Adherence to drug therapy in kidney disease

Non-adherence to drug therapy has not been extensively studied in patients with chronic kidney disease (CKD). The objective of the present study was to identify determinants of non-adherence to drug therapy in patients with CKD, not on dialysis. A prospective cohort study involving 149 patients was conducted over a period of 12 months. Adherence to drug therapy was evaluated by the self-report method at baseline and at 12 months. Patients who knew the type of drug(s) and the respective number of prescribed pills in use at the visit preceding the interview were considered to be adherent. Patients with cognitive decline were assessed by interviewing their caregivers. Mean patient age was 51 ± 16.7 years. Male patients predominated (60.4 percent). Univariate analysis performed at baseline showed that non-adherence was associated with older age, more pills taken per day, worse renal function, presence of coronary artery disease, and reliance on caregivers for the administration of their medications. In multivariate analysis, the factors that were significantly associated with non-adherence were daily use of more than 5 pills and drug administration by a caregiver. Longitudinal evaluation showed an increase in non-adherence over time. Medication non-adherence was lower (17.4 percent) at the baseline period of the study than after 1 year of the study (26.8 percent). Compared to the baseline period, the percentage of adherent patients who became non-adherent (22 percent) was lower than the percentage of non-adherent patients who became adherent (50 percent). In CKD patients not on dialysis, non-adherence was significantly associated with the number of pills taken per day and drug administration by third parties. Adherence is more frequent than non-adherence over time.

Monitoring renal function: measured and estimated glomerular filtration rates: a review

Chronic kidney disease (CKD) is a wrld-wide public health problem, with adverse outcomes of kidney failure, cardiovascular disease, and premature death. This finding has led to the hypothesis that earlier recognition of kidney disease and successful intervention may improve outcome. The National Kidney Foundation, through its Kidney Disease Outcomes Quality Initiative (K/DOQI), and other National institutions recommend glomerular filtration rate (GFR) for the definition, classification, screening, and monitoring of CKD. Blood creatinine clearance, the most widely used clinical marker of kidney function, is now recognized as an unreliable measure of GFR because serum creatinine is affected by age, weight, muscle mass, race, various medications, and extra-glomerular elimination. Cystatin C concentration is a new and promising marker for kidney dysfunction in both native and transplanted kidneys. Because of its low molecular weight, cystatin C is freely filtered at the glomerulus and is almost completely reabsorbed and catabolized, but not secreted, by tubular cells. Given these characteristics, cystatin C concentration may be superior to creatinine concentration in detecting chronic kidney disease. This review aims to evaluate from recent literature the clinical efficiency and relevance of these GFR markers in terms of screening CKD.

Estudo preliminar para detecçäo de cérvico-vaginites e lesöes precursoras do câncer de colo uterino, em índias da tribo Parakanä / Preliminary study on low-trait genital infection and cervical epithelial dysplasia in indian of the Parakanä tribe

OBJETIVO. Avaliaçao preliminar da freqüência de inflamaçoes genitais e lesoes precursoras do câncer cérvico-uterino em um grupo indígena isolado da Amazônia oriental brasileira. MATERIAL E MÉTODO. Estudo transversal, dirigido às mulheres maiores de dez anos das aldeias Maroxewara e Paranatinga, da tribo Parakana. Foram obtidas informaçoes demográficas, etno-culturais, tocoginecológicas; procedeu-se a um exame físico e ginecológico, com coleta de material para bacterioscopia e colpocitologia oncótica.RESULTADOS. Foram examinadas 80 mulheres (89,9 por cento), das quais 69 foram avaliadas laboratorialmente; 14(20,3 por cento) estavam grávidas. Na aldeia Paranatinga, a bacterioscopia revelou um maior número de mulheres com ausência de flora Döderlein (60,0 por cento vs.29,l por cento). Na colpocitologia, o padrao mais encontrado foi o inflamatório (91,5 por cento); das colpites de etiologia específica (63,1 por cento), em 63,4 por cento suspeitou-se de infecçao por Gardenerella vaginalis, em 7,3 por cento por Trichomonas vaginalis, e em 4,9 por cento por microrganismos semelhantes à Candida sp. Em 23,2 por cento dos esfregaços havia alteraçoes citopatológicas relacionadas à infecçao por papilomavírus humano (PVH). As alteraçoes celulares sugeriram NIC I em um caso, NIC II em outro e carcinoma epidermóide em uma índia de 48 anos; nos três casos, foi proposta a posterior realizaçao de biópsia dirigida e avaliaçao clínica em ambientes hospitalar. Conclusoes. A maioria das mulheres Parakanas apresenta alguma patologia cervical, a maior parte das quais de menor gravidade. Apresentam, ainda, início precoce da vida sexual, multiplicidade de parceiros, curto intervalo interparto e alteraçoes citopatológicas sugestivas de infecçao pelo PVH, condiçoes de risco para transmissao sexual de doenças e desenvolvimento de câncer cérvico-uterino.