Publicações - 2007

Evaluation of Peritoneal Transport and Membrane Status in Peritoneal Dialysis: Focus on Incident Fast Transporters

Rodrigues AS, Martins M, Korevaar JC, Silva S, Oliveira JC, Cabrita A, Castro E Melo J, Krediet RT.

Department of Nephrology, Hospital Geral de Santo Antonio, University of Porto, Porto, Portugal.

American Journal of Nephrology 2007; 27: 84-91

Background/Aim: The determinants of baseline fast solute transport are still unclear. We prospectively investigated the relationship of peritoneal solute transport with markers of inflammation, angiogenesis, and membrane status, with a focus on fast transporters. Methods: Seventy-one incident peritoneal dialysis patients were assessed with baseline and annual peritoneal equilibration tests, using a 3.86% glucose dialysis solution. Residual renal function and markers of inflammation, including systemic and intraperitoneal interleukin-6 (IL-6), effluent cancer antigen 125 (CA-125), and vascular endothelial growth factor (VEGF) appearance rates (ARs), were investigated. The time course of the dialysate-to-plasma ratio of creatinine (D/P creatinine ratio) and its relationship with the biomarkers were investigated by a mixed linear model.

Results: Incident fast/fast average transporters had a similar age, diabetes prevalence, and serum and effluent IL-6 levels, but significantly higher levels of CA-125 and VEGF ARs than the slow/slow average group; the D/P creatinine ratio was not correlated with systemic IL-6, but was correlated with effluent CA-125 AR (r = 0.45, p < 0.0001) and VEGF AR (r = 0.52, p < 0.0001). The D/P creatinine ratio decreased with a U-shaped profile (p = 0.02). Intraperitoneal IL-6 was the significant and positive determinant of the time course of the D/P creatinine ratio (p < 0.0001). Effluent CA-125 decreased with time on peritoneal dialysis (p = 0.013).

Conclusions: Baseline peritoneal fast transport was not associated with systemic inflammation, but was related to peritoneal locally produced substances able to mediate transitory hyperpermeability. The D/P creatinine ratio changed during the follow-up period with a U-shaped profile. This was associated with effluent IL-6 and partly with VEGF. CA-125 decreased throughout the follow-up period. Copyright (c) 2007 S. Karger AG, Basel.

PMID: 17284895 [PubMed - as supplied by publisher]

Fungal peritonitis in peritoneal dialysis patients: Is previous antibiotic therapy an essential condition?

Rosa NG, Silva S, Lopes JA, Branco P, de Almeida E, Ribeiro C, Abreu F, Barbas J, Prata MM.

Department of Nephrology, Hospital Central do Funchal, Estrada dos Marmeleiros, Funchal, Portugal.

Mycoses. 2007 Jan;50(1):79-81.

The aim of this study was to analyse the clinical and microbiological features of fungal peritonitis, in chronic peritoneal dialysis patients, focusing on non-traditional risk factors for this feared complication. From 2001 to 2004, five episodes of fungal peritonitis were diagnosed in five different patients, accounting for 4.5% of all peritonitis cases seen during this period. Candida spp. were the most frequent isolates. In all cases, peritoneal dialysis catheter removal and switching to haemodialysis were necessary. In these five cases of fungal peritonitis only one was preceded by antibiotic use, within the previous 3 months, the classical risk factor for fungal peritonitis. Identifying predisposing factors usually not taken into account, may lead to an early diagnosis and to a better understanding of fungal peritonitis pathogenesis.

PMID: 17302754 [PubMed - indexed for MEDLINE]

Diastolic function in several stages of chronic kidney disease in patients with autosomal dominant polycystic kidney disease: a tissue Doppler imaging study

de Almeida EA, de Oliveira EI, Lopes JA, Almeida AG, Lopes MG, Prata MM.

Serviço de Nefrologia e Transplantação Renal, Hospital de Santa Maria, Lisboa, Portugal.

Kidney Blood Press Res. 2007;30(4):234-9. Epub 2007 Jun 15.

BACKGROUND: This study evaluates the prevalence of diastolic dysfunction (DD) in several stages of chronic kidney disease (CKD) in patients with autosomal dominant polycystic kidney disease (ADPKD).
METHODS: 107 ADPKD patients performed echocardiographic and Doppler studies and a tissue Doppler imaging (TDI) study. Patients were divided in three groups: group 1, 57 patients with CKD stage I, group 2, 37 patients in stages II and III, and group 3, 13 patients with CKD stages IV and V (not on dialysis).

RESULTS: In transmitral Doppler, 1 patient in group 1 compared to 5 in group 2, and 4 in group 3 exhibited DD (p < 0.005); moreover, E/A ratio decreases progressively from group 1 to 3 (p < 0.0001). In TDI, DD was observed in 8 patients in group 1, 17 in group 2, and 8 in group 3 had DD (p < 0.001). Em velocity, the best TDI parameter for DD, correlated with age, renal function and blood pressure. When adjusted for age, increased left ventricular mass index and decreased renal function were independent risk factors of DD.

CONCLUSIONS: DD occurred progressively as renal function deteriorates in patients with ADPKD and this effect is independently related to age and blood pressure. Copyright 2007 S. Karger AG, Basel.

Publication Types:
a.. Comparative Study

PMID: 17575469 [PubMed - indexed for MEDLINE]

Ambulatory blood pressure measurement in young normotensive patients with autosomal dominant polycystic kidney disease

de Almeida EA, de Oliveira EI, Lopes JA, Almeida AG, Lopes MG, Prata MM.

Serviço de Nefrologia e Transplantação Renal, Serviço de Cardiologia, Hospital de Santa Maria, Lisboa, Portugal.

Rev Port Cardiol. 2007 Mar;26(3):235-43.

INTRODUCTION: Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic disorder causing chronic kidney disease in adults.
Hypertension occurs early and frequently precedes the development of renal failure. It has been shown that clinically normotensive young adults with ADPKD exhibit increased left ventricular mass and left ventricular mass index (LVMI), which contributes to the increased cardiovascular risk in these patients. We set out to investigate whether normotensive patients have a prehypertensive state that could account for their increased LVMI.

METHODS: Patients with ADPKD followed as outpatients were selected if they were aged between 21-30 years, were normotensive (office and sporadic blood
pressure < 140/90 without medication), and had normal renal function (GFR > 90 ml/min). Normotensive controls aged between 21-30 years were selected, all with normal renal ultrasound, serum creatinine, dipstick analysis and microalbuminuria /creatinine ratio. Patients and controls underwent 24-hour ambulatory blood pressure measurement (ABPM) according to the local protocol.

RESULTS: Systolic (124.7 +/- 7.6 vs. 115.2 +/- 6.9; p < 0.0001), diastolic (77.3 +/- 6.3 vs. 70.5 +/- 3.9; p < 0.0001) and mean (92.7 +/- 8.5 vs. 85.7 +/- < 0.001) 24-hour blood pressure was significantly higher in patients with ADPKD compared to controls. Statistically significant differences were also found when daytime and night-time periods were analyzed separately. Hypertension on ABPM was diagnosed in 6 patients but differences in the ABPM profile persisted even when these patients were excluded from the analysis.

CONCLUSION: In young adults with ADPKD there is a prehypertensive state that can be detected using ABPM.

PMID: 17549981 [PubMed - indexed for MEDLINE]

Extended dosing intervals with erythropoiesis-stimulating agents in chronic kidney disease: a review of clinical data

Fernando Carrera ¹, Alex Disney ² and Manuel Molina ³

¹ Eurodial, Dialysis Unit, Leiria Portugal, ² Queen Elizabeth Hospital, Adelaide, South Australia and ³ Servicio de Nefrologia, Hospital Santa Maria del Rosell, Cartagena, Spain

Nephrol Dial Transplant (2007) 22 [Suppl 4]: iv19–iv30

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Haemoglobin in Chronic Kidney Disease Patients ? The Goalposts May Move, but We Are Still on Target

Fernando Carrera

Senior Consultant Nephrologist, Eurodial, Leiria, Portugal

Eur Renal Dis 2007; 1: 13-14

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Dose requirements among hemodialysis patients treated with darbepoetin-alpha or epoetin-beta

Prata MM, Dos Santos JP, Hegbrant J, Schmid CH, Pereira BJ, Wald R.

Gambro Healthcare, Sintra, Portugal.

Nephron Clin Pract. 2007;107(2):c50-5. Epub 2007 Aug 21.

BACKGROUND/AIMS: In a cohort of hemodialysis patients, we evaluated the hypothesis that weekly administration of intravenous (IV) darbepoetin-alpha (DA) was associated with lower total erythropoiesis-stimulating agent (ESA) requirements as compared to a regimen of multiple subcutaneous (SC) doses per week of epoetin-beta (EB). METHODS: We studied 1,159 hemodialysis patients who were treated exclusively with either IV DA or SC EB across a network of Portuguese clinics during 2004. Linear regression was used to assess the adjusted relationship between the ESA regimen and weekly ESA requirements over the period of observation. Generalized estimating equations were applied in order to model the population average effects of the correlated mean weekly ESA dose for each individual. We also calculated propensity scores for the receipt of DA and assessed the relationship between ESA type and dose requirement within each quintile of the score.

RESULTS: The adjusted dose of IV DA, when expressed as a proportion of the dose used in EB-treated patients, did not differ from the dose administered to EB recipients (0.961, 95% CI 0.904, 1.021). A similar relationship was observed within each propensity score quintile.

CONCLUSIONS: Hemodialysis patients who received IV DA had dose requirements that were similar to their counterparts who were treated with SC EB. A once-weekly dosing regimen and avoidance of SC administration enhance the attractiveness of DA as an alternative to traditional ESAs. The potential for unmeasured confounding, restriction to a population that was treated with a single ESA preparation and application of a 200 IU:1 mug EB:DA dose conversion are important limitations of this study. (c) 2007 S. Karger AG, Basel.

PMID: 17713351 [PubMed - in process]

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Anaemia management in chronic kidney disease patients: focus on erythropoiesis-stimulating agents

Fernando Carrera

Senior Consultant Nephrologist, Eurodial, Leiria, Portugal 

September/October 2007 Hospital Pharmacy Europe

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Combined use of plasmapheresis and antidigoxin antibodies in a patient with severe digoxin intoxication and acute renal failure

Santos-Araújo C, Campos M, Gavina C, Rocha-Gonçalves F, Pestana M.

Nephrology Department, Faculty of Medicine, Hospital S. João, Porto, Portugal.

Nephrol Dial Transplant. 2007 Jan;22(1):257-8. Epub 2006 Sep 8.

PMID: 16963474 [PubMed - in process]

An assessment of the RIFLE criteria for acute renal failure in severely burned patients

Lopes JA, Jorge S, Neves FC, Caneira M, da Costa AG, Ferreira AC, Prata MM.

Nephrol Dial Transplant. 2007 Jan;22(1):285. Epub 2006 Jul 31.

PMID: 16880180 [PubMed - indexed for MEDLINE]

Acute renal failure in severely burned patients

Lopes JA, Jorge S, Neves FC, Costa AG, Prata MM, Caneira M, Ferreira AC.

Resuscitation. 2007 May;73(2):318. Epub 2007 Feb 12.

PMID: 17298861 [PubMed - indexed for MEDLINE]

Prognostic utility of RIFLE for acute renal failure in patients with sepsis

Lopes JA, Jorge S, Resina C, Santos C, Pereira A, Neves J, Antunes F, Prata MM.

Department of Nephrology and Renal Transplantation, Hospital de Santa Maria, Av, Prof, Egas Moniz, 1649-035, Lisboa, Portugal.

Crit Care. 2007 Apr 5;11(2):408 [Epub ahead of print]

PMID: 17430577 [PubMed - as supplied by publisher]

Acute renal failure in patients with sepsis

Lopes JA, Jorge S, Resina C, Santos C, Pereira A, Neves J, Antunes F, Prata MM.

Department of Nephrology and Renal Transplantation, Hospital de Santa Maria, Av, Prof, Egas Moniz, 1649-035, Lisboa, Portugal.

Crit Care. 2007 Apr 19;11(2):411 [Epub ahead of print]

PMID: 17466080 [PubMed - as supplied by publisher]

An assessment of the RIFLE criteria for acute renal failure in critically ill HIV-infected patients

Lopes JA, Fernandes J, Jorge S, Neves J, Antunes F, Prata MM.

Crit Care. 2007;11(1):401.

PMID: 17227575 [PubMed - indexed for MEDLINE]

Acute renal failure in critically ill HIV-infected patients

Lopes JA, Fernandes J, Jorge S, Neves J, Antunes F, Prata MM.

Crit Care. 2007;11(1):404.

Acute renal failure (ARF) is common among hospitalized HIV-infected patients. To our knowledge, however, data regarding ARF in HIV-infected patients in the intensive care unit are still lacking.

PMID: 17274832 [PubMed - indexed for MEDLINE]

Prognostic utility of the acute kidney injury network (AKIN) criteria for acute kidney injury in myeloablative haematopoietic cell transplantation

Lopes JA, Jorge S, Silva S, de Almeida E, Abreu F, Martins C, Alves do Carmo J, Lacerda JF, Prata MM.

Department of Nephrology and Renal Transplantation, Hospital de Santa Maria, Lisboa, Portugal.

Bone Marrow Transplant. 2007 Nov;40(10):1005-6. Epub 2007 Sep 17.

PMID: 17873914 [PubMed - in process]

Renal Dopaminergic System Activity in Uninephrectomized Rats up to 26 Weeks after Surgery

Moreira-Rodrigues M, Sampaio-Maia B, Moura M, Pestana M.

Unit of Research and Development of Nephrology, Faculty of Medicine, Porto, Portugal.

Am J Nephrol. 2007 Mar 27; 27(3): 232-239 [Epub ahead of print]

Background: Dopamine of renal origin exerts natriuretic and diuretic effects by activating D(1)-like receptors located at various regions in the nephron. Two weeks after uninephrectomy the renal dopaminergic system was suggested to be involved in the adaptative increase of sodium excretion.

Aim: The aim of the present study was to evaluate the renal adaptations in sodium handling and renal dopaminergic system activity in uninephrectomized (Unx) rats up to 26 weeks after the surgery. Results: A time-dependent increase in both systolic and diastolic blood pressure was observed in Unx rats up to 26 weeks after uninephrectomy. This was accompanied by a compensatory increase in aromatic L-amino acid decarboxylase at 2 weeks but not 10 and 26 weeks after uninephrectomy. In contrast to what has been found 2 weeks after uninephrectomy, at 10 and 26 weeks after surgery the natriuretic response to volume expansion was reduced in Unx rats and this was accompanied by insensitivity of natriuresis to dopamine D1 receptor selective antagonist (Sch23390).

Conclusion: A time-dependent decrease in dopamine sensitive natriuresis is observed in Unx rats throughout the 26 weeks after uninephectomy. It is suggested that this may contribute to compromise sodium excretion and increase blood pressure. Copyright (c) 2007 S. Karger AG, Basel.

PMID: 17389783 [PubMed - as supplied by publisher]

Cardiac remodeling and dysfunction in nephrotic syndrome

Moreira-Rodrigues M, Roncon-Albuquerque R, Henriques-Coelho T, Lourenço AP, Sampaio-Maia B, Santos J, Pestana M, Leite-Moreira AF.

Unit of Research and Development of Nephrology, University of Porto, Porto, Portugal.

Kidney Int. 2007 Jun;71(12):1240-8. Epub 2007 Apr 25.

There is an increased incidence of heart disease in patients with chronic nephrotic syndrome (NS), which may be attributable to the malnutrition and activated inflammatory state accompanying the sustained proteinuria. In this study, we evaluated renal function, cardiac morphometry, contractile function, and myocardial gene expression in the established puromycin aminonucleoside nephrosis rat model of NS. Two weeks after aminonucleoside injection, there was massive proteinuria, decreased creatinine clearance, and a negative sodium balance. Skeletal and cardiac muscle atrophy was present and was accompanied by impaired left ventricular (LV) hemodynamic function along with decreased contractile properties of isolated LV muscle strips. The expression of selected cytokines and proteins involved in calcium handling in myocardial tissue was evaluated by real time polymerase chain reaction. This revealed that the expression of interleukin-1beta, tumor necrosis factor-alpha, and phospholamban were elevated, whereas that of cardiac sarco(endo)plasmic reticulum calcium pump protein was decreased. We suggest that protein wasting and systemic inflammatory activation during NS contribute to cardiac remodeling and dysfunction.Kidney International (2007) 71, 1240-1248; doi:10.1038/; published online 25 April 2007.

PMID: 17457379 [PubMed - in process] 

Pulmonary alveolar proteinosis: a rare pulmonary toxicity of sirolimus

Pedroso SL, Martins LS, Sousa S, Reis A, Dias L, Henriques AC, Sarmento AM, Cabrita A.

Nephrology Department, Hospital Geral de Santo Antonio, Porto, Portugal.

Transpl Int. 2007 Mar;20(3):291-6

The aim of our paper is to describe an unusual pulmonary toxicity of sirolimus (SRL) in a kidney transplant recipient. We present a 34-year-old woman with a second renal transplantation, complicated with steroid-resistant acute rejection and chronic allograft dysfunction. Two years after initiating SRL, she presented complaints of progressive dyspnoea, nonproductive cough, chest pain and low-grade fever of 1 month duration. She had chronic allograft nephropathy and slight elevation of lactic dehydrogenase levels. After exclusion of common reasons of this condition, a computed tomography (CT) of the thorax and bronchoscopy was performed, revealing ground-glass opacification with polygonal shapes on CT and an opaque appearance with numerous macrophages on bronchoalveolar lavage. The alveolar macrophages stained positive by Periodic acid-Schiff. Diagnosis of pulmonary alveolar proteinosis (PAP) was made and drug-induced toxicity was suspected. SRL was withdrawn with marked improvement in the patients' clinical and radiological status. PAP resolved within 3 months without further therapy. PAP is a very rare complication of SRL therapy with only a few cases described. Withdrawal of SRL with conversion to another immunosuppressant seems to be an appropriate procedure in this condition.

PMID: 17291222 [PubMed - indexed for MEDLINE]

Postrenal transplantation body composition: different evolution depending on gender

Coroas AS, de Oliveira JG, Sampaio SM, Tavares IC, Pestana M, Almeida MD.

Faculty of Nutrition and Food Sciences, Porto University, Porto, Portugal.

J Ren Nutr. 2007 Mar;17(2):151-6

OBJECTIVE: Patients receiving regular hemodialysis have a lower body mass index, which is mainly caused by the reduction of fat mass and body cell mass (BCM) and the accompanying extracellular water (ECW) expansion. Kidney transplant (Tx) recipients normally regain subnormal renal filtration, and they must cope with significant therapeutic-associated metabolic side effects, which may compromise the recovery of normal nutritional status. We investigated the influence of renal function recovery on body fluid composition during the first period post-Tx, when immunosuppressive drugs doses are at their highest. We also analyzed the differences between males and females and compared them with healthy controls.

METHODS: Eighteen patients (11 males and 7 females) were studied. Biolectric impedance analysis was done pre-Tx and at months 1 and 3 post-Tx. We considered the following parameters: total body water, ECW, intracellular water, Na:K exchangeable ratio, phase angle, and BCM. The healthy group was evaluated three times in a year interval.

RESULTS: We observed differences between genders. Compared with healthy males, resistance, reactance, intracellular water, and BCM were greater and ECW was lower among Tx males at pre-Tx time. At months 1 and 3, we observed only different total body water in males compared with controls. Females did not display any differences in biolectric impedance analysis parameters compared with healthy controls, with the exception of lower reactance at month 1.

CONCLUSIONS: Compared with healthy subjects, uremic males presented body water disturbances pre-Tx. During the first 3 months post-Tx, males showed an incomplete recovery of bioelectric impedance analysis parameters with a greater total body water, probably the result of drug therapy side effects. Pre-Tx, Tx females at pre-Tx time had no differences as compared with healthy females.

Publication Types:
· Comparative Study

PMID: 17321956 [PubMed - indexed for MEDLINE]

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