Navegando por Palavras-chave "Renal Insufficiency"
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- ItemAcesso aberto (Open Access)Avaliação da eficiência e segurança do Sugamadex na reversão do bloqueio neuromuscular profundo induzido pelo rocurônio em pacientes com insuficiência renal crônica submetidos a transplante renal(Universidade Federal de São Paulo (UNIFESP), 2019-07-25) Souza, Camila Machado De [UNIFESP]; Oliveira Junior, Itamar Souza De [UNIFESP]; Tardelli, Maria Angela; Tedesco, Hélio; http://lattes.cnpq.br/9044839480768622; http://lattes.cnpq.br/0568989035666759; http://lattes.cnpq.br/9433269759737378; Universidade Federal de São Paulo (UNIFESP)Introduction: In patients with renal failure different physiologic and pharmacologic factors impact pharmacokinetics and pharmacodynamics of nondepolarizing neuromuscular blockers making recovery of neuromuscular function unpredictable. It’s commonly necessary to antagonize neuromuscular blockade at the end of a surgical procedure, to guarantee neuromuscular function is reestablished upon emergence and avoid severe complications like hypoxemia and aspiration. Sugammadex antagonizes rocuronium-induced neuromuscular blockade by encapsulating rocuronium, creating a stable complex molecule that is mainly excreted by the kidneys. Therefore, its pharmacokinetics is profoundly altered in kidney failure. Objective: The objective of this study is to compare the efficacy and safety of sugammadex in reversing profound neuromuscular block induced by rocuronium in patients with end-stage renal disease and those with normal renal function. Method: This prospective clinical trial was performed in two different university hospitals from 1 October 2011 to 31 January 2012 and included 20 patients with renal failure [creatinine clearance (ClCr) <30 ml.min-1] and 20 control patients (ClCr >90 ml.min-1) submitted to elective procedures and kidney transplant. Neuromuscular monitoring was performed by acceleromyography and train-of-four (TOF) stimulation. Profound neuromuscular block (post-tetanic count, one to three responses) was maintained during surgery and reversed with sugammadex 4 mg.kg-1 on completion of skin closure. The efficacy of sugammadex was evaluated by the time taken for the TOF ratio to recover to 0,9. The safety of sugammadex was assessed by monitoring for recurrence of neuromuscular block every 15 min for 2 h postoperatively. Secondary variables were time to recovery of TOF ratio to 0.7 and 0.8. Results: After sugammadex administration, the mean time for recovery of the TOF ratio to 0,9 was prolonged in the renal failure group (5.6 3.6 min) compared with the control group (2.7 1.3 min, P=0.003). No adverse events or evidence of recurrence of neuromuscular block were observed. Conclusion: In patients with renal failure, sugammadex 4 mg.kg-1 effectively and safely reversed profound rocuronium induced neuromuscular block, but the recovery was slower than healthy patients.
- ItemSomente MetadadadosInfecção de trato urinário em pacientes com doença renal crônica em tratamento conservador(Universidade Federal de São Paulo (UNIFESP), 2020-08-27) Moraes, Graciana Maria De [UNIFESP]; Barbosa, Dulce Aparecida [UNIFESP]; Universidade Federal de São PauloIntroduction: After the increase of Brazilians’ life expectancy in the last decades, we have also seen an increase in the incidence and prevalence of chronic diseases like blood hypertension and diabetes, which are considered the main causes of kidney failure. This may result in end-stage renal disease with a burden for the patient, family, and society. The identification of risk factors for urinary infections in this population may decrease or reverse the kidney disease progression, besides preventing the need of renal replacement therapy. Objective: To assess the prevalence and risk factors for urinary tract infection in chronic kidney disease patients on conservative treatment. Method: This is a cross-sectional analytical study carried out in the Ambulatory of Conservative Treatment of Hospital do Rim e Hipertensão from Universidade Federal de São Paulo. We analyzed the registrations of medical records from patients aged ≥18 years, with urine culture tests collected (n=1,555) between 2010 and 2018. A total of 343 (22%) urine culture tests had a positive result, which was considered the first positive result (n=134) to form the study. We studied sociodemographic and clinical variables, comorbidities, and presence or not of urinary tract infection. Risk factors were identified by comparing patients with and without infection to the same inclusion criteria for the study. We applied the logistic regression model to identify the risk factors for urinary tract infection occurrence in the study population. A 5% significance level was considered. Results: The urinary tract infection prevalence in the population was 22%. The Infection Group included 134 patients and the Non-Infection Group had 81 subjects. The Infection Group had a higher presence of female patients that concluded Elementary School and patients that ended High and Higher Schools had a lower percentage in this group. Patients from the Infection Group were older than those without the infection. Diabetics and hypertensive patients with heart disease and other medical history were more prevalent in the Infection Group. In addition, Infection Group patients presented higher body mass index compared to those of the Non-Infection Group. The mean values of urea, creatinine and creatinine clearance were significantly higher in the Infection Group. Most of the patients on conservative treatment was classified in stages 3, 4 and 5 of kidney disease, and the most frequent microorganisms in cultures were Escherichia coli (50.7%), Klebsiella pneumoniae (23.1%), and Enterococcus spp (9,7%) – E. coli and K. pneumoniae were mostly resistant. In the multiple logistic regression model, the variables that best explained the occurrence of urinary tract infection in patients with chronic kidney disease on conservative treatment were advanced age, presence of other medical history, and increase of urea and creatinine values. Conclusion: The prevalence of urinary tract infection in patients with kidney disease on conservative treatment was high. The identified risk factors were age, presence of personal history, and urea and creatinine values.
- ItemAcesso aberto (Open Access)Intervenção educacional de enfermagem para redução da hiperfosfatemia em pacientes em hemodiálise(Assoc Brasileira Enfermagem, 2017) Fernandes Stumm, Eniva Miladi; Kirchner, Rosane Maria; Guido, Laura de Azevedo; Rieth Benetti, Eliane Raquel; Belasco, Angélica Gonçalves Silva [UNIFESP]; Sesso, Ricardo de Castro Cintra [UNIFESP]; Barbosa, Dulce Aparecida [UNIFESP]Objective: to evaluate the effectiveness of an educational nursing intervention to reduce hyperphosphataemia in chronic renal patients on hemodialysis. Method: quasi-experimental study with 63 hyperphosphatemic patients on hemodialysis. The intervention consisted of developing and providing a printed and illustrated manual to patients containing information on disease control. The participant was asked to complete a daily checklist with the aim to reinforce aspects provided in the manual. Laboratory tests and itching intensity were analyzed at the beginning of the study, and at 30 and 60 days after the educational intervention. Results: the mean age of participants was 58 +/- 13.1 years, with a treatment time of 51.1 +/- 44.7 months. A reduction in serum phosphorus values of 7.06 +/- 1.43 to 5.80 +/- 1.53 (p <0.001) and the intensity of itching after the intervention was observed. Conclusion: the educational nursing intervention was effective in reducing phosphate and decreasing itching in hyperphosphatemic patients.
- ItemAcesso aberto (Open Access)Pré-eclâmpsia (indicador de doença renal crônica): da gênese aos riscos futuros(Sociedade Brasileira de Nefrologia, 2012-03-01) Facca, Thais Alquezar [UNIFESP]; Mastroianni Kirsztajn, Gianna [UNIFESP]; Sass, Nelson [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Preeclampsia (PE) is a pregnancy-specific disease which, in addition to other hypertensive disorders, is an important cause of maternal and perinatal morbidity and mortality. With an incidence ranging from 3 to 14% of all pregnancies worldwide, the disease can present in different clinical forms. PE and cardiovascular diseases (CVD) have similar pathophysiological mechanisms, such as endothelial dysfunction, metabolic changes and oxidative stress, and they also share some risk factors such as obesity, kidney disease and diabetes. Although the exact relationship between PE and cardiovascular risk has not been fully elucidated, PE-triggered metabolic stress may cause vascular injury, thus contributing to the development of CVD and/or chronic kidney disease (CKD) in the future. This risk appears to be increased especially in women with a history of recurrent, severe PE and eclampsia. The investigation of a history of PE may assist in assessing the future risk of CVD and CKD, their prevention and early diagnosis.