Percorrer por autor "Azevedo, Pedro"
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- Functional capacity of hemodialysis patients – 13 years of evolutionPublication . Casado, Sónia Alexandra Claro; Bento, Maria Teresa; Mendes, Eugénia; Preto, Leonel; Azevedo, Pedro; Vila-Chã, Carolina; Novo, AndréChronic kidney disease and hemodialysis are factors that affect functional capacity, and physical inactivity, sarcopenia and a sedentary lifestyle are important risk factors for mortality (1,2). Physical exercise can offer multiple benefits to patients with chronic kidney disease, such as improving aerobic and functional capacity and having a positive impact on quality of life (3,4). To describe the changes in functional capacity over 13 years in the same group of people with chronic kidney disease on hemodialysis. Functional capacity was assessed at two different times, spaced 13 years apart, using the 6-meter Timed Up and Go, the 30-second sit to stand test and the handgrip strength test. The data is presented using measures of central tendency and dispersion (compared using the non-parametric Wilcoxon test). Results Seven people (4 women and 3 men) with an average age of 55.49±11.98 years in 2012 (average age of 68.49 years in 2025) took part in the two assessments. The subjects showed statistically significant changes in the results of the tests [2012 data vs. 2025 data] Up and Go (9.66±4.06 vs. 12.03±5.07 seconds), sit to stand (17.33±7.66 vs. 12.15±4.33 repetitions), average right and left hand grip strength (19.12±7.43 vs. 14.72±8.42 Kg/f). From the analysis of the results, it can be seen that the patients saw a clear reduction in their functional capacity when comparing the two assessment moments. Conclusion/Application to practice There was a marked reduction in levels of functionality over the 13 years between the two assessments. The implementation of intervention programs could mitigate the negative effects of biological aging, sedentary lifestyle and the catabolic state resulting from chronic kidney disease and hemodialysis.
- Inspiratory muscle training – effectiveness in the intradialytic periodPublication . Casado, Sónia Alexandra Claro; Mendes, Eugénia; Preto, Leonel; Azevedo, Pedro; Vila-Chã, Carolina; Novo, AndréThe function of the inspiratory muscles in hemodialyzed patients is compromised, with a decrease in diaphragm thickness, muscle strength, and altered lung volumes (1,2). Several studies have demonstrated the effectiveness of inspiratory muscle training: increased functional capacity and strength of inspiratory muscles, decreased sensation of dyspnea, improved quality of life, and lung volumes (3,4). To evaluate the impact of inspiratory muscle training in hemodialysis patients on muscle strength (Maximum Inspiratory Pressure) and electrical activity (Electromyography) of the inspiratory muscles, on functional capacity (6-minute Walk Test), and lung volumes (Spirometry). We intend to carry out a randomized clinical trial (approved by the Ethics Committee of the Polytechnic Institute of Bragança) on a sample of 50 hemodialysis patients. In the intervention group, patients will undergo Inspiratory Muscle Training (IMT) with resistance of 50% of Maximum Inspiratory Pressure using an electronic device. The IMT involves 3 sets of 30 repetitions, during the intradialysis period, for 36 sessions. Pre and post-intervention assessments of the variables under study will be carried out. Results In hemodialysis patients, muscle weakening of the inspiratory muscles is still a little-studied reality: studies with small, heterogeneous samples and non-uniform procedures. It is known that IMT has proven scientific evidence in various chronic diseases. It‘s a simple and safe intervention, with the advantage that it can be performed during hemodialysis sessions in patients with compromised mobility. We intend to clarify the impact of Chronic Renal Failure on these muscle groups and develop an IMT protocol that can be replicated. Conclusion/Application to practice This is an innovative project in the Iberian Peninsula as there are no studies in this area with the variables proposed here. If the cost-effectiveness of this intervention is confirmed, it will be the first step towards integrating this care into all hemodialysis services.
- Physical exercise and hemodialysis – reality in PortugalPublication . Casado, Sónia Alexandra Claro; Felgueiras, Sónia; Fermento, Cristiana; Mendes, Eugénia; Preto, Leonel; Azevedo, Pedro; Vila-Chã, Carolina; Novo, AndréBackground Patients with chronic kidney disease often experience fatigue and a low capacity to perform activities of daily living due to the burden of symptoms, leading to a decrease in quality of life (1). Physical exercise is recommended and safe for hemodialysis patients, in different types of training (aerobic, resistance, or combined) (2,3), with individualized prescription and supervised by health professionals (4). Objectives To gather and characterize the existing scientific evidence in Portugal on the benefits of physical exercise in hemodialysis patients. Methods An integrative review was carried out, with a search in February 2025, in the Portuguese Open Access Scientific Repository, which included studies on physical exercise in hemodialysis patients. Summary information was extracted from each study for critical analysis and presentation of the evidence found. Results We analyzed 15 studies published between 2009 and 2022, including 1 case study, 1 multi-case study, and the rest with an intervention group and a control group. The sample size ranged from 1 patient for the case study to 59 for the studies with two groups. Aerobic training was carried out in 11 studies, resistance training in 2, and combined training in the remaining 2. Training was carried out intradialytically in 7 studies, interdialytically in another 7, and mixed in 2. In 14 studies there were improvements in functional/aerobic capacity, 8 improvements in quality of life and 1 reported a reduction in treatment costs. Conclusion/Application to practice This review included studies demonstrating the effectiveness of exercise programs in hemodialysis patients, whether through aerobic, resistance, or mixed training, regardless of the training time. Its effectiveness has been demonstrated in variables such as functional capacity and quality of life. Despite being widely recommended, physical exercise is still not a consolidated reality in this population in Portugal.
- A sarcopenia como indicador de prognóstico de mortalidade nos doentes em hemodiálisePublication . Rodrigues, Rosária; Oliveira, Bruno; Azevedo, Pedro; Azevedo, José; Travassos, Francisco; Pedroso, Sofia; Novo, André; Pereira, Orlando; Rodrigues, Tânia; Castro, Rui; Correia, FloraA Sarcopenia é a perda de massa e força na musculatura esquelética, que ocorre com o envelhecimento. Nos doentes em HD, vários fatores potenciam a perda de massa e função musculares, pelo que a sarcopenia pode ser muito comum nestes doentes. Além das consequências físicas negativas como aumento de ocorrência de quedas e limitações para as atividades de vida diária, pode promover alterações sistémicas que condicionam um aumento da morbilidade e mortalidade dos doentes. Este trabalho tem como objetivo avaliar a sarcopenia e o estado nutricional, de uma amostra de doentes em HD, determinando retrospetivamente o valor da sarcopenia como preditivo de mortalidade, durante um período de 7 anos. Material e Métodos: Amostra: o estudo incluiu 93 doentes em HD (60,2% homens; 20,4% diabéticos), com uma média de idades de 65,0±13,9 anos (mediana=67,5) que estavam em HD há cerca de 5,0±4,7 anos (mediana=3,59). A maioria realizava HDAF (91,5%), 3 vezes por semana (86%), por FAV (89,4%), com um tempo médio de 10,8±1,6 horas de HD/semana. Os doentes foram avaliados, no início do estudo, por BIA (BIA 101) e dinamometria (JAMAR). Foram recolhidos parâmetros antropométricos (peso, altura, IMC e % peso de referência) e analíticos (albumina, creatinina, colesterol total, proteína C reativa e IL6). Foi feita a avaliação nutricional pela SGA (escala 7 pontos). Diagnosticou -se a sarcopenia de acordo com o consenso europeu (EWGSOP – 2010). Assim, foram considerados com sarcopenia os doentes com Índice de Massa Não Gorda (IMNG= massa não gorda em kg/ altura2) < ao percentil 20, para o sexo e faixa etária, da população de referência NHANES (Homem: <18,1 kg/m2; Mulher: <14,6 kg/m2), avaliado por BIA 101; e com valores de força muscular < ao percentil 10, para o sexo, faixa etária e braço utilizado, dos valores de referência da população espanhola, avaliada por dinamometria (JAMAR). Resultados: Durante o período de estudo faleceram 16 doentes (17,2%). A prevalência da sarcopenia, no início do estudo, foi de 17,2%. Os doentes diagnosticados com sarcopenia foram os mais idosos (63,1±14,5 vs 73,8±4,5; p<0,05) e desnutridos (81,3% dos doentes com sarcopenia com score de SGA<6 e média score de SGA de doentes sem e com sarcopenia: 6,4±0,7 vs 5,6±0,9; p<0,001). Os doentes sarcopénicos apresentaram valores inferiores de: IMC (22,6±2,7 vs 25,5±4,1; p<0,01) e % de peso de referência (82,9,6±15,3 vs 98,6±15,9; <0,001), ângulo de fase_BIA (5,7±1,5 vs 7,2±1,6; p<0,05), massa celular em kg_BIA (19,8±5,1 vs 26,9±8,2; p<0,01), índice de massa celular_BIA (7,8±1,6 vs 10,3±12,9; p<0,01), creatinina (7,2±1,9 vs 8,7±2,4; p<0,05), albumina (3,8±0,3 vs 4,0±0,2; p<0,05) e colesterol total (129,7±37,6 vs 149,0±36,2; p<0,05). Identificaram -se, nos doentes sarcopénicos, valores superiores de: % água extracelular_BIA (47,7±7,2 vs 41,7±5,9; p<0,01), relação Na/k _BIA (1,0±0,35 vs 0,85±0,18; p<0,05), proteína C reativa (0,87±0,81 vs 0,57±0,39; p<0,05) e IL6 (11,3±9,2 vs 7,8±5,3; p<0,05). De acordo com a análise de Kaplan -Meier, a sarcopenia foi um preditor de mortalidade na amostra estudada (Long Rank=16,1; p<0001). Conclusão: A prevalência de sarcopenia, observada na amostra de doentes em hemodiálise, foi de 17,2%. A condição de sarcopenia foi capaz de distinguir os doentes com comprometimento do estado nutricional e da composição corporal. A sarcopenia pode ser um indicador de prognóstico de mortalidade dos doentes em hemodiálise.
- Vascular perfusion, body composition and muscle strength in chronic kidney disease patients on regular hemodialysis programPublication . Bernardino, Bruna; Novo, André; Azevedo, Pedro; Mendes, Eugénia; Preto, LeonelHemodialysis is a technique that effectively replaces some functions of the human kidney, allowing the survival of such patients, since loss of kidney function is incompatible with life. In most patients with chronic kidney disease, the level of renal function tends to gradually decrease over time. The most serious outcome of chronic kidney disease is renal failure. The vascular access is vital in patients with chronic renal failure undergoing dialysis and their dysfunction is a major cause of morbidity and hospitalization. Adequate vascular access for hemodialysis defines not only a better therapeutic outcome and patient survival. The flow of arteriovenous fistula (AVF) is an important factor in the successful execution of the hemodialysis. Were studied 27 patients, 20 males and 7 females, with ages between 39 and 94 years old. The diameter and the flow of the draining vein were evaluated by ultrasound flow. Were also carried out the Hand Grip Test, the Pinch Gauge Test and it was done an anthropometric evaluation using a bioimpedance scale. This study aimed to identify the relationship between vascular perfusion, body composition and muscle strength in chronic kidney disease patients on regular hemodialysis program. The average flow of the arteriovenous fistula was 1340.096±304.615ml/min and the diameter of the arteriovenous fistula was, on average, 0.57±0.06mm. To check for significant differences between the variables we used the Spearman correlation coefficient test. When correlated left handgrip strength and average flow (r = -0.576, p = 0.01), pinch gauge test of the opposite side of the fistula and average flow (r = -0.450, p = 0.059) and visceral fat and average flow (r = -0.444, p = 0.05), there were statistically significant negative correlations. Individuals with higher results in the pinch gauge test in left finger showed lower flow, lower diameter and lower area of the draining vein. Taking into account the results obtained, we can see that the sample is relatively small, which means that the conclusions of this study are not extrapolated to the Portuguese population in regular hemodialysis program, but just be confined to the group of patients evaluated. The results suggest that there is a negative relationship between the flow of the arteriovenous fistula and muscle strength and body composition. For higher values of muscle strength correspond lower flow values of the draining vein.