Search

Made available in DSpace on 2022-04-29T08:35:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-09-23 This study aimed to explore the role of peritoneal dialysis (PD) in acute-on-chronic liver disease (ACLD) in relation to metabolic and fluid control and outcome. Fifty-three patients were treated by PD (prescribed Kt/V = 0.40/session), with a flexible catheter, tidal modality, using a cycler and lactate as a buffer. The mean age was 64.8 ± 13.4 years, model of end stage liver disease (MELD) was 31 ± 6, 58.5% were in the intensive care unit, 58.5% needed intravenous inotropic agents including terlipressin, 69.5% were on mechanical ventilation, alcoholic liver disease was the main cause of cirrhosis and the main dialysis indications were uremia and hypervolemia. Blood urea and creatinine levels stabilized after four sessions at around 50 and 2.5 mg/dL, respectively. Negative fluid balance (FB) and ultrafiltration (UF) increased progressively and stabilized around 3.0 L and −2.7 L/day, respectively. Weekly-delivered Kt/V was 2.7 ± 0.37, and 71.7% of patients died. Five factors met the criteria for inclusion in the multivariable analysis. Logistic regression identified as risk factors associated with Acute Kidney Injury (AKI) in ACLD patients: MELD (OR = 1.14, CI 95% = 1.09–2.16, p = 0.001), nephrotoxic AKI (OR = 0.79, CI 95% = 0.61–0.93, p = 0.02), mechanical ventilation (OR = 1.49, CI 95% = 1.14–2.97, p < 0.001), and positive fluid balance (FB) after two PD sessions (OR = 1.08, CI 95% = 1.03–1.91, p = 0.007). These factors were significantly associated with death. In conclusion, our study suggests that careful prescription may contribute to providing adequate treatment for most Acute-on-Chronic Liver Failure (ACLF) patients without contraindications for PD use, allowing adequate metabolic and fluid control, with no increase in the number of infectious or mechanical complications. MELD, mechanical complications and FB were factors associated with mortality, while nephrotoxic AKI was a protective factor. Further studies are needed to better investigate the role of PD in ACLF patients with AKI. Department of Internal Medicine Botucatu Medical School – University of São Paulo State – UNESP Botucatu Medical School – University of São Paulo State – UNESP Department of Internal Medicine Botucatu Medical School – University of São Paulo State – UNESP Botucatu Medical School – University of São Paulo State – UNESP

Made available in DSpace on 2022-04-28T19:46:03Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Aim: To compare infectious and mechanical complications, technique failure and mortality of a planned PD vs. an unplanned PD program. Design: It was a prospective observational study that included chronic kidney disease (CKD) patients who started PD according to medical recommendation: group1—planned and group 2—unplanned PD. Methods: This study evaluated patients who started planned and unplanned PD programs in a teaching hospital from July 2014 to December 2017. Results: A total of 58 patients were included in the planned PD group and 113 in the unplanned PD group. There was difference between the two groups in leak and hospital admissions, that were more frequent in the unplanned PD group. Periods free from exite site infection, peritonitis and mechanical complications were longer in the planned group. Cox regression analysis identified age and the lowest albumin value as factors associated with mechanical complications; peritonitis indicated the presence of ESI and mechanical complications; the change to HD was associated with a younger age, mechanical complications, diabetes mellitus (DM) and peritonitis. The factors associated with death were age and lower values of albumin. After 48 months, the growth of the PD program was 252%. Conclusion: The technique survival and patient mortality in unplanned PD was similar to planned PD, while the period marked by the absence of complications related to PD was longer in the planned PD group. In the Cox regression, unplanned PD was not identified as risk factor for death, transition to HD or complications related to therapy, while age and lower albumin values were predictors of negative outcomes. Impact: Unplanned PD is not risk factor for death and complications related to PD and can be an option to unplanned HD. Botucatu School of Medicine University of Sao Paulo State, Avenue Mario Rubens Montenegro, PO 18600000

Background: Few studies have evaluated the viability and outcomes between peritoneal dialysis (PD) and haemodialysis (HD) in urgent-start renal replacement therapy (RRT). This study aimed to compare infectious and mechanical complications related to urgent-start PD and HD. Secondary outcomes were to identify risk factors for complications and mortality related to urgent-start dialysis. Methods: A quasi-experimental study with incident patients receiving PD and HD in a Brazilian university hospital, between July 2014 and December 2017. Subjects included individuals with final-stage chronic kidney disease who required immediate RRT, that is, HD through central venous catheter or PD in which the catheter was implanted by a nephrologist and utilized for 72 h, without previous training. Patients with PD were subjected, initially, to high-volume PD for metabolic compensation. After hospital discharge, they remained in intermittent PD in the dialysis unit until training was completed. Mechanical and infectious complications were compared, as well as the recovery of renal function and survival. Results: In total, 93 patients were included in PD and 91 in HD. PD and HD groups were similar regarding age (58 ± 17 vs. 60 ± 15 years; p = 0.49), frequency of diabetes mellitus (37.6% vs. 50.5%; p = 0.10), other comorbidities (74.1% vs. 71.4%; p = 0.67) and biochemical parameters at the beginning of RRT, that is, creatinine (9.1 ± 4.1 vs. 8.0 ± 2.8; p = 0.09), serum albumin (3.1 ± 0.6 vs. 3.3 ± 0.6; p = 0.06) and haemoglobin (9.5 ± 1.8 vs. 9.8 ± 2.0; p = 0.44). After a minimum follow-up period of 180 days and a maximum follow-up period of 2 years, there was no difference regarding mechanical complications (24.7% vs. 37.4%; p = 0.06) or bacteraemia (15.0% vs. 24.0%; p = 0.11); however, there was a difference regarding infection of the exit site (25.8% vs. 39.5%; p = 0.04) and diuresis maintenance [700 (0–1500) vs. 0 (0–500); p < 0.001], with better results in the PD group. There was better phosphorus control at 180 days in the PD group (62.4% vs. 41.8%; p = 0.008), with a lower requirement for phosphate binder usage (28% vs. 55%; p Conclusion: PD is a viable and safe alternative to HD in a scenario of urgent-start RRT with complication rates and outcomes similar to those of HD, highlighting the results regarding renal function recovery.

Made available in DSpace on 2018-12-11T17:34:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-12-01 Background: This study aimed to evaluate mechanical and infectious complications associated with urgent-start peritoneal dialysis (PD) and patients and technique survival in the first 180 days. Methods: It was a prospective study that evaluated chronic patients who started unplanned PD using high-volume PD (HVPD) right after (

AIM This study aimed to evaluate the long-term outcome of patients after a severe episode of acute kidney injury (AKI) on survival and progression to chronic kidney disease (CKD) and to identify risk factors associated with these outcomes. METHODS We performed a prospective study that evaluated the long-term outcome of 509 AKI stage 3 patients who were followed by nephrologists in a Brazilian University Hospital from 2004 to 2013. RESULTS Age was 60.2 years (47.5-71) and the follow-up time was 25 months (12-44). The late mortality was 38.1% and age (HR 2.89, 95% CI=1.88 to 4.46, P

Made available in DSpace on 2022-04-28T19:02:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-06-01 Aim: Starting dialysis in an unplanned manner is frequent situation in dialysis center even for patients with regular nephrology follow-up. Peritoneal dialysis (PD) appears as an option for unplanned initiation of chronic dialysis, offering the advantage of not using central venous catheters and preserving of residual renal function. Since July 2014, we have offered PD as urgent start for chronic kidney disease (CKD) patients. Methods: It was a prospective study that aimed to evaluate the mortality rate in hospitalized patients who started unplanned urgent PD in the first 90 days. It was used high-volume PD right after (

Made available in DSpace on 2018-12-11T17:37:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-01 Background: There is no consensus about the preferable type of catheter for successful peritoneal dialysis. Intra- and extra-peritoneal catheter configuration may be associated with mechanical and infectious complications affecting technique survival. The objective of this study was to compare the mechanical and infectious complications of coiled versus straight swan neck (SN) peritoneal dialysis catheters. Methods: A prospective randomized trial was performed to compare mechanical (tip migration with dysfunction) and infectious (peritonitis and exit site infection) complications between catheters randomly divided into two groups: swan neck straight tip and swan neck coiled tip. The follow-up was 1 year. Results: A total of 49 catheters, in 46 patients, were included from April 2015 to February 2016. The catheters groups were constituted as: 25 coiled tip SN and 24 straight tip SN. The baseline demographics were similar among the groups. Kaplan–Meier survival estimates were not different for time to first exit site infection, peritonitis and time to first catheter tip migration (log-rank test, p = 0.07, p = 0.54 and p = 0.83, respectively). Catheter survival and method survival were also similar (log-rank p = 0.88 and p = 0.91, respectively). Conclusions: The two types of intra-peritoneal segments of SN catheters studied presented similar infectious and mechanical rates with no differences in catheter and technique survival curve. These results were consistent with the recommendations of the International Society for Peritoneal Dialysis. São Paulo State University UNESP, Rubião Junior District University of Sao Paulo - USP Pontificia Universidade Catolica do Parana - PUC São Paulo State University UNESP, Rubião Junior District

Most patients with stage 5 CKD start RRT of unplanned manner. Unplanned dialysis, also known as urgent start, may be defined as hemodialysis (HD) started without permanent vascular access, i.e., using a central venous catheter (CVC), or as peritoneal dialysis (PD) started within seven days after implantation of the catheter, without family training. Although few studies have evaluated the PD as an immediate treatment option for patients starting urgent RRT, theirs results suggest that it is a feasible and safe alternative, with infectious complications and survival similar to patients treated with unplanned HD. Given the importance of the social role of urgent start of dialysis and the lack of studies on the subject, this narrative review aims to analyze and synthesize knowledge in published articles, preferably, from last five years in order to unify information and facilitate future studies. Resumo A maioria dos pacientes com DRC estádio 5 inicia terapia renal substitutiva (TRS) de modo não planejado. A diálise não planejada, também conhecida como de início urgente, pode ser definida como hemodiálise (HD) iniciada sem acesso vascular definitivo funcionante (utilizando cateter venoso central) ou como diálise peritoneal (DP) iniciada dentro de 7 dias após o implante do cateter. Embora poucos estudos tenham avaliado DP como opção de tratamento imediato em pacientes que iniciam a TRS de modo urgente, seus resultados sugerem que é alternativa viável e segura, apresentando complicações infecciosas e sobrevida semelhantes às dos pacientes tratados por HD não planejada. Tendo em vista a relevância do papel social do início não planejado da TRS e a escassez de estudos sobre o tema, a presente revisão narrativa propõe analisar e sintetizar conhecimentos fragmentados em artigos publicados, no período de 5 anos com o intuito de unificar informações e facilitar estudos futuros.

Elderly is the main age group affected by acute kidney injury (AKI). There are no studies that investigated the predictive properties of urinary (u) NGAL as an AKI marker in septic elderly population. This study aimed to evaluate the efficacy of uNGAL as predictor of AKI diagnosis and prognosis in elderly septic patients admitted to ICUs. We prospectively studied elderly patients with sepsis admitted to ICUs from October 2014 to November 2015. Assessment of renal function was performed daily by serum creatinine and urine output. The level of uNGAL was performed within the first 48 hours of the diagnosis of sepsis (NGAL1) and between 48 and 96 hours (NGAL2). The results were presented using descriptive statistics and area under the receiver operating characteristic curve (AUC-ROC) and p value was 5%. Seventy-five patients were included, 47 (62.7%) developed AKI. At logistic regression, chronic kidney disease and low mean blood pressure at admission were identified as factors associated with AKI (OR=0.05, CI=0.01-0.60, p=0.045 and OR=0.81, CI=0,13-0.47; p=0.047). The uNGAL was excellent predictor of AKI diagnosis (AUC-ROC >0.95, and sensitivity and specificity>0.89), anticipating the AKI diagnosis in 2.1±0.3 days. Factors associated with mortality in the logistic regression were presence of AKI (OR=2.14, CI=1.42-3.98, p=0.04), chronic obstructive pulmonary disease (OR = 9.37, CI =1.79-49.1, p=0.008) and vasoactive drugs (OR=2.06, CI=0.98-1.02, p=0.04). The accuracy of NGALu 1 and 2 as predictors of death was intermediate, with AUC-ROC of 0.61 and 0.62; sensitivity between 0.65 and 0.77 and specificity lower than 0.6. The uNGAL was excellent predictor of AKI in septic elderly patients in ICUs and can anticipate the diagnosis of AKI in 2.1 days.

This study aimed to evaluate the long-term outcome of patients after a severe episode of acute kidney injury (AKI) on survival and progression to chronic kidney disease (CKD) and to identify risk factors associated with these outcomes.We performed a prospective study that evaluated the long-term outcome of 509 AKI stage 3 patients who were followed by nephrologists in a Brazilian University Hospital from 2004 to 2013.Age was 60.2 years (47.5-71) and the follow-up time was 25 months (12-44). The late mortality was 38.1% and age (HR 2.89, 95% CI=1.88 to 4.46, P 0.0001), diabetes (HR 1.46, 95% CI=1 0.02 to 2.16, P 0.047), liver disease (HR 2.95, 95% CI=1.19 to 7.3, P = 0.02) and creatinine (Cr) at the time of hospital discharge (HR 1.21, 95% CI=1.04 to 1.41, P = 0.01) were associated with poor long-term survival. At the moment of hospital discharge, 52.1% of patients had complete recovery of renal function, 39.7% had partial recovery and 8.3% had not recovered renal function. After 36 months, 43.5% of patients progressed to CKD, and 5.3% needed for chronic dialysis. Factors associated with progression to CKD were age (HR 1.02, 95% CI=1.008 to 1.035, P = 0.009), CKD (HR 1.05 95% CI=1.007 to 1.09, P = 0.04), diabetes (HR 1.12, CI 1.008-1.035, P = 0.009) and number of AKI episodes (HR 1.65, 95% CI=1.19 to 2.2, P = 0.0023).This study showed that AKI patients have high mortality after hospital discharge and age, diabetes, liver disease, and Cr value at the time of discharge were factors associated with long-term mortality. The risk factors for this progression to CKD were age, the presence of diabetes and the number of AKI episodes.

Objectives To evaluate blood pressure and renal function in the first year postpartum in women who developed severe preeclampsia (PE). Methods This prospective study included previously healthy women who developed preeclampsia during pregnancy. Blood pressure levels, ambulatory blood pressure monitoring (ABPM), and laboratory tests to assess kidney function, proteinuria and microalbuminuria were evaluated at 3, 6, and 12 months postpartum. Results 97 patients had outpatient follow-up. 29.3%, 24.1% and 19% at 3, 6, and 12 months postpartum, respectively, still had high blood pressure. Nineteen patients underwent ABPM with 6 and 23 with follow-up at 1 year. In ABPM at 1 year, 60.9% had altered result, with standard no dipper observed in 30.4% and 30.5% remaining, with altered values of SBP or DBP at some period evaluated. Proteinuria remained positive in 12.5%, 2.8% and 6.6% of patients at 3, 6 and 12 months postpartum, respectively. Albuminuria was seen in 28.9%, 17.5% and 15.3% of patients at 3, 6 and 12 months, respectively. After 3 months of delivery, 28.4% of patients maintained use of antihypertensive medication, 26.2% at 6 months, and 19.2% at one year. Sixty-two patients were available for analysis of proteinuria or microalbuminuria and measures of office BP or ABPM after 6 months of follow-up. Among these, only 61.3% of patients had normal BP and urinary protein loss; 12.9% had proteinuria or albuminuria with high normal BP; 14.5% had elevated BP and normal proteinuria and/or albuminuria; and 11.3% had proteinuria and/or albuminuria with elevated BP that remained high at the final assessment. Conclusions At 12 weeks postpartum we did not observe the normalization of blood pressure and proteinuria in a large proportion of women with severe PE. These changes suggest the increased cardiovascular risk in this population. Disclosures R.A. Costa: None. V.D. Silva: None. D.B. Dias: None. R.P. Rocha: None. L.C. Martin: None. J.C. Peracoli: None.