Treatment of hyperphosphatemia with sevelamer hydrochloride in dialysis patients: effects on vascular calcification, bone and a close look into the survival data
1 Nephrology Department, Hospital de S. João, Medical School and Nephrology Research and Development Unit, University of Porto, Porto, Portugal and 2 Department of Nephrology, Hospital de Santa Cruz, Carnaxide, Portugal
Kidney International (2008) 74 (Suppl 111), S38–S43
Bone Mineral Density, Vascular Calcifications, and Arterial Stiffness in Peritoneal Dialysis Patients
|Teresa Adragão1, Patrícia Branco2, Rita Birne1, José Dias Curto3, Edgar de Almeida2, Mateus Martins Prata2, Maria João Pais1|
1 Nephrology Department, Santa Cruz Hospital, Carnaxide
2 Nephrology Department, Santa Maria Hospital
3 ISCTE Business School, Lisbon, Portugal
Perit Dial Int 2008; 28:668–672
Cardiovascular risk in dialysis patients: an X-ray vision on vascular calcifications
|Teresa Adragão1 and João M. Frazão2|
1 Nephrology Department, Hospital de Santa Cruz, Carnaxide, Portugal; and 2 Nephrology Department, Hospital de São João, School of Medicine and Nephrology Research and Development Unit, Porto University, Porto, Portugal
Kidney International (2008) 74, 1505–1507.
Effects of Sevelamer Hydrochloride and Calcium Carbonate on Renal Osteodystrophy in Hemodialysis Patients
|Aníbal Ferreira,* João Miguel Frazão,† Marie-Claude Monier-Faugere,‡ Cália Gil,§ José Galvão,? Carlos Oliveira,¶ Jorge Baldaia,** Ilidio Rodrigues,†† Carla Santos,‡‡ Silvia Ribeiro,§§ Regula Mueller Hoenger,??? Ajay Duggal,?? and Hartmut H. Malluche,‡ on behalf of the Sevelamer Study Group|
*Nephrology Department, Hospital Curry Cabral, Lisboa, Portugal; †Nephrology Research and Development Unit and School of Medicine, Porto University, Porto, Portugal; ‡Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky; §Hemodial-Vila Franca Xira, Lisboa, Portugal;? FMC-Torres Vedras, Torres Vedras, Portugal; ¶FMC-Entrocamento, Entrocamento, Portugal; **Unidade de Hemodialise de Guimaraes, Guimaraes, Portugal; ††Tagus Dial Barreiro (FMC), Barreiro, Portugal; ‡‡Centro de Hemodialise da Sta. Casa da Mesericordia de Vila Verde, Vila Verde, Portugal; §§HPA-Hospital Particular de Almada, Almada, Portugal; and ??Genzyme Europe Research, Cambridge, United Kingdom
J Am Soc Nephrol 19: 405–412, 2008
The OPTIMA Study: Assessing a New Cinacalcet (Sensipar/Mimpara) Treatment Algorithm for Secondary Hyperparathyroidism
|Piergiorgio Messa,* Fernando Macário,† Magdi Yaqoob,‡ Koen Bouman,§ Johann Braun,? Beat von Albertini,¶ Hans Brink,** Francisco Maduell,†† Helmut Graf,‡‡ João M. Frazão,§§|
Willem Jan Bos,?? Vicente Torregrosa,¶¶ Heikki Saha,*** Helmut Reichel,††† Martin Wilkie,‡‡‡ Valter J. Zani,§§§ Bart Molemans,§§§ Dave Carter,§§§ and Francesco Locatelli???
*Nephrology Division, CROFF Policlinico di Milano, Milan, Italy; †Dialave, Dia´lise de Aveiro, Gambro Healthcare, Aveiro, Portugal; ‡Royal London Hospital, London, United Kingdom; §ZNA, Middelheim, Belgium; ?KfH Kuratorium fur Dialyse und Nierentransplantation, Nurnberg, Germany; ¶Centre de Dialyse Cecil, Lausanne, Switzerland; **Medisch Spectrum
Twente, Enschede, The Netherlands; ††Hospital General de Castello´n, Castello´n de la Plana, Spain; ‡‡Krankenanstalt der Stadt Wien-Rudolfstiftung, Wien, Austria; §§Nephrology Research and Development Unit and School of Medicine, Porto University, Porto, Portugal; ??Antonius Hospital, The Netherlands; ¶¶Hospital Clínic i Provincial de Barcelona, Unitat de Transplantament Renal, Barcelona, Spain; ***Tampere University Hospital, Tampere, Finland; †††University of Heidelberg, Germany; ‡‡‡Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; §§§Amgen GmbH, Zug, Switzerland; ???Department of Nephrology and Dialysis Ospedale A Manzoni, Lecco, Italy
Clin J Am Soc Nephrol (2008); 3: 36–45
Secondary hyperparathyroidism disease stabilization following calcimimetic therapy
¹ Nephrology Research and Development Unit and School of Medicine, University of Porto, Porto, Portugal and ² Unidad de Investigacion, Servicio de Nefrologia, Hospital Universitario, Reina Sofia, Cordoba, Spain
NDT Plus (2008); 1 [Suppl 1]: i12–i17
A new paradigm for the treatment of secondary hyperparathyroidism
¹ Servicio de Nefrología, Hospital Universitario Valdecilla, Santander, Spain and ² Eurodial, Euromedic, Dialysis Unit, Leiria, Portugal
NDT Plus (2008); 1 [Suppl 1]: i24–i28
The pathophysiology of secondary hyperparathyroidism and the consequences of uncontrolled mineral metabolism in chronic kidney disease: the role of COSMOS
¹ University of Oviedo, Oviedo, Spain and ² Eurodial, Euromedic, Dialysis Unit, Leiria, Portugal
NDT Plus (2008); 1 [Suppl 1]: i2–i6
Hemoglobin targets: the jury is still out
¹ Dialysis Unit, Eurodial, Euromedic, Leiria, Portugal and ² Department of Renal Medicine, King’s College Hospital, London, UK
Clinical Nephrology (2008); 69(1): 8-9
Contemporary analysis of the influence of acute kidney injury after reduced intensity conditioning haematopoietic cell transplantation on long-term surviva
Department of Nephrology and Renal Transplantation, Hospital de Santa Maria, Lisboa, Portugal.
Bone Marrow Transplant. 2008 Jul 14. [Epub ahead of print]
We evaluated retrospectively the incidence of acute kidney injury (AKI), defined by risk, injury, failure, loss and end-stage kidney disease (RIFLE) and its influence on long-term survival, in 82 patients aged 18-60 years who underwent a reduced intensity conditioning (RIC) haematopoietic cell transplantation (HCT). Patients (53.6%) developed AKI after HCT: 25% were on risk, 45.5% on injury and 29.5% on failure. In all, 64 patients survived after 100 days of post transplant and were available for long-term survival analysis. At follow-up, 43.7% of patients died. A 5-year overall survival of AKI patients was 41.6% as compared with 67.1% for those who did not develop AKI (P=0.028), and decreased according to AKI severity (risk, 55.6%; injury plus failure, 33.3%; P=0.045). After adjusting for age, history of cardiovascular disease, high-risk disease and chronic GVHD, AKI predicted 5-year overall mortality (AKI: adjusted hazards ratio (AHR), 2.36, 95% CI: 1.03-5.37; P=0.041). Moreover, moderate and severe AKI (injury plus failure) was also associated with an increased 5-year overall mortality (injury plus failure: AHR, 1.64, 95% CI: 1.06-2.54; P=0.024). According to RIFLE, 53.6% of patients had AKI after RIC HCT. Such patients have poor long-term survival, particularly in moderate or severe AKI.Bone Marrow Transplantation advance online publication, 14 July 2008; doi:10.1038/bmt.2008.207.
Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications
Department of Nephrology and Renal Transplantation, Hospital de Santa Maria, Av, Prof, Egas Moniz, Lisboa 1649-035, Portugal. firstname.lastname@example.org
Crit Care. 2008;12(4):R110. Epub 2008 Aug 28.
INTRODUCTION: Whether discernible advantages in terms of sensitivity and specificity exist with Acute Kidney Injury Network (AKIN) criteria versus Risk, Injury, Failure, Loss of Kidney Function, End-stage Kidney Disease (RIFLE) criteria is currently unknown. We evaluated the incidence of acute kidney injury and compared the ability of the maximum RIFLE and of the maximum AKIN within intensive care unit hospitalization in predicting inhospital mortality of critically ill patients.
METHODS: Patients admitted to the Department of Intensive Medicine of our hospital between January 2003 and December 2006 were retrospectively evaluated. Chronic kidney disease patients undergoing dialysis or renal transplant patients were excluded from the analysis.
RESULTS: In total, 662 patients (mean age, 58.6 +/- 19.2 years; 392 males) were evaluated. AKIN criteria allowed the identification of more patients as having acute kidney injury (50.4% versus 43.8%, P = 0.018) and classified more patients with Stage 1 (risk in RIFLE) (21.1% versus 14.7%, P = 0.003), but no differences were observed for Stage 2 (injury in RIFLE) (10.1% versus 11%, P = 0.655) and for Stage 3 (failure in RIFLE) (19.2% versus 18.1%, P = 0.672). Mortality was significantly higher for acute kidney injury defined by any of the RIFLE criteria (41.3% versus 11%, P < 0.0001; odds ratio = 2.78, 95% confidence interval = 1.74 to 4.45, P < 0.0001) or of the AKIN criteria (39.8% versus 8.5%, P < 0.0001; odds ratio = 3.59, 95% confidence interval = 2.14 to 6.01, P < 0.0001). The area under the receiver operator characteristic curve for inhospital mortality was 0.733 for RIFLE criteria (P < 0.0001) and was 0.750 for AKIN criteria (P < 0.0001). There were no statistical differences in mortality by the acute kidney injury definition/classification criteria (P = 0.72).
CONCLUSIONS: Although AKIN criteria could improve the sensitivity of the acute kidney injury diagnosis, it does not seem to improve on the ability of the RIFLE criteria in predicting inhospital mortality of critically ill patients.
Acute kidney injury in patients with sepsis: a contemporary analysis
Department of Nephrology and Renal Transplantation, Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal.
Int J Infect Dis. 2008 Sep 2. [Epub ahead of print]
OBJECTIVES: To analyze the clinical characteristics of septic acute kidney injury (AKI) according to the Acute Kidney Injury Network (AKIN) classification, and to evaluate the capacity of this system in predicting in-hospital mortality of septic patients.
METHODS: Patients with sepsis admitted to the infectious diseases intensive care unit (ICU) of our hospital between January 2004 and June 2007 were retrospectively studied. Maximum AKIN stage within the first three days of hospitalization was recorded.
RESULTS: Three hundred fifteen patients were evaluated. According to AKIN criteria, 99 patients (31.4%) had AKI: 26.2% at stage 1, 20.2% at stage 2, and 53.6% at stage 3. Four patients (1.9%) with no AKI progressed to stage 1, two patients (7.7%) at stage 1 progressed to stage 2, one patient (3.8%) at stage 1 progressed to stage 3, and one patient at stage 2 (5%) progressed to stage 3. The mortality rate was 25.3% and increased significantly from normal renal function to stage 3 (normal, 12.5%; stage 1, 34.6%; stage 2, 45%; stage 3, 64.1%; p<0.0001). After adjusting for age, gender, race, pre-existing chronic kidney disease, illness severity as evaluated by acute physiology and chronic health evaluation, version II (APACHE II) score, need for mechanical ventilation, and vasopressor use, AKIN stage 1 (odds ratio (OR) 3.03, 95% confidence interval (CI) 1.12-8.19, p=0.029), stage 2 (OR 3.3, 95% CI 1.11-9.78, p=0.031), and stage 3 (OR 7.35, 95% CI 3.13-17.25, p<0.0001) predicted mortality.
CONCLUSIONS: AKIN criteria are a useful tool to characterize and stratify septic patients according to the risk of death.
Mycophenolate mofetil in chronic glomerular diseases
Serviço Nefrologia (Dr. Dr. Mário Campos). Hospital da Universidade Coimbra. *Serviço de Nefrologia (Dir. Dr. Armando Carreira). Centro
Hospitalar de Coimbra. Portugal.
Nefrología 2008; 28 (1) 82-92
Posterior reversible encephalopathy syndrome (PRES) and chronic kidney disease
Departament of Nephrology and Renal Transplantation
Posterior reversible encephalopathy (PRES) is a recently described syndrome, defined by clinical and neuroimaging features. Chronic kidney disease patients may be especially vulnerable to this syndrome because they are frequently exposed to several of its possible causes, including uremia and hypertension. In its most severe form, PRES can manifest clinically as seizures, coma or death. However, if properly diagnosed and treated, this syndrome can be completely reversible. Therefore, neuroimaging methods, especially brain magnetic resonance is fundamental for its diagnosis because it shows brain edema in characteristic pattern, and excludes causes of seizures or coma. An important example is the case of a young hypertensive chronic kidney disease patient on peritoneal dialysis, brought to the emergency room comatous with generalized tonic-clonic seizures; the cerebral magnetic resonance imaging features were impressive. Anti-hypertensive therapy and hemodialysis allowed complete recovery. The reversibility of this syndrome depends on timely diagnosis and therapy and therefore it should be kept in mind in the differential diagnosis of seizures. or coma in chronic kidney disease patients.
Acute abdomen and acute kidney injury: a common entity, a not so rare link?
NDT Plus Advance Access published on July 15, 2008
NDT Plus 2008 1: 357-358
Induction immunosuppressive therapy in renal transplantation: does basiliximab make the difference?
Jorge S, Guerra J, Silva S, Santana A, Mil-Homens C, Prata MM.
Serviço de Nefrologia e Transplantação Renal, Hospital de Santa Maria, Lisboa, Portugal. email@example.com
Transplant Proc. 2008 Apr;40(3):693-6.
The optimal prophylactic induction immunosuppressive therapy to prevent renal transplant rejection remains controversial. Recently, basiliximab efficiency has been reported in several studies. We sought to evaluate the efficiency of induction immunosuppressive therapy with basiliximab in renal transplantation in our unit based upon the acute rejection rate, patient and graft survivals, first hospital admission length, and incidence of infectious or malignant complications during 4 years of follow-up. We retrospectively evaluated the outcome of two groups of renal transplant recipients treated with triple immunosuppressive therapy (cyclosporine, mycophenolate mofetil, and prednisolone) without (group 1, 149 patients) or with (group 2, 104 patients) induction immunosuppression with basiliximab. The two groups did not differ in demographic characteristics, number of hypersensitized patients, cold ischemia time, or donor age. The group receiving basiliximab displayed a significantly lower acute rejection rate (7.6% vs 24%, P = .001) and shorter first hospital admission (14.4 +/- 8 vs 19.5 +/- 11 days). There was no difference in graft or patient survival, death due to sepsis, or incidence of posttransplant malignancies. Although there was no difference in graft or patient survival, immunosuppressive induction therapy with basiliximab yielded a significant reduction in the acute rejection rate.
Mycophenolate mofetil: ten years\' experience of a renal transplant unit.
Serviço de Nefrologia e Transplantação Renal, Hospital de Santa Maria, Lisboa, Portugal. firstname.lastname@example.org
Transplant Proc. 2008 Apr;40(3):700-4.
Mycophenolate mofetil (MMF) use in renal transplantation has allowed a significant decrease in early acute rejection rates. We retrospectively evaluated the incidence of acute rejection episodes, renal function at the first year posttransplant, patient and graft survivals, cytomegalovirus (CMV) infection rate, influence of the degree of sensitization, and number of MHC antigen mismatches on graft survival in two groups of patients receiving either MMF or azathioprine. Group 1 included 149 patients receiving cyclosporine, MMF, and prednisolone; group 2 included 191 patients receiving cyclosporine, azathioprine, and prednisolone. The two groups did not differ in terms of age, sex, degree of sensitization (expressed as percentage of antibodies reactive to panel), MHC mismatch number, cold ischemia time, donor age, or anti-thymocyte globulin induction. In group 1 (MMF) there was a significant decrease in early acute rejection rate (19% vs 57%, P < .0001), longer graft survival at 10 years (92% vs 75%, P = .006), and higher rate of CMV infection (22% vs 12%, P = .004). Renal function at the first year posttransplant and patient survival during follow-up did not differ between the groups. The degree of sensitization influenced graft survival in group 2. The number of MHC mismatches did not influence graft survival in either group. With MMF, there was a significant reduction in early acute rejection rate, a significant increase in graft survival at 10-year follow-up, and diminished impact of the degree of sensitization on graft survival.