BENEDITO JORGE PEREIRA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
4 resultados
Resultados de Busca
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- When Is the Best Moment to Assess the Ankle Brachial Index: Pre- or Post-Hemodialysis?(2012) JIMENEZ, Zaida Noemy Cabrera; CASTRO, Lsac de; PEREIRA, Benedito Jorge; OLIVEIRA, Rodrigo Bueno de; ROMAO JR., Joao Egidio; ELIAS, Rosilene MottaBackground: Cardiovascular disease is an important cause of death in patients on dialysis. Peripheral arterial disease (PAD) is a prognostic factor for cardiovascular disease. The ankle brachial index (ABI) is a noninvasive method used for the diagnosis of PAD. The difference between ABI pre- and post-dialysis had not yet been formally tested, and it was the main objective of this study. Methods:The ABI was assessed using an automated oscillometric device in incident patients on hemodialysis. All blood pressure readings were taken in triplicate pre- and post-dialysis in three consecutive dialysis sessions (times 1, 2, and 3). Results: One hundred and twenty-three patients (85 men) aged 53 +/- 19 years were enrolled. We found no difference in ABI pre- and post-dialysis on the right or left side, and there was no difference in times 1, 2, and 3. In patients with a history of PAD, the ABI pre- versus post-dialysis were of borderline significance on the right side (p = 0.088). Conclusion: ABI measured pre- and post-dialysis presented low variability. The ABI in patients with a history of PAD should be evaluated with caution. The applicability of the current method in predicting mortality among patients on hemodialysis therefore needs further investigation.
- Pneumatic Compression, But Not Exercise, Can Avoid Intradialytic Hypotension: A Randomized Trial(2017) ALVARES, Valeria R. C.; RAMOS, Camila D.; PEREIRA, Benedito J.; PINTO, Ana Lucia; MOYSES, Rosa M. A.; GUALANO, Bruno; ELIAS, Rosilene M.Background: Conventional hemodialysis (HD) is associated with dialysis-induced hypotension (DIH) and ineffective phosphate removal. As the main source of extracellular fluid removed during HD are the legs, we sought to reduce DIH and increase phosphate removal by using cycling and pneumatic compression, which would potentially provide higher venous return, preserving central blood flow and also offering more phosphate to the dialyzer. Methods: We evaluated 21 patients in a randomized crossover fashion in which each patient underwent 3 different HD: control; cycling exercise during the first 60 min; and pneumatic compression during the first 60 min. Data obtained included bioelectrical impedance, hourly blood pressure measurement, biochemical parameters, and direct quantification of phosphate through the dialysate. DIH was defined as a drop in mean arterial pressure (MAP) >= 20 mm Hg. Results: There was no difference in the ultrafiltration rate (p = 0.628), delta weight (p = 0.415), delta of total, intra and extracellular body water among the control, cycling, and pneumatic compression (p = 0.209, p = 0.348, and p = 0.467 respectively). Delta MAP was less changed by pneumatic compression when compared to control, cycling, and pneumatic compression respectively (-4.7 [-17.2, 8.2], -4.7 [-20.5, -0.2], and -2.3 [-8.1, 9.0] mm Hg; p = 0.021). DIH occurred in 43, 38, and 24% of patients in control, cycling, and pneumatic compression respectively (p = 0.014). Phosphate removal did not increase in any intervention (p = 0.486). Higher phosphate removal was dependent on ultrafiltration, pre dialysis serum phosphate, and higher parathyroid hormone. Conclusion: Pneumatic compression during the first hour of dialysis was associated with less DIH, albeit there was no effect on fluid parameters. Neither exercise nor pneumatic compression increased phosphate removal. (C) 2017 S. Karger AG, Basel
- Hypokalemia and hyperkalemia in patients on peritoneal dialysis: incidence and associated factors(2020) GONCALVES, Fernanda A.; JESUS, Jessica Santos de; CORDEIRO, Lilian; PIRACIABA, Maria Clara T.; ARAUJO, Luiza K. R. P. de; MARTINS, Carolina Steller Wagner; DALBONI, Maria Aparecida; PEREIRA, Benedito J.; SILVA, Bruno C.; MOYSES, Rosa Maria A.; ABENSUR, Hugo; ELIAS, Rosilene M.Background Hypokalemia is a well-described electrolyte disturbance in patients on peritoneal dialysis (PD). Hyperkalemia, however, is still overlooked, although it also represents a risk factor for mortality. Angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers (ACE/ARB), diuretics, and proton pump inhibitor (PPI) can interfere with potassium levels in these patients. Methods This is a retrospective study that evaluated monthly serum potassium in a 5-year period. Serum potassium disturbances were evaluated as time-average and number of hypo- and hyperkalemia episodes per patient. Prescribed medication such as ACE/ARB, diuretics, and omeprazole were recorded. Results We evaluated 2025 potassium measurements obtained from 146 patients on PD. Serum potassium ranged from 2.5 to 8.3 mEq/L with an average of 4.72 +/- 0.74 mEq/L. Hypokalemia was found in 59 measurements (2.9%) obtained from 35 patients (23.9%) whereas hyperkalemia was demonstrated in 269 (13.3%) measurements obtained from 74 patients (50.7%). Hypokalemia was associated with low albumin (p = 0.022), and omeprazole use (p = 0.024). Black race was a protector factor (p = 0.031). Omeprazole-associated hypokalemia was seen only in non-anuric patients and remained an independent risk factor even after adjustments. Patients who had hyperkalemia were more likely to be anuric (p = 0.001) and in use of furosemide (p = 0.0001). Conclusion Hyperkalemia and hypokalemia are very frequent in patients on PD and should be closely monitored. Interventional studies should address the impact of discontinuing omeprazole in the levels of potassium.
- Hemodynamic Behavior During Hemo-dialysis: Effects of Dialysate Concentrations of Bicarbonate and Potassium(2014) SILVA, Bruno C.; FREITAS, Geraldo R. R.; SILVA, Vitor B.; ABENSUR, Hugo; LUDERS, Claudio; PEREIRA, Benedito J.; OLIVEIRA, Rodrigo B. de; CASTRO, Manuel C. M.; MOYSES, Rosa M. A.; ELIAS, Rosilene M.Background/Aims: Ultrafiltration that occurs during hemodialysis (HD) promotes profound alterations in a relatively short period of time. The dialysate content of bicarbonate (DBic) and potassium (DK) may have impact over intradialytic hemodynamics, which goes beyond ultrafiltration, and its impact was evaluated in a prospective cohort. Methods: 30 patients under HD were submitted to hemodynamic assessment (HA) at the beginning and at the end of HD sessions, through a non-invasive method. Serum minus dialysate potassium concentration was expressed as K-Gap. Cardiac index (CI) and peripheral arterial resistance (PAR) variation (post-HD minus pre-HD) were expressed as Delta CI and Delta PAR. Dialysate content of sodium and calcium were expressed as DNa and DCa, respectively. Results: Mean DNa, DK and DBic were, respectively, 136.4 +/- 1.1, 2.1 +/- 0.6 and 38.2 +/- 2.1 mEq/L. In 15 patients, DCa was > 1.5 mmol/L and in the other 15 patients <= 1.5 mmol/L. The K-Gap ranged from 1.4 to 5.1 mEq/l (median 3.0 mEq/L). There was a reduction in post-HD CI and systolic blood pressure (Delta CI = -0.72l/min/m(2) and -11.3 +/- 15.1 mmHg, respectively, p < 0.001 for both). Conversely, Delta PAR increased (Delta PAR = 272dyn.s/cm(5), p < 0.001). Lower post-HD CI was was associated to higher DBic (p = 0.0013) and lower K-Gap (p = 0.026). In multivariate analysis, Delta CI was dependent on DBic and K-Gap, whereas Delta PAR was dependent on dialysate calcium during HD. Conclusion: We confirmed that Na and Ca dialysate content exerts and important role on hemodynamic during HD. In addition, our findings pointed out that higher dialysate concentrations of bicarbonate and potassium promote lower cardiac performance at the end of hemodialysis session.