Banca de DEFESA: FERNANDA MARCELINO DE REZENDE E SILVA

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : FERNANDA MARCELINO DE REZENDE E SILVA
DATE: 30/11/2023
TIME: 09:00
LOCAL: Videoconferência
TITLE:

EVALUATION OF MARKERS OF RENAL PROGRESSION: GLOMERULAR FILTRATION RATE AND KIDNEY FAILURE RISK EQUATIONS (KFREs) tool


KEY WORDS:
Chronic Kidney Failure, Glomerular Filtration Rate, SUS, KFREs

PAGES: 82
BIG AREA: Ciências da Saúde
AREA: Saúde Coletiva
SUMMARY:
Introduction: chronic kidney disease (CKD) can be defined as abnormalities in
the structure and/or function of the kidneys present for three or more months, with
implications for health. When there is a need for renal replacement therapy (RRT),
when the glomerular filtration rate (GFR) < 15 mL/min/1.73m2 remains reduced
and sustained, or even when there is a 40% increase in the value of serum
creatinine in the interval of at least one month or more in relation to the baseline
value, it is said that there has been evolution to chronic renal failure (CRF). The
exponential increase in the prevalence of CKD and its undesirable outcomes in
Brazil and in the world is a consequence of population aging and concomitant
increase in the prevalence of associated diseases, such as diabetes mellitus (DM),
systemic arterial hypertension (SAH) and obesity. Delay in referral to nephrology
services and the repeated urgent initiation of dialysis, frequent in Brazilian clinical
practice, are independent risk factors for morbidity and mortality among patients
with kidney disease. Recognized by the literature, by scholars in the area and by
most healthcare professionals, GFR is one of the most used parameters to
conduct approaches to patients with CKD who are not on dialysis. However, given
the reality of care with the aforementioned delays in referrals to nephrology
services and frequent urgent initiations of dialysis, the question arises about the
benefits of prioritizing the use of this marker for managing non-dialytic CKD. In
addition, it is assumed that the implementation of new risk predictors based on
tools such as the Kidney Failure Risk Equations (KFREs) and multidisciplinary
clinical management could add important information in the follow-up of these
patients and mitigate inappropriate referrals to the evolution to more severe
conditions of the disease. CKD, and how to better adjust the focus of clinical care
in search of milder outcomes. Methods: this work was divided into two substudies
with similar populations and different objectives. Substudy one refers to a
retrospective cohort of five years of follow-up, developed in a nephrology
outpatient clinic of a large hospital in a city in the center-west of Minas
Gerais/Brazil, in the year 2021, whose objective was to evaluate the behavior of
the rate of estimated glomerular filtration (eGFR) of chronic renal patients on
conservative treatment during five years of follow-up (article 1). Substudy two is a
retrospective cohort with patients from two nephrology outpatient clinics in stages
3 to 5 of non-dialytic CKD followed up for a period of at least two years to at least
five years between 2014 and 2022 and who had available in their medical records
the eGFR results, urinary albumin/creatinine ratio result, or albuminuria during the
follow-up period. The objective of substudy two was to evaluate the application of
the Kidney Failure Risk Equations (KFREs) tool as a predictor of renal evolution in
two and five years in people with non-dialytic kidney disease born and residing in
Brazil. Results: sub-study 1 will be presented in the format of an article already
accepted in a qualis A4 journal, Observatorio de La Economía Latinoamericana
(OLEL), entitled: Profile of estimated glomerular filtration rate in non-dialysis
patients: challenge for the preventive approach. Sub-study two will be presented in
the form of an article to be submitted in the journal Revista de Ciências Médicas e
Bilógicas da UFBA Qualis A4, entitled “Kidney failure risk equations predictive tool
for progression of kidney disease: applicable to the Brazilian population?”
Conclusions: substudy one: At the end of the five-year follow-up, no patient remained in stages 1, 2 and 3 of CKD; there was an upward curve in the number
of people in stage 4 indicating worsening renal function and the number of patients
in stage 5 remained stable. Sub-study two: KFRE was not confirmed as a strong
predictor of evolution to CRI for people with non-dialytic CKD born and residing in
Brazil.

BANKING MEMBERS:
Externa à Instituição - GRACE FERNANDA SEVERINO NUNES - UNESP
Presidente - 1347706 - ALBA OTONI COLLARES
Externa ao Programa - 2028750 - CAROLINE PEREIRA DOMINGUETI
Externo à Instituição - FLÁVIO MENDONÇA PINTO - FSCBH
Externa ao Programa - 1680498 - MARCIA CHRISTINA CAETANO ROMANO
Notícia cadastrada em: 08/11/2023 09:38
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