Danilo Lemes Naves Gonçalves

Chronic kidney disease (CKD) is frequently diagnosed at advanced stages, resulting in high morbidity, mortality, and substantial economic burdens due to increased healthcare utilization and system costs. The relationship between CKD diagnosis and healthcare utilization remains unexplored in Brazilian population-based studies. Therefore, this study aimed to analyze the associations between health service utilization indicators and the presence of CKD in the Brazilian population. This was a cross-sectional study with a sample of 90,846 participants from the 2019 National Health Survey. Sociodemographic, clinical, and behavioral variables were collected. CKD was defined by self-reported prior diagnosis. The indicators of use of health services were a search for a health service or professional in the last two weeks, impairment of usual activities due to illness in the last two weeks, and hospitalizations for 24 h or more in the last 12 months. Other variables related to the use of health services, such as having health insurance, the time since the last consultation, and the type of health service most used, were also assessed. Logistic regression analysis was carried out to assess the associations between indicators of health service use and CKD. CKD increased the chance of hospitalization in the last 12 months by 3.16 times (OR 3.16; 95% CI 2.76–3.62) and the chance of impairment in usual activities due to illness by 3 times (OR 2.99; 95% CI 2.63–3.40). In addition, the presence of CKD increased the chance of the individual seeking health services 2.5 times in the last two weeks (OR 2.50; 95% CI 2.23–2.81), with primary health care (42.5%), private clinics or private outpatient clinics (21.2%) and emergency care units (17.2%) being the most sought-after services. CKD tripled the chance of hospitalization in the last 12 months and impaired usual activities due to illness, doubling the population’s search for health services in the last two weeks. Primary health care has proven to be the leading health service for individuals with CKD.

Background: The use of doxorubicin in chemotherapy has been associated with cardiotoxicity and heart failure. Physical exercise produces favorable morphofunctional adaptations in the cardiovascular system and may reverse cardiac dysfunction in patients undergoing chemotherapy. Objective: To assess the effects of physical training on myocardial structure, cardiac function, and exercise tolerance in Wistar rats initiated after the onset of cardiotoxicity-induced cardiotoxicity. Methods: This study investigated 30 adult male Wistar rats randomly divided into four groups: control (C), exercise (EX), doxorubicin [...] Abstract Background: The use of doxorubicin in chemotherapy has been associated with cardiotoxicity and heart failure. Physical exercise produces favorable morphofunctional adaptations in the cardiovascular system and may reverse cardiac dysfunction in patients undergoing chemotherapy. Objective: To assess the effects of physical training on myocardial structure, cardiac function, and exercise tolerance in Wistar rats initiated after the onset of cardiotoxicity-induced cardiotoxicity. Methods: This study investigated 30 adult male Wistar rats randomly divided into four groups: control (C), exercise (EX), doxorubicin

The function of uric acid (UA) in the genesis and evolution of chronic kidney disease (CKD) has motivated numerous studies, but the results remain inconclusive. We sought to conduct a systematic review and meta-analysis of cohort studies aiming to analyze the association of UA levels with the incidence and progression of CKD. Pubmed/Medline, Lilacs/Bireme and Web of Science were searched to identify eligible studies, following the PRISMA protocol. Data were presented for CKD incidence and progression separately. For the meta-analysis, studies with data stratified by subgroups according to serum UA levels were selected. The inverse variance-weighted random effects model was used to generate a combined effect estimate. Meta-regressions were performed to identify the causes of heterogeneity. The Newcastle–Ottawa Scale was used to assess the risk of bias. The publication bias was tested by funnel plot and Egger’s test. Eighteen CKD incidence studies (n = 398,663) and six CKD progression studies (n = 13,575) were included. An inverse relationship was observed between UA levels and protection from CKD incidence and progression. Lower UA levels were protective for the risk of CKD incidence (RR 0.65 [95% CI 0.56–0.75]) and progression (RR 0.55 [95% CI 0.44–0.68]). UA seems to be implicated both in the genesis of CKD and its evolution.

Background: Recent studies have shown that the serum uric acid/creatinine ratio (SUA/SCr) is a better predictor of chronic kidney disease (CKD) than serum uric acid (SUA) isolated. The aim of the present study was to evaluate the association of isolated SUA and the SUA/SCr with CKD in hypertensive patients. Methods: Cross-sectional study conducted with hypertensive patients followed-up by the Primary Health Care Service (PHC). Sociodemographic, economic, lifestyle, clinical, anthropometric, and biochemical variables were evaluated. The association between SUA parameters (quartiles of SUA and quartiles of SUA/SCr) and CKD was evaluated by bivariate and multivariate logistic regression. The association between SUA parameters (SUA and SUA/SCr) and estimated glomerular filtration rate (eGFR) was evaluated by linear regression. The analyses were performed considering four adjustment models. SUA and SUA/SCr were compared by receiver operating characteristic (ROC) curve. Results: In the fully adjusted model, SUA was positively associated with the presence of CKD (OR = 6.72 [95 % CI 1.96–22.96]) and inversely associated with eGFR (β Coef. = -2.41 [95 % CI -3.44; -1.39]). SUA/SCr was positively associated with eGFR (β Coef. = 2.39 [1.42; 3.36]). According to the ROC curve, the SUA is a better predictor of CKD than the SUA/SCr. Conclusions: Elevated levels of isolated SUA were associated with CKD and eGFR. However, the SUA/SCr was not associated with CKD. We do not recommend using the SUA/SCr to predict CKD in hypertensive patients.