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2.
Blood Purif ; 47 Suppl 2: 31-37, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943479

RESUMO

BACKGROUND/AIMS: There is lack of definitive evidence about the association between erythropoiesis-stimulating agent (ESA) responsiveness in the pre-dialysis phase and mortality. Therefore, we conducted a hospital-based, retrospective, cohort study to assess the predictive value of ESA response for prognosis in incident hemodialysis patients. METHODS: A total of 108 patients without preexisting cardiovascular disease who had been started on maintenance hemodialysis were studied. ESA responsiveness just before starting dialysis was estimated using an erythropoietin resistance index (ERI). The endpoint was defined as all-cause death. RESULTS: During a mean follow-up period of 3.1 ± 1.6 years, 18 (17%) patients died. Overall, the multivariate Cox regression analysis revealed that the log-transformed ERI remained an independent predictor of all-cause death after adjustment using a propensity score (hazard ratio 2.25, 95% CI 1.25-4.06). CONCLUSIONS: Among incident hemodialysis patients, hyporesponsiveness to ESA may be associated with mortality.


Assuntos
Anemia/complicações , Anemia/tratamento farmacológico , Hematínicos/uso terapêutico , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Diálise Renal , Idoso , Anemia/mortalidade , Eritropoese/efeitos dos fármacos , Feminino , Humanos , Japão , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Diálise Renal/mortalidade , Estudos Retrospectivos
3.
Clin Exp Nephrol ; 22(1): 142-150, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28432490

RESUMO

BACKGROUND: Thallium-201 washout rate of stress myocardial perfusion imaging (MPI) has been reported to correlate with coronary flow reserve which is a parameter of myocardial microcirculation. However, the evidence for its use in diabetic kidney disease (DKD) has been lacking, and the association between thallium-201 washout rate and adverse outcomes including death is unknown. Therefore, the present study was conducted to evaluate the predictive ability of thallium-201 washout rate for mortality in DKD patients initiating hemodialysis. METHODS: A total of 96 patients with type 2 diabetes who had been started on maintenance hemodialysis undergoing stress MPI with thallium-201 within 1 year, 72 men and 24 women, with a median age of 67 years, were studied. The endpoint was defined as all-cause death. The Cox proportional hazards model was used to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: During the mean follow-up period of 3.4 ± 2.1 years, 18 (18.8%) deaths occurred. Cumulative survival rates during the follow-up period, with thallium-201 washout rate levels in the lowest tertile (3.1-36.2%), the middle tertile (36.5-46.3%), and the highest tertile (46.4-66.2%), were 51.0, 86.5, and 85.3%, respectively. Overall, the multivariate Cox regression analysis revealed that thallium-201 washout rate remained an independent predictor of death after adjusting by confounding variables (HR 0.91, 95% CI 0.85-0.97). CONCLUSIONS: Among DKD patients initiating hemodialysis, thallium-201 washout rate seems to be useful for predicting death.


Assuntos
Nefropatias Diabéticas/diagnóstico por imagem , Nefropatias Diabéticas/mortalidade , Imagem de Perfusão do Miocárdio/métodos , Compostos Radiofarmacêuticos , Radioisótopos de Tálio , Adulto , Idoso , Estudos de Coortes , Nefropatias Diabéticas/terapia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Diálise Renal , Análise de Sobrevida
4.
Surg Endosc ; 31(12): 5150-5158, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28488178

RESUMO

BACKGROUND: Ultrathin colonoscopes (UTC) reportedly produce less pain during colonoscopy than standard colonoscopes. The aim of this study was to assess the tolerability of an UTC compared with that of a pediatric colonoscope. METHODS: A total of 270 adult patients scheduled to undergo colonoscopy were randomized, with 134 allocated to the UTC group and 136 to the pediatric colonoscope group. Pain was assessed using a visual analog scale. For all procedures, sedation was administered only if requested. Overall pain, rate and time of cecal and terminal ileum intubation, number of patients requesting sedation, adenoma detection rates (ADR), and rate of complications were measured and analyzed. RESULTS: Among all patients, the medians of maximum pain and overall pain were significantly lower in the UTC group than in the pediatric colonoscope group (23 vs. 38, P < 0.001; 12 vs. 22, P = 0.0003, respectively). Significantly fewer patients requested sedation in the UTC group than in the pediatric colonoscope group (1.4 vs. 6.6%; P = 0.0269). No significant differences were seen in either the rate and time of successful cecal and terminal ileum intubation, or in other procedure-related outcomes, including ADR. CONCLUSIONS: Compared with a pediatric colonoscope, the UTC was associated with reduced overall and maximum pain during colonoscopy, with no difference in ADR.


Assuntos
Adenoma/diagnóstico por imagem , Neoplasias do Colo/diagnóstico por imagem , Colonoscópios , Colonoscopia/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Colonoscópios/efeitos adversos , Colonoscopia/efeitos adversos , Colonoscopia/métodos , Sedação Consciente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Dor/diagnóstico , Dor/etiologia , Dor/prevenção & controle , Medição da Dor , Estudos Prospectivos , Método Simples-Cego
6.
Cardiorenal Med ; 5(4): 267-77, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26648943

RESUMO

BACKGROUND/AIMS: An upright T-wave in lead aVR (aVRT) has recently been reported to be associated with cardiovascular death and mortality among the general population and patients with prior cardiovascular disease (CVD). However, evidence for the predictive ability of aVRT in patients with chronic kidney disease is lacking. Therefore, a hospital-based, prospective, cohort study was conducted to evaluate the predictive ability of an upright aVRT for the short-term prognosis in incident hemodialysis patients. METHODS: Among 208 patients who started maintenance hemodialysis, 79 with preexisting CVD (CVD cohort) and 129 with no history of CVD (non-CVD cohort), were studied. An upright and non-upright aVRT were defined as a wave with a positive deflection in amplitude of ≥0 mV and a negative deflection in amplitude of <0 mV, respectively. The endpoint was all-cause death. RESULTS: Overall, the prevalence of an upright aVRT was 22.6% at baseline. During the mean follow-up period of 2.1 ± 1.0 years, 33 deaths occurred. Cumulative survival rates at 3 years after starting dialysis in patients with an upright and non-upright aVRT were 50.0 and 80.7%, respectively, in the CVD cohort and 92.0 and 91.3%, respectively, in the non-CVD cohort. In the CVD cohort, multivariate Cox regression analysis showed that an upright aVRT was an independent predictor of death after adjusting for confounding variables. CONCLUSION: Among Japanese hemodialysis patients at high risk for CVD, an upright aVRT seems to be useful for predicting death.

7.
J Bone Miner Metab ; 33(6): 674-83, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25691284

RESUMO

The World Health Organization Fracture Risk Assessment Tool (FRAX(®)) was recently developed to estimate the 10-year absolute risk of osteoporotic fracture among the general population. However, the evidence for its use in chronic kidney disease patients has been lacking, and the association between the FRAX(®) and mortality is unknown. Therefore, a hospital-based, prospective, cohort study was conducted to evaluate the predictive ability of the FRAX(®) for mortality in hemodialysis patients. A total of 252 patients who had been started on maintenance hemodialysis, 171 men and 81 women, with a mean age of 67 ± 14 years, was studied. The endpoint was defined as all-cause death. The Cox proportional hazards model was used to calculate hazard ratios and 95 % confidence intervals. During the mean follow-up period of 3.4 ± 2.7 years, 61 deaths occurred. The median (interquartile range) of the FRAX(®) for major osteoporotic fracture was 6.9 (4.6-12.0) % in men and 19.0 (7.6-33.0) % in women. Cumulative survival rates at 5 years after starting dialysis, with the FRAX(®) levels above and below the median, were 51.9 and 87.9 %, respectively, in men and 67.4 and 83.7 %, respectively, in women. Overall, in men, the multivariate Cox regression analyses revealed that the log-transformed FRAX(®) remained an independent predictor of death after adjusting by confounding variables. However, in women, the significant association between the FRAX(®) value and the outcome was eliminated if age was put into these models. Among Japanese hemodialysis patients, the FRAX(®) seems to be useful for predicting death, especially in men.


Assuntos
Povo Asiático/estatística & dados numéricos , Fraturas por Osteoporose/epidemiologia , Diálise Renal/mortalidade , Medição de Risco/métodos , Idoso , Estudos de Coortes , Demografia , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Análise Multivariada , Modelos de Riscos Proporcionais , Fatores de Risco
8.
Intern Med ; 53(12): 1275-81, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24930645

RESUMO

OBJECTIVE: A link between urinary albumin excretion and an increased incidence of cardiovascular mortality has already been demonstrated. However, the reported prevalence of microalbuminuria (MAU) in patients with hypertension is highly variable. We therefore aimed to conduct a cross-sectional multicenter study to investigate the prevalence of urinary albumin excretion in treated hypertensive patients in our current practice. METHODS: A total of 1,258 hypertensive patients were enrolled in this study. Patients with macroalbuminuria were excluded. The concentrations of urinary microalbumin and creatinine were measured. Urinary albumin excretion was expressed as the ratio of albumin to creatinine excretion. RESULTS: The mean systolic and diastolic blood pressures were 130.9±12.7 mmHg and 74.7±8.9 mmHg, respectively. The overall prevalence of MAU was 42.8%, and it was observed in 35.8% of patients treated with a single medication. Patients with polyvascular disease exhibited a higher prevalence of MAU compared with patients with monovascular disease. The factors related to the presence of MAU included the estimated glomerular filtration rate (eGFR), systolic blood pressure, and glycated hemoglobin (HbA1c) level (odds ratios [ORs] of 0.988, 1.026, and 1.371, respectively). CONCLUSION: The present study showed that the prevalence of MAU among hypertensive patients was 42.8%, even in patients whose blood pressure was relatively well controlled. Additionally, the eGFR, systolic blood pressure, and HbA1c level are risk factors for the development of MAU. These findings suggest that a substantial number of hypertensive patients have MAU and highlight the importance of strictly controlling these factors to improve patient prognosis.


Assuntos
Albuminúria/epidemiologia , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Idoso , Albuminúria/diagnóstico , Albuminúria/etiologia , Anti-Hipertensivos/uso terapêutico , Estudos de Coortes , Creatinina/urina , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Hemoglobinas Glicadas/metabolismo , Humanos , Hipertensão/metabolismo , Japão , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Fatores de Risco
9.
J Atheroscler Thromb ; 21(6): 593-604, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24500142

RESUMO

AIM: The medical management of patients with chronic kidney disease(CKD) has changed within the past 20 years. We speculate that this change has resulted in a decrease in the prevalence of atherosclerotic cardiovascular disease in patients with CKD. The aim of the present study was to analyze changes in the prevalence of coronary artery disease(CAD) in patients newly started on hemodialysis, as well as trends in clinical factors and medications over the past two decades. METHODS: This single-center cross-sectional study examined data for 315 consecutive patients starting hemodialysis(age, 64±12 years; men, 73%; diabetic nephropathy, 57%) between January 1993 and December 2010. All patients were routinely screened for CAD within three months of starting hemodialysis, regardless of whether ischemic heart disease was suspected. The patients were categorized into six groups based on the date of the initial dialysis session in order to compare the historical prevalence of unidentified CAD(uCAD) in association with the clinical factors. In addition, we performed a subgroup analysis among 222 patients without known cardiac disease. RESULTS: The prevalence of uCAD gradually declined from 69% to 25% over 18 years(p<0.001 for trend). The mean high-density lipoprotein cholesterol(HDL-C) concentration increased(p<0.001 for trend), while the median C-reactive protein(CRP) level decreased over time. In parallel with these trends, the proportion of statin users significantly increased over time(p<0.001 for trend). The use of erythropoiesis-stimulating agents(ESAs) and renin angiotensin aldosterone system inhibitors(RAS-Is) also increased during the same period(both p<0.001 for trend). A univariate logistic regression analysis identified a significant association between the prevalence of uCAD and the use of ESAs(OR: 0.565, p=0.016) or RAS-Is(OR: 0.501, p=0.004). In addition, a lower BMI, lower HDL-Clevel and higher CRP level were found to be closely associated with uCAD, independent of confounding variables. The findings for the new dialysis patients without cardiac disease were similar. CONCLUSIONS: The prevalence of uCAD in patients with end-stage kidney disease has remarkably decreased over the past two decades. Major improvements in the medical management of CKD may modify the prevalence of coronary atherosclerosis.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Idoso , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , HDL-Colesterol/sangue , Doença da Artéria Coronariana/complicações , Estudos Transversais , Nefropatias Diabéticas/complicações , Feminino , Humanos , Incidência , Japão/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Diálise Renal
10.
Nephrology (Carlton) ; 18(7): 497-504, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23574011

RESUMO

AIM: The usefulness of the absolute N-terminal pro-brain natriuretic peptide (NT-ProBNP) concentration and its digit number for screening for cardiac disease was explored in new haemodialysis patients. METHODS: A cross-sectional study involving 71 (68 ± 14 years, 83% male) new dialysis patients was conducted. Receiver operator characteristic curve analysis was performed to identify the cutoff level of NT-proBNP for identifying cardiac disease at the start of dialysis. RESULTS: The median NT-proBNP concentration was 6576 pg/mL just before the first dialysis session and its mean digit number was 4.3 ± 0.6. Overall, 67%, 52%, 9% and 35% of patients had left ventricular (LV) hypertrophy, LV dilatation, systolic dysfunction and significant coronary artery disease, respectively. NT-proBNP levels of about 6000, 10,000 and 14,000 pg/mL were the best cutoff levels for the diagnosis of coronary artery disease (AUC, 0.754; P < 0.001), LV systolic dysfunction (area under the curve (AUC), 0.765, P = 0.001) and LV dilatation (AUC, 0.685, P = 0.008), respectively. Interestingly, 4.5 was the best digit number cutoff for all cardiac abnormalities. These findings suggest that a digit number of 5 or more means a potentially high risk for cardiovascular disease and a digit number of 3 or less means a relatively low risk. CONCLUSIONS: The NT-proBNP concentration just before the first dialysis session is a useful tool for screening for cardiac abnormalities. Considering the wide variation of the NT-proBNP cutoff levels depending on each cardiac abnormality, the digit number could be potentially easier to use for initial risk stratification for cardiac disease in new dialysis patients.


Assuntos
Cardiopatias/diagnóstico , Falência Renal Crônica/terapia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Diálise Renal , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Biomarcadores/sangue , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico , Estudos Transversais , Feminino , Cardiopatias/sangue , Cardiopatias/epidemiologia , Humanos , Hipertrofia Ventricular Esquerda/sangue , Hipertrofia Ventricular Esquerda/diagnóstico , Japão/epidemiologia , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Prevalência , Curva ROC , Medição de Risco , Fatores de Risco , Regulação para Cima , Disfunção Ventricular Esquerda/sangue , Disfunção Ventricular Esquerda/diagnóstico
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