi
- Universidade Luterana do Brasil - Curso de Medicina, Porto Alegre, RS -
Brazil
| | | | - Luiz Felipe Gonçalves
- Universidade Federal do Rio Grande do Sul - Faculdade de Medicina,
Porto Alegre, RS - Brazil
- Hospital Mãe de Deus - Departamento de Nefrologia, Porto Alegre,
RS - Brazil
| | - Guido Aranha Rosito
- Universidade Federal de Ciências da Saúde de Porto Alegre
- Programa de Pós-graduação em Ciências da Saúde,
Porto Alegre, RS - Brazil
- Universidade Luterana do Brasil - Curso de Medicina, Porto Alegre, RS -
Brazil
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Sette LHBC, Almeida Lopes EPD. Liver enzymes serum levels in patients with chronic kidney disease on hemodialysis: a comprehensive review. Clinics (Sao Paulo) 2014; 69:271-8. [PMID: 24714836 PMCID: PMC3971360 DOI: 10.6061/clinics/2014(04)09] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/27/2013] [Indexed: 12/17/2022] Open
Abstract
We reviewed the literature regarding the serum levels of the enzymes aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase in patients with chronic kidney disease on hemodialysis with and without viral hepatitis. Original articles published up to January 2013 on adult patients with chronic kidney disease on hemodialysis were selected. These articles contained the words "transaminases" "aspartate aminotransferase" "alanine aminotransferase" "gamma glutamyl transferase," "liver enzymes", AND "dialysis" OR "hemodialysis". A total of 823 articles were retrieved. After applying the inclusion and exclusion criteria, 49 articles were selected. The patients with chronic kidney disease on hemodialysis had reduced serum levels of aminotransferases due to hemodilution, lower pyridoxine levels, or elevated homocysteine levels. The chronic kidney disease patients on hemodialysis infected with the hepatitis C virus also had lower aminotransferase levels compared with the infected patients without chronic kidney disease. This reduction is in part due to decreased viremia caused by the dialysis method, the production of a hepatocyte growth factor and endogenous interferon-α, and lymphocyte activation, which decreases viral action on hepatocytes. Few studies were retrieved on gamma-glutamyl transferase serum levels; those found reported that there were no differences between the patients with or without chronic kidney disease. The serum aminotransferase levels were lower in the patients with chronic kidney disease on hemodialysis (with or without viral hepatitis) than in the patients with normal renal function; this reduction has a multifactorial origin.
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Albuquerque SEKD, Cavalcante RDS, Ponce D, Fortaleza CMCB. Epidemiology of healthcare-associated infections among patients from a hemodialysis unit in southeastern Brazil. Braz J Infect Dis 2013; 18:327-30. [PMID: 24275375 PMCID: PMC9427539 DOI: 10.1016/j.bjid.2013.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 09/29/2013] [Accepted: 10/12/2013] [Indexed: 11/04/2022] Open
Abstract
Patients submitted to hemodialysis are at a high risk for healthcare-associated infections (HAI). Presently there are scarce data to allow benchmarking of HAI rates in developing countries. Also, most studies focus only on bloodstream infections (BSI) or local access infections (LAI). Our study aimed to provide a wide overview of HAI epidemiology in a hemodialysis unit in southeastern Brazil. We present data from prospective surveillance carried out from March 2010 through May 2012. Rates were compared (mid-p exact test) and temporally analyzed in Shewhart control charts for Poisson distributions. The overall incidence of BSI was 1.12 per 1000 access-days. The rate was higher for patients performing dialysis through central venous catheters (CVC), either temporary (RR = 13.35, 95% CI = 6.68–26.95) or permanent (RR = 2.10, 95% CI = 1.09–4.13), as compared to those with arteriovenous fistula. Control charts identified a BSI outbreak caused by Pseudomonas aeruginosa in April 2010. LAI incidence was 3.80 per 1000 access-days. Incidence rates for other HAI (per 1000 patients-day) were as follows: upper respiratory infections, 1.72; pneumonia, 1.35; urinary tract infections, 1.25; skin/soft tissues infections, 0.93. The data point out to the usefulness of applying methods commonly used in hospital-based surveillance for hemodialysis units.
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Affiliation(s)
- Silvia Eduara Kennerly de Albuquerque
- Comissão de Controle de Infecção Relacionada à Assistência em Saúde, Hospital das Clínicas da Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, City of Botucatu, Brazil.
| | - Ricardo de Souza Cavalcante
- Comissão de Controle de Infecção Relacionada à Assistência em Saúde, Hospital das Clínicas da Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, City of Botucatu, Brazil; Departamento de Doenças Tropicais e Diagnóstico por Imagem, Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, City of Botucatu, Brazil
| | - Daniela Ponce
- Disciplina de Nefrologia, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, City of Botucatu, Brazil
| | - Carlos Magno Castelo Branco Fortaleza
- Comissão de Controle de Infecção Relacionada à Assistência em Saúde, Hospital das Clínicas da Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, City of Botucatu, Brazil; Departamento de Doenças Tropicais e Diagnóstico por Imagem, Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, City of Botucatu, Brazil
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Dantas LG, Cruz C, Rocha M, Moura JA, Paschoalin E, Paschoalin S, Marcilio de Souza C. Prevalence and predictors of nonadherence to hemodialysis. Nephron Clin Pract 2013; 124:67-71. [PMID: 24135618 DOI: 10.1159/000355866] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 09/17/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The prevalence of nonadherence to dialysis (NAD) presents a wide variation, depending on the parameters used and demographic regions studied. This study aimed to assess the prevalence and predictors of NAD of patients with chronic kidney disease undergoing hemodialysis (HD). MATERIALS AND METHODS This was a cross-sectional study with 255 adult patients receiving HD for >3 months. Skipping a session per month, shortening a session for at least 10 min, phosphorus >7.5 mg/dl, potassium >6.0 mmol/l and interdialytic weight gain (IDWG) >5.7% of body weight were indicative of NAD. The association of sociodemographic and clinical variables with NAD was assessed using logistic regression. RESULTS Mean age was 50 ± 13.1 years, 62.7% were male, 85.5% were of African descent and 62% were married. The prevalence rates of NAD were: 49% of shortening sessions, 18% of hyperkalemia, 12% of hyperphosphatemia, 9% of IDWG >5.7% of dry weight and 8% of skipping HD. Independent predictors of NAD were: age ≤50 years, not being married, living alone, living in Salvador, attending dialysis without a companion, ethnic African descent, Kt/V <1.3 and residual diuresis <100 ml/day. CONCLUSION NAD is frequent and distinct sociodemographic and clinical variables predict different parameters.
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Affiliation(s)
- L G Dantas
- Postgraduate Course in Medicine and Human Health, Bahia School of Medicine and Public Health, Salvador, Brazil
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Cordeiro AC, Carrero JJ, Qureshi AR, Cunha RFD, Lindholm B, Castro ID, Noronha IL. Study of the incidence of dialysis in São Paulo, the largest Brazilian city. Clinics (Sao Paulo) 2013; 68:760-5. [PMID: 23778473 PMCID: PMC3675216 DOI: 10.6061/clinics/2013(06)06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 02/09/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Chronic kidney disease is a major public health problem worldwide. In Brazil, approximately 100,000 patients (January 2012) receive renal replacement therapy. Nevertheless, data on dialysis incidence in the Brazilian population are scarce. This study aims to analyze the incidence of patients starting dialysis therapy in São Paulo City, the largest Brazilian metropolis. METHOD This cohort study analyzed data from 9,994 patients starting hemodialysis or peritoneal dialysis funded by the Brazilian Public Health System during a 5-year period (2007-2011). Patient data for this study (recorded as electronic files) were obtained from the São Paulo City's Dialysis Regulatory Bureau, which regulates the allocation of patients requiring dialytic therapy. RESULTS The dialysis incidence rates were 178, 174, 170, 185 and 188 per million population for the years 2007, 2008, 2009, 2010 and 2011, respectively. The incidence rates increased with age. Hypertension and diabetes were the main etiologies diagnosed. Hemodialysis was the chosen dialysis modality in the majority of patients (92.6%), whereas the percentage of patients referred for peritoneal dialysis decreased from 10.1% to 5.5%. CONCLUSION The incidence of patients starting renal replacement therapy from 2007-2011 in São Paulo was stable but higher than the projected incidence for the entire country. The authors emphasize the need for further studies of the incidence of dialysis in the Brazilian population and for the creation of a Brazilian registry of dialysis patients, which would be a valuable tool for developing healthcare policies and renal replacement therapy strategies.
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Affiliation(s)
- Antonio Carlos Cordeiro
- Dante Pazzanese Institute of Cardiology, Department of Hypertension and Nephrology, São Paulo/SP, Brazil.
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