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CHA2DS2-VASc score as a predictor of cardiovascular and all-cause mortality in a prospective cohort of hemodialysis patients of predominantly African ancestry: The PROHEMO

2026-03-06T13:05:38Z

Título: CHA2DS2-VASc score as a predictor of cardiovascular and all-cause mortality in a prospective cohort of hemodialysis patients of predominantly African ancestry: The PROHEMO Autor(es): Gutiérrez-Peredo, Gabriel Brayan; Gutiérrez-Peredo, Andrea Jimena; Montaño-Castellón, Iris; Silva Neto, Marinho Marques da; Silva, Fernanda Albuquerque da; Martins, Marcia Tereza Silva; Matos, Cacia Mendes; Monteiro, Jean Michell Correia; Silva, Pedro Guimarães; Lopes, Gildete Barreto; Lopes, Marcelo Barreto; Correia, Luis Claudio; Pecoits-Filho, Roberto; Norris, Keith C.; Lopes, Antonio Alberto Abstract: Background: Patients with chronic kidney disease undergoing maintenance hemodialysis (MHD) have an increased mortality. The CHA2DS2-VASc score, initially used for stroke prediction in atrial fibrillation, is relevant for various cardiovascular conditions. This study evaluates its effectiveness in predicting cardiovascular and all-cause mortality in MHD patients. Methods: Data are from the "Prospective Study of the Prognosis of Patients on Chronic Hemodialysis" (PROHEMO) in Salvador, Brazil. Patients were divided by CHA2DS2-VASc scores: ≤2 and >2. Cox regression estimated hazard ratios (HR) for death, both unadjusted and adjusted for confounders. We assessed the distribution of each score variable and its association with mortality. A modified CHA2DS2-VASc score was created due to the low percentage of patients over 75 (1.3%) and normotensive (4.6%). Results: A total of 237 patients (mean age 51.6 years; 57.0% male) were included in the study. There were 55 deaths, 21 from cardiovascular causes. For patients with a CHA2DS2-VASc score >2, the unadjusted hazard of all-cause mortality was doubled (HR = 2.05; 95% CI: 1.20, 3.49) compared to those with a score ≤2, and the risk for cardiovascular deaths was more than threefold (HR = 3.53; 95% CI: 1.46, 8.54). These ratios remained consistent after adjusting for covariates. In the most comprehensive Cox model, the HR for all-cause mortality was 2.43 (95% CI: 1.38, 4.23) and for cardiovascular mortality was 3.52 (95% CI: 1.40, 8.84), similar to results from the modified CHA2DS2-VASc score. Conclusions: The results support the CHA2DS2-VASc score as a practical tool for identifying MHD patients at higher risk of mortality, especially from cardiovascular causes. Editora / Evento / Instituição: Programa de Pós-Graduação em Medicina e Saúde (PPgMS), Universidade Federal da Bahia (UFBA) Tipo: Artigo de Periódico

Functional dependence and the mental dimension of quality of life in Hemodialysis patients: the PROHEMO study

2026-03-06T13:03:15Z

Título: Functional dependence and the mental dimension of quality of life in Hemodialysis patients: the PROHEMO study Autor(es): Gutiérrez-Peredo, Gabriel Brayan; Martins, Márcia Tereza Silva; Silva, Fernanda Albuquerque da; Lopes, Marcelo Barreto; Lopes, Gildete Barreto; Lopes, Antonio Alberto Abstract: Functional dependence is highly prevalent in maintenance hemodialysis (MHD) settings. Also, poor health-related quality of life (HRQoL) and high levels of depressive symptoms have been reported by MHD patients. We investigated associations between functional status and mental aspects of quality of life in Brazilian MHD patients. Methods Cross sectional study of 235 patients enrolled in two of the four participating MHD clinics of the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO) in Salvador, BA, Brazil. Data were collected from September 2016 to August 2017. The Katz’s questionnaire was used for basic activities of daily living (ADL) and the Lawton-Brody’s questionnaire for instrumental activities of daily living (IADL). ADL and IADL scores were combined to create 3 functional status groups: highly dependent (n = 47), moderately dependent (n = 109) and independent (n = 82). The validated Brazilian version of the Kidney Disease Quality of Life Short Form (KDQOL-SF) was used for scores of two distinct HRQoL measures, i.e., the mental component summary (MCS) and the 5-item mental health inventory (MHI-5). We used linear regression to estimate differences in scores with adjustment for possible confounders: months of dialysis, age, gender, other sociodemographic variables, body mass index, type of vascular access, dialysis dose by Kt/V, laboratory variables (albumin, blood hemoglobin, calcium, phosphorus, urea, creatinine and parathyroid hormone) and nine comorbid conditions. Results Mean age was 51.2 ± 12.4 yr (median age = 51.0 yr), 59.1% were male, 93.2% were non-White. The prevalence of self-reported functional status differed by age: 54.4% for age < 45 yr, 67.8% for age 45–60 yr and 73.9% for age ≥ 60 yr. Using functionally independent as reference, lower scores were observed for highly dependent patients in MCS (difference: -4.69, 95% CI: -8.09, -0.29) and MHI-5 (difference: -5.97, 95% CI: -8.09, -1.29) patients. These differences changed slightly with extensive adjustments for covariates. Conclusions Our results call attention to a high prevalence of functional dependence in younger and older MHD patients. The results suggest that the lower self-reported mental quality of life in functionally dependent MHD patients cannot be explained by differences in age and comorbidities. Editora / Evento / Instituição: Programa de Pós-Graduação em Medicina e Saúde (PPgMS), Universidade Federal da Bahia (UFBA) Tipo: Artigo de Periódico

Prontuário Orientado por Problemas e Evidências (POPE)

2026-03-23T18:21:32Z

Título: Prontuário Orientado por Problemas e Evidências (POPE) Autor(es): Lopes, Antonio Alberto Abstract: O presente versão (2020) do manual do Prontuário Orientado por Problemas e Evidências (POPE) é fruto de sucessivas modificações desde a primeira versão usada para o ensino de raciocínio clínico na década de 1990. Neste manual são descritos os itens que compõem o POPE e mostrados exemplos do uso do POPE em paciente internado e ambulatorial. Tipo: Artigo de Periódico