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1.
Rev. baiana saúde pública ; 45(Supl. Especial 2): 48-57, 2021/12/28.
Article in Portuguese | LILACS | ID: biblio-1352325

ABSTRACT

A rabdomiólise como complicação da dengue é subnotificada e pouco descrita na literatura. O presente caso traz um alerta para recordar tal possibilidade, principalmente devido à alta incidência da dengue no Brasil e da importância do manejo inicial, que pode evitar um desfecho desfavorável. Este relato trata de um paciente de 54 anos que iniciou com quadro agudo de fraqueza, com dor intensa em membros inferiores, dor abdominal, náuseas, vômitos e anúria. Foi observada evidente disfunção renal aguda em urgência dialítica com acidose metabólica grave, além de hiperuricemia, hiponatremia, hipocalcemia e hipercalemia, com valores de creatinofosfoquinase (CPK) de 125.010 e de mioglobina, 318,28. O paciente necessitou de três sessões de hemodiálise e recebeu alta com recuperação da função renal. O resultado da sorologia IgM para dengue foi positivo após um mês e dez dias da admissão hospitalar.


Reports on rhabdomyolysis as a complication of dengue are scarce in the literature. This study warns about such a possibility, especially considering the high incidence of dengue in Brazil and the importance of early management to avoid an unfavorable outcome for the patient. The case consists of a 54-year-old patient admitted to the hospital with complains of acute weakness, severe lower limb pain, abdominal pain, nausea, vomiting, and anuria. Clinical evaluation indicated acute renal dysfunction in dialysis emergency with severe metabolic acidosis, as well as hyperuricemia, hyponatremia, hypocalcemia, and hyperkalemia, with creatine phosphokinase (CPK) values equal to 125.010 and myoglobin to 318.28. The patient was discharged with recovery of renal function after three hemodialysis sessions. Serology results were positive for dengue IgM one month and ten days after hospital admission.


La rabdomiólisis como complicación del dengue está poco implementada en la literatura y poco reportada, y este caso trae una advertencia para recordar esta posibilidad, principalmente por la alta incidencia del dengue en el país en el que vivimos y la importancia del manejo inicial, evitando un desfavorable resultado para el paciente. Se trata de un paciente de 54 años que inicia debilidad aguda, dolor severo en miembros inferiores, dolor abdominal, náuseas, vómitos y anuria. Se evidenció disfunción renal aguda en urgencia de diálisis con acidosis metabólica severa, además de hiperuricemia, hiponatremia, hipocalcemia e hiperpotasemia, con valores de creatinfosfoquinasa (CPK)de 125.010 y mioglobina de 318,28. El paciente requirió tres sesiones de hemodiálisis y fue dado de alta con recuperación de la función renal. El resultado de la serología IgM para el dengue fue positivoun mes y diez días después del ingreso hospitalario.


Subject(s)
Rhabdomyolysis , Immunoglobulin M , Recovery of Function , Dengue , Dialysis
2.
Iatreia ; 34(2): 97-106, abr.-jun. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1250060

ABSTRACT

RESUMEN Objetivo: describir el porcentaje de resistencia a la mupirocina y a otros antibióticos en aislados de Staphylococcus aureus que colonizan pacientes en hemodiálisis. Métodos: estudio descriptivo en el que se incluyeron pacientes en hemodiálisis en una unidad renal de Medellín. La colonización por S. aureus fue evaluada en las fosas nasales y en la piel. La identificación bacteriana se realizó por PCR y la sensibilidad antibiótica se determinó por el sistema automatizado VITEK-2 y por el método E-test. Las características clínicas de los pacientes fueron evaluadas con la historia clínica. Resultados: se incluyeron 210 pacientes, de estos el 50,5 % (n = 106) fueron mujeres, con una mediana para la edad de 62 años (RIC 51,87-71,13). De las características clínicas se destacó el uso frecuente de antibióticos: 59 % (n = 124) y la historia de hospitalización: 69 % (n = 145). El porcentaje de colonización por S. aureus fue de 33,8 % (n = 71) y el sitio más frecuente de colonización fue las fosas nasales (19 %; n = 40). Todos los aislados fueron sensibles a la mupirocina por el método de VITEK-2. Sin embargo, un aislado presentó resistencia de bajo nivel a la mupirocina por E-test. La colonización por aislados resistentes a meticilina (SARM) fue de 4,8 % (n = 10) y estos presentaron, principalmente, resistencia solamente a la oxacilina (58,3 %; n = 7). Conclusión: la alta sensibilidad a la mupirocina en aislados de S. aureus colonizantes sugiere su uso como terapia profiláctica en pacientes en hemodiálisis con alto riesgo de infección. Es importante fortalecer los programas de uso racional de antibióticos para evitar la diseminación de mecanismos de resistencia a estos y a otros en las unidades renales.


SUMMARY Objective: To describe the resistance percentage to mupirocin and other antibiotics in Staphylococcus aureus isolates colonizing hemodialysis patients. Methods: A descriptive study was conducted at an outpatient dialysis center in Medellín and hemodialysis patients with catheter were included. Colonization by S. aureus was evaluated in nostrils and skin. Bacterial identification was performed by PCR and antibiotic susceptibility was determined by the Vitek-2 automated system and by E-test. Clinical information was obtained from medical records. Results: Two hundred and ten patients were included, of which 50.5% (n=106) were women, with a median for the age of 62 years (IQR 51,87-71,13). Among the clinical characteristics, the frequent use of antibiotics 59% (n=124) and the history of hospitalization 69% (n=145) were highlighted. The percentage of colonization by S. aureus was 33.8% (n=71) and the most frequent site of colonization was nostrils (19%; n=40). All isolates were susceptible to mupirocin by the method of Vitek-2. However, one isolate showed low level resistance to mupirocin by E-test. Colonization by methicillinresistant isolates (MRSA) was 4.8% (n=10); which presented mainly resistance only to oxacillin (58,3%; n = 7). Conclusion: The high susceptibility to mupirocin in isolates of colonizing S. aureus suggests its use as prophylactic therapy in hemodialysis patients with high risk of infection. It is important to strengthen programs for the rational use of antibiotics to prevent the spread of mechanisms of resistance to this and other antibiotics at dialysis units.


Subject(s)
Humans , Renal Dialysis , Mupirocin , Dialysis
3.
Infectio ; 24(4): 243-247, oct.-dic. 2020. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1114876

ABSTRACT

Abstract Objective: to describe an experience in identification and control of an outbreak of Ralstonia spp. in a renal unit. Material and Method: an epidemiological investigation of a hospital outbreak in 2 sites and extramural service of a renal unit. The investigation included patients who presented fever or chills, during or after dialysis, and who had positive blood culture for Ralstonia spp. Results: Of 769 hemodialysis patients, 124 were identified with bacteremia by Ralstonia spp.; of these, 98.4% had catheter access and 1.6% had fistula. The overall attack rate was 16.1% and the case fatality rate was 0.8%. Environmental cultures were taken and drugs and devices were tracked. Several cultures were taken of the prefilled heparin following the methods described in the International Pharmacopoeia. However, it was the technique of microbial isolation recommended by experts that enabled the isolation of the microorganism and confirmed the source. Conclusions: The outbreak described exceeded the number of patients affected documented in literature. It was caused by a contaminated batch of heparin. Evidence is provided of a recommended by expert technique used for the isolation of Ralstonia spp. in order to achieve control of outbreaks in a timely manner, minimizing clinical, economic, and social impact.


Resumen Objetivo: describir la experiencia en la identificación y control de un brote por Ralstonia spp. en una unidad renal. Material y Método: investigación epidemiológica de brote hospitalario en 2 sedes y servicio extramural de una unidad renal. Se incluyeron pacientes que presentaron fiebre o escalofrío, durante o después de la terapia dialítica, y que tuvieran hemocultivo positivo para Ralstonia spp. Resultados: De los 709 pacientes para hemodiálisis, se identificaron 124 con bacteriemia por Ralstonia spp., 98,4% tenían acceso por catéter. La tasa de ataque global fue del 16,1% y la tasa de letalidad 0,8%. Se realizaron cultivos ambientales y trazabilidad de medicamentos y dispositivos, pero ante la presencia de casos extramurales la hipótesis fue redireccionada. La heparina prellenada había sido cultivada en varias oportunidades siguiendo la metodología de la farmacopea internacional. Sin embargo, la técnica de aislamiento microbiano recomendada por expertos fue la que permitió aislar el microorganismo y confirmar la fuente. Conclusiones: El brote que se describe excedió el número de pacientes documentados en la literatura y fue causado por un lote contaminado de heparina. Se aporta evidencia de una técnica recomendada por expertos utilizada para el aislamiento de Ralstonia spp. a fin de lograr el control de brotes de manera oportuna, minimizando el impacto clínico, económico y social.


Subject(s)
Humans , Male , Middle Aged , Ralstonia , Dialysis , Control , Pharmaceutical Preparations , Disease Outbreaks , Mortality , Renal Dialysis , Equipment and Supplies , Catheters
4.
Rev. colomb. nefrol. (En línea) ; 7(2): 37-43, jul.-dic. 2020. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1251563

ABSTRACT

Resumen Introducción: la enfermedad renal puede generar un cambio en la vida de las personas que la padecen, pues los obliga a cambiar sus estilos y proyectos de vida, facilitando las afecciones a nivel físico, psicológico y social. Objetivo: determinar la prevalencia y los factores asociados a la ansiedad en pacientes con enfermedad renal crónica atendidos en dos unidades de diálisis de Boyacá, Colombia. Materiales y métodos: se realizó un estudio transversal analítico en pacientes con enfermedad renal crónica en fases avanzadas que estuvieran en manejo con terapia dialítica. Se incluyeron 224 participantes mayores de 18 años de edad que fueron seleccionados mediante un muestreo aleatorio simple y que firmaron un consentimiento informado de participación voluntaria. Resultados: la prevalencia de ansiedad fue de 41,33 %, además se encontró que tener pareja y apoyo familiar (0,42 %), estar empleado (0,56 %) y recibir una buena atención por parte del personal de salud (0,69 %) son factores protectores para la ansiedad. Por su parte, tener más de 2 años en diálisis (2,73 %) o hemodiálisis (2,92 %), tener enfermedad pulmonar obstructiva crónica (3,19 %), padecer de diabetes mellitus (3,23 %), tener antecedente familiar de enfermedad renal crónica (3,58 %), ser mujer (4,46 %) y ser mayor de 50 años (4,73 %) son factores que aumentan la probabilidad de presentar ansiedad. Conclusiones: los factores asociados a la ansiedad encontrados en la población estudiada son congruentes con los de la mayoría de estudios al respecto. Dada la importante prevalencia de este trastorno en pacientes con enfermedad renal crónica, es importante implementar estrategias psicoterapéuticas haciendo énfasis en la población con mayor riesgo de desarrollarla.


Abstract Introduction: Kidney pathology can generate a change in people's lives, since it forces us to change life styles and projects, facilitating physical, psychological and social conditions. Objective: To determine the factors associated with anxiety in patients with chronic kidney disease treated in two dialysis units of the department of Boyacá. Materials and methods: An analytical cross-sectional study was conducted, which included patients with chronic kidney disease in advanced stages who were managed with dialysis therapy. We included 224 patients over 18 years of age who accepted the informed consent for voluntary participation, selected by simple random sampling. Results: The prevalence of anxiety was 41.33 %, where it was found that having a partner, family support (0.42), being employed (0.56) and good care by health personnel (0.69) are protective factors for anxiety, while having more than 2 years on dialysis (2.73), hemodialysis (2.92), having chronic obstructive pulmonary disease (3.19), suffering from diabetes mellitus (3.23), Family history of chronic kidney disease (3.58), being a woman (4.46) and being older than 50 years (4.73) are factors that increase the likelihood of anxiety. Conclusions: the factors associated with anxiety in our study in patients with chronic kidney disease are congruent with the majority of studies carried out in this regard. Given the significant prevalence of anxiety in patients with chronic kidney disease, it is important to implement psychotherapeutic strategies in these patients with emphasis on the population with a higher risk of developing it.


Subject(s)
Humans , Male , Female , Anxiety , Renal Insufficiency, Chronic , Patients , Prevalence , Colombia , Dialysis , Protective Factors , Hemodialysis Units, Hospital
5.
An. Fac. Cienc. Méd. (Asunción) ; 53(3): 147-152, 20201201.
Article in Spanish | LILACS | ID: biblio-1177998

ABSTRACT

La función renal (FR) es medida por varios métodos. La más utilizada es el aclaramiento de creatinina (ClCr), que reflejaría, el filtrado glomerular (FG). Para su medición se recurre a la recolección de orina durante 24 horas o a la utilización de fórmulas, siendo la más utilizada, la ecuación CKD-EPI (Chronic kidney disease Epidemiology Collaboration). La disfunción renal se clasifica en 5 estadios. El estadio 5 (cuando el ClCr es igual o inferior a 15 ml/min), es cuando los pacientes están prontos a recibir tratamiento sustitutivo renal (TSR). La hemodiálisis (HD), es una técnica muy utilizada como TSR y normalmente es llevada a cabo 3 veces a la semana, por 4 horas cada una. Un paciente de 59 años, quién debido a la distancia entre su domicilio y el Centro de diálisis decide (consentimiento firmado), someterse a solo 2 sesiones de HD por semana. Al inicio del tratamiento, el paciente presentaba todos los datos clínicos y bioquímicos de la Enfermedad renal Crónica Avanzada, estadio 5 y un volumen diurético (VD) ≥ 1 litro/día. En caso de empeoramiento clínico y/o bioquímico, las sesiones de HD serían 3 veces por semana. Al año, los parámetros clínicos, bioquímicos y la función renal residual (FRR), permanecen óptimos. Si FRR (medido por el aclaramiento de urea (Kru) y el VD), declina serán necesarias 3 sesiones de HD, semanales. El mantenimiento de la FRR, está relacionado con la mortalidad y la HD incremental, al preservar mejor la FRR, mejora la sobrevida del paciente.


Several methods are useful to measure renal function (RF). In clinical practice, the creatinina cleareance (CrCl), is widely used, which approximately reflects the glomerular filtration rate (GFR). The 24 hs urine volume collection is required to measure CrCl, however, thanks different formulas we can have a precise CrCl value. The CKD-EPI (chronic kidney disease epidemiology collaboration), is the equation frequently used. According to glomerular filtration rate (GFR), the renal function has been classified in 5 stages. At advances stages (stage 5), (CrCl: 15 ml/min), the patient is faced to receive renal replacement therapy (RRT). Hemodialysis (HD) method is often used. It is carry out 3 times per week (4 hours each). A 59 years old male, due to the distance between the Capital City and his home, decided to receive HD only two times per week (signed consent). At the beginning of the treatment the patient presents all the clinical and biochemical data corresponding to Chronic Renal Failure stage 5. His diuretic volume (DV), ≥ 1 lt/day. In the case of RF deterioration reflected clinical and/or biochemically, the HD session would be 3 times a week. At year, presents adequate residual renal function (RRF) and clinics, biochemical parameters as well. If the RRF (measured by urea clareance (Kru) and the DV) decline, 3 sessions per week will be necessary. The RRF maintenance is related to mortality, therefore, its preservation thanks incremental HD, improve the patient survival.


Subject(s)
Renal Dialysis , Creatinine , Dialysis , Renal Insufficiency, Chronic , Kidney Failure, Chronic , Residence Characteristics , Epidemiology , Mortality
7.
Rev. colomb. nefrol. (En línea) ; 7(1): 84-96, ene.-jun. 2020.
Article in Spanish | LILACS, COLNAL | ID: biblio-1144376

ABSTRACT

Resumen La terapia de acuaféresis ha sido estudiada como una herramienta terapéutica para pacientes con sobrecarga de volumen refractaria al tratamiento con diuréticos de asa. Su objetivo principal es mitigar el impacto clínico de esta sobrecarga en los pacientes con insuficiencia cardiaca descompensada y SCR, reconociendo de esta manera los balances acumulados positivos en los pacientes críticamente enfermos como un factor independiente de mortalidad. Se realizó una búsqueda en las principales bases de datos científicas sobre la terapia de acuaféresis. Se incluyeron guías de manejo, ensayos clínicos controlados, revisiones sistemáticas y metaanálisis. Las bases bibliográficas que arrojaron resultados relevantes fueron Web of Sciences, Scopus, PubMed y SciELO y en total se encontraron 47 referencias bibliográficas publicadas entre 2005 y 2017. La acuaféresis es una terapia de ultrafiltración patentada que mejora la sobrecarga refractaria en pacientes con insuficiencia cardiaca congestiva. Hay brechas en el conocimiento en relación a su costo-efectividad, a los eventos adversos graves que se le atribuyen y a los candidatos que beneficia, por tanto, se requieren más estudios de calidad para llegar a conclusiones sólidas. Hasta el momento no hay evidencia contundente que respalde el uso sistemático y rutinario de la terapia de acuaféresis en las unidades de cuidado intensivo.


Abstract The therapy of Aquapheresis has been studied as a therapeutic tool for patients with volume overload refractory to treatment with ASA diuretics, whose main objective is to mitigate the clinical impact of the same in patients with decompensated heart failure and cardiorenal syndrome, recognizing positive cumulative balances in critically ill patients as a factor regardless of mortality. A search was made in the main scientific databases for review articles, and studies that included the Acuapheresis strategy. Bibliographic references were found in databases from 2005 to 2017. Aquapheresis therapy is a patented ultrafiltration therapy aimed at improving refractory overload in patients with congestive heart failure. There are gaps in knowledge regarding cost-effectiveness therapy, real adverse adverse event relationships attributable to it and candidates will benefit, and we believe that more quality studies are required to reach solid conclusions. So far there is no compelling evidence to support Aquapheresis therapy to implement its routine and routine use of the ICU.


Subject(s)
Humans , Male , Female , Therapeutics , Patients , Ultrafiltration , Colombia , Dialysis , Acute Kidney Injury , Cardio-Renal Syndrome
8.
Rev. Pesqui. Fisioter ; 10(2): 212-219, Maio 2020. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-1223590

ABSTRACT

A doença renal crônica (DRC) é caracterizada por alterações heterogêneas, que afetam tanto a estrutura quanto a função renal, poderá decorrer com redução da capacidade funcional e da qualidade de vida dessa população. OBJETIVO: avaliar a capacidade funcional e qualidade de vida de pacientes com DRC hospitalizados. MATERIAIS E MÉTODOS: Estudo de natureza observacional, quantitativo, descritivo, transversal. Utilizou três questionários: um clínico, o SF36 para a avaliação da qualidade de vida, e o Health Assessment Questionnaire (HAQ), para avaliação da capacidade funcional. Os dados foram analisados através de estatística descritiva, considerando média, desvio padrão e porcentagem. RESULTADOS: A amostra foi composta por 11 pacientes com DRC (63,63% homens). Os piores scores no SF36, em ambos os gêneros, foram relacionados aos aspectos físicos (0) e emocionais (0). O HAQ evidenciou maior déficit funcional no sexo feminino (1,80). Em relação à idade, em todas as faixas etárias o SF-36 apontou "aspectos físicos" (0) e "emocionais" (0) com piores índices. O HAQ encontrou pior escore na faixa de 30-59 anos e nos indivíduos com mais de três doenças associadas, Doença Renal Crônica, Hipertensão Arterial e Diabetes (deficiência moderada 1,09/1,70, respectivamente). Também foram encontrados nesses indivíduos piores scores no SF36 para os domínios de "capacidade funcional" (66,20), "estado geral" (56,50), "vitalidade" (55,00) e "aspectos sociais" (43,50). CONCLUSÃO: Os indivíduos analisados com DRC apresentaram baixos escores relacionados à qualidade de vida, e capacidade funcional moderada nas mulheres e leve nos homens.


Chronic kidney disease (CKD) is characterized by heterogeneous changes, which affect both the structure and the renal function, may result in a reduction in the functional capacity and quality of life of this population. OBJECTIVE: To evaluate the functional capacity and quality of life of patients with CKD hospitalized. MATERIALS AND METHODS: Observational, quantitative, descriptive, cross-sectional study. It used three questionnaires: a clinical one, the SF36 for assessing quality of life, and the Health Assessment Questionnaire (HAQ), for assessing functional capacity. Data were analyzed using descriptive statistics, considering mean, standard deviation and percentage. RESULTS: The sample consisted of 11 patients with CKD (63.63% men). The worst scores in SF36, in both genders, were related to the physical (0) and emotional (0) aspects. The HAQ showed a greater functional deficit in females (1.80). Regarding age, in all age groups, the SF-36 pointed to "physical aspects" (0) and "emotional" (0) with the worst indexes. The HAQ found the worst score in the 30-59 age group and in individuals with more than three associated diseases, Chronic Kidney Disease, Arterial Hypertension and Diabetes and (moderate deficiency 1.09 / 1.70 respectively). These individuals also found worse scores in the SF36 for the domains of "functional capacity" (66.20), "general state" (56.50), "vitality" (55.00) and "social aspects" (43.50). CONCLUSION: The individuals analyzed with CKD had low scores related to quality of life, and moderate functional capacity in women and mild in men.


Subject(s)
Renal Insufficiency , Quality of Life , Dialysis
10.
Acta méd. colomb ; 45(1): 19-24, Jan.-Mar. 2020. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1124065

ABSTRACT

Abstract Introduction: approximately 50% of the annual health care expenditure of patients with chronic kidney disease on dialysis is related to hospitalizations. Infections represent the second reason for consultation, with a high morbidity and mortality. There are no studies comparing hospitalization time due to infectious causes between the different dialysis options. Objective: to determine the difference in hospitalization time for treatment of infectious diseases in patients with chronic kidney disease on dialysis, comparing patients on hemodialysis vs. peritoneal dialysis. Materials and methods: a retrospective, dynamic cohort study of patients on hemodialysis and peritoneal dialysis who were admitted to the emergency department at the Hospital Universitario Mayor due to infectious diseases. The study patients were included using nonprobabilistic methods. The sample size was calculated by comparison of means. A total of 172 hemodialysis patients and 85 peritoneal dialysis patients were included for statistical analysis. Results: hospitalization time is greater in patients on hemodialysis than in patients on peritoneal dialysis; 12 (IQR 8-21) vs. 10 (IQR 6.5-13) days, respectively, p= 0.004. Conclusions: hospitalization time due to infectious causes is greater in patients on hemodialysis than in patients on peritoneal dialysis. In addition, the incidence of treatment-related infections in our population is lower than the globally reported incidence.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1222).


Resumen Introducción: aproximadamente el 50% del gasto anual en salud de los pacientes con enfermedad renal crónica en diálisis está relacionada con hospitalizaciones; las causas infecciosas representan la segunda causa de consulta con una alta morbilidad y mortalidad. No existen estudios donde se compare el tiempo de hospitalización por causas infecciosas entre las diferentes opciones de diálisis. Objetivo: determinar las diferencias en tiempos de hospitalización que se deriva del manejo de patologías infecciosas en pacientes con enfermedad renal crónica en diálisis, comparando los pacientes que se encuentran en hemodiálisis vs diálisis peritoneal. Material y métodos: estudio de cohorte retrospectiva, dinámica, de pacientes en hemodiálisis y diálisis peritoneal que ingresan al servicio de urgencias del Hospital Universitario Mayor por patologías infecciosas. Los pacientes que ingresaron al estudio se incluyeron por métodos no probabilísticos. El cálculo de tamaño de muestra se realizó por comparación de medias. Para el análisis estadístico se incluyeron 172 pacientes en hemodiálisis y 85 en diálisis peritoneal. Resultados: el tiempo de hospitalización es mayor en pacientes con hemodiálisis en comparación con los pacientes en diálisis peritoneal, 12 (RIC 8-21) vs 10 (RIC 6.5-13) días respectivamente, p= 0.004. Conclusiones: el tiempo de hospitalización por causas infecciosas es mayor en los pacientes con hemodiálisis que los de diálisis peritoneal, adicionalmente la incidencia de infecciones asociadas a la terapia en nuestra población es menor que lo reportado a nivel mundial.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1222).


Subject(s)
Humans , Male , Female , Renal Insufficiency, Chronic , Communicable Diseases , Dialysis , Hospitalization
11.
Rev. bras. anal. clin ; 52(1): 11-17, 20200330. ilus
Article in Portuguese | LILACS | ID: biblio-1104125

ABSTRACT

A anemia é uma complicação importante na doença renal crônica (DRC), culminando com o aumento da morbidade e mortalidade, tornando-se fundamental a busca de marcadores hematológicos que permitam seu diagnóstico precoce. Este artigo teve como objetivo revisar na literatura estudos que investigaram a associação entre o conteúdo de hemoglobina contida nos reticulócitos com a anemia em pacientes com DRC em tratamento dialítico e gerar evidências de sua importância na prática clínica. Foi realizada a busca nas bases de dados eletrônicas: Medline e Web of Science. O período de busca definido foi de janeiro de 1997 a dezembro de 2017. O conteúdo de hemoglobina dos reticulócitos avalia a hemoglobina contida nos reticulócitos, sendo que estes, após liberação da medula óssea, permanecem no sangue periférico de um a quatro dias antes de completar sua maturação, conferindo-lhe maior especificidade em refletir a disponibilidade de ferro aos precursores hematopoiéticos, além de fornecer uma avaliação precoce da resposta eritropoética frente ao tratamento de ferro IV. Os artigos selecionados nessa revisão demonstraram que o conteúdo de hemoglobina do reticulócito, além de refletir precocemente a disponibilidade de ferro aos precursores hematopoiéticos, o mesmo não sofre interferência de citocinas inflamatórias, tornando-o um marcador eficaz no monitoramento da cinética do ferro em pacientes em diálise.


Anemia is an important complication in chronic kidney disease (CKD), culminating with the increase in morbidity and mortality, making it fundamental to search for hematological markers that allow its early diagnosis. This review aimed to review in the literature studies that investigated the association between hemoglobin content in reticulocytes and anemia in patients with CKD in dialysis and to generate evidence of its importance in clinical practice. The hemoglobin content of the reticulocytes evaluates the hemoglobin contained in the reticulocytes, which, after release of the bone marrow, remain in the peripheral blood 1 to 4 days before their maturation completes, giving it greater specificity in reflecting the availability of iron to the reticulocytes. Hematopoietic precursors, in addition to providing an early assessment of the erythropoietic response to IV iron treatment. The articles selected in this review have demonstrated that the reticulocyte hemoglobin content in addition to early reflection of the availability of iron to the hematopoietic precursors does not suffer interference from inflammatory cytokines, making it an effective marker in the monitoring of iron kinetics in dialysis patients.


Subject(s)
Reticulocytes , Dialysis , Renal Insufficiency, Chronic , Anemia
13.
Chonnam Medical Journal ; : 27-35, 2020.
Article in English | WPRIM | ID: wpr-787277

ABSTRACT

Intradialytic blood pressure abnormalities are associated with adverse outcomes in patients with end-stage renal disease on dialysis. Vascular calcification is a common complicating feature, but whether this complication results in intradialytic blood pressure abnormalities remains uncertain. Therefore, this study investigated the relationship between coronary artery calcium score and intradialytic blood pressure abnormalities in patients with end-stage renal disease on maintenance hemodialysis. Thirty-six patients who received nongated chest computed tomography scans were included. Intradialytic hypotension was defined as a minimum intradialytic systolic blood pressure of <100 mmHg or a pre-dialysis blood pressure – minimum intradialytic systolic blood pressure >30 mmHg. Intradialytic hypertension was defined as >10 mmHg increase in systolic blood pressure (pre- to post-dialysis). Patients were classified as 22 (61.1%) with coronary artery calcium score <400 and 14 (38.9%) with coronary artery calcium score ≥400. Median systolic and diastolic blood pressures were equivalent, but median pulse pressure was higher in patients with coronary artery calcium score ≥400 than in those with scores <400. Coronary artery calcium score was comparable according to both intradialytic hypotension and hypertension, and had no correlation with systolic blood pressure fall and nadir systolic blood pressure. Coronary artery calcium score predicted the occurrence of cardiovascular events and all-cause mortality (hazard ratio 1.001 and 1.001; p=0.058 and 0.010). Coronary vascular calcification could be irrelevant to intradialytic blood pressure abnormalities in patients with end-stage renal disease on dialysis.


Subject(s)
Blood Pressure , Calcium , Coronary Vessels , Dialysis , Humans , Hypertension , Hypotension , Kidney Failure, Chronic , Mortality , Renal Dialysis , Thorax , Vascular Calcification
14.
Article in English | WPRIM | ID: wpr-785424

ABSTRACT

PURPOSE: To develop and validate a clinical scoring model to predict 1-year access survival among end-stage renal disease (ESRD) patients who received a new arteriovenous fistula (AVF).METHODS: The data of 195 ESRD patients in the development cohort who underwent first-time AVF creation between January 2009 and June 2013 and who had successful cannulation for dialysis use were reviewed. The clinical features that were significantly associated with 1-year AVF survival were incorporated into a clinical scoring model. The validity of this clinical score was then tested in a validation cohort of 204 ESRD patients who received a new AVF between July 2013 and December 2017.RESULTS: Of the 195 patients in the development cohort, 168 patients (86.2%) had a well-functioning AVF at 1 year. Absence of diabetes mellitus, no previous history of central venous catheter insertion, and absence of intervention performed to achieve access maturation were positively associated with 1-year AVF survival. These 3 factors were incorporated into a clinical scoring model, which ranged from 0 to 4 points. For a cutoff score of ≥3, the sensitivity, specificity and area under the receiver operating characteristic curve to predict 1-year AVF survival were 81.5%, 70.4%, and 0.760, respectively. The predictive performance of the clinical score was confirmed in the validation cohort, with a sensitivity of 76.1%, a specificity of 64.4% and an area under the curve of 0.703.CONCLUSION: The scoring model using clinical data yielded acceptable performance in predicting 1-year access survival among patients receiving a new AVF.


Subject(s)
Arteriovenous Fistula , Catheterization , Central Venous Catheters , Cohort Studies , Diabetes Mellitus , Dialysis , Humans , Kidney Failure, Chronic , Renal Dialysis , ROC Curve , Sensitivity and Specificity , Treatment Outcome
16.
Fisioter. Mov. (Online) ; 33: e003364, 2020. tab, graf
Article in English | LILACS | ID: biblio-1133894

ABSTRACT

Abstract Introduction: Chronic kidney disease is characterized as the gradual loss of kidney function, with patients on dialysis experiencing a decline in functional capacity and pulmonary function. One of the non-traditional risk factors is parathyroid hormone (PTH), which influences metabolism and the status of the disease. Objective: Assess the effect of parathyroid hormone levels on functional capacity and pulmonary function in patients on dialysis. Method: Cross-sectional study with hemodynamically stable dialysis patients of both sexes, aged 18 to 59 years, who did not gain more than 2.5kg between dialysis sessions. Two groups were created according to PTH blood levels: PTH (A), with values outside the normal range, and PTH (C), who exhibited normal levels of the hormone. Pulmonary function (PF) was assessed by spirometry and functional capacity (FC) via the six-minute walk test (6MWT). Results: The PTH A group displayed a negative association between PTH levels and PF, based on the values obtained for the spirometric variables forced expiratory volume in 1 second (FEV1) (r = -0.54) and forced vital capacity (FVC) (r= -0.69). The average distance walked by the PTH (C) group was 343.85 ± 98.14 meters. Conclusion: The results suggest that high PTH levels have a negative effect on the PF of patients on dialysis.


Resumo Introdução: A Doença Renal Crônica (DRC) é caracterizada pela normalidade do funcionamento e da estrutura do rim. Nos pacientes dialíticos é observado um declínio da capacidade funcional pulmonar e física, que tem entre os fatores de risco não tradicionais, o paratormônio (PTH) que influencia no metabolismo e estado desta doença. Objetivo: Avaliar os efeitos dos níveis de paratormônio sobre a capacidade funcional física e pulmonar de pacientes dialíticos. Método: Foi realizado um estudo transversal com dialíticos de ambos os sexos, com idade entre 18 a 59 anos, hemodinamicamente estáveis, e que não apresentassem aumento de peso entre diálise >2,5kg. Foram criados dois grupos de acordo com os níveis séricos de PTH: PTH (A) com valores fora da faixa de normalidade e PTH (C) com níveis normais de paratormônio. Foi realizada a avaliação da capacidade funcional pulmonar (CFP) pela espirometria e da capacidade funcional física (CFF) pelo teste de caminhada de seis minutos (TC6'). Resultados: Observou-se que o grupo PTH A apresentou associação negativa entre os níveis de PTH e a CFP referente aos valores as variáveis espirométricas, volume expirado forçado no primeiro minuto (VEF1) (r = -0,54) e capacidade vital forçada (CVF) (r= -0,69) no grupo PTH (A). A distância média percorrida pelo grupo PTH (C) foi de 343,85 ± 98,14 metros. Conclusão: Os resultados sugerem que os níveis elevados de PTH exerce efeitos negativos sobre a CFP de pacientes dialíticos.


Subject(s)
Humans , Male , Adolescent , Adult , Middle Aged , Spirometry , Renal Insufficiency, Chronic , Teriparatide , Dialysis , Walk Test
17.
São Paulo; s.n; 2020. 107 p.
Thesis in Portuguese | LILACS | ID: biblio-1130097

ABSTRACT

Introdução - A doença renal crônica (DRC) tem sido considerada um importante problema na saúde pública por ser uma doença silenciosa nos estágios iniciais e, no estágio avançado, apresentar complicações que demandam tratamento dialítico ou transplante renal, denominados de Terapia Renal Substitutiva (TRS). No Brasil, o sistema de informação ambulatorial recebe das instituições vinculadas ao Sistema Único de Saúde (SUS), por meio da Autorização de Procedimentos de Alta Complexidade/TRS (APAC/TRS), as informações dos pacientes em tratamento dialítico. Seus dados possibilitam conhecer o perfil epidemiológico desses pacientes. Objetivo - Descrever o perfil epidemiológico e letalidade dos pacientes com DRC, no estágio 5, em tratamento dialítico (DRC G5D) pelo SUS, no estado de São Paulo (ESP), no período de 2008 a 2017. Métodos - Trata-se de um estudo descritivo e retrospectivo, de abordagem quantitativa, que utiliza como base o banco da APAC/TRS. Os dados foram analisados para os 17 Departamentos Regionais de Saúde (DRS) do estado. Foi feita a série temporal dos casos prevalentes, casos novos e letalidade dos pacientes em tratamento dialítico no SUS, estratificados por sexo e faixa etária. As curvas de sobrevida foram estimadas pelo método de Kaplan Meyer e comparadas pelo teste de log-rank. A produção ofertada de diálise no SUS foi comparada com o parâmetro de cobertura assistencial estabelecido na Portaria ministerial 1631, de 2015. As causas dos óbitos foram retiradas do Sistema de Informações de Mortalidade. Resultados - No período observado foram realizados 275.778 procedimentos de diálise para 86.381 pacientes, sendo inseridos 70.615 casos novos e houve 30.784 óbitos. O perfil sociodemográfico geral mostrou um predomínio do sexo masculino, raça branca e média de idade dos pacientes em diálise de 56,5 anos, sendo a hemodiálise o procedimento principal em 92% dos casos. Os dados referentes às causas dos óbitos mostram em primeiro lugar a doença cardiovascular (20,1%) - sendo 10,5% correspondente à hipertensão e 9,6% ao infarto agudo do miocárdio, seguida de diabetes (18,1%), broncopneumonia (15,6%) e septicemia (13,8%). Na série temporal houve uma tendência crescente para casos prevalentes e níveis estacionários para casos novos e letalidade. A média geral de sobrevida dos pacientes em diálise foi de 75,9 meses. Em 2017, o ESP apresentou produção de diálise de 69/100.000 hab., menor que o parâmetro de cobertura assistencial, estimado em 75/100.000 hab., com heterogeneidade entre os DRS. No período analisado verificou-se uma ampliação de cerca de 10% de serviços de diálise para o SUS. Conclusão - Houve aumento de serviços de diálise e de casos prevalentes no ESP, embora a oferta de procedimentos de diálise tenha sido menor que o parâmetro de cobertura assistencial, estimado para a população. A análise dos dados da APAC, mesmo tendo como finalidade o pagamento dos procedimentos médico hospitalares, contribuiu para avaliar o perfil epidemiológico dos pacientes portadores de DRC G5D, no SUS, e identificar diferenças regionais de oferta de diálise, de pacientes dialisados e na sobrevida. Esses resultados podem orientar outras análises que permitam entender melhor essas desigualdades e subsidiar ações para minimizá-las.


Introduction - Chronic kidney disease (CKD) has been considered an important public health problem, for being a silent disease in the early stages and presenting complications in the advanced stage that will require dialysis i.e. Renal Replacement Therapy (TRS) or kidney transplantation. In Brazil, the outpatient information system, receives information from patients undergoing dialysis treatment from institutions linked to the Unified Health System (SUS), through the Authorization for High Complexity Procedures/TRS (APAC/TRS). Its data make it possible to know the epidemiological profile of these patients. Objective - Describe the epidemiological profile and lethality of patients with CKD, in stage 5, undergoing dialysis treatment (CKD G5D) at SUS, in the State of São Paulo (ESP), from 2008 to 2017.Methods - This is a descriptive and retrospective study, which applies a quantitative approach that uses the database of APAC/TRS. Data was analyzed for the State's 17 Regional Health Departments (DRS). A time series was made considering prevalent cases, new cases and the lethality of patients undergoing dialysis treatment at SUS, stratified by sex and age group. Survival curves were estimated using the Kaplan Meyer method and compared using the log-rank test. The offered production of dialysis in SUS was compared with the parameter of care coverage established in Ministerial Decree 1631, from 2015. The causes of death were removed from the Mortality Information System. Results - With regards to the observed period, 275.778 dialysis procedures were performed, on 86.381 patients, from which 70.615 were inserted as new cases, and 30.784 died. The general sociodemographic profile showed a predominance of male, white and average age of 56.5 years of patients on dialysis, with hemodialysis being the main procedure in 92% of the cases. Data related to causes of death show cardiovascular disease (22.1%) in the first place, with 10.5% corresponding to hypertension and 9.6% to acute myocardial infarction; followed by diabetes (18.1%), bronchopneumonia (15.6%) and septicemia (13.8%). In the assessed time series, there was an increasing trend for prevalent cases, but new cases and lethality remained at stationary levels. The overall average survival of patients on dialysis was 75.9 months. In 2017, the state presented a dialysis production rate of 69/100,000 hab., which was less than the parameter of assistance coverage, estimated at 75/100,000 hab., with heterogeneity between the DRS, and an increase of about 10% in the offer of dialysis services for SUS, in the analyzed period. Conclusion - There was an increase in dialysis services as well as prevalent cases in the State of São Paulo (ESP), although the number of dialysis procedures performed was less than the the parameter of assistance coverage for the population. The analysis of the APAC data, even though its main purpose is for paying for hospital medical procedures, contributed to the assessment of the epidemiological profile of patients with DRC G5D, treated at SUS, as well as to identify regional differences in the supply of dialysis, dialysis patients and survival rates. These results may guide other analyzes that would allow for a better understanding of these inequalities and subsidize actions to minimize them.


Subject(s)
Health Profile , Mortality , Renal Replacement Therapy , Dialysis , Renal Insufficiency, Chronic
18.
Ann. afr. méd. (En ligne) ; 13(3): 3727¬3730-2020.
Article in French | AIM | ID: biblio-1259089

ABSTRACT

Les patients en hémodialyse présente un risqué élevé d'infection à SARS-Cov-2. Les stratégies préventives doivent donc être mises en place pour réduire le risque de transmission de la maladie en hémodialyse parmi lesquelles, l'éducation du staff médical ainsi que des patients, le screening de la maladie à COVID-19 ainsi que la séparation des patients infectés ou symptomatiques des non infectés


Subject(s)
COVID-19 , Coronavirus Infections , Democratic Republic of the Congo , Dialysis , Hemodialysis Units, Hospital , Practice Guideline
19.
Rev. bioét. (Impr.) ; 27(3): 394-400, jul.-set. 2019.
Article in Portuguese | LILACS | ID: biblio-1041979

ABSTRACT

Resumo A doença renal crônica atinge níveis epidêmicos em praticamente todos os países. No Brasil, mais de 30 mil pessoas por ano precisam de tratamento dialítico, sendo mais comum a hemodiálise. Se, por um lado, a falta de vagas para diálise é o principal problema, por outro, têm crescido os casos de recusa e abandono do tratamento. Este artigo trata justamente dessa questão, a partir de temas como sentidos da vida e da morte, autonomia e terminalidade. Foram identificadas algumas estratégias que podem diminuir ou mesmo evitar a recusa e o abandono do tratamento, como diagnóstico precoce, acompanhamento nefrológico prévio, abordagem multidisciplinar e humanização dos serviços de diálise. Caso a decisão do paciente seja irreversível, o termo de consentimento livre e esclarecido é fundamental. Além disso, a expansão dos comitês de bioética é importante para proteger os profissionais de saúde e os interesses dos pacientes.


Abstract Chronic kidney disease reaches epidemic levels all over the world. In Brazil, more than 30 thousand people a year need dialysis treatment, specially hemodialysis. If, on the one hand, the lack of dialysis vacancies is the main problem, on the other hand, the number of cases of refusal and abandonment of dialysis has increased. This article deals precisely with this issue, based on subjects such as the meanings of life and death, autonomy and terminality. Some strategies which may reduce or even avoid treatment refusal and abandonment are early diagnosis, previous nephrological follow-up, multidisciplinary approach and humanization of dialysis services. If the patient's decision is irreversible, the informed consent form is essential. In addition, the expansion of the bioethics committees is important to protect health professionals and the interests of patients.


Resumen La enfermedad renal crónica alcanza niveles epidémicos en prácticamente todos los países. En Brasil, más de 30 mil personas por año requieren tratamiento de diálisis, siendo la hemodiálisis la más común. Si, por un lado, la falta de vacantes para diálisis es el problema principal, por otro, han aumentado los casos de rechazo y abandono del tratamiento. Este artículo aborda precisamente esta cuestión, a partir de temas como sentidos de la vida y de la muerte, autonomía y terminalidad. Se han identificado algunas estrategias que pueden disminuir o incluso evitar el rechazo y el abandono del tratamiento, como diagnóstico precoz, seguimiento nefrológico previo, abordaje multidisciplinario y humanización de los servicios de diálisis. En caso de que la decisión del paciente sea irreversible, el documento de consentimiento libre e informado es fundamental. Además, la expansión de los comités de bioética es importante para proteger a los profesionales de la salud y los intereses de los pacientes.


Subject(s)
Right to Die , Personal Autonomy , Dialysis
20.
Rev. colomb. anestesiol ; 47(3): 142-153, July-Sept. 2019. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1013883

ABSTRACT

Abstract Introduction: Patients undergoing cardiac surgery frequently develop low cardiac output syndrome (LCOS). Multiple interventions including levosimendan have been used in the prevention and treatment of LCOS. Preliminary studies reported lower mortality respect to placebo or other inotropes, however, recently, 3 clinical trials found no benefit against this outcome. Objective: Our objective was to evaluate the evidence of levosimendan on mortality and secondary outcomes in patients undergoing cardiac surgery, and to determine the sources of heterogeneity. Methods: We conducted a systematic review and meta-analysis of the clinical trials that evaluated the efficacy of levosimendan in patients undergoing cardiac surgery. We obtained the odds ratio (OR) of mortality and other outcomes such as kidney injury with dialysis requirement and LCOS, using fixed and random effects models. The risk of bias was assessed and the sources of heterogeneity were explored. Results: Of 47 studies identified, 14 studies were selected (n=2752). Regarding the mortality outcome and use of levosimendan, only a decrease was found in the studies of low quality (OR 0,30; CI 95%, 0,18 to 0,51). While high-quality studies, there was no protective effect (OR 0.99,95% CI 0.70-1.40) with an I2 = 0%. The quality of the studies and ejection fraction were the main sources of heterogeneity. Conclusion: In high-quality studies, the use of levosimendan in patients undergoing cardiovascular surgery has no effect on 30-day mortality. There was a protective effect on postoperative renal failure with dialysis.


Resumen Introducción: Los pacientes llevados a cirugía cardiaca tienen riesgo de desarrollar síndrome de bajo gasto cardiaco posoperatorio (SBGC). Estudios previos han encontrado una menor mortalidad con levosimendán respecto a placebo u otros inotrópicos; sin embargo, tres experimentos clínicos no encontraron beneficio frente a este desenlace. Objetivo: Evaluar la evidencia del levosimendán sobre la mortalidad y los desenlaces secundarios en pacientes sometidos a cirugía cardiaca, y determinar las fuentes de heterogeneidad. Métodos: Mediante una revisión sistemática y metaanálisis de los experimentos clínicos que evaluaron la eficacia del levosimendán en los pacientes llevados a cirugía cardiaca, se evaluó la eficacia en la mortalidad y en otros desenlaces, como lesión renal y SBGC, utilizando los modelos de efectos fijos y aleatorios. Resultados: De 47 estudios identificados, fueron seleccionados 14 (n = 2752). Respecto al desenlace de mortalidad y el uso de levosimendán solo se encontró una disminución en los estudios de baja calidad (OR 0.30; IC 95%, 0.18-0.51), mientras que para los de alta calidad no hubo efecto protector (OR 0.99; IC 95%, 0.70-1.40) con un I2=0%. La calidad de los estudios y la fracción de eyección fueron las principales fuentes de heterogeneidad. Conclusión: el uso del levosimendán en los pacientes llevados a cirugía cardiovascular no tiene efectos sobre la mortalidad a 30 días en los estudios de alta calidad. Hubo efecto protector sobre la falla renal postoperatoria con necesidad de diálisis.


Subject(s)
Humans , Thoracic Surgery , Cardiac Output, Low , Perioperative Care , Acute Kidney Injury , Simendan , Atrial Fibrillation , Meta-Analysis as Topic , Mortality , Dialysis
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