Association between arteriovenous fistulae and hematomas in a dialysis center in the state of Rio Grande do Sul, southern Brazil

Introduction: Chronic kidney disease (CKD) is characterized by slow, progressive, and irreversible loss of kidney function. CKD has become a serious public health issue because of its increasing morbidity and mortality rates. The present study aimed to investigate factors associated with hematomas caused by arteriovenous fistula (AVF) at a Renal Replacement Therapy Unit in the state of Rio Grande do Sul, southern Brazil.Methods: In this cross-sectional study, 72 patients with CKD aged 18 years or over, presenting with AVF, and undergoing three hemodialysis sessions per week were evaluated from June 2014 to March 2015. Prevalence ratios (PRs) with 95% confidence intervals (95% CIs) were estimated for identification of risk factors associated with AVF. P-values 0.05). The single factor associated with hematomas was AVF time shorter than 60 days (PR = 2.04; 95% CI: 1.28-3.27; p < 0.01).Conclusion: AVF maturation time was associated with higher prevalence of hematomas at the cannulation site. Therefore, AVF time should be given special attention in patients undergoing renal therapy at dialysis centers.Keywords: Arteriovenous fistula; hematoma; chronic renal failur

Performance of creatinine-based equations to estimate glomerular filtration rate in White and Black populations in Europe, Brazil and Africa.

peer reviewed("[en] BACKGROUND: A new Chronic Kidney Disease Epidemiology Collaboration equation without the race variable has been recently proposed (CKD-EPIAS). This equation has neither been validated outside USA nor compared with the new European Kidney Function Consortium (EKFC) and Lund-Malmö Revised (LMREV) equations, developed in European cohorts. METHODS: Standardized creatinine and measured glomerular filtration rate (GFR) from the European EKFC cohorts (n = 13 856 including 6031 individuals in the external validation cohort), from France (n = 4429, including 964 Black Europeans), from Brazil (n = 100) and from Africa (n = 508) were used to test the performances of the equations. A matched analysis between White Europeans and Black Africans or Black Europeans was performed. RESULTS: In White Europeans (n = 9496), both the EKFC and LMREV equations outperformed CKD-EPIAS (bias of -0.6 and -3.2, respectively versus 5.0 mL/min/1.73 m², and accuracy within 30% of 86.9 and 87.4, respectively, versus 80.9%). In Black Europeans and Black Africans, the best performance was observed with the EKFC equation using a specific Q-value (= concentration of serum creatinine in healthy males and females). These results were confirmed in matched analyses, which showed that serum creatinine concentrations were different in White Europeans, Black Europeans and Black Africans for the same measured GFR, age, sex and body mass index. Creatinine differences were more relevant in males. CONCLUSION: In a European and African cohort, the performances of CKD-EPIAS remain suboptimal. The EKFC equation, using usual or dedicated population-specific Q-values, presents the best performance in the whole age range in the European and African populations included in this study.","[en] ",""

Avalia??o da estimativa da taxa de filtra??o glomerular com cistatina C em pacientes pedi?tricos

Made available in DSpace on 2015-04-14T13:35:38Z (GMT). No. of bitstreams: 1 446128.pdf: 4314617 bytes, checksum: 28ae5dd4320a91899f6c6fcd8f7097b3 (MD5) Previous issue date: 2012-12-18Introduction : There have been national and international recommendations to estimate glomerular filtration rate as a predictor of kidney disease, in the general population, measuring plasma creatinine concentration. In pediatrics, however, there is a high incidence of factors that affect plasma creatinine concentration, such as growth rate and the equations most commonly used to estimate GFR are derivative from Bedside Schwartz formula. The serum cystatin C, an unglycosylated protein of low molecular weight, produced by all nucleated cells, has been proposed as a marker of glomerular filtration. In this context in Brazil, there have been doubts among professionals about using cystatin C in pediatrics, due to the lack of appropriate studies about it. Objective : We sought to investigate the transversal diagnostic accuracy, either related to cystatin C or plasma creatinine or both in comparison with inulin, for estimating changes in GFR in a prospective cohort of children with kidney disease. Patients and Methods : Firstly, we have chosen as methodological strategy for the estimation of GFR the measurement by inulin clearance, in pediatrics and in a young adult population, followed by a respective publication. Secondly, we have used repeated and simultaneous measurements of renal clearance by inulin in pediatric patients. The analysis has been performed by linear mixed model due to the number of repeated measurements from the same patient. In order to assess the equivalence between methods, we applied Bland & Altman graphics, as well as concordance correlation tests. In a second phase, we had cystatin C and serum creatinine measured in pediatric renal patients, including those patients who had undergone a transplant. Consequently, an article was submitted to publication and another one was submitted to analysis. Results : This thesis has generated four presentations at international scientific congresses, 4 articles and 1 book chapter in French (attached). Conclusions : The adequate measurement of GFR is of fundamental importance in clinical practice in all phases of one's life. The GFR progressively declines with time, in most renal diseases, which results in complications such as hypertension, anemia, malnutrition, bone disease, neuropathies.Introdu??o : As recomenda??es internacionais e nacionais recomendam a aferi??o da taxa de filtra??o glomerular como preditor de doen?a renal na popula??o geral, com uso de creatinina plasm?tica. Entretanto, na pediatria existe uma alta preval?ncia de fatores que interferem na creatinina plasm?tica, dentre os quais a taxa de crescimento. As equa??es mais empregadas s?o derivadas da f?rmula de Schwartz abreviada (bedside). A cistatina C s?rica, uma prote?na n?o glicosilada de baixo peso molecular que ? produzida por todas as c?lulas nucleadas, tem sido apontada como um marcador de filtra??o glomerular. Nesse contexto, h? d?vidas em rela??o ? cistatina C na pediatria, devido ? escassez de estudos com delineamento adequado no Brasil. Objetivo : Avaliar transversalmente a acur?cia diagn?stica da cistatina C, creatinina plasm?tica, ou ambas em estimar mudan?as na TFG comparados ? inulina numa coorte prospectiva de crian?as com doen?a renal. Pacientes e M?todos : Em uma fase inicial, adquirimos a estrat?gia metodol?gica para a realiza??o da TFG por depura??o plasm?tica de inulina, em pediatria e na popula??o de adultos jovens, com respectiva publica??o. Ap?s, utilizou-se de medidas simult?neas e repetidas de depura??o renal de inulina em pacientes pedi?tricos. A an?lise foi realizada por modelo linear misto, devido ao n?mero repetido de medidas no mesmo paciente. Para avaliar a concord?ncia entre os m?todos foram utilizados gr?ficos de Bland Altman e teste de correla??o de concord?ncia. Em uma segunda fase, foram realizadas medidas de cistatina C e de creatinina plasm?tica em pacientes renais pedi?tricos, inclusive transplantados, com subsequente publica??o de um artigo e submiss?o de outro para an?lise. Resultados : Essa tese gerou 4 apresenta??es em congressos cient?ficos internacionais, 4 artigos e 1 cap?tulo de livro em franc?s (em anexo). Conclus?es : A aferi??o adequada da TFG ? de fundamental import?ncia na pr?tica cl?nica em todas as fases da vida do indiv?duo. A TFG declina progressivamente, com o tempo, na maioria das enfermidades renais, o que resulta em complica??es como hipertens?o arterial, anemia, desnutri??o, enfermidade ?ssea, neuropatias

Nefropatia induzida por contraste ap?s tomografia computadorizada

Made available in DSpace on 2015-04-14T13:34:56Z (GMT). No. of bitstreams: 1 423234.pdf: 1078063 bytes, checksum: 6a299e1c4b16d08e29d7fca46679d196 (MD5) Previous issue date: 2010-01-11A nefropatia por contraste (NIC) ? definida como uma piora na fun??o renal que se segue ? administra??o de contraste parenteral, tendo sido exclu?das outras causas. A NIC manifesta-se, usualmente, como uma insufici?ncia renal aguda n?o olig?rica. Por defini??o, deve haver um aumento na creatinina basal de 25-50% ou um aumento superior a 0,5 mg/dl de 24 a 48 horas ap?s o uso vascular de contraste. As medidas de preven??o s?o baseadas na corre??o dos fatores que levam ao desenvolvimento da NIC e dividem-se em: escolha de agentes de contrastes menos nefrot?xicos (n?o-i?nicos) e utiliza??o de doses menores; melhora no estado cl?nico do paciente com hidrata??o; uso de drogas que reduzam vasoconstri??o renal e estresse oxidativo; e suspens?o tempor?ria de drogas com potencial nefrot?xico ou prejudiciais, no caso de diminui??o da filtra??o glomerular. Essa revis?o tem o objetivo de examinar as principais recomenda??es de manejo para prevenir sua ocorr?ncia

elderly-lyon-2018

CKD-EPI, FAS, LMR and BIS 1 in older person

Association of housing distance in relation to recycling sites on schoolchildren’s cognitive abilities

Aims: We verified the association of housing distance in relation to recycling sites on schoolchildren’s cognitive abilities.Methods: This is a cross-sectional study, in which the Wechsler Abbreviated Scale of Intelligence was applied to 100 schoolchildren aged 6 to 14 years. Children were divided into a study group (exposed), whose households were located less than 100 meters from recycling sites in a neighborhood in the city of Caxias do Sul, and a control group, whose homes were located more than 150 meters from a recycling site in the same neighborhood or nearby.Results: Residences located more than 150 meters away from a recycling site can reduce the chance of low intelligence quotient in schoolchildren in the univariate analysis (OR 2.19; 95% CI 1.21-3.95). The full-scale intelligence quotient score was 84 in the exposed group and 95 in the control group (p≤0.01). When adjusted for other potentially harmful variables, higher maternal education was a mitigating factor of distance impact (OR 0.28, 95% CI 0.11-0.72). The difference found among verbal intelligence quotient scores was 14 points (p<0.01); in the performance intelligence quotient, the difference was 4 points (p=0.04).Conclusions: Living close to waste recycling sites can reduces cognitive abilities in schoolchildren, and this effect seems to be attenuated by maternal education. This association reinforces concerns about the impact of inadequate urban waste management, and may subsidize the creation of public policies that aim to reduce potentially harmful environmental exposures.Objetivos: Verificar a associação da distância da habitação em relação a sítios de reciclagem sobre habilidades cognitivas em escolares.Métodos: Estudo transversal, no qual aplicou-se a escala Wechsler Abreviada de Inteligência em 100 escolares de 6 a 14 anos. As crianças foram divididas em um grupo de estudo (expostos), cujas residências estavam situadas a menos de 100 metros de sítios de reciclagem, em um bairro da cidade de Caxias do Sul. Houve um grupo controle, cujas residências estavam a mais de 150 metros de algum sítio de reciclagem, no mesmo bairro ou adjacências.Resultados: A habitação próxima a sítios de reciclagem aumentou a chance de apresentar quociente de inteligência baixo nos escolares na análise univariada (OR 2,19; IC95% 1,21–3,95). No quociente de inteligência total, o escore obtido foi de 84 no grupo exposto e 95 no grupo controle (p≤0,01). Quando ajustadas para outras variáveis potencialmente prejudiciais, a escolaridade materna elevada mostrou-se um fator atenuador do impacto da distância (OR 0,28; IC95% 0,11–0,72). A diferença encontrada entre os escores de quociente de inteligência verbal foi de 14 pontos (p<0,01); no quociente de inteligência de execução a diferença foi de 4 pontos (p=0,04).Conclusões: A distância entre a habitação e os sítios de reciclagem de resíduos pode reduzir habilidades cognitivas em escolares, mas esse efeito parece ser atenuado pela escolaridade materna. Essa associação reforça as preocupações sobre o impacto do manejo inadequado de resíduos urbanos, podendo vir a subsidiar a criação de políticas públicas que visem diminuir exposições ambientais potencialmente danosas

Aplicação de lise celular forçada em sistema de tratamento aeróbio precedido de reator UASB

Este estudo visou avaliar as implicações do uso da lise celular sobre a produção de lodos e acumulação de nutrientes no efluente do sistema combinado de tratamento (anaeróbio/aeróbio) de despejo sintético simulando esgoto sanitário. O sistema operado era constituído de reator UASB (V = 10,5 l), reator aeróbio (V = 4,4 l) e sedimentador (V = 2,7 l), operando com tempo de detenção hidráulica de 8,0 h, 3,5 h e 2,7 h respectivamente. Durante a fase de controle, acompanhou-se as características de funcionamento do processo sem o emprego da lise celular no lodo de excesso e posteriormente fez-se uso de equipamento de ultra-som para promover a lise do lodo, com retorno posterior do lodo lisado à entrada do reator UASB. Verificou-se que a eficiência média global de remoção de DQO do sistema foi de 90% em ambas as fases considerando DQO efluente filtrada. A conversão de nitrogênio amoniacal a nitrato foi pequena no tanque de aeração e a remoção de fósforo foi insignificante no processo de tratamento, no entanto não ocorreu alteração na qualidade do efluente do sistema em função do retorno do material lisado. Na escala estudada foi freqüente o aparecimento de bulking (controlado pela aplicação de hipoclorito de sódio no sedimentador), fato esse que dificultou a operação do sistema de tratamento e interferiu na manutenção do tempo de retenção celular. Os resultados obtidos da simulação realizada por meio do software GPS-X 4.0, para reator em escala real empregando a lise celular, mostraram acréscimo na concentração de fósforo total no efluente de 30% após 5 anos de operaçãoThe aim of this research is to value the use of cell lyses over the sludge production and effluent nutrient accumulation from a combined treatment system (anaerobic/aerobic) from a synthetic sanitary wastewater. The parts of this system where one UASB reactor (V = 10,5 l), one aeration tank (V = 4,4 l) and one sedimentation tank (V = 2,7 l), hydraulic detention times of 8,0 h, 3,5 h e 2,7 h, respectively. During the control period, the characteristics of the system working without the use of cell lyses were recorded. After this phase, ultrasound equipment was used to cause the sludge lyses and then the sludge was returned to the entrance of the UASB reactor. From these tests we could not observe changes in mean global DQO removal efficiency for the both phases and it was 90% considering filtrated effluent COD. Few ammonia-nitrogen changes into nitrate inside the aeration tank were observed. Phosphorus removal in the treatment system was insignificant, but we could notice no damage to the treatment system caused by the lyses material returned. In the reduced scale of the system bulking events were frequent. This was controlled with sodium hypochlorite at the sedimentation tank, but these events caused operation difficulties and had interfered on the cellular detention time maintenance. Results from a real scale simulation, using cell lyses, done with the GPS-X 4.0 software, show an increase in effluent total phosphorus equal to 30% after 5 year

Contrast-induced nephropathy after computed tomography

Introduction: Contrast induced nephropathy is the third most prevalent preventable cause of acute kidney injury in hospitalized patients. It defined as an absolute increase in serum creatinine ≥ 0.5 mg/dL and relative ≥ 25% increase. Objective: We studied the risk factors to intravenous injection contrast nephropathy after computed tomography. Methods: We studied 400 patients prospectively. Results: The incidence of contrast induced nephropathy, with an absolute or a relative increase were 4.0% and 13.9%, respectively. Diabetes and cardiac failure were independent risk factors for CIN a relative increase de serum creatinine (O.R.: 3.5 [95% CI: 1.92-6.36], p < 0.01, 2.61 [95% CI: 1.14-6.03%], p < 0.05, respectively). Conclusions: We showed association between uses of intravenous injection contrast after computed tomography with acute injury renal, notably with diabetes and heart failure