ETIENNE MARIA VASCONCELLOS DE MACEDO
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- Phenotype standardization for drug-induced kidney disease(2015) MEHTA, Ravindra L.; AWDISHU, Linda; DAVENPORT, Andrew; MURRAY, Patrick T.; MACEDO, Etienne; CERDA, Jorge; CHAKARAVARTHI, Raj; HOLDEN, Arthur L.; GOLDSTEIN, Stuart L.Drug-induced kidney disease is a frequent cause of renal dysfunction; however, there are no standards to identify and characterize the spectrum of these disorders. We convened a panel of international, adult and pediatric, nephrologists and pharmacists to develop standardized phenotypes for drug-induced kidney disease as part of the phenotype standardization project initiated by the International Serious Adverse Events Consortium. We propose four phenotypes of drug-induced kidney disease based on clinical presentation: acute kidney injury, glomerular, tubular, and nephrolithiasis, along with the primary and secondary clinical criteria to support the phenotype definition, and a time course based on the KDIGO/AKIN definitions of acute kidney injury, acute kidney disease, and chronic kidney disease. Establishing causality in drug-induced kidney disease is challenging and requires knowledge of the biological plausibility for the specific drug, mechanism of injury, time course, and assessment of competing risk factors. These phenotypes provide a consistent framework for clinicians, investigators, industry, and regulatory agencies to evaluate drug nephrotoxicity across various settings. We believe that this is the first step to recognizing drug-induced kidney disease and developing strategies to prevent and manage this condition.
bookPart Terapias de substituição renal(2015) SILVA, Bruno Caldin da; MACEDO, Etienne- RENALOUTCOMES IN CRITICALLY ILL PATIENTS RECEIVING PROPOFOLOR MIDAZOLAM A PROPENSITY SCORING ANALYSIS(2015) LIBORIO, Alexandre; TAVARES, Tacyano; MACEDO, Etienne
- Urine Output Assessment as a Clinical Quality Measure(2015) MACEDO, EtienneUrine output (UO) is a relevant marker of kidney function and an independent marker of serum creatinine. Although oliguria can be the result of transitory changes in volume status or due to external influences, such as drug administration, UO is currently included as a criterion to diagnose and stage acute kidney injury (AKI). In clinical practice, the potential of earlier alert of kidney injury with frequent assessment of UO can help patient screening and risk assessment. In this review, we will discuss recent studies applying UO for AKI diagnosis and prognostication and propose methods to assess UO and improve quality of care. (C) 2015 S. Karger AG, Basel
- Renal Outcomes in Critically Ill Patients Receiving Propofol or Midazolam(2015) LEITE, Tacyano Tavares; MACEDO, Etienne; MARTINS, Izanio da Silva; NEVES, Femanda Macedo de Oliveira; LIBORIO, Alexandre BragaBackground and objectives Propofol has been shown to provide protection against renal ischemia/reperfusion injury experimentally, but clinical evidence is limited to patients undergoing cardiac surgery. There are no data about its association with oliguria and AKI in critically ill patients. Design, setting, participants, & measurements We obtained data from the Multiparameter Intelligent Monitoring in Intensive Care II database (2001-2008). Patient selection criteria included adult patients in their first intensive care unit (ICU) admission, need for mechanical ventilation, and treatment with propofol or midazolam. Propensity score analysis (1:1) was used and renal-related outcomes (AKL oliguria, cumulative fluid balance, and need for RRT) were evaluated during the first 7 days of ICU stay. Results There were 1396 propofol/midazolam-matched patients. AKI in the first 7-day ICU time period was statistically lower in propofol-treated patients compared with midazolam-treated patients (55.0% versus 67.3%, P<0.001). Propofol was associated with lower AKI incidence using both urine output (45.0% versus 55.7%, P<0.001) and serum creatinine criteria (28.8% versus 37.2%, P=0.001). Patients receiving propofol had oliguria (<400 ml/d) less frequently (12.4% versus 19.6%, P=0.001) and had diuretics prescribed less often (8.5% versus 14.3%, P=0.001). In addition, during the first 7 days of ICU stay, patients receiving propofol less frequently achieved cumulative fluid balance >5% of body weight (50.1% versus 58.3%, P=0.01). The need for RRT in the first 7 days of ICU stay was also less frequent in propofol-treated patients (3.4% versus 5.9%, P=0.03). ICU mortality was lower in propofol-treated patients (14.6% versus 29.7%, P<0.001). Conclusions In this large, propensity-matched ICU population, patients treated with propofol had a lower risk of AKL fluid-related complications, and need for RRT.
- Preventing Acute Kidney Injury(2015) MACEDO, Etienne; MEHTA, Ravindra L.Epidemiologic studies applying the acute kidney injury (AKI) classification system have confirmed the increasing incidence of AKI in different settings and its association with adverse outcomes. AKI is now a recognized important risk factor for new-onset chronic kidney disease, determining acceleration in progression to end-stage renal disease, leading to poor quality of life, disability, and long-term costs. AKI has been associated with high mortalities; however, it is likely that a significant number of deaths associated with AKI could be avoided. This article reviews the key aspects of the 0by25 initiative and its application in critically ill patients.