Teresa Adragao - Academia.edu (original) (raw)

Papers by Teresa Adragao

Recenti progressi in medicina, Nov 1, 2010

ABSTRACT

Nephrology Dialysis Transplantation, May 1, 2022

Case reports in transplantation, 2015

A 56-year-old African patient received a kidney from a deceased donor with 4 HLA mismatches in Ap... more A 56-year-old African patient received a kidney from a deceased donor with 4 HLA mismatches in April 2013. He received immunosuppression with basiliximab, tacrolimus, mycophenolate mofetil, and prednisone. Immediate diuresis and a good allograft function were soon observed. Six months later, the serum creatinine level increased to 2.6 mg/dL. A renal allograft biopsy revealed interstitial fibrosis and tubular atrophy grade II. Toxicity of calcineurin inhibitor was assumed and, after a switch for everolimus, renal function improved. However, since March 2014, renal function progressively deteriorated. A second allograft biopsy showed no new lesions. Two months later, the patient was admitted due to anuria, haematochezia with anaemia, requiring 5 units of packed red blood cells, and diffuse skin thickening. Colonoscopy showed haemorrhagic patches in the colon and the rectum; histology diagnosis was Kaposi sarcoma (KS). A skin biopsy revealed cutaneous involvement of KS. Rapid clinical deterioration culminated in death in June 2014. This case is unusual as less than 20 cases of KS with gross gastrointestinal bleeding have been reported and only 6 cases had the referred bleeding originating in the lower gastrointestinal tract. So, KS should be considered in differential diagnosis of gastrointestinal bleeding in some kidney transplant patients.

Clinical Nephrology, Mar 1, 2017

Peritoneal dialysis (PD) has been proposed as a therapeutic option for patients with end-stage re... more Peritoneal dialysis (PD) has been proposed as a therapeutic option for patients with end-stage renal disease (ESRD) and cardiovascular (CV) disease. The study presented here aimed to compare incident PD patients with and without CV disease at baseline, in order to determine the impact of CV disease in the outcomes of long-term PD patients. This is a prospective cohort study performed at a single PD unit where 112 consecutive incident patients admitted to the PD program during 5 years were studied. The background of CV disease at PD initiation was defined as: presence of coronary artery disease, cerebrovascular disease, heart failure, or peripheral arterial disease. Laboratory measurements as well as PD adequacy were obtained at the beginning of PD and at the last evaluation. The outcomes examined were patient and technique survival, hospitalization and peritonitis rate. Prevalence of diabetes was higher in patients with CV disease (53.3% vs. 31.7%, p = 0.036). Patients who suffered from CV disease were, on average, older (62.8 ± 13.1 vs. 49.7 ± 15.7 years, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). There were no significant differences in other demographic or clinical variables, including hospital admissions (0.99 vs. 0.72 episodes/patient-year, p = 0.057) or peritonitis rates (0.69 vs. 0.61 episodes/patient-year, p = 0.652). The overall rates of PD technique failure were similar between both groups (CV disease patients: 12.7 transfers to hemodialysis (HD)/100 patient-years vs. 13.7 transfers to HD/100 patient-year; p = 0.54). Diabetes and age were independently associated with the presence of CV disease (p = 0.011), in a model adjusted for time on PD. The mortality rate was higher in CV disease patients (14.9 vs. 0.8 deaths/100 patient-years, p = 0.000) and 75% of all-cause mortality occurred in diabetic patients. In a multivariate analysis, diabetes (hazard ratio (HR): 5.5, confidence interval (CI): 0.84 - 36.29, p = 0.049) and age (HR: 1.07, CI: 1.0 - 1.13, p = 0.047) were independent predictors of death in a model adjusted for residual diuresis, body mass index, and time on PD. This study compared incident PD patients with and without CV disease. CV disease patients were older but clinical and laboratorial targets, peritonitis rates, hospitalizations, and technique survival were similar between both groups, suggesting PD as an effective therapy for patients with CV comorbidities.

Journal of Nephrology, Mar 6, 2014

Background In some patients the potential benefits of the arteriovenous (AV) access over catheter... more Background In some patients the potential benefits of the arteriovenous (AV) access over catheter for hemodialysis seem to be outweighed by global cardiovascular status deterioration. Methods We prospectively evaluated 44 pre-dialysis chronic kidney disease patients submitted to vascular access creation during a follow-up of 25 ± 9 months. We performed pulse wave analysis and biochemical assessment before and 2 months after AV access construction, and we registered premature vascular access thrombosis, and all-cause and cardiovascular hospitalizations throughout follow-up. Results We found a statistically significant decrease in the subendocardial viability ratio (SEVR) and pulse pressure (PP) parameters after AV access creation while brain natriuretic peptide significantly increased. Receiver operating characteristic curve analysis identified SEVR B113 % evaluated 2 months after vascular access construction as the best cutoff value for predicting all-cause and cardiovascular hospitalizations. Kaplan-Meier analysis showed that a SEVR B113 % was associated with allcause (p = 0.010) and cardiovascular (p = 0.029) hospitalizations; Cox regression analysis verified a 4.9-fold higher risk of all-cause hospitalization in patients with SEVR B113 % (p = 0.005). Conclusion To our best knowledge, this report indicates, for the first time, that despite the decrease in PP parameters, the creation of a vascular access for hemodialysis was also associated with a reduction of SEVR which predicted a worse clinical outcome. We argue that the decrease of pulse pressure after arteriovenous construction may reflect a new hemodynamic set-point after vascular access creation and may not indicate a protective cardiovascular effect.

DOAJ (DOAJ: Directory of Open Access Journals), Jul 1, 1992

Iron deficiency occurs often in patients with recombinant human Erythropoietin (rhEPO) therapy in... more Iron deficiency occurs often in patients with recombinant human Erythropoietin (rhEPO) therapy in chronic renal failure (CRF) associated anemia. We have studied 10 patients with CRF on regular hemodialysis (HD), female = 8, male = 2, average age = 49 [32 to 72], time on HD 44.2 +/- 25.0 months. Before starting rhEPO, the mean hemoglobin value was 7.36 +/- 1.29 gr/dl, the mean ferritin 695.4 +/- 276.0 ng/ml, the mean serum iron 160.3 +/- 49.5 micrograms/dl and the mean transferrin saturation 55.3 +/- 12.6%. Transfusional requirements in the 12 months Pré-rhEPO were 10.9 +/- 3.2 units. The rhEPO dose level was 80 U/kg body weight (3 times a week, after HD) in the Correction Period (mean time = 46.7 +/- 18.6 days), being reduced afterwards in order to remain target Hb stable between 10 and 11 gr/dl. Iron deficiency was detected (transferrin iron saturation less than 16% or serum ferritin less than 30 ng/ml) in 5 of the 10 patients. Patients have been divided into two Groups (GI--patients which developed iron deficiency; GII--patients which remained iron replete). There were no significant differences between GI and GII in the serum iron, transferrin and transferrin saturation values of the Pré-rhEPO. Serum ferritin in the Pré-rhEPO was lower in GI than GII (GI = 489.2 +/- 23.6 ng/ml; GII = 901.6 +/- 96.4 ng/ml; p less than 0.01). Falls in the transferrin iron saturation during the Correction Period and 3, 6 and 12 months and in the serum ferritin at 3, 6 and 12 months versus Pré-rhEPO have occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Nephrology Dialysis Transplantation, Jun 1, 2023

40≤LVEF<50%, LVEF<40%) and the presence of arrhythmia. The secondary outcome is all-cause mortali... more 40≤LVEF<50%, LVEF<40%) and the presence of arrhythmia. The secondary outcome is all-cause mortality (6 months, overall) according to the LV function or presence of arrhythmia. To analyze, patients were divided into 3 groups according to the LV function and separately divided into 2 groups according to the presence of arrhythmia. Cox regression univariate and multivariate analyses was used. Results: 1,002 patients were divided into 6 groups (LVEF≥50% without arrhythmia [

Brazilian Journal of Nephrology, Sep 1, 2022

SARS-CoV-2 infection in kidney transplant recipients: clinical impact and outcomes-a single cente... more SARS-CoV-2 infection in kidney transplant recipients: clinical impact and outcomes-a single center experience Infecção por SARS-CoV-2 em receptores de transplante renal: impacto clínico e outcomes-uma experiência de centro único

Nephrology Dialysis Transplantation, May 1, 2021

BACKGROUND AND AIMS: Erythropoietin Resistance Index (EPORI) has been previously associated with ... more BACKGROUND AND AIMS: Erythropoietin Resistance Index (EPORI) has been previously associated with higher risk of mortality and morbidity in hemodialysis (HD) patients (pts). The objectives of this study were to identify which factors, such as the risk of malnutrition, are associated with EPORI and to assess its association with mortality and hospitalization risk. METHOD: Historical cohort study in a group of high-flux HD pts from 25 outpatient HD clinics, starting from a baseline group of 2975 pts. We evaluated EPORI, interdialytic weigh gain (IDWG), Malnutrition Inflammation Score (MIS) and the other parameters at the study baseline. For a better understanding of weight gain patterns, we calculated the average of the IDWG at the day of monthly blood sample collection of the previous 3 months, values >4% were considered high. A MIS>5 indicated nutritional risk. RESULTS: We analyzed 2044 pts, 1148 (56%) males, 642 (31%) diabetic, with a mean age 68.4614.12 years, a mean HD vintage 105674 months and mean EPORI 7.2367.51 (U/week/kg)/(g/dL). During a follow-up of 48 months, 719 pts (35%) died and 1291 pts (63%) were hospitalized at least once after baseline assessment, 531 pts and 400 pts were excluded because follow up was not possible and EPORI data was not available, respectively. ROC curve analysis identified different cutoff values for EPORI in relation with allcause mortality and hospitalizations.

Arquivos da Maternidade Dr. Alfredo da Costa, 2000

$Research paper thumbnail of Bortezomib in the treatment of refractory kidney graft rejection$

portuguese journal of nephrology and hypertension, Oct 1, 2012

Background. Bortezomib, a 26S proteasome inhibitor, is a novel treatment for refractory acute rej... more Background. Bortezomib, a 26S proteasome inhibitor, is a novel treatment for refractory acute rejection. The main mechanism proposed for its action is the induction of apoptosis of mature plasma cells leading to an interruption of donor-specific antibody production, but other properties may also be involved. Patients and Methods. Four patients presenting with antibody-mediated rejection were treated with bortezomib as rescue therapy. Renal function, proteinuria and anti-HLA antibodies were monitored for 1-3 years. Results. In three cases, graft function recovery and decreased proteinuria occurred, despite the maintenance of donor-specific antibody levels. However, in one case graft function was lost. Side effects were mostly transient. There were no episodes of opportunistic infection. Conclusion. Bortezomib may be effective in antibodymediated rejection by different mechanisms than simply through reducing donor-specific antibody levels. The timing of its introduction and the length of time that donor-specific antibodies have been present may be determinants of its efficacy.

Journal of Medical Virology, May 1, 2023

Nephrology Dialysis Transplantation, Oct 8, 2008

Background. Vascular calcifications are highly prevalent in dialysis patients and are associated ... more Background. Vascular calcifications are highly prevalent in dialysis patients and are associated with arterial stiffness and mortality. The use of simple and inexpensive methods to evaluate arterial stiffness and vascular calcifications is desired. The objective of this study was to evaluate the relationship of a simple vascular calcification score (SVCS) with pulse wave velocity (PWV) and pulse pressure (PP) and to evaluate their association with all-cause mortality. Methods. 101 haemodialysis patients (71 men; 19% diabetic) were evaluated. At baseline, arterial stiffness was measured by PP and by PWV with Complior. SVCS was evaluated in plain X-ray of pelvis and hands. Results. During a 43-month observational period, 31 patients died. By Kaplan-Meier analysis, SVCS >3 (P = 0.001), PP > 70 mmHg (P = 0.001) and PWV > 10.5 m/s (P < 0.001) were found to be associated with lower cumulative survival. Adjusting for multiple variables, association with mortality was maintained for SVCS >3 (HR = 3.308, P = 0.032) and PP > 70 mmHg (HR = 3.227, P = 0.031) in all patients and for PWV > 10.5 m/s (HR = 2.981, P = 0.047) in non-diabetic patients. Age (P < 0.001), systolic pressure (P = 0.004) and SVCS > 3 (P = 0.032) were associated with PWV. Diabetes (P = 0.031), calcium carbonate dose (P = 0.009) and SVCS > 3 (P = 0.012) were associated with PP. Conclusion. Higher SVCS, PWV and PP were associated with higher mortality in this population. SVCS was associated with arterial stiffness. Simple and inexpensive methods such as PP or SVCS may be used to detect mortality risk and to provide important information that may be relevant for guiding therapeutic intervention in dialysis patients.

Nephrology Dialysis Transplantation, May 1, 2017

previously demonstrated the serious behavioral and severe central kynurenine pathway disturbances... more previously demonstrated the serious behavioral and severe central kynurenine pathway disturbances in rats with end-stage chronic renal insufficiency. Recently, we have observed the association between intensified peripheral kynurenine turnover and impaired bone strength in growing rats with mild to moderate CKD. The ultimate aim of the present study was to determine the association between central kynurenine metabolism and biomechanical as well as geometrical properties of bone in the experimental model of the early stage of CKD. METHODS: Thirty-three Wistar rats aged 4 weeks were randomly divided into two groups (sham-operated and subtotal nephrectomized animals). The subtotal nephrectomy was performed according to the procedure described by Sviglerova and colleagues (2010). Sham-operated rats underwent renal evacuation and decapsulation. Three months after surgery, serum samples were obtained for the determination of biochemical parameters, and bone turnover biomarkers; tibias were collected for bone biomechanical and geometrical analysis; brains were removed and divided into 5 regions (cerebellum, brainstem, frontal cortex, hypothalamus, and striatum) for the determination of kynurenine pathway metabolites. RESULTS: Subtotal nephrectomized rats presented higher concentrations of creatinine (p<0.001), urea nitrogen (p<0.001), and parathyroid hormone (p<0.001) in the serum; higher kynurenine concentrations (p<0.05), kynurenine/tryptophan ratio (p<0.001), and lower tryptophan levels (p<0.01) in all studied parts of the brain. Kynurenine concentrations in the frontal cortex correlated positively with the ultimate load (r=0.542; p=0.020), tibial weight (r=0.474; p=0.047), tibial length (r=0.492; p=0.038), medial-lateral periosteal diameter (r=0.641; p=0.004), wall thickness (r=0.571; p=0.013), cross-sectional area (r=0.492; p=0.038), and mean relative wall thickness (r=0.509; p=0.031). Tryptophan concentrations in the frontal cortex correlated positively with the wall thickness (r=0.569; p=0.014) and cross-sectional area (r=0.536; p=0.022), while 3-hydroxykynurenine correlated positively with mediallateral endosteal diameter (r=0.487; p=0.040). Kynurenine levels in the hypothalamus correlated positively with the cortical index (r=0.536; p=0.023) and mean relative wall thickness (r=0.594; p=0.009), but it was inversely associated with the medial-lateral periosteal diameter (r=-0.493; p=0.038). There were also statistically significant positive correlations between tryptophan concentrations in the striatum and stiffness (r=0.490; p=0.039), yield load (r=0.517; p=0.028), tibial weight (r=0.585; p=0.011), medial-lateral endosteal diameter (r=0.471; p=0.048) and the cross-sectional moment of inertia (r=0.701; p=0.001). CONCLUSIONS: In addition to the complex mineral, hormone, and metabolite changes, intensified central kynurenine turnover may play an important role in the development of bone changes in the course of CKD.

F1000Research, Jun 23, 2015

portuguese journal of nephrology and hypertension, Jan 4, 2012

In chronic kidney disease patients there are three main stimuli for parathyroid hormone (PTH) sec... more In chronic kidney disease patients there are three main stimuli for parathyroid hormone (PTH) secretion by the chief cell in the parathyroid glands: hypocalcaemia, low 1,25(OH)2D3 levels and hyperphosphataemia.

International Journal of Nephrology, Aug 19, 2021

Introduction. Recent data have emerged about a protective association between JCV viruria and chr... more Introduction. Recent data have emerged about a protective association between JCV viruria and chronic kidney disease (CKD). Material and Methods. Single-center retrospective cohort study; 230 living kidney donors (LKD) candidates and 59 potential living kidney receptors (LKR) were enrolled. Plasma and urinary JCV and BKV viral loads were measured in all LKD candidates and in nonanuric LKR candidates. Twenty-six living kidney transplant surgeries were performed. LKR were followed in order to evaluate BKV and JCV viremia and urinary viral shedding after KT. Results. In LKD candidates, JCV viruria was negatively associated with proteinuria of >200 mg/24 hours (JC viruric LKD: 12.5% vs JCV nonviruric LKD: 26.7%, p � 0.021, OR:0.393; 95% CI: 0.181-0.854). In a multivariate analysis, LKD candidates with JCV viruria had a lower risk of proteinuria of >200 mg/24 hours (p � 0.009, OR: 0.342, 95% CI: 0.153-0.764), in a model adjusted for age, gender, presence of hypertension, and eGFR <80 mL/ min. Prevalence of JCV viruria was higher in LKD candidates when compared with LKR candidates (40.0% vs 1.7%, p < 0.001). Among the 26 LKR, 14 (53.8%) KT patients evolved with JCV viruria; 71.4% received a graft from a JCV viruric donor. Conclusion. Our data corroborate the recent findings of an eventual protective association between JCV viruria and kidney disease, and we extrapolated this concept to a South European population.

Journal of Renal Nutrition, Sep 1, 2022

OBJECTIVE Since its development, cumulative evidence has accumulated regarding the prognostic val... more OBJECTIVE Since its development, cumulative evidence has accumulated regarding the prognostic value of the Malnutrition-Inflammation Score (MIS/Kalantar score) prognostic value; however, there is a shortage of recent and large studies with comprehensive statistical methodologies that contribute to support a higher level of evidence and a consensual cutoff. The aim of this study was to assess the strength of MIS association with hospitalization and mortality in a nationwide cohort. METHODS This was a historical cohort study of hemodialysis patients from 25 outpatient centers followed up for 48 months. Univariable and multivariable Cox additive regression models were used to analyze the data. The C-index was estimated to assess the performance of the final model. RESULTS Two thousand four hundred forty-four patients were analyzed, 59.0% males, 32.0% diabetic, and median age of 71 years (P25 = 60, P75 = 79). During a median period of 45-month follow-up, with a maximum of 48 months (P25 = 31; P75 = 48), 875 patients presented an MIS <5 (35.8%) and 860 patients (35.2%) died. The proportion of deaths was 23.1% for patients with the MIS <5 and 41.9% if the MIS ≥5 (P < .001). A total of 1,528 patients (62.5%) were hospitalized with a median time to the first hospitalization of 26 months (P25 = 9; P75 = 45). A new cutoff point regarding the risk of death, MIS ≥6, was identified for this study data set. In multivariable analysis for hospitalization risk, a higher MIS, higher comorbidity index, and arteriovenous graft or catheter increased the risk, whereas higher Kt/V and higher albumin had a protective effect. In multivariable analysis for mortality risk, adjusting for age, albumin, normalized protein catabolic rate, Charlson comorbidity index, interdialytic weight gain, Kt/V, diabetes, hematocrit, and vascular access, patients with the MIS ≥6 showed a hazard ratio of 1.469 (95% confidence interval: 1.262-1.711; P < .001). Higher age, higher interdialytic weight gain, higher comorbidity index, and catheter increased significantly the risk, whereas higher Kt/V, higher albumin, and higher normalized protein catabolic rate (≥1.05 g/kg/d) reduced the risk. CONCLUSION The MIS maintains its relevant and significant association with hospitalization and mortality.