Prevalência da doença arterial coronariana em diabéticos tipo 1 candidatos a transplante duplo (rim e pâncreas)

Oliveira, Dinaldo Cavalcanti de; Filho, Glauco Gusmão; Nakamoto, Alysson; Souza, Francival Leite de; Sá, João Roberto de; Pestana, José Osmar Medina; Lima, Valter C.

doi:10.1590/s0066-782x2005000200003

Cited by 3 publications

(4 citation statements)

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“…Estimation of the GFR used to define glomerular filtration rate (GFR) and CKD stages according to the criteria of the US National Kidney Foundation is considered the new standard of evaluation and severity of renal diseases [12,27]. So far, the utility of this system of staging based on the GFR as a risk factor for prediction of adverse outcome has not been extensively evaluated in patients in less advanced stages of CHF [16,28].…”

Section: Discussionmentioning

confidence: 99%

“…Renal function was evaluated by the GRF estimated from creatinine, and not by the use of methods considered to be the gold standard, such as inulin clearance [27]. In addition, we chose to exclusively utilize the functional component of the definition of CKD, in other words, GFR <60 mL/min/1.73 m 2 ; however, previous studies have demonstrated that it is below this level of renal function that the risk of mortality increases for all causes of CHF [12,34].…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis and stage of the CKD were made according to the criteria of the US National Kidney Foundation [27]. Patients with two results of GFR <60 mL/min/1.73 m 2 , measured at least 3 months apart, were diagnosed with CKD [27]. The outcomes were cardiovascular death or hospitalization secondary to decompensated CHF, during the 12 months of follow up.…”

Section: Methodsmentioning

confidence: 99%

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Chronic kidney disease increases cardiovascular unfavourable outcomes in outpatients with heart failure

et al. 2009

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BackgroundChronic heart failure (CHF) has a high morbidity and mortality. Chronic kidney disease (CKD) has consistently been found to be an independent risk factor for unfavorable cardiovascular (CV) outcomes. Early intervention on CKD reduces the progression of CHF, hospitalizations and mortality, yet there are very few studies about CKD as a risk factor in the early stages of CHF. The aims of our study were to assess the prevalence and the prognostic importance of CKD in patients with systolic CHF stages B and C.MethodsThis is a prospective cohort study, dealing with prognostic markers for CV endpoints in patients with systolic CHF (ejection fraction ≤ 45%).ResultsCKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2 and CV endpoints as death or hospitalization due to CHF, in 12 months follow-up. Eighty three patients were studied, the mean age was 62.7 ± 12 years, and 56.6% were female. CKD was diagnosed in 49.4% of the patients, 33% of patients with CHF stage B and 67% in the stage C. Cardiovascular endpoints were observed in 26.5% of the patients. When the sample was stratified into stages B and C of CHF, the occurrence of CKD was associated with 100% and 64.7%, respectively, of unfavorable CV outcomes. After adjustments for all other prognostic factors at baseline, it was observed that the diagnosis of CKD increased in 3.6 times the possibility of CV outcomes (CI 95% 1.04-12.67, p = 0.04), whereas higher ejection fraction (R = 0.925, IC 95% 0.862-0.942, p = 0.03) and serum sodium (R = 0.807, IC 95% 0.862-0.992, p = 0.03) were protective.ConclusionIn this cohort of patients with CHF stages B and C, CKD was prevalent and independently associated with increased risk of hospitalization and death secondary to cardiac decompensation, especially in asymptomatic patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Chronic kidney disease increases cardiovascular unfavourable outcomes in outpatients with heart failure

et al. 2009

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“…Uma outra contribuição do nosso grupo foi a caracterização angiográfica e através do USIC, da DAC no diabético tipo 1 com insuficiência renal crônica terminal em hemodiálise (19). Esses pacientes, quando submetidos a cateterismo na avaliação pré-operatória de transplante de rim ou duplo (rim e pâncreas), têm prevalência de DAC grave (estenose > 50%) de 58%.…”

Section: Características Anatômicas E Angiográ-unclassified

Cateterismo cardíaco, diagnóstico (angiografia) e terapêutico (angioplastia) na doença arterial coronária dos pacientes diabéticos

Lima

2007

Arq Bras Endocrinol Metab

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Screening, diagnosis and revascularization of coronary artery disease (CAD) in type 2 diabetes mellitus are major challenges for current clinical practice. Diagnostic (angiography) and therapeutic (angioplasty) cardiac catheterization are important resources for the clinical assessment and management of coronary atherosclerosis. Anatomic peculiarities of CAD in diabetics can be well characterized by angiography, associated or not by intravascular ultrasound. The worse outcome following coronary revascularization procedures, either angioplasty or surgery, in diabetic is one of the main fields of clinical research. In spite of controversies, about one quarter of angioplasty and one third of surgical revascularization procedures are performed in diabetics. Two ongoing, large, randomized, multicentric trials are investigating the best management of CAD in diabetics. The BARI 2D trial is randomizing asymptomatic or mildly symptomatic patients with CAD for either medical therapy or revascularization (angioplasty or surgery, according to the best clinical judgment). The FREEDOM trial is randomizing stable patients with multivessel CAD for either angioplasty with drug eluting stents or surgery, with or without extracorporeal circulation. While the evidences are not available, in order to decide on the best revascularization procedure for individual patients, medical practice has been balanced according to a number of variables. Conditions that favor angioplasty: short lesions, lesions in large vessels, absence of left anterior descending artery disease, previous coronary bypass surgery and high surgical risk due to co-morbidities. Conditions that favor surgery: long lesions, lesions in small vessels, presence of left anterior descending artery disease and need for associated valve surgery.

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The evolution of diabetic chronic complications after pancreas transplantation

Sá

Monteagudo

Rangel

et al. 2009

Diabetol Metab Syndr

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Pancreas transplantation is an invasive procedure that can restore and maintain normoglycemic level very successfully and for a prolonged period in DM1 patients. The procedure elevates the morbimortality rates in the first few months following the surgery if compared to kidney transplants with living donors, but it offers a better quality of life to patients.Although controversial, several studies have shown the stabilization or the improvement of some of the chronic complications related to diabetes, as well as the extra number of years of life that patients submitted to a double pancreas-kidney transplantation may gain.Recent studies have demonstrated clashing outcomes regarding isolated pancreas transplantations, a fact which reinforces the need for a more discerning selection of patients for this procedure.

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Prevalência da doença arterial coronariana em diabéticos tipo 1 candidatos a transplante duplo (rim e pâncreas)

Abstract: Patients with type I diabetes in a dialysis program and candidates for double transplantation had an elevated prevalence of coronary artery disease. It is worth noting that those patients had no symptoms of the disease.

Cited by 3 publications

References 17 publications

Chronic kidney disease increases cardiovascular unfavourable outcomes in outpatients with heart failure

Chronic kidney disease increases cardiovascular unfavourable outcomes in outpatients with heart failure

Cateterismo cardíaco, diagnóstico (angiografia) e terapêutico (angioplastia) na doença arterial coronária dos pacientes diabéticos

The evolution of diabetic chronic complications after pancreas transplantation

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