HUGO ABENSUR
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
- Letter(2024) KASSAR, Liliana de Meira Lins; SENNA, Joao Paulo; WAYLA, Karoline; ARAUJO, Luiza Karla R. P.; PEREIRA, Benedito J.; ABENSUR, Hugo; ELIAS, Rosilene M.
- Returning to PD after kidney transplant failure is a valuable option(2022) MELO, Ana Gabriela J. T.; BARBOSA, Gessica Sabrine B.; CORTES, Daniela Del P. V. R.; RIBEIRO, Rayra G.; ARAUJO, Luiza K.; PEREIRA, Benedito J.; ABENSUR, Hugo; MOYSES, Rosa M. A.; ELIAS, Rosilene M.Purpose There is a paucity of data on the prognosis for patients returning to peritoneal dialysis (PD) after a failed transplant. PD has an advantage over hemodialysis in preserving residual renal function, which is associated with better outcomes. Methods We have reviewed the electronic charts of patients on PD in a tertiary academic hospital for the last 8 years. We have compared technique survival, peritonitis-free survival, and residual diuresis in two groups: patients with graft failure which returned to PD (PD-KTx, N = 18) and patients starting PD for other causes (PD-not KTx, N = 163). Results The median follow-up was similar between groups [42(16,71) in PD-not KTx vs. 48(22,90) months in PD-KTx, p = 0.293]. Kaplan-Meier survival comparing PD-KTx and PD-not KTx showed no difference in technique survival (p = 0.196), and peritonitis-free survival (log-rank 0.238), which were confirmed in a fully adjusted Cox regression. Diuresis at baseline and at the end of the first year was similar between groups (p = 0.799 and p = 0.354, respectively). Six out of 18 patients from the PD-KTx group had the immunosuppression maintained and none of those had peritonitis. The reduction of diuresis across the first year of PD was significant for all patients, except for those on continued immunosuppressive therapy. Conclusion PD is a worthy dialysis alternative after a failed kidney transplant, providing similar outcomes when compared to patients who started PD for other reasons.
- 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.
- High-Flux versus High-Retention-Onset Membranes: In vivo Small and Middle Molecules Kinetics in Convective Dialysis Modalities(2020) CORDEIRO, Isis S. F.; CORDEIRO, Lilian; WAGNER, Carolina S.; ARAUJO, Luiza Karla R. P.; PEREIRA, Benedito J.; ABENSUR, Hugo; ELIAS, Rosilene M.; SILVA, Bruno C.Background: Patients undergoing maintenance hemodialysis (HD) exhibit increased levels of uremic toxins, which are associated with poor outcomes. Recently, new dialysis membranes have allowed clearance of solutes with higher molecular weight, without significant albumin losses high-retention-onset-HD (HRO-HD). Methods: Prospective crossover trial, in which 16 prevalent patients switched from high-flux HD (HF-HD) to online hemodiafiltration (olHDF) and HRO-HD for 4 weeks. The following variables were evaluated: pre- and post-dialysis serum concentrations of albumin, urea, phosphate (P), beta-2 microglobulin (beta M-2), and total mass (TM) extraction and dialyzer clearance of urea, P, and beta M-2. Results: Comparing HF-HD, olHDF, and HRO-HD, respectively, there were no differences regarding pre-dialysis serum concentrations of albumin (3.94 +/- 0.36, 4.06 +/- 0.22, and 3.93 +/- 0.41 g/dL, p = 0.495), urea (166 +/- 29, 167 +/- 30, and 164 +/- 27 mg/dL, p = 0.971), P (4.9 +/- 2.1, 5.2 +/- 1.6, and 4.9 +/- 2.1 mg/dL, p = 0.879), and beta M-2 (31.3 +/- 7.1, 32.6 +/- 8.6, and 33.7 +/- 5.9 mu g/mL, p = 0.646). beta M-2 clearance was significantly lower in HF-HD in comparison to both olHDF and HRO-HD: 43 (37-53) versus 64 (48-85) mL/min, p = 0.013, and 69 (58-86) mL/min, p = 0.015, respectively. Post-dialysis beta M-2 serum concentration was higher in HF-HD in comparison to olHDF and HRO-HD: 11.6 (9.6-12.4) vs. 5.7 (4.5-7.0) mu g/mL, p = 0.001, and 5.6 (5.3-7.6) mu g/mL, p = 0.001, respectively. TM extraction of urea, P, and beta M-2 were similar across the 3 dialysis modalities. Conclusions: olHDF and HRO-HD were superior to HF-HD regarding beta M-2 clearance, leading to lower post-dialysis beta M-2 levels.
- A randomized clinical trial to evaluate the effects of icodextrin on left ventricular mass index in peritoneal dialysis(2022) CORDEIRO, Lilian; ISHIKAWA, Walther Yoshiharu; ANDREOLI, Maria Claudia C.; CANZIANI, Maria Eugenia F.; ARAUJO, Luiza Karla R. P.; PEREIRA, Benedito J.; ABENSUR, Hugo; MOYSES, Rosa M. A.; ELIAS, Rosilene M.Left ventricular hypertrophy is a risk factor for cardiovascular mortality in patients on peritoneal dialysis (PD). Because icodextrin has a greater ultrafiltration power compared with glucose-based solutions for long dwell, it could improve left ventricular mass by reducing fluid overload. This was a randomized clinical trial that included patients on PD recruited from 2 teaching hospitals, in Sao Paulo-Brazil. Patients were allocated to the control glucose group (GLU) or the intervention icodextrin (ICO) group. Clinical and cardiac magnetic resonance image (MRI) parameters were evaluated at baseline and 6 months after randomization. The primary outcome was the change in left ventricular mass adjusted by surface area (Delta LVMI), measured by cardiac MRI. A total of 22 patients completed the study (GLU, N =12 and ICO, N =10). Baseline characteristics such as age, sex, underlying disease, and time on dialysis were similar in both groups. At baseline, 17 patients (77.3%) presented with left ventricular hypertrophy with no difference between groups (p= 0.748). According to the total body water (TBW)/extracellular water (ECW) ratio, 36.8% and 80% of patients from GLU and ICO groups, respectively, were considered hypervolemic (p= 0.044). During follow-up, Delta LVMI was 3.9 g/m (-10.7, 2.2) in GLU and 5.2 (- 26.8, 16.8) in ICO group (p = 0.651). Delta LVMI correlated with change in brain natriuretic peptide (r= 0.566, p =0.044), which remained significant in a multiple regression analysis. The use of the icodextrin-based solution in prevalent patients on PD compared with a glucose-based solution was not able to improve LMV. A larger randomized trial with a longer follow-up period may be needed to show changes in LVM in this patient population.