EMMANUEL DE ALMEIDA BURDMANN
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
LIM/12 - Laboratório de Pesquisa Básica em Doenças Renais, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/12 - Laboratório de Pesquisa Básica em Doenças Renais, Hospital das Clínicas, Faculdade de Medicina - Líder
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conferenceObject Performance of the 2021 CKD-EPI equations without a race coefficient in a multi-racial population of adults with solid tumors: A prospective cross-sectional study.(2022) SILVA, Veronica Torres Costa E; GIL- JR., Luiz A.; INKER, Lesley; CAIRES, Renato; COSTALONGA, Elerson; COURA-FILHO, George; ESTEVEZ-DIZ, Maria Del Pilar; CASTRO, Gilberto; MATHEW, Paul; LEVEY, Andrew; BURDMANN, Emmanuel de Almeida- A prospective cross-sectional study estimated glomerular filtration rate from creatinine and cystatin C in adults with solid tumors(2022) SILVA, Veronica T. Costa e; JR, Luiz A. Gil; INKER, Lesley A.; CAIRES, Renato A.; COSTALONGA, Elerson; COURA-FILHO, George; SAPIENZA, Marcelo T.; JR, Gilberto Castro; ESTEVEZ-DIZ, Maria Dp; ZANETTA, Dirce Maria T.; ANTONANGELO, Leila; MARCAL, Lia; TIGHIOUART, Hocine; MIAO, Shiyuan; MATHEW, Paul; LEVEY, Andrew S.; BURDMANN, Emmanuel A.Current guidelines recommend estimating glomerular filtration rate (eGFR) using creatinine (eGFRcr) with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation as the first test for GFR evaluation, but the Cockcroft-Gault (CG) equation is still commonly used in oncology practice and clinical trials despite increasing evidence of its inaccuracy compared to measured GFR (mGFR). Guidelines recommend eGFR using cystatin C (eGFRcys) or both markers (eGFRcr-cys) as a confirmatory test, but neither was carefully evaluated in cancer patients. Therefore, we compared performance of the CKD-EPI equations and others to the CG equation in adults with a variety of solid tumors. The mGFR was determined by plasma clearance of Cr-51-EDTA. Bias was defined as the median of the differences between mGFR and eGFR while accuracy was defined as the percentage of estimates that differed by more than 30% from the measured GFR (1-P30). We prospectively recruited 1,200 patients between April 2015 and September 2017 with a mean age and mGFR of 58.8 years and 78.4 ml/min/1.73m 2 , respectively. Bias among eGFRcr equations varied from -8.1 to +6.1 ml/min/1.73 m(2). CG was the least accurate, 1-P30 (95% confidence interval) was 24.9 (22.4- 27.3)%; CKD-EPI had 1-P30 of 19.1 (16.8-21.2)% while eGFRcr-cys had the best performance: bias -2.0 (-2.6 to -1.1) ml/min/1.73m(2) and 1-P30 7.8 (6.3-9.4)%. Thus, the CG equation should not be preferred over CKD-EPI equation, and eGFRcr-cys can be used as a confirmatory test in adults with solid tumors. Hence, a major policy implication would be to adopt general practice guideline-recommended methods for GFR evaluation in oncology practice and clinical trials.
- Assessment of Kidney Function in Patients With Cancer(2018) SILVA, Veronica Torres da Costa e; COSTALONGA, Elerson C.; COELHO, Fernanda O.; CAIRES, Renato A.; BURDMANN, Emmanuel A.Cancer patients are living longer. The sequelae of cancer treatment and the role of comorbid conditions present before the diagnosis, such as CKD, have been increasingly recognized. The interface between CKD and cancer is multifaceted. CKD is frequently observed in patients with cancer, and cancer treatment contributes to CKD development and progression. In addition, CKD has been recognized as an important risk factor for cancer development and reduced specific cancer survival. In this context, an accurate evaluation of the glomerular filtration rate (GFR) during oncologic treatment is pivotal and is used to define surgery strategies, program prophylactic management of contrasted examinations, make decisions on cisplatin eligibility, and adjust drug prescriptions, particularly chemotherapy agents. Although the most commonly used equations to estimate GFR based on serum creatinine levels in clinical practice (Cockcroft-Gault, Modification of Diet in Renal Disease Study, and CKD Epidemiology Collaboration equations) have not been validated in patients with cancer in large prospective studies, there is increasingly evidence supporting the use of CKD Epidemiology Collaboration equation to assess the GFR in patients with cancer, including for the use of chemotherapy prescriptions. Many patients with cancer may have changes in nutrition status and clearance measurements such as exogenous filtration markers might be extremely useful when clinical decisions differ depending on the GFR level. Future perspectives include the advent of new serum GFR biomarkers such as cystatin C, beta-trace protein, and beta 2 microglobulin as well as the GFR assessment by measuring total kidney parenchymal volume through image examinations.
- Risk Factors for Vancomycin Nephrotoxicity: Still a Matter of Debate(2014) SILVA, Veronica T. Costa e; MARCAL, Lia J.; BURDMANN, Emmanuel A.
- Drug-Induced Acute Kidney Injury(2019) CAIRES, R. A.; SILVA, V. T. da Costa e; BURDMANN, E. A.; COELHO, F. O.; COSTALONGA, E. C.The epidemiology of acute kidney injury (AKI) has changed remarkably over the last few decades. Currently a majority of affected patients are critically ill older individuals hospitalized in an intensive care unit (ICU) with comorbidities and multiple organ failure. In the ICU, either nephrotoxicity alone or, most commonly, associated with ischemia, has been a relevant related factor in the pathogenesis of AKI in almost half of the cases. Virtually all mechanisms or processes potentially leading to renal injury have been associated with drug nephrotoxicity: acute tubular cell injury, changes in renal hemodynamics, intratubular obstruction, acute interstitial nephritis, hypersensitivity vasculitis, thrombotic microangiopathy, osmotic nephrosis, and rhabdomyolysis. Measurement of serum creatinine always should be performed before administration of potentially nephrotoxic drugs, and even small increments in creatinine are an independent risk factor for increased mortality in hospitalized patients. The use of a nonnephrotoxic drug must be considered for patients at higher risk for renal injury. Patients must be adequately hydrated and sodium repleted before receiving a nephrotoxic drug. The concomitant use of two or more different nephrotoxic drugs must be avoided. Drug dosage should be adjusted in accordance with organ functional status, distribution volume, and drug pharmacokinetics. It always should be checked if a nephrotoxic drug had specific measures to prevent or attenuate its potential for renal damage. Currently, numerous drugs have been related to development of AKI. Of the vast array of drugs with potential for nephrotoxicity, those more frequently prescribed for patients in the ICU are discussed in this chapter: antiinfective agents (aminoglycosides, vancomycin, amphotericin B, polymyxins, highly active antiretroviral therapy [HAART]), contrast agents, NSAIDs, and drugs blocking the renin-angiotensin-aldosterone system (ACEI, ARB, and renin inhibitors). © 2019 Elsevier Inc. All rights reserved.
- Use of regional citrate anticoagulation for continuous venovenous hemodialysis in critically ill cancer patients with acute kidney injury(2018) SILVA, Veronica Torres Costa e; CAIRES, Renato Antunes; BEZERRA, Juliana Silva; COSTALONGA, Elerson C.; OLIVEIRA, Ana Paula Leandro; COELHO, Fernanda Oliveira; FUKUSHIMA, Julia T.; SOARES, Cilene Muniz; OIKAWA, Luciane; HAJJAR, Ludhmila Abrahao; BURDMANN, Emmanuel A.Purpose: This study aimed to evaluate the safety and efficacy of a regional citrate anticoagulation (RCA) protocol for continuous venovenous hemodialysis (CVVHD) in cancer patients with acute kidney injury (AKI) in the intensive care unit (ICU) setting. Material and methods: One hundred twenty two consecutive ICU cancer patients with AKI treated with citrate-based CVVHD were prospectively evaluated in this prospective observational study. Results: A total of 7198 h of CVVHD therapy (250 filters) were performed. Patients were 613 +/- 15.7 years old, 78% had solid cancer and the main AKI cause was sepsis (50%). The in-hospital mortality was 78.7%. Systemic ionized calcium (SCai) was 435 (4.10-4.60) mg/dL, severe hypocalcemia (SCai <3.6 mg/dL) was observed in 4.3% of procedures and post-filter ionized calcium was 1.60 (1.40-1.80) mg/dL. Median filter pa tency was 24.8 (11-43) hours. Factors related to filter clotting were: no tumor evidence (OR 0.44, C10.18-0.99); genitourinary tumor (OR 1.83, CI 1.18-2.81); platelets number (each 10,000/mm(3)) (OR 1.02, CI 1.00-1.04); International Normatized Ratio (INR) (OR 059, CI 0.41-0.85) and citrate dose (each 10 mL/h) (OR 0.88, CI 0.82-0.95). Conclusion: Filler plenty was relatively short and dotting was associated with active cancer disease, genitourinary tumor, lower citrate dose and lower INR. (C) 2018 Published by Elsevier Inc.
conferenceObject Geriatric evaluation in oncologic setting and predictors of the emergency department visit(2018) GIL- JR., L. A.; KANAJI, A. L.; HIGASHI, L. S.; KARNAKIS, T.; SILVA, V. Costa e; BURDMANN, E.; JACOB-FILHO, W.; SUEMOTO, C.- Evaluation of Intermittent Hemodialysis in Critically Ill Cancer Patients with Acute Kidney Injury Using Single-Pass Batch Equipment(2016) SILVA, Veronica Torres da Costa e; COSTALONGA, Elerson C.; OLIVEIRA, Ana Paula Leandro; HUNG, James; CAIRES, Renato Antunes; HAJJAR, Ludhmila Abrahao; FUKUSHIMA, Julia T.; SOARES, Cilene Muniz; BEZERRA, Juliana Silva; OIKAWA, Luciane; YU, Luis; BURDMANN, Emmanuel A.Background Data on renal replacement therapy (RRT) in cancer patients with acute kidney injury (AKI) in the intensive care unit (ICU) is scarce. The aim of this study was to assess the safety and the adequacy of intermittent hemodialysis (IHD) in critically ill cancer patients with AKI. Methods and Findings In this observational prospective cohort study, 149 ICU cancer patients with AKI were treated with 448 single-pass batch IHD procedures and evaluated from June 2010 to June 2012. Primary outcomes were IHD complications (hypotension and clotting) and adequacy. A multiple logistic regression was performed in order to identify factors associated with IHD complications (hypotension and clotting). Patients were 62.2 +/- 14.3 years old, 86.6% had a solid cancer, sepsis was the main AKI cause (51%) and in-hospital mortality was 59.7%. RRT session time was 240 (180-300) min, blood/dialysate flow was 250 (200-300) mL/min and UF was 1000 (0-2000) ml. Hypotension occurred in 25% of the sessions. Independent risk factors (RF) for hypotension were dialysate conductivity (each ms/cm, OR 0.81, CI 0.69-0.95), initial mean arterial pressure (each 10 mmHg, OR 0.49, CI 0.40-0.61) and SOFA score (OR 1.16, CI 1.03-1.30). Clotting and malfunctioning catheters (MC) occurred in 23.8% and 29.2% of the procedures, respectively. Independent RF for clotting were heparin use (OR 0.57, CI 0.33-0.99), MC (OR 3.59, CI 2.24-5.77) and RRT system pressure increase over 25% (OR 2.15, CI 1.61-4.17). Post RRT blood tests were urea 71 (49-104) mg/dL, creatinine 2.71 (2.10-3.8) mg/dL, bicarbonate 24.1 (22.5-25.5) mEq/L and K 3.8 (3.5-4.1) mEq/L. Conclusion IHD for critically ill patients with cancer and AKI offered acceptable hemodynamic stability and provided adequate metabolic control.
- A Prospective Cross-Sectional Study on the Performance of the 2021 CKD-EPI Equations Without Race in a Multiracial Population of Adults With Solid Tumors in Brazil(2023) SILVA, Veronica T. Costa e; JR, Luiz A. Gil; INKER, Lesley A.; CAIRES, Renato A.; COSTALONGA, Elerson; COURA-FILHO, George; SAPIENZA, Marcelo T.; JR, Gilberto Castro; ESTEVEZ-DIZ, Maria D. P.; ZANETTA, Dirce Maria T.; ANTONANGELO, Leila; MARCAL, Lia; TIGHIOUART, Hocine; MIAO, Shiyuan; MATHEW, Paul; LEVEY, Andrew S.; BURDMANN, Emmanuel A.
- Performance of the Cockcroft-Gault, Modification of Diet in Renal Disease, and new Chronic Kidney Disease Epidemiology Collaboration equations without race in older acute medical patients reply(2022) SILVA, Veronica T. Costa e; INKER, Lesley A.; BURDMANN, Emmanuel A.; LEVEY, Andrew S.