Acesso vascular definitivo em usuários de hemodiálise: construção e validação de uma escala de conhecimento

Pós-graduação em Enfermagem (mestrado profissional) - FMB

The long-term outcome after acute kidney injury: a narrative review

This review will focus on long-term outcomes after acute kidney injury (AKI). Surviving AKI patients have a higher late mortality compared with those admitted without AKI. Recent studies have claimed that long-term mortality in patients after AKI varied from 15% to 74% and older age, presence of previous co-morbidities, and the incomplete recovery of renal function have been identified as risk factors for reduced survival. AKI is also associated with progression to chronic kidney (CKD) disease and the decline of renal function at hospital discharge and the number and severity of AKI episodes have been associated with progression to CKD. IN the most studies, recovery of renal function is defined as non-dependence on renal replacement therapy which is probably too simplistic and it is expected in 60-70% of survivors by 90 days. Further studies are needed to explore the long-term prognosis of AKI patients.

Peritoneal dialysis in acute kidney injury: trends in the outcome across time periods

Peritoneal dialysis (PD) should be considered a suitable method of renal replacement therapy in acute kidney injury (AKI) patients. This study is the largest cohort providing patient characteristics, clinical practice, patterns and their relationship to outcomes in a developing country. Its objective was to describe the main determinants of patient and technique survival, including trends over time of PD treatment in AKI patients. This was a Brazilian prospective cohort study in which all adult AKI patients on PD were studied from January/2004 to January/2014. For comparison purposes, patients were divided into 2 groups according to the year of treatment: 2004-2008 and 2009-2014. Patient survival and technique failure (TF) were analyzed using the competing risk model of Fine and Gray. A total of 301 patients were included, 51 were transferred to hemodialysis (16.9%) during the study period. The main cause of TF was mechanical complication (47%) followed by peritonitis (41.2%). There was change in TF during the study period: compared to 2004-2008, patients treated at 2009-2014 had relative risk (RR) reduction of 0.86 (95% CI 0.77-0.96) and three independent risk factors were identified: period of treatment at 2009 and 2014, sepsis and age>65 years. There were 180 deaths (59.8%) during the study. Death was the leading cause of dropout (77.9% of all cases) mainly by sepsis (58.3%), followed cardiovascular disease (36.1%). The overall patient survival was 41% at 30 days. Patient survival improved along study periods: compared to 2004-2008, patients treated at 2009-2014 had a RR reduction of 0.87 (95% CI 0.79-0.98). The independent risk factors for mortality were sepsis, age>70 years, ATN-ISS > 0.65 and positive fluid balance. As conclusion, we observed an improvement in patient survival and TF along the years even after correction for several confounders and using a competing risk approach.

Systemic lupus erythematous and clinical outcomes in peritoneal dialysis

Background: The prevalence of systemic lupus erythematous (SLE) patients requiring renal replacement therapy (RRT) is increasing but data on clinical outcomes are scarce. Interestingly, data on technique failure and peritoneal-dialysis (PD)-related infections are rarer, despite SLE patients being considered at high risk for infections. The aim of our study is to compare clinical outcomes of SLE patients on PD in a large PD cohort. Methods: We conducted a nationwide prospective observational study from the BRAZPD II cohort. For this study we identified all patients on PD for greater than 90 days. Within that subset, all those with SLE as primary renal disease were matched with PD patients without SLE for comparison of clinical outcomes, namely: patient mortality, technique survival and time to first peritonitis, then were analyzed taking into account the presence of competing risks. Results: Out of a total of 9907 patients, we identified 102 SLE patients incident in PD and with more than 90 days on PD. After matching the groups consisted of 92 patients with SLE and 340 matched controls. Mean age was 46.9 +/- 16.8 years, 77.3% were females and 58.1% were Caucasians. After adjustments SLE sub-hazard distribution ratio for mortality was 1.06 (CI 95% 0.55-2.05), for technique failure was 1.01 (CI 95% 0.54-1.91) and for time to first peritonitis episode was 1.40 (CI 95% 0.92-2.11). The probability for occurrence of competing risks in all three outcomes was similar between groups. Conclusion: PD therapy was shown to be a safe and equally successful therapy for SLE patients compared to matched non-SLE patients.

Efeito do treinamento intradialítico resistido e aeróbio sobre a função cognitiva e capacidade funcional de pacientes em hemodiálise: estudo controlado

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

The effect of 6% Hydroxyethyl starch vs. Ringer's lactate on acute kidney injury after renal ischemia in rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Raloxifene therapy inhibits osteoclastogenesis during the alveolar healing process in rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Efficacy of hormone therapy with and without methyltestosterone augmentation of venlafaxine in the treatment of postmenopausal depression: A double-blind controlled pilot study

Objective: This study evaluated the augmentation of venlafaxine with hormone therapy in the treatment of postmenopausal depression. The hormones evaluated were estrogen (0.625 mg) in combination with medroxyprogesterone acetate (2.5 mg) and methyltestosterone (2.5 mg). Design: Seventy-two menopausal women (mean age: 53.6 ± 4.27 years) diagnosed with depression (Montgomery-Åsberg Depression Rating Scale [MADRS] scores ≥ 20) were treated with venlafaxine and one of the following hormone therapy combinations, in a double-blind regimen: estrogen + medroxyprogesterone + methyltestosterone (group 1, n = 20); estrogen + medroxyprogesterone acetate (group 2, n = 20); methyltestosterone only (group 3, n = 16); and no hormone therapy (group 4, n = 16). Study duration was 24 weeks. Primary efficacy outcome was remission according to the MADRS, whereas secondary efficacy measures included the Clinical Global Impression (CGI), Blatt-Kupperman Index, and Women's Health Questionnaire (WHQ). Results: Forty-eight patients completed the study. All groups showed significant improvement from baseline. Group 3 demonstrated significant improvement on the MADRS compared with placebo (group 4) at weeks 20 (P = 0.048) and 24 (P = 0.030); effect size 8.04 (0.83; 15.26) (P = 0.029), but also had the highest dropout rate. Groups 1 and 3 had significant CGI improvement rates compared with placebo: 42.23% (P = 0.012) and 44.45% (P = 0.08), respectively. There were no differences in the WHQ or BKI scores among the groups. Conclusions: Methyltestosterone 2.5 mg had the highest effect size compared with placebo, but the high dropout rate prevented its efficacy from being determined. Estrogen plus medroxyprogesterone, combined with methyltestosterone or otherwise, demonstrated a trend toward increased efficacy of venlafaxine. Further larger-scale clinical trials are needed to elucidate the findings of this pilot study. © 2006 by The North American Menopause Society.

Qualidade de vida e fatores associados em pacientes submetidos a transplante renal

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Extended Daily Dialysis in Acute Kidney Injury Patients: Metabolic and Fluid Control and Risk Factors for Death

Intermittent hemodialysis (IHD) and continuous renal replacement therapies (CRRT) are used as Acute Kidney Injury (AKI) therapy and have certain advantages and disadvantages. Extended daily dialysis (EDD) has emerged as an alternative to CRRT in the management of hemodynamically unstable AKI patients, mainly in developed countries.Objectives: We hypothesized that EDD is a safe option for AKI treatment and aimed to describe metabolic and fluid control of AKI patients undergoing EDD and identify complications and risk factors associated with death.Study Selection: This is an observational and retrospective study describing introduction of EDD at our institution. A total of 231 hemodynamically unstable AKI patients (noradrenalin dose between 0.3 and 1.0 ucg/kg/min) were assigned to 1367 EDD session. EDD consisted of 6-8 h of HD 6 days a week, with blood flow of 200 ml/min, dialysate flows of 300 ml/min.Data Synthesis: Mean age was 60.6 +/- 15.8 years, 97.4% of patients were in the intensive care unit, and sepsis was the main etiology of AKI (76.2). BUN and creatinine levels stabilized after four sessions at around 38 and 2.4 mg/dl, respectively. Fluid balance decreased progressively and stabilized around zero after five sessions. Weekly delivered Kt/V was 5.94 +/- 0.7. Hypotension and filter clotting occurred in 47.5 and 12.4% of treatment session, respectively. Regarding AKI outcome, 22.5% of patients presented renal function recovery, 5.6% of patients remained on dialysis after 30 days, and 71.9% of patients died. Age and focus abdominal sepsis were identified as risk factors for death. Urine output and negative fluid balance were identified as protective factors.Conclusions: EDD is effective for AKI patients, allowing adequate metabolic and fluid control. Age, focus abdominal sepsis, and lower urine output as well as positive fluid balance after two EDD sessions were associated significantly with death.

Effects of oestrogen deficiency and 17 beta-estradiol therapy on bone healing in calvarial critical size defects treated with bovine bone graft

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Evaluation of different periods of estrogen replacement onset in the tibia of ovariectomized rats

Background and aims Estrogen deficiency results in increased bone turnover and can lead to osteoporosis. Hormone replacement therapy (HRT) seems to be the most effective means of reducing bone loss and fractures. However, the effects of the period of HRT onset on bone tissue require further elucidation. This study aimed to evaluate the effects of different periods of HRT onset on the trabecular bone of ovariectomized rats.Methods Seventy-five ovariectomized Wistar rats were divided into five groups according to the onset of treatment. Each group was subdivided into experimental (E; n = 10) and control (C; n = 5), according to treatment with 17-beta-estradiol or vehicle alone (soybean oil), respectively, administered subcutaneously. The first group received treatment immediately post-surgery, while treatment in the remaining groups was initiated 1, 2, 3 and 4 weeks post-surgery. Euthanasia occurred at 9 weeks post-surgery. The left tibias were removed and prepared for histomorphometric analyses. The histomorphometric results were statistically analyzed by the Student's t test (p < 0.05).Results The percentage of trabecular bone was significantly greater in the first (p = 0.002) and second (p = 0.039) experimental subgroups compared with the control for the same period. In the experimental subgroups, the percentage of trabecular bone decreased according to the delay in HRT onset and was statistically significant (t = 3.367; p = 0.0023).Conclusion These findings indicate an increase in trabecular bone loss in tibia at 9 weeks post-ovariectomy. The period of HRT/E onset is important for preventing bone loss; however, despite its preventive effects, HRT/E does not restore lost bone.

Estresse, depressão e suporte familiar em pacientes em diálise peritoneal e hemodiálise

Pós-graduação em Psicologia do Desenvolvimento e Aprendizagem - FC

Fatores de risco para osteoporose em mulheres na pós-menopausa do sudeste brasileiro

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Qualidade de vida em mulheres na pós-menopausa, usuárias e não usuárias de terapia hormonal

OBJETIVO: avaliar a qualidade de vida (QV) de mulheres na pós-menopausa usuárias e São Paulo. MÉTODOS: foi conduzido estudo clínico transversal, com 250 mulheres na pós-menopausa, idade entre 45 a 70 anos, atendidas em uma Unidade Básica de Saúde (UBS), de setembro de 2007 a agosto de 2008. As participantes foram divididas em dois grupos: usuárias de terapia hormonal (TH, n=70) e não usuárias (n=180). Consideraram-se como usuárias de TH aquelas que faziam uso contínuo dessa terapia há pelo menos seis meses. Foram avaliadas as características sociodemográficas e clínicas. Aplicou-se o Índice Menopausal de Blatt e Kupperman (IMBK), para avaliar a intensidade dos sintomas climatéricos, e o Questionário de Saúde da Mulher (QSM), para a avaliação da QV. A análise estatística foi realizada pelo teste do χ2 ou exato de Fisher, teste de Mann-Whitney e de Kruskal-Wallis. RESULTADOS: não foram encontradas diferenças significativas na comparação entre os grupos quanto à idade, menarca, menopausa, paridade e índice massa corpórea. Observou-se que 67,2% eram casadas, 83,2% com ensino fundamental e 53,2% se ocupavam com os trabalhos domésticos, não diferindo entre os grupos. As usuárias de TH relataram menor frequência de sintomas climatéricos (IMBK) de intensidade moderada e acentuada, comparadas a não usuárias (p<0,001). Na avaliação do QSM, verificou-se, entre as usuárias de TH, menor escore médio quanto ao déficit cognitivo (p<0,001), sintomas vasomotores (p=0,04), problemas com o sono (p<0,001) e atratividade (p=0,02), contudo, sem diferença no escore total quando comparadas a não usuárias. CONCLUSÕES: as mulheres na pós-menopausa usuárias e não usuárias de TH, atendidas em UBS, não apresentaram diferenças na QV global.