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1.
J. bras. nefrol ; 41(4): 550-559, Out.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1056604

ABSTRACT

Abstract Fluid volume and hemodynamic management in hemodialysis patients is an essential component of dialysis adequacy. Restoring salt and water homeostasis in hemodialysis patients has been a permanent quest by nephrologists summarized by the 'dry weight' probing approach. Although this clinical approach has been associated with benefits on cardiovascular outcome, it is now challenged by recent studies showing that intensity or aggressiveness to remove fluid during intermittent dialysis is associated with cardiovascular stress and potential organ damage. A more precise approach is required to improve cardiovascular outcome in this high-risk population. Fluid status assessment and monitoring rely on four components: clinical assessment, non-invasive instrumental tools (e.g., US, bioimpedance, blood volume monitoring), cardiac biomarkers (e.g. natriuretic peptides), and algorithm and sodium modeling to estimate mass transfer. Optimal management of fluid and sodium imbalance in dialysis patients consist in adjusting salt and fluid removal by dialysis (ultrafiltration, dialysate sodium) and by restricting salt intake and fluid gain between dialysis sessions. Modern technology using biosensors and feedback control tools embarked on dialysis machine, with sophisticated analytics will provide direct handling of sodium and water in a more precise and personalized way. It is envisaged in the near future that these tools will support physician decision making with high potential of improving cardiovascular outcome.


Resumo O volume de fluidos e o controle hemodinâmico em pacientes em hemodiálise é um componente essencial da adequação da diálise. A restauração da homeostase do sal e da água em pacientes em hemodiálise tem sido uma busca constante por parte dos nefrologistas, no que condiz à abordagem do "peso seco. Embora essa abordagem clínica tenha sido associada a benefícios no desfecho cardiovascular, recentemente tem sido questionada por estudos que mostram que a intensidade ou agressividade para remover fluidos durante a diálise intermitente está associada a estresse cardiovascular e dano potencial a órgãos.para remover fluidos durante a diálise intermitente está associada a estresse cardiovascular e dano potencial a órgãos. Uma abordagem mais precisa é necessária para melhorar o desfecho cardiovascular nessa população de alto risco. A avaliação e monitorização do estado hídrico baseiam-se em quatro componentes: avaliação clínica, ferramentas instrumentais não invasivas (por exemplo, US, bioimpedância, monitorização do volume sanguíneo), biomarcadores cardíacos (e.g. peptídeos natriuréticos), algoritmos e modelagem de sódio para estimar a transferência de massa. O manejo otimizado do desequilíbrio hídrico e de sódio em pacientes dialíticos consiste em ajustar a remoção de sal e líquido por diálise (ultrafiltração, dialisato de sódio), e restringir a ingestão de sal e o ganho de líquido entre as sessões de diálise. Tecnologia moderna que utiliza biosensores e ferramentas de controle de feedback, hoje parte da máquina de diálise, com análises sofisticadas, proporcionam o manejo direto sobre o sódio e a água de uma maneira mais precisa e personalizada. Prevê-se no futuro próximo que essas ferramentas poderão auxiliar na tomada de decisão do médico, com alto potencial para melhorar o resultado cardiovascular.


Subject(s)
Humans , Sodium/metabolism , Renal Dialysis/adverse effects , Hemodynamics/physiology , Homeostasis/physiology , Kidney Failure, Chronic/therapy , Water-Electrolyte Balance/physiology , Blood Pressure/physiology , Algorithms , Biomarkers/metabolism , Dialysis Solutions/chemistry , Cardiovascular System/physiopathology , Renal Dialysis/standards , Treatment Outcome , Cardiovascular Deconditioning , Nephrologists/statistics & numerical data , Kidney Failure, Chronic/physiopathology
2.
Braz. j. med. biol. res ; 51(3): e7174, 2018. tab, graf
Article in English | LILACS | ID: biblio-889044

ABSTRACT

Excess weight (overweight and obesity) is associated with kidney and cardiovascular disease. The aim of this study was to investigate the association between syndecan-1 and renal function among adolescents with excess weight. A total of 56 students from a public school at Fortaleza, CE, Brazil, were investigated. The adolescents were submitted to anthropometric evaluation, including weight, height, blood pressure and body mass index. Blood and urine samples were collected for the determination of serum lipids (total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglycerides), and the endothelial injury biomarker syndecan-1. Participants' mean age was 16±1 years (range 14-19 years), and 68% were females. Overweight was observed in 4 cases (7.1%) and obesity in 7 (12.5%). Changes in serum lipid levels were more frequent in the overweight group. A positive correlation between syndecan-1 and serum creatinine (r=0.5, P=0.001) and triglycerides (r=0.37, P=0.004), and a negative correlation with glomerular filtration rate (r=-0.33, P=0.02) were found. These findings suggest that adolescents with excess weight present incipient changes at the cellular level that make them more vulnerable to the development of kidney and cardiovascular diseases.


Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Cardiovascular Diseases/etiology , Endothelium, Vascular/physiopathology , Kidney Diseases/physiopathology , Obesity/physiopathology , Syndecan-1/blood , Biomarkers/blood , Blood Pressure/physiology , Body Mass Index , Brazil/epidemiology , Cross-Sectional Studies , Kidney Diseases/etiology , Kidney Failure, Chronic/physiopathology , Obesity/blood , Obesity/complications , Obesity/epidemiology , Renal Insufficiency, Chronic , Risk Factors , Syndecan-1/urine
3.
Rev. latinoam. enferm. (Online) ; 26: e3091, 2018. tab, graf
Article in English | LILACS, BDENF | ID: biblio-978606

ABSTRACT

ABSTRACT Objective: to analyze the impact of an educational and motivational intervention for patients with a chronic kidney disease, undergoing hemodialysis treatment, on the control of fluid intake during interdialytic periods. Method: a quasi-experimental, non-randomized clinical trial with patients from a Nephrological Unit of the State of São Paulo. Participants were included in two groups: Control Group with 106 patients and Intervention Group with 86 patients, totaling 192 participants. The used intervention was an educational and motivational video to control liquid intake, based on the Bandura's Theory. The measure of control of water intake was the percentage of lost weight, also considered the variable outcome of the research. For the data analysis, descriptive analyses and regression analysis of the Inflated Beta Model were used. Results: patients who participated in the intervention had a decrease in the pattern of weight gain in interdialytic periods, with a 3.54 times more chance of reaching the goal of 100% of weight loss when compared to participants from the control group. Conclusion: the educational and motivational intervention was effective in reducing the percentage of weight loss in patients undergoing hemodialysis. Brazilian Clinical Trials Registry (ReBEC) under the opinion RBR-4XYTP6.


RESUMO Objetivo: analisar o impacto de uma intervenção educativa e motivacional para pacientes com doença renal crônica em tratamento hemodialítico, no controle do consumo de líquidos, nos períodos interdialíticos. Método: estudo quase experimental do tipo ensaio clínico não randomizado, com pacientes de uma Unidade Nefrológica no interior do Estado de São Paulo. Os participantes foram inseridos em dois grupos: Grupo Controle com 106 pacientes e Grupo Intervenção com 86 pacientes, totalizando 192 participantes do estudo. A intervenção utilizada tratou-se de um vídeo educativo e motivacional para controle do consumo de líquidos, baseado na Teoria de Bandura. A medida de controle da ingestão hídrica foi o percentual de peso perdido, também considerado a variável desfecho da pesquisa. Para a análise dos dados foram utilizadas análises descritivas e análise de regressão do Modelo Beta Inflacionado. Resultados: os pacientes que participaram da intervenção apresentaram diminuição no padrão de ganho de peso nos períodos interdialíticos, com 3,54 vezes mais chance de atingir a meta de 100% de perda de peso, comparados aos participantes do grupo controle. Conclusão: a intervenção educativa e motivacional mostrou-se efetiva na diminuição do porcentual de perda de peso dos pacientes em hemodiálise. Registro Brasileiro de Ensaios Clínicos (ReBEC), sob o parecer RBR-4XYTP6.


RESUMEN Objetivo: analizar el impacto de una intervención educativa y motivacional para pacientes con enfermedad renal crónica en tratamiento hemodialítico, en el control del consumo de líquidos, en los periodos interdialíticos. Método: estudio casi experimental del tipo ensayo clínico no aleatorio, con pacientes de una Unidad Nefrológica en el interior del Estado de São Paulo. Los participantes fueron inseridos en dos grupos: Grupo Control con 106 pacientes y Grupo Intervención con 86 pacientes, totalizando 192 participantes del estudio. La intervención utilizada se trató de un video educativo y motivacional para el control del consumo de líquidos, basado en la Teoría de Bandura. La medida de control de la ingestión hídrica fue el porcentaje de peso perdido, también considerado la variable de resultado de la investigación. Para el análisis de los datos fueron utilizados análisis descriptivos y análisis de regresión del Modelo Beta aumentado. Resultados: los pacientes que participaron de la intervención presentaron disminución en el patrón de ganancia de peso en los periodos interdialíticos, con 3,54 veces más chances de alcanzar la meta de 100% de pérdida de peso, comparados a los participantes del grupo de control. Conclusión: la intervención educativa y motivacional se mostró efectiva en la disminución del porcentaje de pérdida de peso de los pacientes en hemodiálisis. Registro Brasileño de Ensayos Clínicos (ReBEC), bajo el dictamen RBR-4XYTP6.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Renal Dialysis/methods , Drinking/physiology , Fluid Therapy/methods , Kidney Failure, Chronic/prevention & control , Health Education , Regression Analysis , Kidney Failure, Chronic/physiopathology
4.
J. bras. nefrol ; 39(3): 275-282, July-Sept. 2017. tab, graf
Article in English | LILACS | ID: biblio-893767

ABSTRACT

Abstract Introduction: Patients on hemodialysis (HD) present high mortality from cardiovascular complications and high morbidity, including decreasing functional capacity and quality of life. Objective: To analyze clinical and laboratory responses of patients in HD to intradialytic cardiopulmonary rehabilitation on an outpatient basis. Methods: We evaluated 14 patients in a prospective study for 8 months using cardiopulmonary rehabilitation protocol (CRehab) consisted of intradialytic aerobic exercise with a cycle ergometer. We analyzed heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP), peripheral oxygen saturation (SpO2) and modified Borg scale. We evaluated cardiac function by echocardiogram, functional capacity by six minutes walk test (6MWT), and quality of life by SF-36 survey, before and after CRehab. Biochemical data and KT/Vsp were collected form medical records. Results: During CRehab, the results of HR, SBP, DBP, SpO2 and Borg scale showed no significant changes. 6MWT test showed progressive increase in the distance covered (p < 0.001) as well as a reduction in the scale of Borg post-6MWT (p = 0.009). There was no significant change in any biochemical data or in KT/Vsp. There was increase in left ventricular ejection from 65.7 ± 10.2% to 73.6 ± 10.1% (p = 0.028) and in left ventricular diastolic diameter (p = 0.027). According to SF-36 survey, patients showed improvement in three areas: physical role functioning (p = 0.012), bodily pain (p = 0.007) and vitality (p = 0.009). Conclusion: The intradialytic CRehab applied in this population was safe and allowed objective improvement of functional capacity and exercise tolerance, subjective improvement in the perception of effort, significant increase in cardiac function and better quality of life in different domains.


Resumo Introdução: Pacientes em hemodiálise (HD) têm alta mortalidade e morbidade por complicações cardiovasculares, inclusive por redução da capacidade funcional e qualidade de vida. Objetivo: Analisar a evolução clínica e laboratorial de pacientes em HD ambulatorial submetidos à reabilitação cardiopulmonar (RCP) intradialítica. Métodos: Avaliamos 14 pacientes em um estudo prospectivo por 8 meses, utilizando protocolo de RCP com exercícios aeróbicos intradialíticos. Analisamos frequência cardíaca (FC), pressão arterial sistólica (PAS) e diastólica (PAD), saturação periférica de oxigênio (SpO2) e escala de Borg modificada em todas as sessões de HD. Avaliamos função cardíaca por ecocardiograma, capacidade funcional (CF) pelo teste de caminhada de seis minutos (TC6M), e qualidade de vida pelo Questionário SF-36, antes e depois da RCP. Dados bioquímicos e de Kt/Vsp foram coletados dos prontuários. Resultados: Durante a RCP, os resultados de FC, PAS, PAD, SpO2 e escala de Borg não mostraram alterações significativas. No TC6M observamos aumento progressivo da distância percorrida (p < 0,001) e redução na escala de Borg pós-TC6M entre D0-D180 (p = 0,009). Não houve alteração significativa nos testes bioquímicos e no KT/Vsp. Houve aumento na fração de ejeção de 65,7 ± 10,2 para 73,6 ± 10,1% (p = 0,028) e no diâmetro diastólico do ventrículo esquerdo (p = 0,027). No questionário SF-36, houve melhora significativa nos domínios: limitação física (p = 0,012), dor (p = 0,007) e vitalidade (p = 0,009). Conclusão: A RCP intradialítica nesta população foi segura e permitiu melhora objetiva da CF e tolerância ao exercício, melhora subjetiva na percepção do esforço, aumento significativo da função cardíaca, bem como melhoria na qualidade de vida em diferentes domínios.


Subject(s)
Humans , Male , Female , Middle Aged , Exercise , Renal Dialysis , Kidney Failure, Chronic/therapy , Quality of Life , Prospective Studies , Exercise Tolerance , Exercise Test , Cardiac Rehabilitation , Heart Function Tests , Kidney Failure, Chronic/physiopathology
5.
Arq. bras. oftalmol ; 80(3): 176-180, May-June 2017. tab, graf
Article in English | LILACS | ID: biblio-888118

ABSTRACT

ABSTRACT Purpose: To evaluate the effects of hemodialysis (HD) on corneal and anterior chamber morphometry, as well as intraocular pressure (IOP) in patients with end-stage renal disease. Methods: Fifty right eyes were examined 30 minutes before and after HD. IOP was measured with a Goldmann applanation tonometer, and Ehlers' formula was used to calculate the corrected IOP values. The central corneal thickness (CCT), corneal volume (CV), keratometric values, anterior chamber depth (ACD), aqueous depth (AQD), anterior chamber volume (ACV), and anterior chamber angle (ACA) in the nasal and temporal quadrants were measured with a Sirius anterior segment analysis system. Blood urea nitrogen levels, body mass, and systolic and diastolic arterial pressure were also measured before and after HD. Results: The mean age was 60.80 ± 13.38 (range: 35-80) years. The mean uncorrected and corrected IOP values decreased from 18.06 ± 3.91 and 18.31 ± 4.83 mmHg to 16.94 ± 3.87 and 16.95 ± 4.74 mmHg after HD, respectively (p=0.011 and p=0.003, respectively). The mean CCT decreased from 536.38 ± 24.73 to 533.18 ± 27.25 µm (p=0.002), and the mean CV decreased from 57.52 ± 3.15 to 55.68 ± 3.55 mm³ (p<0.001) after HD. There were no significant changes in ACD, AQD, ACV, ACA, or the keratometric values (p>0.05 for all values). There were no significant correlations between the ocular and systemic parameters (p>0.05 for all correlations). Conclusions: Uncorrected IOP, corrected IOP, CCT, and CV values decreased after HD, whereas the anterior chamber morphometry values remained similar between the measurements performed before and after HD.


RESUMO Objetivo: Avaliar os efeitos da hemodiálise (HD) na morfometria da córnea e da câmara anterior e da pressão intraocular (PIO) em pacientes com doença renal terminal. Métodos: Cinquenta olhos direitos foram examinados 30 minutos antes e após hemodiálise. A pressão intraocular foi medida com um tonômetro de aplanação de Goldmann, e a fórmula de Ehlers foi utilizada para calcular os valores de pressão in traocular corrigidos. Mediram-se a espessura corneana central (CCT), o volume corneano (CV), os valores ceratométricos, a profundidade da câmara anterior (ACD), a profundidade aquosa (AQD), o volume da câmara anterior (ACV) e o ângulo da câmara anterior (ACA) nos quadrantes nasais e temporais com um sistema de análise de segmento Sirius anterior. Os níveis de nitrogênio ureico no sangue (BUN), peso corporal e pressão arterial sistólica e diastólica também foram medidos antes e após a HD. Resultados: A média de idade foi de 60,80 ± 13,38 (35-80) anos. Os valores médios não corrigidos e corrigidos da pressão intraocular diminuíram de 18,06 ± 3,91 e 18,31 ± 4,83 mmHg para 16,94 ± 3,87 e 16,95 ± 4,74 mmHg após hemodiálise (p=0,011 e p=0,003, respectivamente). A espessura corneana central média diminuiu de 536,38 ± 24,73 para 533,18 ± 27,25 µm (p=0,002), e o volume corneano médio diminuiu de 57,52 ± 3,15 para 55,68 ± 3,55 mm³ (p<0,001) após hemodiálise. Não houve alteração significativa nos valores de profundidade da câmara anterior, profundidade aquosa, volume da câmara anterior, ângulo da câmara anterior e ceratométricos (p>0,05 para todos os valores). Não houve correlação significativa entre os parâmetros oculares e sistêmicos (p>0,05 para todas as correlações). Conclusão: A pressão intraocular não corrigida, a pressão intraocular corrigida, a espessura corneana central e os valores de volume corneano diminuíram após hemodiálise, enquanto os valores de morfometria da câmara anterior foram semelhantes entre as medidas realizadas antes e após a hemodiálise.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Renal Dialysis/adverse effects , Cornea/pathology , Intraocular Pressure/physiology , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/therapy , Anterior Chamber/pathology , Reference Values , Time Factors , Tonometry, Ocular , Blood Urea Nitrogen , Cross-Sectional Studies , Treatment Outcome , Statistics, Nonparametric , Corneal Topography , Corneal Pachymetry
6.
Ann. hepatol ; 16(2): 230-235, Mar.-Apr. 2017. tab
Article in English | LILACS | ID: biblio-887227

ABSTRACT

ABSTRACT Background. Chronic renal failure (CRF) is a significant cause of morbidity and mortality in post-liver transplantation (LT) recipients. The risk factors associated with the development of renal dysfunction are not clearly elucidated. Objectives. To examine the risk factors in the development of CRF in these patients. Material and methods. Retrospective case-cohort of liver transplant patients without baseline kidney dysfunction who developed chronic renal failure during their follow-up. Results. Of 370 patients, 254 met the inclusion criteria. 30% (76) of these patients had CRF of which 57% (43) were male. Age, estimated glomerular filtration rate (eGFR) at discharge, and HCV infection were found to be risk factors for CRF post-LT. The odds ratio of developing CRF was 1.4 (0.6-3.3) in males with HCV, 1.6 (0.7-3.9) in females without HCV and 4.4 (1.5-13.2) among females with HCV when compared to men without HCV. Conclusions. In this cohort of LT receipients of a major Canadian city, age, eGFR, and HCV infection were risk factors for CRF. Female gender and HCV increased this odds by a factor of more than 4.


Subject(s)
Humans , Liver Transplantation/adverse effects , Hepatitis C/complications , Kidney Failure, Chronic/etiology , Time Factors , British Columbia , Chi-Square Distribution , Logistic Models , Odds Ratio , Sex Factors , Retrospective Studies , Risk Factors , Treatment Outcome , Hepatitis C/diagnosis , Risk Assessment , Glomerular Filtration Rate , Kidney/physiopathology , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/physiopathology
7.
Arq. bras. cardiol ; 108(3): 204-211, Mar. 2017. tab, graf
Article in English | LILACS | ID: biblio-838706

ABSTRACT

Abstract Background: Abnormal ankle-brachial index (ABI) has been found to be a strong predictor of mortality in some hemodialysis populations in studies with relatively short periods of follow-up, lower than 2 years. Objective: This study aimed to assess the predictive value of abnormal ABI as a risk factor for death among patients on maintenance hemodialysis after a 5-year follow-up. Methods: A total of 478 patients on hemodialysis for at least 12 months were included in the study. ABI measurement was performed using a mercury column sphygmomanometer and portable Doppler. Patients were divided into 3 groups according to ABI (low: <0.9; normal: 0.9 to 1.3; and high: >1.3) and followed for a 60-month period. Results: The prevalence rates of low, normal and high ABI were 26.8%, 64.6% and 8.6%, respectively. The 5-year survival rate was lower in the groups with low ABI (44.1%, P<0.0001) and high ABI (60.8%, P= 0.025) than in the group with normal ABI (71.7%). Cox regression was used to evaluate the association between ABI and mortality, adjusting for potential confounders. Using normal ABI as reference, a low, but not a high ABI was found to be an independent risk factor for all-cause mortality (HR2.57; 95% CI, 1.84-3.57 and HR 1.62; 95% CI, 0.93-2.83, respectively). Conclusions: long-term survival rates of patients with either low or high ABI were lower than the one from those with normal ABI. However, after adjustment for potential confounders, only low ABI persisted as an independent risk factor for all-cause mortality among hemodialysis patients.


Resumo Fundamento: O índice tornozelo-braquial (ITB) foi apontado como um forte preditor de mortalidade em algumas populações de pacientes em hemodiálise em estudos com períodos relativamente curtos de acompanhamento (inferior a 2 anos). Objetivo: Avaliar o valor preditivo do ITB anormal como um fator de risco de morte em pacientes em hemodiálise após 5 anos de acompanhamento. Métodos: Um total de 478 pacientes em hemodiálise por pelo menos 12 meses foram incluídos no estudo. A medida de ITB foi realizada usando-se esfigmomanômetro com coluna de mercúrio e Doppler portátil. Os pacientes foram divididos em 3 grupos de acordo com o ITB (baixo: < 0,9; normal: 0,9 - 1,3; e alto: >1,3), e acompanhados por um período de 60 meses. Resultados: As prevalências de ITB baixo, normal e alto foram 26,8%, 64,6% e 8,6%, respectivamente. A taxa de sobrevida de 5 anos foi menor nos grupos com ITB baixo (44,1%, p <0,0001) e ITB alto (60,8%, p = 0,025) que no grupo com ITB normal (71,7%). A regressão de Cox foi usada para avaliar a associação entre ITB e mortalidade, ajustando para potenciais fatores de confusão. Usando o ITB normal como referência, um baixo ITB, mas não um alto ITB foi identificado como um fator de risco independente para mortalidade por todas as causas (HR2,57; IC95%, 1,84-3,57 e HR 1,62; 95% CI, 0,93-2,83, respectivamente). Conclusões: as taxas de sobrevida em longo prazo de pacientes com um ITB baixo ou alto foram menores que de pacientes com um ITB normal. No entanto, após ajuste por fatores de confusão, somente o ITB baixo manteve-se como um fator de risco independente para mortalidade por todas as causas entre pacientes em hemodiálise.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Blood Pressure/physiology , Renal Dialysis/mortality , Risk Assessment/methods , Ankle Brachial Index/methods , Phosphorus/blood , Time Factors , Calcium/blood , Survival Rate , Predictive Value of Tests , Prospective Studies , Risk Factors , Analysis of Variance , Follow-Up Studies , Statistics, Nonparametric , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/mortality , Kidney Failure, Chronic/therapy
8.
Yonsei Medical Journal ; : 75-81, 2017.
Article in English | WPRIM | ID: wpr-65060

ABSTRACT

PURPOSE: Diabetes mellitus (DM) is the most common cause of end-stage renal disease (ESRD) and an important risk factor for cardiovascular (CV) disease. We investigated the impact of DM on subclinical CV damage by comprehensive screening protocol in ESRD patients. MATERIALS AND METHODS: Echocardiography, coronary computed tomography angiogram, 24-h ambulatory blood pressure monitoring, and central blood pressure with pulse wave velocity (PWV) were performed in 91 ESRD patients from the Cardiovascular and Metabolic disease Etiology Research Center-HIgh risk cohort. RESULTS: The DM group (n=38) had higher systolic blood pressure than the non-DM group (n=53), however, other clinical CV risk factors were not different between two groups. Central aortic systolic pressure (148.7±29.8 mm Hg vs. 133.7±27.0 mm Hg, p= 0.014), PWV (12.1±2.7 m/s vs. 9.4±2.1 m/s, p<0.001), and early mitral inflow to early mitral annulus velocity (16.7±6.4 vs. 13.7±5.9, p=0.026) were higher in the DM group. Although the prevalence of coronary artery disease (CAD) was not different between the DM and the non-DM group (95% vs. 84.4%, p=0.471), the severity of CAD was higher in the DM group (p=0.01). In multivariate regression analysis, DM was an independent determinant for central systolic pressure (p=0.011), PWV (p<0.001) and the prevalence of CAD (p=0.046). CONCLUSION: Diabetic ESRD patients have higher central systolic pressure and more advanced arteriosclerosis than the non-DM control group. These findings suggest that screening for subclinical CV damage may be helpful for diabetic ESRD patients.


Subject(s)
Aged , Aorta , Biomarkers , Blood Pressure/physiology , Blood Pressure Monitoring, Ambulatory , Coronary Artery Disease/diagnostic imaging , Diabetes Mellitus/physiopathology , Diabetic Nephropathies/physiopathology , Echocardiography , Female , Humans , Kidney Failure, Chronic/physiopathology , Male , Middle Aged , Pulse Wave Analysis , Regression Analysis , Risk Factors , Systole/physiology
9.
Arq. bras. cardiol ; 107(6): 518-522, Dec. 2016. tab
Article in English | LILACS | ID: biblio-838662

ABSTRACT

Abstract Background: Myocardial revascularization surgery is the best treatment for dyalitic patients with multivessel coronary disease. However, the procedure still has high morbidity and mortality. The use of extracorporeal circulation (ECC) can have a negative impact on the in-hospital outcomes of these patients. Objectives: To evaluate the differences between the techniques with ECC and without ECC during the in-hospital course of dialytic patients who underwent surgical myocardial revascularization. Methods: Unicentric study on 102 consecutive, unselected dialytic patients, who underwent myocardial revascularization surgery in a tertiary university hospital from 2007 to 2014. Results: Sixty-three patients underwent surgery with ECC and 39 without ECC. A high prevalence of cardiovascular risk factors was found in both groups, without statistically significant difference between them. The group "without ECC" had greater number of revascularizations (2.4 vs. 1.7; p <0.0001) and increased need for blood components (77.7% vs. 25.6%; p <0.0001) and inotropic support (82.5% vs 35.8%; p <0.0001). In the postoperative course, the group "without ECC" required less vasoactive drugs, (61.5% vs. 82.5%; p = 0.0340) and shorter time of mechanical ventilation (13.0 hours vs. 36,3 hours, p = 0.0217), had higher extubation rates in the operating room (58.9% vs. 23.8%, p = 0.0006), lower infection rates (7.6% vs. 28.5%; p = 0.0120), and shorter ICU stay (5.2 days vs. 8.1 days; p = 0.0054) as compared with the group with ECC surgery. No difference in mortality was found between the groups. Conclusion: Myocardial revascularization with ECC in patients on dialysis resulted in higher morbidity in the perioperative period in comparison with the procedure without ECC, with no difference in mortality though.


Resumo Fundamento: A revascularização cirúrgica do miocárdio é o melhor tratamento para o paciente dialítico com doença coronariana multiarterial. Contudo, o procedimento ainda apresenta elevada morbimortalidade. O uso da circulação extracorpórea (CEC) pode impactar de maneira negativa na evolução intra-hospitalar desses pacientes. Objetivos: Avaliar a diferença entre as técnicas com ou sem CEC na evolução intra-hospitalar de pacientes dialíticos submetidos a cirurgia de revascularização do miocárdio. Métodos: Estudo unicêntrico de 102 pacientes dialíticos consecutivos e não selecionados, submetidos à revascularização cirúrgica do miocárdio em um hospital terciário universitário no período de 2007 a 2014. Resultados: 63 pacientes foram operados com CEC e 39 sem o uso de CEC. Foi observada alta prevalência de fatores de risco cardiovascular em ambos grupos, porém sem diferença estatisticamente significante entre eles. O grupo "com CEC" apresentou maior número de coronárias revascularizadas (2,4 vs 1,7; p <0,0001), maior necessidade de hemocomponentes (77,7% vs 25,6%; p <0,0001) e apoio inotrópico (82,5% vs 35,8%; p <0,0001). Na evolução pós-operatória, o grupo "sem CEC" apresentou menor necessidade de drogas vasoativas (61,5% vs 82,5%; p = 0,0340), maior taxa de extubação em sala cirúrgica (58,9% vs 23,8%, p = 0,0006), menor tempo de ventilação mecânica (13,0 horas vs 36,3 horas, p = 0,0217), menor taxa de infecções (7,6% vs 28,5%; p = 0,0120) e menor tempo de internação em UTI (5,2 dias vs 8,1 dias; p = 0,0054) em comparação ao grupo "com CEC". Não houve diferença de mortalidade entre os grupos. Conclusão: O uso da CEC na revascularização do miocárdio em pacientes dialíticos resultou em maior morbidade no período perioperatório em comparação ao procedimento realizado sem CEC, contudo, sem diferença de mortalidade.


Subject(s)
Humans , Male , Female , Middle Aged , Renal Dialysis/methods , Extracorporeal Circulation/methods , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/mortality , Myocardial Revascularization/methods , Postoperative Complications , Time Factors , Coronary Artery Disease/surgery , Coronary Artery Disease/physiopathology , Coronary Artery Disease/mortality , Reproducibility of Results , Risk Factors , Renal Dialysis/mortality , Treatment Outcome , Hospital Mortality , Statistics, Nonparametric , Extracorporeal Circulation/mortality , Tertiary Care Centers , Hospitals, University , Intensive Care Units , Length of Stay , Myocardial Revascularization/mortality
10.
Acta cir. bras ; 31(11): 744-752, Nov. 2016. tab, graf
Article in English | LILACS | ID: biblio-827663

ABSTRACT

ABSTRACT PURPOSE: To characterize an experimental model of progressive renal disease induced by different degrees of nephrectomy in rats. METHODS: Eighty male Wistar rats were divided into four experimental groups (n=20/group): sham surgery (control group), progressive degrees of nephrectomy leading to mild uremia (group 1), moderate uremia (group 2) and severe uremia (group 3). Ten animals of each group were followed for two or four weeks. At the end, blood and 24-hour urine samples were collected to determine renal function parameters. Urine output and water and food intake were daily monitored. RESULTS: In rats of group 1, serum levels of creatinine and urea and microalbuminuria were increased, while reduced creatinine clearance (p<0.05, compared with control group), without changing blood pressure. Animals of group 2 had more accentuated alterations: increases in urinary output, blood pressure, serum concentrations of urea, creatinine, sodium, potassium, and in microalbuminuria, and reduction of creatinine clearance (p<0.05). Group 3 exhibited even more increased serum concentrations of urea, creatinine, sodium and potassium, blood pressure and microalbuminuria, and decreased creatinine clearance (p<0.05) in comparison with control group and unilateral nephrectomy. CONCLUSION: Progressive nephrectomy in rats seems to be useful to study the physiopathology of chronic kidney disease and its mechanisms of progression.


Subject(s)
Animals , Male , Rats , Uremia/metabolism , Kidney/physiopathology , Kidney Failure, Chronic/physiopathology , Nephrectomy/adverse effects , Urea/blood , Uremia/etiology , Severity of Illness Index , Rats, Wistar , Disease Progression , Creatinine/blood , Albuminuria/blood , Disease Models, Animal , Arterial Pressure/physiology , Glomerular Filtration Rate/physiology , Kidney Failure, Chronic/pathology , Nephrectomy/methods
11.
J. bras. nefrol ; 38(3): 344-350, July-Sept. 2016. tab
Article in English | LILACS | ID: lil-796194

ABSTRACT

Abstract Introduction: Literature shows that patients undergoing hemodialysis present poor physical conditioning and low tolerance to exercise. They may also suffer from respiratory dysfunctions. The purpose of this study was to evaluate the effects of neuromuscular electrical stimulation on pulmonary function and functional capacity of patients with chronic kidney disease on hemodialysis. Methods: Forty adult patients with chronic kidney disease on hemodialysis were prospectively studied and randomized into two groups (control n = 20 and treatment n = 20). The treatment group underwent bilateral femoral quadriceps muscles electrical stimulation for 30 minutes during hemodialysis, three times per week, for two months. The patients were evaluated by pulmonary function test, maximum respiratory pressures, maximum one-repetition test, and six-minute walk test (6MWT), before and after the treatment protocol. Results: The treatment group presented increased maximum inspiratory (MIP) (p = 0.02) and expiratory pressures (MEP) (p < 0.0001), muscular strength in maximum one-repetition test (p < 0.001), and distance covered in the 6MWT (p = 0.03), and decreased systolic blood pressure (p < 0.001) and respiratory frequency (p < 0.001) when compared with the control group. Conclusion: Electrical neuromuscular stimulation had a positive impact on pulmonary function and functional capacity, leading to better physical performance in patients on hemodialysis.


Resumo Introdução: Pacientes submetidos à hemodiálise apresentam baixo condicionamento físico além de serem acometidos por disfunções respiratórias. Objetivamos avaliar os efeitos da estimulação elétrica neuromuscular na função pulmonar e capacidade funcional de pacientes com doença renal crônica em hemodiálise. Método: 40 adultos com doença renal crônica em hemodiálise foram estudados prospectivamente e randomizados em dois grupos (controle n = 20 e tratamento n = 20). O grupo tratamento realizou protocolo com estimulação elétrica neuromuscular em quadríceps femoral por 30 minutos durante a hemodiálise, três vezes por semana, durante dois meses. Todos pacientes realizaram espirometria, pressões respiratórias máximas, teste de uma repetição máxima e teste da caminhada dos seis minutos (TC6), antes e após o período de acompanhamento. Resultados: O grupo tratamento apresentou aumento da pressão inspiratória máxima com p = 0,02 na comparação entre grupos e p < 0,001 para a pressão máxima expiratória. O teste de uma repetição máxima e a distância percorrida no TC6 apresentaram-se maiores após o protocolo no grupo de tratamento com p < 0,001 e 0,03 respectivamente. Houve diminuição da pressão arterial sistólica (p < 0,001) e frequência respiratória (p < 0,001) após a estimulação elétrica quando comparado ao grupo controle. Conclusão: A estimulação elétrica neuromuscular teve impacto positivo sobre a função pulmonar e a capacidade funcional levando ao melhor desempenho físico em pacientes em hemodiálise.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Electric Stimulation Therapy , Renal Dialysis , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/therapy , Respiratory Function Tests , Neuromuscular Junction
12.
Arq. bras. oftalmol ; 79(4): 229-232, July-Aug. 2016. tab, graf
Article in English | LILACS | ID: lil-794575

ABSTRACT

ABSTRACT Purpose: To assess the effect of hemodialysis on retinal and choroidal thicknesses using spectral-domain optical coherence tomography (SD-OCT). Methods: In this prospective interventional study, 25 hemodialysis patients (17 male, 8 female) were enrolled. All participants underwent high-speed, high-resolution SD-OCT (λ=840 mm; 26.000 A-scans/s; 5 µm resolution) before and after hemodialysis. Choroidal thickness was measured perpendicularly from the outer edge of the retinal pigment epithelium to the choroid-sclera boundary at the fovea and at five additional points: 500 µm and 1000 µm nasal to the fovea and 500 µm, 1000 µm, and 1500 µm temporal to the fovea. Two masked physicians performed the measurements. Choroidal and retinal thicknesses before and after hemodialysis were compared. Results: The median choroidal thicknesses before and after hemodialysis were 182 µm (range, 103-374 µm) and 161 µm (range, 90-353 µm), respectively (P<0.001). The median retinal thicknesses were 246 µm (range, 179-296 µm) before and 248 µm (range, 141-299 µm) after hemodialysis (P>0.05). Systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, heart rate, and ocular perfusion pressure significantly decreased after hemodialysis (P<0.001). Intraocular pressure did not vary significantly (P=0.540). Conclusion: Hemodialysis seems to cause a significant decrease in choroidal thickness, whereas it has no effect on retinal thickness. This significant decrease in choroidal thickness might be due to the extensive fluid absorption in hemodialysis, which could result in decreased ocular blood flow.


RESUMO Objetivo: Avaliar o efeito da hemodiálise (HD) na espessura da retina (RT) e na espessura da coroide (CT) usando tomografia de coerência óptica de domínio espectral (SD-OCT). Método: Neste estudo prospectivo intervencionista foram incluídos 25 pacientes em HD (17 homens e 8 mulheres). Todos os participantes foram submetidos a SD-OCT com dispositivo de alta resolução (λ=840 mm; 26.000 A-scans/seg e resolução de 5 µm), antes e após HD. A CT foi medida perpendicularmente a partir da borda externa do epitélio pigmentar da retina até o limite coroide-esclera na fóvea e em mais de 5 pontos localizados 500 µm nasal à fóvea, 1.000 µm nasal à fóvea; 500 µm temporal à fóvea, 1.000 µm temporal à fóvea, e 1.500 µm temporal à fóvea. Dois médicos realizaram as medidas sem o conhecimento do diagnóstico. Os dados da CT e RT, antes e após a HD foram comparados. Resultados: As CTs medianas antes e após a HD foram 182 µm (variação de 103-374 µm) e 161 µm (variação de 90-353 µm), respectivamente (p<0,001). A RT foi 246 µm (variação de 179-296 µm) antes e 248 µm (variação de 141-299 µm) após a HD (p>0,05). A pressão arterial sistólica, pressão arterial diastólica, as médias de pressão arterial média, frequência cardíaca e pressão de perfusão ocular diminuíram significativamente após HD (p<0,001). A pressão intraocular não alterou significativamente (p=0,540). Conclusão: A HD parece causar uma redução significativa da CT, e não ter efeito sobre a RT. Esta redução significativa da CT pode ser devida à grande absorção de fluido durante a HD, o que pode resultar numa diminuição do fluxo sanguíneo ocular.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Retina/anatomy & histology , Retina/diagnostic imaging , Choroid/anatomy & histology , Choroid/diagnostic imaging , Renal Dialysis/adverse effects , Organ Size , Reference Values , Retina/physiopathology , Time Factors , Observer Variation , Prospective Studies , Choroid/physiopathology , Statistics, Nonparametric , Tomography, Optical Coherence/methods , Eye/blood supply , Hemodynamics , Intraocular Pressure , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/therapy
13.
Article in English | WPRIM | ID: wpr-143638

ABSTRACT

In this study, we characterized cerebral blood flow changes by assessment of blood flow parameters in neck arteries using carotid duplex ultrasonography and predictive factors for these hemodynamic changes. Hemodynamic variables were measured before and during hemodialysis in 81 patients with an arteriovenous access in their arm. Hemodialysis produced significant lowering in peak systolic velocity and flow volume of neck arteries and calculated total cerebral blood flow (1,221.9 ± 344.9 [before hemodialysis] vs. 1,085.8 ± 319.2 [during hemodialysis], P < 0.001). Effects were greater in vessels on the same side as the arteriovenous access and these changes were influenced by arteriovenous access flow during hemodialysis, both in the CCA (r = -0.277, P = 0.015) and the VA (r = -0.239, P = 0.034). The change of total cerebral blood flow during hemodialysis was independently related with age, presence of diabetes, and systemic blood pressure.


Subject(s)
Aged , Carotid Arteries/diagnostic imaging , Cerebrovascular Circulation/physiology , Dizziness/etiology , Female , Hemodynamics/physiology , Humans , Kidney Failure, Chronic/physiopathology , Male , Middle Aged , Renal Dialysis , Risk Factors , Ultrasonography, Doppler, Duplex
14.
Article in English | WPRIM | ID: wpr-143627

ABSTRACT

In this study, we characterized cerebral blood flow changes by assessment of blood flow parameters in neck arteries using carotid duplex ultrasonography and predictive factors for these hemodynamic changes. Hemodynamic variables were measured before and during hemodialysis in 81 patients with an arteriovenous access in their arm. Hemodialysis produced significant lowering in peak systolic velocity and flow volume of neck arteries and calculated total cerebral blood flow (1,221.9 ± 344.9 [before hemodialysis] vs. 1,085.8 ± 319.2 [during hemodialysis], P < 0.001). Effects were greater in vessels on the same side as the arteriovenous access and these changes were influenced by arteriovenous access flow during hemodialysis, both in the CCA (r = -0.277, P = 0.015) and the VA (r = -0.239, P = 0.034). The change of total cerebral blood flow during hemodialysis was independently related with age, presence of diabetes, and systemic blood pressure.


Subject(s)
Aged , Carotid Arteries/diagnostic imaging , Cerebrovascular Circulation/physiology , Dizziness/etiology , Female , Hemodynamics/physiology , Humans , Kidney Failure, Chronic/physiopathology , Male , Middle Aged , Renal Dialysis , Risk Factors , Ultrasonography, Doppler, Duplex
15.
J. bras. nefrol ; 37(3): 306-314, July-Sept. 2015. tab
Article in Portuguese | LILACS | ID: lil-760444

ABSTRACT

ResumoIntrodução:O estado nutricional (EN) de pacientes em hemodiálise (HD) é motivo de preocupação e de desafio. A desnutrição é comum nestes pacientes e relaciona-se com pior prognóstico clínico.Objetivos:Avaliar a associação entre o EN e o ganho de peso interdialítico (GPID) de pacientes com doença renal crônica (DRC) em hemodiálise (HD).Métodos:Estudo transversal realizado com 322 pacientes maiores de 18 anos. O EN foi avaliado por meio do índice de massa corporal (IMC), percentual de gordura corporal estimado pela somatória de quatro dobras cutâneas (tricipital, bicipital, suprailíaca e subescapular), massa corporal magra (MCM), creatinina e albumina sérica e a taxa de aparecimento do nitrogênio (PNA). O GPID foi avaliado a partir da somatória da diferença de peso de 12 sessões de hemodiálise (GPIDm).Resultados:Considerando-se a amostra em quartis de GPIDm, verificou-se que o IMC, MCM, creatinina sérica (p < 0,001) e PNA (p = 0,011) estavam diretamente correlacionados. Não foi verificada associação entre o GPIDm e os níveis de albumina sérica. Por meio de análise multivariada, verificou-se que a prevalência de pacientes com adequação ao IMC e a creatinina sérica foi significativamente maior para pacientes do último quartil de GPIDm em relação ao primeiro.Conclusão:O EN associou-se positivamente ao GPID. Os resultados apontam para necessidade de avaliação individualizada e cautelosa do GPID, a fim de não se generalizar uma recomendação que não satisfaça as expectativas de manutenção e promoção do estado nutricional desses pacientes.


AbstractIntroduction:The nutritional status (NS) of patients on hemodialysis (HD) is a major concern and challenge. Malnutrition is common in these patients and is related to poorer clinical outcomes.Objectives:To assess the association between the NS and the interdialytic weight gain (IDWG) of patients with chronic kidney disease (CKD) on HD.Methods:Cross-sectional study with 322 patients older than 18 years. The NS was assessed by body mass index (BMI), percentage body fat estimated by the sum of four skinfolds (triceps, biceps, subscapular and supra iliac), lean body mass (LBM), serum creatinine and albumin and rate of nitrogen appearance (PNA). The IDWG was evaluated from the sum of the weight difference of 12 hemodialysis sessions (IDWGm).Results:Considering the sample into quartiles IDWGm, it was found that BMI, LBM, serum creatinine ( p < 0.001) and PNA ( p = 0.011) were directly correlated. There was no association between IDWGm and serum albumin. Using multivariate analysis, it was found that the prevalence of patients with BMI suitability and serum creatinine were significantly higher for patients in the bottom quartile with respect to the first IDWGm.Conclusion:The NS is positively associated with IDWG. The results point to the need for individualized assessment of IDWG and cautious in order not to generalize a recommendation that does not meet the expectations of maintaining and promoting the nutritional status of these patients.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Weight Gain , Nutritional Status , Renal Dialysis , Kidney Failure, Chronic/therapy , Cross-Sectional Studies , Kidney Failure, Chronic/physiopathology
16.
Int. braz. j. urol ; 40(3): 379-383, may-jun/2014. tab
Article in English | LILACS | ID: lil-718262

ABSTRACT

Purpose Aim of this study is to examine the effectiveness of dextranomer/hyaluronic acid copolymer and polyacrylate polyalcohol copolymer in endoscopic treatment of vesicoureteral reflux disease in adult patients with and without chronic renal failure. Materials and Methods Thirty two patients (12 female, 20 male) with a total of 50 renal units were treated for vesicoureteral reflux. There were 26 (81%) chronic renal failure patients. The success of treatment was evaluated by voiding cystouretrography at 3rd and 12th months after subureteric injection. The persistence of reflux was considered as failure. Patients were divided into two groups according to injected material. Age, sex, grade of reflux and treatment results were recorded and evaluated. Results Reflux was scored as grade 1 in seven (14%), grade 2 in 16 (32%), grade 3 in 21 (42%) and grade 4 in six (12%) renal units. There was not patient with grade 5 reflux. Fourteen renal units (28%) were treated with dextranomer/hyaluronic acid copolymer (group 1) and 36 renal units (72%) were treated with polyacrylate polyalcohol copolymer (group 2). The overall treatment success was achieved at 40 renal units (80%). The treatment was successful at 11 renal units (79%) in group 1 and 29 renal units (81%) in group 2 (p = 0.71). There was not statistically significant difference between two groups with patients with chronic renal failure in terms of treatment success (p = 1.00). Conclusions The effectiveness of two bulking agents was similar in treatment of vesicoureteral reflux disease in adult patients and patients with chronic renal failure. .


Subject(s)
Adult , Female , Humans , Male , Acrylic Resins/therapeutic use , Dextrans/therapeutic use , Hyaluronic Acid/therapeutic use , Ureteroscopy/methods , Vesico-Ureteral Reflux/surgery , Biocompatible Materials/therapeutic use , Injections/methods , Kidney Failure, Chronic/physiopathology , Reproducibility of Results , Time Factors , Treatment Outcome , Vesico-Ureteral Reflux/physiopathology
17.
Arq. bras. endocrinol. metab ; 57(6): 457-463, ago. 2013. graf, tab
Article in English | LILACS | ID: lil-685408

ABSTRACT

OBJECTIVE: To better explore the relationship between parameters of glycemic control of T2DM in RRT, we studied 23 patients on hemodialysis (HD), 22 on peritoneal dialysis (PD), and compared them with 24 T2DM patients with normal renal function (NRF). MATERIALS AND METHODS: We performed, on four consecutive days, 10 assessments of capillary blood glucose [4 fasting, 2 pre- and 4 postprandial (post-G) and average (AG)], random glycemia, and HbA1c in all patients. RESULTS: Preprandial blood glucose was greater in patients on RRT compared with NRF. Correlations between AG and HbA1c were 0.76 for HD, 0.66 for PD, and 0.82 for NRF. The regression lines between AG and HbA1c were similar for patients on HD and with NFR, but they were displaced upward for PD. CONCLUSION: Similar HbA1c values in PD patients may correspond to greater levels of AG than in HD or NRF patients.


OBJETIVO: Para melhor explorar a relação entre os parâmetros de controle glicêmico em DM2 em TRS, estudamos 23 pacientes em hemodiálise (HD), 22 em diálise peritoneal (DP) em comparação à 24 DM2 com função renal normal (FRN). MATERIAIS E MÉTODOS: Em quatro dias consecutivos, realizamos 10 glicemias capilares [4 em jejum, 2 pré- e 4 pós-prandiais (G-pós) e a média glicêmica (MG)], glicemia aleatória e HbA1c em todos os pacientes. RESULTADOS: As glicemias pré-prandiais foram mais elevadas nos pacientes em TRS se comparadas àqueles com FRN. As correlações entre MG e HbA1c foram em HD = 0,76; DP = 0,66 e FRN = 0,82. As retas de regressão entre MG e HbA1c assemelham-se nos pacientes em HD e NFR e estão deslocadas para cima em DP. CONCLUSÃO: Valores similares de HbA1c podem corresponder a MG maiores em pacientes em DP do que em HD ou FRN.


Subject(s)
Humans , Male , Middle Aged , Blood Glucose/analysis , Glycated Hemoglobin A/analysis , Kidney Failure, Chronic/physiopathology , Renal Dialysis , /complications , /mortality , Fasting , Kidney Function Tests , Kidney Failure, Chronic/mortality , Kidney/physiopathology , Peritoneal Dialysis
18.
Arq. bras. cardiol ; 100(3): 261-268, mar. 2013. ilus, tab
Article in Portuguese | LILACS | ID: lil-670867

ABSTRACT

FUNDAMENTO: Os indivíduos com insuficiência renal crônica terminal estão sujeitos a um elevado estresse cardíaco pelo carácter repetitivo e intermitente da terapia dialítica. As alterações na sístole elétrica ventricular induzidas pela necessária terapia dialítica são um contributo importante na predição da ocorrência de morte súbita arrítmica na insuficiência renal crônica terminal. OBJETIVO: O objetivo principal desta investigação é avaliar o comportamento da repolarização ventricular em face da terapia dialítica, mediante o estudo do intervalo QTc e dispersão do QTc. MÉTODOS: A amostra em estudo inclui 47 indivíduos sujeitos a hemodiálise (61,7% do sexo masculino e 38,3% do sexo feminino) com idade média de 66,79 ± 13,16 anos. Todos os indivíduos foram sujeitos a três eletrocardiogramas realizados em três momentos durante a terapia dialítica (pré, durante e após a sessão), sendo posteriormente analisada a sístole elétrica ventricular. RESULTADOS: Ocorreu um aumento do intervalo QTc máximo e da dispersão do QTc associado à terapia dialítica. Aliado ao aumento desses intervalos ocorreu um aumento do número de indivíduos com critérios eletrocardiográficos para hipertrofia ventricular esquerda, registando-se no período pós-diálise uma média superior do intervalo QTc máximo (473 ± 27,63 mseg) e da dispersão do QTc (58,95 ± 18,87 mseg) desses indivíduos, comparativamente aos indivíduos sem HVE, 455,21 ± 26,85 mseg e 44 ± 16,41 mseg, respectivamente. CONCLUSÃO: O presente estudo confirmou um aumento do intervalo QTc e da dispersão do QTc associado à terapia dialítica. Esse aspecto reforça a dependência da repolarização ventricular em relação ao equilíbrio hídrico e eletrolítico e sugere um perfil de maior vulnerabilidade arrítmica associada à terapia dialítica.


BACKGROUND: Patients with end-stage kidney disease (ESKD) experience elevated cardiac stress because of the repetitive and intermittent character of dialysis. Changes in ventricular electrical systole induced by necessary dialysis significantly contribute to predict sudden death due to arrhythmia in ESKD. OBJECTIVE: The major objective of this study was to assess the behavior of ventricular repolarization in dialysis by analyzing QTc interval and QTc dispersion. METHODS: This study sample consisted of 47 patients undergoing hemodialysis (61.7% males and 38.3% females), whose mean age was 66.79±13.16 years. All of them underwent three electrocardiograms performed before, during and after one dialysis session. Ventricular electrical systole was analyzed later. RESULTS: An increase in maximum QTc interval and QTc dispersion associated with dialysis was observed. In addition, an increase in the number of individuals meeting the electrocardiographic criteria for left ventricular hypertrophy (LVH) was observed. After dialysis, higher means of the maximum QTc interval (473 ± 27.63 mseg) and of the QTc dispersion (58.95 ± 18.87 mseg) were observed in individuals with LVH as compared with those in individuals without LVH (455.21 ± 26.85 mseg and 44 ± 16.41 mseg, respectively). CONCLUSION: This study confirmed an increase in the QTc interval and QTc dispersion associated with dialysis. That emphasizes the dependence of ventricular repolarization on fluid and electrolyte balance, and suggests a profile of higher vulnerability to arrhythmia associated with dialysis .


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Heart Conduction System/physiopathology , Hypertrophy, Left Ventricular/physiopathology , Kidney Failure, Chronic/physiopathology , Renal Dialysis/adverse effects , Ventricular Function/physiology , Arrhythmias, Cardiac/prevention & control , Chi-Square Distribution , Death, Sudden, Cardiac/prevention & control , Electrocardiography , Hypertrophy, Left Ventricular/pathology , Kidney Failure, Chronic/therapy , Linear Models , Systole/physiology
20.
CoDAS ; 25(3): 202-208, 2013. graf, tab
Article in Portuguese | LILACS | ID: lil-680031

ABSTRACT

OBJETIVO: Investigar o comportamento auditivo de pacientes com insuficiência renal crônica submetidos ao transplante renal. MÉTODOS: Foram avaliados 30 pacientes, 10 do gênero feminino e 20 do gênero masculino, na faixa etária de 13 a 26 anos (média de idade 16,97 anos). Os sujeitos foram submetidos a anamnese, avaliação otorrinolaringológica, avaliação audiológica convencional e de altas frequências, medidas de imitância acústica e avaliação do processamento auditivo central. Para os resultados da audiometria de altas frequências foi utilizado um grupo controle. RESULTADOS: Os sujeitos não apresentaram queixas auditivas na anamnese. Os resultados da audiometria convencional demonstraram predomínio da normalidade; na audiometria de altas frequências, os pacientes apresentaram resultados piores do que os sujeitos do grupo controle. Na imitanciometria houve predomínio de curva tipo A bilateral. Na avaliação do processamento auditivo central, 14 sujeitos (46,67%) apresentaram resultados alterados no Staggered Spondaic Word Test (SSW). Houve diferença significativa entre a variável idade e o resultado da audiometria tonal limiar: quanto maior a idade, menor a sensibilidade auditiva nos limiares de 250 Hz a 8 kHz. Houve relação entre o tipo de doador (cadáver ou vivo) e o resultado do teste SSW: os índices de resultados alterados foram maiores quando o doador era cadáver, em comparação com casos de doador vivo. CONCLUSÃO: Houve alterações na avaliação audiológica convencional e de altas frequências e no processamento auditivo central de sujeitos com insuficiência renal crônica submetidos ao transplante renal, sugerindo a necessidade de orientação à equipe envolvida quanto aos cuidados, prevenção e identificação precoce de acometimentos audiológicos.


PURPOSE: To investigate the auditory behavior of patients with chronic renal failure (CRF) undergoing kidney transplantation. METHODS: Thirty patients were evaluated, 10 (33.33%) females and 20 (66.67%) males, aging from 13 to 26 years (average, 16.97 years; standard deviation, 3.60 years). Patients underwent the following procedures: anamnesis, otolaryngological examination, audiological evaluation (pure tone and high frequency), acoustic impedance measurements and central auditory processing evaluation. A control group was used to compare the high-frequency audiometry results. RESULTS: The following observations were made: absence of auditory complaints at the time of anamnesis; pure-tone audiometry was predominantly normal; patients presented lower hearing levels at the high-frequency audiometry, when compared to the control group, and as for the acoustic impedance measurements, curves of the type A were predominant; there was a change of the central auditory processing for 14 patients (46.67%) in the Staggered Spondaic Word Test (SSW); there was a significant difference between the age variable and the result of the pure-tone audiometry, that is, hearing sensitivity in thresholds from 250Hz to 8,000Hz decreased with advancing age; and the relation between the type of donor and the SSW test result was significant. Rates were higher when the patients had been transplanted from deceased donors compared to living donors. CONCLUSION: There were no changes in conventional audiological and high-frequency evaluation, or in the central auditory processing. Professionals involved in the care of kidney transplantation recipients must be better informed about the care, prevention, and early identification of auditory disorders.


Subject(s)
Adolescent , Adult , Female , Humans , Male , Young Adult , Hearing Disorders/etiology , Kidney Transplantation , Kidney Failure, Chronic/complications , Audiometry , Auditory Threshold , Case-Control Studies , Hearing Tests , Kidney Failure, Chronic/physiopathology
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