SNU - Artigos publicados em revistas indexadas na Medline
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- Acute Kidney Injury in the Critically Ill PatientPublication . Herrera-Gutiérrez, M.; Seller-Pérez, G.; Maynar-Moliner, J.; Sánchez-Izquierdo-Riera, J.; Marinho, A.; Do pico, J.
- ALTERAÇÕES VÉSICO-ESFINCTERIANAS NO PARKINSONISMOPublication . Andrade, M.; Trêpa, ADepois de uma breve revisão da euroanatomia e da neurofisiologia vésico-esfincteriana é feita uma análise das alterações vésico-esfincterianas no Parkinsonismo e a sua correlação com a doença, com os fármacos utilizados no tratamento desta doença e com eventuais problemas prostáticos. Conclui-se que cada caso terá obrigatoriamente que ser estudado individualmente.Further to a brief review of the vesical-sphincterian neuroanatomy and neurophisology, we analyse the vesical-sphincterian dysfunction in the Parkinson disease and its relation with this illness, with the drugs used in its treatment and with eventual prostatic problems. We therefore conclude that each case should be studied individually.
- Chemical peritonitis in a patient treated with icodextrin and intraperitoneal vancomycinPublication . Freitas, C.; Rodrigues, A.; Carvalho, M.; Cabrita, A.
- Delivered dose of renal replacement therapy and mortality in critically ill patients with acute kidney injuryPublication . Vesconi, S.; Cruz, D.; Fumagalli, R.; Kindgen-Milles, D.; Monti, G.; Marinho, A.; Mariano, F.; Formica, M.; Marchesi, M.; René, R.; Livigni, S.; Ronco, C.Introduction The optimal dialysis dose for the treatment of acute kidney injury (AKI) is controversial. We sought to evaluate the relationship between renal replacement therapy (RRT) dose and outcome. Methods We performed a prospective multicentre observational study in 30 intensive care units (ICUs) in eight countries from June 2005 to December 2007. Delivered RRT dose was calculated in patients treated exclusively with either continuous RRT (CRRT) or intermittent RRT (IRRT) during their ICU stay. Dose was categorised into more-intensive (CRRT ≥ 35 ml/kg/hour, IRRT ≥ 6 sessions/week) or less-intensive (CRRT < 35 ml/kg/hour, IRRT < 6 sessions/week). The main outcome measures were ICU mortality, ICU length of stay and duration of mechanical ventilation. Results Of 15,200 critically ill patients admitted during the study period, 553 AKI patients were treated with RRT, including 338 who received CRRT only and 87 who received IRRT only. For CRRT, the median delivered dose was 27.1 ml/kg/hour (interquartile range (IQR) = 22.1 to 33.9). For IRRT, the median dose was 7 sessions/week (IQR = 5 to 7). Only 22% of CRRT patients and 64% of IRRT patients received a more-intensive dose. Crude ICU mortality among CRRT patients were 60.8% vs. 52.5% (more-intensive vs. less-intensive groups, respectively). In IRRT, this was 23.6 vs. 19.4%, respectively. On multivariable analysis, there was no significant association between RRT dose and ICU mortality (Odds ratio (OR) moreintensive vs. less-intensive: CRRT OR = 1.21, 95% confidence interval (CI) = 0.66 to 2.21; IRRT OR = 1.50, 95% CI = 0.48 to 4.67). Among survivors, shorter ICU stay and duration of mechanical ventilation were observed in the more-intensive RRT groups (more-intensive vs. less-intensive for all: CRRT (median): 15 (IQR = 8 to 26) vs. 19.5 (IQR = 12 to 33.5) ICU days, P = 0.063; 7 (IQR = 4 to 17) vs. 14 (IQR = 5 to 24) ventilation days, P = 0.031; IRRT: 8 (IQR = 5.5 to 14) vs. 18 (IQR = 13 to 35) ICU days, P = 0.008; 2.5 (IQR = 0 to 10) vs. 12 (IQR = 3 to 24) ventilation days, P = 0.026). Conclusions After adjustment for multiple variables, these data provide no evidence for a survival benefit afforded by higher dose RRT. However, more-intensive RRT was associated with a favourable effect on ICU stay and duration of mechanical ventilation among survivors. This result warrants further exploration. Trial Registration Cochrane Renal Group (CRG110600093).
- Effect of Aging in the Perception of Health-Related Quality of Life in End-Stage Renal Disease Patients under Online-HemodiafiltrationPublication . Moura, A.; Madureira, J.; Alija, P.; Fernandes, J.; Oliveira, J.; Lopez, M.; Filgueiras, M.; Amado, L.; Sameiro-Faria, M.; Miranda, V.; Santos-Silva, A.; Costa, E.This work aimed to evaluate how aging could influence patients’ perception of health quality of life (HRQOL), as well as, the effect of aging on dialysis adequacy and in hematological, iron status, inflammatory and nutritional markers. In this transversal study were enrolled 305 ESRD patients under Online-hemodiafiltration (OL-HDF) (59.67% males; 64.9 ± 14.3 years old). Data about comorbidities, hematological data, iron status, dialysis adequacy, nutritional and inflammatory markers were collected from patient’s records. Moreover, HRQOL score, by using the Kidney Disease Quality of Life-Short Form (KDQOL-SF), was assessed. Analyzing the results according to quartiles of age, significant differences were found for some parameters evaluated by the KDQOL-SF instrument, namely for work status, physical functioning and role-physical, which decreased with increasing age. We also found a higher proportion of diabetic patients, a decrease in creatinine, iron, albumin serum levels, transferrin saturation and nPCR, with increasing age. Moreover, significant negative correlations were found between age and mean cell hemoglobin concentration, iron, transferrin saturation, albumin, nPCR, work status, physical functioning and role-physical. In conclusion, our results showed that aging is associated with a decreased work status, physical functioning and role-physical, with a decreased dialysis adequacy, iron availability and nutritional status, and with an increased proportion of diabetic patients and of patients using central venous catheter, as the vascular access. The knowledge of these changes associated with aging, which have impact in the quality of life of the patients, could be useful in their management.
- Estimating glomerular filtration rate in kidney transplantation: Still searching for the best markerPublication . Santos, J.; Martins, L.Kidney transplantation is the treatment of choice for end-stage renal disease. The evaluation of graft function is mandatory in the management of renal transplant recipients. Glomerular filtration rate (GFR), is generally considered the best index of graft function and also a predictor of graft and patient survival. However GFR measurement using inulin clearance, the gold standard for its measurement and exogenous markers such as radiolabeled isotopes ((51)Cr EDTA, (99m)Tc DTPA or (125)I Iothalamate) and non-radioactive contrast agents (Iothalamate or Iohexol), is laborious as well as expensive, being rarely used in clinical practice. Therefore, endogenous markers, such as serum creatinine or cystatin C, are used to estimate kidney function, and equations using these markers adjusted to other variables, mainly demographic, are an attempt to improve accuracy in estimation of GFR (eGFR). Nevertheless, there is some concern about the inability of the available eGFR equations to accurately identify changes in GFR, in kidney transplant recipients. This article will review and discuss the performance and limitations of these endogenous markers and their equations as estimators of GFR in the kidney transplant recipients, and their ability in predicting significant clinical outcomes.
- Estimating Kidney Function in the Critically Ill PatientsPublication . Seller-Pérez, G.; Herrera-Gutiérrez, M.; Maynar-Moliner, J.; Sánchez-Izquierdo-Riera, J.; Marinho, A.; do Pico, J.Glomerular filtration rate (GFR) is an accepted measure for assessment of kidney function. For the critically ill patient, creatinine clearance is the method of reference for the estimation of the GFR, although this is often not measured but estimated by equations (i.e., Cockroft-Gault or MDRD) not well suited for the critically ill patient. Functional evaluation of the kidney rests in serum creatinine (Crs) that is subjected to multiple external factors, especially relevant overhydration and loss of muscle mass. The laboratory method used introduces variations in Crs, an important fact considering that small increases in Crs have serious repercussion on the prognosis of patients. Efforts directed to stratify the risk of acute kidney injury (AKI) have crystallized in the RIFLE or AKIN systems, based in sequential changes in Crs or urine flow. These systems have provided a common definition of AKI and, due to their sensitivity, have meant a considerable advantage for the clinical practice but, on the other side, have introduced an uncertainty in clinical research because of potentially overestimating AKI incidence. Another significant drawback is the unavoidable period of time needed before a patient is classified, and this is perhaps the problem to be overcome in the near future.
- European best practice guidelines for peritoneal dialysis. 1 General guidelines.Publication . Dombros, N.; Dratwa, M.; Feriani, M.; Gokal, R.; Heimbürger, O.; Krediet, R.; Plum, J.; Rodrigues, A.; Selgas, R.; Struijk, D.; Verger, C.
- European best practice guidelines for peritoneal dialysis. 2 The initiation of dialysis.Publication . Dombros, N.; Dratwa, M.; Gokal, R.; Heimbürger, O.; Krediet, R.; Plum, J.; Rodrigues, A.; Selgas, R.; Struijk, D.; Verger, C.
- European best practice guidelines for peritoneal dialysis. 3 Peritoneal access.Publication . Dombros, N.; Dratwa, M.; Gokal, R.; Heimbürger, O.; Krediet, R.; Plum, J.; Rodrigues, A.; Selgas, R.; Struijk, D.; Verger, C.