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
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- Prevention of Intradialytic Hypotension in Patients with Acute Kidney Injury Submitted to Sustained Low-Efficiency Dialysis(2012) LIMA, Emerson Q.; SILVA, Ricardo G.; DONADI, Endrigo L. S.; FERNANDES, Alex B.; ZANON, Jeferson R.; PINTO, Klinger R. D.; BURDMANN, Emmanuel A.Objectives: This study evaluated the effects of a protocol aiming to reduce hypotension in acute kidney injury (AKI) patients submitted to sustained low-efficiency dialysis (SLED). Methods: Patients were randomly assigned to two SLED prescriptions-control group, dialysate temperature was 37.0 degrees C with a fixed sodium concentration [138 mEq/L] and ultrafiltration (UF) rate; and profiling group, dialysate temperature was 35.5 degrees C with a variable sodium concentration [150-138 mEq/L] and UF rate. Results: Sixty-two SLED sessions were evaluated (34 in profiling and 28 in control). Patients (n = 31) were similar in terms of gender, age, and Sequential Organ Failure Assessment (SOFA) score. Dialysis time, dialysis dose, and post-dialysis serum sodium were similar in both groups. The profiling group had significantly less hypotension episodes (23% vs. 57% in control, p = 0.009) and achieved higher UF volume (2.23 +/- 1.25 L vs. 1.59 +/- 1.03 L in control, p = 0.04) when compared with control group. Conclusions: SLED protocol with modulation of dialysate temperature, sodium, and UF profiling showed similar efficacy but less intradialytic hypotension when compared with a standard SLED prescription.
- A Decade After the KDOQI CKD Guidelines: A Perspective From Brazil(2012) ABENSUR, Hugo; YU, Luis; BURDMANN, Emmanuel A.
- Annexin A1 protein attenuates cyclosporine-induced renal hemodynamics changes and macrophage infiltration in rats(2012) ARAUJO, Leandro Pires; TRUZZI, Renata Ramos; MENDES, Gloria Elisa Florido; LUZ, Marcus Alexandre Mendes; BURDMANN, Emmanuel A.; OLIANI, Sonia MariaCyclosporine (CsA) remains an important immunosuppressant for transplantation and for treatment of autoimmune diseases. The most troublesome side effect of CsA is renal injury. Acute CsA-induced nephrotoxicity is characterized by reduced renal blood flow (RBF) and glomerular filtration rate (GFR) due to afferent arteriole vasoconstriction. Annexin A1 (ANXA1) is a potent anti-inflammatory protein with protective effect in renal ischemia/reperfusion injury. Here we study the effects of ANXA1 treatment in an experimental model of acute CsA nephrotoxicity. Salt-depleted rats were randomized to treatment with VH (vehicles 1 mL/kg body weight/day), ANXA1 (Ac2-26 peptide 1 mg/kg body weight/day intraperitoneally), CsA (20 mg/kg body weight/day subcutaneously) and CsA + ANXA1 (combination) for seven days. We compared renal function and hemodynamics, renal histopathology, renal tissue macrophage infiltration and renal ANXA1 expression between the four groups. CsA significantly impaired GFR and RBF, caused tubular dilation and macrophage infiltration and increased ANXA1 renal tissue expression. Treatment with ANXA1 attenuated CSA-induced hemodynamic changes, tubular injury and macrophage infiltration. ANXA1 treatment attenuated renal hemodynamic injury and inflammation in an acute CsA nephrotoxicity model.
- The EXTRIP (EXtracorporeal TReatments In Poisoning) workgroup: Guideline methodology(2012) LAVERGNE, Valery; NOLIN, Thomas D.; HOFFMAN, Robert S.; ROBERTS, Darren; GOSSELIN, Sophie; GOLDFARB, David S.; KIELSTEIN, Jan T.; MACTIER, Robert; MACLAREN, Robert; MOWRY, James B.; BUNCHMAN, Timothy E.; JUURLINK, David; MEGARBANE, Bruno; ANSEEUW, Kurt; WINCHESTER, James F.; DARGAN, Paul I.; LIU, Kathleen D.; HOEGBERG, Lotte C.; LI, Yi; CALELLO, Diane P.; BURDMANN, Emmanuel A.; YATES, Christopher; LALIBERTE, Martin; DECKER, Brian Scott; MELLO-DA-SILVA, Carlos Augusto; LAVONAS, Eric; GHANNOUM, MarcExtracorporeal treatments (ECTRs), such as hemodialysis and hemoperfusion, are used in poisoning despite a lack of controlled human trials demonstrating efficacy. To provide uniform recommendations, the EXTRIP group was formed as an international collaboration among recognized experts from nephrology, clinical toxicology, critical care, or pharmacology and supported by over 30 professional societies. For every poison, the clinical benefit of ECTR is weighed against associated complications, alternative therapies, and costs. Rigorous methodology, using the AGREE instrument, was developed and ratified. Methods rely on evidence appraisal and, in the absence of robust studies, on a thorough and transparent process of consensus statements. Twenty-four poisons were chosen according to their frequency, available evidence, and relevance. A systematic literature search was performed in order to retrieve all original publications regardless of language. Data were extracted on a standardized instrument. Quality of the evidence was assessed by GRADE as: High = A, Moderate = B, Low = C, Very Low = D. For every poison, dialyzability was assessed and clinical effect of ECTR summarized. All pertinent documents were submitted to the workgroup with a list of statements for vote (general statement, indications, timing, ECTR choice). A modified Delphi method with two voting rounds was used, between which deliberation was required. Each statement was voted on a Likert scale (1-9) to establish the strength of recommendation. This approach will permit the production of the first important practice guidelines on this topic.
- Extracorporeal Treatment for Thallium Poisoning: Recommendations from the EXTRIP Workgroup(2012) GHANNOUM, Marc; NOLIN, Thomas D.; GOLDFARB, David S.; ROBERTS, Darren M.; MACTIER, Robert; MOWRY, James B.; DARGAN, Paul I.; MACLAREN, Robert; HOEGBERG, Lotte C.; LALIBERTE, Martin; CALELLO, Diane; KIELSTEIN, Jan T.; ANSEEUW, Kurt; WINCHESTER, James F.; BURDMANN, Emmanuel A.; BUNCHMAN, Timothy E.; LI, Yi; JUURLINK, David N.; LAVERGNE, Valery; MEGARBANE, Bruno; GOSSELIN, Sophie; LIU, Kathleen D.; HOFFMAN, Robert S.Background The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning. To test and validate its methods, the workgroup reviewed data for thallium (Tl). Methods After an extensive search, the co-chairs reviewed the articles, extracted the data, summarized findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and RAND/UCLA Appropriateness Method to quantify disagreement. Blinded votes were compiled, returned, and discussed during a conference call. A second vote determined the final recommendations. Results Forty-five articles met inclusion criteria. Only case reports and case series were identified, yielding a very low quality of evidence for all recommendations. Data on 74 patients, including 11 who died, were abstracted. The workgroup concluded that Tl is slightly dialyzable and made the following recommendations: ECTR is recommended in severe Tl poisoning (1D). ECTR is indicated if Tl exposure is highly suspected on the basis of history or clinical features (2D) or if the serum Tl concentration is > 1.0 mg/L (2D). ECTR should be initiated as soon as possible, ideally within 24-48 hours of Tl exposure (1D), and be continued until the serum Tl concentration is < 0.1 mg/L for a minimal duration of 72 hours (2D). Conclusion Despite Tl's low dialyzability and the limited evidence, the workgroup strongly recommended extracorporeal removal in the case of severe Tl poisoning. Clin J Ant Soc Nephrol 7: 1682-1690, 2012. doi: 10.2215/CJN.01940212
conferenceObject PREDICTIVE FACTORS FOR AKI DEVELOPMENT IN OLDER PATIENTS(2012) PALOMBA, Henrique; CASTRO, Isac; SOUSA, Sirlei Regina; JESUS, Andressa Nascimento; ROMANO, Thiago; BURDMANN, Emannuel; YU, Luis