DECIO MION JUNIOR
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- Chronic kidney disease and risk factors responsible for sudden cardiac death: a whiff of hope?(2016) KIUCHI, Marcio G.; MION JR., DecioSeveral studies have shown a strong independent association between chronic kidney disease (CKD) and cardiovascular events, including death, heart failure, and myocardial infarction. Recent clinical trials extend this range of adverse cardiovascular events, also including ventricular arrhythmias and sudden cardiac death. Furthermore, other studies suggest structural remodeling of the heart and electrophysiological alterations in this population. These processes may explain the increased risk of arrhythmia in kidney disease and help to identify patients who are at increased risk of sudden cardiac death. Sympathetic hyperactivity is well known to increase cardiovascular risk in CKD patients and is a hallmark of essential hypertensive state that occurs early in the clinical course of the disease. In CKD, the sympathetic hyperactivity seems to be expressed at the earliest clinical stage of the disease, showing a direct relationship with the severity of the condition of renal failure, being more pronounced in the terminal stage of CKD. The sympathetic efferent and afferent neural activity in kidney failure is a key mediator for the maintenance and progression of the disease. The aim of this review was to show that the feedback loop of this cycle, due to adrenergic hyperactivity, also aggravates many of the risk factors responsible for causing sudden cardiac death and may be a potential target modifiable by percutaneous renal sympathetic denervation. If it is feasible and effective in end-stage renal disease, little is known.
conferenceObject Influence of Time of Day on Post-Exercise Hypotension Might Be Different in Hypertensives Receiving Different Anti-hypertensive Drugs: An Exploratory Study(2016) BRITO, Leandro; PECANHA, Tiago; FECCHIO, Rafael; SOUSA, Patricia; REZENDE, Rafael; NAVARRO, Manilla; SILVA, Giovanio; ABREU, Andrea; MION-JUNIOR, Decio; FORJAZ, ClaudiabookPart Crises hipertendivas(2016) JúNIOR, Décio Mion; ORTEGA, Katia Coelho; NOBRE, Fernando- Post-Exercise Hypotension Is Mediated by a Decrease in Sympathetic Nerve Activity in Stages 2-3 CKD(2016) APRILE, Daniele C. B.; ONEDA, Bruna; GUSMAO, Josiane L.; COSTA, Luiz A. R.; FORJAZ, Claudia L. M.; MION JR., Decio; TINUCCI, TaisBackground: This study aimed at evaluating the after effects of a single bout of aerobic exercise on muscle sympathetic nerve activity (MSNA), peripheral vascular resistance and blood pressure (BP) in stages 2-3 chronic kidney disease (CKD) patients. We hypothesized that CKD patients present a greater decline in these variables after the exercise than healthy individuals. Methods: Nine patients with stages 2-3 CKD (50 +/- 8 years) and 12 healthy volunteers (50 +/- 5 years) underwent 2 sessions, conducted in a random order: exercise (45 min, cycle ergometer, 50% of peak oxygen uptake) and rest (seated, 45 min). Sixty minutes after either intervention, MSNA (by microneurography), BP (by oscillometry), and forearm vascular resistance (FVR) were measured. A 2-way analysis of variance with group (between) and session (within) as main factors was employed, accepting p < 0.05 as significant. Results: Diastolic BP and MSNA were higher in the CKD than the control group in both sessions. Responses after exercise were similar in both groups. Systolic BP, diastolic BP, MSNA and FVR were significantly lower after the exercise than after the rest session in both the CKD and the control groups (162 +/- 15 vs. 152 +/- 23 and 155 +/- 11 vs. 145 +/- 16 mm Hg, 91 +/- 11 vs. 85 +/- 14 and 77 +/- 5 vs. 71 +/- 10 mm Hg, 38 +/- 4 vs. 31 +/- 4 and 34 +/- 2 vs. 27 +/- 4 burst/min, 59 +/- 29 vs. 41 +/- 29 and 45 +/- 20 vs. 31 +/- 8 U, respectively, all p < 0.05). Conclusion: These results showed that aerobic exercise may produce hemodynamic and neural responses that can be beneficial to these patients in spite of CKD. (C) 2016 S. Karger AG, Basel
bookPart Adesão ao Tratamento(2016) GUSMãO, Josiane Lima de; PEREIRA, Renan Sallazar Ferreira; JúNIOR, Décio MionbookPart Hipertensão Arterial(2016) GIORGI, Dante Marcelo Artigas; JúNIOR, Décio Mion; BORTOLOTTO, Luiz Aparecido- Proof of concept study: Improvement of echocardiographic parameters after renal sympathetic denervation in CKD refractory hypertensive patients(2016) KIUCHI, Marcio Galindo; MION JR., Decio; GRACIANO, Miguel Luis; CARREIRA, Maria Angela Magalhaes de Queiroz; KIUCHI, Tetsuaki; CHEN, Shaojie; LUGON, Jocemir RonaldoAim: Evaluation of the effectiveness of the renal sympathetic denervation (RSD) in reducing lesions of target organs such as the heart and kidneys, in resistant hypertensive CKD patients. Methods and results: Forty-five patients were included and treated with an ablation catheter with open irrigated tip. RSD was performed by a single operator following the standard technique. Patients included with CKD were on stages 2 (n = 22), 3 (n 16), and 4 (n = 7). Data were obtained at baseline and monthly until the 6th month of follow-up. Twenty-six out of the 45 patients had LVH and nineteen did not present LVH. The LV mass index decreased from 123.70 +/- 38.44 glm2 at baseline to 106.50 +/- 31.88 g/m(2) at the 6th month after RSD, P < 0.0001. The end-diastolic left ventricular internal dimension (LVIDd) reduced from 53.02 +/- 6.59 mm at baseline to 51.11 +/- 5.85 mm 6 months post procedure, P < 0.0001. The left ventricular end-diastolic posterior wall thickness (PWTd) showed a reduction from 10.58 +/- 139 mm at baseline to 9.82 +/- 1.15 mm at the 6th month of follow-up, P < 0.0001. The end-diastolic interventricular septum thickness (IVSTd) also decreased from 10.58 +/- 1.39 mm at baseline to 9.82 +/- 1.15 mm 6 months post procedure, P < 0.0001. The left ventricular ejection fraction (LVET) improved from 58.90 +/- 10.48% at baseline W 62.24 +/- 10.50 at the 6th month of follow-up, P < 0.0001. When the A between baseline and the 6th month post RSD in LVH patients and non LVH patients were compared to the same parameters no significant difference was found. Conclusions: The RSD seemed to be feasible, effective, and safe resulting in an improvement of echocardiographic parameters in LVH and non LVH CKD refractory hypertensive patients.
bookPart Hipertensão Arterial: papel dos rins e doença renovascular(2016) SILVA, Giovanio Vieira da; MION JR., Décioarticle 7TH BRAZILIAN GUIDELINE OF ARTERIAL HYPERTENSION(2016) MALACHIAS, Marcus Vinicius Bolivar; SOUZA, Weimar Kunz Sebba Barroso de; PLAVNIK, Frida Liane; RODRIGUES, Cibele Isaac Saad; BRANDAO, Andrea Araujo; NEVES, Mario Fritsch Toros; BORTOLOTTO, Luiz Aparecido; FRANCO, Roberto Jorge da Silva; FIGUEIREDO, Carlos Eduardo Poli de; JARDIM, Paulo Cesar Brandao Veiga; AMODEO, Celso; BARBOSA, Eduardo Costa Duarte; KOCH, Vera; GOMES, Marco Antonio Mota; PAULA, Rogerio Baumgratz de; PAVOA, Rui Manuel dos Santos; COLOMBO, Fernanda Consolim; FERREIRA FILHO, Sebastiao; MIRANDA, Roberto Dischinger; MACHADO, Carlos Alberto; NOBRE, Fernando; NOGUEIRA, Armando da Rocha; MION JUNIOR, Decio; KAISER, Sergio; FORJAZ, Claudia Lucia de Moraes; ALMEIDA, Fernando Antonio; MARTIM, Jose Fernando Vilela; SASS, Nelson; DRAGER, Luciano Ferreira; MUXFELDT, Elizabeth; BODANESE, Luiz Carlos; FEITOSA, Audes Diogenes; MALTA, Deborah; FUCHS, Sandra; MAGALHAES, Maria Eliane; OIGMAN, Wille; MOREIRA FILHO, Osni; PIERIN, Angela Maria Geraldo; FEITOSA, Gilson Soares; BORTOLOTTO, Maria Rita de Figueiredo Lemos; MAGALHAES, Lucelia Batista Neves Cunha; SILVA, Ana Cristina Simoes e; RIBEIRO, Jose Marcio; BORELLI, Flavio Antonio de Oliveira; GUS, Miguel; PASSARELLI JUNIOR, Oswaldo; TOLEDO, Juan Yugar; SALLES, Gil Fernando; MARTINS, Luis Cuadrado; JARDIM, Thiago de Souza Veiga; GUIMARAES, Isabel Cristina Britto; ANTONELLO, Ivan Carlos; LIMA JUNIOR, Emilton; MATSUDO, Victor; SILVA, Giovanio Vieira da; COSTA, Lilian Soares da; ALESSI, Alexandre; SCALA, Luiz Cezar Nazario; COELHO, Eduardo Barbosa; SOUZA, Dilma de; LOPES, Heno Ferreira; GOWDAK, Marcia Maria Godoy; CORDEIRO JUNIOR, Antonio Carlos; TORLONI, Maria Regina; KLEIN, Marcia Regina Simas Torres; NOGUEIRA, Paulo Koch; LOTAIF, Leda Aparecida Daud; ROSITO, Guido Bernardo Aranha; MORENO JUNIOR, Heitor- Ambulatory Blood Pressure Monitoring: Five Decades of More Light and Less Shadows(2016) NOBRE, Fernando; MION JUNIOR, DecioCasual blood pressure measurements have been extensively questioned over the last five decades. A significant percentage of patients have different blood pressure readings when examined in the office or outside it. For this reason, a change in the paradigm of the best manner to assess blood pressure has been observed. The method that has been most widely used is the Ambulatory Blood Pressure Monitoring - ABPM. The method allows recording blood pressure measures in 24 hours and evaluating various parameters such as mean BP, pressure loads, areas under the curve, variations between daytime and nighttime, pulse pressure variability etc. Blood pressure measurements obtained by ABPM are better correlated, for example, with the risks of hypertension. The main indications for ABPM are: suspected white coat hypertension and masked hypertension, evaluation of the efficacy of the antihypertensive therapy in 24 hours, and evaluation of symptoms. There is increasing evidence that the use of ABPM has contributed to the assessment of blood pressure behaviors, establishment of diagnoses, prognosis and the efficacy of antihypertensive therapy. There is no doubt that the study of 24-hour blood pressure behavior and its variations by ABPM has brought more light and less darkness to the field, which justifies the title of this review.