ROSILENE MOTTA ELIAS
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/16 - Laboratório de Fisiopatologia Renal, Hospital das Clínicas, Faculdade de Medicina
LIM/16 - Laboratório de Fisiopatologia Renal, Hospital das Clínicas, Faculdade de Medicina
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bookPart Doença renal crônica(2022) SILVA, Bruno Caldin da; ABENSUR, Hugo; ELIAS, Rosilene Motta- Early Start Peritoneal Dialysis: Technique Survival in Long-Term Follow-Up(2018) SILVA, Bruno C.; ADELINA, Erica; PEREIRA, Benedito J.; CORDEIRO, Lilian; RODRIGUES, Camila E.; DUARTE, Ricardo J.; ABENSUR, Hugo; ELIAS, Rosilene M.Background/Aims: Peritoneal dialysis (PD) has gained interest over the last decade as a viable option for early start dialysis. It is still unknown if shorter break-in periods and less time for proper patient evaluation and training could influence technique survival in comparison to planned-start PD. Methods: A prospective and observational study that compared technique survival in a cohort of patients who started either early or planned PD. Early start PD was defined as break-in period from 3 to 14 days with no previous nephrologist follow-up or patient training. Results: A total of 154 patients were included (40 as early start PD), followed by a median time of 381 days. Comparing early vs. planned-start PD, groups were similar concerning age 56 (40; 70) vs. 48 (32; 63) years, p=0.071, body mass index (BMI) 23.3 +/- 4.2 vs. 23.8 +/- 4.0 kg/m(2), p=0.567 and male gender (60 vs. 48%, p=0.201), respectively. Comparing early vs. planned-start groups, there were no differences regarding PD dropout for peritonitis (7.5 vs. 11.4%, p=0.764), catheter dysfunction (12.5 vs. 17.5%, p=0.619) and patient burnout (0 vs. 4.4%, p=0.328), respectively. Less patients in early start group quit PD for peritoneal membrane failure in comparison to planned-start group (2.5 vs. 16.7%, p=0.026). In multivariate cox-regression analysis, the only factors independently associated with technique failure were BMI > 25 kg/m(2) (p=0.033) and Diabetes Mellitus (p=0.013), whereas no differences regarding early vs. planned-PD start were observed (p=0.184). Conclusion: Despite the adverse scenario for initiating dialysis, early start PD had similar outcomes in comparison to planned-start PD in long-term follow-up. (C) 2018 The Author(s) Published by S. Karger AG, Basel
- 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.
conferenceObject PARATHYROIDECTOMY MAY IMPAIR PHYSIOLOGIC SYSTEMIC VASOCONSTRICTION AFTER HEMODIALYSIS PROCEDURE(2014) FREITAS, Geraldo R.; SILVA, Vitor B.; ABENSUR, Hugo; LUDERS, Claudio; PEREIRA, Benedito J.; CASTRO, Manuel C. M.; OLIVERIRA, Rodrigo B.; MOYSES, Rosa M. A.; ELIAS, Rosilene M.; SILVA, Bruno C.- Ankle-Brachial Index: A Simple Way to Predict Mortality among Patients on Hemodialysis - A Prospective Study(2012) JIMENEZ, Zaida Noemy Cabrera; PEREIRA, Benedito Jorge; ROMAO JR., Joao Egidio; MAKIDA, Sonia Cristina da Silva; ABENSUR, Hugo; MOYSES, Rosa Maria Affonso; ELIAS, Rosilene MottaBackground: Ankle-brachial index (ABI) can access peripheral artery disease and predict mortality in prevalent patients on hemodialysis. However, ABI has not yet been tested in incident patients, who present significant mortality. Typically, ABI is measured by Doppler, which is not always available, limiting its use in most patients. We therefore hypothesized that ABI, evaluated by a simplified method, can predict mortality in an incident hemodialysis population. Methodology/Principal Findings: We studied 119 patients with ESRD who had started hemodialysis three times weekly. ABI was calculated by using two oscillometric blood pressure devices simultaneously. Patients were followed until death or the end of the study. ABI was categorized in two groups normal (0.9-1.3) or abnormal (<0.9 and >1.3). There were 33 deaths during a median follow-up of 12 months (from 3 to 24 months). Age (1 year) (hazard of ratio, 1.026; p = 0.014) and ABI abnormal (hazard ratio, 3.664; p = 0.001) were independently related to mortality in a multiple regression analysis. Conclusions: An easy and inexpensive technique to measure ABI was tested and showed to be significant in predicting mortality. Both low and high ABI were associated to mortality in incident patients on hemodialysis. This technique allows nephrologists to identify high-risk patients and gives the opportunity of early intervention that could alter the natural progression of this population.
- 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.
- Use of icodextrin solution to evaluate peritoneal transport capacity(2022) PEREIRA, Lucas de J.; GUIMARAES, Erica A.; MOHRBACHER, Sarah; PEREIRA, Benedito J.; ELIAS, Rosilene M.; ABENSUR, HugoPeritoneal equilibration test (PET) is the gold standard for evaluating peritoneal transport, and measurement of the drain volume after 4-h dwell time with glucose 4.25% is a simple means of evaluating failure of ultrafiltration. The study objective was to verify if the measurement of the volume drained after 4 h dwell of icodextrin at 7.5% (ICO), has a better correlation with the parameters of PET. Patients in a peritoneal dialysis program (N = 35) underwent three procedures: PET; determination of the drain volume after a 4-h dwell with glucose 4.25%; and determination of the drain volume after a 4-h dwell with ICO. Among patients who were classified as high transporters, the ultrafiltration volume was greater after ICO use. The ICO ultrafiltration volume correlated negatively with the ratio between the 4- and 0-h dialysate glucose concentrations (D4/D0 ratio, r = -0.579; P = 0.002), correlating positively with the dialysate-to-plasma ratio for creatinine (D/PCr ratio, r = 0.474; P = 0.002). For ICO, the area under the receiver operating characteristic curve was 0.867 and 0.792 for the D/PCr and D4/D0 ratios (P < 0.0001 and P = 0.004, respectively), compared with 0.738 and 0.710 for glucose 4.25% (P = 0.020 and P = 0.041, respectively). A cut-off volume of 141 mL discriminated high/high-average transporters from low/low-average transporters. Volume drained after ICO use better predicts peritoneal transport patterns than does that drained after the use of glucose 4.25%.
- 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.
- Dialysis as a Treatment Option for a Patient With Normal Kidney Function and Familial Tumoral Calcinosis Due to a Compound Heterozygous FGF23 Mutation(2018) GOLDENSTEIN, Patricia T.; NEVES, Precil D.; BALBO, Bruno E.; ELIAS, Rosilene M.; PEREIRA, Alexandre C.; ONUCHIC, Luiz F.; JUPPNER, Harald; JORGETTI, Vanda; ABENSUR, Hugo; MOYSES, Rosa MariaPrimary tumoral calcinosis is a rare autosomal recessive disorder characterized by ectopic calcified tumoral masses. Mutations in 3 genes (GALNT3, FGF23, and KL) have been linked to this human disorder. We describe a case of a 28-year-old man with a history of painful firm masses over his right and left gluteal region, right clavicle region, knees, and left elbow. Biochemical analysis disclosed hyperphosphatemia (phosphate, 9.0 mg/dL) and normocalcemia (calcium, 4.8 mg/dL), with normal kidney function and fractional excretion of phosphate of 3%. Parathyroid hormone was suppressed (15 pg/mL), associated with a low-normal 25-hydroxyvitamin D (26 ng/mL) concentration but high 1,25-dihydroxyvitamin D concentration (92 pg/mL). Serum intact FGF-23 (fibroblast growth factor 23) was undetectable. Genetic analysis revealed tumoral calcinosis due to a compound heterozygous mutation in FGF23, c. 201G>C (p. Gln67His) and c. 466C>T (p. Gln156*). Due to lack of other treatment options and because the patient was facing severe vascular complications, we initiated a daily hemodialysis program even in the setting of normal kidney function. This unusual therapeutic option successful controlled hyperphosphatemia and reduced metastatic tumoral lesions. This is a report of a new mutation in FGF23 in which dialysis was an effective treatment option for tumoral calcinosis with normal kidney function.