Cardiovascular Risk Factors: The Old Ones and a Closer Look to the Mineral Metabolism

Patients with chronic kidney disease (CKD) are particularly susceptible to cardiovascular complications, and cardiovascular disease (CVD) accounts for more than 50% of all deaths in this population. Cardiac diseases are independently associated with a deterioration of renal function and worsening of existing kidney disease. On the other hand, chronic kidney disease is an independent risk factor for increased cardiovascular morbidity and mortality. It has a complex pathogenesis, and traditional risk factors are not able to fully explain its high incidence and prevalence. Several substances have been identified, and they seem to play important roles in different physiological functions. This chapter will review traditional risk factors such as hypertension, diabetes, dyslipidemia, and left ventricular hypertrophy. The most relevant bibliography will be referred, and also interventional studies will be discussed. Other new emerging factors associated with the osteomineral metabolism have been described, mainly in advanced stages of CKD, and frequently are associated with higher cardiovascular risk, which in turn will contribute to the unfavorable prognosis of this population

One-year rehospitalisations for congestive heart failure in Portuguese NHS hospitals: a multilevel approach on patterns of use and contributing factors

Identification of rehospitalisations for heart failure and contributing factors flags health policy intervention opportunities designed to deliver care at a most effective and efficient level. Recognising that heart failure is a condition for which timely and appropriate outpatient care can potentially prevent the use of inpatient services, we aimed to determine to what extent comorbidities and material deprivation were predictive of 1 year heart failure specific rehospitalisation.info:eu-repo/semantics/publishedVersio

A diálise peritoneal na actual crise pandémica: uma oportunidade de reflexão

São difíceis os tempos que se vivem, e tempos mais difíceis poderão estar por chegar. A actual pandemia do novo coronavírus obrigou a uma total reformulação da sociedade em geral e, em especial, dos cuidados que concernem à área da saúde.info:eu-repo/semantics/publishedVersio

Developing an individualized survival prediction model for colon cancer

In this work a 5-year survival prediction model was developed for colon cancer using machine learning methods. The model was based on the SEER dataset which, after preprocessing, consisted of 38,592 records of colon cancer patients. Survival prediction models for colon cancer are not widely and easily available. Results showed that the performance of the model using fewer features is close to that of the model using a larger set of features recommended by an expert physician, which indicates that the first may be a good compromise between usability and performance. The purpose of such a model is to be used in Ambient Assisted Living applications, providing decision support to health care professionals.info:eu-repo/semantics/publishedVersio

Risk factors for fractures in type 2 diabetic with chronic kidney disease stage: the saints and the sinners

Since the population in the developed world is aging, the burden offragility fractures is aconstantly increasing problem. Despite the fact that potent bone-specific pharmaceutical agents have become available, the problem of how to identify patients with high fracture risk yet remains an enigma. Some studies mention the role of a normal mineral metabolism is critical for skeletal development and preservation of bone integrity. The aim of this study isto investigate the association of mineralmetabolism with hip fractures in type 2 diabetic with chronic kidney disease (CKD)

Angels and demons regarding cardiovascular disease in diabetic renal patients: the role of FGF-23 Andklotho on the pulse pressure

The last decade have shown thatFGF23 and Klotho may have relevant independent actions on the renal and cardiovascular systems. Theyinterfere with vascular functions and may playa role in vascularcalcification, atherosclerosis and arteriolosclerosis. On the other hand, pulse pressureis awell-known risk factorof cardiovascular morbidityand mortality in renal patients. The aim of this study isto investigate the relationship between FGF-23 and Klothowith pulse pressure in type 2 diabetic with chronic kidney disease (CKD) stages 2-3

A reasoning module for distributed clinical decision support systems

One of the main challenges in distributed clinical decision support systems is to ensure that the flow of information is kept. The failure of one or more components should not bring down an entire system. Moreover, it should not impair any decision processes that are taking place in a functioning component. This work describes a decision module that is capable of managing states of incomplete information which result from the failure of communication between components or delays in making the information available. The framework is also capable of generating scenarios for situations in which there are information gaps. The proposal is described through an example about colon cancer staging.This work is part-funded by ERDF-European Regional Development Fund through the COMPETE Programme (operational programme for competitiveness) and by National Funds through the FCT-Fundacao para a Ciencia e a Tecnologia (Portuguese Foundation for Science and Technology) within project FCOMP-01-0124-FEDER-028980 and project scope UID/CEC/00319/2013. The work of Tiago Oliveira is supported by a FCT grant with the reference SFRH/BD/85291/2012.info:eu-repo/semantics/publishedVersio

Severe Relapsing Goodpasture's Disease Successfully Treated with Mycophenolate Mofetil

Goodpasture's disease is a rare autoimmune disorder characterised by the development of antiglomerular basement membrane autoantibodies, which typically presents with rapidly progressive crescentic glomerulonephritis and pulmonary haemorrhage. Even with aggressive nonspecific immunosuppression and plasma exchange, mortality remains high. We report a case of life-threatening Goodpasture's disease with relapsing pulmonary haemorrhage refractory to conventional therapy. Second line treatment was based on mycophenolate mofetil 1 g every 12 hours and prednisolone 60 mg/day. In this case, the use of a low-dose mycophenolate mofetil regimen turned out to be insufficient. However, in our opinion higher mycophenolate mofetil doses should be considered an alternative treatment, mainly in relapsing disease, due to its mechanism of action and current insufficient therapeutic weapons

Gla-rich protein (GRP) as an early and novel marker of vascular calcification and kidney dysfunction in diabetic patients with CKD: a pilot cross-sectional study

Vascular calcification (VC) is one of the strongest predictors of cardiovascular risk in chronic kidney disease (CKD) patients. New diagnostic/prognostic tools are required for early detection of VC allowing interventional strategies. Gla-rich protein (GRP) is a cardiovascular calcification inhibitor, whose clinical utility is here highlighted. The present study explores, for the first time, correlations between levels of GRP in serum with CKD developmental stage, mineral metabolism markers, VC and pulse pressure (PP), in a cohort of 80 diabetic patients with mild to moderate CKD (stages 2-4). Spearman's correlation analysis revealed a positive association of GRP serum levels with estimated glomerular filtration rate (eGFR) and α-Klotho, while a negative correlation with phosphate (P), fibroblast growth factor 23 (FGF-23), vascular calcification score (VCS), PP, calcium (x) phosphate (CaxP) and interleukin 6 (IL-6). Serum GRP levels were found to progressively decrease from stage 2 to stage 4 CKD. Multivariate analysis identified low levels of eGFR and GRP, and high levels of FGF-23 associated with both the VCS and PP. These results indicate an association between GRP, renal dysfunction and CKD-mineral and bone disorder. The relationship between low levels of GRP and vascular calcifications suggests a future, potential utility for GRP as an early marker of vascular damage in CKD.Portuguese Society of Nephrology (SPN) ; Portuguese national funds from FCT-Foundation for Science and Technology through the transitional provision DL57/2016/CP1361/CT0006 UIDB/04326/2020info:eu-repo/semantics/publishedVersio