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do Nascimento Lima H, Monárrez-Espino J, Nerbass FB, Moura-Neto JA, Sesso R, Lugon JR. Comparison of 1-year survival between patients initiating chronic hemodialysis under public and private health insurance: register-based data analysis from Brazil. Int Urol Nephrol 2024:10.1007/s11255-024-04018-4. [PMID: 38578392 DOI: 10.1007/s11255-024-04018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/29/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Brazil has one of the world's highest numbers of patients on hemodialysis (HD). Most dialysis centers are private and perform HD for patients with private and public health insurance. We compared 1-year survival between patients initiating chronic HD with public and private health insurance. METHODS This is an HD register-based retrospective cohort. Adult patients starting HD from January 2011 to December 2021 were included. Survival analysis was stratified according to the period entered in the HD register. Multivariate Cox regression focused on 1-year survival differences between private and public patients. RESULTS In the final sample (n = 5114), 68.5% of participants had public and 31.3% to private health insurance, with overall 1-year survival of 92.8% and 89.9%, respectively (p = 0.002). Crude analysis showed a slightly higher survival rate among patients with public health insurance than those with private health insurance (91 vs. 87%, p = 0.030) in the first period (2019-21). However, the adjusted hazard ratio (HR) did not remain significantly higher for patients with private health insurance compared to those with public health insurance (HR = 1.07; 95% CI 0.80-1.41; p = 0.651), even after propensity score matching of the groups by several baseline features. CONCLUSION Brazilian chronic HD patients funded by either private health plans or the public system have a similar 1-year mortality risk after controlling for several sociodemographic and clinical parameters.
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Affiliation(s)
- Helbert do Nascimento Lima
- Medicine Department, University of the Region of Joinville (Univille), Rua Rio do Sul 270, Joinville, Santa Catarina, 89202-201, Brazil.
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
- Brazilian Society of Nephrology, SBN, Sao Paulo, Brazil.
| | - Joel Monárrez-Espino
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - José A Moura-Neto
- Internal Medicine Division, Bahiana School of Medicine and Public Health, Salvador, Brazil
- Brazilian Society of Nephrology, SBN, Sao Paulo, Brazil
| | - Ricardo Sesso
- Nephrology Division, Federal University of São Paulo, Sao Paulo, Brazil
- Brazilian Society of Nephrology, SBN, Sao Paulo, Brazil
| | - Jocemir Ronaldo Lugon
- Nephrology Division, Universidade Federal Fluminense (UFF), Niterói, Brazil
- Brazilian Society of Nephrology, SBN, Sao Paulo, Brazil
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Cordeiro RCC, de Souza LC, Lugon JR. Reducing Airway Occlusion Time Without Losing Accuracy to Predict Successful Mechanical Ventilator Liberation During the Measurement of the Timed Inspiratory Effort Index. Respir Care 2024:respcare.11546. [PMID: 38565304 DOI: 10.4187/respcare.11546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND In 2013, a new predictor of successful mechanical ventilation liberation named timed inspiratory effort (TIE) index was devised with the normalization of the maximum inspiratory pressure (obtained within 60 s of unidirectional airway occlusion) with the time at which the value was reached. The aim of this study was to verify whether the presence of a sequence of a certain number of inspiratory effort values between 30-60 s > 1.0 cm H2O/s could predict weaning success in a performance comparable to the TIE index. METHODS This was a retrospective observational study using 4 databases of previous studies on the TIE index. All patients receiving mechanical ventilation for ≤ 24 h were eligible. Liberation from mechanical ventilation-extubation decisions was made based on performance with spontaneous breathing trials. P < .05 was considered significant. The performance of the TIE index was evaluated by calculating the area under the receiver operating characteristics (AUROC) curve. RESULTS From 349 eligible patients, 165 subjects were selected for analysis. The AUROC for the TIE index in the studied sample was 0.92 (95% CI 0.87-0.97, P < .001). A sequence of ≤ 4 inspiratory efforts > 1.0 cm H2O/s was found in 51.5% of the subjects, with successful ventilatory liberation occurring in 95.3%. The highest specificity values belonged to the sequence of ≤ 4 and ≤ 5 inspiratory efforts > 1.0 cm H2O/s; the highest positive predictive value and positive likelihood ratio belonged to the sequence of ≤ 4 inspiratory efforts > 1.0 cm H2O/s. The mean time that could have been spared if the procedure were interrupted after the first sequence of 4 inspiratory efforts > 1.0 cm H2O/s was 23 ± 3 s. CONCLUSIONS The presence of a sequence of ≤ 4 inspiratory efforts > 1.0 cm H2O/s during the TIE index measurement was a reliable predictor of weaning success, which could allow timely interruption of the procedure and entail a substantial reduction in airway occlusion time.
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Affiliation(s)
| | | | - Jocemir Ronaldo Lugon
- Medicine/Nephrology, Medical School of Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
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Abstract
INTRODUCTION The Brazilian Dialysis Survey (BDS) is an annual national survey about patients on chronic dialysis that contributes to health policies. OBJECTIVE To report the 2022 epidemiological data from the BDS of the Brazilian Society of Nephrology (BSN). METHODS A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire that included clinical and epidemiological aspects of patients on chronic dialysis, dialysis therapy data, and dialysis center characteristics. RESULTS Overall, 28% (n = 243) of the centers answered the questionnaire. In July 2022, the estimated total number of patients on dialysis was 153,831. The estimated prevalence and incidence rates of patients per million population (pmp) were 758 and 214, respectively. Of the prevalent patients, 95.3% were on hemodialysis (HD, 4.6% of these on hemodiafiltration) and 4.7% on peritoneal dialysis (PD). Only 1.3% of patients were not vaccinated against COVID-19. The prevalence of anemia (Hb < 10g/dL) was 27% and hyperphosphatemia (P > 5.5mg/dL) reached 30%. The estimated overall crude annual mortality rate was 17.1%. CONCLUSIONS The absolute number and prevalence rate of patients on chronic dialysis continue to increase. A growing number of patients were receiving hemodiafiltration. The mortality rate decreased, probably due to the end of COVID-19 pandemic. The conclusions were drawn in the context of relatively low voluntary participation, which imposed methodological limitations on our estimates.
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Affiliation(s)
| | | | | | | | - Ricardo Sesso
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Nerbass FB, Lima HDN, Lugon JR, Sesso R. Sex-specific differences in a large cohort of Brazilian incident dialysis patients over 12 years: A retrospective study. Int J Artif Organs 2024; 47:140-146. [PMID: 38268084 DOI: 10.1177/03913988231225137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE Sex-specific differences in the epidemiology of chronic kidney disease, such as higher prevalence of women on pre-dialysis and men on chronic dialysis treatment, have been reported worldwide. In this regard, data from non-high-income countries are scarce. We aimed to compare the demographic, clinical, and dialysis characteristics of incident dialysis patients, both men and women, in a large cohort of Brazilian patients over a 12-year period. METHODS This was a multicentric retrospective cohort study coordinated by the Brazilian Society of Nephrology. The study included all adult incident dialysis patients in the Brazilian Dialysis Registry from January 2011 to December 2022. The variables studied encompassed age, skin color, education, CKD etiology, predialysis nephrologist care, dialysis characteristics, and geographic region. Additionally, the sample was analyzed for each of the three 4-year periods over the 12 years of data collection. RESULTS A total of 24,632 incident dialysis patients were included. Men were 59.1% of the dialysis population, remaining stable over the three 4-year periods. Besides other differences, women started dialysis younger (58.5 ± 16.2 years vs 59.5 ± 14.4 years; p < 0.001), had a lower educational level (less than 8 years at school: 54% vs 44%; p < 0.001), received more predialysis nephrologist care (46.2% vs 44.2%; p = 0.04), and had a higher prevalence of peritoneal dialysis (4.4% vs 3.5%; p = 0.03). CONCLUSION We consistently observed a higher prevalence of men on dialysis and differences in demographic, clinical, and dialysis characteristics. The underlying reasons for these sex differences still necessitate further clarification.
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Affiliation(s)
| | | | | | - Ricardo Sesso
- Universidade Federal de São Paulo, São Paulo, Brazil
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Lomba GSB, da Silva PHA, do Rosário NF, Medeiros T, Alves LS, Silva AA, Almeida JR, Lugon JR. Post-discharge all-cause mortality in COVID-19 recovered patients hospitalized in 2020: the impact of chronic kidney disease. Rev Inst Med Trop Sao Paulo 2024; 66:e1. [PMID: 38198374 PMCID: PMC10768652 DOI: 10.1590/s1678-9946202466001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/16/2023] [Indexed: 01/12/2024] Open
Abstract
In Brazil, the COVID-19 burden was substantial, and risk factors associated with higher in-hospital mortality rates have been extensively studied. However, information on short-term all-cause mortality and the factors associated with death in patients who survived the hospitalization period of acute SARS-CoV-2 infection is limited. We analyzed the six-month post-hospitalization mortality rate and possible risk factors of COVID-19 patients in a single center in Brazil. This is a retrospective cohort study focused on a six-month follow-up. The exclusion criteria were death during hospitalization, transference to another hospital, and age under 18. We collected data from the charts of all hospitalized patients from March 2020 to December 2020 with a positive RT-PCR test for SARS-CoV-2, resulting in a sample size of 106 patients. The main outcome was death after hospitalization, whereas comorbidities and demographics were evaluated as risk factors. The crude post-hospitalization death rate was 16%. The first 30 days of follow-up had the highest mortality rate. In a Cox regression model for post-hospitalization mortality, previous chronic kidney disease (HR, 4.06, 95%CI 1.46 - 11.30) and longer hospital stay (HR 1.01, 95%CI 1.00 - 1.02) were the only factors statistically associated with death. In conclusion, a high six-month all-cause mortality was observed. Within the six-month follow-up, a higher risk of death was observed for patients who had prior CKD and longer hospital stay. These findings highlight the importance of more intensive medical surveillance during this period.
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Affiliation(s)
| | | | - Natalia Fonseca do Rosário
- Universidade Federal Fluminense, Faculdade de Medicina, Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Niterói, Rio de Janeiro, Brazil
| | - Thalia Medeiros
- Universidade Federal Fluminense, Faculdade de Medicina, Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Niterói, Rio de Janeiro, Brazil
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Patologia, Niterói, Rio de Janeiro, Brazil
| | - Lilian Santos Alves
- Universidade Federal Fluminense, Faculdade de Medicina, Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Niterói, Rio de Janeiro, Brazil
| | - Andrea Alice Silva
- Universidade Federal Fluminense, Faculdade de Medicina, Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Niterói, Rio de Janeiro, Brazil
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Patologia, Niterói, Rio de Janeiro, Brazil
| | - Jorge Reis Almeida
- Universidade Federal Fluminense, Faculdade de Medicina, Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Niterói, Rio de Janeiro, Brazil
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Medicina Clínica, Divisão de Nefrologia, Niterói, Rio de Janeiro, Brazil
| | - Jocemir Ronaldo Lugon
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Medicina Clínica, Divisão de Nefrologia, Niterói, Rio de Janeiro, Brazil
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de Carvalho VCP, da Silva Guimarães BL, Fujihara MTF, Ceotto VF, Turon R, Lugon JR, Gismondi RAOC. Daily ROX index can predict transitioning to mechanical ventilation within the next 24 h in COVID-19 patients on HFNC. Am J Emerg Med 2023; 73:160-165. [PMID: 37688983 DOI: 10.1016/j.ajem.2023.08.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/11/2023] Open
Abstract
INTRODUCTION High flow nasal cannula (HFNC) is used to prevent invasive ventilation in COVID-19-associated hypoxemia. The respiratory rate‑oxygenation (ROX) index has been reported to predict failure of HFNC in patients with COVID-19 pneumonia during the intensive care unit stay when measured in first hours of therapy. However, the clinical course of ICU patients may change substantially in the first days of admission. The objective of this study was to investigate whether ROX index obtained in the first four days of ICU admission could predict the need for invasive respiratory support within the next 24 h of measurements. METHODS A retrospective cross-sectional study was performed using a database that included adult patients with COVID-19 pneumonia treated in the ICU. Patients were followed from ICU admission and ROX index was calculated daily on HFNC. Receiver operating characteristics curves (ROCs) were performed. RESULTS Two hundred forty-nine patients were enrolled, 48% of whom require mechanical ventilation (MV). The area under the ROC of the pooled 4-day values of the ROX index as a predictor of transition from HFNC to MV within 24 h of measurements was 0.86 (95%CI 0.83 to 0.88, P < 0.001) with a cutoff point of 4.06. CONCLUSION In COVID-19 patients in high flow nasal cannula, daily ROX index measurements successfully predicted transition to mechanical ventilation within the next 24 h.
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Affiliation(s)
| | | | | | | | - Ricardo Turon
- Intensive Care Unit, Hospital Niteroi D'Or, Niteroi, Rio de Janeiro, Brazil
| | - Jocemir Ronaldo Lugon
- Department of Medicine, Medical School, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
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Nerbass FB, Lima HDN, Lugon JR, Sesso R. Hemodialysis in Brazil: differences across geographic regions regarding demographics, laboratory parameters and drug prescription. J Bras Nefrol 2023; 45:410-416. [PMID: 37395543 PMCID: PMC10726669 DOI: 10.1590/2175-8239-jbn-2022-0169en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/10/2023] [Indexed: 07/04/2023] Open
Abstract
INTRODUCTION Brazil has a vast territory divided into five geographic regions with important differences in sociodemographic indices. We aimed to present and compare socio-demographic characteristics, biochemical results, and drug prescription of patients on chronic hemodialysis (HD) treatment in the five geographic regions. METHODS We evaluated data from the Brazilian Dialysis Registry of all adult patients undergoing chronic HD in 2021. Variables included sociodemographic characteristics, serum levels of phosphate, calcium, and albumin, hemoglobin, urea reduction rate, and prescription of phosphate binders, erythropoietin, and intravenous iron. Data from the North and Northeast regions were combined into one group. RESULTS A total of 13,792 patients (57.9 ± 16.0 years old, 58.5% male, median HD vintage of 31 (11-66) months) from 73 dialysis centers were analyzed. Regional distribution was 59.5% in the Southeast; 21.7% in the South; 5.9% in the Midwest; and 12.9% in the North/Northeast. Sociodemographic features, biochemical results, and medication prescriptions differed across regions. The prevalence of elderly patients was lower in the Midwest and North/Northeast. The South region had the highest prevalence of hyperphosphatemia (41.2%) and urea reduction rate <65% (24.8%), while anemia and hypoalbuminemia were more prevalent in the Southeast, 32.7% and 11.6%, respectively. CONCLUSION We found differences in socio-demographics, clinical features, and drug prescriptions across Brazilian geographic regions. Some findings reflect the socio-demographic diversity of the country, while others deserve further elucidation.
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Affiliation(s)
| | | | | | - Ricardo Sesso
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Barra ABL, da Silva APR, Canziani MEF, Lugon JR, de Matos JPS. Survival in hemodialysis in Brazil according to the source of payment for the treatment: Public Healthcare System (SUS) versus private insurance. J Bras Nefrol 2023; 45:302-309. [PMID: 36662571 PMCID: PMC10697161 DOI: 10.1590/2175-8239-jbn-2022-0131en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/07/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Brazil has the largest public and universal healthcare system in the world, but little is known about the outcomes of patients on hemodialysis (HD) in the country according to the source of funding for the treatment. OBJECTIVE To compare the profile and survival of patients under HD treatment funded by the Public Healthcare System (SUS) to those with private insurance. METHODS Retrospective analysis of adults undergoing HD between 2012 and 2017 in 21 dialysis centers in Brazil that provided both by the SUS and private health insurance. Participants, regardless of the paying source, received similar dialysis treatment. Data were censored after 60 months of follow-up or at the end of 2019. RESULTS 4,945 patients were included, 59.7% of which were financed by the SUS. Patients financed by SUS, compared to those with private insurance, were younger (58 vs. 60 years; p < 0.0001) and with a lower prevalence of diabetes (35.8% vs. 40.9%; p < 0.0001). The 60-month survival rates in these groups were 51.1% and 52.1%, respectively (p = 0.85). In the analysis of the subdistribution proportional hazard ratio by the Fine-Gray model, including adjustment for concurrent outcomes, a significant increase in the risk ratio for death was found (1.22 [95% confidence interval 1.04 to 1.43]) in patients with treatment funded by the SUS. CONCLUSIONS Patients on HD with treatment funded by the SUS have a higher adjusted risk of death when compared to those with private insurance, despite similar dialysis treatment. Factors not directly related to dialysis therapy could explain this difference.
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Affiliation(s)
- Ana Beatriz Lesqueves Barra
- Universidade Federal Fluminense, Faculdade de Medicina, Programa de
Pós-Graduação em Ciências Médicas, Niterói, RJ, Brazil
- Fresenius Medical Care Brasil, Rio de Janeiro, RJ, Brazil
| | - Ana Paula Roque da Silva
- Universidade Federal Fluminense, Faculdade de Medicina, Programa de
Pós-Graduação em Ciências Médicas, Niterói, RJ, Brazil
| | | | - Jocemir Ronaldo Lugon
- Universidade Federal Fluminense, Faculdade de Medicina, Programa de
Pós-Graduação em Ciências Médicas, Niterói, RJ, Brazil
- Universidade Federal Fluminense, Faculdade de Medicina, Divisão de
Nefrologia, Niterói, RJ, Brazil
| | - Jorge Paulo Strogoff de Matos
- Universidade Federal Fluminense, Faculdade de Medicina, Programa de
Pós-Graduação em Ciências Médicas, Niterói, RJ, Brazil
- Universidade Federal Fluminense, Faculdade de Medicina, Divisão de
Nefrologia, Niterói, RJ, Brazil
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Abstract
INTRODUCTION The Brazilian Dialysis Survey (BDS) is an important source of national data about people on chronic dialysis that contributes to the formulation of health policies regarding kidney failure. OBJECTIVE To report the 2021 epidemiological data from the BDS of the Brazilian Society of Nephrology (BSN). METHODS A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire covering clinical and epidemiological aspects of patients in chronic dialysis, data on dialysis therapy, characteristics of dialysis centers, and the impact of the COVID-19 pandemic of 2021. RESULTS Thirty percent (n = 252) of the centers answered the questionnaire. In July 2021, the estimated total number of patients on dialysis was 148,363. The estimated prevalence and incidence rates of patients per million population (pmp) were 696 and 224, respectively. Of the prevalent patients, 94.2% were on hemodialysis (HD) (1.8% of these on hemodiafiltration), and 5.8% on peritoneal dialysis (PD); 21% were on the transplant waiting list. The incidence rate of confirmed COVID-19 between January and July 2021 was 1,236/10,000 dialysis patients, and the case-fatality rate reached 25.5%. Up to July 2021, 88.6% of patients had received at least one dose of the anti-SARS-CoV-2 vaccine. The estimated overall and COVID-19 crude annual mortality rates were 22.3% and 5.3%, respectively. CONCLUSION The absolute number and the prevalence rate of patients on chronic dialysis continue to increase. Most dialysis patients were vaccinated against COVID-19 during the year. The COVID-19 pandemic was associated to the overall mortality rate.
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Affiliation(s)
| | | | | | | | - Ricardo Sesso
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Barra ABL, Silva APRD, Canziani MEF, Lugon JR, Matos JPSD. Sobrevida na hemodiálise no Brasil de acordo com a fonte pagadora do tratamento: Sistema Único de Saúde versus convênio privado. J Bras Nefrol 2023. [DOI: 10.1590/2175-8239-jbn-2022-0131pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Resumo Introdução: O Brasil possui o maior sistema público e universal de saúde do mundo, mas pouco se sabe sobre os desfechos dos pacientes em hemodiálise (HD) no país de acordo com a fonte de financiamento do tratamento. Objetivo: Comparar o perfil e a sobrevida dos pacientes que têm o tratamento de HD custeado pelo Sistema Único de Saúde (SUS) com aqueles com convênio privado. Métodos: Análise retrospectiva dos adultos incidentes em HD entre 2012 e 2017 em 21 centros de diálise no Brasil que atendiam tanto pelo SUS quanto por convênios privados. Os participantes, independentemente da fonte pagadora, receberam tratamento dialítico semelhante. Os dados foram censurados com 60 meses de acompanhamento ou ao final de 2019. Resultados: Foram incluídos 4945 pacientes, sendo 59,7% financiados pelo SUS. Os pacientes financiados pelo SUS, em comparação aos que tinham convênio privado, eram mais jovens (58 vs 60 anos; p < 0,0001) e com menor prevalência de diabetes (35,8% vs 40,9%; p < 0,0001). As taxas de sobrevida, em 60 meses nesses grupos foram de 51,1% e 52,1%, respectivamente (p = 0,85). Na análise da razão de risco proporcional de subdistribuição pelo modelo de Fine-Gray, incluindo ajuste para desfechos concorrentes, foi encontrado um aumento significativo na razão de risco para morte (1,22 [intervalo de confiança de 95% 1,04 a 1,43]) nos pacientes com tratamento custeado pelo SUS. Conclusões: Pacientes em HD com tratamento custeado pelo SUS têm um risco ajustado de morte mais elevado do que aqueles com convênio privado, apesar do tratamento dialítico semelhante. Fatores não relacionados diretamente à terapia dialítica poderiam justificar esta diferença.
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Nerbass FB, Lima HDN, Vieira Neto OM, Sesso R, Lugon JR. Prevalence and Determinants of Predialysis Dietitian Follow-Up: Results From the Brazilian Dialysis Registry. J Ren Nutr 2023; 33:97-102. [PMID: 35597320 DOI: 10.1053/j.jrn.2022.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/11/2022] [Accepted: 04/24/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the prevalence and sociodemographic determinants of predialysis dietitian follow-up in a large cohort of Brazilian dialysis patients. METHODS We retrospectively evaluated data from all incident adult dialysis patients included in the Brazilian Dialysis Registry from January 2011 to September 2021. Predialysis dietitian follow-up was classified as present when a period more than 6 months of dietitian care was reported. Gender, age, skin color, education, body mass index, chronic kidney disease etiology, first chronic dialysis program, healthcare provider, and geographic regions were tested in logistic regression models. RESULTS Ten thousand three hundred and eighty two patients met the inclusion criteria and 1,254 (12.1%) reported predialysis dietitian follow-up, most of them referred by a nephrologist (94.2%). The independent determinants of dietitian follow-up were older age, white skin color, higher education level, not having diabetes, living in North/Northeast and South (compared to Southeast), and having a nonpublic healthcare provider. When considered only patients under a predialysis care of a nephrologist, higher education, hemodialysis as the first dialysis modality, and living in the North/Northeast and South regions (compared with Southeast) were associated with dietitian follow-up. CONCLUSION Predialysis dietitian follow-up for more than 6 months in a country where the public health system is the main dialysis provider is still very low. The nephrologist is pivotal for referral to dietitians but socioeconomic factors also seem to play a role in this regard.
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Affiliation(s)
| | | | | | - Ricardo Sesso
- Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
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Nerbass FB, Lima HDN, Thomé FS, Vieira Neto OM, Sesso R, Lugon JR. Censo Brasileiro de Diálise 2021. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2022-0083pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
RESUMO Introdução: O Censo Brasileiro de Diálise (CBD) constitui importante fonte de dados nacionais sobre pessoas em diálise crônica que contribui para a formulação de políticas de saúde. Objetivo: Relatar dados epidemiológicos de 2021 do CBD da Sociedade Brasileira de Nefrologia (SBN). Métodos: Realizou-se pesquisa em centros brasileiros de diálise crônica utilizando questionário online abrangendo aspectos clínicos e epidemiológicos de pacientes em diálise crônica, dados sobre terapia dialítica, características dos centros de diálise e o impacto da pandemia COVID-19 em 2021. Resultados: Trinta por cento (n = 252) dos centros responderam ao questionário. Em Julho de 2021, o número total estimado de pacientes em diálise foi 148.363. As taxas estimadas de prevalência e incidência de pacientes por milhão da população (pmp) foram 696 e 224, respectivamente. Dos pacientes prevalentes, 94,2% estavam em hemodiálise (HD) (1,8% destes em hemodiafiltração), e 5,8% em diálise peritoneal (DP); 21% estavam na lista de espera para transplante. A taxa de incidência de COVID-19 confirmada entre Janeiro e Julho de 2021 foi 1.236/10.000 pacientes em diálise, e a taxa de letalidade atingiu 25,5%. Até Julho de 2021, 88,6% dos pacientes haviam recebido pelo menos uma dose da vacina anti-SARS-CoV-2. As taxas estimadas de mortalidade bruta anual geral e por COVID-19 foram de 22,3% e 5,3%, respectivamente. Conclusão: O número absoluto e a taxa de prevalência de pacientes em diálise crônica continuam aumentando. A maioria dos pacientes em diálise foram vacinados contra COVID-19 durante o ano. A pandemia COVID-19 contribuiu com a taxa de mortalidade geral.
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Nerbass FB, Lima HDN, Sesso R, Lugon JR. Prevalência elevada de hipercalemia em pacientes brasileiros em diálise crônica e diferenças entre as regiões geográficas. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2022-0053pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Introdução: A hipercalemia é uma condição multifatorial comum em pessoas em diálise crônica e está associada à mortalidade. Nosso objetivo foi informar e discutir a prevalência de hipercalemia em uma grande população de pacientes em diálise crônica no Brasil e diferenças entre as regiões geográficas. Métodos: A prevalência de hipercalemia (potássio sérico ≥6,0 mEq/L) foi avaliada por meio do Censo Brasileiro de Diálise (CBD) em Julho de 2019, uma pesquisa online de participação voluntária na qual foram convidados todos os centros de diálise registrados na Sociedade Brasileira de Nefrologia. Resultados: Aproximadamente um terço (n=263 de 805) das clínicas de diálise brasileiras participaram. A prevalência de hipercalemia na população total foi de 16,1% (n=7.457 de 46.193; IC95%=15,8-16,5%), e variou de 12,1% no Norte a 18,7% no Nordeste. Conclusão: Encontramos uma elevada prevalência de hipercalemia em umagrande população brasileira em diálise crônica. É necessária uma investigação nacional dos fatores de risco, opções de tratamento e se esta alta prevalência contribui para a mortalidade desta população.
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Nerbass FB, Lima HDN, Sesso R, Lugon JR. High prevalence of hyperkalemia in Brazilian chronic dialysis patients and differences across geographic regions. J Bras Nefrol 2022; 45:106-109. [PMID: 35920444 PMCID: PMC10139716 DOI: 10.1590/2175-8239-jbn-2022-0053en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/22/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Hyperkalemia is a common multifactorial condition of people on chronic dialysis and is associated with mortality. We aimed to inform and discuss the prevalence of hyperkalemia in a large population of chronic dialysis patients in Brazil and its geographic regions. METHODS Prevalence of hyperkalemia (serum potassium ≥6.0 mEq/L) was assessed in the Brazilian Dialysis Survey (BDS) in July 2019, an online survey of voluntary participation in which all dialysis centers registered at the Brazilian Society of Nephrology were invited. RESULTS Approximately one-third (n=263 of 805) of the Brazilian dialysis clinics participated. The prevalence of hyperkalemia in the whole population was 16.1% (n=7,457 of 46,193; 95%CI=15.8-16.5%,), and varied from 12.1% in the North to 18.7% in the Northeast. CONCLUSION We found a high prevalence of hyperkalemia in a large Brazilian chronic dialysis population. A nationwide investigation of risk factors, treatment options, and whether this high prevalence contributes to dialysis mortality is warranted.
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Affiliation(s)
| | | | - Ricardo Sesso
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Medeiros T, Guimarães GMC, Carvalho FR, Alves LS, Faustino R, Campi-Azevedo AC, Peruhype-Magalhães V, Teixeira-Carvalho A, de Souza Gomes M, Rodrigues do Amaral L, Martins-Filho OA, Lugon JR, Almeida JR, Silva AA. Acute kidney injury associated to COVID-19 leads to a strong unbalance of circulant immune mediators. Cytokine 2022; 157:155974. [PMID: 35907365 PMCID: PMC9309102 DOI: 10.1016/j.cyto.2022.155974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/02/2022] [Accepted: 07/19/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Severe cases of coronavirus disease 2019 (COVID-19) have increased risk for acute kidney injury (AKI). The exacerbation of the immune response seems to contribute to AKI development, but the immunopathological process is not completely understood. OBJECTIVES To analyze levels of circulant immune mediators in COVID-19 patients evolving with or without AKI. We have also investigated possible associations of these mediators with viral load and clinical outcomes. METHODS This is a longitudinal study performed with hospitalized patients with moderate to severe COVID-19. Serum levels of 27 immune mediators were measured by a multiplex immunoassay. Data were analyzed at two timepoints during the follow-up: within the first 13 days of the disease onset (early sample) and from the 14th day to death or hospital discharge (follow-up sample). RESULTS We studied 82 COVID-19 patients (59.5 ± 17.5 years, 54.9% male). Of these, 34 (41.5%) developed AKI. These patients presented higher SARS-CoV-2 viral load (P = 0.03), higher frequency of diabetes (P = 0.01) and death (P = 0.0004). Overall, AKI patients presented significantly higher and sustained levels (P < 0.05) of CCL-2, CCL-3, CCL-4, CXCL-8, CXCL-10, IFN-γ, IL-2, IL-6, TNF-α, IL-1Ra, IL-10 and VEGF. Importantly, higher levels of CCL-2, CXCL-10, IL-2, TNF-α, IL-10, FGFb, and VEGF were observed in AKI patients independently of death. ROC curves demonstrated that early alterations in CCL-2, CXCL-8, CXCL-10, IFN-γ, IL-6, IL-1Ra and IL-10 show a good predictive value regarding AKI development. Lastly, immune mediators were significantly associated with each other and with SARS-CoV-2 viral load in AKI patients. CONCLUSIONS COVID-19 associated AKI is accompanied by substantial alterations in circulant levels of immune mediators, which could significantly contribute to the establishment of kidney injury.
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Affiliation(s)
- Thalia Medeiros
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil; Department of Pathology, Faculty of Medicine, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.
| | - Gabriel Macedo Costa Guimarães
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
| | - Fabiana Rabe Carvalho
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
| | - Lilian Santos Alves
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
| | - Renan Faustino
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
| | | | | | | | - Matheus de Souza Gomes
- Laboratory of Bioinformatics and Molecular Analysis (LBAM), Federal University of Uberlandia, Patos de Minas, Minas Gerais, Brazil
| | - Laurence Rodrigues do Amaral
- Laboratory of Bioinformatics and Molecular Analysis (LBAM), Federal University of Uberlandia, Patos de Minas, Minas Gerais, Brazil
| | | | - Jocemir Ronaldo Lugon
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil; Department of Clinical Medicine - Nephrology, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
| | - Jorge Reis Almeida
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil; Department of Clinical Medicine - Nephrology, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
| | - Andrea Alice Silva
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil; Department of Pathology, Faculty of Medicine, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Cunha FDS, Jann HW, Lugon JR, Peralta JM, Peralta RHS. Molecular characterization of Cryptosporidium spp. obtained from fecal samples of immunosuppressed patients from Brazil. Rev Soc Bras Med Trop 2022; 55:e05552021. [PMID: 35416875 PMCID: PMC9009872 DOI: 10.1590/0037-8682-0555-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/30/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Cryptosporidium spp. are pathogenic protozoans that play an important role in developing diseases in the elderly, children, and immunosuppressed individuals. Methods: The objective of this study was to detect and genetically characterize Cryptosporidium spp. in kidney transplanted patients (n = 97 samples; group 1) and immunosuppressed individuals from an outpatient clinic suspected of having Cryptosporidium infection (n = 53 samples; group 2). All fecal samples were analyzed by parasitological stool examination, immunochromatographic test, and real-time polymerase chain reaction (real-time PCR). Cryptosporidium-positive samples were tested using nested PCR for the gp60 gene, followed by sequencing for subtype determination. Results: Parasitological examination was negative in all Group 1, and positive in four Group 2 samples. Real-time PCR revealed Cryptosporidium in 13 samples: four in Group 1 (three C. hominis and one C. parvum) and nine in Group 2 (seven C. hominis, one C. parvum, and one mixed C. hominis/C. parvum). The immunochromatographic test was reactive in 11 samples (four in Group 1 and seven in Group 2). All 11 C. hominis isolates were identified as subtype IbA10G2 and one C. parvum as subtype IIbA15G2R1. All C. hominis belonged to subtype IbA10G2, which is recognized as the most prevalent and pathogenic subtype. Conclusions: This study showed, for the first time, that the presence of Cryptosporidium subtypes is considered more virulent in Brazilian transplanted kidney patients.
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Affiliation(s)
- Flávia de Souza Cunha
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Patologia, Niterói, RJ, Brasil
| | - Higor Wilson Jann
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Patologia, Niterói, RJ, Brasil
| | - Jocemir Ronaldo Lugon
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Nefrologia, Niterói, RJ, Brasil
| | - José Mauro Peralta
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Paulo de Góes, Departamento de Imunologia, Rio de Janeiro, RJ, Brasil
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Abstract
Introduction: National data on chronic dialysis treatment are essential to support the development of health policies aimed at improving the treatment for thousands of people. Objective: To report epidemiological data from the 2020 Brazilian Dialysis Survey, sponsored by the Brazilian Society of Nephrology. Methods: A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire for the year, covering clinical and epidemiological aspects of patients in a chronic dialysis program, data on dialysis therapy, characteristics of dialysis units and the impact of the COVID-19 pandemic. Results: 235 (28%) of the centers responded to the questionnaire. In July 2020, the estimated total number of patients on dialysis was 144,779. The estimated prevalence and incidence rates of patients per million population (pmp) were 684 and 209, respectively. Of the prevalent patients, 92.6% were on hemodialysis (HD) and 7.4% were on peritoneal dialysis (PD); 23% were on the transplant waiting list. A central venous catheter was used by a quarter of patients on HD. The incidence rate of confirmed COVID-19 between February and July 2020 was 684/10,000 dialysis patients, and the lethality rate was 25.7%. The estimated overall mortality and COVID-19 crude annual mortality rates were 24.5 and 4.2%, respectively. Conclusion: The absolute number of patients on chronic dialysis and prevalence rate continued to increase. The low use of PD as dialysis therapy was maintained and the use of long-term catheters for HD increased. The COVID-19 pandemic contributed to the increase in the overall mortality rate.
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Affiliation(s)
| | | | | | | | | | - Ricardo Sesso
- Universidade Federal de São Paulo, São Paulo, SP, Brasil
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19
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Lugon JR, Neves PDMDM, Pio-Abreu A, do Nascimento MM, Sesso R. Evaluation of central venous catheter and other risk factors for mortality in chronic hemodialysis patients with COVID-19 in Brazil. Int Urol Nephrol 2022; 54:193-199. [PMID: 34132971 PMCID: PMC8207494 DOI: 10.1007/s11255-021-02920-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Hemodialysis patients with COVID-19 are at increased risk of death. We aimed to describe the characteristics of a cohort of Brazilian hemodialysis patients with COVID-19 and assess their mortality rate and risk factors for death. METHODS Retrospective cohort study of 741 Brazilian hemodialysis patients with confirmed COVID-19 from Feb-Dec/2020, of 52 dialysis centers of the country. We analyzed comorbid conditions, sociodemographic factors, and dialysis-related parameters. To detect risk factors for mortality in hemodialysis patients, we performed multivariable Cox proportional hazard regression analysis. Survival was analyzed by Kaplan-Meier. RESULTS From 9877 hemodialysis patients, 741 were diagnosed with COVID-19. Mean age was 57 ± 16 years, 61% were male, and 51% white. The most frequent symptoms were fever (54.1%), cough (50.9%), and dyspnea (37.2%); 14.2% were asymptomatic. There were 139 deaths (18.8%), with 66% within the disease's first 15 days. 333 patients (44.9%) required hospitalization, and 211 (28.5%) were admitted to an intensive care unit. The cumulative probability of survival at 90 days of diagnosis was 79% (95% CI 76-82%). In the fully adjusted multivariate model, the risk factors significantly associated with death were diabetes mellitus (HR 1.52, 95% CI 1.05-2.19, P = 0.026), use of a central venous catheter (CVC) (HR 1.79, 95% CI 1.22-2.64, P = 0.003), age (HR 1.03, 95% CI 1.01-1.04, P < 0.001), and origin from the North vs. Southeast region (HR 2.60, 95% CI 1.01-6.68, P = 0.047). CONCLUSIONS Hemodialysis patients using a CVC as the vascular access, aside from diabetic and elderly ones, should be closely monitored due to their high risk of death in the course of the COVID-19.
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Affiliation(s)
| | | | - Andrea Pio-Abreu
- Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, SP, Brazil
| | | | - Ricardo Sesso
- Division of Nephrology, Escola Paulista de Medicina, Federal University of São Paulo, Rua Botucatu 740, São Paulo, SP, 04023-900, Brazil.
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Malta LMDA, Santos AASMDD, Malta MC, Machado LM, Lugon JR. TREATMENT OF QUADRICEPS TENDON RUPTURE IN HEMODIALYSIS PATIENTS: A 2020 UPDATE. Acta ortop bras 2022; 30:e245692. [PMID: 35864830 PMCID: PMC9270044 DOI: 10.1590/1413-785220223001e245692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/04/2021] [Indexed: 11/22/2022]
Abstract
ABSTRACT Quadriceps tendon tears are uncommon injuries often associated with chronic diseases, including end-stage renal disease (ESRD). The role of secondary hyperparathyroidism as a predisposing factor for tendon tears in this group of patients is well documented, and the weakening of the tendon-bone junction is part of this context. The treatment of choice for quadriceps tendon ruptures in patients with ESRD is surgery, which should be performed as soon as possible. There are several surgical techniques to be used, but the lack of comparative studies does not allow us to conclude which one is the best option. More recent publications have preferred the association of techniques, with emphasis on the use of autologous tendon grafts as a reinforcement tool, which is the author’s procedure of choice. Recent studies reported the use of biological agents to stimulate healing and allografts, but the information seems preliminary to be routinely recommended. Level of evidence II; Obsevation of therapeutic studies.
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de Sandes-Freitas TV, de Andrade LGM, Moura LRR, Cristelli MP, Medina-Pestana JO, Lugon JR, Sesso R. Comparison of 30-day case-fatality rate between dialysis and transplant Covid-19 patients: a propensity score matched cohort study. J Nephrol 2022; 35:131-141. [PMID: 34677805 PMCID: PMC8532104 DOI: 10.1007/s40620-021-01172-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/17/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Patients undergoing kidney replacement therapies (KRTs) have a poor prognosis after Covid-19 infection. Few studies have compared the outcomes of such patients in the different KRT modalities. This study aimed to analyze the 30-day Covid-19-associated case-fatality rate of dialysis and kidney transplant patients. METHODS Retrospective cohort study analyzing data from patients with confirmed Covid-19 between Mar/20 and Jan/21 included in two multicenter studies, the Brazilian Covid-19 Dialysis Study (Dialysis group, n = 703) and the Covid-19-KT Brazilian Study (Transplant group, n = 1907). To assess the risk factors for death, adjusted Cox hazards models were used. A sensitivity analysis was performed using a propensity score analysis to match the groups (n = 587 patients in each group). RESULTS A higher percentage of transplant patients required hospitalization (68 vs. 51%, p < 0.001), intensive care (37 vs. 30%, p = 0.023), and invasive mechanical ventilation (28 vs. 22%, p = 0.035). Multivariate analysis of the before-matching sample showed that subjects in the transplant group were at a lower death risk at baseline (HR 0.380.560.85). However, they showed higher risk over time (HR 1.031.061.09). Kaplan-Meier analysis after propensity score matching confirmed the inferior 30-day cumulative survival in the transplant recipients (83 vs. 78%, p = 0.0014). CONCLUSION Both transplant and dialysis patients have high 30-day case-fatality rates after a Covid-19 diagnosis. Despite lower death risk at baseline, transplant patients have an increased death risk of 6% per day than dialysis patients.
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Affiliation(s)
- Tainá Veras de Sandes-Freitas
- Programa de Pós-Graduação Em Ciências Médicas, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Do Ceará, Fortaleza, CE, Brazil
- Hospital Universitário Walter Cantídio, Fortaleza, CE, Brazil
- Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | | | - Lucio Roberto Requião Moura
- Hospital Do Rim, Fundação Oswaldo Ramos, São Paulo, SP, Brazil.
- Departamento de Medicina, Disciplina de Nefrologia, Universidade Federal de São Paulo. Rua Botucatu, 740, São Paulo, SP, 04023-062, Brazil.
- Unidade de Transplante Renal, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | - José Osmar Medina-Pestana
- Hospital Do Rim, Fundação Oswaldo Ramos, São Paulo, SP, Brazil
- Departamento de Medicina, Disciplina de Nefrologia, Universidade Federal de São Paulo. Rua Botucatu, 740, São Paulo, SP, 04023-062, Brazil
| | - Jocemir Ronaldo Lugon
- Departamento de Medicina, Divisão de Nefrologia, Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | - Ricardo Sesso
- Departamento de Medicina, Disciplina de Nefrologia, Universidade Federal de São Paulo. Rua Botucatu, 740, São Paulo, SP, 04023-062, Brazil
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da Silva Guimarães B, de Souza LC, Cordeiro HF, Regis TL, Leite CA, Puga FP, Alvim SH, Lugon JR. Inspiratory Muscle Training With an Electronic Resistive Loading Device Improves Prolonged Weaning Outcomes in a Randomized Controlled Trial. Crit Care Med 2021; 49:589-597. [PMID: 33332819 DOI: 10.1097/ccm.0000000000004787] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To test if the use of an inspiratory muscle training program with an electronic resistive loading device is associated with benefits as to muscle strength, weaning, and survival in the ICU. DESIGN Prospective randomized controlled trial. SETTINGS Study conducted at the ICU of a Navy's hospital, Rio de Janeiro, Brazil, from January 2016 to September 2018. PATIENTS Tracheostomized patients (18-86 yr) on prolonged weaning. INTERVENTIONS Participants were assigned to inspiratory muscle training (intervention group) or a traditional T-piece protocol (control group). In the inspiratory muscle training group, participants underwent training with an electronic inspiratory training device (POWERbreathe K-5; Technologies Ltd, Birmingham, United Kingdom). MEASUREMENTS AND MAIN RESULTS Changes in respiratory muscle strength and rates of ICU survival and weaning success were compared between groups. Forty-eight participants in the inspiratory muscle training group and 53 ones in the control group were included in the final analysis. The inspiratory muscle training was associated with a substantially higher gain on muscle strength as assessed by the maximal inspiratory pressure (70.5 [51.0-82.5] vs -48.0 cm H2O [36.0-72.0 cm H2O]; p = 0.003) and the timed inspiratory effort index (1.56 [1.25-2.08] vs 0.99 cm H2O/s [0.65-1.71 cm H2O/s]; p = 0.001). Outcomes at the 60th day of ICU were significantly better in the intervention group regarding both survival (71.1% vs 48.9%; p = 0.030) and weaning success (74.8% vs 44.5%; p = 0.001). CONCLUSIONS The use of an inspiratory muscle training program with an electronic resistive loading device was associated with substantial muscle strength gain and positive impacts in two very relevant clinical outcomes: the rates of ICU survival and successful weaning.
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Affiliation(s)
- Bruno da Silva Guimarães
- Medical Science Post-graduation Program, Universidade Federal Fluminense, Rio de Janiero, Brazil
- Physical Therapy Hospital Naval Marcilio Dias, Rio de Janiero, Brazil (Brazil's Navy)
| | | | - Hebe Faria Cordeiro
- Physical Therapy Hospital Naval Marcilio Dias, Rio de Janiero, Brazil (Brazil's Navy)
| | - Thiago Loureiro Regis
- Physical Therapy Hospital Naval Marcilio Dias, Rio de Janiero, Brazil (Brazil's Navy)
| | | | | | - Sergio Hernando Alvim
- Intensive Care Unit Hospital Naval Marcilio Dias, Rio de Janiero, Brazil (Brazil's Navy)
| | - Jocemir Ronaldo Lugon
- Division of Nephrology, Department of Medicine, Medical School, Universidade Federal Fluminense, Rio de Janiero, Brazil
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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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Gonçalves JG, Lugon JR, Nascimento MMD, Sesso RC. Demographics and clinical features of elderly patients undergoing regular dialysis in Brazil. Braz J Med Biol Res 2021; 54:e9806. [PMID: 33624734 PMCID: PMC7894391 DOI: 10.1590/1414-431x20209806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022] Open
Abstract
An increasing number of elderly people in renal support is expected in the coming years. The objective of this study was to report the clinical and socio-demographic data of end-stage renal disease (ESRD) adult patients undergoing regular dialysis treatment comparing elderly (≥65 years old) and non-elderly subjects using data from the Brazilian Dialysis Registry database. The regional distribution of the sample was Southeast (48.8%), South (33.7), Northeast (13.1%), Midwest (5.1%), and North (0.1%). A total of 18,030 patients were included in the analysis with elderly patients accounting for 29.5% of the sample. The elderly patients were predominantly male, white, retired, and literate. Elderly ESRD patients had a slightly higher frequency of undernourishment and a lower frequency of obesity than the non-elderly adults. A higher frequency of elderly patients were from the South and Southeast regions. The dialysis treatment of patients from both groups was predominantly funded by the public system, but the percent of non-public funding was higher for the elderly group. The most used initial access in the elderly was the central venous catheter and hemodialysis was the main modality at the beginning of treatment (93.2%), as well as during maintenance therapy (91.8%). Advanced age was associated with greater use of central venous catheter in the first dialysis session. The survival of the elderly on dialysis was lower than that of the non-elderly early in the course of dialysis and this difference increased over time. This is yet the largest national epidemiological study of elderly people on chronic dialysis.
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Affiliation(s)
- J G Gonçalves
- Departamento de Medicina, Divisão de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J R Lugon
- Departamento de Medicina, Divisão de Nefrologia, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, Brasil
| | - M M do Nascimento
- Departamento de Medicina, Divisão de Nefrologia, Faculdade de Medicina, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - R C Sesso
- Departamento de Medicina, Divisão de Nefrologia, Faculdade de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Pio-Abreu A, do Nascimento MM, Vieira MA, de Menezes Neves PDM, Lugon JR, Sesso R. High mortality of CKD patients on hemodialysis with Covid-19 in Brazil. J Nephrol 2020; 33:875-877. [PMID: 32770522 PMCID: PMC7414252 DOI: 10.1007/s40620-020-00823-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Andrea Pio-Abreu
- Nephrology Division, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | | | | | | | - Ricardo Sesso
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Silva APR, Strogoff-de-Matos JP, Lugon JR. Metabolic acidosis in hemodialysis: a neglected problem in Brazil. J Bras Nefrol 2020; 42:323-329. [PMID: 32353104 PMCID: PMC7657043 DOI: 10.1590/2175-8239-jbn-2019-0210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/13/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction: Metabolic acidosis is associated with the high mortality seen in hemodialysis patients. The panorama of metabolic acidosis in hemodialysis in Brazil is unclear since 1996 when the analysis of bicarbonate levels was no longer a compulsory exam. We aimed to establish the prevalence of metabolic acidosis in a hemodialysis population and analyze the factors associated with low bicarbonate levels. Methods: A cross-sectional study was carried out to assess the prevalence of metabolic acidosis in adults undergoing regular hemodialysis from January to April 2017, in four dialysis centers from Niteroi, Rio de Janeiro, Brazil, and surroundings. For blood gas analysis, samples of 2 mL were collected in heparinized syringes before a midweek dialysis session. Results: 384 patients with a mean age of 58.1 ± 15.8 years (54.5% men and 63.0%, non-white) were included. Approximately 30% had diabetes and 48%, hypertension. Nearly 88% used primary arteriovenous fistula as vascular access. The pre-dialysis mean serum tCO2 in the midweek session was 22.7 ± 3.0 mEq/L. The prevalence rate of serum bicarbonate below DOQI recommendation (22 mEq/L or higher) was 40.3%, and 6.5% had serum bicarbonate < 18 mEq/L. The dialyzer use count and the use of low-flux dialyzers were negatively associated whereas age and the standard Kt/V values were positively associated with the serum bicarbonate levels. Conclusion: The findings were in agreement with global data reported in previous studies. However, because the sample was relatively small and non-representative of the Brazilian population, a more comprehensive study, addressing national data is necessary to substantiate our findings.
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Braga D, Garcia Rosa ML, Altenburg Gismondi R, Lugon JR, Torres K, Nalin B, Kang H, Alcoforado V, Martínez Cerón DM. Uric acid and salt intake as predictors of incident hypertension in a primary care setting. Revista Colombiana de Cardiología 2020. [DOI: 10.1016/j.rccar.2019.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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de Souza Costa HLL, de Souza LC, da Silva Neto AE, da Silva Guimarães BL, de Azeredo LM, Godoy MDP, Lugon JR. Involvement of Respiratory Muscles During the Timed Inspiratory Effort Index Measurement With Surface Electromyography. Respir Care 2020; 65:1857-1863. [PMID: 32723857 DOI: 10.4187/respcare.07465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Mechanical ventilation is a life-support therapy that can be associated with respiratory muscle dysfunction that may perturb the weaning process. The timed inspiratory effort (TIE) index is a recently proposed weaning index that has been reported to be effective in predicting successful weaning. We sought to analyze the respiratory muscle groups involved with the TIE index measurement utilizing the surface electromyography (sEMG). METHODS We conducted a prospective observational study including 46 mechanically ventilated subjects. The variable analyzed with sEMG was the root mean square (RMS) for correlation with the degree of recruitment of motor units and strength. The data were obtained along the 60 s of the TIE index measurement and analyzed in each one of the 3 20-s intervals. Pooled and individual muscle RMS values were analyzed comparing success and failure groups. P < .05 was considered significant. RESULTS The median (interquartile range) age of the participants was 80 (71-87) y. The pooled sEMG data showed that muscle strength increased over time, following the profile observed for maximum inspiratory pressure, irrespective of the analyzed group. However, in line with the findings regarding maximum inspiratory pressure, the RMS medians were statistically higher at every 20-s interval in the success group. Diaphragm strength increased over time, with values reaching statistically significant differences at the end of the observation period, but only in the success group. In addition, diaphragm strength was statistically higher during the whole test in the success group. Finally, there was a substantial increase in sternocleidomastoid strength over time after 40 s of observation, which was not observed in the scalene muscles. CONCLUSIONS Subjects succeeding in a weaning trial had higher muscle strength, confirmed in the pooled and the individual sEMG analysis. A vigorous diaphragm with low fatigue potential seems essential for successful weaning; the sternocleidomastoid may also be of importance in this regard.
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Affiliation(s)
| | - Leonardo Cordeiro de Souza
- Physiotherapy College, Universidade Estácio de Sá, Niterói, Rio de Janeiro, Brazil. .,Intensive Care Division, Hospital Icaraí, Niterói, Rio de Janeiro, Brazil.,Intensive Care Division, Hospital & Clínica São Gonçalo, São Gonçalo, Rio de Janeiro, Brazil
| | - Arthur Evangelista da Silva Neto
- Medical Science Postgraduate Program, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.,Intensive Care Division, Hospital Icaraí, Niterói, Rio de Janeiro, Brazil
| | | | | | - Marcos David Parada Godoy
- Medical Science Postgraduate Program, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.,Intensive Care Division, Hospital & Clínica São Gonçalo, São Gonçalo, Rio de Janeiro, Brazil
| | - Jocemir Ronaldo Lugon
- Medicine/Nephrology, Medical School of Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Almeida RDCMD, Jorge AJL, Rosa MLG, Leite AR, Correia DMS, Mesquita ET, Chermont S, Lugon JR, Martins WDA. Left Ventricular Remodeling Patterns in Primary Healthcare. Arq Bras Cardiol 2020; 114:59-65. [PMID: 32049171 PMCID: PMC7025300 DOI: 10.36660/abc.20180258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/10/2019] [Indexed: 01/19/2023] Open
Abstract
Background Left ventricular remodeling (LVR) is related to both non-fatal and fatal outcomes. Objective To describe the geometric patterns of the LV and their associations. Methods A total of 636 individuals between the ages of 45 and 99 years in Rio de Janeiro, Brazil, were submitted to clinical evaluation, laboratory tests, electrocardiogram, and tissue Doppler echocardiography (TDE). The difference between categories was tested with Kruskall-Wallis with post hoc tests, once all variables studied are non-normally distributed and Pearson’s Qui-square (categorical variables). Gross and adjusted ORs were estimated by logistic regression. The level of significance was 5% for all tests. Subjects had LVR characterized as: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). Results The prevalence of altered patterns was 33%. Subjects presented NG (n = 423; 67%); EH (n = 186; 29%); CH (n = 14; 2%); and CR (n = 13; 2%). The variables of gender, age, level of education and albumin/creatinine ratio (A/C), showed a relationship with the chance of EH even after adjustment. Conclusion Approximately one third of the studied individuals had LVR and were at risk for developing heart failure. Altered A/C in urine was associated with EH, indicating an early relationship between cardiac and renal dysfunction.
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Affiliation(s)
| | - Antonio José Lagoeiro Jorge
- Curso de Pós-Graduação em Ciências Cardiovasculares da Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil
| | - Maria Luiza Garcia Rosa
- Curso de Pós-Graduação em Ciências Cardiovasculares da Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil
| | - Adson Renato Leite
- Curso de Pós-Graduação em Ciências Cardiovasculares da Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil
| | - Dayse Mary S Correia
- Curso de Pós-Graduação em Ciências Cardiovasculares da Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil
| | - Evandro Tinoco Mesquita
- Curso de Pós-Graduação em Ciências Cardiovasculares da Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil
| | - Sergio Chermont
- Curso de Pós-Graduação em Ciências Cardiovasculares da Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil
| | - Jocemir Ronaldo Lugon
- Curso de Pós-Graduação em Ciências Médicas da Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil
| | - Wolney de Andrade Martins
- Curso de Pós-Graduação em Ciências Cardiovasculares da Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil
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Sant'Anna MD, Carvalhal RF, Oliveira FDFBD, Zin WA, Lopes AJ, Lugon JR, Guimarães FS. Respiratory mechanics of patients with morbid obesity. ACTA ACUST UNITED AC 2019; 45:e20180311. [PMID: 31644708 PMCID: PMC8653979 DOI: 10.1590/1806-3713/e20180311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/16/2019] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To evaluate the different components of the resistance of the respiratory system, respiratory muscle strength and to investigate the occurrence of expiratory flow limitation (EFL) in patients with morbid obesity (MO) when seated. METHODS The sample was composed of MO (BMI≥40 kg/m2) and non-obese individuals (NO) with a BMI between 18 and 30 kg/m2. The protocol consisted of the anthropometric assessment and the following measures of respiratory function: spirometry, maximal inspiratory and expiratory pressures (MIP and MEP, respectively) and impulse oscillometry. The group comparison was performed using T-test for unpaired samples. The correlations were evaluated by the Pearson test with a significance level of 5%. RESULTS Fifty MO (age 40±10.4 years, 1.64±0.09 m, 138.8±33.6 kg and 50.7±8.9 kg/m2), and 30 NO (age 37.6±11.5 years, 1.67±0.09 m, 65.2±10.3 kg and 23.2±22 kg/m2) were evaluated. The MO showed higher values of total, peripheral, airways, tissue and central resistance when compared to the NO. No patient showed EFL. The waist circumference was associated with spirometric variables, MIP, and MEP. The waist-to-hip ratio was correlated to respiratory mechanics and spirometric variables, MIP, and MEP. CONCLUSION Morbidly obese patients with no obstructive spirometric pattern show increased total, airway, peripheral, and tissue respiratory system resistance when compared to nonobese. These individuals, however, do not present with expiratory flow limitation and reduced respiratory muscles strength.
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Affiliation(s)
- Mauricio de Sant'Anna
- Curso de Fisioterapia, Instituto Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Renata Ferreira Carvalhal
- Programa de cirurgia bariátrica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | | | - Walter Araújo Zin
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Agnaldo José Lopes
- Programa de Pós-Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ) Brasil.,Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro (RJ) Brasil
| | - Jocemir Ronaldo Lugon
- Departamento de Medicina Clínica/Nefrologia, Faculdade de Medicina, Universidade Federal Fluminense, Niterói (RJ) Brasil
| | - Fernando Silva Guimarães
- Departamento de Fisioterapia, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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Abstract
INTRODUCTION Having national data on chronic dialysis is essential in treatment planning. OBJECTIVE To present data of the survey from the Brazilian Society of Nephrology on patients with chronic kidney disease on dialysis in July 2017. METHODS Data was collected from dialysis units in Brazil. The data collection was done using a questionnaire completed online by the dialysis units. RESULTS Two hundred and ninety-one centers (38.4%) answered the questionnaire. In July 2017, the estimated total number of dialysis patients was 126,583. National estimates of prevalence and incidence rates of dialysis patients per million population (pmp) were 610 (range: 473 in the North region and 710 in the Midwest) and 194, respectively. The incidence rate of new dialysis patients with diagnosis of diabetic nephropathy was 77 pmp. The annual gross mortality rate was 19.9%. Of the prevalent patients, 93.1% were on hemodialysis and 6.9% on peritoneal dialysis, with 31,226 (24%) on the waiting list for renal transplantation. Venous catheter was used as access in 22.6% of patients on hemodialysis. The prevalence rate of positive serology for hepatitis C continued with a tendency to decrease (3.3%). CONCLUSION The absolute number of patients and rates of incidence and prevalence on dialysis continued to increase; the mortality rate tended to rise. There were obvious regional and state discrepancies in these rates.
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Affiliation(s)
- Fernando Saldanha Thomé
- Universidade Federal do Rio Grande do
SulPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul,
Porto Alegre, RS, Brasil.
| | - Ricardo Cintra Sesso
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo,
SP, Brasil.
| | - Antonio Alberto Lopes
- Universidade Federal da BahiaSalvadorBABrasilUniversidade Federal da Bahia, Salvador, BA,
Brasil.
| | - Jocemir Ronaldo Lugon
- Universidade Federal FluminenseNiteróiRJBrasilUniversidade Federal Fluminense, Niterói, RJ,
Brasil.
| | - Carmen Tzanno Martins
- Sociedade Brasileira de NefrologiaSão PauloSPBrasilSociedade Brasileira de Nefrologia, São Paulo,
SP, Brasil.
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da Silva Guimarães BL, de Souza LC, Guimarães FS, Lugon JR. Serial Weekly Measurements of the Timed Inspiratory Effort Index Can Predict Successful Prolonged Weaning. Respir Care 2019; 64:1286-1292. [DOI: 10.4187/respcare.06367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Viana FS, Boechat YEM, Lugon JR, de Matos JPS. Differences in quality of life and cognition between the elderly and the very elderly hemodialysis patients. J Bras Nefrol 2019; 41:375-383. [PMID: 30897190 PMCID: PMC6788852 DOI: 10.1590/2175-8239-jbn-2018-0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/29/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In the last decades, there was an expressive increase in the number of elderly patients with chronic kidney disease starting hemodialysis. Thus, our goal was to evaluate the profile of the elderly in chronic hemodialysis and to compare the cognition and quality of life of the younger elderly with those of the very elderly. METHODS Patients on hemodialysis for at least 3 months, who were 65 years of age or older when they started dialysis were invited to participate, and stratified according to age (under or over 80 years). The participants answered a clinical-epidemiological questionnaire and underwent cognitive tests (Mini Mental State Exam [MMSE], clock drawing test [CDT] and verbal fluency test [VFT]) and a quality of life assessment 36- Item Short Form Health Survey). RESULTS Of the 125 eligible patients, 124 agreed to participate. The mean age was 76 ± 6 years (28% ≥ 80 years), 56% were men and 55% had ≥ 8 years of schooling. Depression was suggested in 38%. The prevalence of cognitive deficit was 38%, 70% and 30%, by MEEM, CDT and VFT, respectively. The prevalence of any deficit was higher among the very elderly (94% vs. 72%, p = 0.007). Quality of life scores were similar between the two age groups, except for the functional capacity domain, worse in the group with ≥ 80 years (p = 0.033). CONCLUSION Elderly patients on chronic hemodialysis have a high prevalence of cognitive deficits, especially the very elderly, but this group does not have a worse quality of life, except for functional capacity.
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Affiliation(s)
- Fernanda Siqueira Viana
- Universidade Federal FluminenseFaculdade de MedicinaNiteróiRJBrasilUniversidade Federal Fluminense, Faculdade de
Medicina, Niterói, RJ, Brasil.,Correspondence to: Fernanda Siqueira Viana. E-mail:
| | - Yolanda Eliza M. Boechat
- Universidade Federal FluminenseFaculdade de MedicinaDepartamento de Medicina ClínicaNiteróiRJBrasilUniversidade Federal Fluminense, Faculdade de
Medicina, Departamento de Medicina Clínica, Niterói, RJ, Brasil.
| | - Jocemir Ronaldo Lugon
- Universidade Federal FluminenseFaculdade de MedicinaNiteróiRJBrasilUniversidade Federal Fluminense, Faculdade de
Medicina, Niterói, RJ, Brasil.,Universidade Federal FluminenseFaculdade de MedicinaDepartamento de Medicina ClínicaNiteróiRJBrasilUniversidade Federal Fluminense, Faculdade de
Medicina, Departamento de Medicina Clínica, Niterói, RJ, Brasil.
| | - Jorge Paulo Strogoff de Matos
- Universidade Federal FluminenseFaculdade de MedicinaNiteróiRJBrasilUniversidade Federal Fluminense, Faculdade de
Medicina, Niterói, RJ, Brasil.,Universidade Federal FluminenseFaculdade de MedicinaDepartamento de Medicina ClínicaNiteróiRJBrasilUniversidade Federal Fluminense, Faculdade de
Medicina, Departamento de Medicina Clínica, Niterói, RJ, Brasil.
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de Almeida Thiengo D, Strogoff-de-Matos JP, Lugon JR, Graciano ML. Troponin I at admission in the intensive care unit predicts the need of dialysis in septic patients. BMC Nephrol 2018; 19:329. [PMID: 30453890 PMCID: PMC6245612 DOI: 10.1186/s12882-018-1129-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 11/02/2018] [Indexed: 11/23/2022] Open
Abstract
Background In a previous study we showed that troponin I (TnI) > 0.42 ng/mL predicted the need of dialysis in a group of 29 septic patients admitted to the intensive care unit (ICU). We aimed to confirm such finding in a larger independent sample. Methods All septic patients admitted to an ICU from March 2016 to February 2017 were included if age between 18 and 90 years, onset of sepsis < 24 h, normal left ventricular ejection fraction, and no previous coronary or kidney diseases. TnI was measured on day 1. Patients were followed by 30 days or until death. Results A total of 120 patients were included (51% male, 74 ± 13 years old). At ICU admission, 70 patients had TnI > 0.42 ng/mL. These patients had serum creatinine slightly higher (1.66 ± 0.34 vs. 1.32 ± 0.39 mg/dL; P < 0.0001) than those with lower TnI and similar urine output (1490 ± 682 vs. 1406 ± 631 mL; P = 0.44). At the end of the follow-up period, 70.0% of the patients with lower TnI were alive in comparison with 38.6% of those with higher TnI (p = 0.0014). After 30 days, 69.3 and 2.9% of the patients with lower and higher TnI levels remained free of dialysis, respectively (p < 0.0001). In a Cox regression model, after adjustment for gender, age, Charlson comorbidity index, serum creatinine, potassium, pH, brain natriuretic peptide and urine output, TnI > 0.42 ng/mL persisted as a strong predictor of dialysis need (hazard ratio 3.48 [95%CI 1.69–7.18]). Conclusions TnI levels at ICU admission are a strong independent predictor of dialysis need in sepsis.
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Lima VDACDC, Gouvêa ALF, Menezes P, Santos JDF, Rochael MC, Carvalho FR, Almeida JR, Lugon JR. Hemophagocytic lymphohistiocytosis, a rare condition in renal transplant - a case report. ACTA ACUST UNITED AC 2018; 40:423-427. [PMID: 30328466 PMCID: PMC6533997 DOI: 10.1590/2175-8239-jbn-2018-0012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/07/2018] [Indexed: 11/30/2022]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is an uncommon and life-threating
condition characterized by major immune activation and massive cytokine
production by mononuclear inflammatory cells, due to defects in cytotoxic
lymphocyte function. It is even more unusual in renal transplant recipients, in
which it is often associated with uncontrolled infection. The mortality is high
in HLH and differential diagnosis with sepsis is a challenge. The approach and
management depend on the underlying trigger and comorbidities. We report a case
of a 50-year-old renal transplant female admitted with fever and malaise 3
months post-transplant and presenting anemia, fever, hypertriglyceridemia, high
levels of serum ferritin, and positive CMV antigenemia. Urine was positive for
decoy cells and BKV-DNA. Graft biopsy showed CMV nephritis. Both blood and urine
cultures where positive for E. coli. Hemophagocytosis was
confirmed by bone marrow aspiration. Immunosuppression was reduced, and the
patient received high-dose intravenous immunoglobulin and dexamethasone, with
complete response after 3 weeks. We highlight the importance of early diagnosis
and proper management of a rare and serious condition in a renal transplant
patient, which can allow a favorable clinical course and improve survival
rate.
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Affiliation(s)
| | | | - Paulo Menezes
- Universidade Federal Fluminense, Niterói, RJ, Brasil
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Sesso RC, Lopes AA, Thomé FS, Lugon JR, Martins CT. Brazilian Chronic Dialysis Survey 2016. J Bras Nefrol 2018; 39:261-266. [PMID: 29044335 DOI: 10.5935/0101-2800.20170049] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/23/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION National chronic dialysis data are important for the treatment planning. OBJECTIVE To report data of the annual survey of the Brazilian Society of Nephrology about chronic kidney disease patients on dialysis in July 2016. METHODS A survey based on data of dialysis centers from the whole country. The data collection was performed by using a questionnaire filled out on-line by the dialysis centers. RESULTS 309 (41%) of the dialysis units in the country answered the questionnaire. In July 2016, the total estimated number of patients on dialysis was 122,825. The estimated prevalence and incidence rates of chronic maintenance dialysis were 596 (range: 344 in the North region and 700 in the Southeast) and 193 patients per million of population (pmp), respectively. The annual incidence rate of patients with diabetic nephropathy was 79 pmp. The annual gross mortality rate was 18.2%. For prevalent patients, 92% were on hemodialysis and 8% on peritoneal dialysis, and 29,268 (24%) were on a waiting list of renal transplant. A venous catheter was the vascular access for 20.5% of the hemodialysis patients. The prevalence rates of positive serology for hepatitis B and C showed a tendency to reduce from 2013 (1.4% and 4.2%, respectively) to 2016 (0.7% and 3.7%, respectively). CONCLUSION The absolute number and the prevalence and incidence rates of patients on dialysis continue to rise steadily; the gross mortality rate remained stable. Regional inequities are evident in these rates.
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Lobo CLDC, Nascimento EMD, Jesus LJCD, Freitas TGD, Lugon JR, Ballas SK. Mortality in children, adolescents and adults with sickle cell anemia in Rio de Janeiro, Brazil. Rev Bras Hematol Hemoter 2017. [PMID: 29519371 PMCID: PMC6002966 DOI: 10.1016/j.bjhh.2017.09.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To determine the mortality rate of children, adolescents and adults with sickle cell anemia in Rio de Janeiro, Brazil. Methods The number of deaths, the mortality rate and the causes of deaths in patients with sickle cell anemia who were treated and followed up at our institution for 15 years were determined and compared to data available for the Brazilian population. Results The overall number of deaths was 281 patients with a mortality rate of 16.77%. Survival probability was significantly higher in females. The number of deaths and the mortality rate were age-specific with a significant increase in the 19- to 29-year-old age group. The remaining life expectancy of the patients with sickle cell anemia was less than that of Brazilians at large. The gap between the two was about 20 years for ages between one and five years with this gap decreasing to ten years after the age of 65 years. The most common causes of death were infection, acute chest syndrome, overt stroke, organ damage and sudden death during painful crises. Conclusion To the best of our knowledge, this is the first Brazilian study in a single institution in Rio de Janeiro; the mortality rate was 18.87% among adult patients with sickle cell anemia. The mortality rates in children and adults are higher than those reported in developed countries of the northern hemisphere.
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Affiliation(s)
| | - Emilia Matos do Nascimento
- Instituto de Hematologia Arthur de Siqueira Cavalcanti (HEMORIO), Rio de Janeiro, RJ, Brazil; Centro Universitário Estadual da Zona Oeste (UEZO), Rio de Janeiro, RJ, Brazil
| | | | | | | | - Samir K Ballas
- Instituto de Hematologia Arthur de Siqueira Cavalcanti (HEMORIO), Rio de Janeiro, RJ, Brazil; Cardeza Foundation, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, United States.
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Silva ACAE, Gómez JFB, Lugon JR, Graciano ML. Creatinine measurement on dry blood spot sample for chronic kidney disease screening. J Bras Nefrol 2017; 38:15-21. [PMID: 27049360 DOI: 10.5935/0101-2800.20160004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/24/2015] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) screening is advisable due to its high morbidity and mortality and is usually performed by sampling blood and urine. OBJECTIVE Here we present an innovative and simpler method, by measuring creatinine on a dry blood spot on filter paper. METHODS One-hundred and six individuals at high risk for CKD were enrolled. The creatinine values obtained using both tests and the demographic data of each participant allowed us to determinate the eGFR. The adopted cutoff for CKD was an eGFR < 60 ml/min. RESULTS Mean age was 57 ± 12 years, 74% were female, 40% white, and 60% non-white. Seventy-six percent were hypertensive, 30% diabetic, 37% had family history of CKD, and 22% of smoking. The BMI was 29.5 ± 6.9 kg/m2, median systolic blood pressure was 125 mmHg (IQR 120-140 mmHg) and median diastolic blood pressure was 80 mmHg (IQR 70-80 mmHg). According to MDRD equation, sensitivity was 96%, specificity 55%, predictive positive value 96%, predictive negative value 55% and accuracy 92%. By the CKD-EPI equation the sensitivity was 94%, specificity 55%, predictive positive value 94%, predictive negative value 55% and accuracy 90%. A Bland and Altman analysis showed a relatively narrow range of creatinine values differences (+ 0.68mg/dl to -0.55mg/dl) inside the ± 1.96 SD, without systematic differences. CONCLUSION Measurement of creatinine on dry blood sample is an easily feasible non-invasive diagnostic test with good accuracy that may be useful to screen chronic kidney disease.
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Thiengo DDA, Lugon JR, Graciano ML. Troponin I serum levels predict the need of dialysis in incident sepsis patients with acute kidney injury in the intensive care unit. J Bras Nefrol 2017; 37:433-8. [PMID: 26648491 DOI: 10.5935/0101-2800.20150069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/01/2015] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Sepsis, an extremely prevalent condition in the intensive care unit, is usually associated with organ dysfunction, which can affect heart and kidney. OBJECTIVE To determine whether the cardiac dysfunction and the Troponin I forecast the occurrence of acute renal failure in sepsis. METHODS Cardiac dysfunction was assessed by echocardiography and by the serum troponin I levels, and renal impairment by AKIN criteria and the need of dialysis. Twenty-nine patients with incident sepsis without previous cardiac or renal dysfunction were enrolled. RESULTS AND DISCUSSION Patients averaged 75.3 ± 17.3 years old and 55% were male. Median APACHE II severity score at ICU admission was 16 (9.7 - 24.2) and mortality rate in 30 days was 45%. On the fifth day, 59% had ventricular dysfunction. Troponin serum levels on day 1 in the affected patients were 1.02 ± 0.6 ng/mL compared with 0.23 ± 0.18 ng/mL in patients without heart dysfunction (p = 0.01). Eighteen out of 29 patients (62%) underwent renal replacement therapy (RRT) and the percent of patients with ventricular dysfunction who required dialysis was higher (94% vs. 16%, p = 0.0001). Values of troponin at day 1 were used to develop a ROC curve to determine their ability to predict the need of dialysis. The area under the curve was 0.89 and the cutoff value was 0.4 ng/mL. CONCLUSION We found that an elevation in serum troponin levels, while guarding a relationship with ventricular dysfunction, can be a precious tool to predict the need for dialysis in sepsis patients.
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Greffin S, André MB, Matos JPSD, Kang HC, Jorge AJL, Rosa MLG, Lugon JR. Chronic kidney disease and metabolic syndrome as risk factors for cardiovascular disease in a primary care program. J Bras Nefrol 2017; 39:224-228. [PMID: 28902230 DOI: 10.5935/0101-2800.20170040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/17/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is especially prevalent in patients with chronic kidney disease (CKD). OBJECTIVE To evaluate the role of CKD and metabolic syndrome (MS), which is a cluster of risk factors for CVD, as predictors of CVD. METHODS Observational, cross-sectional study with a random sample aged 45 or more years extracted from the population assisted by the primary care program in Niterói city in the state of Rio de Janeiro, Brazil. CKD was diagnosed by the K/DOQI guidelines and MS, by the harmonized criteria. CVD was said to be present if the participant had one or more of the following findings: echocardiographic abnormalities, and history of myocardial infarction, stroke or heart failure. A logistic regression model was developed to analyze risk factors for CVD using CKD as the variable of primary interest. RESULTS Fifty hundred and eighty-one participants (38.2% male) with a mean age of 59.4 ± 10.2 years were analyzed. The prevalence rate of CKD was 27.9%. In participants without CKD, MS was associated with a slight but statistically significant increase in the risk for CVD (OR = 1.52, p = 0.037); in those with CKD but without MS the risk for CVD was also statistically significant and at a greater magnitude (OR = 2.42, p = 0.003); when both were present the risk for CVD was substantially higher (OR = 5.13, p < 0.001). CONCLUSION In this study involving a population assisted by a primary care program, CKD was confirmed as an independent risk factor for CVD. The presence of MS concurrent with CKD substantially amplified the risk for CVD.
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Miguel JB, Matos JPSD, Lugon JR. Ankle-Brachial Index as a Predictor of Mortality in Hemodialysis: A 5-Year Cohort Study. Arq Bras Cardiol 2017; 108:204-211. [PMID: 28443959 PMCID: PMC5389869 DOI: 10.5935/abc.20170026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/02/2016] [Indexed: 12/12/2022] Open
Abstract
Background Abnormal ankle-brachial index (ABI) has been found to be a strong predictor
of mortality in some hemodialysis populations in studies with relatively
short periods of follow-up, lower than 2 years. Objective This study aimed to assess the predictive value of abnormal ABI as a risk
factor for death among patients on maintenance hemodialysis after a 5-year
follow-up. Methods A total of 478 patients on hemodialysis for at least 12 months were included
in the study. ABI measurement was performed using a mercury column
sphygmomanometer and portable Doppler. Patients were divided into 3 groups
according to ABI (low: <0.9; normal: 0.9 to 1.3; and high: >1.3) and
followed for a 60-month period. Results The prevalence rates of low, normal and high ABI were 26.8%, 64.6% and 8.6%,
respectively. The 5-year survival rate was lower in the groups with low ABI
(44.1%, P<0.0001) and high ABI (60.8%, P= 0.025) than in the group with
normal ABI (71.7%). Cox regression was used to evaluate the association
between ABI and mortality, adjusting for potential confounders. Using normal
ABI as reference, a low, but not a high ABI was found to be an independent
risk factor for all-cause mortality (HR2.57; 95% CI, 1.84-3.57 and HR 1.62;
95% CI, 0.93-2.83, respectively). Conclusions long-term survival rates of patients with either low or high ABI were lower
than the one from those with normal ABI. However, after adjustment for
potential confounders, only low ABI persisted as an independent risk factor
for all-cause mortality among hemodialysis patients.
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Alonso MAG, Lima VDACDC, Carreira MAMDQ, Lugon JR. Reproducibility and Reliability Of QTc and QTcd Measurements and Their Relationships with Left Ventricular Hypertrophy in Hemodialysis Patients. Arq Bras Cardiol 2017; 109:222-230. [PMID: 28793044 PMCID: PMC5586229 DOI: 10.5935/abc.20170112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/29/2017] [Indexed: 11/20/2022] Open
Abstract
Background Left ventricular hypertrophy (LVH) is very common in hemodialysis patients
and an independent risk factor for mortality in this population. The
myocardial remodeling underlying the LVH can affect ventricular
repolarization causing abnormalities in QT interval. Objective to evaluate the reproducibility and reliability of measurements of corrected
QT interval (QTc) and its dispersion (QTcd) and correlate these parameters
with LVH in hemodialysis patients. Methods Case-control study involving hemodialysis patients and a control group.
Clinical examination, blood sampling, transthoracic echocardiogram, and
electrocardiogram were performed. Intra- and interobserver correlation and
concordance tests were performed by Pearson´s correlation, Cohen’s Kappa
coefficient and Bland Altman diagram. Linear regression was used to analyze
association of QTc or QTcd with HVE. Results Forty-one HD patients and 37 controls concluded the study. Hemodialysis
patients tended to have higher values of QTc, QTcd and left ventricular mass
index (LVMi) than controls but statistical significance was not found.
Correlation and concordance tests depicted better results for QTc than for
QTcd. In HD patients, a poor but significant correlation was found between
QTc and LVMi (R2 = 0.12; p = 0.03). No correlation was found
between values of QTcd and LVMi (R2= 0.00; p=0.940). For the
control group, the correspondent values were R2= 0.00; p = 0.67
and R2= 0.00; p = 0.94, respectively. Conclusion We found that QTc interval, in contrast to QTcd, is a reproducible and
reliable measure and had a weak but positive correlation with LVMi in HD
patients.
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Affiliation(s)
| | | | | | - Jocemir Ronaldo Lugon
- Hospital Universitário Antônio Pedro - Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil
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Gouvêa ALF, Cosendey RIJ, Nascimento ALR, Carvalho FR, Silva AA, de Moraes HP, Rochael MC, Varella RB, Almeida SG, Almeida JR, Lugon JR. BK polyomavirus nephropathy in two kidney transplant patients with distinct diagnostic strategies for BK virus and similar clinical outcomes: two case reports. J Med Case Rep 2017; 11:146. [PMID: 28535782 PMCID: PMC5442665 DOI: 10.1186/s13256-017-1300-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 04/21/2017] [Indexed: 12/18/2022] Open
Abstract
Background BK polyomavirus-associated nephropathy is an important cause of post-transplantation renal failure. We present two cases of BK polyomavirus-associated nephropathy who were submitted to contrasting strategies of clinical follow-up to BK polyomavirus reactivation, but progressed to a similar final outcome. Case presentation Case 1 is a 37-year-old white man whose graft had never presented a good glomerular filtration rate function, with episodes of tacrolimus nephrotoxicity, and no urinary monitoring for BK polyomavirus; stage B BK polyomavirus-associated nephropathy was diagnosed by biopsy at 14 months post-transplant. Despite clinical treatment (dosage decrease and immunosuppressive drug change), he progressed to stage C BK polyomavirus-associated nephropathy and loss of graft function 30 months post-transplant. Case 2 is a 49-year-old mulatto man in his second renal transplantation who was submitted to cytological urinary monitoring for BK polyomavirus; he presented early, persistent, and massive urinary decoy cell shedding and concomitant tacrolimus nephrotoxicity. Even with decreasing immunosuppression, he developed BK polyomavirus-associated nephropathy 1-year post-transplant. Loss of graft function occurred 15 months post-transplant. Conclusions Cytological urinary monitoring was an efficient strategy for monitoring BK virus reactivation. Decoy cell shedding may be related to BK polyomavirus-associated nephropathy when extensive and persistent. The presence of associated tacrolimus nephrotoxicity may be a confounding factor for the clinical diagnosis of BK polyomavirus-associated nephropathy.
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Affiliation(s)
- Ana Luisa Figueira Gouvêa
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Department of Clinical Medicine, Universidade Federal Fluminense, Rua Marquês do Paraná, 303, Niterói, 24033-900, Rio de Janeiro, Brazil. .,Department of Pathology, Universidade Federal Fluminense, Niterói, Brazil.
| | - Rachel Ingrid Juliboni Cosendey
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Department of Clinical Medicine, Universidade Federal Fluminense, Rua Marquês do Paraná, 303, Niterói, 24033-900, Rio de Janeiro, Brazil
| | | | - Fabiana Rabe Carvalho
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Department of Clinical Medicine, Universidade Federal Fluminense, Rua Marquês do Paraná, 303, Niterói, 24033-900, Rio de Janeiro, Brazil
| | - Andrea Alice Silva
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Department of Clinical Medicine, Universidade Federal Fluminense, Rua Marquês do Paraná, 303, Niterói, 24033-900, Rio de Janeiro, Brazil.,Department of Pathology, Universidade Federal Fluminense, Niterói, Brazil
| | - Heleno Pinto de Moraes
- Department of Pathology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rafael Brandão Varella
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Department of Clinical Medicine, Universidade Federal Fluminense, Rua Marquês do Paraná, 303, Niterói, 24033-900, Rio de Janeiro, Brazil
| | - Stephanie Gomes Almeida
- Department of Preventive Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jorge Reis Almeida
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Department of Clinical Medicine, Universidade Federal Fluminense, Rua Marquês do Paraná, 303, Niterói, 24033-900, Rio de Janeiro, Brazil
| | - Jocemir Ronaldo Lugon
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Department of Clinical Medicine, Universidade Federal Fluminense, Rua Marquês do Paraná, 303, Niterói, 24033-900, Rio de Janeiro, Brazil
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Gouvêa ALF, Cosendey RIJ, Carvalho FR, Varella RB, de Souza CF, Lopes PF, Silva AA, Rochael MC, de Moraes HP, Lugon JR, Almeida JR. Pilot Study of Early Monitoring Using Urinary Screening for BK Polyomavirus as a Strategy for Prevention of BKV Nephropathy in Kidney Transplantation. Transplant Proc 2017; 48:2310-2314. [PMID: 27742286 DOI: 10.1016/j.transproceed.2016.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Urine monitoring programs represent an important strategy for early diagnosis of reactivation of BK polyomavirus (BKV) in kidney transplant recipients. This study analyzes a BKV urine screening model in kidney transplant patients. METHODS Urinary screening for BKV reactivation was performed by urinary decoy cell and polymerase chain reaction (PCR) tests in samples from 32 consecutive kidney transplant patients, collected in a 6-month follow-up period. PCR in plasma samples and BKV immunohistochemical studies to assess BKV renal disease, if a kidney biopsy was indicated, were performed. RESULTS The urinary screening for BKV among 32 renal receptors was positive in 18 patients (56%) by the concomitant use of the decoy cells and/or qualitative PCR at some time during the study period. Transfusion before transplantation was significantly associated with urinary decoy cell positive screening (odds ratio = 11; 95% confidence interval = 1.47 to 82.4; P < .05); and so was male sex (odds ratio = 2.02; 95% confidence interval = 1.07 to 3.83; P < .05). The clinical management of screening positive cases consisted of decreasing or changing the immunosuppression regimen. Sixteen renal biopsies were performed. Immunohistochemistry for SV40 T antigen was negative in all biopsies. After 1 year of follow-up, no patient developed BKV-associated nephropathy, and there was no difference in renal function between patients positive and negative for BKV urinary screening. CONCLUSIONS Early urinary monitoring is effective in detection of BKV replication and represents a good strategy to minimize the deleterious effects caused by the presence of the virus on preservation of graft function.
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Affiliation(s)
- A L F Gouvêa
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil; Departamento de Patologia/Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - R I J Cosendey
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - F R Carvalho
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - R B Varella
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - C F de Souza
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - P F Lopes
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil; Departamento de Patologia/Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - A A Silva
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil; Departamento de Patologia/Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - M C Rochael
- Departamento de Patologia/Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - H P de Moraes
- Faculdade de Ciências Médicas/Anatomia Patológica/Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - J R Lugon
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - J R Almeida
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas (LAMAP), Departamento de Medicina Clínica/Universidade Federal Fluminense, Rio de Janeiro, Brazil.
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Carvalho FR, Rosário NF, Souza CF, Schmitz V, Pinto FA, Velarde LGC, Lugon JR, Almeida JR, Silva AAD. CD64 expression on polymorphonuclear cells as a potential marker for monitoring the
human cytomegalovirus replication after kidney transplantation. Jornal Brasileiro de Patologia e Medicina Laboratorial 2017. [DOI: 10.5935/1676-2444.20170020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Rezende LR, Souza PBD, Pereira GRM, Lugon JR. Metabolic acidosis in hemodialysis patients: a review. J Bras Nefrol 2017; 39:305-311. [DOI: 10.5935/0101-2800.20170053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/26/2016] [Indexed: 11/20/2022] Open
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Lugon JR, Strogoff-de-Matos JP. Comparing costs of renal replacement therapy in a Brazilian city: a case for improvement of our health policies. J Bras Nefrol 2017; 39:106-107. [DOI: 10.5935/0101-2800.20170027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/21/2017] [Indexed: 11/20/2022] Open
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Sesso RC, Lopes AA, Thomé FS, Lugon JR, Dos Santos DR. Brazilian Chronic Dialysis Survey 2013 - trend analysis between 2011 and 2013. J Bras Nefrol 2016; 36:476-81. [PMID: 25517276 DOI: 10.5935/0101-2800.20140068] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 07/31/2014] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION National chronic dialysis data have had impact in the treatment planning. OBJECTIVE To report data of the annual survey of the Brazilian Society of Nephrology about chronic kidney disease patients on dialysis in July 2013 and compare with 2011-12. METHODS A survey based on data of dialysis units from the whole country. The data collection was performed by using a questionnaire filled out on-line by the dialysis units. RESULTS Three hundred thirty four (51%) of the dialysis units in the country answered the questionnaire. In July 2013, the total estimated number of patients on dialysis was 100,397. The estimated prevalence and incidence rates of chronic maintenance dialysis were 449 (range: 284 in the North region and 622 in the South) and 170 patients per million population, respectively. The estimated number of new patients starting dialysis in 2013 was 34,161. The annual gross mortality rate was 17.9%. For prevalent patients, 31.4% were aged 65 years or older, 90.8% were on hemodialysis and 9.2% on peritoneal dialysis, 31,351 (31.2%) were on a waiting list of renal transplant, 30% were diabetics, 17% had PTH levels > 600 pg/ml and 23% hemoglobin < 10 g/ dl. A venous catheter was the vascular access for 15.4% of the hemodialysis patients. CONCLUSION The absolute number of patients on dialysis has increased 3% per year. The prevalence and incidence rates of patients on dialysis leveled off, while the mortality rate tended to decrease compared with 2012. There was a trend towards a better control of the anemia and PTH levels.
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Carvalho FR, Cosendey RIJ, Souza CF, Medeiros T, Menezes PA, Silva AA, Almeida JR, Lugon JR. Clinical correlates of pp65 antigenemia monitoring in the first months of post kidney transplant in patients undergoing universal prophylaxis or preemptive therapy. Braz J Infect Dis 2016; 21:51-56. [PMID: 27888673 PMCID: PMC9425529 DOI: 10.1016/j.bjid.2016.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/09/2016] [Accepted: 09/19/2016] [Indexed: 11/13/2022] Open
Abstract
Introduction Human cytomegalovirus is a major cause of morbidity in kidney transplant patients. Objectives We aimed to study viral replication and serological response in the first months post kidney transplant in patients undergoing universal prophylaxis or preemptive therapy and correlate the findings with the clinical course of Human cytomegalovirus infection. Patients and methods Independent from the clinical strategy adopted for managing Human cytomegalovirus infection, prophylaxis versus preemptive therapy, the pp65 antigenemia assay and serological response were assessed on the day of transplantation, and then weekly during the first three months of post-transplant. Results From the 32 transplant recipients, 16 were positive for pp65 antigenemia, with a similar incidence rate in each group. There were no positive results in the first three weeks of monitoring; the positivity rate peaked at week eight. There was a trend for a higher and earlier frequency of positivity in the universal prophylaxis group in which the course of the Human cytomegalovirus infection was also more severe. Despite the differences in clinical picture and in the initial immunosuppressant schedule, the serological response was similar in both groups. Conclusion Routine monitoring during the first three post-transplant months has a positive impact on the early detection of Human cytomegalovirus viral replication allowing for timely treatment in order to reduce morbidity of the disease. The strategy of universal therapy employing intravenous ganciclovir was associated to a worse clinical course of the Human cytomegalovirus infection suggesting that the use of >10 cells/2 × 105 leukocytes as a cut-off in this setting may be inappropriate.
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Affiliation(s)
- Fabiana Rabe Carvalho
- Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Laboratório Multiusuário de Apoio a Pesquisa em Nefrologia e Ciências Médicas, Niterói, RJ, Brazil
| | - Rachel Ingrid Juliboni Cosendey
- Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Laboratório Multiusuário de Apoio a Pesquisa em Nefrologia e Ciências Médicas, Niterói, RJ, Brazil
| | - Cintia Fernandes Souza
- Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Laboratório Multiusuário de Apoio a Pesquisa em Nefrologia e Ciências Médicas, Niterói, RJ, Brazil
| | - Thalia Medeiros
- Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Laboratório Multiusuário de Apoio a Pesquisa em Nefrologia e Ciências Médicas, Niterói, RJ, Brazil
| | - Paulo Alexandre Menezes
- Universidade Federal Fluminense, Departamento de Medicina Interna, Nefrologia, Niterói, RJ, Brazil
| | - Andrea Alice Silva
- Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Laboratório Multiusuário de Apoio a Pesquisa em Nefrologia e Ciências Médicas, Niterói, RJ, Brazil; Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Patologia, Niterói, RJ, Brazil
| | - Jorge Reis Almeida
- Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Laboratório Multiusuário de Apoio a Pesquisa em Nefrologia e Ciências Médicas, Niterói, RJ, Brazil; Universidade Federal Fluminense, Departamento de Medicina Interna, Nefrologia, Niterói, RJ, Brazil.
| | - Jocemir Ronaldo Lugon
- Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Laboratório Multiusuário de Apoio a Pesquisa em Nefrologia e Ciências Médicas, Niterói, RJ, Brazil; Universidade Federal Fluminense, Departamento de Medicina Interna, Nefrologia, Niterói, RJ, Brazil
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