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- A diálise peritoneal na actual crise pandémica: uma oportunidade de reflexãoPublication . Domingos, Ana; Guedes, A Malho; Neves, Pedro LeãoSão difíceis os tempos que se vivem, e tempos mais difíceis poderão estar por chegar. A actual pandemia do novo coronavírus obrigou a uma total reformulação da sociedade em geral e, em especial, dos cuidados que concernem à área da saúde.
- Pseudomonas mendocina: the first case of peritonitis on peritoneal dialysisPublication . Jeronimo, Teresa M.; Malho Guedes, A; Stieglmair, Sandra; Guerreiro, Raquel; Laranjo, Ceu; Bernardo, Idalecio; Neves, Pedro Leão
- Peritoneal protein loss, inflammation, and nutrition: refuting mythsPublication . Malho Guedes, A.; Calças Marques, Roberto; Ribeiro, Brigitte; Fernandes, Mónica T.; Faísca, Marília; Silva, Ana Paula; Bragança, José; Rodrigues, AnabelaPeritoneal protein loss (PPL) has been correlated with mortality, malnutrition and inflammation. More recently overhydration was brought to the equation. This study aims to review classic and recent factors associated with PPL. Prevalent and incident peritoneal dialysis (PD) patients were included. Dialysate and serum IL-6 was obtained during PET. Hydration and nutritional status were assessed by bio-impedance. Linear regression and Cox regression were performed. The 78 included patients presented median values of PPL 4.8 g/24 h, serum IL-6: 5.1 pg/mL, and IL-6 appearance rate 153.5 pg/min. Mean extracellular water excess (EWexc) was 0.88 ± 0.94 L, and lean body mass index (LBMI) 17.3 ± 2.4 kg/m2 . After mean follow-up of 33.9 ± 29.3 months, 12 patients died. Linear univariable analysis showed positive associations between PPL and small solute transport, body composition (LBMI and EWexc), comorbidities and performing CAPD (vs. cycler). PPL correlated positively with dialysate appearance rate of IL-6, but not with serum IL-6. Linear multivariable analysis confirmed positive association between PPL and EWexc (p = 0.012; 95%CI: 4.162–31.854), LBMI (p = 0.008; 95%CI: 1.720–11.219) and performing CAPD (p = 0.023; 95%CI: 4.375–54.190). In survival analysis, no relationship was found between mortality and PPL. Multivariable Cox regression showed Charlson Comorbidity Index (HR: 1.896, 95%CI: 1.235–2.913), overhydration (HR: 10.034, 95%CI: 1.426–70.587) and lower PPL (HR: 0.576, 95%CI: 0.339–0.978) were predictors for mortality. Overhydration, was a strong predictor of PPL, overpowering variables previously reported as determinants of PPL, namely clinical correlates of endothelial dysfunction or local inflammation. PPL were not associated with malnutrition or higher mortality, emphasizing the importance of volume overload control in PD patients.
- The effect of paricalcitolon dialysate protein loss in peritoneal dialysis patientsPublication . Jerónimo, Teresa; del Peso, Gloria; Gayo, Lucia; Guedes, A. Malho; Silva, Ana P.; Neves, Pedro L.; Selgas, Rafael; Bajo, Maria A.Ever since peritoneal dialysis (PD) has been used in the treatment of chronic kidney disease (CKD), high peritoneal protein loss has been observed on each PD exchange. In adult patients, the loss has been estimated at 6 to 13 g daily. Paricalcitol, a selective activator of vitamin D receptors (VDR), is successfully used as a treatment of hyperparathyroidism secondary to CKD. In addition, it has been proposed for reducing proteinuria in patients with CKD. Nonetheless, little is known about its effect on peritoneal protein loss (PPL) in patients on PD, namely after the identification of VDRon the peritoneal membrane. The aim of this study wasto examine the effect of paricalcitol on PPL in PD patients.
- Gla-Rich protein is associated with vascular calcification, inflammation, and mineral markers in peritoneal dialysis patientsPublication . MARREIROS, CATARINA; Viegas, Carla; Malho Guedes, Anabela; Silva, Ana Paula de Andrade; Águas, Ana Catarina; Faísca, Marília; Schurgers, Leon; Simes, DinaVascular calcification (VC) is a crucial risk factor for cardiovascular diseases (CVD), particularly in chronic kidney disease (CKD) populations. However, the specific relationship between VC and end-stage renal disease (ESRD) patients undergoing peritoneal dialysis (PD) remains to be fully understood. The identification of new biomarkers to improve VC diagnosis and monitoring would significantly impact cardiovascular risk management in these high-risk patients. Gla-rich protein (GRP) is a VC inhibitor and an anti-inflammatory agent and thus is a potential VC marker in CKD. Here we explored the potential role of GRP as a marker for CVD and investigated the impact of VC in 101 PD patients. Methods: Circulating total Gla-rich protein (tGRP) was quantified in serum and in 24 h dialysate samples. VC score (VCS) was determined using the Adragão method. Results: Serum tGRP was negatively associated with VCS, serum calcium (Ca), phosphate (P), and high-sensitivity C-reactive protein (hsCRP), while it was positively associated with magnesium (Mg). A total of 35.6% of PD patients presented with extensive calcifications (VCS ≥ 3), and the lowest tGRP serum levels were present in this group (419.4 ± 198.5 pg/mL). tGRP in the 24 h dialysate was also negatively associated with VCS and with serum Ca and P. Moreover, serum Ca, P, and VCS were identified as independent determinants of serum tGRP levels. Conclusions: The association of serum tGRP with VC, mineral, and inflammation markers reinforces its potential use as a novel VC biomarker in CKD patients undergoing PD.