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Browsing by Author "Farinha, A"

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  • Anemia and Iron Deficiency Diagnosis, Management and Treatment in Chronic Kidney Disease - Consensus and Agreement through a Delphi Panel
    Publication . Ferreira, A; Farinha, A; Macedo, A; Robalo Nunes, A; Lopes, J; Branco, P; Ponce, P; Neto, R
    Background: Anemia is a common complication of Chronic Kidney Disease (CKD), in which iron deficiency’s (ID) role is frequently underrated. In CKD, anemia has been associated with higher morbidity and lower quality of life. Nonetheless, reported treatment rates of anemia in CKD are low and guidelines’ variability and/or absence for its management and treatment may be preventing patients from receiving optimal treatment. Within this context, we aimed to assess the agreement level on anemia and iron deficiency diagnosis, management, and treatment in CKD patients, by Portuguese physicians in Nephrology, through a Delphi Panel. Methods: A group of seven medical experts in Nephrology and Transfusion Medicine was assembled, and a focus group was conducted, in which 28 statements were agreed upon. Then, a two-round Delphi Panel using a Likert scale was conducted online, inviting Portuguese Society of Nephrology associates to participate. Results: Answers were collected from 76 participants in Round 1 and consensus level was obtained for 1 statement, 57 (75%) respondents fully disagreeing on transfusing all patients with hemoglobin below 9 g/dl, regardless of the clinical situation. The remaining 27 statements were used in Round 2, none obtaining consensus level and 14 statements being categorized as qualified majority: 4 on diagnosis, 3 on disease management, and 7 on treatment. Discussion: Our study showed a lack of consensus on diagnosis, management, and treatment of anemia in CKD patients among the nephrology community in Portugal. Overall, our results illustrated the heterogeneity of national clinical practices in: laboratory parameters’ choice; cutoff values defining anemia and/or ID; parameter-based therapeutic decisions. Nonetheless, it was shown clear that patient’s individual characteristics, clinical settings, and the physician’s “clinical sense” seem to be considered to a further extent than the available guidelines. Future studies should be considered to develop recommendations that can be widely accepted.
    2020Journal article Open access Show more
  • Cognitive Disorders in Patients with Chronic Kidney Disease: Approaches to Prevention and Treatment
    Publication . Pépin, M; Klimkowicz‐Mrowiec, A; Godefroy, O; Delgado, P; Carriazo, S; Ferreira, AC; Golenia, A; Malyszko, J; Grodzicki, T; Giannakou, K; Paolisso, G; Barbieri, M; Garneata, L; Mocanu, CA; Liabeuf, S; Spasovski, G; Zoccali, C; Bruchfeld, A; Farinha, A; Arici, M; Capasso, G; Wiecek, A; Massy, ZA
    Background: Cognitive impairment is common in patients with chronic kidney disease (CKD), and early intervention may prevent the progression of this condition. Methods: Here, we review interventions for the complications of CKD (anemia, secondary hyperparathyroidism, metabolic acidosis, harmful effects of dialysis, the accumulation of uremic toxins) and for prevention of vascular events, interventions that may potentially be protective against cognitive impairment. Furthermore, we discuss nonpharmacological and pharmacological methods to prevent cognitive impairment and/or minimize the latter's impact on CKD patients' daily lives. Results: A particular attention on kidney function assessment is suggested during work-up for cognitive impairment. Different approaches are promising to reduce cognitive burden in patients with CKD but the availabe dedicated data are scarce. Conclusions: There is a need for studies assessing the effect of interventions on the cognitive function of patients with CKD.
    2023Journal article Open access Show more