Papers by Adrian Guinsburg
The MONitoring Dialysis Outcomes (MONDO) initiative. (DOCX 39 kb)
This study examined changes in pupils' agency beliefs and control expectancy from grade four to g... more This study examined changes in pupils' agency beliefs and control expectancy from grade four to grade six, and whether they were associated with studying in a class with a special emphasis on a subject as compared to studying in a class without emphasis. After controlling for the effects of mother's education, prior school achievement, and gender, we found that the average pattern of change varied for different action-control beliefs, and that class membership did not moderate these changes. Mother's education, pupils' prior school achievement, and gender all predicted class membership, but their effects on action-control beliefs varied depending on the type of belief. Implications for educational policy will be discussed.
Osteoporosis and Sarcopenia, 2021
Osteoporosis and Sarcopenia, 2021
Objectives: Sarcopenia is the loss of skeletal muscle mass and function that occurs with aging th... more Objectives: Sarcopenia is the loss of skeletal muscle mass and function that occurs with aging that can lead to greater morbidity and mortality. Chronic kidney disease and hemodialysis (HD) favors the development of sarcopenia. We studied the prevalence of sarcopenia and its components using European Working Group on Sarcopenia in Elderly People 2 proposed criteria and risk factors for its development in HD patients. Methods: In 100 adult HD patients, we evaluated: hand grip strength (HGS), muscle mass by dual energy X-ray absorptiometry and physical performance (gait-speed and sit-stand test). Results: Sixty patients were male and 40 were female; mean age 55.6 years. Prevalence of sarcopenia was 16% (11.1% in males and 25% in females; P ¼ 0.05); 7% had severe sarcopenia. Prevalence of low HGS was 33% in males and 28% in females; low muscle mass was 30% in males but 70% in females and low physical performance 23% in males and 45% in females. Falls were reported by 23 patients. Patients with lower HGS had a higher prevalence of falls in the last year (40% two or more falls; P ¼ 0.03). Only females with sarcopenia had lower bone mineral content. Neither age, body mass index, time on dialysis, or prevalence of diabetes predicted sarcopenia. Conclusions: A significant proportion of dialysis patients had sarcopenia, more frequent in females. Low HGS was associated with a higher prevalence of falls. Only females with sarcopenia had lower bone mineral content.
Cardiology, 2015
Access to full text and tables of contents, including tentative ones for forthcoming issues: www.... more Access to full text and tables of contents, including tentative ones for forthcoming issues: www.karger.com/crd_issues 91 The Ankle-Brachial Index Is Related to Left Ventricular Ejection Fraction in Bonnet Macaques
Nephrology Dialysis Transplantation, 2014
Introduction and Aims: Although some guidelines recommend salt restriction, few studies have exam... more Introduction and Aims: Although some guidelines recommend salt restriction, few studies have examined the association between salt restriction and clinical outcomes in hemodialysis (HD) patients. Methods: We conducted a retrospective cohort study of 88,115 adult patients enrolled in the Japanese Society for Dialysis Therapy (JSDT) registry (2008) who had received HD for at least two years and were considered anuric. The primary outcome measure was all-cause mortality at one year, and the secondary outcome was cardiovascular (CV) mortality. Estimated salt intake was the main predictor, and was calculated from interdialytic weight gain and pre-and postdialysis serum sodium levels according to the validated method of Kimura and Ramdeen. Nonlinear logistic regression was used to determine the association of salt intake with mortality, adjusting for age, gender, body mass index, vintage of HD, dialysis time, Kt/V, protein catabolic rate normalized to body weight, comorbid conditions, type of vascular access, serum potassium, phosphate, calcium, CRP level, and endotoxin level in dialysate. Cubic splines were plotted and the reference was median salt intake. Salt consumption was categorized by intake levels of 2 g per day and the association with mortality examined. Results: Median [25th-75th percentile] salt intake at baseline was 6.4 [4.6-8.3] g per day. At one year, all-cause mortality occurred in 1,845 (2.1%) patients, including cardiovascular mortality in 821 (0.9%). We observed an association between low salt intake and clinical outcomes (all-cause and CV mortality) (Fig.1). We observed the highest all-cause mortality in the low salt group (<6g/day) (Fig.2), and no association between all-cause mortality and high salt intake. Further, we observed similar associations between salt intake and CV mortality. Conclusions: Low salt intake is associated with all-cause and CV mortality. These findings do not support current clinical guidelines, which recommend restricting salt intake to less than 6g per day.
Nephrology Dialysis Transplantation, 2012
The GNRI is a very simple and objective method to assess nutritional condition, utilizing only th... more The GNRI is a very simple and objective method to assess nutritional condition, utilizing only three objective parameters: body weight, height and serum albumin values. To date, there have been few longitudinal studies that have used GNRI to predict mortality in chronic hemodialysis patients. In the present study, we validated whether using GNRI as a nutritional screening tool could be a clinical predictor of mortality in Korean hemodialysis patients. Methods: We examined the GNRI of 120 maintenance hemodialysis patients and followed these patients for 120 months. Predictors for all-cause death were examined using life table analysis and the Cox proportional hazards model Results: Life table analysis revealed that subjects with a GNRI; < 90 (n = 19) had a marginally lower survival rate than did those with a GNRI = 90 (n = 101) (Wilcoxon test, P = 0.048). Multivariate Cox proportional hazards analyses demonstrated that the GNRI was a significant predictor of mortality [hazard ratio (HR) 0.966, 95% confidence interval (CI) 0.945-0.995, P = 0.018], after adjusting for age, sex, presence of type 2 diabetes mellitus, and body weight Conclusions: These results demonstrate that the GNRI may be a significant predictor of mortality in Korean hemodialysis patients. SAP262 Table 1 Clinical characteristics of 120 chronic hemodialysis patients according to GNRI SAP262 Table 2. Multivariate Cox proportional hazards analysis of mortality PCR : normalized protein catabolic rate SBP : systolic blood pressure
Blood Purification, 2013
Access to full text and tables of contents, including tentative ones for forthcoming issues: www.... more Access to full text and tables of contents, including tentative ones for forthcoming issues: www.karger.com/bpu_issues No. 2
Blood Purification, 2013
Purpose: To determine the frequency of CYP3A5 and MDRI gene polymorphisms and study their relatio... more Purpose: To determine the frequency of CYP3A5 and MDRI gene polymorphisms and study their relationship to Tacrolimus (Tac) pharmacokinetics. Methods: Across sectional study was performed in 51 transplant children. A 12 h Tac pharmacokinetic profile (pk) was obtained with eight time sample points, DNA was obtained from peripheral blood for CYP3A5 genotyping by direct sequencing. The 51 patients were classified according to the genotype, as expressors CYP3A5*1*1 and CYP3A5*3*3 known as wild type and mutated allele (non-expressers). A nine pointpharmacokinetic profile of Tacrolimus was performed. Results: 22 patients (43.1%) were CYP3A5 expressers and 29 (56.8%) non expressers. The statistical analysis was performed with Kruskal-Wallis test. Twenty-two (43.1%) were CYP3A5 expressers and required high tacrolimus dose (0.12 mg/Kg/day) to appropriate tacrolimus serum levels. Twenty nine patients (56.8%) were non-expressers, they needed 0.06 mg/Kg/day. The AUC0-/dose was lower in nonexpressers patients. The trough levels, half life time and the time to reach the maximum concentration were no different between the groups.Pharmacokinetic parameters by genotype are depicted in Table 1. Conclusion: The CYP3A5*3*3 allele frequency was 56.8% in mexican renal transplant children. The CYP3A5 gene polymorphism predicts Tac PK.
Blood Purification, 2013
mized patient data and collaboratively analyze populations across national and regional boundarie... more mized patient data and collaboratively analyze populations across national and regional boundaries. To that end, datasets from different electronic health record systems are converted into a uniform structure. Patients are enrolled without systematic exclusions into open cohorts representing the diversity of patients. A large number of patient level treatment and outcome data is recorded frequently and can be analyzed with little delay. Detailed variable definitions are used to determine if a parameter can be studied in a subset or all databases. Conclusion: MONDO has created a large repository of validated dialysis data, expanding the opportunities for outcome studies in dialysis patients. The density of longitudinal information facilitates in particular trend analysis. Limitations include the paucity of uniform definitions and standards regarding descriptive information (e.g. comorbidities), which limits the identification of patient subsets. Through its global outreach, depth, breadth and size, MONDO advances the observational study of dialysis patients and care.
Kidney International, 2013
LA Usvyat et al.: IDWG, SBP, serum albumin, and CRP levels change before death c l i n i c a l i ... more LA Usvyat et al.: IDWG, SBP, serum albumin, and CRP levels change before death c l i n i c a l i n v e s t i g a t i o n
Nephrology Dialysis Transplantation
Background and Aims Mineral bone disease in dialysis patients is an important predictor of morbim... more Background and Aims Mineral bone disease in dialysis patients is an important predictor of morbimortality.iPTH levels had been previously associated with different parameters, but not clearly to diabetic disease (DBT). We aim to analyze relationship between DBT and iPTH levels in a large cohort of dialysis patients from Fresenius Medical Care LatinAmerica (FMC LA). Method Prevalent dialysis patients (more than 90 days on renal replacement therapy) by November 2019 in FMC LA dialysis units (Argentina, Brasil, Chile, Colombia, Ecuador, Perú) were included into the dataset. We obtained demographic, treatment and laboratory data by November 2019. Patients were identified as DBT when DBT was informed as etiology of renal disease or any DBT related ICD10 code was recorded as comorbid condition into the database. Use of insulin, calcitriol, paricalcitol and cinacalcet was also obtained.To evaluate association between DBT and iPTH level, Student t test for independent samples was used. Krus...
Nephrology Dialysis Transplantation
Background and Aims Patients with CKD are at higher risk of hospitalization (hosp) and this event... more Background and Aims Patients with CKD are at higher risk of hospitalization (hosp) and this event is a known marker of prognosis. In this study we aim to describe hospitalizations in LatinAmerica and the impact on body composition as measured by multifrequency bioimpedance. Method All hospitalizations from Fresenius Medical Care clinical database (EuCliD®) registered in dialysis patients from Argentina, Brasil, Chile, Colombia, Ecuador and Perú during calendar year 2018 were included into the analysis. For each hospitalization we reviewed main reason (ICD10 code), duration and outcome (discharge or death). Body composition was measured using multifrequency bioimpedance (BMC®). On patients with BCM data available in the 30 days prior to hospitalization and before 15 days after discharge values pre and post hospitalization were recorded (BCM data, lab data, treatment data). Pre and post data were compared using Student t test for paired samples. All values expressed as mean ± standard...
American Journal of Nephrology
Background: Low serum sodium (SNa) is associated with an increased mortality in chronic hemodialy... more Background: Low serum sodium (SNa) is associated with an increased mortality in chronic hemodialysis (HD) patients. Dialysis patients are thought to have an individual pre-dialysis SNa set-point, yet there is evidence for variability of pre-dialysis SNa in individual patient. In this study, we explored the association of several SNa variability metrics with all-cause mortality in a large patient population from the international MONitoring Dialysis Outcomes (MONDO) Initiative. Methods: All adult incident patients from the MONDO database with more than 5 SNa measurements during the first year on HD were included. All patients were required to survive the first year on HD (defined as the baseline). During the subsequent 2 years of follow-up, all-cause mortality was recorded. The following variability indicators were calculated during baseline: mean SNa and its SD; average real variability (ARV, average the absolute distance of the 2 consecutive SNa measurements), and average direction...
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Papers by Adrian Guinsburg