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1.
Cad. Saúde Pública (Online) ; 38(2): e00090821, 2022. tab, graf
Article in English | LILACS | ID: biblio-1360290

ABSTRACT

Abstract: Complications of chronic kidney disease (CKD) can be avoided when promptly diagnosed and treated. The objective was to describe quality indicators of CKD detection and health care in the primary care public service of a city in the State of São Paulo, Brazil. This retrospective study analyzed charts of patients who attended primary care in the public service between November 2019 and February 2020. We selected 10 health quality indicators based on their scientific relevance and availability from the medical records that could express how CKD was identified and managed in primary health care. We estimated the adequate percentage of health indicators with data from 1,066 individuals who had ≥ one risk factor for CKD: hypertension, diabetes, or > 60 years old. Among patients, 79.4% had information on serum creatinine, whereas 58.8% were investigated for proteinuria. Blood pressure data were found in 98.9% of the records. The percentage of patients with blood pressure < 140x90mmHg, glycosylated hemoglobin < 6.5% and LDL-cholesterol < 100mg/dL was 79.2%, 49.2%, and 33.3%, respectively. Renin-angiotensin system blockers were prescribed to 82.8% of the patients with hypertension and CKD. Serum potassium was measured in 35.7% for those who were using renin-angiotensin system blockers. Among those people with CKD, 16.7% had CKD assigned in the medical records as a diagnose. Among those participants at higher risk for CKD, the referral rate to a nephrologist was 31.6%. This study confirmed some missed quality indicators of CKD in primary healthcare. Our results may help administrators develop public policies that improve health care for individuals at high risk for CKD. Long-term follow-up of the health indicators we proposed here will be useful to assess the impact of policy intervention.


Resumo: As complicações da doença renal crônica (DRC) podem ser evitadas quando a doença é diagnosticada e tratada oportunamente. O estudo teve como objetivo descrever a qualidade dos indicadores da detecção e assistência para a DRC no sistema púbico de saúde em um município do Estado de São Paulo, Brasil. O estudo retrospectivo analisou prontuários de pacientes que utilizaram serviços de atenção primária no sistema público entre novembro de 2019 e fevereiro de 2020. Selecionamos dez indicadores de qualidade com base na relevância científica e disponibilidade, a partir dos prontuários médicos. Calculamos o percentual de adequação com dados de 1.066 indivíduos que apresentavam ≥ 1 fatores de risco para DRC: hipertensão, diabetes ou idade > 60 anos. No total, 79,4% dos pacientes apresentavam informação sobre creatinina sérica, e 58,8% foram investigados para proteinúria. Dados de pressão arterial foram encontrados em 98,9% dos prontuários. As proporções de pacientes com pressão arterial < 140x90mmHg, hemoglobina glicada < 6,5% e LDL < 100mg/dL foram 79,2%, 49,2% e 33,3%, respectivamente. Os antagonistas do sistema renina-angiotensina foram prescritos em 82,8% dos pacientes com hipertensão e DRC. O potássio sérico foi medido em 35,7% dos pacientes em uso de antagonistas do sistema renina-angiotensina. Entre os indivíduos com DRC, 16,7% tinham esse diagnóstico registrado no prontuário médico. Entre os participantes com risco mais elevado de DRC, 31,6% foram encaminhados para um nefrologista. O estudo confirmou a falta de alguns indicadores de qualidade para DRC na assistência primária. Os resultados podem ajudar gestores a desenvolverem políticas públicas que melhorem a assistência para indivíduos com risco maior de DRC. O seguimento a longo prazo dos indicadores de saúde propostos aqui será útil para avaliar o impacto dessa política de intervenção.


Resumen: Las complicaciones de la enfermedad crónica de riñón (ECR) se pueden evitar cuando esta enfermedad se diagnostica con prontitud y se trata. El objetivo fue describir indicadores de calidad en la detección de ECR, así como la asistencia en el servicio público de una ciudad, en el Estado de São Paulo, Brasil. Este estudio retrospectivo analizó fichas de pacientes que acudían a atención primaria en el servicio público, entre noviembre 2019 y febrero 2020. Seleccionamos 10 indicadores de calidad en salud, basados en relevancia científica y disponibilidad de registros médicos. Calculamos el porcentaje de adecuación de ellos con datos de 1.066 personas que tenían ≥ 1 factor de riesgo ECR: hipertensión, diabetes, o > 60 años. Un 79,4% de los pacientes tenían información sobre la creatinina sérica, y se investigó a un 58,8% en el caso de la proteinuria. Los datos de presión sanguínea se encontraron en un 98,9% de los registros. El porcentaje de pacientes con presión sanguínea < 140x90mmHg, hemoglobina glicada < 6,5% y LDL < 100mg/dL fue 79,2%, 49,2%, y 33,3%, respectivamente. Se prescribieron bloqueadores del sistema renina-angiotensina a un 82,8% de los pacientes con hipertensión y ECR. Se midió el potasio sérico en un 35,7% de aquellos quienes estaban usando bloqueadores del sistema renina-angiotensina. Entre aquellas personas con ECR, 16,7% había ECR asignado en los registros médicos como diagnosis. Entre aquellos participantes en riesgo mayor por ECR, la tasa de derivación a un nefrólogo fue 31,6%. Este estudio confirmó algunos indicadores de calidad olvidados de ECR en los cuidados de salud en la atención primaria. Nuestros resultados quizás podrían ayudar a los gestores a desarrollar políticas públicas que mejoraran el cuidado de salud para las personas con alto riesgo de ECR. El seguimiento a largo plazo de los indicadores de salud que propusimos aquí será útil para evaluar el impacto de la política de intervención.


Subject(s)
Humans , Quality Indicators, Health Care , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/epidemiology , Primary Health Care , Brazil/epidemiology , Retrospective Studies , Middle Aged
2.
Ciênc. Saúde Colet ; 26(4): 1207-1219, abr. 2021. tab
Article in English, Portuguese | LILACS | ID: biblio-1285919

ABSTRACT

Resumo O objetivo deste artigo é comparar as prevalências autorreferidas e medidas por exames laboratoriais, assim como a ocorrência de valores de falsos positivos e negativos, para diabetes, doença renal crônica e hipercolesterolemia. Foram utilizadas informações da entrevista e exames laboratoriais da Pesquisa Nacional de Saúde (2013, 2014-2015). Foram calculadas a sensibilidade e a especificidade, segundo sexo, idade, escolaridade, ter plano de saúde e tempo desde a última consulta médica. Por meio de regressão logística, foram analisados fatores associados à ocorrência de falsos positivos e falsos negativos. A sensibilidade foi mais elevada para o diabetes e entre os idosos e os que tiveram consulta médica mais recentemente. A especificidade foi alta para todas as doenças, com melhor desempenho entre os jovens, os com alta escolaridade e os que consultaram há mais de um ano. As chances de falsos positivos e falsos negativos diminuíram com a escolaridade e aumentaram com a idade. A sensibilidade baixa indica que as prevalências podem ser mais elevadas que as medidas autoreferidas apontam.


Abstract This paper aims to compare the self-reported prevalence measured by laboratory tests and the false positive and negative values for diabetes, chronic kidney disease, and hypercholesterolemia. We used information from the interview and laboratory tests of the National Health Survey (2013, 2014-2015). Sensitivity and specificity were calculated by gender, age, schooling, having health insurance, and time since the last medical visit. We used logistic regression to analyze associated factors with false positives and negatives. Sensitivity was higher for diabetes and among older adults and those who had a medical visit more recently. Specificity was high for all diseases, with better performance among younger people, those with high schooling, and a visit more than one year ago. The likelihood of false positives and negatives decreased with schooling and increased with age. Low sensitivity suggests that prevalence might be higher than indicated by self-reported measures.


Subject(s)
Humans , Aged , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/epidemiology , Hypercholesterolemia/diagnosis , Hypercholesterolemia/epidemiology , Self Report , Laboratories
3.
Rev. bras. oftalmol ; 80(5): e0045, 2021. graf
Article in English | LILACS | ID: biblio-1347259

ABSTRACT

ABSTRACT Exudative retinal detachment occurs when fluid accumulates between the neurosensory retina and the retinal pigment epithelium. Ocular diseases or multisystem conditions such as nephrotic syndrome may lead to exudative retinal detachment. This report describes a case of nephrotic syndrome secondary to minimal change disease, anasarca and bilateral serous macular detachment in an adult patient. A 75-year-old male patient presented to the emergency department with generalized edema, asthenia, and visual impairment. Medical history included a recent diagnosis of nephrotic syndrome secondary to minimal change disease, which had been controlled with corticosteroid therapy. At presentation, best corrected visual acuity was 20/100. Slit-lamp examination revealed xanthelasmas and mild bilateral eyelid edema and chemosis. Dilated fundus examination confirmed bilateral macular detachment. The patient did not respond to diuretic therapy. Ttherefore, hemodialysis was started. Two months later, visual acuity improved to 20/25 and near normal restoration of retinal anatomy was achieved, with concurrent remission of proteinuria. Exudative retinal detachment is a multifactorial condition. However, in diseases associated with severe hypoalbuminemia, such as nephrotic syndrome, low oncotic pressure in choroidal vessels and high interstitial pressure in the choroid may explain retinal detachment. Patients with chronic kidney disease carry a high risk of ophthalmic disease development. Several mechanisms that affect ocular vessels, the retina and the choroid are thought to be involved. A multidisciplinary approach is crucial to resolve the ophthalmic condition and improve overall health.


RESUMO O descolamento de retina exsudativo ocorre quando o fluido se acumula entre a retina neurossensorial e o epitélio pigmentado da retina. Patologias oculares isoladas ou doenças multissistêmicas, como a síndrome nefrótica, podem levar ao descolamento de retina exsudativo. Apresenta-se aqui o caso de um adulto com síndrome nefrótica por doença de lesões mínimas, anasarca e descolamento de retina exsudativo macular bilateral. Trata-se de um homem de 75 anos de idade, que recorreu ao serviço de urgência com edema generalizado, astenia e diminuição da acuidade visual. Os antecedentes pessoais incluíam diagnóstico recente de síndrome nefrótica secundária à doença de lesões mínimas, em uso de corticoterapia. Na apresentação, a melhor acuidade visual corrigida era 20/100. A biomicroscopia revelou xantelasmas, edema palpebral leve e quemose nos dois olhos. Fundoscopia mostrou descolamento macular bilateral. O doente iniciou diuréticos com pouca resposta clínica, tendo sido adicionada hemodiálise. Verificou-se melhora da acuidade visual para 20/25 e restauração quase total da anatomia da retina 2 meses após o início do tratamento, coincidindo com a remissão da proteinúria. A fisiopatologia dos descolamentos de retina exsudativos é multifatorial, mas, em doenças com hipoalbuminemia grave, como a síndrome nefrótica, a baixa pressão oncótica e a alta pressão intersticial na coroide podem explicar o descolamento macular exsudativo. Doentes com doença renal crônica constituem um grupo de risco para o desenvolvimento de doença ocular, envolvendo vários mecanismos que afetam vasos, retina e coroide. Uma abordagem multidisciplinar é crucial para a melhoria da doença oftalmológica e do estado geral do doente.


Subject(s)
Humans , Male , Aged , Retinal Detachment/etiology , Renal Insufficiency, Chronic/complications , Nephrotic Syndrome/complications , Ophthalmoscopy , Retinal Detachment/diagnosis , Visual Acuity , Tomography, Optical Coherence , Diagnostic Techniques, Ophthalmological , Renal Insufficiency, Chronic/diagnosis , Exudates and Transudates , Slit Lamp Microscopy , Fundus Oculi , Macula Lutea
4.
Ciênc. Saúde Colet ; 25(10): 4021-4032, Out. 2020. tab, graf
Article in Portuguese | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1133007

ABSTRACT

Resumo Indivíduos com doença renal crônica (DRC) frequentemente utilizam polifarmácia o que os expõe ao risco de problemas relacionados a medicamentos (PRMs). No Brasil, não existem instrumentos que possam sistematizar a avaliação da farmacoterapia e a gestão de PRMs nesta população. Portanto, o objetivo deste trabalho foi realizar a adaptação transcultural do instrumento PAIR (Pharmacotherapy Assessment in Chronic Renal Disease) para o português brasileiro. O PAIR consiste numa lista de 50 PRMs considerados clinicamente significativos para renais crônicos. O processo de adaptação transcultural envolveu as etapas de tradução, síntese, retrotradução, análise por um comitê de especialistas e pré-teste da versão preliminar. O comitê de 2 farmacêuticos e 2 nefrologistas analisou a equivalência semântica, idiomática, experiencial e conceitual entre as versões original e traduzida. Todos os itens que obtiveram acordo inferior a 80% foram revisados. Foram realizados ajustes de palavras, assim como a exclusão de 6 PRMs devido à não aplicabilidade ao contexto brasileiro. Assim, foi obtida a versão final do PAIR definida como "Avaliação da farmacoterapia na doença renal crônica", traduzida e adaptada na língua portuguesa do Brasil.


Abstract Individuals suffering from chronic kidney disease (CKD) are often on multiple medications, which exposes them to drug-related problems (DRP). There are no available tools in Brazil to assess the pharmacotherapy and management of DRPs systematically in this population. The scope of this study was to perform a cross-cultural adaptation of PAIR criteria (Pharmacotherapy Assessment in Chronic Renal Disease) to Brazilian Portuguese. PAIR criteria consist of 50 DRP clinically significant items for CKD. The process of cross-cultural adaptation involved translation, synthesis, back-translation, and an analysis by an expert committee as well as a pre-test of the first draft document. A review committee consisting of 2 pharmacists and 2 nephrologists analyzed the semantic, linguistic, experiential, and conceptual equivalence between the original and translated versions. All items that obtained a score below 80% were reviewed. Word adjustments were made, as well as the exclusion of 6 DRP due to non-applicability to the Brazilian context. Thus, the final version of PAIR defined as "Avaliação da farmacoterapia na doença renal crônica" was translated and adapted into the Brazilian Portuguese language.


Subject(s)
Humans , Cross-Cultural Comparison , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/drug therapy , Translations , Brazil , Surveys and Questionnaires
5.
Gac. méd. Méx ; 156(5): 432-437, sep.-oct. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1249942

ABSTRACT

Resumen Introducción: La presión de pulso ampliada (PPA) se asocia a un filtrado glomerular calculado ≤ 60/mL/minuto/1.73 m2, por lo que puede ser útil como prueba diagnóstica para identificar a personas con insuficiencia renal crónica (IRC) estadio K/DOQI III-b. Objetivo: Determinar la utilidad de la PPA como prueba diagnóstica de IRC estadio K/DOQI III-b. Método: Estudio de prueba diagnóstica que incluyó a pacientes adultos sin comorbilidades, registrados en la Cohorte de Trabajadores de la Salud. Se utilizó la fórmula CKD-EPI para calcular la filtración glomerular. Se determinó la presión de pulso restando la presión arterial diastólica a la presión arterial sistólica. Se calculó sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y prevalencia. Se elaboró una curva ROC para determinar el área bajo la curva. Resultados: Se incluyeron 6215 pacientes. Se observó que una PPA ≥ 50 mm Hg tuvo sensibilidad de 74 %, especificidad de 70 %, valor predictivo positivo de 1 %, valor predictivo negativo de 100 % y prevalencia de 1 %. El punto de inflexión en la curva ROC para identificar IRC K/DOQI III-b fue de 0.71. Conclusión: La PPA ≥ 50 mm Hg es útil como prueba diagnóstica para identificar a personas con IRC estadio K/DOQI III-b.


Abstract Introduction: Increased pulse pressure (IPP) is associated an estimated glomerular filtration ≤ 60/mL/min/1.73 m2; thus, it can be useful as a diagnostic test to identify people with K/DOQI stage III-b chronic kidney disease (CKD). Objective: To determine the usefulness of IPP as a diagnostic test for K/DOQI stage III-b CKD. Method: Diagnostic test study that included adult patients without comorbidities, registered in the Health Workers Cohort. The CKD-EPI formula was used to calculate glomerular filtration. Pulse pressure was determined by subtracting diastolic from systolic blood pressure. Sensitivity, specificity, positive predictive value, negative predictive value and prevalence were calculated using standard formulas. A ROC curve was generated to determine the area under the curve. Results: A total of 6,215 patients were included. An IPP ≥ 50 mmHg was observed to have a sensitivity of 74 %, specificity of 70 %, positive predictive value of 1 %, negative predictive value of 100 % and a prevalence of 1 %. The inflection point in the ROC curve to identify K/DOQI III-b CKD was 0.71. Conclusion: An IPP ≥ 50 mmHg is useful as a diagnostic test to identify people with K/DOQI stage III-b CKD.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Blood Pressure/physiology , Renal Insufficiency, Chronic/diagnosis , Blood Pressure Determination/methods , Predictive Value of Tests , ROC Curve , Sensitivity and Specificity , Area Under Curve , Renal Insufficiency, Chronic/physiopathology , Glomerular Filtration Rate/physiology
6.
Rev. Hosp. Ital. B. Aires (2004) ; 40(3): 105-116, sept. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1129064

ABSTRACT

Este trabajo tiene como objetivo revisar las contribuciones de la biotecnología, en relación con el tratamiento, diagnóstico y la monitorización de la enfermedad renal crónica (ERC) y sus comorbilidades más frecuentes, especialmente la anemia. En relación con los tratamientos, enfocamos el desarrollo de productos biofarmacéuticos como los agentes estimulantes de la eritropoyesis (ESA), que fueron los primeros biofármacos utilizados para el tratamiento de la anemia asociada a la ERC; analizamos sus características y utilización actual después de varios años de experiencia clínica, así como también otras alternativas en desarrollo. Revisamos distintos tipos de bioterapias, la utilización de las células estromales mesenquimales de médula ósea (MSC) y tratamientos alternativos con modificaciones dietarias, que se basan en la asociación entre la microbiota intestinal de los pacientes renales crónicos y sus condiciones fisiopatológicas. Finalmente, en relación con el diagnóstico y monitorización, nos referimos al estudio y validación de biomarcadores diagnósticos, predictivos y terapéuticos que han permitido optimizar los resultados clínicos en este tipo de pacientes. (AU)


The aim of this work is to review the contributions of biotechnology, in relation to the treatment, diagnosis and monitoring of chronic kidney disease (CKD) and its most frequent comorbidities, especially anemia. Regarding the treatment, we focus on the development of biopharmaceutical products such as erythropoiesis stimulating agents (ESA), which were the first biopharmaceuticals used to treat anemia associated with chronic kidney disease (CKD). We analyzed their characteristics and their current use after several years of clinical experience, as well as other alternatives in development. We also review different types of biotherapies, the use of bone marrow mesenchymal stromal cells (MSC) and alternative treatments with dietary modifications, which are based on the association between the intestinal microbiota of chronic kidney patients and their pathophysiological conditions. Finally, in relation to diagnosis and monitoring, we refer to the study and validation of diagnostic, predictive and therapeutic biomarkers that have made clinical results possible to be optimized in this type of patient. (AU)


Subject(s)
Humans , Biological Therapy/trends , Renal Insufficiency, Chronic/therapy , Quality of Life , Biotechnology , Biomarkers , Erythropoietin/deficiency , Probiotics/therapeutic use , Mesenchymal Stem Cell Transplantation/trends , Erythropoiesis/drug effects , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/diet therapy , Renal Insufficiency, Chronic/rehabilitation , Prebiotics/classification , Glycoside Hydrolase Inhibitors/therapeutic use , Gastrointestinal Microbiome , Hematinics/administration & dosage , Hematinics/pharmacology , Hematinics/pharmacokinetics , Anemia/diagnosis , Anemia/etiology , Anemia/drug therapy
7.
Acta bioquím. clín. latinoam ; 54(4): 383-393, jul. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1149028

ABSTRACT

Resumen La enfermedad renal crónica (ERC) se define como la pérdida progresiva de la estructura y función renal. Es asintomática en etapas iniciales, pero lleva a insuficiencia renal y mortalidad cardiovascular prematura. La investigación e marcadores de lesión y función renal permite su detección precoz y la evaluación del riesgo de progresión. Se estudiaron 73 voluntarios aparentemente sanos con factores de riesgo, de ambos sexos, asintomáticos y con edades entre 20 y 70 años, y se los comparó con una población control sin factores de riesgo. Fueron evaluadas las historias clínicas, los parámetros antropométricos y la presión arterial. Se analizó la creatinina sérica por métodos enzimático y cinético, se estimó la filtración glomerular con las ecuaciones CKD-EPI, MDRD-IDMS y MDRD-4 y la creatinina urinaria y la albuminuria por métodos cinético e inmunoturbidimétrico, respectivamente. La lipocalina asociada a gelatinasa de neutrófilos (NGAL) sérica y urinaria se determinó por ELISA. El 66% de la población estudiada presentaba sobrepeso, el 34% hipertensión arterial y el 31% tabaquismo. El riesgo de progresión de ERC se estadificó con el filtrado glomerular estimado y la albuminuria y se evidenció un 87% con bajo riesgo, 12% con riesgo moderado y 1% con riesgo alto. La NGAL sérica mostró diferencias significativas respecto al grupo control 11,65 vs. 5,4 ng/mL (p<0,05), e incrementos en las distintas categorías conforme aumentaba el riesgo de progresión. La detección de ERC temprana, en pacientes asintomáticos con factores de riesgo considerados modificables, permitirá la implementación de acciones que retrasen la progresión a estadios avanzados y las complicaciones cardiovasculares asociadas a la enfermedad.


Abstract Progressive loss of renal structure and function define chronic kidney disease (CKD). It is silent in early stages but leads to renal failure and premature cardiovascular mortality. Investigation of renal function and injury markers allows CKD early detection and progression risk evaluation. A total of 73 apparently healthy volunteers, both sexes, asymptomatic with risk factors, from 20 to 70 years old were studied compared to the control population without risk factors. Clinical histories, anthropometric parameters and blood pressure were evaluated. Serum creatinine was analyzed with enzymatic and kinetic methods. Estimated glomerular filtration was calculated with CKD-EPI, MDRD-IDMS and MDRD-4 equations, urinary creatinine by kinetics method and albuminuria by immunoturbidimetry. Serum and urinary neutrophil gelatinase-associated lipocalin (NGAL) were investigated by ELISA. Population risk factors analyzed showed 66% overweight, 34% hypertensive and 31% smoking patients. CKD risk progression was staged with estimated glomerular filtration and albuminuria, according to KDIGO 2012. Population showed 87% patients in low CKD risk, 12% with moderate risk, and only 1% with high risk progression. Serum NGAL showed significant differences with respect to the control group, 11.65 vs 5.4 ng/mL (p<0,05), and increases in different categories as progression risk increases. CKD detection of asymptomatic patients with modifiable risk factors, in reversible early stages, will allow implementing actions that delay associated cardiovascular complications and disease progression to advanced stages.


Resumo A doença renal crônica (DRC) é definida como a perda progressiva da estrutura e função dos rins. Assintomático nos estágios iniciais, leva à insuficiência renal e à mortalidade cardiovascular prematura. A pesquisa de marcadores de lesão e função renal permite sua detecção precoce e avaliação do risco de progressão. Foram estudados 73 voluntários aparentemente saudáveis com fatores de risco, de ambos os sexos, assintomáticos e idades entre 20 e 70 anos, comparados à população controle sem fatores de risco. Prontuários, parâmetros antropométricos e pressão arterial foram avaliados. A creatinina sérica foi analisada pelo método enzimático e cinético, estimando a filtração glomerular com as equações CKD-EPI, MDRD-IDMS e MDRD-4, e a creatinina urinária e albuminúria, pelos métodos cinético e imunoturbidimétrico, respectivamente. Lipocalina associada à gelatinase de neutrófílos (NGAL), sérica e urinária foi determinada pelo método ELISA. 66% da população estudada apresentavam sobrepeso, 34% pressão arterial alta e 31% tabagismo. O risco de progressão da DRC foi classificado com a filtração glomerular estimada e albuminúria, mostrando 87% com baixo risco, 12% com risco moderado e apenas 1% com alto risco. A NGAL sérica mostrou diferenças significativas em relação ao grupo controle 11,65 vs 5,4 ng/mL (p<0,05) e incrementos nas diferentes categorias à medida que o risco de progressão aumentava. A detecção da DRC precoce, em pacientes assintomáticos com fatores de risco considerados modificáveis, permitirá a implementação de ações que atrasem a progressão para estágios avançados e complicações cardiovasculares associadas à doença.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Biomarkers/analysis , Disease Progression , Renal Insufficiency, Chronic/diagnosis , Cross-Sectional Studies , Risk Factors , Early Diagnosis , Glomerular Filtration Rate
8.
Rev. chil. pediatr ; 91(3): 324-329, jun. 2020. graf
Article in Spanish | LILACS | ID: biblio-1126168

ABSTRACT

Resumen: El recién nacido prematuro se enfrenta a las condiciones extrauterinas con sistemas aún inmaduros, tanto anatómica como fisiológicamente. El riñón termina de desarrollarse a finales del tercer trimes tre del embarazo, por lo que está especialmente expuesto a alterar su desarrollo normal en caso de nacer en forma prematura. Esta situación puede condicionar, entre otras consecuencias, una menor masa renal funcional y cambios microvasculares que representan un riesgo elevado de hipertensión arterial y daño renal crónico en el largo plazo. En el presente artículo se analiza la evidencia existente actual sobre estos riesgos en los prematuros y se ofrece un esquema de seguimiento de estos niños desde el punto de vista nefrológico.


Abstract: The premature newborn faces extrauterine conditions with some systems still immature, both ana tomically and physiologically. The kidney finishes developing at the end of the third trimester of pregnancy, so it is especially exposed to alter its normal development if preterm birth occurs. This si tuation may condition, among other consequences, a lower functional renal mass and microvascular changes comprising a high risk of chronic kidney disease in the long term and arterial hypertension. This article analyzes the current evidence on these risks in premature infants and offers a nephrology follow-up scheme of these children.


Subject(s)
Humans , Infant, Newborn , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/etiology , Renal Insufficiency, Chronic/physiopathology , Renal Insufficiency, Chronic/therapy , Hypertension/diagnosis , Hypertension/etiology , Hypertension/physiopathology , Hypertension/therapy , Infant, Premature, Diseases/diagnosis , Infant, Premature, Diseases/etiology , Infant, Premature, Diseases/physiopathology , Infant, Premature, Diseases/therapy , Risk , Aftercare/methods , Kidney/growth & development , Kidney/embryology , Kidney/physiopathology , Nephrology/methods
9.
Rev. cuba. med. mil ; 49(2): e292, abr.-jun. 2020. fig
Article in Spanish | LILACS, CUMED | ID: biblio-1138998

ABSTRACT

Introducción: A partir de los años 50, la presentación clínica clásica de la endocarditis infecciosa ha variado. Debido al uso de antibióticos, drogas ilícitas, catéteres venosos, etc., las manifestaciones tradicionales no son frecuentes. Objetivo: Presentar un caso con endocarditis infecciosa y comentar las manifestaciones embolígenas, así como las medidas preventivas con las nuevas técnicas. Caso clínico: Enfermo con insuficiencia renal crónica, diabético, hipertenso, con catéter venoso central, que presentó, después de una sección de hemodiálisis; escalofríos intensos, fiebre de 39,5 0C, cefalea intensa, toma del estado general, dolor torácico intenso punzante, tos, expectoración con sangre roja rutilante, disnea, soplo regurgitante holosistólico. Se le realizó ecocardiograma dópler que muestra múltiples vegetaciones pequeñas, hemocultivos positivos a estafilococos dorado. Fue tratado según los resultados del antibiograma durante 6 semanas y resolvió su extrema gravedad. Conclusiones: La endocarditis infecciosa puede tener manifestaciones muy diferentes al de décadas anteriores; puede aparecer como cuadro agudo fulminante por manifestaciones embólicas y sépticas múltiples(AU)


Introduction: Since the 1950s, the classical clinical presentation of infectious endocarditis (E.I) has varied. Due to the use of antibiotics, illicit drugs, venous catheters, traditional manifestations are not frequent. Objectives: To review the embolic presentation of endocarditis and pecify the preventive measures with the new techniques. Clinical case: A patient with chronic renal insufficiency, diabetic, hypertensive, with central venous catheter, intense chills, fever of 39.5 ° C, intense headache, general state, severe chest pain, cough, expectoration with bright red blood, dyspnea, holosystolic regurgitant murmur, after a section of hemodialysis. Doppler echocardiogram was performed, visualizing multiple small vegetation's, positive blood cultures to golden staphylococci, treatment according to antibiograms for 6 weeks, at the end of which the extreme severity was resolved. Comments: Infective endocarditis can have a very different behavior from previous decades; it can appear as an acute fulminating disease due to embolic, septic, multiple manifestations(AU)


Subject(s)
Humans , Male , Middle Aged , Chest Pain , Microbial Sensitivity Tests , Renal Dialysis/instrumentation , Dyspnea/complications , Renal Insufficiency, Chronic/diagnosis
12.
Med. leg. Costa Rica ; 37(1): 121-129, ene.-mar. 2020. graf
Article in Spanish | LILACS | ID: biblio-1098379

ABSTRACT

Resumen Desde la década de 1990, se comenzó a notar un incremento en la prevalencia de enfermedad renal crónica (ERC) a nivel de Centroamérica. Este incremento se ha presentado principalmente en trabajadores de campos agrícolas en esa región, quienes se encuentran sometidos a elevadas temperaturas, lo que condujo a su designación como nefropatía mesoamericana (MeN por sus siglas en inglés). Aunque su etiología no está esclarecida, se considera que existe un componente ocupacional y ambiental involucrado. El presente artículo, describe sus principales características, su posible etiología, diagnóstico y estrategias de prevención y tratamiento.


Abstract Since the 1990s, an increase in the prevalence of chronic kidney disease (CKD) in several countries in Central America began to be noticed. This increase has occurred mainly in agricultural workers within that region, who are subjected to high temperatures, which led to its designation as Mesoamerican Nephropathy (MeN). Although its etiology is not clarified, it is considered that there is an occupational and environmental component involved. In this article, its main characteristics are described, including what is known about its possible etiology, diagnosis and prevention and treatment strategies.


Subject(s)
Humans , Renal Insufficiency, Chronic/diagnosis , Central America , Heat-Shock Response , Costa Rica , Renal Insufficiency, Chronic/etiology
13.
Rev. cuba. med ; 59(1): e174, ene.-mar. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1139043

ABSTRACT

La esclerosis peritoneal encapsulante es una complicación poco común, pero muy grave, de la diálisis peritoneal. Esta complicación está asociada con altas tasas de morbilidad y mortalidad. El diagnóstico clínico requiere la presencia de obstrucción intestinal o función gastrointestinal alterada con signos patológicos y radiológicos de encapsulamiento intestinal. El diagnóstico patognomónico es solo con la realización de una biopsia peritoneal. El mecanismo patogénico exacto de esta entidad sigue siendo desconocido, aunque se asocia firmemente con el tiempo de duración del paciente en el tratamiento con diálisis peritoneal. Se presenta un caso clínico de esclerosis peritoneal encapsulante y se analizan las manifestaciones clínicas, diagnóstico, tratamiento, pronóstico y prevención(AU)


Encapsulating peritoneal sclerosis is a rare but very serious complication of peritoneal dialysis. This complication is associated with high morbidity and mortality rates. Clinical diagnosis is based on the presence of intestinal obstruction or altered gastrointestinal function with pathological and radiological signs of intestinal encapsulation. The pathognomonic diagnosis is achieved only by performing peritoneal biopsy. The exact pathogenic mechanism of this entity remains unknown, although it is strongly associated with the duration of the patient with peritoneal dialysis. We report a clinical case of encapsulating peritoneal sclerosis and the clinical manifestations, diagnosis, treatment, prognosis and prevention are analyzed(AU)


Subject(s)
Humans , Male , Adult , Peritoneal Dialysis/adverse effects , Renal Insufficiency, Chronic/diagnosis , Peritoneal Fibrosis/complications , Peritoneal Fibrosis/pathology
14.
Braz. j. med. biol. res ; 53(3): e9614, 2020. tab, graf
Article in English | LILACS | ID: biblio-1089341

ABSTRACT

The global burden of chronic kidney disease (CKD) is rapidly increasing with a projection of becoming the 5th most common cause of years of life lost globally by 2040. CKD is a major cause of catastrophic health expenditure. The costs of dialysis and transplantation consume up to 3% of the annual healthcare budget in high-income countries. However, the onset and progression of CKD is often preventable. In 2020, the World Kidney Day campaign highlights the importance of preventive interventions - be it primary, secondary, or tertiary. This article focuses on outlining and analyzing measures that can be implemented in every country to promote and advance CKD prevention. Primary prevention of kidney disease should focus on the modification of risk factors and addressing structural abnormalities of the kidney and urinary tracts, as well as exposure to environmental risk factors and nephrotoxins. In persons with pre-existing kidney disease, secondary prevention, including blood pressure optimization and glycemic control, should be the main goal of education and clinical interventions. In patients with advanced CKD, management of co-morbidities such as uremia and cardiovascular disease is a highly recommended preventative intervention to avoid or delay dialysis or kidney transplantation. Political efforts are needed to proliferate the preventive approach. While national policies and strategies for non-communicable diseases might be present in a country, specific policies directed toward education and awareness about CKD screening, management, and treatment are often lacking. Hence, there is an urgent need to increase the awareness of preventive measures throughout populations, professionals, and policy makers.


Subject(s)
Humans , Health Equity , Renal Insufficiency, Chronic/epidemiology , Global Burden of Disease , Health Services Accessibility , Preventive Health Services/methods , Mass Screening/economics , Risk Factors , Early Diagnosis , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/prevention & control , Health Policy , Health Promotion
15.
Cienc. tecnol. salud ; 7(1): 7-25, 2020. ^c27 cmilus
Article in Spanish | LILACS | ID: biblio-1118317

ABSTRACT

El Centro para la Salud, el Trabajo y el Ambiente (CHWE por sus siglas en inglés) inició un proyecto de colaboración con Pantaleon, una empresa agrícola de caña de azúcar en Guatemala, para hacer frente a una epidemia de enfermedad renal crónica (ERC) de causa no tradicional (ERCnT) que afecta a las comunidades agrícolas en Centroamérica y otros lugares. Este artículo describe el conocimiento actual de la epidemia en Centroamérica, las manifestaciones clínicas, el tratamiento y el manejo; las hipótesis actuales de su etiología, la colaboración y el enfoque de CHWE-Pantaleon. Nuestro enfoque de Total Worker Health® (TWH) para abordar la salud renal en Guatemala incluye múltiples estudios de investigación con trabajadores de caña de azúcar, para evaluar la prevalencia, incidencia y factores de riesgo de la lesión renal aguda y la ERC; se incluye también el desarrollo e implementación de medidas de prevención mejoradas e intervenciones para proteger a los trabajadores abordando los factores de riesgo ya conocidos. Se examinan también las necesidades futuras de investigación y las implicaciones globales de la ERCnT, al igual que la producción de bienes y la economía, así como las recomendaciones actuales para las estrategias de prevención ocupacional y comunitaria.


The Center for Health, Work and Environment (CHWE) began a collaborative project with Pantaleon, a Guatemalan sugarcane agribusiness, to address an epidemic of chronic kidney disease of unknown cause (CKDu) that affects agricultural communities in Central America and elsewhere. This paper describes the current knowledge of the epidemic in Central America including clinical manifestations, course, and management, current etiology hypotheses, and the CHWE-Pantaleon collaboration and approach. Our Total Worker Health® (TWH) approach to addressing kidney health in Guatemala has included multiple research studies with sugarcane workers to assess prevalence, incidence and risk factors for acute kidney injury and chronic kidney disease, as well as development and implementation of enhanced prevention measures and interventions to protect workers by addressing known risk factors. Future research needs and the global implications of CKDu including for economy and commodity production are discussed, as well as current recommendations for occupational and community prevention strategies.


Subject(s)
Humans , Male , Female , Risk Factors , Renal Insufficiency, Chronic/prevention & control , Rural Workers , Occupational Health/economics , Renal Insufficiency, Chronic/diagnosis , Acute Kidney Injury/prevention & control , Guatemala/epidemiology
16.
Article in French | AIM, AIM | ID: biblio-1258761

ABSTRACT

Introduction: L'hyperparathyroïdie secondaire est une complication grave de l'insuffisance rénale chronique, ayant un impact négatif sur la morbi-mortalité. La parathyroïdectomie trouve toute son indication en cas d'échec du traitement médical. Le but de cette étude était de partager notre expérience dans la prise en charge de l'hyperparathyroïdie secondaire et de présenter les caractéristiques démographiques, biochimiques, cliniques et thérapeutiques des patients opérés dans notre service. Matériels et Méthodes : Etude d'une série de cas consécutifs opérés entre janvier 2002 et décembre 2013. Etaient inclus tous les patients ayant présenté une hyperparathyroïdie secondaire prouvée biologiquement et remplissant les critères d'opérabilité. Résultats : La série était composée de 69 patients (35 femmes, 34 hommes). La moyenne d'âge était de 37,7 ±13 ans. Le tableau clinique était dominé par les signes osseux et cutanés. En préopératoire, la valeur moyenne de la PTH était de 1727 ± 1380,10 pg/mL et celle de la calcémie de 2,39 ± 0,28 mmol/L. Sur le plan chirurgical, la parathyroïdectomie était subtotale chez 60 patients (87%) et totale chez 9 patients (13%) dont 7 avec auto transplantation et 2 sans autotransplantation. En post opératoire, la valeur de la PTH avait baissé significativement par rapport à la valeur préopératoire (p<0,01). Conclusion : Les résultats de cette étude suggèrent que la parathyroïdectomie entre les mains d'experts est un moyen efficace pour réduire la sécrétion de PTH avec une faible morbi-mortalité dans le cadre de l'hyperparathyroïdie secondaire réfractaire au traitement médical


Subject(s)
Algeria , Hyperparathyroidism, Secondary/complications , Hyperparathyroidism, Secondary/therapy , Parathyroidectomy , Renal Insufficiency, Chronic , Renal Insufficiency, Chronic/diagnosis
17.
Rev. bras. epidemiol ; 23: e200044, 2020. tab
Article in Portuguese | LILACS | ID: biblio-1101603

ABSTRACT

RESUMO: Objetivos: Identificar a prevalência da doença renal crônica (DRC) autorreferida no Brasil e caracterizar os fatores associados a essa enfermidade. Métodos: Trata-se de um inquérito epidemiológico de base domiciliar, a Pesquisa Nacional de Saúde (PNS) realizada em 2013. O desfecho analisado foi a prevalência de DRC. Os grupos de variáveis explicativas foram: características sociodemográficas, estilos de vida, doenças crônicas autorreferidas, antropometria e avaliação de saúde. Foram estimadas as prevalências de DRC e os respectivos intervalos de confiança de 95% e foram realizados a análise univariada e o modelo de regressão logística múltipla, permanecendo as variáveis estatisticamente significativas (p < 0,05). Resultados: Observou-se que 1,42% (intervalo de confiança de 95% - IC95% 1,33 - 1,52) dos 60.202 entrevistados referiram ser portadores de DRC. O odds ratio (OR) aumentou com a idade, sendo 2,68 entre os idosos com 65 anos ou mais (IC95% 1,75 - 4,09). Apresentaram chance maior de DRC: possuir planos de saúde, com OR = 1,51 (IC95% 1,28 - 1,78), tabagismo, hipertensão, colesterol elevado e autoavaliação de saúde ruim, com OR = 1,75 (IC95% 1,45 - 2,12), OR = 1,20 (IC95% 1,02 - 1,42), OR = 1,83 (IC95% 1,56 - 2,15), OR = 4,70 (IC95% 3,75 - 5,88), respectivamente. Conclusões: A prevalência de DRC foi maior em idade mais avançada, baixa escolaridade, possuir plano de saúde, tabagismo, hipertensão, hipercolesterolemia e avaliação regular ou ruim do estado de saúde. O conhecimento da prevalência da DRC e dos fatores de risco e de proteção são essenciais para prevenção da doença e para subsidiar as políticas públicas de saúde.


ABSTRACT: Objective: To identify the prevalence of chronic kidney disease (CKD) self-reported in Brazil and characterize the factors associated with it. Methods: This study was a cross-sectional health survey with a household-based, the National Health Survey, performed in 2013. The outcome in the present study was the prevalence of CKD. The groups of explanatory variables were socio-demographic characteristics, lifestyles, chronic self-reported diseases, anthropometry, and health evaluation. The prevalence of CKD, e their 95% respective confidence interval were estimated, univariate analysis and the multiple logistic regression model were calculated, and remained the variables statistically significant (p < 0.05). Results: It noticed that 1.42% (95%CI 1.33 - 1.52) of the 60,202 interviewees self-reported CKD. The OR increased progressively with age, being 2.68 among the elderly with 65 years or more (95%CI 1.75 - 4.09). Having health plans with OR = 1.51 (95%CI 1.28 - 1.78), as well as smoking, hypertension and high cholesterol and poor self-reported health with OR = 1.75 (95%CI 1.45 - 2.12), OR = 1.20 (95%CI 1.02 - 1.42), OR = 1.83 (95%CI 1.56 - 2.15), OR = 4.70 (95%CI 3.75 - 5.88), respectively, showed a higher chance of CKD. Conclusions: The associated variables were increasing age, health plan coverage, smoking, hypertension, hypercholesterolemia, and regular or poor health status. The knowledge of CKD prevalence in Brazil and risk and protection factors are essential for disease prevention and the establishment of supporting public health policies.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Renal Insufficiency, Chronic/epidemiology , Socioeconomic Factors , Brazil/epidemiology , Prevalence , Cross-Sectional Studies , Risk Factors , Renal Insufficiency, Chronic/diagnosis , Self Report , Life Style , Middle Aged
18.
Rev. enferm. UERJ ; 27: e34084, jan.-dez. 2019. ilus, tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1009995

ABSTRACT

Objetivo: analisar a autopercepção de saúde e os fatores associados dos indivíduos com doença renal crônica em terapia dialítica. Método: estudo transversal, quantitativo, com 42 pacientes assistidos na unidade de nefrologia de um hospital público em Recife/PE, no período de maio a agosto de 2016. Os dados foram coletados por meio de entrevista semiestruturada, analisados por estatística descritiva e inferencial, após aprovação do Comitê de Ética em Pesquisa. Resultados: a autoavaliação de saúde ruim esteve presente em 29 (69%) pacientes, porém sem associação com as características sociodemográficas e clínicas (p<0,05). Conclusão: a alta prevalência da autoavaliação de saúde ruim reflete a necessidade de informações educativas e autocuidado para uma melhor compreensão do estado de saúde e consequente adesão terapêutica.


Objective: to examine health self-perception and associated factors in individuals with chronic kidney disease in dialysis therapy. Method: in this quantitative, cross-sectional study of 42 patients attending the nephrology unit of a public hospital in Recife, Pernambuco, from May to August 2016, data were collected by semistructured interview and analyzed by descriptive and inferential statistics, after approval by the research ethics committee. Results: 29 patients (69%) self-assessed their health as poor, but no association was found with sociodemographic and clinical characteristics (p<0.05). Conclusion: the high prevalence of self-assessed poor health reflects the need for educational information and self-care for a better understanding of health status and consequent adherence to therapy.


Objetivo: analizar la autopercepción de salud y los factores asociados de los individuos con enfermedad renal crónica en terapia dialítica. Método: estudio transversal, cuantitativo, junto a 42 pacientes asistidos en la unidad de nefrología de un hospital público en Recife/Pernambuco, en el período de mayo a agosto de 2016. Los datos fueron recolectados por medio de entrevista semiestructurada, analizados por estadística descriptiva e inferencial, después de la aprobación del Comité de Ética en Investigación.Resultados: la autoevaluación de mala salud estuvo presente en 29 (69%) pacientes, pero sin asociación con las características sociodemográficas y clínicas (p <0,05). Conclusión: la alta prevalencia de la autoevaluación de mala salud refleja la necesidad de informaciones educativas y autocuidado para una mejor comprensión del estado de salud y consecuente adhesión terapéutica


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Health Status Indicators , Renal Dialysis/psychology , Peritoneal Dialysis/psychology , Renal Insufficiency, Chronic , Renal Insufficiency, Chronic/psychology , Diagnostic Self Evaluation , Quality of Life , Self Care , Social Change , Cross-Sectional Studies , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/therapy
19.
Rev. medica electron ; 41(4): 850-861, jul.-ago. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1094093

ABSTRACT

RESUMEN Introducción: la Organización Mundial de la Salud, estima que la enfermedad renal crónica estará incluida dentro de las principales causas de discapacidad para el 2020. La prevalencia en países desarrollados es aproximadamente de 500 a 1400 pacientes por millón de habitantes y la incidencia anual se encuentra alrededor de 350 pacientes por millón de población. Objetivo: determinar la prevalencia de la enfermedad renal oculta e identificar algunos factores de riesgos predisponentes en adultos mayores con diabetes mellitus tipo 2 pertenecientes al Policlínico Universitario "Jimmy Hirzel", Bayamo, Granma, en el período comprendido entre junio 2016 - junio 2017. Materiales y métodos: se realizó estudio observacional descriptivo, de corte transversal en el que se incluyeron 180 gerontes con diabetes mellitus tipo 2. Resultados: se estableció el diagnóstico de enfermedad renal oculta en 167 individuos de 180 sujetos estudiados, el grupo de 70 - 79 años de edad fue el más afectado por la nefropatía crónica, mientras que el sexo femenino y la raza blanca fueron los de mayor prevalencia. Los principales factores de riesgo predisponentes de enfermedad renal oculta fueron: cardiopatía isquémica crónica, dislipemias e hipertensión arterial. Conclusiones: existe una alta morbilidad de enfermedad renal oculta en los senescentes estudiados.


ABSTRACT Introduction: the World Health Organization (WHO) estimates that chronic hidden renal disease (ERC) will be included within the principal causes of disability by 2020. The prevalence in developed countries is around 500 to 1400 patients per million inhabitants, and the yearly incidence is around 350 patients per million people. Objective: to determine the prevalence of the hidden renal disease and to identify some predisposing risk factors in elder people with type II diabetes mellitus belonging to the University Policlinic "Jimmy Hirzel", Bayamo, Gramma, in the period between June 2016 and June 2017. Material and methods: an observational descriptive, cross-sectional study was carried out in 180 elder people with type 2 diabetes mellitus. Results: the chronic hidden renal disease was diagnosed in 167 individuals from the 180 studied subjects; the 70-79 years-old-group was the most affected one by chronic renal disease, while the female sex and white race showed the highest prevalence. The main risk factors predisposing to chronic hidden renal disease were: chronic ischemic heart disease, dyslipidemia and arterial hypertension. Conclusions: there is a high morbidity due to hidden renal disease in the studied senescent people.


Subject(s)
Humans , Female , Aged , Prevalence , Risk Factors , Morbidity , Myocardial Ischemia/etiology , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/etiology , Diabetes Mellitus, Type 2/epidemiology , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/prevention & control , Renal Insufficiency, Chronic/epidemiology , Dyslipidemias/etiology , Hypertension/etiology , Epidemiology, Descriptive , Cross-Sectional Studies , Diabetic Nephropathies/etiology , Observational Study , Kidney Diseases/etiology
20.
J. bras. nefrol ; 41(2): 176-184, Apr.-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1012539

ABSTRACT

Abstract Introduction: The aim of the study was to report the implementation of a functional network for the early diagnosis of chronic kidney disease (CKD) in patients with risk factors and the coordinated work between primary and specialized care in social security in Perú. Material and methods: A cross-sectional analysis of the data of patients evaluated in a health network in the city of Lima (2013 to 2016), older than 18 years, with risk factors for CKD, evaluated with serum creatinine and creatine albumin ratio in random urine (ACR). A multivariate logistic regression analysis was performed to evaluate the factors associated with the finding of CKD. Results: The implementation included training in renal health, installation of a digital database, organization of laboratories, and empowerment of primary care. We evaluated 42,746 patients of which 41.8% were men, with median age 69.2 years. The most frequent cause of detection was hypertension (HBP): 23,921 (55.9%). The prevalence of CKD was 12,132 (28.4%), the most frequent stage of CKD was 3a: 4735 (39.0%). Of the total, 6214 (14.5%) patients had microalbuminuria and 1335 (3.1%), macroalbuminuria. The risk of CKD increased 2.5 times (95% CI: 2.3-2.7) in patients with diabetes (DM) and HBP, in men (OR 1.2, 95% CI: 1.2-1.3) and as age increased (> 77 years: OR 2.7, 95% CI: 2.5-2.8). The identification of the disease in the primary care setting is 60% less likely than in specialized care. Conclusions: One of every four patients are diagnosed with CKD, and the simultaneous diagnosis of DM and HBP and old age are the most important factors.


Resumo Introdução: O objetivo do presente estudo foi descrever a implementação de uma rede funcional para o diagnóstico precoce de doença renal crônica (DRC) em pacientes com fatores de risco e o coordenar os trabalhos entre atenção primária e especializada no sistema de seguridade social peruano. Material e métodos: Análise transversal dos dados de pacientes maiores de 18 anos com fatores de risco para DRC avaliados em uma rede de saúde na cidade de Lima (2013 a 2016) por meio de creatinina sérica e relação albumina/creatinina (RAC) em amostra aleatória de urina. Análise de regressão logística multivariada foi executada para avaliar os fatores associados à presença de DRC. Resultados: A implementação incluiu treinamento em saúde renal, instalação de um banco de dados digital, organização de laboratórios e empoderamento da atenção primária. Foram avaliados 42.746 pacientes, dos quais 41,8% eram homens, com idade mediana de 69,2 anos. A causa mais comum de detecção foi hipertensão, observada em 23.921 indivíduos (55,9%). A prevalência de DRC foi de 12.132 (28,4%), com estágio 3A sendo o mais frequente com 4735 casos (39,0%). Do total, 6214 (14,5%) pacientes apresentavam microalbuminúria e 1335 (3,1%) macroalbuminúria. O risco de DRC foi 2,5 vezes maior (IC 95%: 2,3-2,7) nos pacientes com diabetes e hipertensão, em homens (OR 1,2, IC 95%: 1,2-1,3) e idosos (> 77 anos: OR 2,7, IC 95%: 2,5-2,8). A identificação da doença no cenário da atenção primária é 60% menos provável do que na atenção especializada. Conclusões: Um em cada quatro pacientes é diagnosticado com DRC. Idade avançada e diagnóstico simultâneo de DM e hipertensão são os fatores mais relevantes.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Primary Health Care , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/epidemiology , Ambulatory Care Facilities , Peru/epidemiology , Prevalence , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Creatinine/blood , Early Diagnosis , Diabetes Complications , Albuminuria , Renal Insufficiency, Chronic/etiology , Hypertension/complications
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