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PublicouIsabela César Gabeira Alterado mais de 6 anos atrás
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Dia Mundial do Rim O Dia Mundial do Rim é celebrado na segunda quinta-feira de março Objetivo: Sensibilizar a população em geral para as doenças renais que afetam milhões de pessoas em todo o mundo A detecção precoce e a adoção de um estilo de vida saudável são fortes aliados para evitar o aumento do número de casos das doenças renais crônicas
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O Dia Mundial do Rim foi criado em 2006
O Dia Mundial do Rim foi criado em A cada ano é escolhido um tema particular Doença renal e as crianças e “Agir cedo para prevenir”. 2015 – Saúde Renal para Todos 2014 – A Doença Renal Crônica e o Envelhecimento 2013 – Rins para a Vida – Pare a Lesão Renal Aguda! 2012 – Doar – Rins para a Vida – Receber 2011 – Proteja os seus Rins: Salve o seu Coração 2010 – Proteja os seus Rins: Controle a Diabetes 2009 – Proteja os seus Rins: Controle a Pressão Arterial 2008 – Os Seus Rins Incríveis 2007 – Doença Renal Crônica: Comum, Nociva e Tratável 2006 – Os seus Rins estão OK?
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“Homem Nu amanhece vestido”
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DRC e Obesidade DRC afeta 1 em 10 pessoas em nível mundial.
Afeta cerca de 641 milhões de adultos (220 milhões – crianças em idade escolar) ou 13% da população mundial adulta e pode chegar até 20% em 2025
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DRC e Obesidade Obesidade aumenta o risco de fatores de risco para DRC, como DM e HAS. Obesos possuem um risco 83% maior de DRC, comparados a indivíduos com peso normal. Impacto direto na DRC e na ESRD 2,6 milhões de pacientes em diálise (2010), com projeção de 5,4 milhões (2030) A boa notícia é que a obesidade, bem como a DRC, é em grande parte evitável.
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Doença Renal e Obesidade – Mecanismo
Kidney International (2017) 91, 260–262;
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Obesity-related perihilar focal segmental glomerulosclerosis on a background of glomerulomegaly. Periodic acid–Schiff stain, original magnification ×400. Figure courtesy of Dr. Patrick D. Walker, MD (Arkana Laboratories, Little Rock, AR). Kidney International , DOI: ( /j.kint ) Copyright © 2016 World Kidney Day 2017 Steering Committee Terms and Conditions
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2 condições associadas à obesidade
Nefrolitíase Neoplasias renais
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Resistência à insulina
SS Resistência à insulina
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Adequate Dietary Intake and Nutritional Status in Patients With Nephrolithiasis: New Targets and Objectives Larissa Marques Tondin de Oliveira, ESP,* Daniela Barbieri Hauschild, ESP,*Christiane de Mesquita Barros Almeida Leite, MS,* Deise Regina Baptista, MS,*and Mauricio Carvalho, MD, PhD, FACP†
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Adequate Dietary Intake and Nutritional Status in Patients With Nephrolithiasis: New Targets and Objectives Larissa Marques Tondin de Oliveira, ESP,* Daniela Barbieri Hauschild, ESP,*Christiane de Mesquita Barros Almeida Leite, MS,* Deise Regina Baptista, MS,*and Mauricio Carvalho, MD, PhD, FACP†
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Provável patogênese da litíase por ácido úrico
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Obesidade, Insulina e Fatores de Crescimento Tumorais
NATURE REVIEWS | CANCER VOLUME 4 | AUGUST 2004 | 579
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Overweight, Obesity, and Mortality from Cancer in a Cohort of U. S
Overweight, Obesity, and Mortality from Cancer in a Cohort of U.S. Adults - N Engl J Med 2003; 348:
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Overweight, Obesity, and Mortality from Cancer in a Cohort of U. S
Overweight, Obesity, and Mortality from Cancer in a Cohort of U.S. Adults - N Engl J Med 2003; 348:
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Adiposity and cancer at major anatomical sites: umbrella review of the literature
BMJ 2017;356:j477
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Adiposity and cancer at major anatomical sites: umbrella review of the literature
BMJ 2017;356:j477
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Estratégias de manejo Modificação de Estilo de Vida - Look Ahead
Cirurgia Bariátrica Farmacológico Liraglutida – Estudo LEADER Empaglifozina – Estudo EMPAREG
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Clinical Outcomes with Antihyperglycemic Agents
LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results)
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Clinical Outcomes with Liraglutide
LEADER Study Design Key Results N=9340 patients with T2D and high CV risk Randomization Liraglutide: n=4672 Placebo: n=4668 Noninferiority study: prespecified margin = 1.3 for upper bound of 95% CI of the HR for the primary endpoint Primary endpoint: composite of CV death, nonfatal MI (including silent MI), or nonfatal stroke Secondary endpoint: composite of CV death, nonfatal MI (including silent MI), nonfatal stroke, coronary revascularization, and hospitalization for unstable angina or HF Median follow-up: 3.5 years Difference from placebo at 36 months A1C: −0.40% (95% CI, −0.45% to −0.34%) Weight: −2.3 kg (95% CI, −2.0 to −2.5 kg) SBP: −1.2 mm Hg (95% CI, −0.5 to −1.9 mm Hg) CV outcomes Primary: HR 0.87 (95% CI 0.78 to 0.97); P=0.01 for superiority Secondary HR: 0.88 (95% CI 0.81 to 0.96); P=0.005 for superiority Significantly lower rates of all-cause death and CV death with liraglutide Increased rates of gastrointestinal events in liraglutide-treated patients Lower numerical incidence of pancreatitis in liraglutide group (not statistically significant) CI, confidence interval; CV, cardiovascular; HF, heart failure; HR, hazard ratio; MI, myocardial infarction. Marso SP, et al. N Engl J Med Jun 13. [Epub ahead of print]
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Clinical Outcomes with Liraglutide
LEADER (N=9340) Hazard ratio (95% CI) P value Primary composite endpoint* 0.87 ( ) 0.01 Expanded composite endpoint† 0.88 ( ) 0.005 Death from any cause 0.85 ( ) 0.02 CV death 0.78 ( ) 0.007 Fatal or nonfatal MI 0.86 ( ) 0.046 Nephropathy 0.78 ( ) 0.003 Favors liraglutide *CV death, nonfatal MI (including silent MI), or nonfatal stroke; †CV death, nonfatal MI (including silent MI), nonfatal stroke, coronary revascularization, and hospitalization for unstable angina or HF. CI, confidence interval; CV, cardiovascular; MI, myocardial infarction. Marso SP, et al. N Engl J Med Jun 13. [Epub ahead of print]
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LEADER trial: Primary Outcome
First occurrence of CV death, nonfatal myocardial infarction, or nonfatal stroke in the time-to-event analysis in patients with type 2 diabetes and high CV risk. Hazard ratio, 0.87 (95% CI, 0.78–0.97) P<0.001 for noninferiority P=0.01 for superiority Patients with an event (%) Placebo Liraglutide Months since randomisation Liraglutide Effect and Action in Diabetes: Evaluation of cardiovascular outcome Results (LEADER) trial Adapted from: Marso SP et al., NEJM 2016
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Clinical Outcomes with Antihyperglycemic Agents
EMPA-REG outcome (Empagliflozin cardiovascular Outcome event trial in type 2 diabetes mellitus patients)
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Clinical Outcomes with Empagliflozin
EMPA-REG OUTCOME Study Design Key Results N=7020 patients with T2D and CVD Randomization Empagliflozin: n=4687 Placebo: n=2333 Noninferiority study: prespecified HR margin = 1.3 for primary endpoint Primary endpoint: composite of CV death, nonfatal MI (excluding silent MI), or nonfatal stroke Secondary endpoint: composite of CV death, nonfatal MI (excluding silent MI), nonfatal stroke, and hospitalization for unstable angina Median follow-up: 3.1 years Week 206 A1C, difference from placebo Empagliflozin 10 mg: -0.24% (95% CI, -0.40% to -0.08%) Empagliflozin 25 mg: -0.36% (95% CI, -0.51% to -0.20%) CV outcomes (pooled analysis) Primary: HR 0.86 (95% CI 0.74 to 0.99); P=0.04 for superiority Secondary HR: 0.89 (95% CI 0.78 to 1.01); P<0.001 for noninferiority and P=0.08 for superiority Significantly lower rates of all-cause death, CV death, and HF hospitalization with empagliflozin Increased rates of genital infections in empagliflozin-treated patients CI, confidence interval; CV, cardiovascular; HF, heart failure; HR, hazard ratio; MI, myocardial infarction. Zinman B, et al. N Engl J Med. 2015;373:
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Clinical Outcomes with Empagliflozin
EMPA-REG OUTCOME Pooled Analysis (N=7020) Hazard ratio (95% CI) P value Primary composite endpoint* 0.86 ( ) 0.04 Secondary composite endpoint† 0.89 ( ) 0.08 Death from any cause 0.68 ( ) <0.001 CV death 0.62 ( ) Fatal or nonfatal MI 0.87 ( ) 0.23 Hospitalization for HF 0.65 ( ) 0.002 Hospitalization for HF or CV death 0.66 ( ) Favors empagliflozin *CV death, nonfatal MI (excluding silent MI), or nonfatal stroke; †CV death, nonfatal MI (excluding silent MI), nonfatal stroke, and hospitalization for unstable angina. CI, confidence interval; CV, cardiovascular; HF, heart failure; HR, hazard ratio; MI, myocardial infarction. Zinman B, et al. N Engl J Med. 2015;373:
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Renal Outcomes with Empagliflozin Over 3.2 Years
EMPA-REG RENAL (N=7020) Hazard ratio (95% CI) P value Incident or worsening nephropathy or CV death 0.61 ( ) <0.001 Incident or worsening nephropathy 0.61 ( ) Progression to macroalbuminuria 0.62 ( ) Doubling of SCr + eGFR ≤45 0.56 ( ) Initiation of renal replacement therapy 0.45 ( ) 0.04 Doubling of SCr + eGFR ≤45, renal replacement therapy, or renal disease death 0.54 ( ) Incident albuminuria* 0.95 ( ) 0.25 Favors empagliflozin *In patients with normal albuminuria at baseline. CI, confidence interval; CV, cardiovascular; eGFR, estimated glomerular filtration rate in mL/min/1.73 m2; HR, hazard ratio; SCr, serum creatinine. Wanner C, et al. N Engl J Med Jun 14. [Epub ahead of print]
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Renal Outcomes with Empagliflozin Over 3.2 Years
EMPA-REG RENAL (N=7020) 39% P<0.001 44% P<0.001 Patients (%) Patients (%) 38% P<0.001 Patients (%) Arrows = relative risk reduction. *Doubling of SCr + eGFR ≤45 mL/min/1.73 m2, initiation of renal replacement therapy, or death from renal disease. CI, confidence interval; eGFR, estimated glomerular filtration rate; SCr, serum creatinine. Wanner C, et al. N Engl J Med Jun 14. [Epub ahead of print]
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Em resumo… DRC – 1 em 10 indivíduos; Obesidade – 50% população brasileira Consequências: Glomerulopatia da Obesidade Nefrolitíase Neoplasia renal Tratamento: MEV; Bariátrica; Novos agentes (Análogos GLP-1; SGLT2) Obesidade, bem como a DRC, é em grande parte evitável
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