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Dariva M, Guedes M, Rigodon V, Kotanko P, Larkin JW, Ferlin B, Pecoits-Filho R, Barretti P, de Moraes TP. Transition between peritoneal dialysis modalities: Impact on blood pressure levels and drug prescription in a national multicentric cohort. Perit Dial Int 2024:8968608241240566. [PMID: 38596899 DOI: 10.1177/08968608241240566] [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: 04/11/2024] Open
Abstract
BACKGROUND Hypertension is a leading cause of kidney failure, affects most dialysis patients and associates with adverse outcomes. Hypertension can be difficult to control with dialysis modalities having differential effects on sodium and water removal. There are two main types of peritoneal dialysis (PD), automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). It is unknown whether one is superior to the other in controlling blood pressure (BP). Therefore, the aim of our study was to analyse the impact of switching between these two PD modalities on BP levels in a nationally representative cohort. METHODS This was a cohort study of patients on PD from 122 dialysis centres in Brazil (BRAZPD II study). Clinical and laboratory data were collected monthly throughout the study duration. We selected all patients who remained on PD at least 6 months and 3 months on each modality at minimum. We compared the changes in mean systolic/diastolic blood pressures (SBP/DBP) before and after modality transition using a multilevel mixed-model where patients were at first level and their clinics at the second level. RESULTS We analysed data of 848 patients (814 starting on CAPD and 34 starting on APD). The SBP decreased by 4 (SD 22) mmHg when transitioning from CAPD to APD (p < 0.001) and increased by 4 (SD 21) mmHg when transitioning from APD to CAPD (p = 0.38); consistent findings were seen for DBP. There was no significant change in the number of antihypertensive drugs prescribed before and after transition. CONCLUSIONS Transition between PD modalities seems to directly impact on BP levels. Further studies are needed to confirm if switching to APD could be an effective treatment for uncontrolled hypertension among CAPD patients.
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Affiliation(s)
- Marcus Dariva
- Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Murilo Guedes
- Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Vladimir Rigodon
- Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
- Global Medical Office, Fresenius Medical Care, Waltham, MA, USA
| | - Peter Kotanko
- Renal Research Institute, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John W Larkin
- Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
- Global Medical Office, Fresenius Medical Care, Waltham, MA, USA
| | - Bruno Ferlin
- Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Roberto Pecoits-Filho
- Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
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Tuma ISM, Cambi MPC, Moraes TPD, Magro DO, Kotze PG. BODY FAT COMPOSITION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES: A COMPARATIVE STUDY BETWEEN SKINFOLDS AND ULTRASONOGRAPHY. Arq Gastroenterol 2024; 61:e23088. [PMID: 38451660 DOI: 10.1590/s0004-2803.246102023-88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/23/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND Inflammatory bowel diseases (IBD) are associated with important changes in nutritional status. OBJECTIVE The aim of the study was to compare body fat composition between two anthropometric methods: skinfolds and ultrasonography, in patients with IBD. METHODS Single-center cross-sectional study with IBD patients in remission or active disease. For the agreement analysis between the body fat assessment methods, the Bland Altman method was used. RESULTS A total of 101 patients with IBD were included, 75 with Crohn's disease and 26 with ulcerative colitis. Approximately 56% of the patients with Crohn's disease and 65.4% of those with ulcerative colitis had a body fat composition above normal levels, with no significant difference between the diseases (P=0.63). The Bland-Altman concordance analysis showed that the methods for assessing the percentage of fat by the adipometer and ultrasound were not in full agreement (P=0.001), despite both presented good correlation (CC 0.961; P=0.000). CONCLUSION The analysis of body fat percentage in patients with IBD was different between the skinfolds and ultrasound. Both methods can be used to assess the of body fat percentage of patients with IBD. However, monitoring of body fat sequentially and longitudinally should always be performed using the same method throughout the disease course. Prospective longitudinal studies are warranted to precisely define the role of these two methods of measuring body composition in patients with IBD. BACKGROUND • Inflammatory bowel diseases are associated with changes in nutritional status. BACKGROUND • Skinfolds measurements and ultrasound are valid methods for assessing body composition and body fat. BACKGROUND • These methods despite comparable are not identical and are useful in clinical nutritional practices in IBD.
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Affiliation(s)
- Isadora Sayuri Macedo Tuma
- Pontifícia Universidade Católica do Paraná, Unidade de Cirurgia Colorretal, Ambulatório de DII, Curitiba, PR, Brasil
| | - Maria Paula Carlin Cambi
- Pontifícia Universidade Católica do Paraná, Unidade de Cirurgia Colorretal, Ambulatório de DII, Curitiba, PR, Brasil
| | - Thyago Proença de Moraes
- Pontifícia Universidade Católica do Paraná, Unidade de Cirurgia Colorretal, Ambulatório de DII, Curitiba, PR, Brasil
| | - Daniéla Oliveira Magro
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Paulo Gustavo Kotze
- Pontifícia Universidade Católica do Paraná, Unidade de Cirurgia Colorretal, Ambulatório de DII, Curitiba, PR, Brasil
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Proença de Moraes T. What Are the Impacts of Introducing an SGLT2 Inhibitor after a Recent Episode of Acute Kidney Injury? Kidney360 2024; 5:333-334. [PMID: 38546982 PMCID: PMC11000725 DOI: 10.34067/kid.0000000000000386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Thyago Proença de Moraes
- Postgraduate Program in Health and Biological Sciences-Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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Ali El Chab Parolin S, Benicio Stocco R, Kneipp Lopes JDC, Curcio Pereira MR, Massae Yamashita M, Domareski Goulart ME, Demeneck H, Olandoski M, Hermann de Souza Nunes L, Keniche Morisawa V, Fanhani Cracco LA, Busto Silva I, Silva Motta Júnior J, Veit Barreto D, Lenci Marques G, Proença de Moraes T, Pellegrino Baena C. Association between inpatient glycemic variability and COVID-19 mortality: a prospective study. Diabetol Metab Syndr 2023; 15:185. [PMID: 37697407 PMCID: PMC10494398 DOI: 10.1186/s13098-023-01157-z] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND This study aimed to determine the association between glycemic variability (GV) and mortality in hospitalized patients with coronavirus disease 2019 (COVID-19). METHODS We prospectively analyzed data from inpatients (> 18 years old) with RT-PCR confirmed COVID-19 admitted between March 2020 and July 2021. All patients were hospitalized for more than 48 h and had at least six point-of-care capillary glucose tests obtained three times daily in the pre-prandial period during hospitalization. GV was measured using the glucose standard deviation (SD) and coefficient of variation (CV). ROC curve was adjusted to determine the SD and CV cutoff values associated with mortality (44.7 mg/dL and 27.5%, respectively); values above these were considered indicative of high GV. Logistic regression models were fitted to explore the association between GV and mortality in patients with and without diabetes. RESULTS A total of 628 patients were stratified into SD < 44.7 mg/dL (n = 357) versus ≥ 44.7 mg/dL (n = 271) and CV < 27.5% (n = 318) versus ≥ 27.5% (n = 310) groups. After controlling for age, sex, presence of diabetes mellitus (DM) and cardiovascular disease, we found a significant association between high GV and mortality (odds ratio 2.99 [1.88-4.77] for SD and 2.43 [1.54-3.85] for CV; p values < 0.001). The mortality rate was higher with SD ≥ 44.7 mg/dL and CV ≥ 27.5% compared to that with SD < 44.7 mg/dL and CV < 27.5%, regardless of DM (p < 0.001 for all). CONCLUSION High glycemic variability was independently associated with mortality in patients with and without DM, who were hospitalized with COVID-19.
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Affiliation(s)
- Salma Ali El Chab Parolin
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil.
| | - Rebecca Benicio Stocco
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Julia do Carmo Kneipp Lopes
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Marcos Roberto Curcio Pereira
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Milena Massae Yamashita
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | | | - Henrique Demeneck
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Marcia Olandoski
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | | | - Victor Keniche Morisawa
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Luiz Augusto Fanhani Cracco
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Isabela Busto Silva
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Jarbas Silva Motta Júnior
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Daniela Veit Barreto
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Gustavo Lenci Marques
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Thyago Proença de Moraes
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
| | - Cristina Pellegrino Baena
- Pontifical Catholic University of Paraná (PUCPR), Rua Imaculada Conceição, 1155, Curitiba, Paraná, 80215-901, Brazil
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Chow KM, Li PKT, Cho Y, Abu-Alfa A, Bavanandan S, Brown EA, Cullis B, Edwards D, Ethier I, Hurst H, Ito Y, de Moraes TP, Morelle J, Runnegar N, Saxena A, So SWY, Tian N, Johnson DW. ISPD Catheter-related Infection Recommendations: 2023 Update. Perit Dial Int 2023:8968608231172740. [PMID: 37232412 DOI: 10.1177/08968608231172740] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Peritoneal dialysis (PD) catheter-related infections are important risk factors for catheter loss and peritonitis. The 2023 updated recommendations have revised and clarified definitions and classifications of exit site infection and tunnel infection. A new target for the overall exit site infection rate should be no more than 0.40 episodes per year at risk. The recommendation about topical antibiotic cream or ointment to catheter exit site has been downgraded. New recommendations include clarified suggestion of exit site dressing cover and updated antibiotic treatment duration with emphasis on early clinical monitoring to ascertain duration of therapy. In addition to catheter removal and reinsertion, other catheter interventions including external cuff removal or shaving, and exit site relocation are suggested.
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Affiliation(s)
- Kai Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Ali Abu-Alfa
- Division of Nephrology and Hypertension, American University of Beirut, Lebanon
- Section of Nephrology, Yale School of Medicine, New Haven, CT, USA
| | | | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Imperial College NHS Trust, London, UK
| | - Brett Cullis
- Department of Nephrology and Child Health, University of Cape Town, South Africa
| | - Dawn Edwards
- National Forum of ESRD Networks, Kidney Patient Advisory Council (KPAC), USA
| | - Isabelle Ethier
- Division of Nephrology, Centre hospitalier de l'Université de Montréal, Canada
- Health Innovation and Evaluation Hub, Centre de recherche du Centre hospitalier de l'Université de Montréal, Canada
| | - Helen Hurst
- School of Health and Society, University of Salford, Salford Royal, Northern Care Alliance Trust, UK
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Thyago Proença de Moraes
- Programa de Pós-Graduação em Ciências da Saúde, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Johann Morelle
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Naomi Runnegar
- Infectious Management Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Anjali Saxena
- Department of Medicine, Division of Nephrology, Stanford University, CA, USA
- Department of Medicine, Division of Nephrology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Simon Wai-Yin So
- Department of Pharmacy, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - Na Tian
- Department of Nephrology, General Hospital of NingXia Medical University, Yinchuan, China
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
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Larkin J, Barretti P, de Moraes TP. Editorial: Peritoneal dialysis: Recent advances and state of the art. Front Physiol 2023; 14:1185810. [PMID: 37123282 PMCID: PMC10131108 DOI: 10.3389/fphys.2023.1185810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/24/2023] [Indexed: 05/02/2023] Open
Affiliation(s)
- John Larkin
- Fresenius Medical Care, Global Medical Office, Waltham, MA, United States
- *Correspondence: John Larkin, ; Pasqual Barretti, ; Thyago Proença de Moraes,
| | - Pasqual Barretti
- Botucatu Medical School, São Paulo State University, Universidade do Estado de São Paulo, Botucatu, São Paulo, Brazil
- *Correspondence: John Larkin, ; Pasqual Barretti, ; Thyago Proença de Moraes,
| | - Thyago Proença de Moraes
- Post Graduate Program in Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
- *Correspondence: John Larkin, ; Pasqual Barretti, ; Thyago Proença de Moraes,
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Franco RP, Chula DC, de Moraes TP, Campos RP. Health insurance provider and endovascular treatment availability are associated with different hemodialysis vascular access profiles: A Brazilian national survey. Front Nephrol 2022; 2:985449. [PMID: 37675012 PMCID: PMC10479601 DOI: 10.3389/fneph.2022.985449] [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] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/09/2022] [Indexed: 09/08/2023]
Abstract
In Brazil, most hemodialysis (HD) patients are treated by the country's public health system. However, accessibility to healthcare is different for public and private patients. This study aimed to identify the profile of vascular access in a Brazilian HD sample. Additionally, it aimed to examine the influence of public and private health insurance, accessibility to endovascular treatments, and timely arteriovenous access creation on the prevalence of tunneled catheters (TCs), non-tunneled catheters (NTCs), and arteriovenous (AV) access. We conducted a cross-sectional electronic survey across 834 centers. Centers were inquired about the number of patients with public and private health insurance, the profiles of vascular access, time for AV access creation, accessibility to TC insertion and endovascular treatments, and the availability of peritoneal dialysis and kidney transplantation. Logistic regression and multilevel logistic regression were performed to evaluate possible interactions between the independent variables. A total of 7,973 patients across 47 HD centers were included in the survey. Public health patients accounted for 77% of the study sample. The overall vascular access profiles of the public and private insurance groups were significantly different (p < 0.001). For patients with public health insurance, the prevalence of any catheter was 25%, while that for private patients was 31.8% (p < 0.001). The prevalence of TCs was more common in private patients (15.3% vs. 23.1%, p < 0.001). AV accesses were more common in public health patients (75% vs. 68.2%, p < 0.001), as were fistulas (72.4% vs. 63.1%, p < 0.001). AV grafts were more prevalent among patients with private insurance (2.6 vs. 5.1%, p < 0.001). The availability of endovascular treatments increased the chance of having a TC by 2.3-fold (OR = 2.33, 95% CI = 1.30-4.18); however, it did not reduce the chance of having any catheter. A high chance of having a catheter was found when the time to AV access creation exceeded 60 days. The differences between public and private patients may be explained by underpayments and the decreased accessibility to care infrastructure in the public system, especially for endovascular treatments. In this sample, public health patients had a decreased risk of having a TC over an NTC. Differences in care accessibility and insurance type might influence the type of vascular access.
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Affiliation(s)
| | | | - Thyago Proença de Moraes
- Department of Nephrology, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
- Department of Nephrology, Santa Casa de Misericórdia de Curitiba, Curitiba, Brazil
| | - Rodrigo Peixoto Campos
- Department of Internal Medicine, Faculdade de Medicina da Universidade Federal de Alagoas, Maceió, Brazil
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Hangai KT, Pecoits-Filho R, Blake PG, da Silva DP, Barretti P, de Moraes TP. Impact of unplanned peritoneal dialysis start on patients' outcomes-A multicenter cohort study. Front Med (Lausanne) 2022; 9:717385. [PMID: 36507496 PMCID: PMC9727097 DOI: 10.3389/fmed.2022.717385] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Patients with end-stage kidney disease (ESKD) who start unplanned dialysis therapy are more likely to be treated with hemodialysis (HD) using a central venous catheter, which has been associated with a greater risk of infections and other complications, as well as with a higher long-term risk of death. Urgent-start PD is an alternative that has been suggested as an option for starting dialysis in these cases, with potentially better patient outcomes. However, the definition of urgent-start PD is not homogeneous, and no study, to our knowledge, has compared clinical outcomes among urgent start, early start, and conventional start of PD. In this study, we aimed to compare these types of initiation of dialysis therapy in terms of a composite outcome of patient survival and technique failure. Methods This is a retrospective, multicenter, cohort study, involving data from 122 PD clinics in Brazil. We used the following: Urgent-start groups refer to patients who initiated PD within 72 h after the PD catheter insertion; early-start groups are those starting PD from 72 h to 2 weeks after the catheter insertion; and conventional-start groups are those who used the PD catheter after 2 weeks from its insertion. We analyzed the composite endpoint of all causes of patient's mortality and technique failure (within the initial 90 days of PD therapy) using the following three different statistical models: multivariate Cox, Fine and Gay competing risk, and a multilevel model. Results We included 509 patients with valid data across 68 PD clinics. There were 38 primary outcomes, comprising 25 deaths and 13 technique failures, with a total follow-up time of 1,393.3 months. Urgent-start PD had no association with the composite endpoint in all three models. Conclusion Unplanned PD seems to be a safe and feasible option for treatment for patients with non-dialysis ESKD in urgent need of dialysis.
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Affiliation(s)
- Kellen Thayanne Hangai
- Programa de Pós- Graduação em Ciências da Saúde-Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Roberto Pecoits-Filho
- Programa de Pós- Graduação em Ciências da Saúde-Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Peter G. Blake
- Division of Nephrology, University of Western Ontario, London, ON, Canada
| | - Daniela Peruzzo da Silva
- Programa de Pós- Graduação em Ciências da Saúde-Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Pasqual Barretti
- Division of Nephrology, Department of Internal Medicine, Universidade Estadual Paulista (UNESP), Botucatu, Brazil,*Correspondence: Pasqual Barretti
| | - Thyago Proença de Moraes
- Programa de Pós- Graduação em Ciências da Saúde-Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
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Marques S, Cruz JAW, da Cunha MAVC, Tuon FF, de Moraes TP, Daiane Zdziarski A, Bomher ST, Donnelly LF, Capasso R. Patient and family experience with telemedicine and in-person pediatric and obstetric ambulatory encounters throughout 2020, during the COVID-19 epidemic: the distance effect. BMC Health Serv Res 2022; 22:659. [PMID: 35578239 PMCID: PMC9109949 DOI: 10.1186/s12913-022-08037-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 07/23/2021] [Accepted: 05/03/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Telemedicine has grown significantly in recent years, mainly during the COVID-19 pandemic, and there has been a growing body of literature on the subject. Another topic that merits increased attention is differences in patient and family experience between telehealth and in-person visits. To our team's knowledge, this is the first study evaluating pediatric and obstetrics outpatients experience with telemedicine and in-person visit types in an academic maternal and children's hospital, and its correlation with geographic distance from the medical center throughout 2020, during the COVID-19 crisis. METHODS We aim to evaluate and compare patients' telemedicine and in-person experience for ambulatory encounters based on survey data throughout 2020, during the COVID-19 pandemic, with particular focus on the influence of distance of the patient's home address from the medical facility. A total of 9,322 patient experience surveys from ambulatory encounters (6,362 in-person and 2,960 telemedicine), in a maternal and children's hospital during 2020 were included in this study. The percentage of patients who scored the question "Likelihood to recommend practice" with a maximum 5/5 (top box) score was used to evaluate patient experience. The k-means model was used to create distance clusters, and statistical t-tests were conducted to compare mean distances and Top Box values between telemedicine and in-person models. Logistic regression analysis was used to evaluate the correlation between Top Box scores and patients' distance to the hospital. RESULTS Top Box likelihood to recommend percentages for in-person and telemedicine were comparable (in-person = 81.21%, telemedicine = 81.70%, p-value = 0.5624). Mean distance from the hospital was greater for telemedicine compared to in-person patients (in-person = 48.89 miles, telemedicine = 61.23 miles, p-value < 0.01). Patients who live farther displayed higher satisfaction scores regardless of the visit type (p-value < 0.01). CONCLUSIONS There is a direct relationship between the family experience and the distance from the considered medical center, during year 2020, i.e., patients who live farther from the hospital record higher Top Box proportion for "Likelihood to Recommend" than patients who live closer to the medical center, regardless of the approach, in-person or telemedicine.
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Moreno-Amaral AN, Soares Tozoni S, de Castro Deus M, Carolina Gadotti A, Clara Flórido A, Bohnen G, Bacarin Monte Alegre J, Sousa Dias E, Proença de Moraes T. MO321: The Critical Role of Cytokine Dysregulation in Acute Kidney Injury Development in Patients With COVID-19. Nephrol Dial Transplant 2022. [PMCID: PMC9383902 DOI: 10.1093/ndt/gfac068.031] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND AIMS One of the complications described in critically ill patients in intensive care units with severe COVID-19 was acute kidney injury (AKI). The pathophysiology of AKI in patients with COVID-19 is multifactorial. In addition to the direct virulence of SARS-CoV-2 in renal cells, the tissue inflammation and local immune cell infiltration, cytokine storm, secondary infections and nephrotoxicity associated drugs may contribute to AKI [1]. Mounting evidence throughout the pandemic suggests that patients with severe COVID-19 may have a cytokine storm syndrome, one of the possible causes of AKI in these patients [2]. The present prospective cohort study analysed the correlation between circulating cytokine profile and estimated glomerular filtration rate (eGFR) in patients with COVID-19. METHOD After signing the informed consent, patients positive for SARS-CoV-2 infection (n = 74) had blood samples (n = 139) collected at hospital admission until the day of the outcome. ELISA measured the cytokines IL-10, IL-4, L-6, TNF-α and IFN-γ, and the eGFR was calculated by the CKD-EPI Cystatin C equation. Statistics description: Continuous variables were checked for normality and presented as mean ± standard deviation or median and interquartile range. The association between continuous variables is shown in scatterplots, and a predicted response with 95% confidence interval (95% CI) is plotted using fractional polynomials. For linear correlations, we obtained P-values using Pearson's correlation coefficient. RESULTS There is a more significant distribution of eGFR below 90 mL/min in the population studied, associated with older patients. Glomerular filtration rates were negatively correlated with age as expected (–0.60; P < 0.0001). Lower eGFR was correlated with levels of proinflammatory cytokines such as IL-6 (–0.33; P < .0007) and TNF- α (–0.21; P < .03); but without positive correlation with IL-10 (0.04; P < 0.68) or IFN-γ (–0.14; P < .16), even though higher IFN-γ levels have been linked to a worse prognosis in patients with severe COVID-19 [3]. Curiously, a positive correlation was observed between lower eGFR and IL-4 levels. CONCLUSION These results demonstrate that a shift in the immune response profile, cytokines with a Th2 profile such as IL-4, and cytokines with systemic functions such as IL-6 and TNF-α can be related to renal failure. The elucidation of the potential pathophysiological mechanisms of AKI associated with COVID-19 as well as monitoring of cytokine levels can (a) help to identify patients with severe COVID-19 at risk of loss of renal function, (b) provide information on specific therapeutic strategies.
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Affiliation(s)
- Andrea N Moreno-Amaral
- Anemia and Immunology Research Laboratory (LabAIRe), Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Sara Soares Tozoni
- Anemia and Immunology Research Laboratory (LabAIRe), Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Marina de Castro Deus
- Anemia and Immunology Research Laboratory (LabAIRe), Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Ana Carolina Gadotti
- Anemia and Immunology Research Laboratory (LabAIRe), Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Ana Clara Flórido
- Anemia and Immunology Research Laboratory (LabAIRe), Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Gabriela Bohnen
- Anemia and Immunology Research Laboratory (LabAIRe), Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Julia Bacarin Monte Alegre
- Anemia and Immunology Research Laboratory (LabAIRe), Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Erika Sousa Dias
- Anemia and Immunology Research Laboratory (LabAIRe), Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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11
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Cruz JAW, da Cunha MAVC, de Moraes TP, Marques S, Tuon FF, Gomide AL, de Paula Linhares G. Brazilian private health system: history, scenarios, and trends. BMC Health Serv Res 2022; 22:49. [PMID: 35012514 PMCID: PMC8751295 DOI: 10.1186/s12913-021-07376-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 07/17/2021] [Accepted: 11/18/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Health care is a complex economic and social system, which combines market elements and public and social interest. This combination in Brazil, like systems in China and United States of America, is operationalized through the public and private system. The sector represents approximately 9% of the country's GDP, of which 56% is privately sourced and 44% is of public origin. In the private sector includes a structure with 711 private health institutions, 47 million beneficiaries and revenues of US$30 billion a year. METHODS Therefore, this research describes and analyzes the complementarity of Private Health before the Brazilian Unified Health System, highlighting its main characteristics, scenarios, and trends in the face of the health system and the Brazilian market. This descriptive and exploratory research uses secondary data from various sources, submitted to quantitative data analysis methods. The object of the research is the history of private health in Brazil and its main actors. RESULTS The data are organized into three groups, each with its approach of collection and analysis. Thus, it is perceived as the notorious growth of large operators, to the detriment of operators with a lower concentration of beneficiaries; the increasing concentration of the market through mergers and acquisitions promoted by large publicly traded corporations, especially in regions with a lower rate of private health coverage; and the growth of the sector through business plans, whose central characteristic is the dependence on the country's employability rate. CONCLUSIONS It is possible to perceive an intense trend of concentration of Brazilian private health in large institutions that have capitalized and have a great appetite for growth through mergers and acquisitions, whether from smaller operators or health institutions that integrate their health networks, following complementary health models already consolidated in countries such as China, and the United States of America, among others. This concentration projects a market with fewer options and competitiveness, reduction in transaction costs and increase the operational effectiveness of health care.
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Affiliation(s)
- June Alisson Westarb Cruz
- Fundação Getúlio Vargas – EAESP, São Paulo, Brazil
- Pontifical Catholic University of Paraná, Curitiba, Brazil
- School of Business, Pontifical Catholic University of Paraná, Curitiba, Paraná 80215-901 Brazil
| | | | | | - Sandro Marques
- Pontifical Catholic University of Paraná, Curitiba, Brazil
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, USA
- Pontifical Business School at the Catholic University of Paraná – EUA, Curitiba, Brazil
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12
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Pellizzari C, de Moraes TP. Urgent-start peritoneal dialysis. J Bras Nefrol 2022; 44:464-465. [PMID: 36332006 PMCID: PMC9838660 DOI: 10.1590/2175-8239-jbn-2022-e009en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 08/18/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Caio Pellizzari
- Santa Casa de Misericórdia de Curitiba, Curitiba, PR, Brasil,Pontifícia Universidade Católica do Paraná, Programa de
Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil
| | - Thyago Proença de Moraes
- Santa Casa de Misericórdia de Curitiba, Curitiba, PR, Brasil,Pontifícia Universidade Católica do Paraná, Programa de
Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil
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13
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Tabuti NIM, Pellizzari C, Carrascossi H, Calice-Silva V, Figueiredo A, Gordon GM, Biangini G, Rodrigues ME, Dias DB, da Silva DR, de Moraes TP. Impact of telemedicine on metabolic control and hospitalization of peritoneal dialysis patients during the COVID-19 pandemic: a national multicentric cohort study. J Bras Nefrol 2022; 44:473-481. [PMID: 35199824 PMCID: PMC9838680 DOI: 10.1590/2175-8239-jbn-2021-0113] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 01/04/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The coronavirus-19 pandemic threatens the lives of all people, but results in higher mortality rates for patients with end-stage kidney disease (ESKD) including those on peritoneal dialysis (PD). Telemedicine was the main alternative to reduce exposure to the virus, but it was introduced in the Brazil without proper training. OBJECTIVE To investigate the impact of telemedicine on metabolic control, peritonitis rates, and hospitalization in PD patients during the pandemic. METHODS This was a retrospective multicenter cohort study. We included all adult patients on chronic PD from 9 clinics selected by convenience during the pandemic. The outcomes of interest were measured and compared between before and after switching to telemedicine using repeated measure analysis and multilevel Poisson regression. RESULTS The study included 747 patients with a mean age of 59.7±16.6 years, of whom 53.7% were male and 40.8% had diabetes. Biochemical parameters including hemoglobin, potassium, phosphate, calcium, and urea serum levels did not change significantly after transition to telemedicine. There was no association between telemedicine and peritonitis rates. In contrast, hospitalization rates increased significantly in the telemedicine period. The incidence rate ratio (IRR) for hospitalization in the telemedicine period was 1.54 (95%CI 1.10-2.17; p 0.012) and 1.57 (95%CI 1.12-2.21; p 0.009) in the mixed-effects Poisson regression before and after adjustment for the presence of confounders. Admissions for hypervolemia and infections not related to PD doubled after transition to telemedicine. CONCLUSION The implementation of telemedicine without proper training may lead to an increase in adverse events in PD patients.
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Affiliation(s)
| | | | | | - Viviane Calice-Silva
- Fundação Pró-rim, Joinville, SC, Brasil.,Universidade da Região de Joinville, Joinville, SC, Brasil
| | - Ana Figueiredo
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | | | | | | | | | - Thyago Proença de Moraes
- Santa Casa de Misericórdia de Curitiba, PR, Brasil.,Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil
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14
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Pellizzari C, Moraes TPD. Diálise peritoneal de início urgente. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2022-e009pt] [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: 11/06/2022] Open
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15
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Azevedo CAB, da Cunha RS, Junho CVC, da Silva JV, Moreno-Amaral AN, de Moraes TP, Carneiro-Ramos MS, Stinghen AEM. Extracellular Vesicles and Their Relationship with the Heart-Kidney Axis, Uremia and Peritoneal Dialysis. Toxins (Basel) 2021; 13:toxins13110778. [PMID: 34822562 PMCID: PMC8618757 DOI: 10.3390/toxins13110778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/04/2021] [Revised: 10/19/2021] [Accepted: 10/28/2021] [Indexed: 12/18/2022] Open
Abstract
Cardiorenal syndrome (CRS) is described as primary dysfunction in the heart culminating in renal injury or vice versa. CRS can be classified into five groups, and uremic toxin (UT) accumulation is observed in all types of CRS. Protein-bound uremic toxin (PBUT) accumulation is responsible for permanent damage to the renal tissue, and mainly occurs in CRS types 3 and 4, thus compromising renal function directly leading to a reduction in the glomerular filtration rate (GFR) and/or subsequent proteinuria. With this decrease in GFR, patients may need renal replacement therapy (RRT), such as peritoneal dialysis (PD). PD is a high-quality and home-based dialysis therapy for patients with end-stage renal disease (ESRD) and is based on the semi-permeable characteristics of the peritoneum. These patients are exposed to factors which may cause several modifications on the peritoneal membrane. The presence of UT may harm the peritoneum membrane, which in turn can lead to the formation of extracellular vesicles (EVs). EVs are released by almost all cell types and contain lipids, nucleic acids, metabolites, membrane proteins, and cytosolic components from their cell origin. Our research group previously demonstrated that the EVs can be related to endothelial dysfunction and are formed when UTs are in contact with the endothelial monolayer. In this scenario, this review explores the mechanisms of EV formation in CRS, uremia, the peritoneum, and as potential biomarkers in peritoneal dialysis.
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Affiliation(s)
- Carolina Amaral Bueno Azevedo
- Experimental Nephrology Laboratory, Basic Pathology Department, Universidade Federal do Paraná, Curitiba 81531-980, Brazil; (C.A.B.A.); (R.S.d.C.)
| | - Regiane Stafim da Cunha
- Experimental Nephrology Laboratory, Basic Pathology Department, Universidade Federal do Paraná, Curitiba 81531-980, Brazil; (C.A.B.A.); (R.S.d.C.)
| | - Carolina Victoria Cruz Junho
- Laboratory of Cardiovascular Immunology, Center of Natural and Human Sciences (CCNH), Federal University of ABC, Santo André 09210-580, Brazil; (C.V.C.J.); (J.V.d.S.); (M.S.C.-R.)
| | - Jessica Verônica da Silva
- Laboratory of Cardiovascular Immunology, Center of Natural and Human Sciences (CCNH), Federal University of ABC, Santo André 09210-580, Brazil; (C.V.C.J.); (J.V.d.S.); (M.S.C.-R.)
| | - Andréa N. Moreno-Amaral
- Graduate Program in Health Sciences, School of Medicine, Pontifical Catholic University of Paraná, Curitiba 80215-901, Brazil; (A.N.M.-A.); (T.P.d.M.)
| | - Thyago Proença de Moraes
- Graduate Program in Health Sciences, School of Medicine, Pontifical Catholic University of Paraná, Curitiba 80215-901, Brazil; (A.N.M.-A.); (T.P.d.M.)
| | - Marcela Sorelli Carneiro-Ramos
- Laboratory of Cardiovascular Immunology, Center of Natural and Human Sciences (CCNH), Federal University of ABC, Santo André 09210-580, Brazil; (C.V.C.J.); (J.V.d.S.); (M.S.C.-R.)
| | - Andréa Emilia Marques Stinghen
- Experimental Nephrology Laboratory, Basic Pathology Department, Universidade Federal do Paraná, Curitiba 81531-980, Brazil; (C.A.B.A.); (R.S.d.C.)
- Correspondence:
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16
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Roth-Stefanski CT, Rodrigues de Almeida N, Biagini G, Scatone NK, Nerbass FB, de Moraes TP. The Diagnosis of Protein Energy Wasting in Chronic Peritoneal Dialysis Patients Is Influenced by the Method of Calculating Muscle Mass. A Prospective, Multicenter Study. Front Med (Lausanne) 2021; 8:702749. [PMID: 34513874 PMCID: PMC8424066 DOI: 10.3389/fmed.2021.702749] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/02/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: To analyze the concordance and agreement between bioimpedance spectroscopy (BIS) and anthropometry for the diagnosis of protein energy wasting (PEW) in chronic peritoneal dialysis patients. Methods: Prospective, multi-center, observational study using multifrequency bioimpedance device (Body Composition Monitor -BCM®- Fresenius Medical Care) and anthropometry for the diagnosis of PEW as recommended by the International Society of Renal Nutrition and Metabolism (ISRNM). Cohen's kappa was the main test used to analyze concordance and a Bland-Altmann curve was built to evaluate the agreement between both methods. Results: We included 137 patients from three PD clinics. The mean age of the study population was 57.7 ± 14.9, 47.8% had diabetes, and 52.2% were male. We calculated the scores for PEW diagnosis at 3 and 6 months after the first collection (T3 and T6) and on average 40% of the study population were diagnosed with PEW. The concordance in the diagnosis of PEW was only moderate between anthropometry and BIS at both T3 and T6. The main factor responsible for our results was a low to moderate correlation for muscle mass in kilograms, with an r-squared (R2) of 0.35. The agreement was poor, with a difference of more than 10 kg of muscle mass on average and with more than a quarter of all cases beyond the limits of agreements. Conclusion: Current diagnosis of PEW may differ depending on the tools used to measure muscle mass in peritoneal dialysis patients.
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Affiliation(s)
- Cristina Techy Roth-Stefanski
- Pontificia Univerdidade Catolica do Parana, Post Graduate Program in Health and Biological Sciences, Curitiba, Brazil
| | - Naiane Rodrigues de Almeida
- Pontificia Univerdidade Catolica do Parana, Post Graduate Program in Health and Biological Sciences, Curitiba, Brazil.,Santa Casa de Misericórdia de Curitiba, Curitiba, Brazil
| | - Gilson Biagini
- Pontificia Univerdidade Catolica do Parana, Post Graduate Program in Health and Biological Sciences, Curitiba, Brazil.,Instituto Do Rim, Curitiba, Brazil
| | | | | | - Thyago Proença de Moraes
- Pontificia Univerdidade Catolica do Parana, Post Graduate Program in Health and Biological Sciences, Curitiba, Brazil.,Santa Casa de Misericórdia de Curitiba, Curitiba, Brazil
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17
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Weissheimer R, Bucharles SGE, Truyts CAM, Jorgetti V, Figueiredo AE, Barrett P, Olandoski M, Pecoits-Filho R, Moraes TPD. High prevalence of biochemical disturbances of chronic kidney disease - mineral and bone disorders (CKD-MBD) in a nation-wide peritoneal dialysis cohort: are guideline goals too hard to achieve? J Bras Nefrol 2021; 43:173-181. [PMID: 33538758 PMCID: PMC8257285 DOI: 10.1590/2175-8239-jbn-2020-0147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/30/2020] [Accepted: 11/15/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Chronic kidney disease - mineral and bone disorders (CKD-MBD) are common in dialysis patients. Definition of targets for calcium (Ca), phosphorus (P), parathormone (iPTH), and alkaline phosphatase (ALP) and their treatment recommendations, are provided by international guidelines. There are few studies analyzing CKD-MBD in peritoneal dialysis (PD) patients and the impact of guidelines on mineral metabolism control. The aim of our study was to describe the prevalence of biomarkers for CKD-MBD in a large cohort of PD patients in Brazil. METHODS Data from the nation-wide prospective observational cohort BRAZPD II was used. Incident patients were followed between December 2004 and January 2011. According to KDOQI recommendations, reference ranges for total Ca were 8.4 to 9.5 mg/dL, for P, 3.5 to 5.5 mg/dL, for iPTH, 150-300 pg/mL, and for ALP, 120 U/L. RESULTS Mean age was 59.8 ± 16 years, 48% were male, and 43% had diabetes. In the beginning, Ca was 8.9 ± 0.9 mg/dL, and 48.3% were on the KODQI target. After 1 year, Ca increased to 9.1 ± 0.9 mg/dL and 50.4% were in the KDOQI preferred range. P at baseline was 5.2 ± 1.6 mg/dL, with 52.8% on target, declining to 4.9 ± 1.5 mg/dL after one year, when 54.7% were on target. Median iPTH at baseline was 238 (P25% 110 - P75% 426 pg/mL) and it remained stable throughout the first year; patients within target ranged from 26 to 28.5%. At the end of the study, 80% was in 3.5 meq/L Ca dialysate concentration, 66.9% of patients was taking any phosphate binder, and 25% was taking activated vitamin D. CONCLUSIONS We observed a significant prevalence of biochemical disorders related to CKD-MBD in this dialysis population.
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Affiliation(s)
- Rafael Weissheimer
- Pontifícia Universidade Católica do Paraná, Escola de Medicina, Curitiba, PR, Brasil
| | | | | | - Vanda Jorgetti
- Universidade de São Paulo, Escola de Medicina, São Paulo, SP, Brasil
| | - Ana Elizabeth Figueiredo
- Pontifícia Universidade Católica do Rio Grande do Sul, Programa de Pós-Graduação em Medicina e Ciências da Saúde, Porto Alegre, RS, Brasil
| | - Pasqual Barrett
- Universidade Estadual de São Paulo, Escola de Medicina, Botucatu, SP, Brasil
| | - Marcia Olandoski
- Pontifícia Universidade Católica do Paraná, Escola de Medicina, Curitiba, PR, Brasil
| | - Roberto Pecoits-Filho
- Pontifícia Universidade Católica do Paraná, Escola de Medicina, Curitiba, PR, Brasil
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18
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Guedes M, Pecoits-Filho R, Leme JEG, Jiao Y, Raimann JG, Wang Y, Kotanko P, de Moraes TP, Thadhani R, Maddux FW, Usvyat LA, Larkin JW. Impacts of dialysis adequacy and intradialytic hypotension on changes in dialysis recovery time. BMC Nephrol 2020; 21:529. [PMID: 33287719 PMCID: PMC7720452 DOI: 10.1186/s12882-020-02187-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/09/2020] [Accepted: 11/25/2020] [Indexed: 11/22/2022] Open
Abstract
Background Dialysis recovery time (DRT) surveys capture the perceived time after HD to return to performing regular activities. Prior studies suggest the majority of HD patients report a DRT > 2 h. However, the profiles of and modifiable dialysis practices associated with changes in DRT relative to the start of dialysis are unknown. We hypothesized hemodialysis (HD) dose and rates of intradialytic hypotension (IDH) would associate with changes in DRT in the first years after initiating dialysis. Methods We analyzed data from adult HD patients who responded to a DRT survey ≤180 days from first date of dialysis (FDD) during 2014 to 2017. DRT survey was administered with annual KDQOL survey. DRT survey asks: “How long does it take you to be able to return to your normal activities after your dialysis treatment?” Answers are: < 0.5, 0.5-to-1, 1-to-2, 2-to-4, or > 4 h. An adjusted logistic regression model computed odds ratio for a change to a longer DRT (increase above DRT > 2 h) in reference to a change to a shorter DRT (decrease below DRT < 2 h, or from DRT > 4 h). Changes in DRT were calculated from incident (≤180 days FDD) to first prevalent (> 365-to- ≤ 545 days FDD) and second prevalent (> 730-to- ≤ 910 days FDD) years. Results Among 98,616 incident HD patients (age 62.6 ± 14.4 years, 57.8% male) who responded to DRT survey, a higher spKt/V in the incident period was associated with 13.5% (OR = 0.865; 95%CI 0.801-to-0.935) lower risk of a change to a longer DRT in the first-prevalent year. A higher number of HD treatments with IDH episodes per month in the incident period was associated with a 0.8% (OR = 1.008; 95%CI 1.001-to-1.015) and 1.6% (OR = 1.016; 95%CI 1.006-to-1.027) higher probability of a change to a longer DRT in the first- and second-prevalent years, respectively. Consistently, an increased in incidence of IDH episodes/months was associated to a change to a longer DRT over time. Conclusions Incident patients who had higher spKt/V and less sessions with IDH episodes had a lower likelihood of changing to a longer DRT in first year of HD. Dose optimization strategies with cardiac stability in fluid removal should be tested. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-020-02187-9.
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Affiliation(s)
- Murilo Guedes
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Roberto Pecoits-Filho
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Juliana El Ghoz Leme
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Yue Jiao
- Global Medical Office, Fresenius Medical Care, 920 Winter Street, Waltham, MA, 02451, USA
| | | | - Yuedong Wang
- University of California Santa Barbara, Santa Barbara, CA, USA
| | - Peter Kotanko
- Research Division, Renal Research Institute, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Franklin W Maddux
- Global Medical Office, Fresenius Medical Care, 920 Winter Street, Waltham, MA, 02451, USA
| | - Len A Usvyat
- Global Medical Office, Fresenius Medical Care, 920 Winter Street, Waltham, MA, 02451, USA
| | - John W Larkin
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil. .,Global Medical Office, Fresenius Medical Care, 920 Winter Street, Waltham, MA, 02451, USA.
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19
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Rigo M, Pecoits-Filho R, Lambie M, Tuon FF, Barretti P, de Moraes TP. Clinical utility of a traditional score system for the evaluation of the peritoneal dialysis exit-site infection in a national multicentric cohort study. Perit Dial Int 2020; 41:292-297. [PMID: 32856533 DOI: 10.1177/0896860820949032] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Exit-site infection (ESI) is an important risk factor for peritonitis in patients under chronic peritoneal dialysis (PD). The International Society for Peritoneal Dialysis (ISPD) recommend its diagnosis as the presence of purulent drainage in the exit site (ES) but time-consuming scores using others skin signs are routinely used. OBJECTIVE To investigate the correlation between the diagnosis of ESI with a score based on five clinical signs obtained from ES inspection, and also if there are interaction with patient's race. METHODS Multicenter and prospective cohort. We included adult patients from 122 clinics, incident on PD and with a 12-month stay in therapy. The event of interest was ESI, defined as purulent drainage. The clinical score used was composed of hyperemia, edema, pain, scab, and granuloma. Statistical analysis was performed using multilevel logistic regression model, likelihood test, and Cohen concordance analysis. RESULTS A total of 35,354 ES assessments were performed during the first year of dialysis in 3297 patients. There was a rate of 10.1 (9.1-11.2) episodes of ESI per 1000 patients/month. In patients with ESI, the prevalence of hyperemia was 55.9%, edema 67.3%, pain 31.8%, and scab 23.2%. The agreement with the score was 60.6% and showed differences according to the patient's race, being 53.2% for African Americans descendants and 65.4% for others. The use of scales for the diagnosis of ESI does not add much information in addition to the presence of purulent secretion as currently recommended by the ISPD.
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Affiliation(s)
- Mariane Rigo
- School of Medicine, 28100Pontifical Catholic University of Paraná(PUCPR), Curitiba, Brazil
| | - Roberto Pecoits-Filho
- School of Medicine, 28100Pontifical Catholic University of Paraná(PUCPR), Curitiba, Brazil
| | - Mark Lambie
- School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, UK
| | - Felipe Francisco Tuon
- School of Medicine, 28100Pontifical Catholic University of Paraná(PUCPR), Curitiba, Brazil
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Guedes M, Guetter CR, Erbano LHO, Palone AG, Zee J, Robinson BM, Pisoni R, de Moraes TP, Pecoits-Filho R, Baena CP. Physical health-related quality of life at higher achieved hemoglobin levels among chronic kidney disease patients: a systematic review and meta-analysis. BMC Nephrol 2020; 21:259. [PMID: 32641153 PMCID: PMC7346455 DOI: 10.1186/s12882-020-01912-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 02/10/2020] [Accepted: 06/26/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The impact of anemia treatment with erythropoietin stimulating agents (ESA) on health-related quality of life (HRQOL) in chronic kidney disease (CKD) patients is controversial, particularly regarding optimal hemoglobin (Hb) target ranges. METHODS We conducted a systematic review and meta-analysis of observational studies and randomized controlled trials (RCT) with ESA to estimate the effect of different achieved Hb values on physical HRQOL and functionality. We searched PubMed, EMBASE, CENTRAL, PEDro, PsycINFO and Web of Science databases, until May 2020. Two authors independently extracted data from studies. We included observational and RCTs that enrolled CKD patients undergoing anemia treatment with ESA with different achieved Hb levels among groups. We excluded studies with achieved Hb < 9 g/dL. For the meta-analysis, we included RCTs with control groups achieving Hb 10-11.5 g/dL and active groups with Hb > 11.5 g/dL. We analyzed the standardized mean difference (SMD) between groups for physical HRQOL. RESULTS Among 8496 studies, fifteen RCTs and five observational studies were included for the systematic review. We performed the meta-analysis in a subset of eleven eligible RCTs. For physical role and physical function, SMDs were 0.0875 [95% CI: - 0.0025 - 0.178] and 0.08 [95% CI: - 0.03 - 0.19], respectively. For fatigue, SMD was 0.16 [95% CI: 0.09-0.24]. Subgroup analysis showed that trials with greater achieved Hb had greater pooled effects sizes - 0.21 [95% CI: 0.07-0.36] for Hb > 13 g/dL vs. 0.09 [95% CI: 0.02-0.16] for Hb 11.5-13 g/dL. Proportion of older and long-term diabetic patients across studies were associated with lower effect sizes. CONCLUSION Achieved hemoglobin higher than currently recommended targets may be associated with small but potentially clinically significant improvement in fatigue, but not in physical role or physical function. Younger and non-diabetic patients may experience more pronounced benefits of higher Hb levels after treatment with ESAs.
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Affiliation(s)
- Murilo Guedes
- Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil.
| | | | - Lucas H O Erbano
- Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Andre G Palone
- Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Ronald Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Thyago Proença de Moraes
- Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Roberto Pecoits-Filho
- Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Cristina P Baena
- Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
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21
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Larkin JW, Han M, Han H, Guedes MH, Gonçalves PB, Poli-de-Figueiredo CE, Cuvello-Neto AL, Barra ABL, de Moraes TP, Usvyat LA, Kotanko P, Canziani MEF, Raimann JG, Pecoits-Filho R. Impact of hemodialysis and post-dialysis period on granular activity levels. BMC Nephrol 2020; 21:197. [PMID: 32450793 PMCID: PMC7249440 DOI: 10.1186/s12882-020-01853-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/01/2019] [Accepted: 05/12/2020] [Indexed: 11/26/2022] Open
Abstract
Background Physical activity (PA) is typically lower on hemodialysis (HD) days. Albeit intradialytic inactivity is expected, it is unknown whether recovery after HD contributes to low PA. We investigated the impact of HD and post-HD period on granular PA relative to HD timing. Methods We used baseline data from the HDFIT trial conducted from August 2016 to October 2017. Accelerometry measured PA over 1 week in patients who received thrice-weekly high-flux HD (vintage 3 to 24 months), were clinically stable, and had no ambulatory limitations. PA was assessed on HD days (0 to ≤24 h after start HD), first non-HD days (> 24 to ≤48 h after start HD) and second non-HD day (> 48 to ≤72 h after start HD). PA was recorded in blocks/slices: 4 h during HD, 0 to ≤2 h post-HD (30 min slices), and > 2 to ≤20 h post-HD (4.5 h slices). Blocks/slices of PA were captured at concurrent/parallel times on first/second non-HD days compared to HD days. Results Among 195 patients (mean age 53 ± 15 years, 71% male), step counts per 24-h were 3919 ± 2899 on HD days, 5308 ± 3131 on first non-HD days (p < 0.001), and 4926 ± 3413 on second non-HD days (p = 0.032). During concurrent/parallel times to HD on first and second non-HD days, patients took 1308 and 1128 more steps (both p < 0.001). Patients took 276 more steps and had highest rates of steps/hour 2-h post-HD versus same times on first non-HD days (all p < 0.05). Consistent findings were observed on second non-HD days. Conclusions PA was higher within 2-h of HD versus same times on non-HD days. Lower PA on HD days was attributable to intradialytic inactivity. The established PA profiles are of importance to the design and development of exercise programs that aim to increase activity during and between HD treatments. Trial registration HDFIT was prospectively registered 20 April 2016 on ClinicalTrials.gov (NCT02787161)
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Affiliation(s)
- John W Larkin
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil. .,Global Medical Office, Fresenius Medical Care, Waltham, MA, USA.
| | - Maggie Han
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil.,Research Division, Renal Research Institute, New York, NY, USA
| | - Hao Han
- Global Medical Office, Fresenius Medical Care, Waltham, MA, USA
| | - Murilo H Guedes
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | | | | | | | | | - Thyago Proença de Moraes
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Len A Usvyat
- Global Medical Office, Fresenius Medical Care, Waltham, MA, USA
| | - Peter Kotanko
- Research Division, Renal Research Institute, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Roberto Pecoits-Filho
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
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22
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Boudville N, de Moraes TP. 2005 Guidelines on targets for solute and fluid removal in adults being treated with chronic peritoneal dialysis: 2019 Update of the literature and revision of recommendations. Perit Dial Int 2020; 40:254-260. [PMID: 32048566 DOI: 10.1177/0896860819898307] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/15/2022] Open
Abstract
BACKGROUND The International Society for Peritoneal Dialysis guidelines for small solute clearance and fluid removal in peritoneal dialysis (PD) were published in 2005. The aim of this article is to update those guidelines by reviewing the literature that supported those guidelines and examining publications since then. METHODS An extensive search of publications was performed through electronic databases and a hand search through reference lists from the existing guideline and selected articles. RESULTS There have been no prospective intervention trials to inform the area of small solute clearance in PD since the publication of the original guideline in 2005. The trials to date are largely limited to a few prospective cohort studies and retrospective studies. These have, however, consistently demonstrated that residual renal function (RRF) is more often associated with patient outcome than peritoneal clearance. One of the few randomised controlled trials performed in this area does suggest that a weekly Kt/V of 2.27 ± 0.02 provides no statistically significant survival advantage over a weekly Kt/V of 1.80 ± 0.02. The lower limit of Kt/V is unknown but there is weak evidence to suggest that anuric people doing PD should have a weekly Kt/V of at least 1.7. CONCLUSIONS There continues to be very poor evidence in the area of small solute clearance and fluid removal in PD. The evidence that exists suggests that RRF is more important than peritoneal clearance and that there appears to be no survival advantage in aiming for a weekly Kt/V >1.70.
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Affiliation(s)
- Neil Boudville
- Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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23
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Radunz V, Pecoits-Filho R, Figueiredo AE, Barretti P, de Moraes TP. Impact of Glucose Exposure on Outcomes of a Nation-Wide Peritoneal Dialysis Cohort - Results of the BRAZPD II Cohort. Front Physiol 2019; 10:150. [PMID: 30890947 PMCID: PMC6411763 DOI: 10.3389/fphys.2019.00150] [Citation(s) in RCA: 3] [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: 08/21/2018] [Accepted: 02/07/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Data investigating the association of glucose exposure with technique failure and patient survival are limited to retrospective cohorts and was never tested outside Asia and considering the presence of competing risks. Methods: Prospective multicenter cohort study of incident peritoneal dialysis patients where the association of cumulative glucose exposure in 6, 12, and 24 months with patient survival and technique failure was tested using Cox regression analysis and competing risk analysis. Results: We analyzed 4367 incident peritoneal dialysis patients with mean age 59.0 ± 15.8 years, 43.9% were diabetics, 46.7% males and 64.4% Caucasians. Glucose exposure was not associated with patient survival independent of the time of exposure and even after adjustments for confounders. In contrast, higher glucose exposure was associated with more technique failure in the Cox and competing risk models. The higher risk for technique failure was found in the subgroup exposed to the higher amount of glucose to a maximum of 86% in the model analyzing cumulative glucose exposure for 1 year. Conclusion: Glucose exposure was associated with technique failure but not with patient survival.
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Affiliation(s)
- Vitor Radunz
- Programa de Pós-Graduação em Ciências da Saúde, Escola de Medicina, Curitiba, Brazil
| | - Roberto Pecoits-Filho
- Programa de Pós-Graduação em Ciências da Saúde, Escola de Medicina, Curitiba, Brazil
| | - Ana Elizabeth Figueiredo
- Programa de Pós-Graduação em Medicina e Ciências da Saúde (Nefrologia), Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pasqual Barretti
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, Brazil
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24
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Pecoits-Filho R, Larkin JW, Poli-de-Figueiredo CE, Cuvello Neto AL, Barra AB, Canhada S, de Campos LG, Woehl J, Gonçalves PB, Han H, de Moraes TP, Raimann JG, Canziani MEF. Design and methodology of the impact of HemoDiaFIlTration on physical activity and self-reported outcomes: a randomized controlled trial (HDFIT trial) in Brazil. BMC Nephrol 2019; 20:98. [PMID: 30894141 PMCID: PMC6425582 DOI: 10.1186/s12882-019-1247-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/23/2018] [Accepted: 02/01/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND End stage renal disease (ESRD) patients require a renal replacement therapy (RRT) to filter accumulated toxins and remove excess water, which are associated with impaired physical function. Hemodialysis (HD) removes middle-molecular weight (MMW) toxins less efficiently compared to hemodiafiltration (HDF); we hypothesized HDF may improve physical function. We detailed the design and methodology of the HDFIT protocol that is testing whether changing from HD to HDF effects physical activity levels and various outcomes. METHODS HDFIT is a prospective, multi-center, unblinded, randomized control trial (RCT) investigating the impact of dialysis modality (HDF verses HD) on objectively measured physical activity levels, self-reported quality of life, and clinical/non-clinical outcomes. Clinically stable patients with HD vintage of 3 to 24 months without any severe limitation ambulation were recruited from sites throughout southern Brazil. Eligible patients were randomized in a 1:1 ratio to either: 1) be treated with high volume online HDF for 6 months, or 2) continue being treated with high-flux HD. This study includes run-in and randomization visits (baseline), 3- and 6-month study visits during the interventional period, and a 12-month observational follow up. The primary outcome is the difference in the change in steps per 24 h on dialysis days from baseline to the 6-month follow up in patients treated with HDF versus HD. Physical activity is being measured over one week at study visits with the ActiGraph ( www.actigraphcorp.com ). For assessment of peridialytic differences during the dialysis recovery period, we will analyze granular physical activity levels based on the initiation time of HD on dialysis days, or concurrent times on non-dialysis days and the long interdialytic day. DISCUSSION In this manuscript, we provide detailed information about the HDFIT study design and methodology. This trial will provide novel insights into peridialytic profiles of physical activity and various self-reported, clinical and laboratory outcomes in ESRD patients treated by high volume online HDF versus high-flux HD. Ultimately, this investigation will elucidate whether HDF is associated with patients having better vitality and quality of life, and less negative outcomes as compared to HD. TRIAL REGISTRATION Registered on ClinicalTrials.gov on 20 April 2016 ( NCT02787161 ).
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Affiliation(s)
- Roberto Pecoits-Filho
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição 1155, Curitiba, PR, 80215-901, Brazil.
| | - John W Larkin
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição 1155, Curitiba, PR, 80215-901, Brazil.,Fresenius Medical Care North America, 920 Winter Street, Waltham, MA, 02451, USA
| | | | | | - Ana Beatriz Barra
- Fresenius Medical Care Brazil, R. Amoreira 891, Jaguariúna, São Paulo, 13820-000, Brazil
| | - Sinaia Canhada
- Fresenius Medical Care Brazil, R. Amoreira 891, Jaguariúna, São Paulo, 13820-000, Brazil
| | - Ludimila Guedim de Campos
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição 1155, Curitiba, PR, 80215-901, Brazil
| | - Juliane Woehl
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição 1155, Curitiba, PR, 80215-901, Brazil
| | - Priscila Bezerra Gonçalves
- Health Technology Graduate Program, Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Hao Han
- Fresenius Medical Care North America, 920 Winter Street, Waltham, MA, 02451, USA
| | - Thyago Proença de Moraes
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição 1155, Curitiba, PR, 80215-901, Brazil
| | - Jochen G Raimann
- Research Division, Renal Research Institute, 315 East 62nd Street, 4th Floor, New York, NY, 10065, USA
| | - Maria Eugenia F Canziani
- Universidade Federal de São Paulo, R. Sena Madureira 1500, São Paulo, São Paulo, 04021-001, Brazil
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25
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Erthal Leinig C, Pecoits-Filho R, Kunii L, Claro LM, Merlin J, Almeida NRD, Carvalho CRDS, Moraes TPD. Low-Fiber Intake Is Associated With High Production of Intraperitoneal Inflammation Biomarkers. J Ren Nutr 2019; 29:322-327. [PMID: 30642655 DOI: 10.1053/j.jrn.2018.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/20/2018] [Accepted: 10/20/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Fiber intake influences disturbances in the gastrointestinal tract and is associated with systemic inflammation in the general population. Systemic and intraperitoneal inflammation play an important role in defining outcomes in peritoneal dialysis (PD), but the relationship between dietary fiber intake and inflammatory biomarkers has not yet been reported in the population on PD. The objective of the present study is to analyze whether or not fiber intake in patients on PD is associated with serum and intraperitoneal levels of inflammatory biomarkers. DESIGN AND METHODS Adult and clinically stable PD patients were included in this observational and cross-sectional study. Fiber intake was assessed by means of a dietary survey and calculated using the DietPro program 5.6i. The population was divided into two groups according to the median fiber intake. We investigated interleukin (IL)-1β, IL-6, tumor necrosis factor-α, monocyte chemoattractant protein-1 (MCP-1), B-cell-activating factor, and plasminogen-activator inhibitor-1 in both serum and peritoneal fluid. The latter was determined after a dwell time of 4 hours. RESULTS Fifty-two patients (42% men; aged 53 ± 14 years, 36% diabetics) were evaluated. Low intake of dietary fiber was found in 90% of patients, with a median of 12.2 g per day (3.4-33.3). The group with the highest fiber intake presented lower intraperitoneal levels of IL-6, IL-8, and MCP-1. In contrast, only MCP-1 was lower in the serum of those who consumed more fiber. All the associations remained significant after adjustment for confounders with plasminogen-activator inhibitor-1 included. CONCLUSIONS Patients on PD frequently present inadequate dietary fiber intake, which appears to have an association with the inflammatory response, particularly in the intraperitoneal component. Further prospective studies, evaluating whether or not a dietetic intervention with a focus on fiber intake affects these biomarkers and clinical outcomes, are essential to determine causality and clinical relevance.
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Affiliation(s)
- Cyntia Erthal Leinig
- School of Medicine, Pontifical Catholic University of Paraná (PUCPR), Curitiba, Brazil.
| | - Roberto Pecoits-Filho
- School of Medicine, Pontifical Catholic University of Paraná (PUCPR), Curitiba, Brazil
| | - Luiz Kunii
- State University of Londrina, Londrina, Brazil; Pontifical Catholic University of Paraná (PUCPR), Londrina, Brazil
| | - Ligia Maria Claro
- School of Medicine, Pontifical Catholic University of Paraná (PUCPR), Curitiba, Brazil
| | - Julio Merlin
- School of Medicine, Pontifical Catholic University of Paraná (PUCPR), Curitiba, Brazil
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26
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Bucharles SGE, Wallbach KKS, Moraes TPD, Pecoits-Filho R. Hypertension in patients on dialysis: diagnosis, mechanisms, and management. ACTA ACUST UNITED AC 2018; 41:400-411. [PMID: 30421784 PMCID: PMC6788847 DOI: 10.1590/2175-8239-jbn-2018-0155] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 07/16/2018] [Accepted: 09/05/2018] [Indexed: 12/19/2022]
Abstract
Hypertension (blood pressure > 140/90 mm Hg) is very common in patients undergoing regular dialysis, with a prevalence of 70-80%, and only the minority has adequate blood pressure (BP) control. In contrast to the unclear association of predialytic BP recordings with cardiovascular mortality, prospective studies showed that interdialytic BP, recorded as home BP or by ambulatory blood pressure monitoring in hemodialysis patients, associates more closely with mortality and cardiovascular events. Although BP is measured frequently in the dialysis treatment environment, aspects related to the measurement technique traditionally employed may be unsatisfactory. Several other tools are now available and being used in clinical trials and in clinical practice to evaluate and treat elevated BP in chronic kidney disease (CKD) patients. While we wait for the ongoing review of the CKD Blood Pressure KIDGO guidelines, there is no guideline for the dialysis population addressing this important issue. Thus, the objective of this review is to provide a critical analysis of the information available on the epidemiology, pathogenic mechanisms, and the main pillars involved in the management of blood pressure in stage 5-D CKD, based on current knowledge.
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Affiliation(s)
| | | | | | - Roberto Pecoits-Filho
- Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Curitiba, PR, Brasil
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27
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Chaiben VBDO, Silveira TBD, Guedes MH, Fernandes JPDA, Ferreira JHF, Beltrão J, Leal GF, Erbano LHO, Bosch NL, Pecoits Filho R, Moraes TPD, Baena CP. Cognition and renal function: findings from a Brazilian population. ACTA ACUST UNITED AC 2018; 41:200-207. [PMID: 30222178 PMCID: PMC6699443 DOI: 10.1590/2175-8239-jbn-2018-0067] [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: 03/20/2018] [Accepted: 05/25/2018] [Indexed: 11/23/2022]
Abstract
Introduction: The prevalence of chronic kidney disease (CKD) is increasing, with a
potential impact in the risk of acceleration of dementia. The potential
association between glomerular filtration rate (eGFR) and cognitive
performance was scarcely studied. The aim of this study was to evaluate
cognitive performance levels across different degrees of kidney
function. Methods: We analyzed 240 outpatients in a nephrology service, classified according to
eGFR: Advanced (≤ 30ml/min/1.73m2), Moderate
(30,1ml/min/1.73m2 to ≤ 60ml/min/1.73m2),
and Mild CKD (> 60ml/min/1.73m2). Word list memory, Semantic
fluency, Mental State Mini Exam and Trail Making Test (TMT) were applied to
evaluate cognitive performance. In the TMT, lower scores are associated with
better cognition. In linear regression, cognitive function was considered as
dependent variables while groups based on eGFR were considered explanatory
variables. The group with eGFR > 60ml/min was the reference and models
were adjusted for confounding factors. Results: In our population (n = 240) 64 patients (26.7%) were classified as having
advanced, 98(40,8%) moderate, and 78(32,5%) mild. There was no statistical
difference among them in MMSE or in the verbal fluency test. However,
comparing to mild, patients with advanced CKD presented significantly worse
cognitive performance measured by TMTA [50,8s ± 31.1s versus 66,6s
± 35,7s (p = 0.016)] and TMTB [92,7s ± 46,2s
versus 162,4s ± 35,7s (p < 0.001)]. Significantly
lower TMTB scores (CI95%) 33,0s (4,5-61,6s) were observed in patients with
mild compared to advanced CKD in the multivariate analysis adjusting for
age, education, sex, diabetes, and alcohol use. Conclusion: Advanced CKD is independently associated with poorer cognitive performance
measured by an executive performance test compared to mild CKD.
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Affiliation(s)
| | | | - Murilo Henrique Guedes
- Pontifícia Universidade Católica do Paraná, Departamento de Medicina, Curitiba, PR, Brasil
| | | | | | - Julianna Beltrão
- Pontifícia Universidade Católica do Paraná, Escola de Saúde e Biociências, PR, Brasil
| | - Giovanna Foltran Leal
- Pontifícia Universidade Católica do Paraná, Escola de Saúde e Biociências, PR, Brasil
| | | | - Natasha Ludmila Bosch
- Pontifícia Universidade Católica do Paraná, Departamento de Medicina, Curitiba, PR, Brasil
| | - Roberto Pecoits Filho
- Pontifícia Universidade Católica do Paraná, Departamento de Medicina, Curitiba, PR, Brasil
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28
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Siemens TA, Riella MC, Moraes TPD, Riella CV. APOL1 risk variants and kidney disease: what we know so far. ACTA ACUST UNITED AC 2018; 40:388-402. [PMID: 30052698 PMCID: PMC6533999 DOI: 10.1590/2175-8239-jbn-2017-0033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 12/21/2017] [Accepted: 04/19/2018] [Indexed: 01/08/2023]
Abstract
There are striking differences in chronic kidney disease between Caucasians and African descendants. It was widely accepted that this occurred due to socioeconomic factors, but recent studies show that apolipoprotein L-1 (APOL1) gene variants are strongly associated with focal segmental glomerulosclerosis, HIV-associated nephropathy, hypertensive nephrosclerosis, and lupus nephritis in the African American population. These variants made their way to South America trough intercontinental slave traffic and conferred an evolutionary advantage to the carries by protecting against forms of trypanosomiasis, but at the expense of an increased risk of kidney disease. The effect of the variants does not seem to be related to their serum concentration, but rather to local action on the podocytes. Risk variants are also important in renal transplantation, since grafts from donors with risk variants present worse survival.
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29
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Banin VB, Ponce D, Dias DB, de Oliveira RC, Martin LC, de Moraes TP, Barretti P. Influence of the intra-peritoneal segment of the swan neck peritoneal catheter on infectious and mechanical complications and technique survival. Clin Exp Nephrol 2018; 23:135-141. [DOI: 10.1007/s10157-018-1618-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/14/2018] [Indexed: 10/28/2022]
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30
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Brown EA, Bargman J, van Biesen W, Chang MY, Finkelstein FO, Hurst H, Johnson DW, Kawanishi H, Lambie M, de Moraes TP, Morelle J, Woodrow G. Length of Time on Peritoneal Dialysis and Encapsulating Peritoneal Sclerosis - Position Paper for ISPD: 2017 Update. Perit Dial Int 2018; 37:362-374. [PMID: 28676507 DOI: 10.3747/pdi.2017.00018] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/04/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Joanne Bargman
- University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Wim van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Ming-Yang Chang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Helen Hurst
- Central Manchester and Manchester Children's NHS Foundation Trust, Manchester, UK
| | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Hideki Kawanishi
- Tsuchiya General Hospital, Faculty of Medicine, Hiroshima University, Japan
| | - Mark Lambie
- Institute for Applied Clinical Sciences, Keele University, Stoke-on-Trent, UK
| | | | - Johann Morelle
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium, et Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
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Modesto AP, Usvyat L, Calice-Silva V, Spigolon DN, Figueiredo AE, de Moraes TP, Olandoski M, Shimakura SE, Barreti P, Kotanko P, Pecoits-Filho R. Impact of the Karnofsky Performance Status on Survival and its Dynamics during the Terminal Year of Peritoneal Dialysis Patients. Perit Dial Int 2018; 38:24-29. [DOI: 10.3747/pdi.2015.00241] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 05/02/2017] [Indexed: 11/15/2022] Open
Abstract
Background Simple and low-cost tools to monitor the risk profile of patients on peritoneal dialysis (PD) at high risk of complications and mortality are scarce. One of the tools available to monitor the variation in vitality and dependence levels is the Karnofsky performance status (KPS). This study analyzed the average trends and variation of KPS during the 12 months before death and its independent value in predicting patients’ survival. Methods The data were compiled from the BRAZPD II multi-center study, performed in Brazil between 2004 and 2011. For the analysis of KPS dynamics, we included patients with at least 12 months of follow-up on PD and who had a fatal event during the follow-up. The following covariables were evaluated: age, gender, ethnicity, educational level, and presence of diabetes. We used the linear regression model to present the results: the log (time) before death was represented by the regression variable and KPS was the response. We also analyzed the independent impact of baseline KPS on patients’ survival. Results From the population of 9,905 patients enrolled in the BRAZPD study, 4,133 survived 12 months on PD and were included in the analysis. There was a gradual decline in the KPS scores, which accelerated in the last 2 months before death. These changes were similar irrespective of age, race, family income, gender, diabetes, PD modality, and education level. We observed 989 fatal events in this population during the observation period, and the KPS score was identified as an independent predictor for mortality in this cohort. Conclusions This study demonstrates for the first time the dynamics of KPS before death in PD patients, indicating a progressive and accelerated decline of KPS in the 12 months before patients died. In addition, KPS was an independent predictor of mortality in this population.
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Affiliation(s)
- Ana Paula Modesto
- Pontifícia Universidade Católica do Paraná (PUCPR), School of Medicine, Curitiba, Brazil
| | - Len Usvyat
- Renal Research Institute, New York, NY, USA
- Fresenius Medical Care North America, Waltham, MA, USA
| | - Viviane Calice-Silva
- Pontifícia Universidade Católica do Paraná (PUCPR), School of Medicine, Curitiba, Brazil
| | | | | | | | - Marcia Olandoski
- Pontifícia Universidade Católica do Paraná (PUCPR), School of Medicine, Curitiba, Brazil
| | | | | | - Peter Kotanko
- Renal Research Institute, New York, NY, USA
- The Mount Sinai Hospital, New York, NY, USA
| | - Roberto Pecoits-Filho
- Pontifícia Universidade Católica do Paraná (PUCPR), School of Medicine, Curitiba, Brazil
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Ponce D, de Moraes TP, Pecoits-Filho R, Figueiredo AE, Barretti P. Peritonitis in Children on Chronic Peritoneal Dialysis: The Experience of a Large National Pediatric Cohort. Blood Purif 2017; 45:118-125. [PMID: 29241184 DOI: 10.1159/000484344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 07/11/2017] [Accepted: 10/17/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND We performed this study to evaluate the incidence, risk factors, microbiology, treatment, and outcome of peritonitis in pediatric Peritoneal dialysis (PD) patients at a nationwide prospective study. METHODOLOGY Patients younger than 18 years recruited in the BRAZPD II study from 2004 to 2011, who presented their first peritonitis episode, were included in the study. RESULTS We found 125 first episodes of peritonitis in 491 children PD patients (0.43 episodes/patient-year). Patients free of peritonitis episode constituted 75.6% in 1 year. Culture-negative episodes were very high (59.2%) and gram-positive (GP) bacteria were the most commonly found organisms (58.8%). First-generation cephalosporin was the initial choice to cover GP (40.5%) and aminoglycosides was the most prescribed antibiotics used for gram-negative agents (27.5%). Treatment failure was 26.4%. Technique failure (TF) occurred in 12.1% and peritonitis was the main cause (65.1%). Pseudomonas (p = 0.04) and negative cultures (p < 0.001) were identified as predictors of TF. CONCLUSION Peritonitis remains a common complication of PD in children and negative cultures and pseudomonas had a negative impact on TF.
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Affiliation(s)
- Daniela Ponce
- Department of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | | | | | - Ana Elizabeth Figueiredo
- Programa de Pós-Graduação em Medicina e Ciências da Saúde (Nefrologia), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Pasqual Barretti
- Department of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
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Tuon FF, Gasparetto J, Wollmann LC, Moraes TPD. Mobile health application to assist doctors in antibiotic prescription – an approach for antibiotic stewardship. Braz J Infect Dis 2017; 21:660-664. [PMID: 28941393 PMCID: PMC9425452 DOI: 10.1016/j.bjid.2017.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 11/19/2022] Open
Abstract
Background Technologies applied to mobile devices can be an important strategy in antibiotic stewardship programs. Objective The aim of this study was to determine the impact of a decision-making application on antibiotic prescription. Methods This was an observational, analytical and longitudinal study on the implementation of an antimicrobial guide for mobile application. This study analyzed the period of 12 months before and 12 months after the app implementation at a university hospital based on local epidemiology, avoiding high cost drugs and reducing the potential for drug resistance including carbapenem. Antimicrobials consumption was evaluated in Daily Defined Dose/1000 patients-day and direct expenses converted into USD. Results The monthly average consumption of aminoglycosides and cefepime had a statistically significant increase (p < 0.05), while the consumption of piperacillin/tazobactam and meropenem was significantly decreased (p < 0.05). The sensitivity to meropenem as well as to polymyxin increased after the app implementation. A decrease in sensitivity to cefepime was observed after introduction of this antibiotic as a substitute of piperacillin/tazobactam for treating intra-hospital infections. There was a net saving of USD 296,485.90 (p < 0.05). Conclusion An antibiotic protocol in the app can help antibiotic stewardship reducing cost, changing the microbiological profile and antimicrobial consumption.
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Affiliation(s)
- Felipe Francisco Tuon
- Pontifícia Universidade Católica do Paraná, Escola de Saúde e Biociências, Departamento de Medicina, Curitiba, PR, Brazil.
| | - Juliano Gasparetto
- Pontifícia Universidade Católica do Paraná, Escola de Saúde e Biociências, Departamento de Medicina, Curitiba, PR, Brazil
| | - Luciana Cristina Wollmann
- Pontifícia Universidade Católica do Paraná, Escola de Saúde e Biociências, Departamento de Medicina, Curitiba, PR, Brazil
| | - Thyago Proença de Moraes
- Pontifícia Universidade Católica do Paraná, Escola de Saúde e Biociências, Departamento de Medicina, Curitiba, PR, Brazil
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Ribeiro SC, Figueiredo AE, Barretti P, Pecoits-Filho R, de Moraes TP. Impact of Renin-Angiotensin Aldosterone System Inhibition on Serum Potassium Levels among Peritoneal Dialysis Patients. Am J Nephrol 2017; 46:150-155. [PMID: 28738355 DOI: 10.1159/000479011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 02/24/2017] [Accepted: 06/15/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The chronic use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blocker has been associated with hyperkalemia in patients with reduced renal function even after the initiation of hemodialysis. Whether such medications may cause a similar effect in peritoneal dialysis patients is not well established. So, the aim of our study was to analyze the impact of renin-angiotensin-aldosterone inhibitors on the serum levels of potassium in a national cohort of peritoneal dialysis patients. METHOD A prospective, observational, nationwide cohort study was conducted. We identified all incident patients on peritoneal dialysis that had angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) prescribed for at least 3 months and a similar period of time without these medications. Patients were divided into 4 groups: Groups I and III correspond to patients using, respectively, an ACEi or ARB and then got the drug suspended; Groups II and IV started peritoneal dialysis without the use of any renin-angiotensin aldosterone system inhibitor and then got, respectively, an ACEi or ARB introduced. Changes in potassium serum levels were compared using 2 statistical approaches: (1) the non-parametric Wilcoxon test for repeated measures and (2) a crossover analysis. RESULTS Mean potassium serum levels at the first phase of the study for Groups I, II, III, and IV were, respectively, 4.46 ± 0.79, 4.33 ± 0.78, 4.41 ± 0.63, and 4.44 ± 0.56. Changes in mean potassium serum levels for Groups I, II, III, and IV were -0.10 ± 0.60, 0.02 ± 0.56, -0.06 ± 0.46, and 0.03 ± 0.50, respectively. CONCLUSION The use of ACEi and ARB was not associated with a greater risk for hyperkalemia in stable peritoneal dialysis patients independently of residual renal function.
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Pecoits-Filho R, Ribeiro SC, Kirk A, da Silva HS, Pille A, Falavinha RS, Filho SS, Figueiredo AE, Barretti P, de Moraes TP. Racial and social disparities in the access to automated peritoneal dialysis - results of a national PD cohort. Sci Rep 2017; 7:5214. [PMID: 28701770 PMCID: PMC5507918 DOI: 10.1038/s41598-017-05544-1] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 05/31/2017] [Indexed: 11/09/2022] Open
Abstract
The prevalence of patients on automated peritoneal dialysis (APD) is increasing worldwide and may be guided by clinical characteristics, financial issues and patient option. Whether socioeconomic factors at the patient level may influence the decision for the initial peritoneal dialysis (PD) modality is unknown. This is a prospective cohort study. The primary outcome of interest was the probability to start PD on APD. The inclusion criteria were adult patients incident in PD. Exclusion criteria were missing data for either race or initial PD modality. We used a mixed-model analysis clustering patients according to their PD center and region of the country. We included 3,901 patients of which 1,819 (46.6%) had APD as their first modality. We found a significant disparity for race and educational level with African American patients less likely to start on APD (Odds ratio 0.74 CI95% 0.58-0.94) compared to Whites whilst those with greater educational levels were more likely to start on APD (Odds ratio 3.70, CI95% 2.25-6.09) compared to illiterate patients. Limiting the use of APD in disadvantaged population may be unethical. Demographics and socioeconomic status should not be necessarily part of the decision-making process of PD modality choice.
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Affiliation(s)
| | | | - Adam Kirk
- Wessex Renal and Transplant Service, Queen Alexandra Hospital, Portsmouth, UK
| | | | - Arthur Pille
- Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | | | | | - Ana Elizabeth Figueiredo
- Programa de Pós-Graduação em Medicina e Ciências da Saúde (Nefrologia), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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Figueiredo AE, de Mattos C, Saraiva C, Olandoski M, Barretti P, Pecoits Filho R, de Moraes TP. Comparison between types of dressing following catheter insertion and early exit-site infection in peritoneal dialysis. J Clin Nurs 2017; 26:3658-3663. [DOI: 10.1111/jocn.13738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Ana Elizabeth Figueiredo
- School of Nursing, Nutrition and Physiotherapy (FAENFI) and School of Medicine; Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS); Porto Alegre Brazil
| | - Carolina de Mattos
- School of Nursing, Nutrition and Physiotherapy (FAENFI) and School of Medicine; Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS); Porto Alegre Brazil
| | - Cristine Saraiva
- School of Nursing, Nutrition and Physiotherapy (FAENFI) and School of Medicine; Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS); Porto Alegre Brazil
| | - Marcia Olandoski
- School of Medicine; Pontifícia Universidade Católica do Paraná (PUCPR); Curitiba Brazil
| | | | - Roberto Pecoits Filho
- School of Medicine; Pontifícia Universidade Católica do Paraná (PUCPR); Curitiba Brazil
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Hallvass AE, Claro LM, Gonçalves S, Olandoski M, Nerbass FB, Aita CAM, de Moraes TP, Pecoits-Filho R. Evaluation of Salt Intake, Urinary Sodium Excretion and Their Relationship to Overhydration in Chronic Kidney Disease Patients. Blood Purif 2015; 40:59-65. [DOI: 10.1159/000430902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 04/23/2015] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to estimate sodium intake in a group of patients with chronic kidney disease (CKD) and to correlate the results with the urinary excretion values of sodium and signs of fluid overload. We included patients with CKD in different stages. Urinary sodium was measured in 24 h urine samples. Body composition monitor (BCM) was used to estimate the hydration status. Sixty patients (38 ± 15 ml/min of GFR) presented 4.14 ± 1.71 g/24 h of urinary sodium excretion. Overhydration was detected in 50% of the patients by the BCM. There was a positive correlation between the measured sodium excretion values and BCM, ICW, ECW and TBW. In conclusion, markers of overhydration evaluated by BCM were positively correlated with urinary sodium excretion.
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de Moraes TP, Andreoli MCC, Canziani ME, da Silva DR, Caramori JCT, Ponce D, Cassi HV, de Andrade Bastos K, Rio DRA, Pinto SW, Filho SRF, de Campos LG, Olandoski M, Divino-Filho JC, Pecoits-Filho R. Icodextrin reduces insulin resistance in non-diabetic patients undergoing automated peritoneal dialysis: results of a randomized controlled trial (STARCH). Nephrol Dial Transplant 2015; 30:1905-11. [PMID: 26063787 DOI: 10.1093/ndt/gfv247] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 01/29/2015] [Accepted: 05/16/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Insulin resistance is a common risk factor in chronic kidney disease patients contributing to the high cardiovascular burden, even in the absence of diabetes. Glucose-based peritoneal dialysis (PD) solutions are thought to intensify insulin resistance due to the continuous glucose absorption from the peritoneal cavity. The aim of our study was to analyse the effect of the substitution of glucose for icodextrin on insulin resistance in non-diabetic PD patients in a multicentric randomized clinical trial. METHODS This was a multicenter, open-label study with balanced randomization (1:1) and two parallel-groups. Inclusion criteria were non-diabetic adult patients on automated peritoneal dialysis (APD) for at least 3 months on therapy prior to randomization. Patients assigned to the intervention group were treated with 2L of icodextrin 7.5%, and the control group with glucose 2.5% during the long dwell and, at night in the cycler, with a prescription of standard glucose-based PD solution only in both groups. The primary end-point was the change in insulin resistance measured by homeostatic model assessment (HOMA) index at 90 days. RESULTS Sixty patients were included in the intervention (n = 33) or the control (n = 27) groups. There was no difference between groups at baseline. After adjustment for pre-intervention HOMA index levels, the group treated with icodextrin had the lower post-intervention levels at 90 days in both intention to treat [1.49 (95% CI: 1.23-1.74) versus 1.89 (95% CI: 1.62-2.17)], (F = 4.643, P = 0.03, partial η(2) = 0.078); and the treated analysis [1.47 (95% CI: 1.01-1.84) versus 2.18 (95% CI: 1.81-2.55)], (F = 7.488, P = 0.01, partial η(2) = 0.195). CONCLUSIONS The substitution of glucose for icodextrin for the long dwell improved insulin resistance measured by HOMA index in non-diabetic APD patients.
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Affiliation(s)
| | | | - Maria Eugênia Canziani
- Division of Nephrology, Department of Internal Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Dirceu Reis da Silva
- Programa de Pós-Graduação em Medicina e Ciências da Saúde (Nefrologia), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | | | - Daniela Ponce
- Internal Medicine Department, University of Sao Paulo State, School of Medicine-UNESP, Botucatu, Brazil
| | | | | | | | | | | | | | - Marcia Olandoski
- School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | | | - Roberto Pecoits-Filho
- School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
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Calice-Silva V, Moraes TPD, Modesto A, Figueiredo AEPL, Campos LGD, Olandowski M, Thijssen ST, Barreti P, Kotanko P, Pecoits-Filho R, Investigators BRAZPD. FP566DYNAMICS OF NUTRITIONAL AND METABOLIC MARKERS BEFORE DEATH IN PERITONEAL DIALYSIS: RESULTS FROM BRAZPD, A NATIONWIDE PROSPECTIVE STUDY. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv180.18] [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: 11/14/2022] Open
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Moraes TPD, Ribeiro SC. Dialysis modality and quality of life. J Bras Nefrol 2015; 37:289-90. [DOI: 10.5935/0101-2800.20150047] [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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de Moraes TP, Figueiredo AE, de Campos LG, Olandoski M, Barretti P, Pecoits-Filho R. Characterization of the BRAZPD II cohort and description of trends in peritoneal dialysis outcome across time periods. Perit Dial Int 2014; 34:714-23. [PMID: 25185014 DOI: 10.3747/pdi.2013.00282] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [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: 02/06/2023] Open
Abstract
Observational studies from different regions of the world provide valuable information in patient selection, clinical practice, and their relationship to patient and technique outcome. The present study is the first large cohort providing patient characteristics, clinical practice, patterns and their relationship to outcomes in Latin America. The objective of the present study was to characterize the cohort and to describe the main determinants of patient and technique survival, including trends over time of peritoneal dialysis (PD) initiation and treatment. This was a nationwide cohort study in which all incident adult patients on PD from 122 centers were studied. Patient demographics, socioeconomic and laboratory values were followed from December 2004 to January 2011 and, for comparison purposes, divided into 3 groups according to the year of starting PD: 2005/06, 2007/08 and 2009/10. Patient survival and technique failure (TF) were analyzed using the competing risk model of Fine and Gray. All patients active at the end of follow-up were treated as censored. In contrast, all patients who dropped the study for any reason different from the primary event of interest were treated as competing risk. Significance was set to a p level of 0.05. A total of 9,905 patients comprised the adult database, 7,007 were incident and 5,707 remained at least 90 days in PD. The main cause of dropout was death (54%) and of TF was peritonitis (63%). Technique survival at 1, 2, 3, 4, and 5 years was 91%, 84%, 77%, 68%, and 58%, respectively. There was no change in TF during the study period but 3 independent risk factors were identified: lower center experience, lower age, and automated PD (APD) as initial therapy. Cardiovascular disease (36%) was the main cause of death and the overall patient survival was 85%, 74%, 64%, 54%, and 48% at 1, 2, 3, 4, and 5 years, respectively. Patient survival improved along all study periods: compared to 2005/2006, patients starting at 2007/2008 had a relative risk reduction (SHR) of 0.83 (95% confidence interval [CI] 0.72 - 0.95); and starting in 2009/2010 of 0.69 (95% CI 0.57 - 0.83). The independent risk factors for mortality were diabetes, age > 65 years, previous hemodialysis, starting PD modality, white race, low body mass index (BMI), low educational level, center experience, length of pre-dialysis care, and the year of starting PD. We observed an improvement in patient survival along the years. This finding was sustained even after correction for several confounders and using a competing risk approach. On the other hand, no changes in technique survival were found.
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Affiliation(s)
- Thyago Proença de Moraes
- School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil; Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; and School of Medicine, UNESP, Botucatu, Brazil
| | - Ana Elizabeth Figueiredo
- School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil; Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; and School of Medicine, UNESP, Botucatu, Brazil
| | - Ludimila Guedim de Campos
- School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil; Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; and School of Medicine, UNESP, Botucatu, Brazil
| | - Marcia Olandoski
- School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil; Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; and School of Medicine, UNESP, Botucatu, Brazil
| | - Pasqual Barretti
- School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil; Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; and School of Medicine, UNESP, Botucatu, Brazil
| | - Roberto Pecoits-Filho
- School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil; Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; and School of Medicine, UNESP, Botucatu, Brazil
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de Moraes TP, Olandoski M, Caramori JCT, Martin LC, Fernandes N, Divino-Filho JC, Pecoits-Filho R, Barretti P. Novel predictors of peritonitis-related outcomes in the BRAZPD cohort. Perit Dial Int 2014; 34:179-87. [PMID: 24385333 DOI: 10.3747/pdi.2012.00333] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 11/15/2022] Open
Abstract
INTRODUCTION Peritonitis remains the main cause of peritoneal dialysis (PD) technique failure worldwide, despite significant reductions in infection rates observed over the past decades. Several studies have described risk factors for peritonitis, technique failure and mortality. However, there are scarce data regarding predictors of complications during and after a peritonitis episode. The aim of our study was to analyze predictors of peritonitis-related outcome in the Brazilian Peritoneal Dialysis study (BRAZPD) cohort. METHODS All adult incident patients recruited in the BRAZPD Study between December 2004 and October 2007, who remained at least 90 days on PD and presented their first peritonitis episode (n = 474 patients) were included in the study. The endpoints analyzed were non-resolution, death due to a peritonitis episode and long-term technique survival after a peritonitis episode. RESULTS In the multivariable regression, non-resolution was independently associated with older age (odds ratio (OR) 1.02; p < 0.01), collagenosis as the primary renal disease (OR 4.6; p < 0.05) and Pseudomonas spp as etiological agent (OR 2.9; p < 0.05). Patients who were transferred from APD to CAPD during peritonitis therapy presented a higher risk of non-response (OR 2.5; p < 0.05). The only factor associated with death during a peritonitis episode was older age (OR 1.04; p < 0.05). Exposure to vancomycin and male gender were the independent predictors of long-term technique failure (OR 2.2; p < 0.01). CONCLUSION Apart from confirming previous observations of the negative impact of older age and Pseudomonas spp peritonitis on outcomes, we observed that collagenosis may negatively impact response to treatment and exposure to vancomycin may possibly reduce long-term technique survival. It is important to emphasize that the association of vancomycin with technique failure does not prove causality. These findings shed light on new factors predicting outcome when peritonitis is diagnosed.
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Ferreira-Filho SR, Machado GR, Ferreira VC, Rodrigues CFMA, Proença de Moraes T, Divino-Filho JC, Olandoski M, McIntyre C, Pecoits-Filho R. Back to basics: pitting edema and the optimization of hypertension treatment in incident peritoneal dialysis patients (BRAZPD). PLoS One 2012; 7:e36758. [PMID: 22649498 PMCID: PMC3359347 DOI: 10.1371/journal.pone.0036758] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 04/09/2012] [Indexed: 11/19/2022] Open
Abstract
Systemic arterial hypertension is an important risk factor for cardiovascular disease that is frequently observed in populations with declining renal function. Initiation of renal replacement therapy at least partially decreases signs of fluid overload; however, high blood pressure levels persist in the majority of patients after dialysis initiation. Hypervolemia due to water retention predisposes peritoneal dialysis (PD) patients to hypertension and can clinically manifest in several forms, including peripheral edema. The approaches to detect edema, which include methods such as bioimpedance, inferior vena cava diameter and biomarkers, are not always available to physicians worldwide. For clinical examinations, the presence of pitting located in the lower extremities and/or over the sacrum to diagnose the presence of peripheral edema in their patients are frequently utulized. We evaluated the impact of edema on the control of blood pressure of incident PD patients during the first year of dialysis treatment. Patients were recruited from 114 Brazilian dialysis centers that were participating in the BRAZPD study for a total of 1089 incident patients. Peripheral edema was diagnosed by the presence of pitting after finger pressure was applied to the edematous area. Patients were divided into 2 groups: those with and without edema according to the monthly medical evaluation. Blood arterial pressure, body mass index, the number of antihypertensive drugs and comorbidities were analyzed. We observed an initial BP reduction in the first five months and a stabilization of blood pressure levels from five to twelve months. The edematous group exhibited higher blood pressure levels than the group without edema during the follow-up. The results strongly indicate that the presence of a simple and easily detectable clinical sign of peripheral edema is a very relevant tool that could be used to re-evaluate not only the patient's clinical hypertensive status but also the PD prescription and patient compliance.
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de Moraes TP, Fortes PCN, Ribeiro SC, Riella MC, Pecoits-Filho R. Comparative analysis of lipid and glucose metabolism biomarkers in non-diabetic hemodialysis and peritoneal dialysis patients. ACTA ACUST UNITED AC 2011; 33:173-9. [PMID: 21789431 DOI: 10.1590/s0101-28002011000200009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 03/30/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate and compare glucose and lipid metabolism biomarkers in non-diabetic peritoneal dialysis and hemodialysis patients. METHODS The study followed a prospective and cross-sectional design. PARTICIPANTS Participants included all prevalent end-stage renal disease patients under renal replacement therapy treated in a university-based clinic. INTERVENTIONS There were no interventions. MAIN OUTCOMES MEASURES Blood samples were taken after 8 hours of fasting. Insulin serum levels were determined by chemiluminescence. Insulin resistance were assessed by the insulin sensitivity check index (QUICKI) determined as follow: 1/[log(Io) + log(Go)], where Io is the fasting insulin, and Go is the fasting glucose. HOMA index was also measured: (FPG × FPI)/22.5; FPG = fasting plasma glucose (mmol/L); FPI = fasting plasma insulin (mU/mL). The others biochemical exams were measured utilizing the routine tests. RESULTS We screened 154 patients (80 on hemodialysis and 74 on peritoneal dialysis). Seventy-four diabetic patients were excluded. Of the remaining 80 patients (55% males, mean age 52 ± 15 years), 35 were on peritoneal dialysis and 45 on hemodialysis. Fasting glucose of peritoneal dialysis patients compared to hemodialysis patients were 5.0 ± 0.14 versus 4,58 ± 0.14 mmol/L, p<0.05; glycated hemoglobin 5.9 ± 0.1 versus 5.5 ± 0.1%, p < 0.05; total cholesterol 5.06 ± 0.19 versus 3.39 ± 0.20 mmol/L, p < 0.01; LDL-c 2.93 ± 0.17 versus 1.60 ± 0.17 mmol/L, p < 0.01; and index HOMA 3.27 versus 1,68, p < 0,05. Importantly, all variables were adjusted for age, gender, dialysis vintage, calcium-phosphorus product, albumin and C-reactive protein levels. CONCLUSION We observed a worst profile of lipid and glucose metabolism biomarkers in peritoneal dialysis patients (lower insulin sensitivity and higher fasting glucose, HbA1c, total cholesterol and LDL-c) when compared to hemodialysis, potentially due to the glucose-based dialysis solutions utilized in the peritoneal dialysis population.
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Moraes TPD, Bucharles SGE, Ribeiro SC, Frumento R, Riella MC, Pecoits-Filho R. Alteração do teor de cálcio no banho de DP para 2,5 mEq/L é eficaz no reestabelecimento dos valores preconizados por diretrizes atuais em pacientes com PTH < 150 pg/dL. J Bras Nefrol 2010. [DOI: 10.1590/s0101-28002010000300009] [Citation(s) in RCA: 3] [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: 11/22/2022] Open
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Moraes TPD, Bucharles SGE, Ribeiro SC, Frumento R, Riella MC, Pecoits-Filho R. Low-calcium peritoneal dialysis solution is effective in bringing PTH levels to the range recommended by current guidelines in patients with PTH levels < 150 pg/dL. J Bras Nefrol 2010; 32:275-280. [PMID: 21103691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 07/09/2010] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION/OBJECTIVE Adinamic bone disease (ABD) is a common finding in peritoneal dialysis (PD) and is associated with higher risk of developing cardiovascular and bone disease. Data from BRAZPD indicates that 3.5 mEq/L calcium PD solutions represents the majority of PD prescriptions in the country. A positive calcium balance can contribute to ABD development. Currently guidelines suggest that PTH-i levels in end stage renal disease should be kept from 150-300 pg/mL. The purpose of this study is to evaluate 6 month PTH-i response after conversion to 2.5 mEq/L calcium PD solution in patients with baseline PTH-i levels < 150 pg/mL. METHODS Prospective, observational study of all prevalent patients (at least 90 days on therapy) on PD of a single Brazilian center from January 2008 to May 2009. Inclusion criteria (1) be in use of a PD solution with 3.5 mEq/L of calcium; (2) baseline PTH levels < 150 pg/ mL. According to clinical practice patients could be switched to PD solutions with 2.5 mEq/L of calcium. RESULTS 35 patients (age 62 ± 17 years) were included. Of these 22 were converted to 2.5 mEq/L calcium solutions. Diabetic nephropathy (36%) was the main cause of renal disease followed by nephrosclerosis (25%) and glomerulonephritis (14%). Converted group presented a greater increase in PTH levels when compared with the control group (Δ194 pg/dL versus Δ 92/dL; p < 0,05). Among patients switched to low calcium solution, 41% reached the target values (PTH 150-300 pg/mL) compared to 14% whose remain with normal calcium solutions (p < 0.05). There were no differences between groups regarding calcium, phosphorus and alkaline phosphatase. CONCLUSION In patients with PTH < 150 pg/mL conversion to low calcium solutions (2.5 mEq/L) appears to be a simple and effective strategy to bring PTH levels to the range determined by current guidelines when compared with 3.5 mEq/L calcium PD solutions.
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Fortes PC, de Moraes TP, Mendes JG, Stinghen AE, Ribeiro SC, Pecoits-Filho R. Insulin Resistance and Glucose Homeostasis in Peritoneal Dialysis. Perit Dial Int 2009. [DOI: 10.1177/089686080902902s28] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular disease (CVD) is the main cause of death in peritoneal dialysis (PD) patients, a situation that can be explained by a combination of traditional and nontraditional risk factors for CVD in these patients. Glucose and insulin homeostasis are altered in chronic kidney disease (CKD) patients even in the early stages of CKD, leading to insulin resistance by various pathways. Several factors have been implicated in the pathogenesis of insulin resistance, including anemia, dyslipidemia, uremia, malnutrition, excess of parathyroid hormone, vitamin D deficiency, metabolic acidosis, and increase in plasma free fatty acids and proinflammatory cytokines. Insulin resistance and dyslipidemia are observed and increase with the progression of CKD, playing an important role in the pathogenesis of hypertension and atherosclerosis. Particularly in PD patients, exposure to glucose from dialysis fluid accentuates the foregoing metabolic abnormalities. In conclusion, insulin resistance and altered glucose metabolism are frequently observed in CKD, and although dialysis partly corrects those disturbances, the use of glucose PD solutions intensifies a series of harmful metabolic consequences. New therapeutic measures aimed at reducing metabolic disorders are urgently needed and perhaps will improve PD patient survival.
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Affiliation(s)
- Paulo Cezar Fortes
- Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Thyago Proença de Moraes
- Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Jamille Godoy Mendes
- Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Andrea E. Stinghen
- Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Silvia Carreira Ribeiro
- Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Roberto Pecoits-Filho
- Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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Fortes PC, de Moraes TP, Mendes JG, Stinghen AE, Ribeiro SC, Pecoits-Filho R. Insulin resistance and glucose homeostasis in peritoneal dialysis. Perit Dial Int 2009; 29 Suppl 2:S145-S148. [PMID: 19270204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Cardiovascular disease (CVD) is the main cause of death in peritoneal dialysis (PD) patients, a situation that can be explained by a combination of traditional and nontraditional risk factors for CVD in these patients. Glucose and insulin homeostasis are altered in chronic kidney disease (CKD) patients even in the early stages of CKD, leading to insulin resistance by various pathways. Several factors have been implicated in the pathogenesis of insulin resistance, including anemia, dyslipidemia, uremia, malnutrition, excess of parathyroid hormone, vitamin D deficiency, metabolic acidosis, and increase in plasma free fatty acids and proinflammatory cytokines. Insulin resistance and dyslipidemia are observed and increase with the progression of CKD, playing an important role in the pathogenesis of hypertension and atherosclerosis. Particularly in PD patients, exposure to glucose from dialysis fluid accentuates the foregoing metabolic abnormalities. In conclusion, insulin resistance and altered glucose metabolism are frequently observed in CKD, and although dialysis partly corrects those disturbances, the use of glucose PD solutions intensifies a series of harmful metabolic consequences. New therapeutic measures aimed at reducing metabolic disorders are urgently needed and perhaps will improve PD patient survival.
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Affiliation(s)
- Paulo Cezar Fortes
- Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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