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OBJECTIVE: This study was to investigate the role of serum Klotho, fetuin-A, and Matrix Gla Protein (MGP) in Coronary Artery Calcification (CAC) in patients with Maintenance Hemodialysis (MHD) and their predictive value for CAC. METHODS: 100 patients receiving MHD were selected. Serum Klotho, fetuin-A, and MGP levels were detected by ELISA. CAC scores were assessed by coronary CT scan. Multifactor analysis was used to evaluate the risk factors affecting CAC. The ability of serum Klotho, fetuin-A, and MGP levels to diagnose CAC was evaluated by receiver operating characteristic curves. RESULTS: Serum Klotho, fetuin-A, and MGP were independent risk factors for CAC. Serum Klotho, fetuin-A, and MGP were valuable in the diagnosis of CAC in MHD patients. CONCLUSION: There is a close relationship between Klotho, fetuin-A, and MGP levels in MHD patients and CAC.
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Biomarcadores , Proteínas de Ligação ao Cálcio , Doença da Artéria Coronariana , Proteínas da Matriz Extracelular , Glucuronidase , Proteínas Klotho , Proteína de Matriz Gla , Diálise Renal , Calcificação Vascular , alfa-2-Glicoproteína-HS , Humanos , Diálise Renal/efeitos adversos , Masculino , Feminino , Proteínas de Ligação ao Cálcio/sangue , Pessoa de Meia-Idade , alfa-2-Glicoproteína-HS/análise , alfa-2-Glicoproteína-HS/metabolismo , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Glucuronidase/sangue , Proteínas da Matriz Extracelular/sangue , Biomarcadores/sangue , Calcificação Vascular/sangue , Calcificação Vascular/diagnóstico por imagem , Idoso , Fatores de Risco , Ensaio de Imunoadsorção Enzimática , Adulto , Curva ROC , Calcinose/sangue , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Valor Preditivo dos TestesRESUMO
INTRODUCTION: The mortality rate in patients on maintenance hemodialysis (HD) is high and is associated with low functional capacity (FC). We analyzed the association of FC and COVID-19 lethality among HD patients. METHODS: A cohort study that included evaluations of FC in patients on HD was underway, and the association between FC and lethality was included as an ad-hoc outcome. RESULTS: One hundred and twelve patients were submitted to a physical, 31 patients contracted symptomatic COVID-19, 20 recovered and 11 died (lethality rate of 35.5%). There was a difference between survivors and non-survivors on six-minutes-walking-test (6MWT) 386.1 ± 112.8 versus 296.9 ± 103.3 meters (p = 0.04), 30 s sit-to-stand test (30CST) score 11.7 ± 3.1 versus 7.7 ± 4.1 (p = 0.006), and timed up and go test (TUG) 9.4 versus 13.6 s (p = 0.009). There was also an association between percentages of predicted 6MWT, 30CST, and TUG with COVID-19 lethality. CONCLUSION: Patients on maintenance HD with poorer physical performance presented the worst prognosis from COVID-19 pandemic.
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COVID-19 , Insuficiência Renal Crônica , Humanos , Estudos de Coortes , Equilíbrio Postural , Pandemias , Estudos de Tempo e Movimento , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Diálise RenalRESUMO
ABSTRACT Objective: This study was to investigate the role of serum Klotho, fetuin-A, and Matrix Gla Protein (MGP) in Coronary Artery Calcification (CAC) in patients with Maintenance Hemodialysis (MHD) and their predictive value for CAC. Methods: 100 patients receiving MHD were selected. Serum Klotho, fetuin-A, and MGP levels were detected by ELISA. CAC scores were assessed by coronary CT scan. Multifactor analysis was used to evaluate the risk factors affecting CAC. The ability of serum Klotho, fetuin-A, and MGP levels to diagnose CAC was evaluated by receiver operating characteristic curves. Results: Serum Klotho, fetuin-A, and MGP were independent risk factors for CAC. Serum Klotho, fetuin-A, and MGP were valuable in the diagnosis of CAC in MHD patients. Conclusion: There is a close relationship between Klotho, fetuin-A, and MGP levels in MHD patients and CAC.
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Objetivo: analizar el efecto de la reflexología podal sobre la fatiga en pacientes en hemodiálisis, combinando los resultados de estudios independientes sobre este tema. Método: estudio de metaanálisis. Se realizó una búsqueda bibliográfica en siete bases de datos. La calidad metodológica de los estudios incluidos se evaluó mediante las herramientas propuestas por el Joanna Briggs Institute. Para el metaanálisis se utilizó el programa Comprehensive Meta-Analysis v3. Resultados: en el metaanálisis se incluyeron ocho estudios. El resultado de la diferencia de medias estandarizada del metaanálisis = 1,580 (Intervalo de Confianza de 95% = 1,075 - 2,085 p = 0,000). El resultado del análisis de subgrupos realizado sobre la base de la diferencia de medias estandarizada en el número de sesiones de reflexología podal = 1,478 (Intervalo de Confianza de 95% = 1,210 - 1,747, p = 0,000). Conclusión: se concluyó que la reflexología podal puede utilizarse para reducir la fatiga en pacientes en hemodiálisis. En los estudios investigados no se proporcionó información sobre los posibles efectos secundarios y negativos de la reflexología podal.
Objective: this meta-analysis study analyzed the effect of foot reflexology on fatigue in hemodialysis patients by combining the results of independent studies on this subject. Method: meta-analysis study. A literature search was conducted in seven databases. The methodological quality of the included studies was assessed using tools proposed by the Joanna Briggs Institute. Comprehensive Meta-Analysis v3 was used for meta-analysis. Results: eight studies were included in the meta-analysis. The result of the meta-analysis standardized mean difference = 1.580 (95% Confidence Interval = 1.075 - 2.085 p = 0.000). The result of the subgroup analysis performed based on the number of foot reflexology sessions standardized mean difference = 1,478 (95% Confidence Interval = 1,210 - 1,747, p = 0.000). Conclusion: it was concluded that foot reflexology can be used to reduce fatigue in hemodialysis patients. No information was provided in the investigated studies about the possible side effects and negative effects of foot reflexology.
Objetivo: analisar o efeito da reflexologia podal sobre a fadiga em pacientes em hemodiálise, combinando os resultados de estudos independentes sobre este assunto. Método: estudo de metanálise. Foi realizada uma pesquisa bibliográfica em sete bases de dados. A qualidade metodológica dos estudos incluídos foi avaliada por meio de ferramentas propostas pelo Joanna Briggs Institute. Para a metanálise, foi utilizado o Comprehensive Meta-Analysis v3. Resultados: oito estudos foram incluídos na metanálise. O resultado da diferença média padronizada da metanálise = 1,580 (Intervalo de Confiança de 95% = 1,075 - 2,085 p = 0,000). O resultado da análise de subgrupo realizada com base na diferença média padronizada do número de sessões de reflexologia podal = 1,478 (Intervalo de Confiança de 95% = 1,210 - 1,747, p = 0,000). Conclusão: a reflexologia podal pode ser utilizada para reduzir a fadiga em pacientes em hemodiálise. Não foram fornecidas informações nos estudos investigados sobre os possíveis efeitos colaterais e negativos da reflexologia podal.
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Humanos , Diálise Renal/efeitos adversos , Manipulações Musculoesqueléticas , Fadiga/etnologia , Fadiga/terapia , Massagem/métodosRESUMO
Rationale & Objective: To address the need for an intradialytic exercise program that is easily delivered in clinical setting, engaging and scalable, we developed a novel COMprehensive EXercise (COMEX) program based on input from patients receiving hemodialysis (HD), dialysis staff members and nephrologists. The objective of this study was to determine the feasibility, safety, and acceptance of COMEX during HD. Study Design: Single-arm prospective pilot feasibility study. Setting & Participants: Seventeen patients receiving in-center HD. Intervention: Three-month participation in the COMEX program, which included video-based dialysis chair exercises (aerobic and resistance) integrated with educational and motivational components. Outcomes: Data on recruitment, adherence, safety and acceptability were collected. Additional assessments were performed to evaluate changes in physical functioning, patient-reported symptoms, and objectively measured sleep and physical activity. We also examined the feasibility of obtaining skeletal muscle biopsies and blood samples to explore molecular mechanisms of muscle atrophy and to assess platelet mitochondrial function and adaptation to exercise during HD. Results: Thirteen of the 17 (76%) participants completed the 3-month intervention. The mean participant age was 63.6 ± 15.1 years. In total, 46% of participants were males, and 55% were White. The mean body mass index was 38.7 ± 11.6 kg/m2. There were no reported adverse effects, and the adherence rate to exercise sessions was high with 88% of the sessions completed. Patient satisfaction was high, as 100% of the patients would recommend the program to other dialysis patients. It was feasible to collect data on physical functioning, patient-reported symptoms, and objective sleep and physical activity and to obtain muscle biopsies and blood samples. Limitations: Small sample size, lack of an onsite exercise professional, and technological issues with telemedicine behavioral motivation. Conclusions: The COMEX intradialytic exercise intervention is safe and acceptable to patients, and outcome measures were feasible to obtain. Future studies should consider including exercise professionals to facilitate progression through a personalized exercise protocol. Funding Source: This work is supported by pilot award from P30 DK079307 (PI, Jhamb). Trial Registration: ClinicalTrials.gov, NCT03055299. Plain-Language Summary: We tested a new COMprehensive EXercise (COMEX) program to deliver exercise during dialysis. This 3-month program included video-based dialysis chair exercises (aerobic and resistance) integrated with educational and motivational components. Our study shows COMEX was feasible, had high satisfaction and adherence, and was safe. It was feasible to collect data on physical functioning, patient-reported symptoms, and objective sleep and physical activity and to obtain muscle biopsies and blood samples. Future studies should consider including exercise professionals to facilitate progression through a personalized exercise protocol.
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ABSTRACT Introduction:Non-compliance with diet and fluid restriction is an important and common health behavior problem in the hemodialysis population and is associated with increased morbidity and mortality. Therefore, investigating the perceptions and experiences of patients undergoing hemodialysis regarding diet and fluid restriction is very important in terms of achieving the management of diet and fluid restriction. Methods: This is a meta-synthesis study. CINAHL, MEDLINE, PubMed, Web of Science, OVID, and Scopus electronic databases were utilized for the literature review. Studies were critically evaluated using the Joanna Briggs critical appraisal tool. Qualitative data were extracted, meta-summarized, and then meta-synthesized. The thematic analysis method was used in the analysis of the data. Results: This review consisted of 23 qualitative studies. The experiences of patients undergoing hemodialysis about diet and fluid restriction were classified into three main themes, namely, "the meaning of diet and fluid restriction for the patient", "perceived barriers", and "patient's own management strategies for diet and fluid restriction". Conclusion: The results of the synthesis in our study indicated that patients undergoing hemodialysis perceived diet and fluid restriction as a complex and challenging process involving a constant struggle. Some personal, social, and systemic barriers perceived by the patients made compliance with diet and fluid restriction even more difficult. More importantly, it was determined that most of the patients were not supported enough in the management of diet and fluid restriction and that they had developed strategies in their own right. In line with these results, we recommend that individual counseling services for diet-fluid restriction of patients undergoing hemodialysis should be increased, the obstacles perceived by the patient should be considered while planning patients' diet-fluid restriction, and that the planning should be realistic and feasible.
RESUMEN Introducción: El incumplimiento de la dieta y la restricción de líquidos es un problema de comportamiento común e importante en la población en hemodiálisis, con impacto en el estado de salud, y que se asocia con aumento de la morbimortalidad. Por lo tanto, investigar las percepciones y experiencias de los pacientes en hemodiálisis con respecto a la dieta y a la restricción de líquidos es muy importante para alcanzar el manejo de los mismos. Métodos: Este es un estudio de metasíntesis. Para la revisión de la literatura se utilizaron las bases de datos electrónicas CINAHL, MEDLINE, PubMed, Web ofScience, OVID y Scopus. Los estudios se evaluaron críticamente utilizando la herramienta de evaluación crítica de Joanna Briggs. Fueron extraídos los datos cualitativos, meta-resumidos y luego meta-sintetizados. En el análisis de los datos se utilizó el método de análisis temático. Resultados: Esta revisión consistió en 23 estudios cualitativos. Las experiencias de los pacientes sometidos a hemodiálisis en relación con la dieta y la restricción de líquidos se clasificaron en tres temas principales, a saber, "el significado de la dieta y la restricción de líquidos para el paciente", "barreras percibidas" y "estrategias de manejo propias del paciente para la dieta y la restricción de líquidos". Conclusión: Los resultados de la síntesis en nuestro estudio indicaron que los pacientes en hemodiálisis percibían la dieta y la restricción de líquidos como un proceso complejo y desafiante que implicaba una lucha constante. Algunas barreras personales, sociales y sistémicas percibidas por los pacientes dificultaron aún más el cumplimiento de las indicaciones. Más importante aún, se determinó que la mayoría de los pacientes no recibieron suficiente apoyo en el manejo de la dieta y la restricción de líquidos y que habían desarrollado estrategias por sí mismos. De acuerdo con estos resultados, recomendamos aumentar los servicios de asesoramiento individual para la restricción dietética-líquida de los pacientes en hemodiálisis, considerar los obstáculos percibidos por ellos al planificar la restricción dietética-líquida y realizar una planificación que sea realista y factible.
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En los pacientes hemodializados son frecuentes las oclusiones de los accesos vasculares por una diálisis insuficiente y en un bajo porcentaje por un estado hipercoagulable desencadenado por anticuerpos dirigidos contra determinados componentes fosfolipídicos. El objetivo del trabajo fue evaluar la prevalencia de estos autoanticuerpos (APL) y del marcador anti anexina V en 79 pacientes en plan de hemodiálisis y en 66 donantes de sangre de la ciudad de Bahía Blanca. Para la detección del anticoagulante lúpico (AL) se realizaron estudios coagulométricos básicos, pruebas de detección, corrección con mezclas con plasma normal y ensayos confirmatorios con lisados plaquetarios. En paralelo, se efectuaron ensayos inmunológicos séricos: anticuerpos anticardiolipinas (ACL) IgM/IgG, anticuerpos anti β2 Glicoproteina I (aβ2GPI) IgM/IgG y anticuerpos anti anexina V IgM/IgG. Para estimar las diferencias se realizó el test de Fisher con una significancia del 5%. No se detectó anticoagulante AL en ninguna de las dos poblaciones. La prevalencia de los ACL IgG fue mayor en los dializados que en los dadores (31,6% vs. 12,1%, p: 0,0056); la correspondiente a las antiβ2 GPI fue similar (2,5% en dializados vs. 7,6% en dadores, p: 0,2458), mientras que la correspondiente a la anti anexina V IgG resultó mayor en dializados (16,4% vs. 4,5%, p: 0,0316). Los resultados obtenidos sugieren la importancia de monitorear la presencia de anticuerpos antifosfolípidos y anti anexina V previo al ingreso de un plan de diálisis para prevenir eventos trombóticos.
In hemodialysis patients, occlusions of vascular access are frequent due to insufficient dialysis and in a low percentage, due to a hypercoagulable state triggered by antibodies directed against certain phospholipid components. The objective of this work was to evaluate the prevalence of these autoantibodies (APL) and the anti-annexin V marker in 79 patients undergoing hemodialysis and in 66 blood donors in the city of Bahía Blanca. For the detection of lupus anticoagulant (LA), basic coagulometric studies, detection tests, correction with mixtures with normal plasma and confirmatory tests with platelet lysates were performed. In parallel, serum immunological assays were performed: IgM/IgG anticardiolipin antibodies (ACL), IgM/IgG anti-β2 glycoprotein I (aβ2GPI) antibodies and IgM/IgG anti-annexin V antibodies. To estimate the differences, a Fisher test with a significance of 5% was performed. Lupus anticoagulant (LA) was not detected in any of the two populations. The prevalence of IgG ACL was higher in the dialysate than in the donors (31.6% vs. 12.1%, p: 0.0056); the corresponding antiβ2GPI was similar (2.5% dialysate vs. 7.6% donors, p: 0.2458), while the corresponding anti-Annexin V IgG was higher in dialysate (16.4% vs. 4.5%, p: 0.0316). The results obtained suggest the importance of monitoring the presence of antiphospholipid and anti-annexin V antibodies prior to entry to a dialysis plan to prevent thrombotic events.
Em pacientes hemodialisados são frequentes as oclusões dos acessos vasculares devido a uma diálise insuficiente e, um percentual baixo, a um estado de hipercoagulabilidade desencadeado por anticorpos dirigidos contra determinados componentes dos fosfolípidos. O objetivo do trabalho foi avaliar a prevalência desses autoanticorpos (APL) e do marcador anti Anexina V em 79 pacientes em plano de hemodiálise e em 66 doadores de sangue da cidade de Bahía Blanca. Para a detecção do anticoagulante lúpico (AL) foram realizados estudos coagulométricos básicos, testes de detecção, correção com misturas com plasma normal e ensaios de confirmação com lisados de plaquetas. Em paralelo se realizaram ensaios imunológicos séricos: anticorpos anticardiolipinas (ACL) a IgM/IgG, anticorpos anti β 2 GlicoproteinaI (aβ 2GPI) IgM/IgG e anticorpos anti Anexina V IgM/IgG. Para estimar as diferenças foi realizado o teste de Fisher com uma significância de 5%. Não foi detectado anticoagulante AL em qualquer uma das duas populações. A prevalência de ACL IgG foi maior nos dialisados que nos doadores (31,6% vs. 12,1%, p: 0,0056); a correspondente às anti β 2GPI foi semelhante (2,5% em dialisados vs. 7,6% em doadores, p: 0,2458), enquanto que o correspondente à anti Anexina V IgG foi maior em dialisados (16,4% vs. 4.5 %, p: 0,0316). Os resultados obtidos sugerem a importância de monitorar a presença de anticorpos antifosfolipídios e anti Anexina V antes de entrar em um plano de diálise para prevenção de eventos trombóticos.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antifosfolipídeos/sangue , Diálise , Prevalência , Biomarcadores/sangue , Fibrinolíticos , HemostasiaRESUMO
Introducción: Los pacientes en tratamiento con hemodiálisis constituyen un grupo de alto riesgo para la infección por virus de hepatitis B y C. Objetivo: Identificar marcadores serológicos y moleculares de infección viral de hepatitis B y C en pacientes hemodializados. Material y métodos: Se realizó un estudio observacional, descriptivo, transversal que incluyó a 103 pacientes con IRC sometidos a régimen de hemodiálisis de las regiones occidental y central de Cuba. Las muestras fueron recibidas entre enero y abril del 2016 para estudio de marcadores serológicos y moleculares de hepatitis B y C a realizar en el Instituto de Gastroenterología. Se estimó la seroprevalencia de anti HCV, HBsAg y Anti S, además se realizaron determinaciones de carga viral mediante prueba de amplificación de ácidos nucleicos para la cuantificación de ADN y ARN para virus de hepatitis B y C respectivamente. Las asociaciones fueron evaluadas mediante el estadígrafo x2. Resultados: EL 7.8 por ciento de los hemodializados fueron portadores inactivos de hepatitis B. El 70.8 por ciento de los pacientes poseían marcadores de infección por virus de hepatitis C con viremia oculta en 18.4 por ciento de los mismos. Conclusiones: Elevada prevalencia de infección y viremia oculta por virus de hepatitis C en los pacientes hemodializados(AU)
Introduction: Patients subjected to hemodialysis treatment are a high risk group for hepatitis B and C infection.Objective: To identify molecular and serologic markers of hepatitis B and C viral infection in hemodialysis patients. Materials and Methods: Was performed an observational, descriptive, cross-sectional study including 103 patients with chronic kidney disease undergoing hemodialysis regime from Cubas Western and Central regions. The samples were received between January and April 2016 to study serologic and molecular markers of hepatitis B and C to be performed at the Gastroenterologys Institute. Seroprevalence of anti HCV, HBsAg and Anti S was estimated, plus viral load determinations using amplification test to measuring nucleic acids DNA and RNA for hepatitis B and C respectively. Associations were evaluated using the x2 statistician.Results: 7.8 percent of hemodialysis patients were inactive carriers of hepatitis B. The 70.8 percent of patients had infection markers of hepatitis C virus; being hepatitis C hidden viremia in 18.4 percent of them. Conclusions: High prevalence of infection and hepatitis C hidden viremia in hemodialysis patients(AU)
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Humanos , Diálise Renal/efeitos adversos , Hepatite C/transmissão , Hepacivirus , Hepatite B/transmissão , Epidemiologia Descritiva , Estudos Transversais , Estudos Observacionais como AssuntoRESUMO
Introducción: Los pacientes en tratamiento con hemodiálisis constituyen un grupo de alto riesgo para la infección por virus de hepatitis B y C. Objetivo: Identificar marcadores serológicos y moleculares de infección viral de hepatitis B y C en pacientes hemodializados. Material y métodos: Se realizó un estudio observacional, descriptivo, transversal que incluyó a 103 pacientes con IRC sometidos a régimen de hemodiálisis de las regiones occidental y central de Cuba. Las muestras fueron recibidas entre enero y abril del 2016 para estudio de marcadores serológicos y moleculares de hepatitis B y C a realizar en el Instituto de Gastroenterología. Se estimó la seroprevalencia de anti HCV, HBsAg y Anti S, además se realizaron determinaciones de carga viral mediante prueba de amplificación de ácidos nucleicos para la cuantificación de ADN y ARN para virus de hepatitis B y C respectivamente. Las asociaciones fueron evaluadas mediante el estadígrafo x2. Resultados: EL 7.8 por ciento de los hemodializados fueron portadores inactivos de hepatitis B. El 70.8 por ciento de los pacientes poseían marcadores de infección por virus de hepatitis C con viremia oculta en 18.4 por ciento de los mismos. Conclusiones: Elevada prevalencia de infección y viremia oculta por virus de hepatitis C en los pacientes hemodializados(AU)
Introduction: Patients subjected to hemodialysis treatment are a high risk group for hepatitis B and C infection. Objective: To identify molecular and serologic markers of hepatitis B and C viral infection in hemodialysis patients. Materials and Methods: Was performed an observational, descriptive, cross-sectional study including 103 patients with chronic kidney disease undergoing hemodialysis regime from Cuba's Western and Central regions. The samples were received between January and April 2016 to study serologic and molecular markers of hepatitis B and C to be performed at the Gastroenterology's Institute. Seroprevalence of anti HCV, HBsAg and Anti S was estimated, plus viral load determinations using amplification test to measuring nucleic acids DNA and RNA for hepatitis B and C respectively. Associations were evaluated using the x2 statistician. Results: 7.8 por ciento of hemodialysis patients were inactive carriers of hepatitis B. The 70.8 por ciento of patients had infection markers of hepatitis C virus; being hepatitis C hidden viremia in 18.4 por ciento of them. Conclusions: High prevalence of infection and hepatitis C hidden viremia in hemodialysis patients(AU)
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Humanos , Diálise Renal/efeitos adversos , Hepatite C/etiologia , Insuficiência Renal Crônica/terapia , Hepatite B/etiologia , Epidemiologia Descritiva , Estudos Transversais , Estudo ObservacionalRESUMO
Intestinal parasites are an important cause of morbidity and mortality. Immunocompromised individuals may develop more severe forms of these infections. Taking into account the immunity impairment in patients suffering from chronic renal failure (CRF), we will determine the prevalence and associated symptoms of intestinal parasites in these patients. Controls without CRF were used for comparison. Stool samples were collected and processed for microscopic identification of parasites using the Formalin-ether concentration method. For Cryptosporidium diagnosis, the ELISA technique was used. One hundred and ten fecal samples from hemodialysis patients were analyzed, as well as 86 from a community group used as control group. A result of 51.6% of intestinal parasites was observed in hemodialysis patients and 61.6% in the control group. Cryptosporidium and Blastocystis were the most common infections in patients with CRF (26.4% and 24.5%, respectively). Blastocystis was the most common infection in the control group (41.9%), however no individual was found positive for Cryptosporidium. Among the CRF patients, 73.6% were symptomatic, 54.3% of these tested positive for at least one parasite, in contrast to 44.8% in asymptomatic patients (p = 0.38). The most common symptoms in this group were flatulence (36.4%), asthenia (30.0%) and weight loss (30.0%). In the control group, 91.9% were symptomatic, 60.8% of these tested positive for at least one parasite, in contrast to 71.4% in asymptomatic patients (p = 0.703). A significant difference between the two groups was observed with regard to symptoms, with bloating, postprandial fullness, and abdominal pain being more frequent in the control group than in the hemodialysis group (all p < 0.05). Comparing symptomatic with asymptomatic, there was no association in either group between symptoms or the prevalence of parasitic infection, nor with the type of parasite or with multiple parasitic infections. Patients with chronic renal failure are frequent targets for renal transplantation, which as well as the inherent immunological impairment of the disease itself, results in immunosuppression by medication. For this reason, carriers of intestinal parasites with pathogenic potential can develop serious clinical complications influencing the success of transplantation. This fact, coupled with the high prevalence of intestinal parasites and the dissociation between symptoms and infection in CRF patients, suggests that the stool test should be incorporated in routine propedeutics. Furthermore, preventive measures for the acquisition of parasites through the fecal-oral contamination route should be introduced.
Doenças parasitárias infectam grande número de indivíduos em todo o mundo. Manifestações clínicas mais severas podem se apresentar em pacientes imunocomprometidos. Considerando o importante comprometimento imunológico observado em pacientes com insuficiência renal crônica (IRC), foi determinada a prevalência e sintomas associados a parasitoses intestinais nesses pacientes em comparação a controles saudáveis. Foram coletadas amostras fecais de cada participante e processadas para identificação microscópica dos parasitas pelo método de concentração por formol-éter. Foi utilizada a técnica de ELISA para identificar coproantígenos de Cryptosporidium. Foram analisadas 110 amostras fecais de pacientes em hemodiálise e 86 de um grupo controle comunitário. Cryptosporidium e Blastocystis foram as infecções mais freqüentes nos pacientes em hemodiálise (26,4% e 24,5%, respectivamente). Blastocystis foi a infecção mais freqüente no grupo controle (41,9%), entretanto nenhum indivíduo positivo para Cryptosporidium foi identificado. Considerando os pacientes com IRC, 73,6% eram sintomáticos, sendo 54,3% positivos para algum parasita, contra 44,8% nos assintomáticos (p = 0,38). Os sintomas mais frequentes neste grupo foram flatulência (36,4%), adinamia (30,0%) e perda de peso (30,0%). No grupo controle, 91,9% eram sintomáticos, sendo 60,8% positivos para algum parasita, contra 71,4% nos assintomáticos (p = 0,703). Em relação aos sintomas, houve diferença significativa entre os dois grupos, sendo que flatulência, plenitude pós-prandial, e dor abdominal foram mais freqüentes no grupo controle que nos pacientes em hemodiálise (todos p < 0,05). Comparando-se sintomáticos com assintomáticos, não houve associação entre a sintomatologia e a prevalência de parasitose, nem com o tipo de parasita, e nem com o poliparasitismo, nos dois grupos. Considerando que pacientes com IRC são frequentes alvos de transplante renal, resultando em imunossupressão por medicamentos, que é somada à deficiência imunológica inerente à própria doença. Os portadores de parasitas intestinais com potencial patogênico podem desenvolver sérias complicações clínicas que influenciam o sucesso do transplante. Este fato, aliado a alta prevalência de parasitas intestinais e dissociação entre os sintomas e infecção nesses pacientes, sugerem a incorporação do exame de fezes na propedêutica de rotina dos mesmos, juntamente com medidas preventivas para a aquisição de parasitas com rota de contaminação fecal-oral.
Assuntos
Adulto , Idoso , Animais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fezes/parasitologia , Enteropatias Parasitárias/epidemiologia , Diálise Renal/estatística & dados numéricos , Brasil/epidemiologia , Estudos de Casos e Controles , Estudos Transversais , Hospedeiro Imunocomprometido , Enteropatias Parasitárias/diagnóstico , Enteropatias Parasitárias/parasitologia , Falência Renal Crônica/parasitologia , Falência Renal Crônica/terapia , PrevalênciaRESUMO
Chronic renal insufficiency disease (CRI) leads to uremia in hemodialysis patients and induces a state of immunodepression that results in higher frequencies of infections and diarrhea. Hemodialysis patients resident in the city of Campo Mourão, Paraná, Brazil were analyzed from April 2006 through September 2007 for Blastocystis sp. and other intestinal parasites and for associated diarrhea. Fecal samples from 86 hemodialysis patients and 146 healthy (reference) persons were examined by standard methods for detecting ova, larvae and cysts, which included preservation in 10 percent formalin and the Kinyoun method. Thirty-three hemodialysis patients (45.1 percent) and 36 reference individuals (25.7 percent) were found to be parasitized. The differences in the percentages of parasitism and polyparasitism between the reference group and the chronic renal patients was significant (p= 0.0318 and 0.0019, respectively). Blastocystis sp. (18 percent-20.1 percent), Endolimax nana (14 percent-16.3 percent), Cryptosporidium sp. (4 percent-4.7 percent) and Entamoeba coli (4 percent-4.7 percent) were the most frequent protozoa found in the hemodialysis patients. Parasitism was not significantly associated with diarrhea (p=0.9947) or with decreased white blood cell counts (p=0.7046) in these individuals. Because parasitic infections may be an important comorbidity factor in hemodialysis patients, we suggest that parasitological stool examinations, especially for Blastocystis sp. and Cryptosporidium sp., be included in routine medical follow-up examinations of these patients.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Blastocystis/epidemiologia , Diarreia/parasitologia , Fezes/parasitologia , Enteropatias Parasitárias/parasitologia , Diálise Renal , Infecções por Blastocystis/diagnóstico , Brasil/epidemiologia , Enteropatias Parasitárias/diagnóstico , Enteropatias Parasitárias/epidemiologia , PrevalênciaRESUMO
El dolor es un aspecto relevante y escasamente estudiado en los pacientes hemodializados. Las estrategias de afrontamiento son vitales para enfrentar el dolor. Se evaluó la prevalencia y severidad del dolor crónico, comorbilidad y estrategias de afrontamiento en pacientes en Hemodiálisis del Hospital Clínico de la Pontificia Universidad Católica de Chile. Para ello, se aplicó la Versión Corta de McGill para dolor(SF-MPQ), con Escala Analógica Visual (VAS) y el Cuestionario para Estrategias de Afrontamiento al Dolor (CAD) a 39 mujeres y 51 hombres, conformándose tres grupos según percentiles de edad. Para el análisis se empleó el SPSS versión 16 para Windows. La prevalencia de dolor crónico fue de 70 por ciento, la causa más frecuente fue el musculoesquelético, con 60,31 por ciento. La severidad no tuvo relación con las causas. Para VAS, el promedio fue 6,92 cms y presentó correlaciones altas con las dimensiones sensorial, afectiva y total. El 39,68 por ciento experimentó dolor moderado y el 53,96 por ciento, severo. La media para Pain Rating Index (PRI) fue 16,68 (Dt. 8,949) y para el Present PAin Intensive (PPI) 0,81 (Dt. 0,998). Las mujeres presentaron puntuaciones superiores para ambas dimensiones, más altas en el grupo entre 45-70 años. El análisis multivariado para dolor y comorbilidad mostró independencia con hipertensión y no significación para diabetes. La estrategia de afrontamiento mas empleada fue autoafirmación (media 16,82 por ciento), seguida de búsqueda de información (14,42 por ciento) y distracción (11,77 por ciento). La catarsis es la menos utilizada. En conjunto, las dimensiones del afrontaiento, hombres y mujeres se comportan diferente, básicamente en religión y catarsis, con valores superiores en mujeres, pero no en cuanto a grupos de edad. Por la elevada prevalencia, severidad y el tipo de afrontamiento, el dolor y la psicoterapia para su enfrentamiento deben incluirse en el manejo de pacientes hemdializados.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Diálise Renal/métodos , Dor/complicações , Dor/epidemiologia , Dor/etiologia , Doença Crônica/epidemiologia , Medição da Dor/métodos , Doenças Musculoesqueléticas/complicações , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/epidemiologia , Transtornos da Cefaleia/complicações , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/epidemiologiaRESUMO
Patients with chronic renal disease have an increased incidence of cancer. It is well known that long periods of hemodialysis treatment are linked to DNA damage due to oxidative stress. This genotoxic effect may cause the loss of chromosome fragments, or even entire chromosomes, which form micronuclei after cell division, and can be detected by the micronucleus test. In the present case-control study, we evaluated the genotoxic effect of hemodialysis treatment in 20 patients undergoing hemodialysis, and 20 subjected to peritoneal dialysis, matched for gender and age with 40 controls. Genetic damage was assessed by examining the frequency of micronuclei in 2000 exfoliated buccal cells per individual. Our results revealed that patients undergoing hemodialysis treatment have a significantly higher frequency of micronucleated cells (MNC; 5.60 ± 5.31) compared to control subjects (1.50 ± 2.01, p < 0.01). Interestingly, the same was not observed for the peritoneal dialysis patients who showed no significant differences in MNC (2.85 ± 2.96) frequency compared to control individuals (3.25 ± 3.85). In addition, we evaluated the possible association between creatine levels, smoking, alcohol intake, age, duration of treatment, and incomes of the individuals (separately analyzed according to their gender) and the frequency of micronuclei. The results reported here indicate that the duration of treatment is the only factor associated with increased MNC frequency among hemodialysis patients (Spearman coefficient of 0.414, p = 0.01). The number of MNC found in individuals with six years or less of treatment was significantly lower (2.91 ± 2.74) compared to patients with seven or more years of treatment (8.89 ± 5.96, p < 0.05). Overall, peritoneal dialysis may be a safer choice of treatment, but further studies need to be performed to investigate the risks and benefits of both treatments.