Pasqual Barretti - Academia.edu (original) (raw)

Papers by Pasqual Barretti

Iranian journal of kidney diseases, 2017

Pulmonary hypertension (PH) has been reported in hemodialysis patients, but data regarding its pa... more Pulmonary hypertension (PH) has been reported in hemodialysis patients, but data regarding its pathogenesis are scarce. This study aimed to evaluate the role of fluid overload in PH and its interrelationships with the usual biomarkers of micro-inflammatory state in hemodialysis patients. In is a cross-sectional and prospective study, 119 consecutive hemodialysis patients at a Brazilian referral university hospital were evaluated between March 2007 and February 2013. Based on the presence of echocardiographic parameters of PH, patients were allocated to two groups of the PH group and the non-PH group. Clinical parameters, site and type of vascular access, bio-impedance, and laboratory findings were compared between the two groups and a logistic regression model was elaborated. Pulmonary hypertension was found in 23 (19.0%) of 119 patients. The groups significantly differed in extracellular water, ventricular thickness, left atrium diameter, and ventricular filling. Additionally, labo...

Pathogens

Pseudomonas aeruginosa, an opportunistic pathogen causing infections in immunocompromised patient... more Pseudomonas aeruginosa, an opportunistic pathogen causing infections in immunocompromised patients, usually shows pronounced antimicrobial resistance. In recent years, the frequency of carbapenemases in P. aeruginosa has decreased, which allows use of new beta-lactams/combinations in antimicrobial therapy. Therefore, the in vitro evaluation of these drugs in contemporary isolates is warranted. We evaluated the antimicrobial susceptibility and genomic aspects of 119 clinical P. aeruginosa isolates from 24 different hospitals in Brazil in 2021–2022. Identification was performed via MALDI-TOF-MS, and antimicrobial susceptibility was identified through broth microdilution, gradient tests, or disk diffusion. Whole-genome sequencing was carried out using NextSeq equipment. The most active drug was cefiderocol (100%), followed by ceftazidime–avibactam (94.1%), ceftolozane–tazobactam (92.4%), and imipenem–relebactam (81.5%). Imipenem susceptibility was detected in 59 isolates (49.6%), and t...

Frontiers in Medicine

BackgroundOverhydration (OH) is common in peritoneal dialysis (PD) and increases the cardiovascul... more BackgroundOverhydration (OH) is common in peritoneal dialysis (PD) and increases the cardiovascular risk. Multifrequency bioimpedance spectroscopy (BIS) has been proposed to estimate the hydration in dialysis. Our objective was to evaluate if BIS is superior than control based on clinical assessment plus single-frequency bioimpedance (SF-BIA) on the fluid control and intermediate cardiovascular outcomes.MethodsRandomized controlled study in adult PD patients, with a 9-month follow-up, allocated into two groups: control and BIS. Data were collected from medical records. SF-BIA and BIS, laboratory exams, ambulatory blood pressure monitoring, echocardiography (ECHO), and pulse wave velocity (PWV) were evaluated. The BIS data were available to the medical team only in BIS group.Results34 patients completed the study, 17 in each group. At the endpoint the BIS group had a significant (p < 0.05) greater proportion of patients with OH/extracellular water (OH/ECW%) ≤ 15% than the control ...

Brazilian Journal of Nephrology

Clinical Nutrition ESPEN, 2020

J. bras. …, 1997

... Texto completo. experimental, Documentos relacionados. Id: 208765. Autor: Caramori, Jacquelin... more ... Texto completo. experimental, Documentos relacionados. Id: 208765. Autor: Caramori, JacquelineCosta Teixeira; Lopes, Adalberto Andrade; Bartoli, Luciane Donilda; Redondo, Ana Paula; Kawano, Paulo Roberto; Felippe, Maria Justina Dalla Bernardina; Barretti, Pasqual. ...

European Journal of Clinical Microbiology & Infectious Diseases, 1993

A study was performed to determine the frequency and antimicrobial susceptibility ofEnterococcus ... more A study was performed to determine the frequency and antimicrobial susceptibility ofEnterococcus species in clinical specimens. Of 943 aesculinpositive isolates, 873 (92 %) were identified as enterococci (737Enterococcus faecalis, 129Enterococcus faecium and 7 otherEnterococcus species). High-level resistance to gentamicin was found in 15.2 % ofEnterococcus faecalis, but not inEnterococcus faecium; 58 % ofEnterococcus faecium were resistant to gentamicin at a

Arquivos brasileiros de cardiologia, 2007

BACKGROUND Interventional treatment of coronary insufficiency is underemployed among dialysis pat... more BACKGROUND Interventional treatment of coronary insufficiency is underemployed among dialysis patients. Studies confirming its efficacy in this set of patients are scarce. OBJECTIVE To assess the results of interventional treatment of coronary artery disease in patients undergoing dialysis. METHODS A total of 34 dialysis patients submitted to coronary angiography between September 1995 and October 2004 were divided according to presence or absence of coronary lesion, type of treatment and presence or absence of diabetes mellitus. The groups were compared according to their clinical and survival characteristics. Survival of patients undergoing interventional treatment was compared to overall survival of 146 dialysis patients at the institution in the same period. Interventional treatment was indicated to the same clinical conditions in the general population. RESULTS Thirteen patients with no angiography coronary lesions presented a survival rate of 100% in 48 months as compared to 3...

The Journal of Clinical Hypertension, 2020

The purpose of this study was to analyze which 24‐hour ambulatory blood pressure measurement (ABP... more The purpose of this study was to analyze which 24‐hour ambulatory blood pressure measurement (ABPM) parameters should be used on masked hypertension (MH) and white‐coat hypertension (WCH) diagnoses in chronic kidney disease (CKD) patients. Non‐dialysis CKD patients underwent 24‐hour ABPM examination between 01/27/2004 and 02/16/2012. They were followed from the 24‐hour ABPM to January/2014 in an observational study. The WCH definitions tested were as follows: (a) office blood pressure (BP) ≥ 140/90 mm Hg and daytime ABPM BP ≤ 135/85 mm Hg (old criterion); and (b) office BP ≥ 140/90 mm Hg and 24‐hour ABPM BP ≤ 130/80 mm Hg, daytime ABPM BP ≤ 135/85 mm Hg, and nighttime ABPM BP ≤ 120/70 mm Hg (new criterion). The MH definitions tested were as follows: (a) office BP < 140/90 mm Hg and daytime ABPM BP > 135/85 mm Hg (old criterion); and (b) office BP < 140/90 mm Hg and 24‐hour ABPM BP > 130/80 mm Hg or daytime ABPM BP > 135/85 mm Hg or nighttime ABPM BP > 120/70 mm Hg ...

Scientific Reports, 2021

Peritonitis due to gram-negative bacilli (GNB), particularly nonfermenting GNB (NF-GNB), is a ser... more Peritonitis due to gram-negative bacilli (GNB), particularly nonfermenting GNB (NF-GNB), is a serious complication of peritoneal dialysis with a low resolution rate. Beyond the patient’s condition, microbiological properties such as antimicrobial resistance, biofilm production and other virulence factors can explain the poor outcomes. This study aimed to evaluate the influence of patient condition, microbiological characteristics, including biofilm production, and treatment on peritonitis outcome. We reviewed the records of 62 index episodes caused by NF-GNB that occurred between 1997 and 2015 in our center. The etiologies were species of Pseudomonas (51.6%), Acinetobacter (32.2%), and other NF-GNB (16.1%). There was a high (72.9%) proportion of biofilm producer lineages. The in vitro susceptibility rate of Pseudomonas spp. to amikacin, ciprofloxacin, and ceftazidime was significantly greater than that of Acinetobacter spp. and other species; however, there was a similar low resolut...

Background: Protein-energy wasting is related to impairment of quality of life and lower survival... more Background: Protein-energy wasting is related to impairment of quality of life and lower survival of end-stage kidney disease (ESKD) patients. The evaluation of body composition, especially fat free mass (FFM) and fat mass (FM), is important for the prediction of outcomes in these individuals. The aim of this study was to compare the FFM and FM measurements obtained by single-frequency bioimpedance (SF-BIA) and by a multiple frequency bioimpedance (MF-BIA) device, using dual energy X-ray absorptiometry (DXA) peritoneal dialysis (PD) patients. Methods: This was a cross-sectional study involving adult patients undergoing regular PD, in which we performed SF-BIA, MF-BIA, and DXA at the same visit. To compare the bioimpedance values with DXA, we used: Person correlation (r), intraclass correlation coefficient (ICC), and Bland-Altman concordance analysis. Results: The sample consisted of 50 patients in the PD, with mean age of 55.1 ± 16.3 years. Both bioimpedance methods showed a strong ...

ABSTRACTBackgroundWe tested if fatigue in incident Peritoneal Dialysis associated with an increas... more ABSTRACTBackgroundWe tested if fatigue in incident Peritoneal Dialysis associated with an increased risk for mortality, independently from main confounders.MethodsWe conducted a side-by-side study from two of incident PD patients in Brazil and the United States. We used the same code to independently analyze data in both countries during 2004 to 2011. We included data from adults who completed KDQOL-SF vitality subscale within 90 days after starting PD. Vitality score was categorized in four groups: >50 (high vitality), ≥40 to ≤50 (moderate vitality), >35 to <40 (moderate fatigue), ≤35 (high fatigue; reference group). In each country’s cohort, we built four distinct models to estimate the associations between vitality (exposure) and all-cause mortality (outcome): (i) Cox regression model; (ii) competitive risk model accounting for technique failure events; (iii) multilevel survival model of clinic-level clusters; (iv) multivariate regression model with smoothing splines tre...

Journal of Renal Nutrition

Ciência Rural

ABSTRACT: Intermittent hemodialysis (IHD) is a form of renal replacement that is used in veterina... more ABSTRACT: Intermittent hemodialysis (IHD) is a form of renal replacement that is used in veterinary medicine for cases involving drug removal, electrolyte imbalance, acute kidney injury, and chronic kidney disease (CKD). The aim of the present study was to verify the efficacy of IHD in dogs with CKD staged at grade III and to evaluate the effect of IHD on quality of life. Twelve dogs with CKD at stage III met the inclusion criteria and were divided equally into two groups. The control group (n=6) received only clinical treatment and intravenous fluid therapy, and the hemodialysis group (n=6) received clinical and IHD treatments. Blood samples were collected before and after treatments in both groups. We evaluated complications and clinical parameters of IHD every 30 minutes. Hemodialysis decreased serum urea, creatinine, and phosphorus. Despite the evident removal of nitrogen compounds, dialysis treatment did not increase survival time in these patients. The results of this study do...

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 2017

Simple and low-cost tools to monitor the risk profile of patients on peritoneal dialysis (PD) at ... more Simple and low-cost tools to monitor the risk profile of patients on peritoneal dialysis (PD) at high risk of complications and mortality are scarce. One of the tools available to monitor the variation in vitality and dependence levels is the Karnofsky performance status (KPS). This study analyzed the average trends and variation of KPS during the 12 months before death and its independent value in predicting patients' survival. The data were compiled from the BRAZPD II multi-center study, performed in Brazil between 2004 and 2011. For the analysis of KPS dynamics, we included patients with at least 12 months of follow-up on PD and who had a fatal event during the follow-up. The following covariables were evaluated: age, gender, ethnicity, educational level, and presence of diabetes. We used the linear regression model to present the results: the log (time) before death was represented by the regression variable and KPS was the response. We also analyzed the independent impact o...

Hemodialysis International, 2016

Chronic kidney disease (CKD) is a matter of global public health. Data from the United States hav... more Chronic kidney disease (CKD) is a matter of global public health. Data from the United States have shown a steady increase in the number of patients on renal replacement therapy (RRT). In 1983, there were 86,354 patients on RRT program in the United States, which rose to more than 615,000 patients in 2011. The census of the Brazilian Society of Nephrology (SBN) showed 65,121 patients on a dialysis program in 2005, while in 2011 there were 91,314 and in 2013 more than 112,000 patients on dialysis in Brazil. The rate of incident dialysis patients was 119 patients per million (ppm) in 2005, 149 ppm in 2011, and 161 ppm in 2013. Nephrologists have two methods of dialysis at their disposal: peritoneal dialysis (PD) and hemodialysis (HD), the latter being the most commonly used method worldwide. Although, historically, PD has been widely used in nephrology, for reasons which are not completely clear, it has been underutilized in recent years. Possible reasons for its underutilization are the perception that it is inferior to HD, which appears technologically advanced, and fear of the infectious, mechanical and metabolic complications associated with PD, along with preferential financial reimbursement with HD use and difficulties with peritoneal catheter insertion. In the United States, in 2007, there were 368,000 patients on RRT, and 92.8% of them were on HD. In Brazil, data from 2013 showed that 90.6% of chronic patients underwent HD and only 9.4% were treated with PD. Several studies have compared the differences between the two types of dialysis, i.e., PD vs. HD, in incident patients on RRT. There is no evidence of the superiority of one method over the other with regards to general mortality within the first two years of therapy. Some studies have shown better results with PD in the group of young patients with no comorbidities, while other studies have shown lower mortality after two years of dialysis in elderly patients with comorbidities treated with HD. Recently, some authors have pointed out the impact of the vascular access used in the mortality of incident patients on HD. These studies found that central venous catheter (CVC) use is associated with reduced survival, especially in the first 90 days of RRT. Furthermore, there is a greater risk of bacteremia, sepsis and hospitalizations in patients using CVC when compared to patients using an arteriovenous fistula (AVF), graft or PD. In this scenario, the PD appears to be an option in cases with an urgent start to chronic dialysis. It can offer the advantage of not using a CVC, thereby preserving vascular access and residual renal function, which can reduce the morbidity and mortality of these patients. Most patients with end-stage CKD start unplanned RRT. Unplanned dialysis may be defined as the start of HD without a functioning definitive vascular access (AVF), i.e., using a CVC, or as the start of PD within less than 7 days after its implantation. Ivarsen et al. retrospectively reviewed the Danish Nephrology Registration from 2008 to 2011 and found that 50% of incident patients on RRT started it in an unplanned manner. In Brazil, approximately 60% of incident patients on RRT have no definitive access and need to be treated through CVC. In the dialysis unit of the University Hospital of the Botucatu Medical School, the reality is worse than elsewhere in the world: more than 90% of incident patients start unplanned dialysis and 60% of Correspondence to: D. Ponce, PhD, Botucatu School of Medicine, Distrito de Rubi~ao Junior, S~ao Paulo 18600090, Brazil. E-mail: dponce@fmb.unesp.br Conflict of Interest: DBD, VB, MLM, PB declare that there is no conflict of interest. Disclosure of grants or other funding: DP has received research grant from Baxter Healthcare Corporation.