26 results on '"Pecoits-Filho, Roberto"'
Search Results
2. Development of a framework for minimum and optimal safety and quality standards for hemodialysis and peritoneal dialysis.
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Sola, Laura, Levin, Nathan, Johnson, David, Pecoits-Filho, Roberto, Aljubori, Harith, Chen, Yuqing, Claus, Stefaan, Collins, Allan, Cullis, Brett, Feehally, John, Harden, Paul, Hassan, Mohamed, Ibhais, Fuad, Levin, Adeera, Saleh, Abdulkarim, Schneditz, Daneil, Tchokhonelidze, Irma, Turan Kazancioglu, Rumeyza, Twahir, Ahmed, Walker, Robert, Were, Anthony, Yu, Xueqing, Finkelstein, Fredric, and Kalantar-Zadeh, Kamyar
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hemodialysis ,minimum safety standards ,peritoneal dialysis ,quality of care - Abstract
Substantial heterogeneity in practice patterns around the world has resulted in wide variations in the quality and type of dialysis care delivered. This is particularly so in countries without universal standards of care and governmental (or other organizational) oversight. Most high-income countries have developed such oversight based on documentation of adherence to standardized, evidence-based guidelines. Many low- and lower-middle-income countries have no or only limited organized oversight systems to ensure that care is safe and effective. The implementation and oversight of basic standards of care requires sufficient infrastructure and appropriate workforce and financial resources to support the basic levels of care and safety practices. It is important to understand how these standards then can be reasonably adapted and applied in low- and lower-middle-income countries.
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- 2020
3. Standardized Outcomes in Nephrology—Peritoneal Dialysis (SONG-PD): Study Protocol for Establishing a Core Outcome Set in PD
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Manera, Karine E., Tong, Allison, Craig, Jonathan C., Brown, Edwina A., Brunier, Gillian, Dong, Jie, Dunning, Tony, Mehrotra, Rajnish, Naicker, Sarala, Pecoits-Filho, Roberto, Perl, Jeffrey, Wang, Angela Y., Wilkie, Martin, Howell, Martin, Sautenet, Benedicte, Evangelidis, Nicole, Shen, Jenny I., Johnson, David W., Investigators, SONG-PD, MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), and Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques
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Nephrology ,Research design ,Comparative Effectiveness Research ,Kidney Disease ,Outcome Assessment ,[SDV]Life Sciences [q-bio] ,medicine.medical_treatment ,030232 urology & nephrology ,0302 clinical medicine ,030212 general & internal medicine ,Patient-centered outcomes ,General Medicine ,Urology & Nephrology ,patientreported outcomes ,3. Good health ,peritoneal dialysis ,patient-reported outcomes ,Research Design ,Hemodialysis ,Health and social care services research ,medicine.medical_specialty ,Consensus ,Clinical Trials and Supportive Activities ,Clinical Sciences ,Peritoneal dialysis ,7.3 Management and decision making ,outcomes research ,03 medical and health sciences ,Clinical Research ,patient-centered outcomes ,Internal medicine ,medicine ,Humans ,Intensive care medicine ,Dialysis ,clinical trials ,business.industry ,Core outcome set ,8.4 Research design and methodologies (health services) ,Health Care ,Clinical trial ,SONG-PD Investigators ,dialysis ,Management of diseases and conditions ,Outcomes research ,business ,chronic kidney disease ,Systematic Reviews as Topic - Abstract
Background Worldwide, approximately 11% of patients on dialysis receive peritoneal dialysis (PD). Whilst PD may offer more autonomy to patients compared with hemodialysis, patient and caregiver burnout, technique failure, and peritonitis remain major challenges to the success of PD. Improvements in care and outcomes are likely to be mediated by randomized trials of innovative therapies, but will be limited if the outcomes measured and reported are not important for patients and clinicians. The aim of the Standardised Outcomes in Nephrology-Peritoneal Dialysis (SONG-PD) study is to establish a set of core outcomes for trials in patients on PD based on the shared priorities of all stakeholders, so that outcomes of most relevance for decision-making can be evaluated, and that interventions can be compared reliably. Methods The 5 phases in the SONG-PD project are: a systematic review to identify outcomes and outcome measures that have been reported in randomized trials involving patients on PD; focus groups using nominal group technique with patients and caregivers to identify, rank, and describe reasons for their choice of outcomes; semi-structured key informant interviews with health professionals; a 3-round international Delphi survey involving a multi-stakeholder panel; and a consensus workshop to review and endorse the proposed set of core outcome domains for PD trials. Discussion The establishment of 3 to 5 high-priority core outcomes, to be measured and reported consistently in all trials in PD, will enable patients and clinicians to make informed decisions about the relative effectiveness of interventions, based upon outcomes of common importance.
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- 2017
4. Urgent-start dialysis in patients referred early to a nephrologist—the CKD-REIN prospective cohort study.
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Fages, Victor, Pinho, Natalia Alencar de, Hamroun, Aghilès, Lange, Céline, Combe, Christian, Fouque, Denis, Frimat, Luc, Jacquelinet, Christian, Laville, Maurice, Ayav, Carole, Liabeuf, Sophie, Pecoits-Filho, Roberto, Massy, Ziad A, Boucquemont, Julie, Stengel, Bénédicte, and collaborators, the CKD-REIN study
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HEMODIALYSIS patients ,ACUTE kidney failure ,KIDNEY transplantation ,COHORT analysis ,LONGITUDINAL method ,HEART failure ,HEMODIALYSIS - Abstract
Background The lack of a well-designed prospective study of the determinants of urgent dialysis start led us to investigate its individual- and provider-related factors in patients seeing nephrologists. Methods The Chronic Kidney Disease Renal Epidemiology and Information Network (CKD-REIN) is a prospective cohort study that included 3033 patients with CKD [mean age 67 years, 65% men, mean estimated glomerular filtration rate (eGFR) 32 mL/min/1.73 m
2 ] from 40 nationally representative nephrology clinics from 2013 to 2016 who were followed annually through 2020. Urgent-start dialysis was defined as that 'initiated imminently or <48 hours after presentation to correct life-threatening manifestations' according to the Kidney Disease: Improving Global Outcomes 2018 definition. Results Over a 4-year (interquartile range 3.0–4.8) median follow-up, 541 patients initiated dialysis with a known start status and 86 (16%) were identified with urgent starts. The 5-year risks for the competing events of urgent and non-urgent dialysis start, pre-emptive transplantation and death were 4, 17, 3 and 15%, respectively. Fluid overload, electrolytic disorders, acute kidney injury and post-surgery kidney function worsening were the reasons most frequently reported for urgent-start dialysis. Adjusted odds ratios for urgent start were significantly higher in patients living alone {2.14 [95% confidence interval (CI) 1.08–4.25] or with low health literacy [2.22 (95% CI 1.28–3.84)], heart failure [2.60 (95% CI 1.47–4.57)] or hyperpolypharmacy [taking >10 drugs; 2.14 (95% CI 1.17–3.90)], but not with age or lower eGFR at initiation. They were lower in patients with planned dialysis modality [0.46 (95% CI 0.19–1.10)] and more nephrologist visits in the 12 months before dialysis [0.81 (95% CI 0.70–0.94)] for each visit. Conclusions This study highlights several patient- and provider-level factors that are important to address to reduce the burden of urgent-start dialysis. [ABSTRACT FROM AUTHOR]- Published
- 2021
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5. European hemodialysis patient satisfaction with phosphate binders is associated with serum phosphorus levels: the Dialysis Outcomes and Practice Patterns Study.
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McCullough, Keith, Port, Friedrich K, Sequera, Patricia de, Rayner, Hugh, Pecoits-Filho, Roberto, Walpen, Sebastian, Evenepoel, Pieter, Pisoni, Ronald L, and Investigators, DOPPS Country
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PATIENT satisfaction ,HEMODIALYSIS patients ,PROPORTIONAL hazards models ,PHOSPHORUS ,DIALYSIS (Chemistry) - Abstract
Background Hemodialysis (HD) patients are commonly prescribed phosphate binders (PBs) to manage serum phosphorus levels, as hyperphosphatemia is strongly associated with poorer survival. Nonadherence with the PB prescription is associated with elevated serum phosphorus levels. We studied associations between patient satisfaction with their PB and serum phosphorus levels and mortality rates. Methods Adult HD patients in Germany, Italy, Spain and the UK in the Dialysis Outcomes and Practice Patterns Study were administered a survey instrument in late 2017. Patients were asked about their satisfaction with their PBs, as measured through three questions (difficulty, inconvenience and dissatisfaction) on a 5-point Likert scale, with each dichotomized into average worst versus good responses. These were used as predictors in linear regression models of continuous serum phosphorus levels and in Cox proportional hazards models of mortality, with adjustments for demographics, comorbidities and laboratory values. Results Patients having greater difficulty, inconvenience and dissatisfaction with their PB had higher serum phosphorus levels in adjusted models {+0.21 mg/dL [95% confidence interval (CI) ±0.23], +0.30 (±0.21) and 0.36 (±0.22), respectively}, and higher odds of having serum phosphorus levels ≥6.0 mg/dL. Measures of dissatisfaction were also associated with an elevated risk of mortality, with adjusted hazard ratios of 2.2 (95% CI 1.3–3.6), 1.6 (1.0–2.6) and 1.7 (1.1–2.7), respectively; this association was not strongly affected by adjustment for baseline serum phosphorous level. Conclusions Self-reported difficulty, inconvenience and dissatisfaction in taking one's prescribed PBs were associated with elevated serum phosphorus levels and serum phosphorus levels above clinically meaningful thresholds. While the mechanism for the association with mortality is unclear, patient-reported satisfaction should be considered when attempting to manage patient serum phosphorus levels. [ABSTRACT FROM AUTHOR]
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- 2021
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6. Hyperkalemia excursions are associated with an increased risk of mortality and hospitalizations in hemodialysis patients.
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Karaboyas, Angelo, Robinson, Bruce M, James, Glen, Hedman, Katarina, Quinn, Carol P Moreno, Sequera, Patricia De, Nitta, Kosaku, and Pecoits-Filho, Roberto
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HYPERKALEMIA ,HEMODIALYSIS patients ,TREATMENT effectiveness ,MORTALITY ,HOSPITAL care - Abstract
Background Hyperkalemia is common among hemodialysis (HD) patients and has been associated with adverse clinical outcomes. Previous studies considered a single serum potassium (K) measurement or time-averaged values, but serum K excursions out of the target range may be more reflective of true hyperkalemia events. We assessed whether hyperkalemia excursions lead to an elevated risk of adverse clinical outcomes. Methods Using data from 21 countries in Phases 4–6 (2009–18) of the Dialysis Outcomes and Practice Patterns Study (DOPPS), we investigated the associations between peak serum K level, measured monthly predialysis, over a 4-month period ('peak K') and clinical outcomes over the subsequent 4 months using Cox regression, adjusted for potential confounders. Results The analysis included 62 070 patients contributing a median of 3 (interquartile range 2–6) 4-month periods. The prevalence of hyperkalemia based on peak K was 58% for >5.0, 30% for >5.5 and 12% for >6.0 mEq/L. The all-cause mortality hazard ratio for peak K (reference ≤5.0 mEq/L) was 1.15 [95% confidence interval (CI) 1.09, 1.21] for 5.1–5.5 mEq/L, 1.19 (1.12, 1.26) for 5.6–6.0 mEq/L and 1.33 (1.23, 1.43) for >6.0 mEq/L. Results were qualitatively consistent when analyzing hospitalizations and a cardiovascular composite outcome. Conclusions Among HD patients, we identified a lower K threshold (peak K 5.1–5.5 mEq/L) than previously reported for increased risk of hospitalization and mortality, with the implication that a greater proportion (>50%) of the HD population may be at risk. A reassessment of hyperkalemia severity ranges is needed, as well as an exploration of new strategies for effective management of chronic hyperkalemia. [ABSTRACT FROM AUTHOR]
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- 2021
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7. Beta-2 microglobulin and all-cause mortality in the era of high-flux hemodialysis: results from the Dialysis Outcomes and Practice Patterns Study.
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Kanda, Eiichiro, Muenz, Daniel, Bieber, Brian, Cases, Aleix, Locatelli, Francesco, Port, Friedrich K, Pecoits-Filho, Roberto, Robinson, Bruce M, and Perl, Jeffrey
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HEMODIALYSIS ,POISSON regression ,C-reactive protein ,MORTALITY - Abstract
Background Beta-2 microglobulin (β2M) accumulates in hemodialysis (HD) patients, but its consequences are controversial, particularly in the current era of high-flux dialyzers. High-flux HD treatment improves β2M removal, yet β2M and other middle molecules may still contribute to adverse events. We investigated patient factors associated with serum β2M, evaluated trends in β2M levels and in hospitalizations due to dialysis-related amyloidosis (DRA), and estimated the effect of β2M on mortality. Methods We studied European and Japanese participants in the Dialysis Outcomes and Practice Patterns Study. Analysis of DRA-related hospitalizations spanned 1998–2018 (n = 23 976), and analysis of β2M and mortality in centers routinely measuring β2M spanned 2011–18 (n = 5332). We evaluated time trends with linear and Poisson regression and mortality with Cox regression. Results Median β2M changed nonsignificantly from 2.71 to 2.65 mg/dL during 2011–18 (P = 0.87). Highest β2M tertile patients (>2.9 mg/dL) had longer dialysis vintage, higher C-reactive protein and lower urine volume than lowest tertile patients (≤2.3 mg/dL). DRA-related hospitalization rates [95% confidence interval (CI)] decreased from 1998 to 2018 from 3.10 (2.55–3.76) to 0.23 (0.13–0.42) per 100 patient-years. Compared with the lowest β2M tertile, adjusted mortality hazard ratios (95% CI) were 1.16 (0.94–1.43) and 1.38 (1.13–1.69) for the middle and highest tertiles. Mortality risk increased monotonically with β2M modeled continuously, with no indication of a threshold. Conclusions DRA-related hospitalizations decreased over 10-fold from 1998 to 2018. Serum β2M remains positively associated with mortality, even in the current high-flux HD era. [ABSTRACT FROM AUTHOR]
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- 2021
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8. Impact of longer term phosphorus control on cardiovascular mortality in hemodialysis patients using an area under the curve approach: results from the DOPPS.
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Lopes, Marcelo Barreto, Karaboyas, Angelo, Bieber, Brian, Pisoni, Ronald L, Walpen, Sebastian, Fukagawa, Masafumi, Christensson, Anders, Evenepoel, Pieter, Pegoraro, Marisa, Robinson, Bruce M, and Pecoits-Filho, Roberto
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HEMODIALYSIS patients ,AKAIKE information criterion ,PHOSPHORUS ,MORTALITY - Abstract
Background Serial assessment of phosphorus is currently recommended by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, but its additional value versus a single measurement is uncertain. Methods We studied data from 17 414 HD patients in the Dialysis Outcomes and Practice Patterns Study, a prospective cohort study, and calculated the area under the curve (AUC) by multiplying the time spent with serum phosphorus >4.5 mg/dL over a 6-month run-in period by the extent to which this threshold was exceeded. We estimated the association between the monthly average AUC and cardiovascular (CV) mortality using Cox regression. We formally assessed whether AUC was a better predictor of CV mortality than other measures of phosphorus control according to the Akaike information criterion. Results Compared with the reference group of AUC = 0, the adjusted hazard ratio (HR) of CV mortality was 1.12 [95% confidence interval (CI) 0.90–1.40] for AUC > 0–0.5, 1.26 (95% CI 0.99–1.62) for AUC > 0.5–1, 1.44 (95% CI 1.11–1.86) for AUC > 1–2 and 2.03 (95% CI 1.53–2.69) for AUC > 2. The AUC was predictive of CV mortality within strata of the most recent phosphorus level and had a better model fit than other serial measures of phosphorus control (mean phosphorus, months out of target). Conclusions We conclude that worse phosphorus control over a 6-month period was strongly associated with CV mortality. The more phosphorus values do not exceed 4.5 mg/dL the better is survival. Phosphorus AUC is a better predictor of CV death than the single most recent phosphorus level, supporting with real-world data KDIGO's recommendation of serial assessment of phosphorus to guide clinical decisions. [ABSTRACT FROM AUTHOR]
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- 2020
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9. Fluid overload is associated with use of a higher number of antihypertensive drugs in hemodialysis patients.
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Morais, Jyana G., Pecoits‐Filho, Roberto, Canziani, Maria E. F., Poli‐de‐Figueiredo, Carlos E., Cuvello Neto, Américo L., Barra, Ana B., Calice‐Silva, Viviane, Raimann, Jochen G., and Nerbass, Fabiana B.
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HEMODIALYSIS patients , *SYSTOLIC blood pressure , *BODY composition , *BODY mass index , *DRUGS - Abstract
Introduction: Hypertension is multifactorial, highly prevalent in the hemodialysis (HD) population and its adequate control requires, in addition to adequate volume management, often the use of multiple antihypertensive drugs. We aimed to describe the use of antihypertensive agents in a group of HD patients and to evaluate the factors associated with the use of multiple classes (≥3) of antihypertensives. Methods: We analyzed the baseline data from the HDFit study. Clinically stable patients with HD vintage between 3 and 24 months without any severe mobility limitation were recruited from sites throughout southern Brazil. Fluid status was measured pre‐dialysis with the Body Composition Monitor (BCM; Fresenius, Germany). Fluid overload (FO) was considered when the overhydration index (OH) was greater than 7% of extracellular water (OH/ECW > 7%) and overweight was defined as a body mass index (BMI) greater than 25 kg/m2. Prescriptions of antihypertensive drugs were obtained from participants' reports and medical records. Logistic regression was employed to determine factors associated with excessive use of antihypertensive medication (≥3 classes). Findings Of 195 studied patients, 171 with complete data were included (70% male, 53 ± 15 years old, 57% of them with FO). Pre‐dialysis systolic blood pressure (SBP) was 150 ± 24 mmHg and patients used a median of 2 (1–3) antihypertensive drugs. Vasodilators (20%) were of lowest prevalence, use of other classes varied from 40% to 53%. Sixty‐two (36%) subjects used ≥3 classes and presented a higher prevalence of diabetes and FO, lower prevalence of overweight, and higher SBP. In a logistic regression model age, BMI <25 kg/m2, and OH/ECW > 7% were associated with excessive drug use. Discussion More than one‐third of participants used ≥3 classes of antihypertensive drugs, and it was associated with older age, BMI <25 kg/m2 and FO. Strategies that better manage FO may aid better blood pressure control and avoid the use of multiple antihypertensive medications. [ABSTRACT FROM AUTHOR]
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- 2020
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10. Effect of Hemodiafiltration on Self-Reported Sleep Duration: Results from a Randomized Controlled Trial.
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Han, Maggie, Guedes, Murilo, Larkin, John, Raimann, Jochen G., Lesqueves Barra, Ana Beatriz, Canziani, Maria Eugênia Fernandes, Cuvello Neto, Américo Lourenço, Poli-de-Figueiredo, Carlos Eduardo, Kotanko, Peter, and Pecoits-Filho, Roberto
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RANDOMIZED controlled trials ,HEMODIAFILTRATION ,SLEEP ,MEDICAL records ,SELF-evaluation - Abstract
Introduction: Dialysis patients suffer from poor sleep duration and quality. We examined the self-reported sleep duration in patients randomized to either high-volume hemodiafiltration (HDF) or high flux hemodialysis (HD). Methods: Patients from 13 Brazilian dialysis clinics were enrolled in the HDFIT randomized controlled trial (RCT) investigating the impact of HDF on physical activity and self-reported outcomes. Self-reported sleep duration was taken from patient diaries recording sleep start and end time over a week during baseline, months 3 and 6, respectively. Sleep duration was analyzed by shift and nights relative to dialysis. Results: The HDFIT study enrolled 197 patients; sleep data were available in 173 patients (87 HD; 86 HDF). Patients' age was 53 ± 15 years, 57% were white, 72% were male, 34% had diabetes, Kt/V was 1.54 ± 0.40, and albumin 3.97 ± 0.36 g/dL. Most patients reported sleeping 510–530 min/night. At 3 months, HDF patients slept 513 ± 71 min/night, HD patients 518 ± 76 min/night. At 6 months, HDF patients slept 532 ± 74 min/night, HD patients 519 ± 80 min/night. At baseline, 1st shift patients slept 406 ± 86 min the night before HD, 534 ± 64 min the night after HD, and 496 ± 99 min the night between 2 non-HD days. Compared to patients in the 2nd and 3rd shifts, patients dialyzed in the 1st shift slept less in the night before dialysis. Similar patterns were seen after 3 and 6 months. Conclusion: In our RCT, the dialysis modality (HDF vs. HD) had no effect on self-reported sleep duration. In both groups, dialysis in the 1st shift adversely affected self reported sleep duration. [ABSTRACT FROM AUTHOR]
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- 2020
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11. Chronic kidney disease and arrhythmias : Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference
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Turakhia, Mintu P, Blankestijn, Peter J, Carrero, Juan-Jesus, Clase, Catherine M, Deo, Rajat, Herzog, Charles A, Kasner, Scott E, Passman, Rod S, Pecoits-Filho, Roberto, Reinecke, Holger, Shroff, Gautam R, Zareba, Wojciech, Cheung, Michael, Wheeler, David C, Wanner, Christoph, Winkelmayer, Wolfgang C, Conference Participants, Amann, Kerstin, Banerjee, Debasish, Bansal, Nisha, Boriani, Giuseppe, Bunch, Jared, Chan, Christopher T, Charytan, David M, Conen, David, Friedman, Allon N, Genovesi, Simonetta, Holden, Rachel M, House, Andrew A, Jadoul, Michel, Jardine, Alan G, Johnson, David W, Jun, Min, Labriola, Laura, Mark, Patrick B, McCullough, Peter A, Nolin, Thomas D, Potpara, Tatjana S, Pun, Patrick H, Ribeiro, Antonio L P, Rossignol, Patrick, Shen, Jenny I, Sood, Manish M, Tsukamoto, Yusuke, Wang, Angela Yee-Moon, Weir, Matthew R, Wetmore, James B, Wranicz, Jerzy K, Yamasaki, Hiro, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, Turakhia, M, Blankestijn, P, Carrero, J, Clase, C, Deo, R, Herzog, C, Kasner, S, Passman, R, Pecoits-Filho, R, Reinecke, H, Shroff, G, Zareba, W, Cheung, M, Wheeler, D, Winkelmayer, W, Wanner, C, and Genovesi, S
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Nephrology ,Heart rhythm disorders ,medicine.medical_treatment ,030232 urology & nephrology ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Kidney ,law.invention ,Sudden cardiac death ,0302 clinical medicine ,Randomized controlled trial ,law ,Risk Factors ,atrial fibrillation ,Arrhythmia/Electrophysiology ,Treatment options ,Atrial fibrillation ,stroke ,Defibrillators, Implantable ,Current Opinion ,cardiovascular system ,Hemodialysis ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Hypokalemia ,arrhythmia ,Sudden death ,sudden cardiac death ,End stage renal disease ,03 medical and health sciences ,Renal Dialysis ,Internal medicine ,Chronic kidney disease, end stage renal disease, arrhythmias, atrial fibrillation, sudden death ,medicine ,Humans ,In patient ,cardiovascular diseases ,Renal Insufficiency, Chronic ,Intensive care medicine ,Inflammation ,business.industry ,Arrhythmias, Cardiac ,medicine.disease ,Oxidative Stress ,Death, Sudden, Cardiac ,Potassium ,Hyperkalemia ,Kidney Failure, Chronic ,business ,Atrial flutter ,chronic kidney disease ,030217 neurology & neurosurgery ,Kidney disease - Abstract
Patients with chronic kidney disease (CKD) are predisposed to heart rhythm disorders, including atrial fibrillation (AF)/atrial flutter, supraventricular tachycardias, ventricular arrhythmias, and sudden cardiac death (SCD). While treatment options, including drug, device, and procedural therapies, are available, their use in the setting of CKD is complex and limited. Patients with CKD and end-stage kidney disease (ESKD) have historically been under-represented or excluded from randomized trials of arrhythmia treatment strategies,1 although this situation is changing.2 Cardiovascular society consensus documents have recently identified evidence gaps for treating patients with CKD and heart rhythm disorders.3–7 To identify key issues relevant to the optimal prevention, management, and treatment of arrhythmias and their complications in patients with kidney disease, Kidney Disease: Improving Global Outcomes (KDIGO) convened an international, multidisciplinary Controversies Conference in Berlin, Germany, titled CKD and Arrhythmias in October 2016. The conference agenda and discussion questions are available on the KDIGO website (http://kdigo.org/conferences/ckd-arrhythmias/; 13 February 2018).
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- 2018
12. Relationships between Neighborhood Walkability and Objectively Measured Physical Activity Levels in Hemodialysis Patients.
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Han, Maggie, Ye, Xiaoling, Preciado, Priscila, Williams, Schantel, Campos, Israel, Bonner, Marcee, Young, Candace, Marsh, Daniel, Larkin, John W., Usvyat, Len A., Maddux, Franklin W., Pecoits-Filho, Roberto, and Kotanko, Peter
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HEMODIALYSIS patients ,PHYSICAL activity ,QUALITY of life ,KIDNEY diseases ,WALKABILITY - Abstract
Background/Aims: Neighborhood walkability is associated with indicators of health in the general population. We explored the association between neighborhood walkability and daily steps in hemodialysis (HD) patients.Methods: We measured daily steps over 5 weeks using Fitbit Flex (Fitbit, San Francisco, CA, USA) and retrieved Walk Score® (WS) data by patient’s home ZIP code (www.walkscore.com; 0 = poorest walkability; 100 = greatest walkability).Results: HD patients took a mean of 6,393 ± 3,550 steps/day (n = 46). Median WS of the neighborhood where they resided was 28. Patients in an above-median WS (n = 27) neighborhood took significantly more daily steps compared to those (n = 19) in a below-median WS neighborhood (7,514 ± 3,900 vs. 4,800 ± 2,228 steps/day; p < 0.001, t test). Daily steps and WS were directly correlated (R = 0.425; p = 0.0032, parametric test; R = 0.359, p = 0.0143, non-parametric test).Conclusion: This is the first study conducted among HD patients to indicate a direct relationship between neighborhood walkability and the actual steps taken. These results should be considered when designing initiatives to increase and improvise exercise routines in HD populations. [ABSTRACT FROM AUTHOR]- Published
- 2018
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13. Sodium Intake and Blood Pressure in Patients with Chronic Kidney Disease: A Salty Relationship.
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Nerbass, Fabiana B., Calice-Silva, Viviane, and Pecoits-Filho, Roberto
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KIDNEY diseases ,HYPERTENSION ,CHRONIC kidney failure ,HEMODIALYSIS ,KIDNEY disease treatments - Abstract
Background: Hypertension affects almost all chronic kidney disease patients and is related to poor outcomes. Sodium intake is closely related to blood pressure (BP) levels in this population and decreasing its intake consistently improves the BP control particularly in short-term controlled trials. However, most patients struggle in following a controlled diet on sodium according to the guidelines recommendation due to several factors and barriers discussed in this article.Summary: This review article summarizes the current knowledge related to the associations between sodium consumption, BP, and the risk of cardiovascular disease and chronic kidney disease (CKD); it also provides recommendations of how to achieve sodium intake lowering.Key Messages: Evidences support the benefits in decreasing sodium intake on markers of cardiovascular and renal outcomes in CKD. Trials had shorter follow-up and to maintain long-term sodium intake control is a major challenge. Larger studies with longer follow-up looking at hard endpoints will be important to drive future recommendations. [ABSTRACT FROM AUTHOR]- Published
- 2018
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14. Effect of hepatitis C serology on C-reactive protein in a cohort of brazilian hemodialysis patients
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Nascimento, M. M., Bruchfeld, A., Suliman, Mohamed E., Hayashi, Shirley Y., Pecoits-Filho, Roberto, Manfro, Roberto Ceratti, Pachaly, Maria A., Renner, L., Stenvinkel, P., Riella, Miguel Carlos, and Lindholm, B.
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Hepatite C ,Hemodialysis ,Diálise renal ,Proteina C-reativa ,Interleucina-6 ,C-reactive protein - Abstract
Hepatitis C (HCV) is not an uncommon feature in hemodialysis (HD) patients and may be a cause of systemic inflammation. Plasma cytokine interleukin-6 (IL-6) is mainly produced by circulating and peripheral cells and induces the hepatic synthesis of C-reactive protein (CRP), which is the main acute phase reactant. The aim of this study was to investigate the influence of HCV on two markers of systemic inflammation, serum CRP and IL-6, in HD patients. The study included 118 HD patients (47% males, age 47 ± 13 years, 9% diabetics) who had been treated by standard HD for at least 6 months. The patients were divided into two groups depending on the presence (HCV+) or absence (HCV-) of serum antibodies against HCV. Serum albumin (S-Alb), plasma high sensitivity CRP (hsCRP), IL-6, and alanine aminotransferase (ALT) were measured and the values were compared with those for 22 healthy controls. Median hsCRP and IL-6 values and hsCRP/IL-6 ratio were: 3.5 vs 2.1 mg/l, P < 0.05; 4.3 vs 0.9 pg/ml, P < 0.0001, and 0.8 vs 2.7, P < 0.0001, for patients and controls, respectively. Age, gender, S-Alb, IL-6 and hsCRP did not differ between the HCV+ and HCV- patients. However, HCV+ patients had higher ALT (29 ± 21 vs 21 ± 25 IU/l) and had been on HD for a longer time (6.1 ± 3.0 vs 4.0 ± 2.0 years, P < 0.0001). Moreover, HCV+ patients had a significantly lower median hsCRP/IL-6 ratio (0.7 vs 0.9, P < 0.05) compared to the HCV- group. The lower hsCRP/IL-6 ratio in HCV+ patients than in HCV- patients suggests that hsCRP may be a less useful marker of inflammation in HCV+ patients and that a different cut-off value for hsCRP for this population of patients on HD may be required to define inflammation.
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- 2005
15. Saliva Urea Nitrogen Continuously Reflects Blood Urea Nitrogen after Acute Kidney Injury Diagnosis and Management: Longitudinal Observational Data from a Collaborative, International, Prospective, Multicenter Study.
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Raimann, Jochen G., Calice-Silva, Viviane, Thijssen, Stephan, Nerbass, Fabiana Baggio, Vieira, Marcos a., Dabel, Pascal, Evans, Rhys, Callegari, John, Carter, Mary, Levin, Nathan W., Winchester, James F., Kotanko, Peter, and Pecoits-Filho, Roberto
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BLOOD urea nitrogen ,SALIVA analysis ,HEMODIALYSIS ,KIDNEY injuries ,BLAND-Altman plot ,PREVENTION ,DIAGNOSIS - Abstract
Background: Acute kidney injury (AKI) is a growing global concern and often reversible. Saliva urea nitrogen (SUN) measured by a dipstick may allow rapid diagnosis. We studied longitudinal agreement between SUN and blood urea nitrogen (BUN) and the diagnostic performance of both. Methods: Agreement between SUN and BUN and diagnostic performance to diagnose AKI severity in AKI patients in the United States and Brazil were studied. Bland-Altman analysis and linear mixed effects models were employed to test the agreement between SUN and BUN. Receiver operating characteristics statistics were used to test the diagnostic performance to diagnose AKI severity. Results: We found an underestimation of BUN by SUN, decreasing with increasing BUN levels in 37 studied patients, consistent on all observation days. The diagnostic performance of SUN (AUC 0.81, 95% CI 0.63-0.98) was comparable to BUN (AUC 0.85, 95% CI 0.71-0.98). Conclusion: SUN reflects BUN especially in severe AKI. It also allows monitoring treatment responses. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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16. Associations Between Global Population Health Indicators and Dialysis Variables in the Monitoring Dialysis Outcomes (MONDO) Consortium.
- Author
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Calice-Silva, Viviane, Hussein, Rasha, Yousif, Dalia, Zhang, Hanjie, Usvyat, Len, Campos, Ludimila G., von Gersdorff, Gero, Schaller, Mathias, Marcelli, Danielle, Grassman, aileen, Etter, Michael, Xu, Xiaoqi, Kotanko, Peter, and Pecoits-Filho, Roberto
- Subjects
HEMODIALYSIS ,HEALTH status indicators ,CHRONIC kidney failure ,HUMAN Development Index - Abstract
Background: The number of patients receiving renal replacement therapy (RRT) increases annually and worldwide. Differences in the RRT incidence, prevalence, and modality vary between regions and countries for reasons yet to be clarified. Aims: Gain a better understanding of the association between hemodialysis (HD)-related variables and general population global health indicators. Methods: The present study included prevalent HD patients from 27 countries/regions from the monitoring dialysis outcomes (MONDO) database from 2006-2011. Global population health indicators were obtained from the 2014 World Health Organization report and the Human Development Index from the Human Development Report Office 2014. The Spearman rank test was used to assess the correlations between population social economic indicators and HD variables. Results: A total of 84,796 prevalent HD patients were included. Their mean age was 63 (country mean 52-71), and 60% were males (country mean 52-85%). Significant correlations were found between HD demographic clusters and population education, wealth, mortality, and health indicators. The cluster of nutrition and inflammation variables were also highly correlated with population mortality, wealth, and health indicators. Finally, cardiovascular, fluid management, and dialysis adequacy clusters were associated with education, wealth, and health care resource indicators. Conclusion: We identified socioeconomic indicators that were correlated with dialysis variables. This hypothesis-generating study may be helpful in the analysis of how global health indicators may interfere with access to HD, treatment provision, dialytic treatment characteristics, and outcomes. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]
- Published
- 2015
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17. Renal replacement therapy in Latin American end-stage renal disease.
- Author
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Rosa-Diez, Guillermo, Gonzalez-Bedat, Maria, Pecoits-Filho, Roberto, Marinovich, Sergio, Fernandez, Sdenka, Lugon, Jocemir, Poblete-Badal, Hugo, Elgueta-Miranda, Susana, Gomez, Rafael, Cerdas-Calderon, Manuel, Almaguer-Lopez, Miguel, Freire, Nelly, Leiva-Merino, Ricardo, Rodriguez, Gaspar, Luna-Guerra, Jorge, Bochicchio, Tomasso, Garcia-Garcia, Guillermo, Cano, Nuria, Iron, Norman, and Cuero, Cesar
- Subjects
LATIN Americans ,PRIMORDIALISM ,MEDICAL care ,HEMODIALYSIS ,MALTHUSIANISM - Abstract
The Latin American Dialysis and Renal Transplant Registry (RLADTR) was founded in 1991; it collects data from 20 countries which are members of Sociedad Latinoamericana de Nefrología e Hipertension. This paper presents the results corresponding to the year 2010. This study is an annual survey requesting data on incident and prevalent patients undergoing renal replacement treatment (RRT) in all modalities: hemodialysis (HD), peritoneal dialysis (PD) and living with a functioning graft (LFG), etc. Prevalence and incidence were compared with previous years. The type of renal replacement therapy was analyzed, with special emphasis on PD and transplant (Tx). These variables were correlated with the gross national income (GNI) and the life expectancy at birth. Twenty countries participed in the surveys, covering 99% of the Latin American. The prevalence of end stage renal disease (ESRD) under RRT in Latin America (LA) increased from 119 patients per million population (pmp) in 1991 to 660 pmp in 2010 (HD 413 pmp, PD 135 pmp and LFG 111 pmp). HD proportionally increased more than PD, and Tx HD continues to be the treatment of choice in the region (75%). The kidney Tx rate increased from 3.7 pmp in 1987 to 6.9 pmp in 1991 and to 19.1 in 2010. The total number of Tx's in 2010 was 10 397, with 58% deceased donors. The total RRT prevalence correlated positively with GNI (r2 0.86; P < 0.05) and life expectancy at birth (r2 0.58; P < 0.05). The HD prevalence and the kidney Tx rate correlated significantly with the same indexes, whereas the PD rate showed no correlation with these variables. A tendency to rate stabilization/little growth was reported in the most regional countries. As in previous reports, the global incidence rate correlated significantly only with GNI (r2 0.63; P < 0.05). Diabetes remained the leading cause of ESRD. The most frequent causes of death were cardiovascular (45%) and infections (22%). Neoplasms accounted for 10% of the causes of death. The prevalence of RRT continues to increase, particularly in countries with 100% public health or insurance coverage for RRT, where it approaches rates comparable to those displayed by developed countries with a better GNI. The incidence also continues to increase in both countries that have not yet extended its coverage to 100% of the population as well as in those that have an adequate program for timely detection and treatment of chronic kidney disease (CKD) and its associated risk factors. PD is still an underutilized strategy for RRT in the region. Even though renal Tx is feasible, its growth rate is still not as fast as it should be in order to compensate for the increased prevalence of patients on waiting lists. Diagnostic and prevention programs for hypertension and diabetes, appropriate policies promoting the expansion of PD and organ procurement as well as transplantation as cost-effective forms of RRT are needed in the region. Regional cooperation among Latin American countries, allowing the more developed to guide and train others in starting registries and CKD programs, may be one of the key initiatives to address this deficit. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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18. Diastolic Heart Failure in Dialysis Patients: Mechanisms, Diagnostic Approach, and Treatment.
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Pecoits-Filho, Roberto, Bucharles, Sérgio, and Barberato, Silvio H.
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HEART failure , *KIDNEY diseases , *LEFT heart ventricle , *CARDIAC contraction , *HEMODIALYSIS - Abstract
Heart failure (HF) is very common in the general population, and risk factors for HF, such as coronary artery disease, diabetes, obesity, and hypertension, are frequently present in patients with CKD. Therefore, HF is also an important cause of morbidity and mortality in this population. Diastolic heart failure (DHF), also called HF with preserved ejection fraction, refers to a clinical syndrome in which patients have symptoms and signs of HF, normal or near normal left ventricular (LV) systolic function, and evidence of diastolic dysfunction (e.g., abnormal LV filling and elevated filling pressure). Recent data suggest that HF with normal ejection fraction is even more common in patients than HF with low ejection fraction, including those on hemodialysis. Not surprisingly, DHF is a strong predictor of death in CKD patients. In this article, we review the information available on the mechanisms, clinical presentation, impact, and potential interventions in DHF based on evidence from CKD patients, as well as evidence from the general population potentially applicable to the CKD population. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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19. Inflammation and the Peritoneal Membrane: Causes and Impact on Structure and Function during Peritoneal Dialysis.
- Author
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Baroni, Gilberto, Schuinski, Adriana, de Moraes, Thyago P., Meyer, Fernando, and Pecoits-Filho, Roberto
- Subjects
INFLAMMATION ,PERITONITIS ,PERITONEAL dialysis ,HEMODIALYSIS ,KIDNEY physiology ,CHRONIC kidney failure ,HEMORRHAGE - Abstract
Peritoneal dialysis therapy has increased in popularity since the end of the 1970s. This method provides a patient survival rate equivalent to hemodialysis and better preservation of residual renal function. However, technique failure by peritonitis, and ultrafiltration failure, which is a multifactorial complication that can affect up to 40% of patients after 3 years of therapy. Encapsulant peritoneal sclerosis is an extreme and potentially fatal manifestation. Causes of inflammation in peritoneal dialysis range from traditional factors to those related to chronic kidney disease per se, as well as from the peritoneal dialysis treatment, including the peritoneal dialysis catheter, dialysis solution, and infectious peritonitis. Peritoneal inflammation generated causes significant structural alterations including: thickening and cubic transformation of mesothelial cells, fibrin deposition, fibrous capsule formation, perivascular bleeding, and interstitial fibrosis. Structural alterations of the peritoneal membrane described above result in clinical and functional changes. One of these clinical manifestations is ultrafiltration failure and can occur in up to 30% of patients on PD after five years of treatment. An understanding of the mechanisms involved in peritoneal inflammation is fundamental to improve patient survival and provide a better quality of life. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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20. Association between Left Atrium Enlargement and Intradialytic Hypotension: Role of Diastolic Dysfunction in the Hemodynamic Complications during Hemodialysis.
- Author
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Barberato, Silvio H., Misocami, Marcio, and Pecoits-Filho, Roberto
- Subjects
HYPOTENSION ,HEMODYNAMICS ,HEMODIALYSIS ,HYPERTENSION ,HEART failure ,DIABETES ,MULTIVARIATE analysis - Abstract
Symptomatic intradialytic hypotension (IH) continues to be an important complication of hemodialysis treatment. It has been suggested that patients with left ventricular (LV) diastolic dysfunction may be more sensitive to the effects of reduced cardiac filling. Left atrial volume index (LAVi) reflects the chronicity of exposure to elevated LV filling pressures. The aim of this study was to identify the association between echocardiographic disease, in particular left atrium enlargement, and IH. Echocardiograms obtained in 172 patients undergoing hemodialysis in sinus rhythm and with no significant valvular or pericardial disease were analyzed. The independent association between LAVi and IH was assessed using multivariate logistic regression. IH was identified in 27 patients (16%). The patients who experienced the hypotensive episodes had a greater prevalence of previous heart failure (59% vs 22%, P < 0.001), systolic dysfunction (33% vs 14%, P = 0.003), and LAVi > 35 mL/m
2 (59% vs 32%, P = 0.008). No differences were noted for age, gender, body mass index, duration of dialysis, blood pressure, use of drugs, and proportions of arterial hypertension, diabetes, LV hypertrophy and diastolic dysfunction by Doppler. After multivariate analysis, only heart failure and LAVi > 35 mL/m2 were seen to be independent predictors of IH. The finding of left atrium enlargement in patients undergoing hemodialysis may be useful in the clinical prediction of IH. [ABSTRACT FROM AUTHOR]- Published
- 2009
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21. A Cross-Sectional Study of Growth and Metabolic Bone Disease in a Pediatric Global Cohort Undergoing Chronic Hemodialysis.
- Author
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Hussein, Rasha, Alvarez-Elías, Ana Catalina, Topping, Alice, Raimann, Jochen G., Filler, Guido, Yousif, Dalia, Kotanko, Peter, Usvyat, Len A., Medeiros, Mara, Pecoits-Filho, Roberto, Canaud, Bernard, Stuard, Stefano, Xiaoqi, Xu, Etter, Michael, Díaz-González de Ferris, Maria E., and MONDO Consortium
- Abstract
Objective: We sought to assess worldwide differences among pediatric patients undergoing hemodialysis. Because practices differ widely regarding nutritional resources, treatment practice, and access to renal replacement therapy, investigators from the Pediatric Investigation and Close Collaboration to examine Ongoing Life Outcomes, the pediatric subset of the MONitoring Dialysis Outcomes Cohort (PICCOLO MONDO) performed this cross-sectional study. We hypothesized that growth would be better in developed countries, possibly at the expense of bone mineral disease.Study Design: In this cross-sectional study, we analyzed growth by height z score and recommended age-specific bone mineral metabolism markers from 225 patients <18 years of age maintained on hemodialysis, between the years of 2000 to 2012 from 21 countries in different regions.Results: The patients' median age was 16 (IQR 14-17) years, and 45% were females. A height z score less than the third percentile was noted in 34% of the cohort, whereas >66% of patients reported normal heights, with patients from North America having the greatest proportion (>80%). More than 70% of the entire cohort had greater than the age-recommended levels of phosphorus, particularly in the Asia-Pacific and North America, where we also observed the greatest body mass index z score (0.99 ± 1.6) and parathyroid hormone levels (557.1 [268.4-740.5]). Below-recommended parathyroid hormone levels were noted in 26% and elevated levels in 61% of the entire sample, particularly in the Asia Pacific region. Lower-than-recommended calcium levels were noted in 36% of the entire cohort, particularly in Latin America.Conclusions: We found regional differences in growth- and age-adjusted bone mineral metabolism markers. Children from North America had the best growth, received the most dialysis, but also had the worst phosphate control and body mass index z scores. [ABSTRACT FROM AUTHOR]- Published
- 2018
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- View/download PDF
22. Continuing Medical Education Program in Echocardiography.
- Author
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Fan, Pohoey, Barberato, Silvio H., Misocami, Marcio, and Pecoits-Filho, Roberto
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ECHOCARDIOGRAPHY ,HYPOTENSION ,HEMODYNAMICS ,HEMODIALYSIS ,MEDICAL education - Abstract
Article Title: Association between Left Atrium Enlargement and Intradialytic Hypotension: Role of Diastolic Dysfunction in the Hemodynamic Complications during Hemodialysis [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF
23. Beyond the membrane—The role of new PD solutions in enhancing global biocompatibility.
- Author
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Pecoits-Filho, Roberto, Stenvinkel, Peter, Heimbürger, Olof, and Lindholm, Bengt
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- *
PERITONEAL dialysis , *BIOCOMPATIBILITY , *PERITONEUM , *HEMODIALYSIS , *BIOMEDICAL materials - Abstract
The article focuses on the role of new peritoneal dialysis (PD) solutions in enhancing the global biocompatibility. The PD technique has improved and peritonitis rates have declined. The PD researchers have focused on ways to improve the biocompatibility of dialysis solutions with the goal of extending the life of the peritoneum as a dialyzing membrane.
- Published
- 2003
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24. Future of icodextrin as an osmotic agent in peritoneal dialysis.
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Pecoits-Filho, Roberto, Mujais, Salim, and Lindholm, Bengt
- Subjects
- *
PERITONEAL dialysis , *HEMODIALYSIS , *ULTRAFILTRATION , *KIDNEY disease treatments , *OSMOREGULATION , *THERAPEUTICS - Abstract
The article explores the impacts on the continuing use of icodextrin drug therapy as an osmotic agent in patient undergoing peritoneal dialysis. Topics include the developments in peritoneal ultrafiltration technique in peritoneal dialysis (PD), the challenges of over-hydration on the developments of PD treatment and the significant factors of residual renal clearance.
- Published
- 2002
- Full Text
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25. Vitamin D Receptor Gene Polymorphisms and Environment Influencing the Impact on Survival in Hemodialysis Patients.
- Author
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Machado-Souza, Cleber, Braosi, Ana Paula Ribeiro, Luczyszyn, Sonia Mara, Olandoski, Marcia, Riella, Miguel Carlos, Trevilatto, Paula Cristina, Pecoits-Filho, Roberto, and Luczyszyn, Sônia Mara
- Subjects
- *
HEMODIALYSIS patients , *VITAMIN D receptors , *GENETIC polymorphisms , *TREATMENT effectiveness , *HUMAN genes , *MORTALITY , *GENOTYPES - Abstract
Introduction: The vitamin D-receptor axis is involved in multiple physiological functions and altered states such as hypertension, mineral metabolism disorders, and inflammation. These disturbances are major risk factors for progression to end-stage kidney disease and cardiovascular disease. In addition, changes in internal systemic environment could be influencing the impact of survival in patients with kidney disease. This study aimed to evaluate the impact of vitamin D receptor (VDR) polymorphisms on hemodialysis patients' survival.Material and Methods: A total of 122 hemodialysis patients and 120 healthy controls were compared for VDR gene polymorphism. Markers for full coverage in the VDR gene were selected and genotyped. The hemodialysis patients were followed until death event, which was considered the primary endpoint for the survival analysis.Results: Two tag SNPs (rs10875695 and rs11168293) showed significant differences between the hemodialysis and healthy patients. In survival analysis, the CC genotype for rs2248098, compared to the TT genotype, was associated with a worse mortality rate. After adjustments for age, sex, diabetes mellitus, and cardiovascular disease, the genotype CC (rs2248098) was associated with a higher risk of mortality in a multivariable analysis.Conclusions: Polymorphisms specific to patients with kidney disease could be influencing different conditions associated with mortality. Thus, these genetic markers, rs2248098 for example, would act in a specific time in the history of kidney disease and would bring different results of patient survival outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2018
26. Effect of preload reduction by hemodialysis on left atrial volume and echocardiographic Doppler parameters in patients with end-stage renal disease
- Author
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Barberato, Silvio H., Mantilla, Diego E.V., Misocami, M.árcio, Gonçalves, Simone M., Bignelli, Alexandre T., Riella, Miguel C., Pecoits-Filho, Roberto, Misocami, M Arcio, and Gonçalves, Simone M
- Subjects
- *
HEMODIALYSIS , *MITRAL valve diseases , *THERAPEUTICS , *BLOOD filtration - Abstract
Left atrial (LA) volume has been proposed as a less preload-dependent parameter of diastolic function than Doppler mitral inflow. We hypothesize that in the absence of mitral regurgitation and atrial fibrilation, LA enlargement could be a more practical (and relatively preload-independent) method for the evaluation of left ventricular diastolic function. The aim of the present study was to determine the effects of preload reduction by hemodialysis on LA volume. [Copyright &y& Elsevier]
- Published
- 2004
- Full Text
- View/download PDF
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