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Pané A, Claro M, Molina-Andujar A, Olbeyra R, Romano-Andrioni B, Boswell L, Montagud-Marrahi E, Jiménez A, Ibarzabal A, Viaplana J, Ventura-Aguiar P, Amor AJ, Vidal J, Flores L, de Hollanda A. Bariatric Surgery Outcomes in Patients with Chronic Kidney Disease. J Clin Med 2023; 12:6095. [PMID: 37763037 PMCID: PMC10532233 DOI: 10.3390/jcm12186095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Obesity increases the risk of developing chronic kidney disease (CKD), which has a major negative impact on global health. Bariatric surgery (BS) has demonstrated a substantial improvement of obesity-related comorbidities and thus, it has emerged as a potential therapeutic tool in order to prevent end-stage renal disease. A limited number of publications to date have examined the beneficial effects and risks of BS in patients with non-advanced stages of CKD. We aimed to investigate the safety of BS in patients with CKD stages 3-4 (directly related or not to obesity) and both the metabolic/renal outcomes post-BS. A total of 57 individuals were included (n = 19 for CKD-group; n = 38 for patients with obesity, but normal eGFR [control-group]). Weight loss and obesity comorbidities resolution after BS were similar in both groups. Renal function (eGFR [CKD-EPI]) improved significantly at the 1-year follow-up: Δ10.2 (5.2-14.9) (p < 0.001) for CKD-group and Δ4.0 (-3.9-9.0) mL/min/1.73 m2 (p = 0.043) for controls. Although this improvement tended to decrease in the 5-year follow-up, eGFR remained above its basal value for the CKD-group. Noteworthy, eGFR also improved in those patients who presented CKD not directly attributed to obesity. For patients with CKD, BS appears to be safe and effective regarding weight loss and obesity comorbidities resolution, irrespective of the main cause of CKD (related or not to obesity).
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Affiliation(s)
- Adriana Pané
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain; (M.C.); (B.R.-A.); (A.J.); (A.J.A.); (J.V.)
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Maria Claro
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain; (M.C.); (B.R.-A.); (A.J.); (A.J.A.); (J.V.)
| | - Alicia Molina-Andujar
- Nephrology and Kidney Transplantation Department, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (A.M.-A.); (E.M.-M.)
- Endocrinology and Nutrition Department, Althaia Universitary Health Network, 08243 Manresa, Spain
| | - Romina Olbeyra
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS)—Fundació Clínic per a la Recerca Biomèdica (FCRB), 08036 Barcelona, Spain; (R.O.); (J.V.)
| | - Bárbara Romano-Andrioni
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain; (M.C.); (B.R.-A.); (A.J.); (A.J.A.); (J.V.)
- Nephrology and Kidney Transplantation Department, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (A.M.-A.); (E.M.-M.)
| | - Laura Boswell
- Endocrinology and Nutrition Department, Althaia Universitary Health Network, 08243 Manresa, Spain
| | - Enrique Montagud-Marrahi
- Nephrology and Kidney Transplantation Department, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (A.M.-A.); (E.M.-M.)
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Centre de recerca biomèdica Cellex (CRB CELLEX), Fundació Clinic, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Amanda Jiménez
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain; (M.C.); (B.R.-A.); (A.J.); (A.J.A.); (J.V.)
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS)—Fundació Clínic per a la Recerca Biomèdica (FCRB), 08036 Barcelona, Spain; (R.O.); (J.V.)
| | - Ainitze Ibarzabal
- Obesity Unit, Gastrointestinal Surgery Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Judith Viaplana
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS)—Fundació Clínic per a la Recerca Biomèdica (FCRB), 08036 Barcelona, Spain; (R.O.); (J.V.)
| | - Pedro Ventura-Aguiar
- Nephrology and Kidney Transplantation Department, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (A.M.-A.); (E.M.-M.)
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Centre de recerca biomèdica Cellex (CRB CELLEX), Fundació Clinic, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Antonio J. Amor
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain; (M.C.); (B.R.-A.); (A.J.); (A.J.A.); (J.V.)
| | - Josep Vidal
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain; (M.C.); (B.R.-A.); (A.J.); (A.J.A.); (J.V.)
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS)—Fundació Clínic per a la Recerca Biomèdica (FCRB), 08036 Barcelona, Spain; (R.O.); (J.V.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Lilliam Flores
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain; (M.C.); (B.R.-A.); (A.J.); (A.J.A.); (J.V.)
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS)—Fundació Clínic per a la Recerca Biomèdica (FCRB), 08036 Barcelona, Spain; (R.O.); (J.V.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Ana de Hollanda
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain; (M.C.); (B.R.-A.); (A.J.); (A.J.A.); (J.V.)
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS)—Fundació Clínic per a la Recerca Biomèdica (FCRB), 08036 Barcelona, Spain; (R.O.); (J.V.)
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Contreras M, Mesa A, Pueyo I, Claro M, Milad C, Viñals C, Roca D, Granados M, Giménez M, Conget I. Effectiveness of flash glucose monitoring in patients with type 1 diabetes and recurrent hypoglycemia between early and late stages after flash glucose monitoring initiation. J Diabetes Complications 2023; 37:108560. [PMID: 37480703 DOI: 10.1016/j.jdiacomp.2023.108560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/07/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
AIMS Evaluate the effectiveness of reimbursed flash glucose monitoring with optional alarms (FGM) in preventing severe hypoglycemia (SH) and reducing hypoglycemia exposure in T1D patients prone to hypoglycemia. METHODS Ambispective study in T1D patients treated with multiple daily injections (MDI) and prone to hypoglycemia, initiating reimbursed FGM (FreeStyle Libre 2). The primary outcome was the number of SH events (requiring third party assistance) and main secondary outcomes were time below range < 70 (TBR < 70) and < 54 mg/dL (TBR < 54), impaired awareness of hypoglycemia (IAH) and quality of life (QoL). Logistic regression models were constructed to explore variables associated with success of the intervention. RESULTS We included 110 patients (52.7 % women, mean age 47.8 ± 17.0 years). SH events at 1-year follow-up decreased from 0.3 ± 0.6 to 0.03 ± 0.2 (p < 0.001). Significant reductions in patients presenting an SH (26.4 % vs. 2.9 %, p < 0.001) and IAH (47.1 % vs. 25.9 %, p = 0.002) were observed, as well as improvements in QoL. TBR < 70 and TBR < 54 were not significantly reduced. Baseline GMI was inversely associated with a decrease in TBR < 70 [OR 0.37 (0.15-0.93)] and directly with an increase in time in range 70-180 mg/dL [OR 2.10 (1.03-4.28)]. CONCLUSIONS FGM decreased SH and improved hypoglycemia awareness and QoL. Initial tight glycemic control was associated with a decrease in hypoglycemia, while patients with suboptimal control reduced hyperglycemia.
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Affiliation(s)
- Macarena Contreras
- Endocrinology and Nutrition Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain; Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Alex Mesa
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Irene Pueyo
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Maria Claro
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Camila Milad
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Daria Roca
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Montse Granados
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain; CIBERDEM (Centro de Investigación en Red de Diabetes y Enfermedades Metabólicas), Madrid, Spain.
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain; CIBERDEM (Centro de Investigación en Red de Diabetes y Enfermedades Metabólicas), Madrid, Spain
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Rodrigues A, Claro M, Alexandre-Pires G, Santos-Mateus D, Martins C, Valério-Bolas A, Rafael-Fernandes M, Pereira MA, Pereira da Fonseca I, Tomás AM, Santos-Gomes G. Leishmania infantum antigens modulate memory cell subsets of liver resident T lymphocyte. Immunobiology 2016; 222:409-422. [PMID: 27615509 DOI: 10.1016/j.imbio.2016.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 08/29/2016] [Indexed: 11/28/2022]
Abstract
In the recent years, the liver has been recognized as an important immune organ with major regulatory functions and immune memory, adding to the well-described vital metabolic functions. There are evidences from experimental infections performed with visceral Leishmania species that immune responses to parasite infection can be organ-specific. The liver is the compartment of acute resolving infection, with minimal tissue damage and resistance to reinfection, whereas the spleen is the compartment of parasite persistence. Control of hepatic infection in mice requires a coordinated immune response that involves the development of inflammatory granulomas. It is also described that the liver harbors populations of resident lymphocytes, which may exhibit memory characteristics. Therefore, the present study aims to address the role of the liver as an immune memory organ in the context of Leishmania infantum infection, by characterizing phenotypically resident liver T lymphocytes. The dynamics of memory T cells in L. infantum infected BALB/c mice and the effect of anti-leishmanial treatment in the differentiation of memory cell subsets were analyzed. The potential of recognition, differentiation and selection of memory lymphocytes by three L. infantum recombinant proteins were also explored. L. infantum infection generates effector and central memory T cells, but the cells did not expand when recalled, demonstrating a possible parasite silencing effect. The treatment with a leishmanicidal drug (antimoniate meglumine) increases the levels of memory and effector T cells, eliciting a more robust hepatic immune response. L. infantum parasites with a decreased sensitivity to the leishmanicidal drug favor the expansion of memory CD8+ T cell subset, but inhibit the proliferation of CD8+ T effector cells, possibly assuring their own survival. The recombinant proteins LirCyp1 and LirSOD are strongly recognized by memory cells of treated mice, indicating that these proteins might be used in a prophylactic or therapeutic vaccine formulation. Thus, L. infantum released antigens induce the development of immune memory subsets in the liver resident T cell population that specifically recognized parasite antigens, including recombinant proteins.
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Affiliation(s)
- A Rodrigues
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - M Claro
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - G Alexandre-Pires
- CIISA, Faculdade de Medicina Veterinária, Universidade de Lisboa, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
| | - D Santos-Mateus
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - C Martins
- CEDOC, Chronic Diseases Research Center, Immunology, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires de Pátria, 1169-056 Lisboa, Portugal
| | - A Valério-Bolas
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - M Rafael-Fernandes
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - M A Pereira
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - I Pereira da Fonseca
- CIISA, Faculdade de Medicina Veterinária, Universidade de Lisboa, Av. Universidade Técnica, 1300-477 Lisboa, Portugal
| | - A M Tomás
- Instituto de Investigação e Inovação em Saúde and Instituto de Biologia Molecular e Celular (IBMC), Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
| | - G Santos-Gomes
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisboa, Portugal.
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Gonçalves F, Almeida A, Antunes C, Cardoso M, Carvalho M, Claro M, Coimbra F, Diniz I, Fonseca B, Fradique E, Gonçalves E, Gonçalves F, Gonçalves M, Magalhães A, Pina P, Pires C, Silva P, Silva R, Silva R, Tavares F, Teixeira L. Symptoms other than pain in palliative care in Portugal. Am J Hosp Palliat Care 2014; 32:335-40. [PMID: 24463203 DOI: 10.1177/1049909114520715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study the burden of patients' symptoms other than pain and their treatment by Portuguese palliative care teams. METHODS Of the 21 Portuguese palliative care teams identified, 10 accepted to participate. Data from all patients observed on the 18th week of 2011 were collected. RESULTS One hundred and sixty-four patients were included in this study. One hundred and fifty-one patients (92%) had cancer. The patients' median age was 71 years (16-95) and 84 (51%) were females. The main symptoms were fatigue (116 [85%]) and depression/sadness (107 [65%]). Many different drugs were used for symptom control and other aims. Symptoms and drugs used here are similar to those practiced in other countries. CONCLUSION The practice of palliative care in Portugal seems to be similar to those in other countries.
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Affiliation(s)
- Ferraz Gonçalves
- Department of Palliative Care, Instituto Português de Oncologia, Porto, Portugal
| | - Ana Almeida
- Department of Palliative Care, Instituto Português de Oncologia, Porto, Portugal
| | - Catarina Antunes
- Department of Palliative Care, Hospital do Mar, Lisboa, Portugal
| | - Maria Cardoso
- Department of Palliative Care, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Margarida Carvalho
- Department of Palliative Care, Hospital do Litoral Alentejano, Santiago do Cacém, Portugal
| | - Maria Claro
- Department of Palliative Care, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Francisca Coimbra
- Department of Palliative Care, Instituto Português de Oncologia, Lisboa, Lisboa, Portugal
| | - Inês Diniz
- Department of Palliative Care, Hospital do Mar, Lisboa, Portugal
| | - Bruno Fonseca
- Department of Palliative Care, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Emília Fradique
- Department of Palliative Care, Hospital de St. Maria, Lisboa, Portugal
| | - Edna Gonçalves
- Department of Palliative Care, Centro Hospitalar de S. João, Porto, Portugal
| | - Florbela Gonçalves
- Department of Palliative Care, Instituto Português de Oncologia, Coimbra, Coimbra, Portugal
| | - Maria Gonçalves
- Department of Palliative Care, Hospital do Litoral Alentejano, Santiago do Cacém, Portugal
| | - Américo Magalhães
- Department of Palliative Care, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Paulo Pina
- Department of Palliative Care, Instituto Português de Oncologia, Lisboa, Lisboa, Portugal
| | - Conceição Pires
- Department of Palliative Care, Centro Hospitalar de S. João, Porto, Portugal
| | - Paula Silva
- Department of Palliative Care, Instituto Português de Oncologia, Porto, Portugal
| | - Ricardo Silva
- Department of Palliative Care, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Rui Silva
- Department of Palliative Care, Instituto Português de Oncologia, Coimbra, Coimbra, Portugal
| | - Filipa Tavares
- Department of Palliative Care, Hospital de St. Maria, Lisboa, Portugal
| | - Laura Teixeira
- Department of Palliative Care, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
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Gonçalves F, Almeida A, Antunes C, Cardoso M, Carvalho M, Claro M, Coimbra F, Diniz I, Fonseca B, Fradique E, Gonçalves E, Gonçalves F, Gonçalves M, Magalhães A, Pina P, Pires C, Silva P, Silva R, Silva R, Tavares F, Teixeira L. A cross-sectional survey of pain in palliative care in Portugal. Support Care Cancer 2013; 21:2033-9. [DOI: 10.1007/s00520-013-1746-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 02/04/2013] [Indexed: 11/29/2022]
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Gonçalves F, Almeida A, Antunes C, Cardoso A, Carvalho M, Claro M, Coimbra F, Diniz I, Fonseca B, Fradique E, Gonçalves E, Gonçalves F, Gonçalves M, Magalhães A, Pina P, Pires C, Silva P, Silva R, Silva R, Tavares F, Teixeira L. A cross-sectional survey of the activity of palliative care teams in Portugal. Am J Hosp Palliat Care 2012; 30:648-51. [PMID: 23264665 DOI: 10.1177/1049909112469718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Of the 21 Portuguese teams identified, 10 accepted to participate in the study. A total of 164 patients were included with a median of 15.5 per team (4-32). Of all the patients included, 60 (37%) were identified as inpatients in palliative care units; 59 (36%) by an intrahospital support team; 26 (16%) as outpatients; and 19 (12%) at home. The median age was 71 years (16-95). Fifty-one percent were females. The diagnosis was cancer in 151 (92%) patients. The most common cancer was colorectal in 22 (15%) patients, followed by gastric 17 (11%), head and neck 17 (11%), breast 15 (10%), and lung cancers 14 (9%). All patients were treated by doctors and nurses experienced in palliative care.
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