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
18 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 18
- 3rd GUIDELINE FOR PERIOPERATIVE CARDIOVASCULAR EVALUATION OF THE BRAZILIAN SOCIETY OF CARDIOLOGY(2017) GUALANDRO, D. M.; YU, P. C.; CARAMELLI, B.; MARQUES, A. C.; CALDERARO, D.; FORNARI, L. S.; PINHO, C.; FEITOSA, A. C. R.; POLANCZYK, C. A.; ROCHITTE, C. E.; JARDIM, C.; VIEIRA, C. L. Z.; NAKAMURA, D. Y. M.; IEZZI, D.; SCHREEN, D.; ADAM, Eduardo L.; D'AMICO, E. A.; LIMA, M. Q.; BURDMANN, E. A.; PACHON, E. I. M.; BRAGA, F. G. M.; MACHADO, F. S.; PAULA, F. J.; CARMO, G. A. L.; FEITOSA-FILHO, G. S.; PRADO, G. F.; LOPES, H. F.; FERNANDES, J. R. C.; LIMA, J. J. G.; SACILOTTO, L.; DRAGER, L. F.; VACANTI, L. J.; ROHDE, L. E. P.; PRADA, L. F. L.; GOWDAK, L. H. W.; VIEIRA, M. L. C.; MONACHINI, M. C.; MACATRAO-COSTA, M. F.; PAIXAO, M. R.; OLIVEIRA JR., M. T.; CURY, P.; VILLACA, P. R.; FARSKY, P. S.; SICILIANO, R. F.; HEINISCH, R. H.; SOUZA, R.; GUALANDRO, S. F. M.; ACCORSI, T. A. D.; MATHIAS JR., W.
- The duration of acute kidney injury after cardiac surgery increases the risk of long-term chronic kidney disease(2017) PALOMBA, Henrique; CASTRO, Isac; YU, Luis; BURDMANN, Emmanuel A.Background Acute kidney injury (Dasta et al., Nephrol Dial Transplant 23(6): 1970-1974, 2008) following cardiac surgery is associated with higher perioperative morbidity and mortality, but its impact on long term development of chronic kidney disease (CKD) is uncertain. Methods A total of 350 patients submitted to elective cardiac surgery were evaluated for AKI, defined as an increase in serum creatinine (SCr) = 0.3 mg/dL over baseline value. Univariate and multivariate analysis were used to study pre, intra and postoperative parameters associated with occurrence CKD after 12 months of follow-up. Results AKI incidence was 41 % (n = 88). The 12-month prevelence of CKD was 9 % (n = 19) in non-AKI patients versus 25 % (n = 54, p < 0.0001) in the AKI group. The factors identified as independent risk factors for long-term CKD development in the multivariate logistic regression model were age > 60 years, hospitalization serum creatinine > 0.8 mg/dL, peripheral artery disease, hemorrhage and AKI duration > 3 days. Conclusion Patients developing AKI after cardiac surgery presented high prevalence of long-term incident CKD. The duration of AKI was a strong independent risk factor for this late CKD development. Recognition of predictive factors for CKD development following cardiac surgery-associated AKI may help to develop strategies to prevent or halt CKD progression in this population.
- 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.
- Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference(2020) OSTERMANN, Marlies; BELLOMO, Rinaldo; BURDMANN, Emmanuel A.; DOI, Kent; ENDRE, Zoltan H.; GOLDSTEIN, Stuart L.; KANE-GILL, Sandra L.; LIU, Kathleen D.; PROWLE, John R.; SHAW, Andrew D.; SRISAWAT, Nattachai; CHEUNG, Michael; JADOUL, Michel; WINKELMAYER, Wolfgang C.; KELLUM, John A.In 2012, Kidney Disease: Improving Global Outcomes (KDIGO) published a guideline on the classification and management of acute kidney injury (AKI). The guideline was derived from evidence available through February 2011. Since then, new evidence has emerged that has important implications for clinical practice in diagnosing and managing AKI. In April of 2019, KDIGO held a controversies conference entitled Acute Kidney Injury with the following goals: determine best practices and areas of uncertainty in treating AKI; review key relevant literature published since the 2012 KDIGO AKI guideline; address ongoing controversial issues; identify new topics or issues to be revisited for the next iteration of the KDIGO AKI guideline; and outline research needed to improve AKI management. Here, we present the findings of this conference and describe key areas that future guidelines may address.
- Peritoneal Dialysis in Acute Kidney Injury: Lessons Learned and Applied(2011) BURDMANN, Emmanuel A.; CHAKRAVARTHI, RajasekaraPeritoneal dialysis (PD) is a simple, safe, gentle, and efficient renal replacement therapy (RRT) method. It is able to correct acute kidney injury (AKI)-induced metabolic, electrolytic, and acid-base disorders and volume overload both in and out the intensive care unit setting. Some PD modalities, such as high-volume PD and continuous flow PD, can provide RRT doses and efficiency comparable to extracorporeal blood purification methods. PD is particularly suitable for children, patients with refractory heart failure or hemodynamically instable, conditions where systemic anticoagulation should be avoided, patients with difficulty for vascular access and hypo- and hyperthermia conditions. In the following manuscript, PD technical aspects and the possible advantages and limitations of this RRT method will be discussed, and the more recent literature on clinical experience with PD for treatment of AKI will be reviewed.
- Association of magnesium abnormalities at intensive care unit admission with kidney outcomes and mortality: a prospective cohort study(2022) RIBEIRO, Heitor S.; BURDMANN, Emmanuel A.; VIEIRA, Edilene A.; FERREIRA, Mateus L.; FERREIRA, Aparecido P.; INDA-FILHO, Antonio J.Background Magnesium abnormalities have been associated with adverse kidney outcomes and mortality in critically ill patients, however, this association remains inconsistent. This study aimed to investigate the association of magnesium abnormalities at intensive care unit (ICU) admission with kidney outcomes (i.e., acute kidney injury (AKI) and kidney function recovery) and mortality risk in a large cohort of critically ill patients. Methods A prospective cohort study was conducted by collecting data from three ICUs in Brazil. The ICU admission serum magnesium level was used to define hypomagnesemia (< 1.60 mg/dL) and hypermagnesemia (> 2.40 mg/dL). The Kidney Disease Improving Global Outcomes AKI Guideline was used to define AKI based on serum creatinine levels. Kidney function recovery was defined as full recovery, partial recovery, and non-recovery at ICU discharge. Mortality was screened up to 28 days during ICU stay. Results A total of 7,042 patients was analyzed, hypomagnesemia was found in 18.4% (n = 1,299) and hypermagnesemia in 4.4% (n = 311). Patients with hypomagnesemia were 25% more likely to develop AKI after adjustment for confounding variables (OR = 1.25; 95% CI 1.08-1.46). No significant association was found for hypermagnesemia and AKI (OR = 1.18; 95% CI 0.89-1.57). Kidney function recovery was similar among groups but hypermagnesemia had lower non-recovery rates. Both hypomagnesemia and hypermagnesemia were associated with 65 and 52% higher mortality risk after adjustments for confounders, respectively (HR = 1.65; 95% CI 1.32-2.06 and 1.52; 95% CI 1.01-2.29). Conclusions Hypomagnesemia, but not hypermagnesemia, at ICU admission was associated with AKI development. On the other hand, both hypomagnesemia and hypermagnesemia were associated with higher mortality risks.
- Acute kidney injury: Global health alert(2013) LI, Philip Kam-Tao; BURDMANN, Emmanuel A.; MEHTA, Ravindra L.Acute kidney injury (AKI) is increasingly prevalent in developing and developed countries and is associated with severe morbidity and mortality. Most etiologies of AKI can be prevented by interventions at the individual, community, regional, and in-hospital levels. Effective measures must include community-wide efforts to increase an awareness of the devastating effects of AKI and provide guidance on preventive strategies, as well as early recognition and management. Efforts should be focused on minimizing causes of AKI, increasing awareness of the importance of serial measurements of serum creatinine in high-risk patients, and documenting urine volume in acutely ill people to achieve early diagnosis; there is as yet no definitive role for alternative biomarkers. Protocols need to be developed to systematically manage prerenal conditions and specific infections. More accurate data about the true incidence and clinical impact of AKI will help to raise the importance of the disease in the community, increase awareness of AKI by governments, the public, general and family physicians, and other health-care professionals to help prevent the disease. Prevention is the key to avoid the heavy burden of mortality and morbidity associated with AKI.
- Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study(2016) MEHTA, Ravindra L.; BURDMANN, Emmanuel A.; CERDA, Jorge; FEEHALLY, John; FINKELSTEIN, Fredric; GARCIA-GARCIA, Guillermo; GODIN, Melanie; JHA, Vivekanand; LAMEIRE, Norbert H.; LEVIN, Nathan W.; LEWINGTON, Andrew; LOMBARDI, Raul; MACEDO, Etienne; ROCCO, Michael; ARONOFF-SPENCER, Eliah; TONELLI, Marcello; ZHANG, Jing; REMUZZI, GiuseppeBackground Epidemiological data for acute kidney injury are scarce, especially in low-income countries (LICs) and lower-middle-income countries (LMICs). We aimed to assess regional differences in acute kidney injury recognition, management, and outcomes. Methods In this multinational cross-sectional study, 322 physicians from 289 centres in 72 countries collected prospective data for paediatric and adult patients with confirmed acute kidney injury in hospital and non-hospital settings who met criteria for acute kidney injury. Signs and symptoms at presentation, comorbidities, risk factors for acute kidney injury, and process-of-care data were obtained at the start of acute kidney injury, and need for dialysis, renal recovery, and mortality recorded at 7 days, and at hospital discharge or death, whichever came earlier. We classified countries into high-income countries (HICs), upper-middle-income countries (UMICs), and combined LICs and LMICs (LLMICs) according to their 2014 gross national income per person. Findings Between Sept 29 and Dec 7, 2014, data were collected from 4018 patients. 2337 (58%) patients developed community-acquired acute kidney injury, with 889 (80%) of 1118 patients in LLMICs, 815 (51%) of 1594 in UMICs, and 663 (51%) of 1241 in HICs (for HICs vs UMICs p = 0.33; p < 0.0001 for all other comparisons). Hypotension (1615 [40%] patients) and dehydration (1536 [38%] patients) were the most common causes of acute kidney injury. Dehydration was the most frequent cause of acute kidney injury in LLMICs (526 [46%] of 1153 vs 518 [32%] of 1605 in UMICs vs 492 [39%] of 1260 in HICs) and hypotension in HICs (564 [45%] of 1260 vs 611 [38%%] of 1605 in UMICs vs 440 [38%] of 1153 LLMICs). Mortality at 7 days was 423 (11%) of 3855, and was higher in LLMICs (129 [12%] of 1076) than in HICs (125 [10%] of 1230) and UMICs (169 [11%] of 1549). Interpretation We identified common aetiological factors across all countries, which might be amenable to a standardised approach for early recognition and treatment of acute kidney injury. Study limitations include a small number of patients from outpatient settings and LICs, potentially under-representing the true burden of acute kidney injury in these areas. Additional strategies are needed to raise awareness of acute kidney injury in community healthcare settings, especially in LICs.
- International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology(2015) MEHTA, Ravindra L.; CERDA, Jorge; BURDMANN, Emmanuel A.; TONELLI, Marcello; GARCIA-GARCIA, Guillermo; JHA, Vivekanand; SUSANTITAPHONG, Paweena; ROCCO, Michael; VANHOLDER, Raymond; SEVER, Mehmet Sukru; CRUZ, Dinna; JABER, Bertrand; LAMEIRE, Norbert H.; LOMBARDI, Raul; LEWINGTON, Andrew; FEEHALLY, John; FINKELSTEIN, Fredric; LEVIN, Nathan; PANNU, Neesh; THOMAS, Bernadette; ARONOFF-SPENCER, Eliah; REMUZZI, Giuseppe
- Acute Kidney Injury: Global Health Alert(2013) LI, Philip Kam Tao; BURDMANN, Emmanuel A.; MEHTA, Ravindra L.Acute kidney injury (AKI) is increasingly prevalent in developing and developed countries and is associated with severe morbidity and mortality. Most etiologies of AKI can be prevented by interventions at the individual, community, regional, and in-hospital levels. Effective measures must include community-wide efforts to increase an awareness of the devastating effects of AKI and provide guidance on preventive strategies, and early recognition and management. Efforts should be focused on minimizing the causes of AKI, increasing awareness of the importance of serial measurements of serum creatinine in high-risk patients, and documenting urine volume in acutely ill people to achieve early diagnosis; there is as yet no definitive role for alternative biomarkers. Protocols need to be developed to systematically manage prerenal conditions and specific infections. More accurate data about the true incidence and clinical impact of AKI will help raise the importance of the disease in the community and increase awareness of AKI by governments, the public, and general and family physicians and other health care professionals to help prevent the disease. Prevention is the key to avoid the heavy burden of mortality and morbidity associated with AKI.