Association between fear of falling and a history of falls in patients with end-stage renal disease on hemodialysis.

Introduction: Hemodialysis patients have complications that increase fear of falling (FOF). This study evaluated the association between FOF and a retrospective history of falls in hemodialysis patients and investigated the ability of the Fall Efficacy Scale-International (FES-I) to discriminate fallers from nonfallers.

Methods: A retrospective study was conducted with 183 patients to investigate the history of falls in the last 12 months and to evaluate FOF by the FES-I.

Cross-sectional assessment of mild cognitive impairment in pre-dialysis chronic kidney disease and its association with inflammation and changes seen on MRI: what the eyes cannot see.

Introduction: Mild cognitive impairment (MCI) is a prevalent and underdiagnosed condition in chronic kidney disease (CKD), that shares common pathophysiological factors such as chronic inflammation.

Objective: To evaluate the association of MCI in CKD stages 1-5 using inflammatory markers and changes by magnetic resonance imaging (MRI).

Patients And Methods: Cross-sectional study in adult patients with pre-dialysis CKD.

The prevalence and associated factors of nonadherence to antihypertensive medication in secondary healthcare.

Purpose: Non-adherence (NA) to medication is a major contributor to treatment failure in hypertensive patients. Factors of the ecological model, at family/healthcare professional, service, and system levels, are rarely evaluated as correlates of NA in hypertensive patients.

Methods: This crossectional study assessed the prevalence of and associated factors of NA to antihypertensive medication among 485 hypertensive patients upon receiving secondary healthcare.

[Cross-cultural adaptation of the PAIR instrument: Pharmacotherapy Assessment in Chronic Renal Disease for application in Brazil].

Individuals suffering from chronic kidney disease (CKD) are often on multiple medications, which exposes them to drug-related problems (DRP). There are no available tools in Brazil to assess the pharmacotherapy and management of DRPs systematically in this population. The scope of this study was to perform a cross-cultural adaptation of PAIR criteria (Pharmacotherapy Assessment in Chronic Renal Disease) to Brazilian Portuguese.

Pharmacotherapy assessment in chronic kidney disease: validation of the PAIR instrument for use in Brazil.

Individuals with chronic kidney disease (CKD) use polypharmacy, which, in combination with renal impairment, exposes them to the risk of drug-related problems (DRPs). There are no available tools in Brazil to systematically assess the pharmacotherapy and management of DRPs in this population. Therefore, the objective of this work was to validate the PAIR instrument (Pharmacotherapy Assessment in Chronic Renal Disease) for use in Brazilian Portuguese.

αKlotho attenuates cardiac hypertrophy and increases myocardial fibroblast growth factor 21 expression in uremic rats.

Unlabelled: In chronic kidney disease (CKD), evidence suggests that soluble αKlotho (sKlotho) has cardioprotective effects. Contrariwise, high circulating levels of fibroblast growth factor 23 (FGF23) are related to uremic cardiomyopathy development. Recently, it has been demonstrated that sKlotho can act as a soluble FGF23 co-receptor, allowing sKlotho to modulate FGF23 actions in the myocardium, leading to the activation of cardioprotective pathways.

Effects of long-term aerobic training and detraining on functional capacity and quality of life in hemodialysis patients: A pilot study.

Although previous studies have shown the benefits of exercise training in hemodialysis patients, little is known about the effects of long-term of exercise program on these patients. We investigated the effects and the safety of long-term aerobic training and the effects of detraining on functional capacity and quality of life in hemodialysis patients. Ten patients were allocated to two groups: training and detraining.

Effects of intradialytic resistance training on physical activity in daily life, muscle strength, physical capacity and quality of life in hemodialysis patients: a randomized clinical trial.

We evaluated the effects of supervised intradialytic resistance training on physical activity in daily life (PADL), muscle strength, physical capacity and quality of life (QoL) in hemodialysis patients. Twenty-four hemodialysis patients were randomly assigned to either a 12-weeks moderate-intensity resistance training or a control period. An accelerometer evaluated PADL for seven consecutive days, measuring the time spent in different activities and positions of daily routine and the number of steps taken.

Dialogue between primary and secondary health care providers in a Brazilian hypertensive population.

Objective: To describe clinical and epidemiological profiles of patients with hypertension referred to a secondary care unit and to assess the adequacy of the referral criteria.

Method: This descriptive transversal study analysed 943 hypertensive patients referred to a secondary healthcare unit from September 2010 to August 2012. Clinical and sociodemographic data as well as data regarding the liaison between secondary and primary care services were collected.

Fibroblast growth factor 21 in chronic kidney disease.

Fibroblast growth factor 21 (FGF21) is a member of the endocrine FGF family that acts as a metabolic regulator of both glucose and lipid metabolism. Similar to fibroblast growth factor 23 (FGF23), serum FGF21 levels rise progressively with the loss of renal function, reaching 20 times normal values in end-stage renal disease. In patients with chronic kidney disease (CKD), higher serum FGF21 levels correlate with poorer metabolic profile, higher inflammatory markers, more comorbidities, and higher mortality.

Intradialytic resistance training: an effective and easy-to-execute strategy.

Unlabelled: Chronic kidney disease (CKD) alters the morphology and function of skeletal muscles, thereby decreasing patient physical capacity (PC) and quality of life (QoL). Intradialytic resistance training (IRT) is a pragmatic tool used to attenuate these complications. However, IRT has not been strongly adopted in nephrology care centers.

Chronic kidney disease: susceptibility in a representative population-based sample.

Chronic kidney disease has high morbidity and mortality. In order to track the disease, we conducted a population-based study in a medium-sized city in Southeastern Brazil. Based on instrument SCreening for Occult REnal Disease (SCORED), we evaluated 1,016 individuals with mean age of 44 (SD = 13.

Validated registry of pre-dialysis chronic kidney disease: description of a large cohort.

Introduction: Chronic diseases account for the majority of deaths in Brazil. These include hypertension (SAH) and diabetes mellitus (DM), which are the main causes of chronic kidney disease (CKD).

Objective: This study aimed to validate the data of an electronic health record and to point out characteristics of the profile of these users in relation to clinical quality indicators for a pre-dialytic CKD.

Quality of Care of Patients with Diabetes in Primary Health Services in Southeast Brazil.

Background: Diabetes management involves multiple aspects that go beyond drug therapy as a way of providing high quality care. The objective of this study was to describe quality of care indicators for individuals with diabetes in southeast Brazil and to explore associations among these indicators.

Methods: In this cross-sectional, observational study, health care providers filled out a questionnaire addressing health care structure and processes at 14 primary health care units (PHCUs).

Different times of day do not change heart rate variability recovery after light exercise in sedentary subjects: 24 hours Holter monitoring.

Incidence of cardiovascular events follows a circadian rhythm with peak occurrence during morning. Disturbance of autonomic control caused by exercise had raised the question of the safety in morning exercise and its recovery. Furthermore, we sought to investigate whether light aerobic exercise performed at night would increase HR and decrease HRV during sleep.

Factors Associated With Functional Capacity in Hemodialysis Patients.

Hemodialysis patients have a marked decrease in functional capacity when compared to healthy individuals. We evaluated the factors associated with functional capacity in hemodialysis patients. A total of 102 hemodialysis patients were evaluated.

Baroreflex gain and vasomotor sympathetic modulation in resistant hypertension.

Purpose: The aim of this study was to determine the gain and latency of arterial baroreflex control of heart rate in patients with resistant hypertension compared to patients with essential hypertension and normotensive subjects.

Methods: Eighteen patients with resistant hypertension (56 ± 10 years, mean of four antihypertensive drugs), 17 patients with essential hypertension (56 ± 11 years, mean of two antihypertensive drugs), and 17 untreated normotensive controls (50 ± 15 years) were evaluated by spectral analysis of the spontaneous fluctuations of arterial pressure (beat-to-beat) and heart rate (ECG). This analysis estimated vasomotor and cardiac autonomic modulations, respectively.

Strengths of primary healthcare regarding care provided for chronic kidney disease.

Objective: to assess the structure and results obtained by the "Chronic Renal Patients Care Program" in a Brazilian city.

Method: epidemiological, cross-sectional study conducted in 14 PHC units and a secondary center from 2010 to 2013. The Donabedian Model was the methodological framework used.

Physical Activity in Hemodialysis Patients Measured by Triaxial Accelerometer.

Different factors can contribute to a sedentary lifestyle among hemodialysis (HD) patients, including the period they spend on dialysis. The aim of this study was to evaluate characteristics of physical activities in daily life in this population by using an accurate triaxial accelerometer and to correlate these characteristics with physiological variables. Nineteen HD patients were evaluated using the DynaPort accelerometer and compared to nineteen control individuals, regarding the time spent in different activities and positions of daily life and the number of steps taken.

Total body water reduction in subjects with chronic kidney disease on peritoneal dialysis is associated with a better hypertension control.

Introduction: Hypertension is highly prevalent in patients with chronic kidney disease and hypervolemia is one of the principal causes.

Objective: To evaluate the influence of the reduction of volemia on blood pressure as well as on echocardiographic parameters in patients on continuous ambulatory peritoneal dialysis.

Methods: Twelve patients with no clinical evidence of hypervolemia were submitted to an increase in the rate of the dialysis with the purpose of reducing body weight by 5%.

Depressed cardiac autonomic modulation in patients with chronic kidney disease.

Introduction: A dysfunctional autonomic nervous system (ANS) has also been recognized as an important mechanism contributing to the poor outcome in CKD patients, with several studies reporting a reduction in heart rate variability (HRV).

Objective: Evaluate the sympathovagal balance in patients with chronic kidney disease on conservative treatment.

Methods: In a cross-sectional study, patients with CKD stages 3, 4 and 5 not yet on dialysis (CKD group) and age-matched healthy subjects (CON group) underwent continuous heart rate recording during two twenty-minute periods in the supine position (pre-inclined), followed by passive postural inclination at 70° (inclined period).

Can Nephrologists Use Ultrasound to Evaluate the Inferior Vena Cava? A Cross-Sectional Study of the Agreement between a Nephrologist and a Cardiologist.

Background/aims: The costs and the need for a specialist impair the implementation of ultrasonography for evaluating the inferior vena cava (IVC) to assess the volemic status in hemodialysis patients. We investigated whether a nephrologist with limited ultrasound training can accurately assess the IVC in patients undergoing hemodialysis.

Methods: A cardiologist and a nephrologist consecutively measured the indexed IVC expiratory diameter (VCDi) and the IVC collapsibility index (IVCCI) of 52 patients during hemodialysis sessions.