Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 71
Filtrar
1.
Arch Iran Med ; 26(3): 126-137, 2023 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-37543935

RESUMO

BACKGROUND: Assessment of quality and cost of medical care has become a core health policy concern. We conducted a nationwide survey to assess these measures in Iran as a developing country. To present the protocol for the Iran Quality of Care in Medicine Program (IQCAMP) study, which estimates the quality, cost, and utilization of health services for seven diseases in Iran. METHODS: We selected eight provinces for this nationally representative short longitudinal survey. Interviewers from each province were trained comprehensively. The standard definition of seven high-burden conditions (acute myocardial infarction [MI], heart failure [HF], diabetes mellitus [DM], stroke, chronic obstructive pulmonary (COPD) disease, major depression, and end-stage renal disease [ESRD]) helped customize a protocol for disease identification. With a 3-month follow-up window, the participants answered pre-specified questions four times. The expert panels developed a questionnaire in four modules (demographics, health status, utilization, cost, and quality). The expert panel chose an inclusive set of quality indicators from the current literature for each condition. The design team specified the necessary elements in the survey to calculate the cost of care for each condition. The utilization assessment included various services, including hospital admissions, outpatient visits, and medication. RESULTS: Totally, 156 specialists and 78 trained nurses assisted with patient identification, recruitment, and interviewing. A total of 1666 patients participated in the study, and 1291 patients completed all four visits. CONCLUSION: The IQCAMP study was the first healthcare utilization, cost, and quality survey in Iran with a longitudinal data collection to represent the pattern, quantity, and quality of medical care provided for high-burden conditions.


Assuntos
Atenção à Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Humanos , Irã (Geográfico) , Hospitalização , Qualidade da Assistência à Saúde
2.
Int Urol Nephrol ; 52(11): 2179-2187, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32761485

RESUMO

PURPOSE: Insulin resistance (IR) is a prevalent disorder in advanced renal failure irrespective of diabetes. Adipokines might play a role in IR, which has not been well-documented in uremic conditions. This study investigated the relationship of Zinc-α2-glycoprotein (ZAG), adipose triglyceride lipase (ATGL), and adipolin with glucose-insulin homeostasis in normal weight (NW) and obese (OB) patients with hemodialysis. METHODS: In this cross-sectional study, 59 patients (29 NW; 18.5 ≤ BMI < 25 kg/m2, and 30 OB; BMI ≥ 30 kg/m2) were studied. Anthropometries, circulating ZAG, adipolin, ATGL, free fatty acids (FFAs), fasting blood glucose (FBG), insulin, and homeostasis model assessment of IR (HOMA)-IR were assessed. RESULTS: There were no significant differences in age, gender, hemodialysis duration, dialysis adequacy and diabetes between the two groups. ZAG (100.9 ± 37.1 vs. 107.5 ± 30.5 ng/mL, P = 0.03) and adipolin (12.4 ± 1.6 vs. 13.2 ± 2.8 ng/mL, P = 0.002) concentrations were significantly lower, and FFAs (228.1 ± 112.6 vs. 185 ± 119 ng/mL, P = 0.014) were significantly higher in the OB than NW group. No significant differences were observed in ATGL, FBG, insulin and HOMA-IR between the two groups. Patients with lower IR had higher ZAG (112.9 ± 31.7 vs. 94.9 ± 34.5 ng/mL; P = 0.046), lower FFAs (167.8 ± 98.4 vs. 249.9 ± 120.8 ng/mL; P = 0.004), and marginally lower ATGL (9.1 ± 5.2 vs. 12.3 ± 9.6 mIU/mL; P = 0.079) concentrations than those with higher IR. ZAG was negatively (r = - 0.323, P = 0.018 and r = - 0.266, P = 0.054) and FFAs were positively (r = 0.321, P = 0.019 and r = 0.353, P = 0.009) correlated with insulin and HOMA-IR, respectively. ATGL was directly correlated with FFAs (r = 0.314, P = 0.018). CONCLUSIONS: Novel adipokines, ZAG and ATGL, might contribute to glucose-insulin homeostasis in hemodialysis. Understanding potential causative, diagnostic or therapeutic roles of adipokines in IR require further studies.


Assuntos
Adipocinas/sangue , Glucose/fisiologia , Homeostase , Insulina/fisiologia , Falência Renal Crônica/terapia , Obesidade/sangue , Obesidade/fisiopatologia , Diálise Renal , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Obesidade/complicações
3.
J Res Pharm Pract ; 7(2): 69-76, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30050959

RESUMO

OBJECTIVE: Delayed graft function (DGF) is an early complication after kidney transplantation with negative impact on allograft outcomes. This study assessed the effect of delayed initiation of tacrolimus as a nephrotoxic drug, on DGF occurrence and allograft function. METHODS: This randomized, open-label clinical trial was conducted on kidney transplant recipients with the age of at least 14 years who underwent the first kidney transplantation from deceased or living donor. Patients were randomly allocated to immediate (n = 26) or delayed tacrolimus (n = 27) groups. All patients received thymoglobulin as induction therapy and similar maintenance immunosuppression including tacrolimus, mycophenolate, and prednisolone with the difference in the time of initiation of tacrolimus either on the day of transplantation (immediate tacrolimus group) or day 3 after transplant (delayed tacrolimus group). FINDINGS: DGF incidence (46.15% vs. 37.04%; P = 0.501) and duration (9.75 ± 6.41 vs. 8.6 ± 6.16 days; P = 0.675) were not different between the immediate and delayed tacrolimus groups. Estimated creatinine clearance using Cockcroft-Gault equation (63.14 ± 18.81 vs. 58.19 ± 19.42 mL/min in immediate and delayed tacrolimus groups respectively; P = 0.373) and estimated acute rejection-free survival were also comparable between the groups over the 3 months of follow-up. Compared with the immediate group, the delayed tacrolimus group showed higher estimated 3-month grafts' survival (100% vs. 84.27%; P = 0.072). CONCLUSION: Delayed initiation of tacrolimus after kidney transplantation under the umbrella of thymoglobulin induction did not result in either lower incidence or duration of DGF or improved the level of graft function in kidney transplant recipients but non-statistically significant increased 3-month grafts' survival.

4.
Nephrology (Carlton) ; 23(4): 331-337, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28152573

RESUMO

AIM: To bridge the gap in the current knowledge, the present study was conducted to obtain evidences relating to clinical outcomes of the end-stage renal disease (ESRD) population in Iran over the last two decades. METHODS: The records of 84 652 incident ESRD patients from 1995 up to and including 2014 in the national registry of ESRD patients were analyzed retrospectively. Data were collected from dialysis and transplant centres in Iran from 1995 to 2008 via paper forms and from 2009 to 2014 through web-based records. RESULTS: Mean age (SD) in incident cases of ESRD (57.7% male) was 52.5 (16.6) years. The prevalence of ESRD patients grew on average 14.9% and 5.3% annually in the periods of 1995-2004 and 2005-2014, respectively. Adjusted mortality rate among dialysis patients in 1995, 2005, and 2014 was 145, 154, and 177/ 1000 patient-years, respectively. Median graft half-life (IQR) and median expected remaining life-years (IQR) for dialysis patients in the 2003 incident patient cohort were 4.4 (1.9-8.3) and 4.2 (1.8-8.2) years, respectively. CONCLUSIONS: The overall slightly decreasing, and still comparable, survival trend in dialysis patients, despite the accessible and free dialysis treatment, may be the result of the counterbalance of different contributory factors, including increased age and the higher proportion of patients with co-morbidities resulting from diabetes and hypertension. The half-lives of renal allografts were generally shorter compared to thus far shared evidence, which may be due to tissue incompatibility. The decreasing trend, in this context, can be attributable to the increased number of transplantation from deceased donors with expanded criteria.


Assuntos
Falência Renal Crônica/terapia , Transplante de Rim , Diálise Renal , Adulto , Idoso , Feminino , Sobrevivência de Enxerto , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Estimativa de Kaplan-Meier , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Mortalidade , Prevalência , Sistema de Registros , Diálise Renal/efeitos adversos , Diálise Renal/mortalidade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
5.
Arch Med Res ; 48(5): 459-466, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29128140

RESUMO

BACKGROUND: Little is known about the potential relationship of obesity, adipose tissue and novel adipokines with cardiometabolic risk factors in end-stage renal disease. Zinc-α2-glycoprotein (ZAG) and adipose triglyceride lipase (ATGL) are novel adipokines with proposed desirable effects on inflammation, and lipid and glucose metabolism. The aim of this study was to investigate serum concentrations of ZAG and ATGL, and the relationship of these adipokines with cardiovascular risk factors in normal weight (NW) and obese (OB) patients undergoing hemodialysis. METHODS: Patients with regular hemodialysis including 44 normal weight (18.5

Assuntos
Peso Corporal , Doenças Cardiovasculares/sangue , Falência Renal Crônica/sangue , Lipase/sangue , Obesidade/sangue , Proteínas de Plasma Seminal/sangue , Adipocinas , Adulto , Proteína C-Reativa/metabolismo , Feminino , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/metabolismo , Lipoproteínas HDL/sangue , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Diálise Renal , Fatores de Risco , Triglicerídeos/sangue , Glicoproteína Zn-alfa-2
6.
Iran J Kidney Dis ; 11(5): 379-384, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29038394

RESUMO

INTRODUCTION: Data on risk factors associated with low bone mineral density are limited in patients with end-stage renal disease. This study evaluated the factors deemed associated with lumbar and femoral Z and T scores. MATERIALS AND METHODS: Clinical and demographic data of 98 patients waiting for kidney transplantation were collected, as well as lumbar and femoral bone densitometries, before transplantation. Osteoporosis and osteopenia and factors associated with bone mineral density were assessed. RESULTS: According to the femoral T score, 38.8% (95% confidence interval [CI], 29.1% to 48.4%), 44.9% (95% CI, 35.1% to 54.7%), and 16.3% (95% CI, 9.0% to 23.6%) of the patients had normal bone density, osteopenia, and osteoporosis, respectively. According to the lumbar T score, 54.1% (95% CI, 44.2% to 63.9%), 33.7% (95% CI, 24.3% to 44.0%), and 12.2% (95% CI, 5.8% to 18.7%) of the patients had normal density, osteopenia, and osteoporosis, respectively. Age, serum levels of creatinine and parathyroid hormone, and use of calcitriol and calcium carbonate were associated with femoral densitometry scores. Serum total protein level, Rh-negative status, and B blood type were associated with the lumbar scores. CONCLUSIONS: Parathyroid hormone contributed to bone loss in our kidney transplant candidates, and B and Rh-negative blood types were associated with a higher risk of lumbar osteoporosis while total protein was negatively associated with the risk of bone loss. Calcitriol might improve femoral mineral density, but calcium carbonate was negatively associated with femoral bone density. Age and higher creatinine levels were associated with higher femoral bone densities.


Assuntos
Densidade Óssea , Colo do Fêmur/diagnóstico por imagem , Falência Renal Crônica/complicações , Vértebras Lombares/diagnóstico por imagem , Osteoporose/etiologia , Absorciometria de Fóton , Adolescente , Adulto , Idoso , Creatinina/sangue , Estudos Transversais , Feminino , Humanos , Falência Renal Crônica/terapia , Transplante de Rim , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Osteoporose/sangue , Osteoporose/diagnóstico por imagem , Hormônio Paratireóideo/sangue , Diálise Renal , Fatores de Risco , Adulto Jovem
7.
Nutr Diet ; 74(3): 283-290, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28731598

RESUMO

AIM: Protein-energy wasting (PEW) is prevalent in haemodialysis. Obesity is an independent risk factor of kidney insufficiency, but it is proposed to have beneficial roles in better outcomes in the final stage of disease. Better nutritional status and body reserves are among probable mechanisms, but direct examinations are limited. The present study aimed to investigate whether obese patients have preferable nutritional status compared to normal weight patients based on malnutrition inflammation score (MIS) and other PEW parameters in haemodialysis. METHODS: This case-control study investigated 52 normal weight (18.5 < body mass index (BMI) < 25 kg/m2 ) and 48 obese (BMI≥30 kg/m2 ) patients on regular haemodialysis. PEW was assessed based on anthropometric and biochemical factors, recent weight changes, appetite, anorexia, dietary intake and MIS. RESULTS: Obese patients had better MIS compared with the normal weight group (P < 0.001), although varying degrees of wasting were prevalent among this group too (75% mild and 25% moderate wasting). The obese group had less significant weight loss (4.2 vs 8%) and anorexia and better appetite. However, a considerable percentage of patients in both groups showed muscle (94.6% of normal weight and 19.5% of obese) and peripheral fat tissue (89.2% of normal weight and 31.7% of obese) losses compared to the 50th percentile. Biochemical parameters were not significantly different between groups except for triglyceride (P = 0.001), transferrin and total iron-binding capacity (P = 0.028). CONCLUSIONS: MIS was significantly better in obese patients; however, both groups showed degrees of wasting based on MIS and other PEW parameters. Nutritional status of obese haemodialysis patients should be monitored regularly because of high risk of PEW like other BMI categories.

8.
Eur J Clin Invest ; 47(8): 545-554, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28621798

RESUMO

BACKGROUND: Protein-energy wasting is a prevalent disorder in haemodialysis. Zinc-α2-glycoprotein (ZAG) and adipose triglyceride lipase (ATGL) are novel adipokines with recognized lipolytic effects and proposed role in metabolic homoeostasis. This study was conducted to investigate the association of ZAG and ATGL concentrations with malnutrition-inflammation score (MIS) and metabolic profile of patients with haemodialysis. MATERIALS AND METHODS: Eighty-eight patients under regular haemodialysis were divided based on MIS to normal to mild wasting (NMW; n = 35) or moderate wasting (MW; n = 53) group. Anthropometric measurements along with fasting serum concentrations of ZAG, ATGL, free fatty acids (FFAs), albumin, transferrin, total iron-binding capacity (TIBC), hs-CRP, lipid profile and glucose metabolism were assessed. RESULTS: Adipose triglyceride lipase concentration was significantly higher in MW than NMW group (10·89 ± 5·7 vs. 8·02 ± 3·37 mIU/mL; P = 0·008). The ZAG and FFAs were not significantly different between two groups. ATGL was directly correlated with FFAs in all of the patients (r = 0·284, P = 0·007) and MW (r = 0·32, P = 0·021), and marginally in NMW (r = 0·31, P = 0·057) groups. ATGL and odds of having mild or moderate wasting were significantly correlated (OR = 1·21, P = 0·033). A positive association was observed between ATGL with TG (r = 0·31, P = 0·049) and also with transferrin and TIBC (r = 0·44, P = 0·001) only in MW group. An inverse relationship was observed between ATGL and HDL in all of the participants (r=-0·222, P = 0·04). No significant correlation was observed between ZAG and other parameters. CONCLUSIONS: The serum concentrations of ATGL, but not ZAG, were significantly higher in MW compared to NMW group. Each unit increase in ATGL concentrations was correlated with 21% increase in the odds of wasting severity. ATGL might play a role in wasting pathogenesis and metabolic profile in haemodialysis.


Assuntos
Adipocinas/metabolismo , Lipase/metabolismo , Desnutrição Proteico-Calórica/sangue , Diálise Renal , Proteínas de Plasma Seminal/metabolismo , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Paniculite/sangue , Desnutrição Proteico-Calórica/etiologia , Glicoproteína Zn-alfa-2
9.
J Renal Inj Prev ; 6(2): 83-87, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28497080

RESUMO

Introduction: Chronic kidney disease (CKD) includes a wide range of pathophysiological processes which will be observed along with abnormal function of kidneys and progressive decrease in glomerular filtration rate (GFR). According to the definition decreasing GFR must have been present for at least three months. CKD will eventually result in end-stage kidney disease. In this process different factors play role and finding the relations between effective parameters in this regard can help to prevent or slow progression of this disease. There are always a lot of data being collected from the patients' medical records. This huge array of data can be considered a valuable source for analyzing, exploring and discovering information. Objectives: Using the data mining techniques, the present study tries to specify the effective parameters and also aims to determine their relations with each other in Iranian patients with CKD. Material and Methods: The study population includes 31996 patients with CKD. First, all of the data is registered in the database. Then data mining tools were used to find the hidden rules and relationships between parameters in collected data. Results: After data cleaning based on CRISP-DM (Cross Industry Standard Process for Data Mining) methodology and running mining algorithms on the data in the database the relationships between the effective parameters was specified. Conclusion: This study was done using the data mining method pertaining to the effective factors on patients with CKD.

10.
Acta Inform Med ; 24(4): 266-270, 2016 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-27708490

RESUMO

INTRODUCTION: Case-based reasoning (CBR) systems are one of the effective methods to find the nearest solution to the current problems. These systems are used in various spheres as well as industry, business, and economy. The medical field is not an exception in this regard, and these systems are nowadays used in the various aspects of diagnosis and treatment. METHODOLOGY: In this study, the effective parameters were first extracted from the structured discharge summary prepared for patients with chronic kidney diseases based on data mining method. Then, through holding a meeting with experts in nephrology and using data mining methods, the weights of the parameters were extracted. Finally, fuzzy system has been employed in order to compare the similarities of current case and previous cases, and the system was implemented on the Android platform. DISCUSSION: The data on electronic discharge records of patients with chronic kidney diseases were entered into the system. The measure of similarity was assessed using the algorithm provided in the system, and then compared with other known methods in CBR systems. CONCLUSION: Developing Clinical fuzzy CBR system used in Knowledge management framework for registering specific therapeutic methods, Knowledge sharing environment for experts in a specific domain and Powerful tools at the point of care.

11.
Cell Tissue Bank ; 17(4): 603-610, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27501816

RESUMO

Durability and the rate of complications of homograft heart valves, adjusted for patient-related contributors and surgical techniques, rely mainly on the quality of allografts which in turn are mirrored in the donor characteristics and most importantly recovery and processing procedures. Aimed to assess the quality, a study was conducted to figure out the durability and late outcome following homograft replacement with valved conduits procured by the Iranian Tissue Bank. Retrospectively, the pre-implantation, perioperative and follow-up data of 400 non-consecutive recipients of cryopreserved heart valves (222 pulmonary and 178 aortic) from 2006 to 2015 were collected and analyzed in terms of variables reflecting late outcome including adverse events and durability. In the context of durability, the event of interest was defined as the need for homograft replacement and homograft-related death. The mean follow-up time (SD) of study entrants (male/female ratio, 1.4) was 49.8 (36.3) months. Median age at the time of implantation was 11 years. Total 10-years mortality was 21 % (84/400), including 66.7 % early (30-days mortality: 56/84) and 33.3 % late (28/84). Overall late complication rate was 2 %. Median survival time was 120 months (95 % CI 83.3-156.6). The pulmonary valves appeared to be more durable (P value <0.001) and survival probabilities in small sized grafts were lower (P value 0.008). One-, five-, and ten-year graft survival was 82, 76 and 73 %, respectively. The evidences suggest that the homografts function satisfactory with low rate of late complications; nevertheless, more emphasis should be given to make long-term durability comparable.


Assuntos
Sobrevivência de Enxerto , Valvas Cardíacas/transplante , Valva Pulmonar/transplante , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aloenxertos , Criança , Pré-Escolar , Criopreservação , Feminino , Seguimentos , Humanos , Lactente , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Preservação de Órgãos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Análise de Sobrevida , Bancos de Tecidos , Doadores de Tecidos , Transplante Homólogo/efeitos adversos , Transplante Homólogo/métodos , Adulto Jovem
12.
Ann Transplant ; 21: 463-8, 2016 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-27457730

RESUMO

The ability of kidney transplantation to improve quality of life has made this therapeutic modality the treatment of choice among renal replacement therapies; however, the continuing organ shortage has forced the use of marginal kidneys as a supplementary source of allografts. It has been repeatedly suggested that failed kidney transplant recipients have greater morbidity and mortality compared with dialysis patients with no renal transplant history. Achieving an optimal balance between the advantages of kidney transplant and disadvantages of allografts with marginal quality is a topic of controversy in transplant medicine. The major and potentially life-threatening complications of immunosuppressive therapies and shorter lifespan following graft failure necessitate a reappraisal of kidney transplant programs from expanded-criteria deceased donors, which can neither necessarily give dialysis patients a better quality of life nor a significant survival benefit, especially in settings with additional diminished graft survival due to HLA-mismatch. It should be offered just to those with short life expectancy and with HLA-matching. The last item is very important in countries without mandatory HLA-matching protocols for kidney transplantation programs.


Assuntos
Seleção do Doador , Transplante de Rim , Doadores de Tecidos/provisão & distribuição , Cadáver , Rejeição de Enxerto , Sobrevivência de Enxerto , Teste de Histocompatibilidade , Humanos , Falência Renal Crônica/mortalidade , Falência Renal Crônica/cirurgia , Falência Renal Crônica/terapia , Terapia de Substituição Renal , Análise de Sobrevida , Obtenção de Tecidos e Órgãos
13.
Clin Nephrol ; 86 (2016)(13): 101-105, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27469150

RESUMO

AIMS: To delineate the kidney transplantation programs in the Middle East and to provide a comparative summary with other international datasets where deemed appropriate. PATIENTS AND METHODS: Data regarding kidney transplantation as the treatment of choice amongst renal replacement therapies in different countries in the Middle East was analyzed from 2004 to 2013. The number of kidney transplants and the source of kidneys were important topics of comparison. All data was collected from published reports and international registries. RESULTS: Eight of 23 countries in the Middle East had active kidney transplantation programs from both living and deceased donors in 2013. The kidney transplantation rate in 2013 was 11.5 per million population in the Middle East compared with 31.68 in America, 27.38 in Europe, 5.68 in the Western Pacific, 3.38 in South Asia, and 0.5 in Africa. The proportion of kidney transplants from deceased donors was 69.5%, 63.1%, 60.9%, 30.2%, 19.4%, and 6.2% in Europe, America, the Western Pacific, the Middle East, South Asia, and Africa, respectively. CONCLUSIONS: Public education on the subject of brain death and cadaveric organs as a reliable source of saving lives and provision of better infrastructure could increase the rate of kidney transplantation from brain-dead donors. Lack of funds and a negative attitudes towards organ donation are the main barriers in the Middle East.


Assuntos
Transplante de Rim/estatística & dados numéricos , Atitude Frente a Saúde , Morte Encefálica/legislação & jurisprudência , Cadáver , Educação em Saúde , Recursos em Saúde , Humanos , Doadores Vivos/estatística & dados numéricos , Oriente Médio , Opinião Pública , Terapia de Substituição Renal/estatística & dados numéricos , Fatores Socioeconômicos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos
14.
Lancet Glob Health ; 4(5): e307-19, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27102194

RESUMO

BACKGROUND: Chronic kidney disease is an important cause of global mortality and morbidity. Data for epidemiological features of chronic kidney disease and its risk factors are limited for low-income and middle-income countries. The International Society of Nephrology's Kidney Disease Data Center (ISN-KDDC) aimed to assess the prevalence and awareness of chronic kidney disease and its risk factors, and to investigate the risk of cardiovascular disease, in countries of low and middle income. METHODS: We did a cross-sectional study in 12 countries from six world regions: Bangladesh, Bolivia, Bosnia and Herzegovina, China, Egypt, Georgia, India, Iran, Moldova, Mongolia, Nepal, and Nigeria. We analysed data from screening programmes in these countries, matching eight general and four high-risk population cohorts collected in the ISN-KDDC database. High-risk cohorts were individuals at risk of or with a diagnosis of either chronic kidney disease, hypertension, diabetes, or cardiovascular disease. Participants completed a self-report questionnaire, had their blood pressure measured, and blood and urine samples taken. We defined chronic kidney disease according to modified KDIGO (Kidney Disease: Improving Global Outcomes) criteria; risk of cardiovascular disease development was estimated with the Framingham risk score. FINDINGS: 75,058 individuals were included in the study. The prevalence of chronic kidney disease was 14·3% (95% CI 14·0-14·5) in general populations and 36·1% (34·7-37·6) in high-risk populations. Overall awareness of chronic kidney disease was low, with 409 (6%) of 6631 individuals in general populations and 150 (10%) of 1524 participants from high-risk populations aware they had chronic kidney disease. Moreover, in the general population, 5600 (44%) of 12,751 individuals with hypertension did not know they had the disorder, and 973 (31%) of 3130 people with diabetes were unaware they had that disease. The number of participants at high risk of cardiovascular disease, according to the Framingham risk score, was underestimated compared with KDIGO guidelines. For example, all individuals with chronic kidney disease should be considered at high risk of cardiovascular disease, but the Framingham risk score detects only 23% in the general population, and only 38% in high-risk cohorts. INTERPRETATION: Prevalence of chronic kidney disease was high in general and high-risk populations from countries of low and middle income. Moreover, awareness of chronic kidney disease and other non-communicable diseases was low, and a substantial number of individuals who knew they were ill did not receive treatment. Prospective programmes with repeat testing are needed to confirm the diagnosis of chronic kidney disease and its risk factors. Furthermore, in general, health-care workforces in countries of low and middle income need strengthening. FUNDING: International Society of Nephrology.


Assuntos
Conscientização , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Hipertensão/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Adulto , Idoso , Bangladesh/epidemiologia , Bolívia/epidemiologia , Bósnia e Herzegóvina/epidemiologia , China/epidemiologia , Estudos de Coortes , Estudos Transversais , Diabetes Mellitus/diagnóstico , Egito/epidemiologia , Feminino , República da Geórgia/epidemiologia , Humanos , Hipertensão/diagnóstico , Índia/epidemiologia , Irã (Geográfico)/epidemiologia , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Moldávia/epidemiologia , Mongólia/epidemiologia , Nepal/epidemiologia , Nigéria/epidemiologia , Prevalência , Insuficiência Renal Crônica/diagnóstico , Fatores de Risco , Inquéritos e Questionários
15.
Iran J Kidney Dis ; 11(1): 1-11, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28174346

RESUMO

INTRODUCTION: The aim of this systematic review and meta-analysis was to evaluate the efficacy-related events and adverse events of 2 different doses of everolimus in kidney transplant recipients. MATERIALS AND METHODS: The Cochrane, PubMed, and Google Scholar databases were searched for randomized controlled trials published by the end of 2015 on the use of everolimus in kidney transplant recipients at doses of 1.5 mg/d and 3 mg/d. Two independent reviewers assessed the studies for quality and eligibility and extracted the data. The relative risk (RR) and 95% confidence interval (CI) for treated efficacy-related events and adverse events were collected to calculate pooled measures. RESULTS: A total of 8 articles describing 7 randomized controlled trials (n = 2148 participants) were included in this study. The overall RR in adverse event outcomes was significantly in favor of the lower dose of everolimus (RR, 0.96; 0.95% CI, 0.93 to 0.99; P < .001). The overall risk of graft loss was lower with 1.5 mg/d of everolimus (RR, 0.76; 0.95% CI, 0.59 to 0.99; P = .04, I2 = 25.0%). There was no relationship between the rates of efficacy failure, biopsy-proven acute rejection, death, or loss to follow up outcomes in all the three time follow-up times between the two doses of everolimus. CONCLUSIONS: The result of this systematic review and meta-analysis showed that the overall outcomes of adverse events and graft loss were better with everolimus, 1.5 mg/d, than with everolimus, 3 mg/d, when combined with other kidney transplantation medications.


Assuntos
Everolimo , Rejeição de Enxerto/prevenção & controle , Transplante de Rim , Relação Dose-Resposta a Droga , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Everolimo/administração & dosagem , Everolimo/efeitos adversos , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Resultado do Tratamento
16.
Hemodial Int ; 20(2): 261-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25991066

RESUMO

Low vitamin D levels have been linked to metabolic syndrome in the general population. In the present study, the relationship between inadequate serum concentrations of vitamin D and metabolic syndrome in patients with end-stage renal disease undergoing hemodialysis was explored. In a cross-sectional setting, 145 patients undergoing maintenance hemodialysis were enrolled. Metabolic syndrome was defined using the International Diabetes Federation criteria. Serum concentration of 25(OH) vitamin D was determined by a commercially available enzyme immunosorbent assay method. The prevalence of metabolic syndrome was 53.1%. The prevalence rate of severe vitamin D deficiency (<5 ng/mL) was 3.4%, mild vitamin D deficiency (5-15 ng/mL) 31.0%, vitamin D insufficiency (16-30 ng/mL) 36.6%, and vitamin D sufficiency (>30 ng/mL) 29.0%. With the increasing number of metabolic abnormalities, vitamin D levels significantly decreased (P for trend = 0.028). Among the components of metabolic syndrome, vitamin D deficiency was significantly associated with central obesity (odds ratio [OR], 95% confident interval [CI] = 2.80, 1.11-7.04, P = 0.028). A positive, but nonsignificant association between vitamin D deficiency and raised fasting plasma glucose was noted (OR, 95% CI = 2.40, 0.94-6.11, P = 0.067). Both vitamin D deficiency and insufficiency were significantly associated with an increased likelihood of having metabolic syndrome (P < 0.05). In a final model controlling for age, sex, and parathyroid hormone levels, vitamin D deficiency increased the odds of having metabolic syndrome by more than threefold (OR, 95% CI = 3.26, 1.30-8.20, P = 0.012). Low levels of vitamin D are frequent among hemodialysis patients and are associated with the metabolic syndrome.


Assuntos
Falência Renal Crônica/complicações , Síndrome Metabólica/complicações , Diálise Renal/efeitos adversos , Deficiência de Vitamina D/etiologia , Vitamina D/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
Glob Cardiol Sci Pract ; 2016(1): e201607, 2016 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-29043257

RESUMO

Tissue transplantation is a life-enhancing therapeutic modality for damaged or non-functioning tissues. In most cases, there is no alternative other than human tissue as replacement, and taking into account the ever-increasing demand for tissue grafts, it makes sense to set up an establishment in charge of human tissue procurement to meet local needs. A quality assurance system, clearly defined standards, and regular audits complement the infrastructure which make this activity feasible. The process of tissue procurement consists of donor identification, consent, tissue recovery, donor screening and testing, tissue processing, preservation, packaging, labeling, terminal sterilization, storage and distribution. The transplantation of homograft heart valves remains controversial, due to the availability of prosthetic and bioprosthetic alternatives. The limited durability of homografts has not yet outweighed the advantages which this graft offers. Adherence to regulations and regularly revised guidelines improve long-term efficacy and minimizes complications or malfunction. Furthermore, the lower price of homograft heart valves and the removal of the need for a lifetime of anticoagulation therapy are noteworthy advantages of this replacement. In our practice, the proportion of homograft heart valves meeting release criteria and successfully implanted grafts were 83% and 95%, respectively.

18.
J Renal Inj Prev ; 4(2): 34-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26060835

RESUMO

INTRODUCTION: Microalbuminuria has been now recognized as the most important risk factor for the increased morbidity and mortality in the obese population. OBJECTIVES: We aimed to know whether severity of obesity is associated with the presence of renal injury while microalbuminuria acts, independent of other risk factors as hypertension and diabetes mellitus. PATIENTS AND METHODS: The current cross-sectional study was conducted on consecutive obese normotensive nondiabetic individuals. Two groups of adult individuals were selected as controls comprised of 161 obese adults with body mass index (BMI) 30-35 kg/m(2) and 25 very obese adults as cases with BMI more than 35 kg/m(2). Microalbuminuria was defined as abnormal urinary albumin to creatinine ratio (UACR) more than 30 mg/g of creatinine. RESULTS: No significant differences in serum creatinine level, urinary albumin concentration, as well as UACR between obese and very obese individuals was seen. Using Pearson correlation coefficient analysis, no significant correlation was observed between BMI and parameters of renal function. Microalbuminuria was more prevalent in very obese individuals compared with obese group (24.0% versus 9.9%, P = 0.043) in univariate analysis. CONCLUSION: Severe obesity compared with milder obesity status cannot predict the occurrence of increased urinary albumin excretion and microalbuminuria.

19.
Clin Nephrol ; 83(7 Suppl 1): 90-4, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25725250

RESUMO

INTRODUCTION: The history of organ shortage has been approached differently by different countries. This review tries to discuss the inverted funnel approach of Iran. METHODS: The whole history of transplants in the country can be divided in three phases of legally regulated living unrelated kidney donation, legislation of brain death donation and lastly how it has been implemented. In each phase, there have been attempts to clarify the role of each sector: the government, professionals, and the public. RESULTS: Based on more than 20 years of experience, it has been shown that kidney transplants from brain dead donors (BDDs) increased from 0.4 per million population (pmp) in 2000 to 2.9 pmp in 2005, 7.9 in 2010, and 15.1 pmp in 2013 and it could eventually change the rate from living source from 20.1 pmp, 24.5 pmp, 21.8 pmp, and 19.5 pmp in these years, respectively. DISCUSSION: It has been shown that the government began to take part when it was convinced that an organ procurement program from BDDs is not a luxury program but can lessen the economic burden on the health budget and be supported by legislations and budget allocation. Professionals took the responsibility not only to make decision makers and the public aware of the subject and adapt the national protocols to consider the general population concerns, but also to train as many medical teams as possible nationwide. Persistence and publishing the results can pave the way for the public to accept the program and take their own responsibilities to solve the problem of organ shortage by taking the opportunity to give life to others after the death of a loved one.


Assuntos
Transplante de Rim/métodos , Desenvolvimento de Programas/métodos , Doadores de Tecidos/provisão & distribuição , Obtenção de Tecidos e Órgãos/organização & administração , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...