1
|
Coy-Canguçu A, Antunes-Correa LM, Mazzali M, Abrão P, Ronco F, Teixeira CM, Viana KP, Cordeiro G, Longato M, Coelho OR, Matos-Souza JR, Nadruz W, Sposito AC, Petersen SE, Jerosch-Herold M, Coelho-Filho OR. Prognostic role of renal replacement therapy among hospitalized patients with heart failure in the Brazilian national public health system. Front Cardiovasc Med 2023; 10:1226481. [PMID: 37680567 PMCID: PMC10482263 DOI: 10.3389/fcvm.2023.1226481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction Data on patients hospitalized with acute heart failure in Brazil scarce. Methods We performed a cross-sectional, retrospective, records-based study using data retrieved from a large public database of heart failure admissions to any hospital from the Brazilian National Public Health System (SUS) (SUS Hospital Information System [SIHSUS] registry) to determine the in-hospital all-cause mortality rate, in-hospital renal replacement therapy rate and its association with outcome. Results In total, 910,128 hospitalizations due to heart failure were identified in the SIHSUS registry between April 2017 and August 2021, of which 106,383 (11.7%) resulted in in-hospital death. Renal replacement therapy (required by 8,179 non-survivors [7.7%] and 11,496 survivors [1.4%, p < 0.001]) was associated with a 56% increase in the risk of death in the univariate regression model (HR 1.56, 95% CI 1.52 -1.59), a more than threefold increase of the duration of hospitalization, and a 45% or greater increase of cost per day. All forms of renal replacement therapy remained independently associated with in-hospital mortality in multivariable analysis (intermittent hemodialysis: HR 1.64, 95% CI 1.60 -1.69; continuous hemodialysis: HR 1.52, 95% CI 1.42 -1.63; peritoneal dialysis: HR 1.47, 95% CI 1.20 -1.88). Discussion The in-hospital mortality rate of 11.7% observed among patients with acute heart failure admitted to Brazilian public hospitals was alarmingly high, exceeding that of patients admitted to North American and European institutions. This is the first report to quantify the rate of renal replacement therapy in patients hospitalized with acute heart failure in Brazil.
Collapse
Affiliation(s)
- Andréa Coy-Canguçu
- Catholic Pontifical University of Campinas Medical School, Campinas, Brazil
- Department of Medicine, State University of Campinas School of Medical Sciences, Campinas, Brazil
| | - Lígia M. Antunes-Correa
- Department of Medicine, State University of Campinas School of Medical Sciences, Campinas, Brazil
| | - Marilda Mazzali
- Department of Medicine, State University of Campinas School of Medical Sciences, Campinas, Brazil
| | | | | | | | | | | | | | - Otávio Rizzi Coelho
- Department of Medicine, State University of Campinas School of Medical Sciences, Campinas, Brazil
| | - José Roberto Matos-Souza
- Department of Medicine, State University of Campinas School of Medical Sciences, Campinas, Brazil
| | - Wilson Nadruz
- Department of Medicine, State University of Campinas School of Medical Sciences, Campinas, Brazil
| | - Andrei C. Sposito
- Department of Medicine, State University of Campinas School of Medical Sciences, Campinas, Brazil
| | - Steffen E. Petersen
- William Harvey Research Institute NIHR Barts Biomedical Research Centre, Queen Mary University London, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Michael Jerosch-Herold
- Non-Invasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | | |
Collapse
|
2
|
Priyadarshani WVD, de Namor AFD, Silva SRP. Rising of a global silent killer: critical analysis of chronic kidney disease of uncertain aetiology (CKDu) worldwide and mitigation steps. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2023; 45:2647-2662. [PMID: 36094692 DOI: 10.1007/s10653-022-01373-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/22/2022] [Indexed: 06/01/2023]
Abstract
Chronic kidney disease of uncertain aetiology (CKDu) is an advanced version of chronic kidney disease (CKD) which bears a high burden on the world health economy. More than 200 articles were analysed to understand the disease responsible for more than 30,000 deaths per year. CKDu is a non-communicable occupational disease that has a progressive deterioration of the kidney in the absence of CKD risk factors such as hypertension, diabetes and glomerulonephritis, while the diagnosis is only possible at the later stages when kidney function is no longer effective. Published evidence for the existence of CKDu was found for around 35 countries. This is a growing health issue in Asia, Central America, Africa and Middle East with identified hot spots. Despite many research studies over decades, the exact root causes are still uncertain. Six main suspected causative factors are identified. Those are heat stress, strenuous labour, dehydration, use of agrochemicals, exposure to heavy metals and the use of polluted water and agricultural lands. This review summarizes four key areas which are CKDu and its general medical background, worldwide prevalence, suspected causative factors and potential circumventing steps to mitigate against CKDu. The importance of further studies addressing early detection and surveillance methods, contribution of nephrotoxins in environmental health, soil chemistry on transporting nephrotoxins, geological parameters which influence the prevalence of the disease and other related sectors to overcome the mysterious nature is highlighted. Mitigation steps to lessen the burden of CKDu are also identified.
Collapse
Affiliation(s)
| | | | - S Ravi P Silva
- Advanced Technology Institute, University of Surrey, Guildford, UK.
| |
Collapse
|
3
|
Pavesi VCS, Martins MD, Coracin FL, Sousa AS, Pereira BJ, Prates RA, da Silva JF, Gonçalves MLL, Bezerra CDS, Bussadori SK, Varellis MLZ, Deana AM. Effects of photobiomodulation in salivary glands of chronic kidney disease patients on hemodialysis. Lasers Med Sci 2021; 36:1209-1217. [PMID: 33745088 DOI: 10.1007/s10103-020-03158-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 10/07/2020] [Indexed: 12/15/2022]
Abstract
This randomized placebo-controlled trial evaluates the impact of photobiomodulation (PBMT) on the salivary flow and biochemistry of patients with chronic kidney disease (CKD) on hemodialysis. Forty-four patients on hemodialysis self-responded two questionnaires for oral health and salivary gland function perception. The subjects were evaluated for function of salivary glands and randomly allocated to two groups: PBMT group (three irradiations at 808 nm, 100 mW, 142 J/cm2, and 4 J per site); and placebo group. Patients were submitted to non-stimulated and stimulated sialometry and after the treatment at baseline and 14 days. Salivary volume and biochemical of the saliva were analyzed. At baseline, most subjects had self-perception of poor oral health (52.6%) and salivary dysfunction (63.1%). Clinical exam revealed that 47.3% of subjects presented dry mucosa. PBMT promoted increase of the non-stimulated (p = 0.027) and stimulated saliva (p = 0.014) and decrease of urea levels in both non-stimulated (p = 0.0001) and stimulated saliva (p = 0.0001). No alteration was detected in total proteins and calcium analysis. Patients with kidney disease can present alteration in flow, concentrations, and composition of saliva, affecting oral health, but our findings suggest that PBMT is effective to improve hyposalivation and urea levels in saliva of patients with CKD.
Collapse
Affiliation(s)
| | - Manoela Domingues Martins
- Universidade Federal do Rio Grande do Sul (UFRGS), R. Ramiro Barcelos, 2492 Santa Cecilia, Porto Alegre, RS, Brazil
| | - Fábio Luiz Coracin
- Universidade Nove de Julho (UNINOVE), R. vergueiro, 235 Liberdade, São Paulo, SP, Brazil
| | - Aline Silva Sousa
- Universidade Nove de Julho (UNINOVE), R. vergueiro, 235 Liberdade, São Paulo, SP, Brazil
| | - Benedito Jorge Pereira
- Universidade Nove de Julho (UNINOVE), R. vergueiro, 235 Liberdade, São Paulo, SP, Brazil
| | - Renato Araújo Prates
- Universidade Nove de Julho (UNINOVE), R. vergueiro, 235 Liberdade, São Paulo, SP, Brazil
| | | | | | | | - Sandra Kalil Bussadori
- Universidade Nove de Julho (UNINOVE), R. vergueiro, 235 Liberdade, São Paulo, SP, Brazil
| | | | - Alessandro Melo Deana
- Universidade Nove de Julho (UNINOVE), R. vergueiro, 235 Liberdade, São Paulo, SP, Brazil.
| |
Collapse
|
4
|
Brito DCSD, Machado EL, Reis IA, Cherchiglia ML. Impact of clinical, sociodemographic and quality of life factors on dialysis patient survival: a nine-year follow-up cohort study. CAD SAUDE PUBLICA 2020; 36:e00007320. [PMID: 33331548 DOI: 10.1590/0102-311x00007320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/15/2020] [Indexed: 11/22/2022] Open
Abstract
Although renal replacement therapy has contributed to the survival of chronic kidney failure (CKF) patients, mortality remains a major concern. This study aimed to identify the factors associated with mortality in a prospective cohort of CKF patients. Sociodemographic, clinical, nutritional, lifestyle and quality of life data were collected from 712 patients. The instruments used were the Short-Form Health Survey (SF-36), Global Subjective Assessment (GSA) and Charlson Comorbidity Index (CCI) questionnaires. A total of 444 patients died during the study. After five years of follow-up, factors such as not being married (hazard ratio - HR = 1.289, 95%CI: 1.001; 1.660), a low frequency of leisure activities (HR = 1.321; 95%CI: 1.010; 1.727) and not being transplanted (HR = 7.246; 95%CI: 3.359; 15.630) remained independently associated with the risk of mortality. At the end of the follow-up period, factors such as not being married (HR = 1.337, 95%CI: 1.019; 1.756), not being transplanted (HR = 7.341, 95%CI: 3.829; 14.075) and having a worse nutritional status (HR = 1.363, 95%CI: 1.002; 1.853) remained independently associated with an increased risk of mortality, whereas a high schooling level (10 to 12 years, HR = 0.578, 95%CI: 0.344; 0.972; and over 12 years, HR = 0.561, 95%CI: 0.329; 0.956) and a better SF-36 physical functioning score (HR = 0.992, 95%CI: 0.987; 0.998) were protective factors associated with survival. The survival of patients with CKF is associated with factors not restricted to the clinical spectrum. The following factors were associated with high mortality: not being married, low schooling level, a limited social routine, a longer time on dialysis, worse nutritional status, and worse physical functioning.
Collapse
|
5
|
Kassa DA, Mekonnen S, Kebede A, Haile TG. Cost of Hemodialysis Treatment and Associated Factors Among End-Stage Renal Disease Patients at the Tertiary Hospitals of Addis Ababa City and Amhara Region, Ethiopia. Clinicoecon Outcomes Res 2020; 12:399-409. [PMID: 32821136 PMCID: PMC7419632 DOI: 10.2147/ceor.s256947] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/30/2020] [Indexed: 01/22/2023]
Abstract
Purpose Hemodialysis is a renal replacement therapy for end-stage renal disease (ESRD) patients who consume substantial healthcare resources, which increases the economic burden. Plenty of factors affects the cost of hemodialysis treatment, particularly in resource-limited settings. Moreover, the demand for hemodialysis may decrease as the cost increases, but there is limited evidence in Ethiopia. Thus, this study aimed to estimate the cost of hemodialysis treatment among ESRD patients in the tertiary hospitals of Addis Ababa City and Amhara region, Ethiopia. Patients and Methods An institutional-based cross-sectional study was conducted among 172 ESRD patients undergoing hemodialysis treatment. A structured questionnaire and patients’ medical chart were used to estimate the costs, and the human capital approach was applied to calculate the indirect costs. A generalized linear model (GLM) was fitted after the modified park test to identify the associated factors. In the final GLM, a p-value of <0.05 and a 95% CI were used to declare the significant variables. Results The mean annual cost of hemodialysis treatment was 121,089.27ETB ($4466.59) ± 33,244.99 ($1226.29). The direct and indirect costs covered 77.0% and 23.0% of the total costs, respectively. Age (ex(b): 1.01, p-value <0.001), highest wealth status (ex(b): 1.09, p-value: 0.008), eight (ex(b): 1.27, p-value <0.001) and 12 visits/month (ex(b): 1.34, p-value <0.001), anemia (ex(b): 1.13, p-value <0.001), and comorbidity (ex(b): 1.09, p-value: 0.039) were the factors associated with the costs of hemodialysis treatment. Conclusion The annual cost of hemodialysis treatment among ESRD patients was high compared to the national per capita health expenditure, and two-thirds covered by the direct medical costs. Old age, high wealth status, more visits, anemia, and comorbidity were factors associated with the costs of hemodialysis. Therefore, the healthcare system must make a great effort for cost reduction and reduce the patients with kidney disease before they reach end-stages.
Collapse
Affiliation(s)
- Daniel Asrat Kassa
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Mekonnen
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adane Kebede
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsegaye Gebremedhin Haile
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
6
|
Amatneeks TM, Hamdan AC. Sensitivity and specificity of the Brazilian version of the Montreal Cognitive Assessment - Basic (MoCA-B) in chronic kidney disease. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2020; 41:327-333. [PMID: 31967193 DOI: 10.1590/2237-6089-2018-0085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/02/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Cognitive impairment in chronic kidney disease (CKD) is commonly associated with neuropsychiatric disorders. As a complex pathology, at all stages of CKD patients need to have a good understanding of the need for drug and nutritional adherence. Cognitive screening is the starting point for detection of cognitive impairments. OBJECTIVE To determine the specificity and sensitivity of the Brazilian Portuguese version of the Montreal Cognitive Assessment - Basic (MoCA-B) for identification of cognitive impairment in the CKD population. METHODS This was a cross-sectional study with 163 CKD patients undergoing hemodialysis treatment. The Mini-Mental State Examination (MMSE) and MoCA-B were administered. RESULTS The MoCA-B has reliable internal consistency (Cronbach's alpha = 0.74). A cutoff point of ≤ 21 points provides the best sensitivity and specificity for detection of cognitive impairment. The education variable had less impact on the total MoCA-B score than on the total MMSE score. CONCLUSIONS The MoCA-B is a suitable screening instrument for evaluating the global cognition of hemodialysis patients. The results can help health professionals to conduct evaluations and plan clinical management.
Collapse
|
7
|
Enfermagem no transplante renal: comparação da demanda de cuidado entre escalas. ACTA PAUL ENFERM 2020. [DOI: 10.37689/acta-ape/2020ao0220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
8
|
Malta DC, Machado ÍE, Pereira CA, Figueiredo AW, Aguiar LKD, Almeida WDSD, Souza MDFMD, Rosenfeld LG, Szwarcwald CL. Evaluation of renal function in the Brazilian adult population, according to laboratory criteria from the National Health Survey. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22Suppl 02:E190010.SUPL.2. [PMID: 31596381 DOI: 10.1590/1980-549720190010.supl.2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/12/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the renal function of the Brazilian adult population, according to laboratory criteria of the National Health Survey (Pesquisa Nacional de Saúde - PNS). METHODOLOGY A descriptive study was carried out with laboratory data from the PNS, which was collected between the years 2014 and 2015. Population prevalence of the serum creatinine (CR) and estimated glomerular filtration rate (GFR) according to sociodemographic variables, were analyzed from the PNS laboratory data. RESULTS The sample consisted of 8,535 individuals aged 18 years old or older for the study of CR and 7,457 for the study of GFR. The GFR prevalence < 60 mL/min/1.73 m2 was 6.7% (95%CI 6.0 - 7.4), higher in women (8.2% 95%CI 7.2 - 9.2) than in men (5.0% 95%CI 4.2 - 6.0) p < 0.001, and in elderly > 60 years old it was 21.4%. For the values of CR ≥ 1.3 mg/dL in men were 5.5% (95%CI 4.6 - 6.5), and in women values of CR ≥ 1.1 mg/dL were 4.6% (95%CI 4.0 - 5.4), with no diference between the genders, p = 0.140. CONCLUSION Results from the PNS laboratory identified a higher prevalence of chronic kidney disease in the Brazilian population than that estimated in self-reported studies, with higher GFR < 60 mL/min/1.73 m2 in women, and reaching one fifth of the elderly. These tests may be useful for the purpose of identifying the disease early on and thus preventing the progression of renal damage and reduce the risk of cardiovascular events and mortality.
Collapse
Affiliation(s)
- Deborah Carvalho Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais-Belo Horizonte (MG), Brasil.,Programa de Pós-graduação em Enfermagem, Escola de Enfermagem Universidade Federal de Minas Gerais - Belo Horizonte(MG), Brasil
| | - Ísis Eloah Machado
- Programa de Pós-graduação em Enfermagem, Escola de Enfermagem Universidade Federal de Minas Gerais - Belo Horizonte(MG), Brasil
| | - Cimar Azeredo Pereira
- Diretoria de Pesquisas, Instituto Brasileiro de Geografia e Estatística - Rio de Janeiro (RJ), Brasil
| | - André Willian Figueiredo
- Diretoria de Pesquisas, Instituto Brasileiro de Geografia e Estatística - Rio de Janeiro (RJ), Brasil
| | - Lilian Kelen de Aguiar
- Programa de Pós-graduação em Enfermagem, Escola de Enfermagem Universidade Federal de Minas Gerais - Belo Horizonte(MG), Brasil.,Universidade do Estado do Amazonas - Manaus (AM), Brasil
| | - Wanessa da Silva de Almeida
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
| | | | | | - Célia Landman Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
| |
Collapse
|
9
|
Rosa A, Silva NFD, Semenoff Segundo A, Semenoff TDV, Borges AH, Borba AM. The Influence of Vasoconstritor Use in Local Anesthesia in Individuals with Chronic Renal Failure. JOURNAL OF HEALTH SCIENCES 2019. [DOI: 10.17921/2447-8938.2019v21n3p269-273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
AbstractIndividuals with chronic renal failure (CRD) undergo hemodialysis to compensate for systemic-based disease and often develop systemic arterial hypertension (SAH). Such individuals, when needing dental treatment, carry with them the consideration of which type of anesthetic to be used in clinical and surgical interventions. The objective of this study was to evaluate the action of anesthetics with vasoconstrictor (AwV) and without vasoconstrictor (AoV) in individuals with chronic renal failure. Research subjects needed dental treatment, with dental restorations, on the right and left lower dental arch in premolars and / or molars, thus receiving the model of a split-mouth clinical study. In a randomized study, each side of the mandible was subjected to an anesthetic infiltration with only one 1.8 mL tube in two different moments with a minimum interval of 7 days (for one moment with AwV and another AoV moment). The parameters of oxygen saturation (SaO2), heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured 5 minutes before anesthesia, 5, 15 and 30 minutes after anesthesia. The results found in this study showed statistical difference only in SaO2 in the time of 5 minutes after the anesthesia in comparison of the AwV and AoV group, this same result was obtained when only those individuals who, besides nephropathies, had a diagnosis of SAH, were evaluated. The findings of this study highlight the safety of the use of anesthetics, with or without vasoconstrictors since in small amounts, in individuals with CRF with or without associated SAH.Keywords: Renal Insufficiency. Hypertension. Anesthetics, Local.ResumoIndivíduos com insuficiência renal crônica (IRC) em geral são submetidos à hemodiálise para compensação da doença de base sistêmica e frequentemente desenvolvem a hipertensão arterial sistêmica (HAS). Tais indivíduos, ao necessitarem de tratamento odontológico, levam consigo a ponderação de qual tipo de anestésico a ser utilizado em intervenções clínicas e cirúrgicas. O objetivo deste estudo foi avaliar a ação de anestésicos com vasoconstritor (ACV) e sem vasoconstritor (ASV) em indivíduos com insuficiência renal crônica. Os indivíduos da pesquisa tinham necessidade de tratamento odontológico, com restaurações dentárias, no arco dentário inferior direito e esquerdo em pré-molares e/ou molares, recebendo assim o modelo de estudo clínico de boca dividida. De forma aleatória, os hemiarcos inferiores foram submetidos, em dois diferentes momentos com intervalo mínimo de 7 dias, a infiltração anestésica com apenas um tubete de 1,8 mL (para um momento com ACV e outro momento ASV). Foi feita aferição dos parâmetros de saturação de oxigênio (SaO2), frequência cardíaca (FC), pressão arterial sistólica (PAS) e diastólicas (PAD), 5 minutos antes da anestesia, 5, 15 e 30 minutos após a anestesia. Os resultados encontrados neste estudo demonstraram diferença estatística apenas na SaO2 no tempo de 5 minutos após a anestesia em comparação do grupo ACV e ASV, esse mesmo resultado foi obtido quando avaliados apenas os indivíduos que, além de nefropatas, apresentavam diagnóstico de HAS. Os achados deste estudo ressaltam a segurança do uso de anestésicos, com ou sem vasoconstritores desde que em pequenas quantidades, em indivíduos com IRC com ou sem HAS associada.Palavras-chave: Insuficiência Renal. Hipertensão. Anestésicos Locais.
Collapse
|
10
|
Fontes BC, Anjos JSD, Black AP, Moreira NX, Mafra D. Effects of Low-Protein Diet on lipid and anthropometric profiles of patients with chronic kidney disease on conservative management. ACTA ACUST UNITED AC 2018; 40:225-232. [PMID: 29944154 PMCID: PMC6533945 DOI: 10.1590/2175-8239-jbn-3842] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 09/04/2017] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Chronic Kidney disease (CKD) patients have a high prevalence of cardiovascular mortality, and among the risk factors are dyslipidemia and obesity, common findings in the early stages of CKD. The aim of this study was to evaluate the effects of low protein diet (LPD) on the lipid and anthropometric profile in non-dialysis CKD patients. METHODS Forty CKD patients were studied (20 men, 62.7 ± 15.2 years, glomerular filtration rate (GFR) 26.16 ± 9.4 mL/min/1.73m2). LPD (0.6g/kg/d) was prescribed for six months and, biochemical and anthropometric parameters like body mass index (BMI), waist circumference and body fat mass (assessed by dual X-ray absorptiometry - DXA) were evaluated before and after six months with LPD. RESULTS After six months of nutritional intervention, patients presented reduction on BMI (from 28.1 ± 5.6 to 27.0 ± 5.3 Kg/m2, p = 0.001), total cholesterol (from 199.7 ± 57.1 to 176.0 ± 43.6mg/dL, p = 0.0001), LDL (from 116.2 ± 48.1 to 97.4 ± 39.1 mg/dL, p = 0,001) and uric acid (from 6.8 ± 1.4 to 6.2 ± 1.3 mg/dL, p = 0.004). In addition, GFR values were increased from 26.2 ± 9.5 to 28.9 ± 12.7mL/min (p = 0.02). The energy, proteins, cholesterol and fiber intake were reduced significantly. CONCLUSION LPD prescribe to non-dialysis CKD patients for six months was able to improve some cardiovascular risk factors as overweight and plasma lipid profile, suggesting that LPD can be also an important tool for protection against cardiovascular diseases in these patients.
Collapse
Affiliation(s)
- Bruna Carvalho Fontes
- Universidade Federal Fluminense, Programa de Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ, Brasil
| | - Juliana Saraiva Dos Anjos
- Universidade Federal Fluminense, Programa de Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ, Brasil
| | - Ana Paula Black
- Universidade Federal Fluminense, Programa de Pós-Graduação em Ciências Médicas, Niterói, RJ, Brasil
| | - Nara Xavier Moreira
- Universidade Federal Fluminense, Faculdade de Nutrição, Departamento de Nutrição e Dietética, Niterói, RJ, Brasil
| | - Denise Mafra
- Universidade Federal Fluminense, Programa de Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ, Brasil.,Universidade Federal Fluminense, Programa de Pós-Graduação em Ciências Médicas, Niterói, RJ, Brasil
| |
Collapse
|
11
|
Lins SMDSB, Leite JL, Godoy SD, Tavares JMAB, Rocha RG, Silva FVCE. Adesão de portadores de doença renal crônica em hemodiálise ao tratamento estabelecido. ACTA PAUL ENFERM 2018. [DOI: 10.1590/1982-0194201800009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo: Identificar o comportamento de adesão do paciente renal crônico ao regime terapêutico nas suas quatro dimensões: hemodiálise uso de medicamentos, dieta e restrição hídrica. Métodos: Estudo descritivo, transversal com abordagem quantitativa, desenvolvido em dois centros de hemodiálise no Estado do Rio de Janeiro. Para coleta de dados, foi utilizado um questionário de avaliação sobre a adesão do portador de doença renal crônica em hemodiálise. Os dados foram analisados por meio de estatística descritiva simples. Resultados: O domínio que apresentou maior percentual de pacientes não aderentes foi a hemodiálise, com 32%. Já a medicação foi o domínio com maior percentual de pacientes aderentes, 93,6%. Conclusão: A adesão à terapêutica é um comportamento dinâmico e, como tal, merece monitorização constante.
Collapse
|
12
|
Bellafronte NT, Batistuti MR, dos Santos NZ, Holland H, Romão EA, G. Chiarello P. Estimation of Body Composition and Water Data Depends on the Bioelectrical Impedance Device. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2018; 9:96-105. [PMID: 33584925 PMCID: PMC7852023 DOI: 10.2478/joeb-2018-0014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Indexed: 06/12/2023]
Abstract
Overweight, obese and chronic kidney disease patients have an altered and negative body composition being its assessment important. Bioelectrical impedance analysis is an easy-to-operate and low-cost method for this purpose. This study aimed to compare and correlate data from single- and multi-frequency bioelectrical impedance spectroscopy applied in subjects with different body sizes, adiposity, and hydration status. It was a cross-sectional study with 386 non-chronic kidney disease volunteers (body mass index from 17 to 40 kg/m2), 30 patients in peritoneal dialysis, and 95 in hemodialysis. Bioelectrical impedance, body composition, and body water data were assessed with single- and multi-frequency bioelectrical impedance spectroscopy. Differences (95% confidence interval) and agreements (Bland-Atman analyze) between devices were evaluated. The intraclass correlation coefficient was used to measure the strength of agreement and Pearson's correlation to measure the association. Regression analyze was performed to test the association between device difference with body mass index and overhydration. The limits of agreement between devices were very large. Fat mass showed the greatest difference and the lowest intraclass and Pearson's correlation coefficients. Pearson's correlation varied from moderate to strong and the intraclass correlation coefficient from weak to substantial. The difference between devices were greater as body mass index increased and was worse in the extremes of water imbalance. In conclusion, data obtained with single- and multi-frequency bioelectrical impedance spectroscopy were highly correlated with poor agreement; the devices cannot be used interchangeably and the agreement between the devices was worse as body mass index and fat mass increased and in the extremes of overhydration.
Collapse
Affiliation(s)
- Natália T. Bellafronte
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marina R. Batistuti
- Department of Physics and Chemistry, Faculty of Pharmaceutical Sciences, University of São Paulo, Ribeirão Preto, Brazil
| | - Nathália Z. dos Santos
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Héric Holland
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Elen A. Romão
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Paula G. Chiarello
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| |
Collapse
|
13
|
Siqueira DS, Costa BEPD, Figueiredo AEPL. Coping e qualidade de vida em pacientes em lista de espera para transplante renal. ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: Caracterizar o perfil de enfrentamento e qualidade de vida dos pacientes em lista de espera de transplante renal. Métodos: Estudo transversal, com abordagem quantitativa, foram entrevistados pacientes maiores de 18 anos, alfabetizados e em lista de espera de transplante renal. Foram excluídos os pacientes em espera de mais de um órgão. A apresentação dos resultados ocorreu pela estatística descritiva - distribuição absoluta e relativa (n - %), bem como, pelas medidas de tendência central e de variabilidade, sendo que, o estudo da distribuição de dados das variáveis contínuas ocorreu pelo teste de Kolmogorov-Smirnov. Na comparação das pontuações relativas dos estilos e das dimensões para qualidade de vida entre dois grupos independentes foi utilizado o teste de Mann Whitney U. Quando as variáveis contínuas foram comparadas aos tipos de tratamentos (com numero de casos superior a 5) foi utilizado o teste de KruskalWallys-PostHocDunn. A relação de linearidade entre os escores dos estilos ECJ e as dimensões da SF36 ocorreu pelo coeficiente de correlação de e Spearman. Os dados foram analisados no programa Statistical Package for Social Sciences versão 20.0 (SPSS Inc., Chicago, IL, USA, 2008) para Windows, sendo que, para critérios de decisão estatística adotou-se o nível de significância de 5%. Resultados: Do total de 58 pacientes, 30 (51,7%) eram do sexo masculino com média de idade de 44,6 (±15,2) anos. O perfil de enfrentamento foi o Autoconfiante (42) e Otimista (6) pacientes. As dimensões com a melhor qualidade de vida foram: a dor (67,2), aspectos sociais (66,6) e saúde mental (65,4). Houve correlação significativa, (r<0,333), entre o estilo paliativo e vitalidade (r=-0,288; p=0,028) e paliativo e aspectos sociais (r=-0,283; p=0,031). O Estado Geral de Saúde e os estilos Emotivo (r=-0,424; p=0,025) e Paliativo (r=-0,524; p=0,004), bem como, entre a Vitalidade e o estilo Paliativo (r=- 0,530; p=0,004) apresentaram correlação significativa. Nos homens houve correlação significativa (0,300<r≤0,600) na comparação da dimensão Dor com os estilos Confrontivo (r=-0,413; p=0,023) e Emotivo (r=-0,370; p=0,044). Conclusão: O estudo identificou o perfil de enfrentamento dos pacientes em hemodiálise e em lista de espera de transplante renal. Destaca-se o perfil Coping autoconfiante e otimista na maioria dos pacientes, bem como, o impacto na qualidade de vida dessa população destacando-se resultados positivos em relação à melhoria da Dor, Aspectos sociais e Saúde mental, porém ficou evidente o comprometimento da qualidade de vida no que se refere aos aspectos físicos e emocionais.
Collapse
|
14
|
Silva A, Soares L, Magajewski F. Epidemiologic and Economic Aspects Related to Hemodialysis and Kidney Transplantation in Santa Catarina in the Period of 2012–2013. Transplant Proc 2016; 48:2284-2288. [DOI: 10.1016/j.transproceed.2016.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
15
|
Gomes RM, Guerra Júnior AA, Lemos LLPD, Costa JDO, Almeida AM, Alvares J, Filho CS, Cherchiglia ML, Andrade EIG, Godman B, Acurcio FA. Ten-year kidney transplant survival of cyclosporine- or tacrolimus-treated patients in Brazil. Expert Rev Clin Pharmacol 2016; 9:991-9. [DOI: 10.1080/17512433.2016.1190270] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Rosângela Maria Gomes
- Post-Graduation Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- SUS Collaborating Centre – Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Augusto Afonso Guerra Júnior
- Post-Graduation Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- SUS Collaborating Centre – Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Lívia Lovato Pires de Lemos
- SUS Collaborating Centre – Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- Post-Graduation Program in Public Health, Department of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Juliana de Oliveira Costa
- Post-Graduation Program in Public Health, Department of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Alessandra Maciel Almeida
- Post-Graduation Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- SUS Collaborating Centre – Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Juliana Alvares
- Post-Graduation Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- SUS Collaborating Centre – Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Charles Simão Filho
- Department of Surgery, College of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Mariângela Leal Cherchiglia
- Post-Graduation Program in Public Health, Department of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Eli Iola Gurgel Andrade
- Post-Graduation Program in Public Health, Department of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Francisco Assis Acurcio
- Post-Graduation Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- SUS Collaborating Centre – Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
| |
Collapse
|
16
|
Moura LD, Andrade SSCDA, Malta DC, Pereira CA, Passos JEF. Prevalência de autorrelato de diagnóstico médico de doença renal crônica no Brasil: Pesquisa Nacional de Saúde, 2013. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2015; 18 Suppl 2:181-91. [DOI: 10.1590/1980-5497201500060016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/18/2015] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Objetivo: Descrever o perfil dos adultos que referiram diagnóstico médico de doença renal crônica (DRC), segundo variáveis selecionadas. Métodos: Estudo transversal em que foram incluídos indivíduos entrevistados pela Pesquisa Nacional de Saúde de 2013, estudo de base populacional e domiciliar realizado no Brasil, representativo da zona rural e urbana. Foram avaliados 60.202 indivíduos com idade ≥ 18 anos que referiram diagnóstico médico de insuficiência renal crônica ou doença renal. Foi realizada estatística descritiva, incluindo cálculos de prevalências e respectivos intervalos de confiança de 95% (IC95%). Resultados: A prevalência de DRC foi de 1,4% (IC95% 1,3 - 1,6), semelhantes entre os sexos; masculino: 1,4% (IC95% 1,1 - 1,6) e feminino 1,5% ((IC95% 1,3 - 1,7). A região Sul apresentou a maior frequência desse indicador (2,1%; IC95% 1,6 - 2,7). A prevalência de tratamento dialítico dentre as pessoas com diagnóstico médico autorreferido de DRC foi de 7,4% (IC95% 4,4 - 10,3), sendo maior no sexo masculino (12,4%; IC95% 6,5 - 18,3) e não houve diferença entre as faixas etárias e os níveis de escolaridade. DRC foi referida por 8,9% (IC95% 3,5 - 14,3) dos pardos, sem diferença entre as raças/cor da pele. Conclusão: Esses resultados revelam os diversos aspectos da DRC no país. Observou-se que a distribuição foi desigual, onerando principalmente os de menor escolaridade, o que demanda maior investimento em programas de saúde para o enfrentamento dessa enfermidade. Dessa forma, esses dados permitem direcionar o planejamento de políticas públicas voltadas à prevenção dessa doença e à promoção da saúde.
Collapse
|
17
|
Guerra AA, Silva GD, Andrade EIG, Cherchiglia ML, Costa JDO, Almeida AM, Acurcio FDA. Cyclosporine versus tacrolimus: cost-effectiveness analysis for renal transplantation in Brazil. Rev Saude Publica 2015; 49:13. [PMID: 25741648 PMCID: PMC4386555 DOI: 10.1590/s0034-8910.2015049005430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 11/09/2014] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To analyze the cost-effectiveness of treatment regimens with cyclosporine or tacrolimus, five years after renal transplantation. METHODS This cost-effectiveness analysis was based on historical cohort data obtained between 2000 and 2004 and involved 2,022 patients treated with cyclosporine or tacrolimus, matched 1:1 for gender, age, and type and year of transplantation. Graft survival and the direct costs of medical care obtained from the National Health System (SUS) databases were used as outcome results. RESULTS Most of the patients were women, with a mean age of 36.6 years. The most frequent diagnosis of chronic renal failure was glomerulonephritis/nephritis (27.7%). In five years, the tacrolimus group had an average life expectancy gain of 3.96 years at an annual cost of R$78,360.57 compared with the cyclosporine group with a gain of 4.05 years and an annual cost of R$61,350.44. CONCLUSIONS After matching, the study indicated better survival of patients treated with regimens using tacrolimus. Moreover, regimens containing cyclosporine were more cost-effective [corrected].
Collapse
Affiliation(s)
- Augusto Afonso Guerra
- Departamento de Medicina Preventiva e Social. Faculdade de Medicina. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Grazielle Dias Silva
- Superintendência de Assistência Farmacêutica. Secretaria de Estado de Saúde de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Eli Iola Gurgel Andrade
- Departamento de Medicina Preventiva e Social. Faculdade de Medicina. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Mariângela Leal Cherchiglia
- Departamento de Medicina Preventiva e Social. Faculdade de Medicina. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Juliana de Oliveira Costa
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Alessandra Maciel Almeida
- Departamento de Medicina Preventiva e Social. Faculdade de Medicina. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Francisco de Assis Acurcio
- Departamento de Medicina Preventiva e Social. Faculdade de Medicina. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| |
Collapse
|
18
|
de Moura L, Prestes IV, Duncan BB, Thome FS, Schmidt MI. Dialysis for end stage renal disease financed through the Brazilian National Health System, 2000 to 2012. BMC Nephrol 2014; 15:111. [PMID: 25008169 PMCID: PMC4099158 DOI: 10.1186/1471-2369-15-111] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/03/2014] [Indexed: 11/10/2022] Open
Abstract
Background Chronic kidney disease has become a public health problem worldwide. Its terminal stage requires renal replacement therapy – dialysis or transplantation – for the maintenance of life, resulting in high economic and social costs. Though the number of patients with end-stage renal disease treated by dialysis in Brazil is among the highest in the world, current estimates of incidence and prevalence are imprecise. Our aim is to describe incidence and prevalence trends and the epidemiologic profile of end-stage renal disease patients receiving publically-financed dialysis in Brazil between 2000 and 2012. Methods We internally linked records of the High Complexity Procedure Authorization/Renal Replacement Therapy (APAC/TRS) system so as to permit analyses of incidence and prevalence of dialysis over the period 2000-2012. We characterized temporal variations in the incidence and prevalence using Joinpoint regression. Results Over the period, 280,667 patients received publically-financed dialysis, 57.2% of these being male. The underlying disease causes listed were hypertension (20.8%), diabetes (12.0%) and glomerulonephritis (7.7%); for 42.3%, no specific cause was recorded. Hemodialysis was the therapeutic modality in 90.1%. Over this period, prevalence increased 47%, rising 3.6% (95% CI 3.2% - 4.0%)/year. Incidence increased 20%, or 1.8% (1.1% – 2.5%)/year. Incidence increased in both sexes, in all regions of the country and particularly in older age groups. Conclusions Incidence and prevalence of end-stage renal disease receiving publically-financed dialysis treatment has increased notably. The linkage approach developed will permit continuous future monitoring of these indicators.
Collapse
Affiliation(s)
- Lenildo de Moura
- Post-Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
| | | | | | | | | |
Collapse
|
19
|
Chagas ACF, Hans Filho G, Oliveira SMDVLD, Ivo ML, Corrêa Filho RAC, Donatti MI. Prevalence of latent tuberculosis and treatment adherence among patients with chronic kidney disease in Campo Grande, State of Mato Grosso do Sul. Rev Soc Bras Med Trop 2014; 47:204-11. [DOI: 10.1590/0037-8682-0035-2014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/11/2014] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | - Maria Lúcia Ivo
- Universidade Federal do Mato Grosso do Sul, Brazi; Universidade Federal do Mato Grosso do Sul, Brazi
| | | | | |
Collapse
|
20
|
Rosetti KAG, Tronchin DMR. Evaluation of the conformity of assistential practice in the maintenance of the temporary double-lumen dialysis catheter. Rev Lat Am Enfermagem 2014; 22:129-35. [PMID: 24553713 PMCID: PMC4292706 DOI: 10.1590/0104-1169.2959.2378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 07/30/2013] [Indexed: 11/22/2022] Open
Abstract
Objective to evaluate the conformity of the assistential practice in the maintenance
of the temporary double-lumen catheter for hemodialysis, by means of the use
of the process indicator, in the University Hospital of the University of
São Paulo. Method a quantitative, exploratory-descriptive and observational study. The sample
was made up of 155 observations of persons with temporary double-lumen
catheters, in the period March - November 2011, using the Indicator of the
Maintenance of the Temporary Double Lumen Catheter for Hemodialysis. Results the rate of general conformity of the assistential practice corresponded to
65.8%. Of the practice's 13 components, 9 (69.2%) attained 100% conformity.
The hygienization of hands by the professionals and the use of a mask by the
patients during the disconnection from the hemodialysis had the worst rates
(83.9%). Conclusion although the actions evaluated are implemented in the unit, it is necessary
to propose and apply educational strategies with the health team, as well as
to institute periodical assessments, so as to raise the conformity rates,
ensuring the quality of the hemodialysis services.
Collapse
Affiliation(s)
- Késia Alves Gomes Rosetti
- Hospital Geral de Guarus, Campos dos GoytacazesRJ, Brazil, MSc, RN, Hospital Geral de Guarus, Campos dos Goytacazes, RJ, Brazil
| | - Daisy Maria Rizatto Tronchin
- Universidade de São Paulo, Escola de Enfermagem, São PauloSP, Brazil, PhD, Associate Professor, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
21
|
Corrêa APA, Brahm MMT, Teixeira CDC, Ferreira SAL, Manfro RC, Lucena ADF, Echer IC. [Complications during the hospitalization of kidney transplant recipients]. Rev Gaucha Enferm 2013; 34:46-54. [PMID: 24344584 DOI: 10.1590/s1983-14472013000300006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The objective of the study was to identify the complications in patients that have received a renal transplant. A Historical cohort performed in a university hospital from January/2007 through January/2009 with a sample of 179 patients; data collected retrospectively from the medical history of patients and submitted to statistical analyses. Mean age of patients was 43 (SD=13.7) years, 114 (63.7%) men, 95 (65.1%) non smokers and 118(66.93%) received the graft from a deceased donor. The main complications were rejection 68 (32.1%) and infection 62 (29.2%). There was statistical significance between rejection and median days of hospital stay (p < 0.001); days of use of central venous catheter (p = 0.010) and smoking status (p = 0.008); infection and central venous catheter (p = 0.029); median days of hospital stay (p < 0.001) and time of use of urinary catheter (p = 0.009). It was concluded that it is important to reduce the days of hospital stay and permanence of catheters, which may be considered in the planning of nursing care.
Collapse
|
22
|
Gurgel TC, Cherchiglia ML, Acurcio FDA, Szuster DAC, Gomes IC, Andrade EIG. [Erythropoietin use by incident hemodialysis patients in the Brazilian Unified National Health System, 2002-2003]. CAD SAUDE PUBLICA 2013; 28:856-68. [PMID: 22641509 DOI: 10.1590/s0102-311x2012000500005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 01/31/2012] [Indexed: 12/18/2022] Open
Abstract
This study aimed to describe the demographic and epidemiological profile of Brazilian patients entering hemodialysis from 2002 to 2003 and identify predictors of erythropoietin use. The study analyzed demographic and clinical characteristics and dialysis facility-related variables from 32,136 patients identified by deterministic-probabilistic matching in the database of authorizations for high-cost procedures and the Mortality Information System. Poisson regression was used to identify predictors of erythropoietin use. Male gender, age < 65 years, diabetic renal failure, arteriovenous fistula at the beginning of hemodialysis, and living in States of Brazil other than Mato Grosso were predictors of erythropoietin use. The policy of care for chronic kidney disease, resource allocation for States and municipalities, and anemia management according to the patient's drug therapy profile need to be revised in order to reduce observed inequities in erythropoietin use.
Collapse
Affiliation(s)
- Thaís Caroline Gurgel
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.
| | | | | | | | | | | |
Collapse
|
23
|
Cordeiro AC, Carrero JJ, Qureshi AR, Cunha RFD, Lindholm B, Castro ID, Noronha IL. Study of the incidence of dialysis in São Paulo, the largest Brazilian city. Clinics (Sao Paulo) 2013; 68:760-5. [PMID: 23778473 PMCID: PMC3675216 DOI: 10.6061/clinics/2013(06)06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 02/09/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Chronic kidney disease is a major public health problem worldwide. In Brazil, approximately 100,000 patients (January 2012) receive renal replacement therapy. Nevertheless, data on dialysis incidence in the Brazilian population are scarce. This study aims to analyze the incidence of patients starting dialysis therapy in São Paulo City, the largest Brazilian metropolis. METHOD This cohort study analyzed data from 9,994 patients starting hemodialysis or peritoneal dialysis funded by the Brazilian Public Health System during a 5-year period (2007-2011). Patient data for this study (recorded as electronic files) were obtained from the São Paulo City's Dialysis Regulatory Bureau, which regulates the allocation of patients requiring dialytic therapy. RESULTS The dialysis incidence rates were 178, 174, 170, 185 and 188 per million population for the years 2007, 2008, 2009, 2010 and 2011, respectively. The incidence rates increased with age. Hypertension and diabetes were the main etiologies diagnosed. Hemodialysis was the chosen dialysis modality in the majority of patients (92.6%), whereas the percentage of patients referred for peritoneal dialysis decreased from 10.1% to 5.5%. CONCLUSION The incidence of patients starting renal replacement therapy from 2007-2011 in São Paulo was stable but higher than the projected incidence for the entire country. The authors emphasize the need for further studies of the incidence of dialysis in the Brazilian population and for the creation of a Brazilian registry of dialysis patients, which would be a valuable tool for developing healthcare policies and renal replacement therapy strategies.
Collapse
Affiliation(s)
- Antonio Carlos Cordeiro
- Dante Pazzanese Institute of Cardiology, Department of Hypertension and Nephrology, São Paulo/SP, Brazil.
| | | | | | | | | | | | | |
Collapse
|
24
|
Peixoto ERDM, Reis IA, Machado EL, Andrade EIG, Acurcio FDA, Cherchiglia ML. Diálise planejada e a utilização regular da atenção primária à saúde entre os pacientes diabéticos do Município de Belo Horizonte, Minas Gerais, Brasil. CAD SAUDE PUBLICA 2013. [DOI: 10.1590/s0102-311x2013000600020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo foi de analisar os fatores associados ao início planejado da diálise dos pacientes diabéticos que iniciaram o tratamento no Município de Belo Horizonte, Minas Gerais, Brasil. Estudo transversal com 250 pacientes diabéticos que iniciaram diálise entre janeiro de 2006 e dezembro de 2007. Iniciar a diálise com fístula arteriovenosa ou em diálise peritoneal foi classificado como início planejado. Foram investigadas as variáveis sociodemográficas, clínicas e de utilização de serviços de saúde por meio de entrevista semiestruturada. Para análise multivariada utilizou-se regressão de Poisson. Setenta por cento dos pacientes começaram a diálise de forma não planejada e 67% dos que consultaram com o nefrologista foram encaminhados com mais de quatro meses. Frequentar o centro de saúde, não ter a primeira consulta com nefrologista paga pelo SUS e ter tido opção de escolha para o tratamento da doença renal foram fatores relacionados ao início planejado da diálise. O início não planejado da diálise é comum no Município de Belo Horizonte e ocorre independentemente do tempo de encaminhamento ao nefrologista.
Collapse
|
25
|
Koch Nogueira PC, de Santis Feltran L, Camargo MF, Leão ER, Benninghoven JR, Gonçalves NZ, Pereira LA, Sesso RC. Estimated prevalence of childhood end-stage renal disease in the state of São Paulo. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1016/s0104-4230(11)70091-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
26
|
Koch Nogueira PC, Santis Feltran LD, Camargo MF, Leão ER, Benninghoven JRCS, Gonçalves NZ, Pereira L, Sesso RC. Prevalência estimada da doença renal crônica terminal em crianças no Estado de São Paulo. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1590/s0104-42302011000400020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
27
|
Effects of a pharmacotherapy follow-up in community pharmacies on type 2 diabetes patients in Brazil. Int J Clin Pharm 2011; 33:273-80. [PMID: 21394570 DOI: 10.1007/s11096-011-9493-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 02/14/2011] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the effects of pharmacotherapy follow-up (PF) on metabolic control and clinical outcomes in type 2 diabetic patients. SETTING Six community pharmacies (4 intervention and 2 control) in the Curitiba metropolitan region (Brazil). MAIN OUTCOME MEASURE Glycosylated Haemoglobin A1 (HbA1) and fasting capillary glycaemia. METHODS We conducted a 12-month controlled trial involving a total of 161 patients in six community pharmacies between July 2004 and March 2006. Pharmacotherapy follow-up was applied only to patients in the intervention group. RESULTS Of the 161 patients enrolled, 96 completed the study (50 intervention and 46 control). The administration of 574 consultations with the intervention group patients led to 119 negative clinical outcomes (2.3/patient [SD = 1.6]). The majority of detected problems were related to the ineffectiveness of pharmacotherapy (68.1%). Relative to the control group, the intervention group exhibited greater glycosylated haemoglobin (HbA1) reduction (-2.2% [95%CI -2.8%:-1.6%] vs. -0.3 [95% CI -0.8:0.2]; P < 0.001) and greater fasting capillary glycaemia reduction (-20.1 mg/dl [95% CI -31.9 mg/dl:-8.3 mg/dl] vs. 4.3 mg/dl [95% CI -13.4 mg/dl:22.2 mg/dl]; P = 0.022). These differences persisted after adjustment for baseline values. There were no significant differences in any other clinical measures between the groups. There were also no significant changes in the number of medications and treatment regimens between groups, with the exception of the percentage of patients undergoing lipid lowering treatment, which increased in the intervention group from 16% to 24% (P = 0.018). The initial medication regimen complexity index (MRCI) in the intervention group was 15.5 (SD = 7.8, range 4-40.5), and it decreased by 1.2 units (SD = 5.9) after 12 months (P = 0.149). CONCLUSIONS PF of type 2 diabetic patients in community pharmacies can improve the glycaemia control of patients through optimisation of medication profiles without significant changes in either the number of drugs used or the regimen complexity.
Collapse
|