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Bansal S, Canziani MEF, Birne R, Anker SD, Bakris GL, Filippatos G, Rossing P, Ruilope LM, Farjat AE, Kolkhof P, Lage A, Brinker M, Pitt B. Finerenone cardiovascular and kidney outcomes by age and sex: FIDELITY post hoc analysis of two phase 3, multicentre, double-blind trials. BMJ Open 2024; 14:e076444. [PMID: 38508632 PMCID: PMC10952937 DOI: 10.1136/bmjopen-2023-076444] [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] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 02/20/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES This study aimed to evaluate the efficacy and safety of finerenone, a selective, non-steroidal mineralocorticoid receptor antagonist, on cardiovascular and kidney outcomes by age and/or sex. DESIGN FIDELITY post hoc analysis; median follow-up of 3 years. SETTING FIDELITY: a prespecified analysis of the FIDELIO-DKD and FIGARO-DKD trials. PARTICIPANTS Adults with type 2 diabetes and chronic kidney disease receiving optimised renin-angiotensin system inhibitors (N=13 026). INTERVENTIONS Randomised 1:1; finerenone or placebo. PRIMARY AND SECONDARY OUTCOME MEASURES Cardiovascular (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke or hospitalisation for heart failure (HHF)) and kidney (kidney failure, sustained ≥57% estimated glomerular filtration rate (eGFR) decline or renal death) composite outcomes. RESULTS Mean age was 64.8 years; 45.2%, 40.1% and 14.7% were aged <65, 65-74 and ≥75 years, respectively; 69.8% were male. Cardiovascular benefits of finerenone versus placebo were consistent across age (HR 0.94 (95% CI 0.81 to 1.10) (<65 years), HR 0.84 (95% CI 0.73 to 0.98) (65-74 years), HR 0.80 (95% CI 0.65 to 0.99) (≥75 years); Pinteraction=0.42) and sex categories (HR 0.86 (95% CI 0.77 to 0.96) (male), HR 0.89 (95% CI 0.35 to 2.27) (premenopausal female), HR 0.87 (95% CI 0.73 to 1.05) (postmenopausal female); Pinteraction=0.99). Effects on HHF reduction were not modified by age (Pinteraction=0.70) but appeared more pronounced in males (Pinteraction=0.02). Kidney events were reduced with finerenone versus placebo in age groups <65 and 65-74 but not ≥75; no heterogeneity in treatment effect was observed (Pinteraction=0.51). In sex subgroups, finerenone consistently reduced kidney events (Pinteraction=0.85). Finerenone reduced albuminuria and eGFR decline regardless of age and sex. Hyperkalaemia increased with finerenone, but discontinuation rates were <3% across subgroups. Gynaecomastia in males was uncommon across age subgroups and identical between treatment groups. CONCLUSIONS Finerenone improved cardiovascular and kidney composite outcomes with no significant heterogeneity between age and sex subgroups; however, the effect on HHF appeared more pronounced in males. Finerenone demonstrated a similar safety profile across age and sex subgroups. TRIAL REGISTRATION NUMBERS NCT02540993, NCT02545049.
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Affiliation(s)
- Shweta Bansal
- Division of Nephrology, Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | | | - Rita Birne
- Department of Nephrology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
- Nova Medical School, University of Lisbon, Lisbon, Portugal
| | - Stefan D Anker
- Department of Cardiology (CVK) of German Heart Center Charité; German Centre for Cardiovascular Research (DZHK) partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - George L Bakris
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Luis M Ruilope
- Cardiorenal Translational Laboratory and Hypertension Unit, Institute of Research imas12, Madrid, Spain
- CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
- Faculty of Sport Sciences, European University of Madrid, Madrid, Spain
| | - Alfredo E Farjat
- Research and Development, Clinical Data Sciences and Analytics, Bayer PLC, Reading, UK
| | - Peter Kolkhof
- Research and Early Development, Cardiovascular Precision Medicines, Bayer AG, Wuppertal, Germany
| | - Andrea Lage
- Cardiology and Nephrology Clinical Development, Bayer SA, São Paulo, Brazil
| | - Meike Brinker
- Cardiology and Nephrology Clinical Development, Bayer AG, Wuppertal, Germany
| | - Bertram Pitt
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
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Roxo MI, Pepe B, Birne R. Wunderlich syndrome in a patient on hemodialysis. J Bras Nefrol 2023; 45:380-381. [PMID: 37071822 PMCID: PMC10697152 DOI: 10.1590/2175-8239-jbn-2023-0011en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/01/2023] [Indexed: 04/20/2023] Open
Affiliation(s)
- Maria Inês Roxo
- Centro Hospitalar de Lisboa Ocidental, Serviço de Nefrologia,
Carnaxide, Portugal
| | - Bruno Pepe
- Centro Hospitalar de Lisboa Ocidental, Serviço de Nefrologia,
Carnaxide, Portugal
| | - Rita Birne
- Centro Hospitalar de Lisboa Ocidental, Serviço de Nefrologia,
Carnaxide, Portugal
- Universidade NOVA de Lisboa, Lisboa, Portugal
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Mateus C, Luís P, Birne R. An Unusual Intestinal Finding in a Patient with ESKD and Abdominal Pain. Kidney360 2023; 4:425-426. [PMID: 36996305 PMCID: PMC10103329 DOI: 10.34067/kid.0000000000000070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/12/2022] [Indexed: 04/01/2023]
Affiliation(s)
- Catarina Mateus
- Centro Hospitalar Lisboa Ocidental, Nephrology, Lisbon, Portugal
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Pina AF, Borges DO, Meneses MJ, Branco P, Birne R, Vilasi A, Macedo MP. Insulin: Trigger and Target of Renal Functions. Front Cell Dev Biol 2020; 8:519. [PMID: 32850773 PMCID: PMC7403206 DOI: 10.3389/fcell.2020.00519] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022] Open
Abstract
Kidney function in metabolism is often underestimated. Although the word “clearance” is associated to “degradation”, at nephron level, proper balance between what is truly degraded and what is redirected to de novo utilization is crucial for the maintenance of electrolytic and acid–basic balance and energy conservation. Insulin is probably one of the best examples of how diverse and heterogeneous kidney response can be. Kidney has a primary role in the degradation of insulin released in the bloodstream, but it is also incredibly susceptible to insulin action throughout the nephron. Fluctuations in insulin levels during fast and fed state add another layer of complexity in the understanding of kidney fine-tuning. This review aims at revisiting renal insulin actions and clearance and to address the association of kidney dysmetabolism with hyperinsulinemia and insulin resistance, both highly prevalent phenomena in modern society.
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Affiliation(s)
- Ana F Pina
- Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,ProRegeM Ph.D. Programme, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Diego O Borges
- Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Molecular Biosciences Ph.D. Programme, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, Portugal
| | - Maria João Meneses
- Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,ProRegeM Ph.D. Programme, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Patrícia Branco
- Department of Nephrology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.,Portuguese Diabetes Association - Education and Research Center (APDP-ERC), Lisbon, Portugal
| | - Rita Birne
- Department of Nephrology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.,Portuguese Diabetes Association - Education and Research Center (APDP-ERC), Lisbon, Portugal
| | - Antonio Vilasi
- Institute of Clinical Physiology - National Research Council, Reggio Calabria Unit1, Reggio Calabria, Italy
| | - Maria Paula Macedo
- Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.,Portuguese Diabetes Association - Education and Research Center (APDP-ERC), Lisbon, Portugal
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Fiel D, Calca R, Cacheira E, Rombo N, Querido S, Nascimento C, Jorge C, Weigert A, Birne R, Clemente B, Martinho A, Toscano C, Bruges M, Malvar B, Machado D. Cupriavius pauculus causing a respiratory tract infection in a post-kidney-transplant patient: A firstly described rare clinical case. ACTA ACUST UNITED AC 2020. [DOI: 10.15406/ppij.2020.08.00277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Monteiro P, Aguiar C, Matos P, Silva-Nunes J, Birne R, Branco P, Calado J, Melo M, Polónia J. Effect of empagliflozin beyond glycemic control: Cardiovascular benefit in patients with type 2 diabetes and established cardiovascular disease. Revista Portuguesa de Cardiologia (English Edition) 2019. [DOI: 10.1016/j.repce.2019.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Martins V, Aguiar L, Dias C, Lourenço P, Pinheiro T, Velez B, Birne R, Borges N, Adragão T, Calhau C, Macário F. FP718DIABETES AND MALNUTRITION RISK IN HEMODIALYSIS PATIENT. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Conceição Calhau
- Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal
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Laranjinha I, Matias P, Oliveira R, Casqueiro A, Bento MT, Carvalho AP, Adragão T, Jorge C, Bruges M, Birne R, Machado D, Weigert A. The impact of functioning hemodialysis arteriovenous accesses on renal graft perfusion: Results of a pilot study. J Vasc Access 2018; 20:482-487. [DOI: 10.1177/1129729818817248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Introduction: After a kidney transplant, it is unknown whether the maintenance of a functioning hemodialysis arteriovenous access could have deleterious effects on renal grafts. We hypothesize that maintaining an arteriovenous access can deviate a significant proportion of the cardiac output from the renal graft. The aim of this study was to investigate whether a temporary closure of the arteriovenous access could lead to an increase in graft perfusion. Methods: We conducted a study in 17 kidney-transplanted patients with a functioning arteriovenous access. We evaluated, at baseline and 30 s after compression of the arteriovenous access (access flow occlusion), the hemodynamic parameters and the renal resistive index of the graft by Doppler ultrasound. Results: After arteriovenous access occlusion 82.4% (n = 14) of the patients had a decrease in resistive index. All patients had a decrease in heart rate (67 vs 58 bpm, p < 0.001) and 14 (82.4%) had an increase in mean blood pressure (98.3 vs 101.7 mm Hg, p = 0.044). There was a significant decrease in the resistive index (ΔRI) after the access occlusion (0.68 vs 0.64, p = 0.030). We found a negative correlation in Qa (r2 = −0.55, p = 0.022) with the ΔRI, and Qa was an independent predictor of ΔRI in a model adjusted to pre-occlusion resistive index. Conclusion: Our results showed that temporary occlusion of an arteriovenous access causes a significant decline in renal graft resistive index and this decline is higher with the occlusion of accesses with higher Qa. These results suggest that the maintenance of arteriovenous accesses, mainly those with higher Qa, can decrease renal graft perfusion.
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Affiliation(s)
- Ivo Laranjinha
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Patricia Matias
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Nova Medical School – Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Regina Oliveira
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana Casqueiro
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Maria Teresa Bento
- Department of Radiology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana Paula Carvalho
- Department of Radiology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Teresa Adragão
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Nova Medical School – Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Cristina Jorge
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Margarida Bruges
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Rita Birne
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Domingos Machado
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - André Weigert
- Kidney Transplant Unit, Nephrology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Faculdade de Medicina, University of Lisbon, Lisbon, Portugal
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Weigert A, Querido S, Carvalho L, Lebre L, Chagas C, Matias P, Birne R, Nascimento C, Jorge C, Adragão T, Bruges M, Machado D. Hepatitis C Virus Eradication in Kidney Transplant Recipients: A Single-Center Experience in Portugal. Transplant Proc 2018; 50:743-745. [PMID: 29661427 DOI: 10.1016/j.transproceed.2018.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Hepatitis C (HCV) is a major cause of liver impairment post-kidney transplantation (KT). Anti-HCV direct-acting antivirals (DAA) made viral eradication possible. METHODS We performed a retrospective review of KT patients (n = 23) who received DAA at our hospital. Sustained viral response (SVR) was defined as absence of viral detection 12 weeks after cessation of therapy. RESULTS From 1985 to September 2017, 1440 patients underwent transplantation at Hospital Santa Cruz. From a total of 32 HCV RNA+ KT recipients on follow-up, we describe the first 23 patients treated with DAA. They were 56.7 ± 9.1 years old; 22 were white, 52.2% were males, they underwent transplantation 18.8 ± 9.0 years ago, and 13 had genotype 1B, 21 were naïve, and 9 had stages F3/F4. All but 2 patients, treated with grazoprevir/elbasvir, received sofosbuvir (18 with ledispasvir, 2 with daclastavir, and 4 with simultaneous ribavirin). Pretreatment, intra-treatment, and post-treatment creatinine clearances were 61.4, 60.6, and 60.7 mL/min/1.73 m2, respectively (not significant [NS]). Cyclosporine A was the basis of immunosuppression in the majority [(n = 14); pretreatment and intra-treatment levels were 79.5 ± 23.0 and 91.8 ± 26.0 ng/mL, respectively (P = .08)]; tacrolimus (n = 8) and mammalian target of rapamycin (mTOR) levels (n = 5) were also similar. One patient interrupted ribavirin after 7 weeks due to anemia; all other patients completed the treatment course without major side effects. Only 3 patients presented positive viral RNA at the fourth week of treatment and SVR was achieved in 100% of the patients 12 weeks after treatment. CONCLUSIONS DAA therapy was well tolerated and effective in 100% of our treated patients, without significant impact on the renal function or on the immunosuppression.
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Affiliation(s)
- A Weigert
- Nephrology Department, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal.
| | - S Querido
- Nephrology Department, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - L Carvalho
- Gastroenterology Department, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - L Lebre
- Gastroenterology Department, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - C Chagas
- Gastroenterology Department, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - P Matias
- Nephrology Department, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - R Birne
- Nephrology Department, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - C Nascimento
- Nephrology Department, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - C Jorge
- Nephrology Department, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - T Adragão
- Nephrology Department, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - M Bruges
- Nephrology Department, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - D Machado
- Nephrology Department, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
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Querido S, Weigert A, Adragão T, Henriques J, Birne R, Matias P, Jorge C, Nascimento C, Bruges M, Machado D. Intravenous Immunoglobulin and Rituximab in HLA Highly Sensitized Kidney Transplant Recipients. Transplant Proc 2018; 50:723-727. [PMID: 29661424 DOI: 10.1016/j.transproceed.2018.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION HLA-sensitized patients are penalized both in the access to kidney transplantation (KT) and, once transplanted, in the incidence of rejections and long-term allograft survival despite aggressive induction and maintenance therapy. METHODS This study retrospectively evaluates the impact of combining T- and B-cell-depleting agents and intravenous immunoglobulin for induction therapy in 45 highly sensitized KT patients (anti-panel reactive antibodies >60%, positive flow cytometry crossmatch or donor specific antibodies at the time of transplantation). The outcome data included the occurrence of biopsy-proven acute rejection, new-onset proteinuria, development of leukopenia, incidence of poliomavirus infection (BK or JC virus), fungal or bacterial infection after KT, de novo neoplasia, graft function, graft loss, or death with functioning KT. RESULTS The average panel reactive antibody was 62.5%; 41 patients (91.1%) had ≥3 HLA mismatches with the donor and 91.1% of patients had class I or II anti-HLA antibodies. Fourteen patients (31.1%) presented pre-KT donor-specific antibodies and 6 patients (13.3%) had a positive flow cytometry cross-match at the time of transplantation. The incidence of acute rejection in the first 6 months was 24.4% and the cumulative incidence was 37.8%. Two patients were diagnosed with leukopenia in the first 6 months after KT. Two patients (4.5%) had cytomegalovirus disease, 17 patients (37.8%) were diagnosed with bacterial infections. Cutaneous neoplasms were identified in 5 patients (11.1%) and solid tumors in 4 (8.9%). The death-censored graft survival was 100% in the first 6 months and 93.5% at the last evaluation. Patient survival in the same periods was 97.8% and 93.3%, respectively. CONCLUSIONS Induction immunosuppressive therapy with intravenous immunoglobulin and rituximab is effective; outcomes demonstrate an excellent patient and allograft survival and allograft function over the follow-up period.
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Affiliation(s)
- S Querido
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal.
| | - A Weigert
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - T Adragão
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - J Henriques
- Department of Pathology, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - R Birne
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - P Matias
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - C Jorge
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - C Nascimento
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - M Bruges
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - D Machado
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
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Carvalho T, Carvalho C, Adragão T, Dickson J, Jorge C, Birne R, Weigert A, Bruges M, Matias P, Oliveira R, Casqueiro A, Frazão J, Machado D. SP354BONE HISTOMORPHOMETRY DATA IN RENAL TRANSPLANT PATIENTS WITH HYPERCALCEMIC HYPERPARATHYROIDISM WITH AND WITHOUT CINACALCET TREATMENT. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx147.sp354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lanca A, Birne R, Laranjinha I, Coelho S, Cunha L, Carvalho T, Jorge C, Weigert A, Machado D. SP789HEMOLYTIC ANEMIA AFTER KIDNEY TRANSPLANT WITH POLYCLONAL ANTIBODIES. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx158.sp789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Laranjinha I, Matias P, Oliveira R, Casqueiro A, Bento MT, Carvalho AP, Adragão T, Jorge C, Bruges M, Birne R, Cerqueira Z, Machado D, Weigert A. MP814THE IMPACT OF FUNCTIONING HEMODIALYSIS ARTERIOVENOUS ACCESSES ON RENAL GRAFT PERFUSION: RESULTS OF A PILOT STUDY. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx182.mp814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fernandes A, Pereira T, Mendes A, Birne R, Matias P, Jorge C, Adragão T, Bruges M, Oliveira R, Salvadinho A, Laranjeira T, Mirco A, Falcão F, Toscano C, Machado D, Weigert A. MP716ARE CRANBERRY CAPSULES EFFECTIVE IN PREVENTING URINARY TRACT INFECTIONS IN KIDNEY TRANSPLANT WOMEN?-RAMDOMIZED TRIAL. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw200.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Querido S, Sousa HS, Pereira TA, Birne R, Matias P, Jorge C, Weigert A, Adragão T, Bruges M, Machado D. Gastrointestinal Bleeding and Diffuse Skin Thickening as Kaposi Sarcoma Clinical Presentation. Case Rep Transplant 2015; 2015:424508. [PMID: 26783491 PMCID: PMC4689922 DOI: 10.1155/2015/424508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/12/2015] [Indexed: 02/06/2023] Open
Abstract
A 56-year-old African patient received a kidney from a deceased donor with 4 HLA mismatches in April 2013. He received immunosuppression with basiliximab, tacrolimus, mycophenolate mofetil, and prednisone. Immediate diuresis and a good allograft function were soon observed. Six months later, the serum creatinine level increased to 2.6 mg/dL. A renal allograft biopsy revealed interstitial fibrosis and tubular atrophy grade II. Toxicity of calcineurin inhibitor was assumed and, after a switch for everolimus, renal function improved. However, since March 2014, renal function progressively deteriorated. A second allograft biopsy showed no new lesions. Two months later, the patient was admitted due to anuria, haematochezia with anaemia, requiring 5 units of packed red blood cells, and diffuse skin thickening. Colonoscopy showed haemorrhagic patches in the colon and the rectum; histology diagnosis was Kaposi sarcoma (KS). A skin biopsy revealed cutaneous involvement of KS. Rapid clinical deterioration culminated in death in June 2014. This case is unusual as less than 20 cases of KS with gross gastrointestinal bleeding have been reported and only 6 cases had the referred bleeding originating in the lower gastrointestinal tract. So, KS should be considered in differential diagnosis of gastrointestinal bleeding in some kidney transplant patients.
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Affiliation(s)
- Sara Querido
- Department of Nephrology, Centro Hospitalar do Médio Tejo, Avenida Xanana Gusmão, Apartado 45, 2350-754 Torres Novas, Portugal
| | - Henrique Silva Sousa
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Tiago Assis Pereira
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Rita Birne
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Patrícia Matias
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Cristina Jorge
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - André Weigert
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Teresa Adragão
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Margarida Bruges
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Domingos Machado
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
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Querido S, Jorge C, Sousa H, Birne R, Matias P, Weigert A, Adragão T, Bruges M, Ramos S, Santos M, Paixão P, Curran M, Machado D. JC polyomavirus nephropathy confirmed by using an in-house polymerase chain reaction method. Transpl Infect Dis 2015. [DOI: 10.1111/tid.12426] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S. Querido
- Department of Nephrology; Médio Tejo Hospitalar Center; Torres Novas Portugal
| | - C. Jorge
- Department of Nephrology; Santa Cruz Hospital; Carnaxide Portugal
| | - H. Sousa
- Department of Nephrology; Santa Cruz Hospital; Carnaxide Portugal
| | - R. Birne
- Department of Nephrology; Santa Cruz Hospital; Carnaxide Portugal
| | - P. Matias
- Department of Nephrology; Santa Cruz Hospital; Carnaxide Portugal
| | - A. Weigert
- Department of Nephrology; Santa Cruz Hospital; Carnaxide Portugal
| | - T. Adragão
- Department of Nephrology; Santa Cruz Hospital; Carnaxide Portugal
| | - M. Bruges
- Department of Nephrology; Santa Cruz Hospital; Carnaxide Portugal
| | - S. Ramos
- Department of Pathology; Lisbon Ocidental Hospitalar Center; Lisbon Portugal
| | - M. Santos
- Department of Clinical Pathology; Lisbon Central Hospitalar Center; Lisbon Portugal
| | - P. Paixão
- Nova Medical School; Lisbon Portugal
| | - M.D. Curran
- Clinical Microbiology and Public Health Laboratory; Public Health England; Addenbrooke's Hospital; Cambridge UK
| | - D. Machado
- Department of Nephrology; Santa Cruz Hospital; Carnaxide Portugal
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Marques IB, Silva RDM, Moraes CE, Azevedo LS, Nahas WC, David-Neto E, Furmanczyk-Zawiska A, Baczkowska T, Chmura A, Szmidt J, Durlik M, Joslin J, Blaker P, White B, Marinaki A, Sanderson J, Goldsmith DJ, Medani S, Traynor C, Mohan P, Little D, Conlon P, Molina M, Gonzalez E, Gutierrez E, Sevillano A, Polanco N, Morales E, Hernandez A, Praga M, Morales JM, Andres A, Park SJ, Kim TH, Kim YW, Kim YH, Kang SW, Kujawa-Szewieczek A, Szotowska M, Kuczera P, Chudek J, Wiecek A, Kolonko A, Mahrova A, Svagrova K, Bunc V, Stollova M, Teplan V, Hundt F, van Heteren P, Woitas R, Cavallo MC, Sepe V, Conte F, Albrizio P, Bottazzi A, Geraci PM, Alpay N, Gumber MR, Kute VB, Vanikar AV, Patel HV, Shah PR, Engineer DP, Trivedi HL, Golebiewska JE, Debska-Slizien A, Rutkowski B, Matias P, Martins AR, Raposo L, Jorge C, Weigert A, Birne R, Bruges M, Adragao T, Almeida M, Mendes M, Machado D, Masin-Spasovska J, Dohcev S, Stankov O, Stavridis S, Saidi S, Dejanova B, Rambabova-Busletic I, Dejanov P, Spasovski G, Nho KW, Kim YH, Han DJ, Park SK, Kim SB, Fenoglio R, Lazzarich EE, Cagna D, Cena T, Conti N, Quaglia M, Radin E, Izzo C, Stratta P, Oh IH, Park JS, Lee CH, Kang CM, Kim GH, Leone F, Lofaro D, Gigliotti P, Lupinacci S, Toteda P, Vizza D, Perri A, Papalia T, Bonofiglio R, di Loreto P, de Silvestro L, Montanaro D, Martino F, Sandrini S, Minetti E, Cabiddu G, Yildirim T, Yilmaz R, Turkmen E, Abudalal A, Altindal M, Ertoy-Baydar D, Erdem Y, Panuccio V, Tripepi R, Parlongo G, Versace MC, Politi R, Zoccali C, Mallamaci F, Porrini E, Silva I, Diaz J, Ibernon M, Moreso F, Benitez R, Delgado Mallen P, Osorio J, Lauzurica R, Torres A, Ersoy A, Koca N, Gullu Koca T, Kirhan E, Sarandol E, Ersoy C, Dirican M, Milne J, Suter V, Mikhail A, Akalin H, Dizdar O, Ersoy A, Pascual J, Torio A, Garcia C, Hernandez J, Perez-Saez MJ, Mir M, Anna F, Crespo M, Carta P, Zanazzi M, Antognoli G, Di Maria L, Caroti L, Minetti E, Dizdar O, Ersoy A, Akalin H, Ray DS, Mukherjee K, Bohidar NP, Pattanaik A, Das P, Thukral S, Kimura T, Yagisawa T, Ishikawa N, Sakuma Y, Fujiwara T, Nukui A, Gavela EE, Sancho AA, Kanter JJ, Avila AA, Beltran SS, Pallardo LL, Dawoud FG, Aithal V, Mikhail A, Majernikova M, Rosenberger J, Prihodova L, Nagyova I, Jarcuskova M, Roland R, Groothoff JW, van Dijk JP, van Agteren M, de Weerd A, van de Wetering J, IJzermans J, Betjes M, Weimar W, Popoola J, Reed A, Tavarro R, Chryssanthopoulou C, MacPhee I, Mayor M, Franco S, Jara P, Ayala R, Orue MG, Martinez A, Martinez M, Wasmouth N, Arik G, Yasar A, Turkmen E, Yildirim T, Altindal M, Abudalal A, Yilmaz S, Arici M, Bihari Bansal S, Pokhariyal S, Jain S, Sethi S, Ahlawat R, Kher V, Martins LS, Aguiar P, Dias L, Fonseca I, Henriques AC, Cabrita A, Davide J, Sparkes TM, Trofe-Clark J, Reese PP, Jakobowski D, Goral S, Doll SL, Abt PL, Sawinski D, MBloom RD, Knap B, Lukac J, Lukin M, Majcen I, Pavlovec F, Kandus A, Bren AF, Kong JM, Jeong JH, Ahn J, Lee DR, Son SH, Kim BC, Choi WY, Whang EJ, Czajka B, Malgorzewicz S, Debska-Slizien A, Rutkowski B, Panizo N, Rengel MA, Vega A, Abad S, Tana L, Arroyo D, Rodriguez-Ferrero M, Perez de Jose A, Lopez-Gomez JM, Koutroutsos K, Sackey J, Paolini L, Ramkhelawon R, Tavarro R, Chowrimootoo M, Whelan D, Popoola J, Szotowska M, Kuczera P, Chudek J, Wiecek A, Kolonko A, Slatinska J, Honsova E, Wohlfahrtova M, Slimackova E, Rajnochova SB, Viklicky O, Yankovoy A, Smith ISJ, Wylie E, Ruiz-Esteban P, Lopez V, Garcia-Frias P, Cabello M, Gonzalez-Molina M, Vozmediano C, Hernandez D, Pavlovic J, Radivojevic D, Lezaic V, Simic-Ogrizovic S, Lausevic M, Naumovic R, Ersoy A, Koca N, Kirhan E, Gullu Koca T, Ersoy C, Sarandol E, Dirican M, Sakhuja V, Gundlapalli S, Rathi M, Jha V, Kohli HS, Sharma A, Minz M, Nimgirova A, Esayan A, Kayukov I, Zuyeva E, Bilen Y, Cankaya E, Keles M, Gulcan E, Turkeli M, Albayrak B, Uyanik A, Yildirim R, Molitor N, Praktiknjo M, Woitas R, Abeygunaratne TN, Balasubramanian S, Baker R, Nicholson T, Toprak O, Sari Y, Keceli S, Kurt H, Rocha A, Malheiro J, Martins LS, Fonseca I, Dias L, Pedroso S, Almeida M, Henriques A, Nihei C, Bacelar Marques I, Seguro CA, David-Neto E, Mate G, Martin N, Colon L, Casellas L, Garangou D, de la Torre M, Torguet P, Garcia I, Calabia J, Valles M, Pruthi R, Calestani M, Leydon G, Ravanan R, Roderick P, Korkmaz S, Ersoy A, Gulten S, Koca N. Transplantation - clinical studies II. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Agnes H, Kalman P, Jozsef A, Henrik B, Mucsi I, Kamata K, Sano T, Naito S, Okamoto T, Okina C, Kamata M, Murano J, Kobayashi K, Uchida M, Aoyama T, Takeuchi Y, Nagaba Y, Sakamoto H, Torino C, Torino C, Panuccio V, Clementi A, Garozzo M, Bonanno G, Boito R, Natale G, Cicchetti T, Chippari A, Logozzo D, Alati G, Cassani S, Sellaro A, D'arrigo G, Tripepi G, Roberta A, Postorino M, Mallamaci F, Zoccali C, Buonanno E, Brancaccio S, Fimiani V, Napolitano P, Spadola R, Morrone L, DI Iorio B, Russo D, Betriu A, Martinez-Alonso M, Vidal T, Valdivielso J, Fernandez E, Bernadette F, Jean-Baptiste B, Frimat L, Madala ND, Thusi GP, Sibisi N, Mazibuko BG, Assounga AGH, Tsai NC, Wang HH, Chen YC, Hung CC, Hwang SJ, Chen HC, Branco P, Adragao T, Birne R, Martins AR, Vizinho R, Gaspar A, Grilo MJ, Barata JD, Bonhorst D, Adragao P, Kim JS, Yang JW, Kim MK, Choi SO, Han BG, Nathalie N, Sunny E, Glorieux G, Daniela B, Fellype B, Sophie L, Horst D L, Ziad M, Raymond V, Yanai M, Okada K, Takeuchi K, Nitta K, Takahashi S, Morena M, Jaussent I, Halkovich A, Dupuy AM, Bargnoux AS, Chenine L, Leray-Moragues H, Klouche K, Vernhet H, Canaud B, Cristol JP, Shutov A, Serov V, Kuznetsova J, Menzorov M, Serova D, Petrescu L, Zugravu A, Capusa C, Stancu S, Cinca S, Anghel C, Timofte D, Medrihan L, Ionescu D, Mircescu G, Hsu TW, Kuo KL, Hung SC, Tarng DC, Lee S, Kim I, Lee D, Rhee H, Song S, Seong E, Kwak I, Holzmann M, Gardell C, Jeppsson A, Sartipy U, Solak Y, Yilmaz MI, Caglar K, Saglam M, Yaman H, Sonmez A, Unal HU, Gok M, Gaipov A, Kayrak M, Eyileten T, Turk S, Vural A, DI Lullo L, Floccari F, Rivera R, Granata A, D'amelio A, Logias F, Otranto G, Malaguti M, Santoboni A, Fiorini F, Connor T, Oygar D, Nitsch D, Gale D, Steenkamp R, Neild GH, Maxwell P, Louise Hogsbro I, Redal-Baigorri B, Sautenet B, Halimi JM, Caille A, Goupille P, Giraudeau B, Solak Y, Yilmaz MI, Caglar K, Saglam M, Yaman H, Unal HU, Gok M, Oguz Y, Gaipov A, Yenicesu M, Cetinkaya H, Eyileten T, Turk S, Vural A, Chen YC, Wang HH, Tsai NC, Hung CC, Hwang SJ, Chen HC, Ishimoto Y, Ohki T, Sugahara M, Kanemitsu T, Kobayashi M, Uchida L, Kotera N, Tanaka S, Sugimoto T, Mise N, Miyazaki N, Matsumoto J, Murata I, Yoshida G, Morishita K, Ushikoshi H, Nishigaki K, Ogura S, Minatoguchi S, Harvey R, Harvey R, Ala A, Banerjee D, Farmer C, Irving J, Hobbs H, Wheeler T, Klebe B, Stevens P, Selim G, Selim G, Stojceva-Taneva O, Tozija L, Stojcev N, Gelev S, Dzekova-Vidimliski P, Pavleska S, Sikole A, Qureshi AR, Evans M, Stendahl M, Prutz KG, Elinder CG, Tamagaki K, Kado H, Nakata M, Kitani T, Ota N, Ishida R, Matsuoka E, Shiotsu Y, Ishida M, Mori Y, Christelle M, Rognant N, Evelyne D, Sophie F, Laurent J, Maurice L, Silverwood R, Pierce M, Kuh D, Savage C, Ferro C, Nitsch D, Moniek DG, De Goeij M, Nynke H, Gurbey O, Joris R, Friedo D, Clayton P, Grace B, Cass A, Mcdonald S, Lorenzo V, Martin Conde M, Betriu A, Dusso A, Valdivielso JM, Fernandez E, Roggeri DP, Cannella G, Cozzolino M, Mazzaferro S, Messa P, Brancaccio D, De Souza Faria R, Fernandes N, Lovisi J, Moura Marta M, Reboredo M, Do Vale Pinheiro B, Bastos M, Hundt F, Hundt F, Pabst S, Hammerstingl C, Gerhardt T, Skowasch D, Woitas R, Lopes AA, Silva LF, Matos CM, Martins MS, Silva FA, Lopes GB, Pizzarelli F, Dattolo P, Tripepi G, Michelassi S, Rossi C, Bandinelli S, Mieth M, Mass R, Ferrucci L, Zoccali C, Parisi S, Arduino S, Attini R, Fassio F, Biolcati M, Pagano A, Bossotti C, Ferraresi M, Gaglioti P, Todros T, Piccoli GB, Salgado TM, Arguello B, Benrimoj SI, Fernandez-Llimos F, Bailey P, Tomson C, Ben-Shlomo Y, Santoro A, Rucci P, Mandreoli M, Caruso F, Corradini M, Flachi M, Gibertoni D, Rigotti A, Russo G, Fantini M, Mahapatra HS, Choudhury S, Buxi G, Sharma N, Gupta Y, Sekhar V, Mahapatra HS, Choudhury S, Buxi G, Sharma N, Gupta Y, Sekhar V, Yanagisawa N, Ando M, Ajisawa A, Tsuchiya K, Nitta K, Janusz O, Mikolaj M, Jacek M, Boleslaw R, Prakash S, Coffin R, Schold J, Einstadter D, Stark S, Rodgers D, Howard M, Sehgal A, Stevens P, Irving J, Wheeler T, Klebe B, Farmer C, Palmer S, Tong A, Manns B, Craig J, Ruospo M, Gargano L, Strippoli G, Ruospo M, Palmer S, Vecchio M, Gargano L, Petruzzi M, De Benedictis M, Pellegrini F, Strippoli G, Ohno Y, Ishimura E, Naganuma T, Kondo K, Fukushima W, Mui K, Inaba M, Hirota Y, Sun X, Sun X, Jiang S, Gu H, Chen Y, XI C, Qiao X, Chen X, Daher E, Junior GS, Jacinto CN, Pimentel RS, Aguiar GBR, Lima CB, Borges RC, Mota LPC, Melo JVL, Melo SA, Canamary VT, Alves M, Araujo SMHA, Chen YC, Hung CC, Huang YK, Tsai NC, Wang HH, Hung CC, Hwang SJ, Chen HC, Rogacev K, Cremers B, Zawada A, Seiler S, Binder N, Ege P, Grosse-Dunker G, Heisel I, Hornof F, Jeken J, Rebling N, Ulrich C, Scheller B, Bohm M, Fliser D, Heine GH, Robinson B, Wang M, Bieber B, Fluck R, Kerr PG, Wikstrom B, Krishnan M, Nissenson A, Pisoni RL, Mykleset S, Osthus TB, Waldum B, Os I, Buttigieg J, Buttigieg J, Cassar A, Farrugia Agius J, Redal-Baigorri B, Hara M, Ando M, Tsuchiya K, Nitta K, Yamato M, Yasuda K, Sasaki K. Clinical Nephrology - Epidemiology II. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Adragao T, Branco P, Birne R, Curto JD, de Almeida E, Prata MM, Pais MJ. Bone Mineral Density, Vascular Calcifications, and Arterial Stiffness in Peritoneal Dialysis Patients. Perit Dial Int 2008. [DOI: 10.1177/089686080802800621] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to evaluate the correlation of bone mineral density (BMD), evaluated by DXA, with vascular calcifications, arterial stiffness, and vascular disease in patients on peritoneal dialysis. Vascular calcifications were evaluated by vascular calcification score on plain x ray, and arterial stiffness was measured by pulse wave velocity using the Complior device (Artech Medical, Pantin, France). Adjusting for multiple factors, lower BMD at the femoral neck, but not at the lumbar spine, was associated with higher pulse wave velocity ( p = 0.037), higher vascular calcification score ( p = 0.013), and peripheral artery disease ( p = 0.006). These data reinforce the hypothesis of the existence of a link between bone disease and cardiovascular disease in dialysis patients.
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Affiliation(s)
- Teresa Adragao
- Nephrology Department Santa Cruz Hospital Lisbon, Portugal
| | | | - Rita Birne
- Nephrology Department Santa Cruz Hospital Lisbon, Portugal
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Adragao T, Branco P, Birne R, Curto JD, de Almeida E, Prata MM, Pais MJ. Bone mineral density, vascular calcifications, and arterial stiffness in peritoneal dialysis patients. Perit Dial Int 2008; 28:668-672. [PMID: 18981400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
The objective of this study was to evaluate the correlation of bone mineral density (BMD), evaluated by DXA, with vascular calcifications, arterial stiffness, and vascular disease in patients on peritoneal dialysis. Vascular calcifications were evaluated by vascular calcification score on plain x ray, and arterial stiffness was measured by pulse wave velocity using the Complior device (Artech Medical, Pantin, France). Adjusting for multiple factors, lower BMD at the femoral neck, but not at the lumbar spine, was associated with higher pulse wave velocity (p = 0.037), higher vascular calcification score (p = 0.013), and peripheral artery disease (p = 0.006). These data reinforce the hypothesis of the existence of a link between bone disease and cardiovascular disease in dialysis patients.
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Affiliation(s)
- Teresa Adragao
- Nephrology Department, Santa Cruz Hospital, Lisbon, Portugal.
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Adragão T, Pires A, Birne R, Curto JD, Lucas C, Gonçalves M, Negrão AP. A plain X-ray vascular calcification score is associated with arterial stiffness and mortality in dialysis patients. Nephrol Dial Transplant 2008; 24:997-1002. [PMID: 18952701 DOI: 10.1093/ndt/gfn584] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vascular calcifications are highly prevalent in dialysis patients and are associated with arterial stiffness and mortality. The use of simple and inexpensive methods to evaluate arterial stiffness and vascular calcifications is desired. The objective of this study was to evaluate the relationship of a simple vascular calcification score (SVCS) with pulse wave velocity (PWV) and pulse pressure (PP) and to evaluate their association with all-cause mortality. METHODS 101 haemodialysis patients (71 men; 19% diabetic) were evaluated. At baseline, arterial stiffness was measured by PP and by PWV with Complior. SVCS was evaluated in plain X-ray of pelvis and hands. RESULTS During a 43-month observational period, 31 patients died. By Kaplan-Meier analysis, SVCS >3 (P = 0.001), PP > 70 mmHg (P = 0.001) and PWV > 10.5 m/s (P < 0.001) were found to be associated with lower cumulative survival. Adjusting for multiple variables, association with mortality was maintained for SVCS >3 (HR = 3.308, P = 0.032) and PP > 70 mmHg (HR = 3.227, P = 0.031) in all patients and for PWV > 10.5 m/s (HR = 2.981, P = 0.047) in non-diabetic patients. Age (P < 0.001), systolic pressure (P = 0.004) and SVCS > 3 (P = 0.032) were associated with PWV. Diabetes (P = 0.031), calcium carbonate dose (P = 0.009) and SVCS > 3 (P = 0.012) were associated with PP. CONCLUSION Higher SVCS, PWV and PP were associated with higher mortality in this population. SVCS was associated with arterial stiffness. Simple and inexpensive methods such as PP or SVCS may be used to detect mortality risk and to provide important information that may be relevant for guiding therapeutic intervention in dialysis patients.
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Adragao T, Pires A, Lucas C, Birne R, Magalhaes L, Gonçalves M, Negrao AP. A simple vascular calcification score predicts cardiovascular risk in haemodialysis patients. Nephrol Dial Transplant 2004; 19:1480-8. [PMID: 15034154 DOI: 10.1093/ndt/gfh217] [Citation(s) in RCA: 208] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cardiovascular morbidity and mortality are highly prevalent in haemodialysis (HD) patients and have been recently associated with vascular calcifications. The objective of our study was to assess the value of a simple vascular calcification score for the prediction of cardiovascular death, cardiovascular hospitalizations and fatal and non-fatal cardiovascular events in HD patients, and to correlate this score with cardiovascular disease and with other known predictors of vascular disease. METHODS In this observational, prospective study 123 chronic HD patients (75 males and 48 females; 20% diabetic) were included, who were on low-flux HD treatment for 46.6+/-52 months (mean+/-SD). We set up a simple vascular calcification score based on plain radiographic films of pelvis and hands. Brachial pulse pressure and mean arterial pressure (MAP) were measured and cardiovascular events and hospitalization episodes were assessed. RESULTS During an observational period of 37 months there were 17 cardiovascular deaths; 28 patients needed cardiovascular hospitalizations and 32 patients suffered fatal and non-fatal cardiovascular events. Coronary artery disease was diagnosed in 43 patients (35%), peripheral arterial disease in 33 patients (26.8%), cerebrovascular disease in 16 patients (13%) and vascular disease (coronary artery disease or peripheral arterial disease or cerebral vascular disease) in 61 patients (49.6%). By binary logistic regression, diabetes (P = 0.01), male sex (P<0.001), age (P = 0.02), HD duration (P = 0.02) and MAP (P = 0.03) were independently associated with a vascular score > or =3. This score > or =3 was independently associated with coronary artery disease (P = 0.008), peripheral arterial disease (P<0.001) and vascular disease (P = 0.001). Patients with a vascular calcification score > or =3 had a 3.9-fold higher risk of cardiovascular mortality (P = 0.03), a 2.8-fold higher risk of cardiovascular hospitalizations (P = 0.02) and a 2.3-fold higher risk of fatal or non-fatal cardiovascular events (P = 0.04). CONCLUSIONS The present vascular calcification scoring represents a simple tool for the assessment of cardiovascular risk related with vascular calcifications in chronic HD patients.
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Affiliation(s)
- Teresa Adragao
- Nefroclinica-Estoril, Rua Vale de S Rita, 19, 2765-293 Esteril, Portugal.
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