David Saitovitch

Is depression a risk factor for mortality in chronic hemodialysis patients

OBJECTIVE The present study was conducted to assess the association between depressive symptomatology and mortality in chronic hemodialysis. METHOD A cohort of 40 patients was followed for a median period of 10.5 months. The Beck Depression Inventory was used to classify patients as exposed to depression (Beck Depression Inventory score > 14) or not (Beck Depression Inventory < or = 14). Kaplan-Meier survival curves were used to compare the mortality rate between the two groups. The effects of potential confounding factors were adjusted using Cox proportional hazards model. RESULTS After 24 months of follow-up, survival rates were 39% for exposed and 95% for non-exposed patients (p = 0.029). The Cox proportional hazards model showed results similar to those of the bivariate analysis, indicating that depressive symptomatology tended to be associated with mortality (HR = 6.5, 95%CI: 0.8-55.6; p = 0.085). Other study variables, including age, concurrent systemic diseases, and biochemical markers, were not significantly associated with mortality. Exposed patients remained on dialysis longer and received kidney transplants less frequently (9% vs. 50% for non-exposed patients). When kidney transplantation was included in the Cox regression model, the hazard ratio of mortality for exposed as compared to non-exposed patients lost statistical significance (HR = 4.5; 95%CI: 0.5-40.0; p = 0.17). CONCLUSIONS Our study suggests that the presence of depressive symptoms may act as an independent risk factor for mortality in chronic hemodialysis patients. However, this finding needs further investigations.

Pharmacokinetics of polymyxin B in patients on continuous venovenous haemodialysis

OBJECTIVES To evaluate the pharmacokinetics of polymyxin B in patients on continuous venovenous haemodialysis (CVVHD) after intravenous administration of unadjusted dosage regimens. PATIENTS AND METHODS Two critically ill patients had eight blood samples collected during a 12 h interval on days 8 and 10 of polymyxin B therapy. Dialysate was collected every hour during the 12 h dosing interval. Polymyxin B binding in plasma was determined by rapid equilibrium dialysis. Concentrations of polymyxin B in plasma and dialysate samples were quantified using a validated ultra-performance liquid chromatography-tandem mass spectrometry assay. RESULTS Respective maximum plasma concentrations in patients 1 and 2 were 8.62 and 4.38 mg/L; total body clearances (scaled linearly by body weight) were 0.043 and 0.027 L/h/kg, respectively, of which 12.2% and 5.62% were dialysis clearance, respectively. The corresponding volumes of distribution of polymyxin B at steady state were 0.50 and 0.34 L/kg, respectively, and protein binding in pooled plasma samples was 74.1% and 48.8%, respectively. CONCLUSIONS Our findings indicate that the recommended polymyxin B doses should not be reduced for patients on CVVHD.

Rethinking the multiple roles of B cells in organ transplantation.

Purpose of reviewTo discuss the B-cell diverse functions in organ transplantation, highlighting the emerging debate on the role of regulatory B cells (Bregs). We underscore the need to re-examine and integrate data on B-cell functional activities, aiming to discriminate their regulatory (REG) and inflammatory (INFLAMMA) functions and to translate this knowledge for the development of novel immunomodulatory therapeutic strategies and to rethink the current ones. Recent findingsData from both experimental models and clinical trials point that B cells of various phenotypes have immunoregulatory activity and play an important role in controlling graft inflammation. Data on the state of operational tolerance, in kidney transplantation, suggest the relevance of preserving a healthy B-cell compartment – in numbers and in the Breg capacity to activate the CD40/STAT3 signalling pathway – for achieving and maintaining homeostasis. Moreover, autoantibodies also comprise transplant immunobiology and it seems that not all alloantibodies are deleterious. SummaryThe role of B cells, in organ transplantation, can no longer be taken as mere generators of plasma cells, which produce alloantibodies deleterious to the graft. B cells also seem to integrate a complex immunoregulatory network in organ transplantation, with Bregs of various phenotypes and possibly also antibodies. The functional discrimination of REG/INFLAMMA B-cell roles needs to be considered in the clinical setting.

First case report of Neisseria lactamica causing cavitary lung disease in an adult organ transplant recipient.

ABSTRACT We describe a case of an adult organ recipient patient with a pulmonary cavitary lesion due to Neisseria lactamica, a harmless commensal organism that rarely causes human infection. To our knowledge, this is the first report of pulmonary disease caused by this organism and the second case of N. lactamica infection in an adult patient.

Is there an association between non-steroidal anti-inflammatory drugs and contrast nephropathy?

FUNDAMENTO: A associacao entre o uso de anti-inflamatorios nao-esteroides (AINEs) e insuficiencia renal aguda ou cronica e bem documentada, mas evidencias sobre a associacao entre AINEs e nefropatia induzida por contraste (NIC) nao sao encontradas na literatura. OBJETIVO: Avaliar uma possivel associacao entre AINEs e NIC. METODOS: Em um estudo de coorte, atraves da entrevista clinica de pacientes que foram submetidos a cateterizacao cardiaca, analisamos o uso de AINEs e sua associacao com desenvolvimento de NIC, atraves da alteracao dos niveis de creatinina serica ou taxa de filtracao glomerular em 48 ou 72 horas. RESULTADOS: No periodo de julho de 2005 a julho de 2006, 236 pacientes foram incluidos no estudo, dos quais 29 foram posteriormente excluidos. A incidencia de NIC foi 10,37% (20 de 207) e 42% dos pacientes estavam recebendo AINEs ate o momento da avaliacao. Nao houve associacao entre o uso de AINEs e o desenvolvimento de NIC com OR de 1,293; IC95% (0,46-4,2). O estudo detectou fatores de risco conhecidos para o desenvolvimento de NIC, tais como diabete, com OR de 2,77; IC95% (1,05-7,47) e insuficiencia renal cronica com OR de 3,48; IC95% (1,1-11,07) e tambem sugeriu uma acao protetora da hidratacao com solucao salina com OR de 0,166; IC95% (0,03-0,92). CONCLUSAO: Com base nos dados obtidos, concluimos que nao houve associacao entre NIC e uso previo de AINEs, pelo menos com um OR > 2,85, o qual nossa amostra detectou.BACKGROUND The association between the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and acute or chronic renal failure is well documented, but evidence of such association between NSAIDs and Contrast-Induced Nephropathies (CIN) is not found in the indexed literature. OBJECTIVE To evaluate the possible association between NSAIDs and CIN. METHODS In a cohort study, through clinical interviews of patients that underwent cardiac catheterization, we analyzed the use of NSAIDs and its association with the development of CIN, through alterations in serum creatinine or glomerular filtration rate in 48 or 72 hours. RESULTS From July 2005 to July 2006, 236 patients were enrolled in the study, of which 29 were later excluded. The incidence of CIN was 10.37% (20 of 207) and 42% of the patients were using NSAIDs until the moment of the evaluation. There was no association between the use of NSAIDs and the development of CIN with OR of 1.293 95% CI (0.46-4.2). The study detected known risk factors for the development of CIN, such as diabetes with OR of 2.77 95%CI (1.05-7.47) and chronic renal failure with OR 3.48 95%CI (1.1-11.07). A protective action of saline solution hydration is also suggested, with OR of 0.166 95%CI (0.03-0.92). CONCLUSION Based on the data obtained, we conclude that there was no association between CIN and previous use of NSAIDs, at least with an OR higher then 2.85, which our sample detected.

Contrast-induced nephropathy after computed tomography

Introduction: Contrast induced nephropathy is the third most prevalent preventable cause of acute kidney injury in hospitalized patients. It defined as an absolute increase in serum creatinine ≥ 0.5 mg/dL and relative ≥ 25% increase. Objective: We studied the risk factors to intravenous injection contrast nephropathy after computed tomography. Methods: We studied 400 patients prospectively. Results: The incidence of contrast induced nephropathy, with an absolute or a relative increase were 4.0% and 13.9%, respectively. Diabetes and cardiac failure were independent risk factors for CIN a relative increase de serum creatinine (O.R.: 3.5 [95% CI: 1.92-6.36], p < 0.01, 2.61 [95% CI: 1.14-6.03%], p < 0.05, respectively). Conclusions: We showed association between uses of intravenous injection contrast after computed tomography with acute injury renal, notably with diabetes and heart failure.INTRODUCTION Contrast induced nephropathy is the third most prevalent preventable cause of acute kidney injury in hospitalized patients. It defined as an absolute increase in serum creatinine ≥ 0.5 mg/dL and relative ≥ 25% increase. OBJECTIVE We studied the risk factors to intravenous injection contrast nephropathy after computed tomography. METHODS We studied 400 patients prospectively. RESULTS The incidence of contrast induced nephropathy, with an absolute or a relative increase were 4.0% and 13.9%, respectively. Diabetes and cardiac failure were independent risk factors for CIN a relative increase de serum creatinine (O.R.: 3.5 [95% CI: 1.92-6.36], p < 0.01, 2.61 [95% CI: 1.14-6.03%], p < 0.05, respectively). CONCLUSIONS We showed association between uses of intravenous injection contrast after computed tomography with acute injury renal, notably with diabetes and heart failure.

Cephalic duodenopancreatectomy in the treatment of a bleeding duodenal ulcer in a pancreas recipient: a case report.

Pancreas transplantation is currently the only known therapy to restore glycemic metabolism in type 1 diabetic patients. Its most prevalent indication is in association with kidney transplantation (simultaneous pancreas and kidney transplantation SPK) for patients with type 1 diabetes mellitus (DM1) and nephropathy, who are under dialysis treatment. Surgical reinterventions, especially those resulting from complications of bladder exocrine pancreatic drainage, are associated with considerable morbidity and mortality. In this report, we present a clinical case of a 31-year-old Caucasian man with DM1 from 12 years of age and hemodialysis for 2 years before undergoing SPK 2 years prior. He then developed massive hematuria owing to a bleeding duodenal graft ulcer. The use of a segmental pancreatic technique with pancreaticocystostomy for exocrine pancreatic drainage allowed the maintenance of the graft and an euglycemic state in the patient, free of exogenous insulin.

Há uma associação entre anti-inflamatórios não-esteroides e nefropatia induzida por contraste?

FUNDAMENTO: A associacao entre o uso de anti-inflamatorios nao-esteroides (AINEs) e insuficiencia renal aguda ou cronica e bem documentada, mas evidencias sobre a associacao entre AINEs e nefropatia induzida por contraste (NIC) nao sao encontradas na literatura. OBJETIVO: Avaliar uma possivel associacao entre AINEs e NIC. METODOS: Em um estudo de coorte, atraves da entrevista clinica de pacientes que foram submetidos a cateterizacao cardiaca, analisamos o uso de AINEs e sua associacao com desenvolvimento de NIC, atraves da alteracao dos niveis de creatinina serica ou taxa de filtracao glomerular em 48 ou 72 horas. RESULTADOS: No periodo de julho de 2005 a julho de 2006, 236 pacientes foram incluidos no estudo, dos quais 29 foram posteriormente excluidos. A incidencia de NIC foi 10,37% (20 de 207) e 42% dos pacientes estavam recebendo AINEs ate o momento da avaliacao. Nao houve associacao entre o uso de AINEs e o desenvolvimento de NIC com OR de 1,293; IC95% (0,46-4,2). O estudo detectou fatores de risco conhecidos para o desenvolvimento de NIC, tais como diabete, com OR de 2,77; IC95% (1,05-7,47) e insuficiencia renal cronica com OR de 3,48; IC95% (1,1-11,07) e tambem sugeriu uma acao protetora da hidratacao com solucao salina com OR de 0,166; IC95% (0,03-0,92). CONCLUSAO: Com base nos dados obtidos, concluimos que nao houve associacao entre NIC e uso previo de AINEs, pelo menos com um OR > 2,85, o qual nossa amostra detectou.BACKGROUND The association between the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and acute or chronic renal failure is well documented, but evidence of such association between NSAIDs and Contrast-Induced Nephropathies (CIN) is not found in the indexed literature. OBJECTIVE To evaluate the possible association between NSAIDs and CIN. METHODS In a cohort study, through clinical interviews of patients that underwent cardiac catheterization, we analyzed the use of NSAIDs and its association with the development of CIN, through alterations in serum creatinine or glomerular filtration rate in 48 or 72 hours. RESULTS From July 2005 to July 2006, 236 patients were enrolled in the study, of which 29 were later excluded. The incidence of CIN was 10.37% (20 of 207) and 42% of the patients were using NSAIDs until the moment of the evaluation. There was no association between the use of NSAIDs and the development of CIN with OR of 1.293 95% CI (0.46-4.2). The study detected known risk factors for the development of CIN, such as diabetes with OR of 2.77 95%CI (1.05-7.47) and chronic renal failure with OR 3.48 95%CI (1.1-11.07). A protective action of saline solution hydration is also suggested, with OR of 0.166 95%CI (0.03-0.92). CONCLUSION Based on the data obtained, we conclude that there was no association between CIN and previous use of NSAIDs, at least with an OR higher then 2.85, which our sample detected.

Comparison of cystatin C- and creatinine-based glomerular filtration rate formulas with inulin clearance in pediatric renal transplantation.

BACKGROUND It has been suggested that plasma cystatin C (Cyst-C) concentrations provide better indicators of changes in glomerular filtration rate (GFR) than plasma creatinine concentration (PCr). METHODS We compared the performance of five equations--2009 Schwartz, Local Schwartz, Larsson, Le Bricon, and Schwartz Combined--in 60 renal transplant children by calculating the mean bias, Pearson correlation coefficient (R) and determination (R2), 10% (P10) and 30% (P30) accuracies, and Bland-Altman plots. GFR was measured by inulin clearance. RESULTS For the whole population, R2 was slightly lower for formulas based on Cyst-C or PCr, but the mean bias was lower, and P10 and P30 were greater, than using combined Schwartz equation. However, the mean estimated GFR by Schwartz 2009, Local Schwartz, and Schwartz combined equations was not statistically different from the mean inulin clearance measurement. CONCLUSIONS In our pediatric transplant population, the combined Schwartz formula exhibited better performance to estimate GFR than formulae based on Cyst-C or combined PCr.

Hay una asociación entre antiinflamatorios no esteroides y nefropatía inducida por contraste

FUNDAMENTO: A associacao entre o uso de anti-inflamatorios nao-esteroides (AINEs) e insuficiencia renal aguda ou cronica e bem documentada, mas evidencias sobre a associacao entre AINEs e nefropatia induzida por contraste (NIC) nao sao encontradas na literatura. OBJETIVO: Avaliar uma possivel associacao entre AINEs e NIC. METODOS: Em um estudo de coorte, atraves da entrevista clinica de pacientes que foram submetidos a cateterizacao cardiaca, analisamos o uso de AINEs e sua associacao com desenvolvimento de NIC, atraves da alteracao dos niveis de creatinina serica ou taxa de filtracao glomerular em 48 ou 72 horas. RESULTADOS: No periodo de julho de 2005 a julho de 2006, 236 pacientes foram incluidos no estudo, dos quais 29 foram posteriormente excluidos. A incidencia de NIC foi 10,37% (20 de 207) e 42% dos pacientes estavam recebendo AINEs ate o momento da avaliacao. Nao houve associacao entre o uso de AINEs e o desenvolvimento de NIC com OR de 1,293; IC95% (0,46-4,2). O estudo detectou fatores de risco conhecidos para o desenvolvimento de NIC, tais como diabete, com OR de 2,77; IC95% (1,05-7,47) e insuficiencia renal cronica com OR de 3,48; IC95% (1,1-11,07) e tambem sugeriu uma acao protetora da hidratacao com solucao salina com OR de 0,166; IC95% (0,03-0,92). CONCLUSAO: Com base nos dados obtidos, concluimos que nao houve associacao entre NIC e uso previo de AINEs, pelo menos com um OR > 2,85, o qual nossa amostra detectou.BACKGROUND The association between the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and acute or chronic renal failure is well documented, but evidence of such association between NSAIDs and Contrast-Induced Nephropathies (CIN) is not found in the indexed literature. OBJECTIVE To evaluate the possible association between NSAIDs and CIN. METHODS In a cohort study, through clinical interviews of patients that underwent cardiac catheterization, we analyzed the use of NSAIDs and its association with the development of CIN, through alterations in serum creatinine or glomerular filtration rate in 48 or 72 hours. RESULTS From July 2005 to July 2006, 236 patients were enrolled in the study, of which 29 were later excluded. The incidence of CIN was 10.37% (20 of 207) and 42% of the patients were using NSAIDs until the moment of the evaluation. There was no association between the use of NSAIDs and the development of CIN with OR of 1.293 95% CI (0.46-4.2). The study detected known risk factors for the development of CIN, such as diabetes with OR of 2.77 95%CI (1.05-7.47) and chronic renal failure with OR 3.48 95%CI (1.1-11.07). A protective action of saline solution hydration is also suggested, with OR of 0.166 95%CI (0.03-0.92). CONCLUSION Based on the data obtained, we conclude that there was no association between CIN and previous use of NSAIDs, at least with an OR higher then 2.85, which our sample detected.