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  1 / 14230 MEDLINE  
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[PMID]:29462136
[Au] Autor:Lecamwasam A; Sexton-Oates A; Carmody J; Ekinci EI; Dwyer KM; Saffery R
[Ad] Endereço:Clinical and Disease Epigenetics Group, Murdoch Childrens Research Institute, Victoria, Australia.
[Ti] Título:DNA methylation profiling of genomic DNA isolated from urine in diabetic chronic kidney disease: A pilot study.
[So] Source:PLoS One;13(2):e0190280, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:AIM: To characterise the genomic DNA (gDNA) yield from urine and quality of derived methylation data generated from the widely used Illuminia Infinium MethylationEPIC (HM850K) platform and compare this with buffy coat samples. BACKGROUND: DNA methylation is the most widely studied epigenetic mark and variations in DNA methylation profile have been implicated in diabetes which affects approximately 415 million people worldwide. METHODS: QIAamp Viral RNA Mini Kit and QIAamp DNA micro kit were used to extract DNA from frozen and fresh urine samples as well as increasing volumes of fresh urine. Matched buffy coats to the frozen urine were also obtained and DNA was extracted from the buffy coats using the QIAamp DNA Mini Kit. Genomic DNA of greater concentration than 20µg/ml were used for methylation analysis using the HM850K array. RESULTS: Irrespective of extraction technique or the use of fresh versus frozen urine samples, limited genomic DNA was obtained using a starting sample volume of 5ml (0-0.86µg/mL). In order to optimize the yield, we increased starting volumes to 50ml fresh urine, which yielded only 0-9.66µg/mL A different kit, QIAamp DNA Micro Kit, was trialled in six fresh urine samples and ten frozen urine samples with inadequate DNA yields from 0-17.7µg/mL and 0-1.6µg/mL respectively. Sufficient genomic DNA was obtained from only 4 of the initial 41 frozen urine samples (10%) for DNA methylation profiling. In comparison, all four buffy coat samples (100%) provided sufficient genomic DNA. CONCLUSION: High quality data can be obtained provided a sufficient yield of genomic DNA is isolated. Despite optimizing various extraction methodologies, the modest amount of genomic DNA derived from urine, may limit the generalisability of this approach for the identification of DNA methylation biomarkers of chronic diabetic kidney disease.
[Mh] Termos MeSH primário: Metilação de DNA
DNA/urina
Complicações do Diabetes/urina
Insuficiência Renal Crônica/urina
[Mh] Termos MeSH secundário: Seres Humanos
Projetos Piloto
Insuficiência Renal Crônica/complicações
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
9007-49-2 (DNA)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180221
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190280


  2 / 14230 MEDLINE  
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[PMID]:27776979
[Au] Autor:Salman IM; Hildreth CM; Phillips JK
[Ad] Endereço:Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia. Electronic address: ibraheem_muhammed@yahoo.com.
[Ti] Título:Chronic kidney disease impairs renal nerve and haemodynamic reflex responses to vagal afferent input through a central mechanism.
[So] Source:Auton Neurosci;204:65-73, 2017 05.
[Is] ISSN:1872-7484
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:We investigated age- and sex-related changes in reflex renal sympathetic nerve activity (RSNA) and haemodynamic responses to vagal afferent stimulation in a rodent model of chronic kidney disease (CKD). Using anaesthetised juvenile (7-8weeks) and adult (12-13weeks) Lewis Polycystic Kidney (LPK) and Lewis control rats of either sex (n=63 total), reflex changes in RSNA, heart rate (HR) and mean arterial pressure (MAP) to vagal afferent stimulation (5-s train, 4.0V, 2.0-ms pulses, 1-16Hz) were measured. In all groups, stimulation of the vagal afferents below 16Hz produced frequency-dependent reductions in RSNA, HR and MAP, while a 16Hz stimulus produced an initial sympathoinhibition followed by sympathoexcitation. In juvenile LPK versus age-matched Lewis, sympathoinhibition was reduced when responses were expressed as % baseline (P<0.05), but not as microvolts, while bradycardic responses were greater. Reflex depressor responses were greater (P=0.015) only in juvenile female LPK. In adult LPK, reflex sympathoinhibition (%) was blunted (P<0.05), and an age-related decline apparent (when expressed as microvolts). Reflex reductions in HR and MAP were only diminished (P<0.05) in adult female LPK versus age-matched Lewis. Peak reflex sympathoexcitation at 16Hz did not differ between groups; however, area under the curve values were greater in the LPK versus Lewis (overall, 9±1 versus 19±3µVs, P<0.05) irrespective of age, suggestive of enhanced sympathoexcitatory drive in the LPK. Our data demonstrates a progressive deficit in the central processing of vagal afferent input and a differential sex influence on reflex regulation of autonomic function and blood pressure homeostasis in CKD.
[Mh] Termos MeSH primário: Hemodinâmica/fisiologia
Rim/inervação
Rim/fisiopatologia
Reflexo/fisiologia
Insuficiência Renal Crônica/fisiopatologia
Nervo Vago/fisiopatologia
[Mh] Termos MeSH secundário: Vias Aferentes/fisiopatologia
Animais
Área Sob a Curva
Pressão Sanguínea/fisiologia
Estudos de Coortes
Modelos Animais de Doenças
Feminino
Frequência Cardíaca/fisiologia
Masculino
Ratos Endogâmicos Lew
Especificidade da Espécie
Sistema Nervoso Simpático/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


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[PMID]:29252031
[Au] Autor:Schlabe S; Rockstroh JK
[Ad] Endereço:a Department of Internal Medicine I , University Hospital Bonn , Bonn , Germany.
[Ti] Título:Advances in the treatment of HIV/HCV coinfection in adults.
[So] Source:Expert Opin Pharmacother;19(1):49-64, 2018 Jan.
[Is] ISSN:1744-7666
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Direct-acting antivirals (DAA) have revolutionized the modern treatment of chronic hepatitis C (HCV). These highly efficacious, well-tolerated, all-oral HCV regimens allow cure of HCV in over 95% of HCV-monoinfected as well as HIV/HCV-coinfected patients with short treatment durations of 8-12 weeks. Areas covered: This review will address recent developments of DAA-therapy in HIV/HCV-coinfected patients in clinical trials and real life cohorts and evaluate remaining challenges, particularly resistance, drug-drug interactions, acute HCV infection and liver transplantation focusing on HIV/HCV-coinfected patients. Expert opinion: Indeed, all available data have shown that HIV/HCV-coinfection has no impact on HCV-treatment outcome. Management, indication of therapy and follow-up of HCV-infection are now the same for both patient populations. HIV/HCV-coinfected patients however, require careful evaluation of potential drug-drug-interactions between HCV drugs and HIV antiretroviral therapy, medication for substance abuse and other comedications. The few remaining gaps in DAA-therapy in particular treatment of cirrhotic treatment-experienced genotype 3 infections, decompensated cirrhosis, chronic kidney disease and patients with prior DAA treatment failure have mostly been overcome by the development of new HCV agents recently licensed. Clearly, the biggest challenge globally remains the access to treatment and the inclusion of all patient populations affected in particular people who inject drugs (PWID).
[Mh] Termos MeSH primário: Antivirais/uso terapêutico
Infecções por HIV/tratamento farmacológico
Hepatite C Crônica/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Coinfecção
Interações Medicamentosas
Genótipo
Seres Humanos
Cirrose Hepática/tratamento farmacológico
Transplante de Fígado
Insuficiência Renal Crônica/tratamento farmacológico
Falha de Tratamento
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antiviral Agents)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE
[do] DOI:10.1080/14656566.2017.1419185


  4 / 14230 MEDLINE  
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[PMID]:29480866
[Au] Autor:Ubukata M; Hara M; Nishizawa Y; Fujii T; Nitta K; Ohta A
[Ad] Endereço:Division of Nephrology, Department of Medicine, Tokyo Metropolitan Komagome Hospital, Bunkyo-Ku.
[Ti] Título:Prevalence and mortality of chronic kidney disease in lymphoma patients: A large retrospective cohort study.
[So] Source:Medicine (Baltimore);97(2):e9615, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In patients with lymphoma, an important issue that has been recognized is renal involvement, including glomerulonephritis, acute kidney injury, and lymphoma infiltrating the kidney. However, the prevalence and mortality of chronic kidney disease (CKD) have not been fully understood in lymphoma patients. This study aimed to evaluate the prevalence of CKD and its impact on mortality in those patients.This was a retrospective cohort study of 429 consecutive lymphoma patients who were admitted or regularly visited our hospital from January 2013 to October 2016. CKD was defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m and/or proteinuria ≥ 1+ that was sustained for at least 3 months. The prevalence of CKD at enrollment was evaluated according to the modified CKD classification by Kidney Disease: Improving Global Outcomes (KDIGO) (eGFR and proteinuria category). Dipstick proteinuria was classified into 3 grades: A1 for - and ±; A2 for 1+ or 2+; and A3 for ≥3+. The eGFR (mL/min/1.73 m) was classified into 6 stages: G1 for ≥90, G2 for 60 to 89, G3a for 45 to 59, G3b for 30 to 44, G4 for 15 to 29, and G5 for <15. The cumulative mortality rate was estimated using the Kaplan-Meier method, with stratification into 2 groups based on the presence or absence of CKD. Furthermore, a multivariate Cox proportional hazards regression model was used to calculate the hazard ratio (HR) and its 95% confidence interval (CI) for all-cause mortality, after adjustments for age, sex, pathologic type, clinical stage of lymphoma, presence or absence of diabetes mellitus, hypertension, and cardiovascular disease.The mean follow-up period was 3.06 ±â€Š0.96 years, and the prevalence of CKD at study enrollment was 34.5%. The cumulative mortality rate was 20.7%, and was significantly higher in the CKD group than in the group without CKD (36.4% vs 18.0%, P = .02). Multivariate analysis found mortality to be significantly associated with CKD (HR 1.58; 95% CI, 1.01-2.46), and this association was the most robust with very high-risk CKD (HR 6.94; 95% CI, 2.50-17.33).The prevalence of CKD in lymphoma patients was high. CKD should be considered an independent risk factor for mortality among patients with lymphoma.
[Mh] Termos MeSH primário: Linfoma/complicações
Linfoma/mortalidade
Insuficiência Renal Crônica/complicações
Insuficiência Renal Crônica/mortalidade
[Mh] Termos MeSH secundário: Comorbidade
Feminino
Seguimentos
Seres Humanos
Estimativa de Kaplan-Meier
Linfoma/fisiopatologia
Masculino
Meia-Idade
Análise Multivariada
Prevalência
Modelos de Riscos Proporcionais
Insuficiência Renal Crônica/fisiopatologia
Estudos Retrospectivos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180227
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009615


  5 / 14230 MEDLINE  
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[PMID]:29386192
[Au] Autor:Tu H; Wen CP; Tsai SP; Chow WH; Wen C; Ye Y; Zhao H; Tsai MK; Huang M; Dinney CP; Tsao CK; Wu X
[Ad] Endereço:Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
[Ti] Título:Cancer risk associated with chronic diseases and disease markers: prospective cohort study.
[So] Source:BMJ;360:k134, 2018 01 31.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To assess the independent and joint associations of major chronic diseases and disease markers with cancer risk and to explore the benefit of physical activity in reducing the cancer risk associated with chronic diseases and disease markers. DESIGN: Prospective cohort study. SETTING: Standard medical screening program in Taiwan. PARTICIPANTS: 405 878 participants, for whom cardiovascular disease markers (blood pressure, total cholesterol, and heart rate), diabetes, chronic kidney disease markers (proteinuria and glomerular filtration rate), pulmonary disease, and gouty arthritis marker (uric acid) were measured or diagnosed according to standard methods, were followed for an average of 8.7 years. MAIN OUTCOME MEASURES: Cancer incidence and cancer mortality. RESULTS: A statistically significantly increased risk of incident cancer was observed for the eight diseases and markers individually (except blood pressure and pulmonary disease), with adjusted hazard ratios ranging from 1.07 to 1.44. All eight diseases and markers were statistically significantly associated with risk of cancer death, with adjusted hazard ratios ranging from 1.12 to 1.70. Chronic disease risk scores summarizing the eight diseases and markers were positively associated with cancer risk in a dose-response manner, with the highest scores associated with a 2.21-fold (95% confidence interval 1.77-fold to 2.75-fold) and 4.00-fold (2.84-fold to 5.63-fold) higher cancer incidence and cancer mortality, respectively. High chronic disease risk scores were associated with substantial years of life lost, and the highest scores were associated with 13.3 years of life lost in men and 15.9 years of life lost in women. The population attributable fractions of cancer incidence or cancer mortality from the eight chronic diseases and markers together were comparable to those from five major lifestyle factors combined (cancer incidence: 20.5% 24.8%; cancer mortality: 38.9% 39.7%). Among physically active (versus inactive) participants, the increased cancer risk associated with chronic diseases and markers was attenuated by 48% for cancer incidence and 27% for cancer mortality. CONCLUSIONS: Chronic disease is an overlooked risk factor for cancer, as important as five major lifestyle factors combined. In this study, chronic diseases contributed to more than one fifth of the risk for incident cancer and more than one third of the risk for cancer death. Physical activity is associated with a nearly 40% reduction in the cancer risk associated with chronic diseases.
[Mh] Termos MeSH primário: Biomarcadores/sangue
Doença Crônica/epidemiologia
Neoplasias/complicações
[Mh] Termos MeSH secundário: Adulto
Artrite Gotosa/epidemiologia
Artrite Gotosa/metabolismo
Doenças Cardiovasculares/complicações
Doenças Cardiovasculares/epidemiologia
Doença Crônica/mortalidade
Complicações do Diabetes
Diabetes Mellitus/epidemiologia
Detecção Precoce de Câncer/métodos
Exercício/fisiologia
Feminino
Seres Humanos
Incidência
Estilo de Vida
Pneumopatias/epidemiologia
Pneumopatias/metabolismo
Pneumopatias/fisiopatologia
Masculino
Meia-Idade
Neoplasias/epidemiologia
Neoplasias/mortalidade
Avaliação de Resultados (Cuidados de Saúde)
Estudos Prospectivos
Insuficiência Renal Crônica/complicações
Insuficiência Renal Crônica/epidemiologia
Fatores de Risco
Taiwan/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Biomarkers)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180202
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k134


  6 / 14230 MEDLINE  
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[PMID]:29295826
[Au] Autor:Krumholz HM
[Ad] Endereço:Yale Schools of Medicine and Public Health, New Haven, CT, USA.
[Ti] Título:Blood pressure guidelines as starting point in clinical decisions.
[So] Source:BMJ;360:j5862, 2018 01 02.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Pressão Sanguínea/fisiologia
Doenças Cardiovasculares/complicações
Tomada de Decisão Clínica
Hipertensão/classificação
Guias de Prática Clínica como Assunto
Insuficiência Renal Crônica/complicações
[Mh] Termos MeSH secundário: Doenças Cardiovasculares/tratamento farmacológico
Complicações do Diabetes/tratamento farmacológico
Seres Humanos
Hipertensão/diagnóstico
Hipertensão/tratamento farmacológico
Insuficiência Renal Crônica/tratamento farmacológico
Fatores de Risco
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180104
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5862


  7 / 14230 MEDLINE  
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[PMID]:29258743
[Au] Autor:Kawada T
[Ad] Endereço:Department of Hygiene and Public Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo 113-8602, Japan. Electronic address: kawada@nms.ac.jp.
[Ti] Título:Association between metabolic syndrome and chronic kidney disease.
[So] Source:Clin Chim Acta;478:44, 2018 03.
[Is] ISSN:1873-3492
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Mh] Termos MeSH primário: Síndrome Metabólica
Insuficiência Renal Crônica
[Mh] Termos MeSH secundário: Doença Crônica
Seres Humanos
Nefropatias
Fatores de Risco
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171221
[St] Status:MEDLINE


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[PMID]:28464520
[Au] Autor:Blute ML; Kucherov V; Rushmer TJ; Damodaran S; Shi F; Abel EJ; Jarrard DF; Richards KA; Messing EM; Downs TM
[Ad] Endereço:Department of Urology, University of Wisconsin Carbone Comprehensive Cancer Center, Madison, WI, USA.
[Ti] Título:Reduced estimated glomerular filtration rate (eGFR <60 mL/min/1.73 m ) at first transurethral resection of bladder tumour is a significant predictor of subsequent recurrence and progression.
[So] Source:BJU Int;120(3):387-393, 2017 09.
[Is] ISSN:1464-410X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate if moderate chronic kidney disease [CKD; estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m ] is associated with high rates of non-muscle-invasive bladder cancer (NMIBC) recurrence or progression. PATIENTS AND METHODS: A multi-institutional database identified patients with serum creatinine values prior to first transurethral resection of bladder tumour (TURBT). The CKD-epidemiology collaboration formula calculated patient eGFR. Cox proportional hazards models evaluated associations with recurrence-free (RFS) and progression-free survival (PFS). RESULTS: In all, 727 patients were identified with a median (interquartile range [IQR]) patient age of 69.8 (60.1-77.6) years. Data for eGFR were available for 632 patients. During a median (IQR) follow-up of 3.7 (1.5-6.5) years, 400 (55%) patients had recurrence and 145 (19.9%) patients had progression of tumour stage or grade. Moderate or severe CKD was identified in 183 patients according to eGFR. Multivariable analysis identified an eGFR of <60 mL/min/1.73 m (hazard ratio [HR] 1.5, 95% confidence interval [CI]: 1.2-1.9; P = 0.002) as a predictor of tumour recurrence. The 5-year RFS rate was 46% for patients with an eGFR of ≥60 mL/min/1.73 m and 27% for patients with an eGFR of <60 mL/min/1.73 m (P < 0.001). Multivariable analysis showed that an eGFR of <60 mL/min/1.73 m (HR 3.7, 95% CI: 1.75-7.94; P = 0.001) was associated with progression to muscle-invasive disease. The 5-year PFS rate was 83% for patients with an eGFR of ≥60 mL/min/1.73 m and 71% for patients with an eGFR of <60 mL/min/1.73 m (P = 0.01). CONCLUSION: Moderate CKD at first TURBT is associated with reduced RFS and PFS. Patients with reduced renal function should be considered for increased surveillance.
[Mh] Termos MeSH primário: Taxa de Filtração Glomerular/fisiologia
Recidiva Local de Neoplasia/epidemiologia
Insuficiência Renal Crônica/epidemiologia
Neoplasias da Bexiga Urinária/epidemiologia
Neoplasias da Bexiga Urinária/patologia
[Mh] Termos MeSH secundário: Idoso
Análise de Variância
Progressão da Doença
Feminino
Seres Humanos
Masculino
Meia-Idade
Recidiva Local de Neoplasia/patologia
Insuficiência Renal Crônica/complicações
Estudos Retrospectivos
Neoplasias da Bexiga Urinária/complicações
Neoplasias da Bexiga Urinária/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1111/bju.13904


  9 / 14230 MEDLINE  
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[PMID]:28463635
[Au] Autor:O'Hare AM; Song MK; Kurella Tamura M; Moss AH
[Ad] Endereço:1 Department of Medicine, University of Washington and Veterans Affairs Puget Sound Healthcare System , Seattle, Washington.
[Ti] Título:Research Priorities for Palliative Care for Older Adults with Advanced Chronic Kidney Disease.
[So] Source:J Palliat Med;20(5):453-460, 2017 May.
[Is] ISSN:1557-7740
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Older adults with advanced chronic kidney disease (CKD) often have multiple comorbid conditions, a high symptom burden, and limited life expectancy. There is mounting concern that the intensive patterns of care that many of these patients receive at the end of life are discordant with their values and preferences. The nephrology community has recognized that there are significant unmet palliative care needs in this population. In this article, we identify three broad areas of knowledge deficit where more evidence is needed to support the "best care possible" for this population: (1) what matters most to older adults with advanced CKD and their caregivers near the end of life; (2) how the nephrology community can best support older adults with advanced CKD to navigate complex treatment decisions throughout their illness; and (3) how the healthcare system should be reconfigured to promote patient- and family-centered care for older adults with advanced CKD. Research priorities include identifying opportunities for improving the end-of-life experience of older adults with CKD and their caregivers; developing and testing communication interventions before and during dialysis to ensure that treatment decisions reflect patients' preferences; and assessing the effectiveness of palliative care in improving quality of life for patients and caregivers, satisfaction with care, and aligning treatment decisions with patient goals and preferences.
[Mh] Termos MeSH primário: Diálise/métodos
Enfermagem Geriátrica/métodos
Cuidados Paliativos/métodos
Preferência do Paciente
Assistência Centrada no Paciente/métodos
Insuficiência Renal Crônica/enfermagem
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Tomada de Decisões
Feminino
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1089/jpm.2016.0571


  10 / 14230 MEDLINE  
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[PMID]:28450414
[Au] Autor:Bohlouli B; Jackson TJ; Tonelli M; Hemmelgarn B; Klarenbach S
[Ad] Endereço:Department of Medicine, University of Alberta, Edmonton, Alberta.
[Ti] Título:Adverse Outcomes Associated with Preventable Complications in Hospitalized Patients with CKD.
[So] Source:Clin J Am Soc Nephrol;12(5):799-806, 2017 May 08.
[Is] ISSN:1555-905X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Patients with CKD are at risk of hospital-acquired complications (HACs). We sought to determine the association of preventable HACs with mortality, length of stay (LOS), and readmission. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: All adults hospitalized from April of 2003 to March of 2008 in Alberta were characterized by kidney function and occurrence of preventable HACs. CKD was defined by eGFR<60 ml/min per 1.73 m and/or albumin-to-creatinine ratio >3-30 mg/mmol for >3 months in the time frame from 365 to 90 days before admission. Regression models examined the association of HACs with outcomes. RESULTS: Of 536,549 hospitalizations, 8.5% ( =45,733) had CKD and 9.8% of patients with CKD had one or more potentially preventable HAC. In patients with potentially preventable HACs, proportions of death within index hospitalization and from discharge to 90 days were 17.7% and 6.8%, respectively. In patients with CKD, comparing with those hospitalizations without potentially preventable HACs, the adjusted odds ratio (OR) of mortality during index hospitalization and from hospital discharge to 90 days in patients with one or more preventable HAC was 4.67 (95% confidence interval [95% CI], 4.17 to 5.22) and 1.08 (95% CI, 0.94 to 1.25), respectively. Median incremental LOS in patients with one or more preventable HAC was 9.86 days (95% CI, 9.25 to 10.48). The OR for readmission with preventable HAC was 1.24 (95% CI, 1.15 to 1.34). In a cohort with and without CKD, the adjusted ORs of mortality during index hospitalization in patients with CKD and no preventable HACs, patients without CKD and with preventable HACs, and patients with CKD and preventable HACs were 2.22 (95% CI, 1.69 to 2.94), 5.26 (95% CI, 4.98 to 5.55), and 9.56 (95% CI, 7.23 to 12.56), respectively (referenced to patients without CKD or preventable HACs). CONCLUSIONS: Preventable HACs are associated with higher mortality, incremental LOS, and greater risk of readmission, especially in people with CKD. Targeted strategies to reduce complications should be a high priority.
[Mh] Termos MeSH primário: Doença Iatrogênica
Admissão do Paciente
Insuficiência Renal Crônica/complicações
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Alberta
Albuminúria/etiologia
Biomarcadores/urina
Creatinina/urina
Feminino
Taxa de Filtração Glomerular
Mortalidade Hospitalar
Seres Humanos
Doença Iatrogênica/prevenção & controle
Rim/fisiopatologia
Tempo de Internação
Masculino
Meia-Idade
Readmissão do Paciente
Serviços Preventivos de Saúde
Insuficiência Renal Crônica/diagnóstico
Insuficiência Renal Crônica/mortalidade
Insuficiência Renal Crônica/terapia
Medição de Risco
Fatores de Risco
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); AYI8EX34EU (Creatinine)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.2215/CJN.09410916



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