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1.
Nephrol Dial Transplant ; 27(10): 3935-42, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22561583

RESUMO

BACKGROUND: Intradialytic hypotension (IDH) is still a major clinical problem for haemodialysis (HD) patients. Haemodiafiltration (HDF) has been shown to be able to reduce the incidence of IDH. METHODS: Fifty patients were enrolled in a prospective, randomized, crossover international study focussed on a variant of traditional HDF, haemofiltration with endogenous reinfusion (HFR). After a 1-month run-in period on HFR, the patients were randomized to two treatments of 2 months duration: HFR (Period A) or HFR-Aequilibrium (Period B), followed by a 1-month HFR wash-out period and then switched to the other treatment. HFR-Aequilibrium (HFR-Aeq) is an evolution of the haemofiltration with endogenous reinfusion (HFR) dialysis therapy, with dialysate sodium concentration and ultrafiltration rate profiles elaborated by an automated procedure. The primary end point was the frequency of IDH. RESULTS: Symptomatic hypotension episodes were significantly lower on HFR-Aeq versus HFR (23 ± 3 versus 31 ± 4% of sessions, respectively, P l= l0.03), as was the per cent of clinical interventions (17 ± 3% of sessions with almost one intervention on HFR-Aeq versus 22 ± 2% on HFR, P <0.01). In a post-hoc analysis, the effect of HFR-Aeq was greater on more unstable patients (35 ± 3% of sessions with hypotension on HFR-Aeq versus 71 ± 3% on HFR, P <0.001). No clinical or biochemical signs of Na/water overload were registered during the treatment with HFR-Aeq. CONCLUSIONS: HFR-Aeq, a profiled dialysis supported by the Natrium sensor for the pre-dialysis Na(+) measure, can significantly reduce the burden of IDH. This could have an important impact in every day dialysis practice.


Assuntos
Biorretroalimentação Psicológica/métodos , Hemodiafiltração/métodos , Hipotensão/prevenção & controle , Sódio/sangue , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Estudos Cross-Over , Feminino , Hemodiafiltração/efeitos adversos , Hemodinâmica , Humanos , Hipotensão/etiologia , Hipotensão/fisiopatologia , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Volume Plasmático/fisiologia , Estudos Prospectivos , Fatores de Tempo
2.
G Ital Nefrol ; 29(2): 205-9, 2012.
Artigo em Italiano | MEDLINE | ID: mdl-22538949

RESUMO

Human papillomavirus (HPV) infection is a risk factor for the development of cervical intraepithelial neoplasia (CIN). The incidence of certain cancers such as HPV-associated CIN is higher among dialysis patients than in the general population. In the literature there are few studies on the prevalence of HPV infection among dialyzed women and almost all of these studies concerned women with positive Pap smears. We enrolled 73 hemodialyzed women attending our center from January 2009 to December 2010; 29 denied informed consent and 44 underwent Pap tests and cervical curettage for HPV (mean age 62 ± 15 years). We found HPV positivity in 6 women (prevalence 13.6%). The prevalence of CIN in our sample was also 13.6% (6/44), 83.3% of which HPV related. Since cervical curettage for HPV is a cheap and easy to perform test with high specificity and sensitivity, we believe it is worthwhile including it in the pre-transplant workup of such women to lower the incidence of CIN in dialyzed patients and transplant recipients.


Assuntos
Infecções por Papillomavirus/epidemiologia , Diálise Renal , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/virologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
3.
J Vasc Access ; 13(2): 208-14, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22139741

RESUMO

PURPOSE: The native arteriovenous fistula is the gold standard for hemodialysis access. Unfortunately, the wrist fistula is often not practical and the upper arm fistula is hindered by several complications. The aim of this study is to assess the safety of the middle-arm fistula as additional native access. METHODS: We reviewed and compared the patency rates at 12, 48, and 60 months of distal, middle, and upper arm fistula performed from January 2003 to December 2008. For diabetic and old patients we compared distal and middle-arm fistulas. RESULTS: Of 273 native access, 149 (54.6%) were distal, 92 (33.7%) middle-arm, and 32 (11.7%) upper fistula. Patency rates were 81%, 58%, and 52% for distal, 85%, 69%, and 69% for middle-arm, and 82%, 46%, and 29% for upper arm fistula (P NS). Patency rates were 92%, 70%, and 54% in middle-arm fistula as first access and 80%, 71%, and 71% in middle-arm fistula as a rescue access (P NS). Among patients > 75 years patency rates were 78%, 62%, and 62% for distal and 87%, 67%, and 67% for middle-arm fistula. Among diabetic subjects patency rates were 81%, 58%, and 58% for middle-arm and 65%, 57%, and 57% for distal fistula at 12, 48, and 60 months (P NS) respectively. CONCLUSIONS: A middle-arm fistula is as safe as a distal fistula among dialyzed patients, even diabetic and elderly. This could be considered a reliable option to expand native accesses.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Diálise Renal , Extremidade Superior/irrigação sanguínea , Fatores Etários , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Distribuição de Qui-Quadrado , Complicações do Diabetes/etiologia , Feminino , Humanos , Itália , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
4.
J Nephrol ; 24(4): 507-14, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21240867

RESUMO

BACKGROUND: B-type natriuretic peptide (BNP) is released in response to extracellular volume and blood pressure (BP) overload and is a risk factor for cardiovascular diseases (CVD). BNP is increased in dialyzed patients (HDpts). The aim of this study was to evaluate the relationships between BNP and renin, aldosterone and blood volume reduction rate (BV/WL), with the presence of CVD and mortality. METHODS: Fifty-one HDpts aged 70 ± 14 years were enrolled. BP, BV/WL, BNP, aldosterone, renin, C-reactive protein (CRP), troponin I and routine biochemistry were measured. According to the predialytic plasma BNP levels, the patients were divided into group A with higher BNP and group B with lower BNP than the median value of 330 pg/mL. Follow-up was 1 year. RESULTS: After HD, plasma BNP (449.6 ± 582.2 pg/mL vs. 264.1 ± 269.8 pg/mL, p=0.0008) and aldosterone (421.8 ± 573.4 pg/mL vs. 265.1 ± 566.2 pg/mL, p=0.0003) decreased, but not rennin. BNP decreased more after hemodiafiltration than after standard HD (-55.1% ± 28.5% vs. -26.5% ± 19.5%, p=0.002). Patients in group A exhibited more diabetes (58% vs. 28%, p=0.03), ischemic heart disease (42% vs. 16%, p=0.04), left ventricular hypertrophy (88.8% vs. 33.3%, p<0.001), elevated levels of troponin I, CRP (50% vs. 24%, p=0.05), and low BV/BWL in a lower percentage (8% vs. 32%, p=0.03). After 11.2 ± 3.5 months, 8 patients (33.3%) had died in group A and 2 (8%) in group B (p=0.02). CONCLUSION: This study demonstrates that BNP is high in HDpts and decreases after HD. It is correlated with a good capacity for plasma refilling, with diabetes, CVD and short-term mortality risk.


Assuntos
Volume Sanguíneo/fisiologia , Doenças Cardiovasculares/sangue , Hemodiafiltração , Falência Renal Crônica/sangue , Peptídeo Natriurético Encefálico/sangue , Idoso , Idoso de 80 Anos ou mais , Aldosterona/sangue , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/mortalidade , Diabetes Mellitus/sangue , Líquido Extracelular/fisiologia , Feminino , Deslocamentos de Líquidos Corporais/fisiologia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/fisiologia , Renina/sangue , Troponina I/sangue , Redução de Peso/fisiologia
5.
J Nephrol ; 24(2): 165-76, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-20586025

RESUMO

BACKGROUND: Few reports have addressed how current practice reflects uncertainty as to the optimal management of renal replacement therapy (RRT) in Western countries. Current dialytic practice for 2007 in the northwest of Italy was assessed. METHODS: A total of 24 nephrology and dialysis centers covering all of the RRT provided in the intensive care units (ICUs) in northwest Italy took part in the survey. Consultant nephrologists of each center reported their own activities throughout the year 2007 by an e-mailed questionnaire. RESULTS: RRT for a total of 7,842 days was provided by 24 dialysis centers in 79 ICUs for 1,118 patients. RRT median duration (5.76 days/patient) increased with the increasing number of hospital ICU beds. Of the RRT cases, 69.9% were due to acute kidney injury, 23.6% for continuation of a treatment in chronic dialysis patients and 4.2% for extrarenal indications. More than 90% of the patients were treated with high permeability membranes, at a median target dosage of 35.0 ml/kg per hour in continuous (39.4%) or extended modality (6-14 hours, 38.5%). Unfractionated heparin was the most common anticoagulant used (67.5%, median 500 IU/hour). In patients at high risk of bleeding, RRT without or with heparin at low-dose + saline flushes was the most commonly adopted line of treatment, followed by citrate (18% of days of dialysis). The decision to start RRT was made by nephrologists alone or in collaboration with intensivists, whereas dose prescriptions were given by nephrologists alone. CONCLUSIONS: This survey may represent a useful starting point for further research into changes in RRT practice and the adoption of common, shared protocols.


Assuntos
Injúria Renal Aguda/terapia , Unidades de Terapia Intensiva/estatística & dados numéricos , Nefropatias/terapia , Padrões de Prática Médica/estatística & dados numéricos , Terapia de Substituição Renal/métodos , Injúria Renal Aguda/epidemiologia , Anticoagulantes/uso terapêutico , Doença Crônica , Pesquisas sobre Atenção à Saúde , Heparina/uso terapêutico , Humanos , Itália/epidemiologia , Nefropatias/epidemiologia , Encaminhamento e Consulta , Estudos Retrospectivos , Inquéritos e Questionários
6.
G Ital Nefrol ; 27(5): 522-6, 2010.
Artigo em Italiano | MEDLINE | ID: mdl-20922684

RESUMO

With 135 million cases the prevalence of diabetes mellitus (DM) is very high worldwide. Diabetic nephropathy is a major complication of DM. In many countries diabetic nephropathy has become the most frequent cause of endstage renal disease. It is believed that in diabetic patients the creation of a native vascular access (NVA) might be difficult. We evaluated 274 occurrences of NVA creation during the period January 2003 to December 2008: 68 in diabetic patients (group 1) and 206 in nondiabetics (group 2). We compared the type of NVA, primary failure, and primary patency in these groups. Age was significantly higher in diabetic patients (68 vs 64 years; p < 0.05). No statistical differences in primary failure between groups were found for any NAV. Wrist vascular access survival rates were higher in diabetic versus nondiabetic patients (56.9% vs 20.7% at 72 months). No statistical differences were observed between groups in primary patency rates for middle- and upper-arm vascular access. According to our experience diabetes does not lead to additional difficulties in the creation of permanent vascular access, provided proper physical and instrumental examination is performed. Despite the advanced age of the diabetic patients in our study, wrist vascular access showed better results in this group than in nondiabetic patients on long-term follow-up.


Assuntos
Derivação Arteriovenosa Cirúrgica , Nefropatias Diabéticas/terapia , Diálise Renal/métodos , Idoso , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Nephrol Dial Transplant ; 22(8): 2283-90, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17442744

RESUMO

BACKGROUND: Few data are available regarding the prevalence of burnout among dialysis health care workers. Aims of the present study were to assess and compare burnout levels in a sample of nurses and physicians working in dialysis units, and to investigate their relationships with quality of life, in a cross-sectional observational study. METHODS: A total of 344 workers from 10 dialysis centres in Northern Italy completed a battery of questionnaires including the Maslach Burnout Inventory, the MOS-36 Item Short Form Health Survey [SF36: physical (PCS) and mental (MCS) component scores] and the 30-item General Health Questionnaire (GHQ30). Data on social and demographic characteristics and working conditions were also collected. General Estimating Equations models were used for the analysis. RESULTS: Overall, burnout scores were lower than the Italian normative sample, with no significant differences between physicians and nurses. However, 30% of nurses had high emotional exhaustion vs 18% of physicians (adjusted OR 2.38, P = 0.003). Emotional exhaustion was also predicted by number of worked hours and months worked in dialysis in the previous 2 years. Depersonalisation was predicted by male gender and bad relationship with coworkers. Having no children and having a permanent hospital position predicted low personal accomplishment. PCS was lower in nurses (50.0 vs 53.3, P < 0.001), while no significant difference was found for MCS and GHQ30. Lower PCS was associated with emotional exhaustion (P = 0.007) and GHQ30 > 5 with depersonalization (P = 0.032). CONCLUSIONS: Although burnout is not a general problem in dialysis health care providers, a subgroup of them may be identified, who would benefit from supportive measures to prevent this condition. Nurses appeared more burned-out in the emotional exhaustion scale than physicians.


Assuntos
Esgotamento Profissional , Diálise/métodos , Adulto , Feminino , Pessoal de Saúde , Humanos , Itália , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Razão de Chances , Médicos , Qualidade de Vida , Inquéritos e Questionários
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