Murilo Guedes

All Publications

• Multinational Real-World Practice Patterns in the Use of Antithrombotic Therapy Among Patients on Hemodialysis and Peritoneal Dialysis. Kidney medicine Guedes, M., Andrews, C., Zhao, J., Atkins, G. B., Barash, I., Bash, L. D., Coyle, C. R., Ke, X., Ramey, D. R., Johnson, D. W., Ureña-Torres, P., Ferraro, P. M., Al Ghonaim, M., Bonaca, M. P., Pecoits-Filho, R., Karaboyas, A. 2026; 8 (3): 101211

  Abstract

  Patients with kidney failure requiring maintenance dialysis have a high risk of cardiovascular events warranting antithrombotic therapies, including oral anticoagulant (OAC) or antiplatelet therapy (APT). However, chronic use of antithrombotic therapy can increase the bleeding risk in patients receiving dialysis. However, little is known about medication use patterns and risk of bleeding events in real-world clinical practice.Retrospective analysis of data from 2 prospective cohort studies.We included 27,612 patients from the Dialysis Outcomes and Practice Patterns Study (DOPPS) and 5,289 patients from the Peritoneal DOPPS (PDOPPS), international cohorts of hemodialysis (HD) and peritoneal dialysis (PD) patients.Patient demographics and comorbid conditions; OAC and APT use.OAC and APT use; a bleeding composite outcome including a hospitalization or death because of a major bleeding event.Descriptive analyses to explore OAC and APT utilization and crude rates of the bleeding composite outcome and Kaplan-Meier analyses to estimate medication discontinuation.Baseline OAC and APT use was 9% and 10% in HD patients and 4% and 7% in PD patients, respectively. Patients prescribed antithrombotic drugs were older and more likely to have a history of cardiovascular disease. After 36 months, the Kaplan-Meier estimated proportions of baseline users who remained on therapy were 57% for OAC and 53% for APT. The composite bleeding rates per 100 patient-years among patients with baseline OAC use versus baseline APT use versus neither were 8.6, 5.6, and 4.1 in HD patients and 12.0, 6.1, and 3.9 in PD patients, respectively.Potential for event misclassification; no over-the-counter medication data; rates unadjusted.Antithrombotic drugs are infrequently prescribed and often discontinued in patients receiving HD or PD. With major bleeding event rates high among antithrombotic users, new strategies are needed to optimize the risks and benefits of antithrombotic agents in the dialysis setting.

  View details for DOI 10.1016/j.xkme.2025.101211

  View details for PubMedID 41675209

  View details for PubMedCentralID PMC12887883

• Anemia-independent prognostic value of iron deficiency in incident peritoneal dialysis patients. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis Rigodon, V., Guedes, M., Pecoits, P. G., Hartley, B., Jiao, Y., Usvyat, L. A., Chatoth, D. K., Hymes, J. L., Maddux, F. W., Kooman, J., Moraes, T. P., Raimann, J. G., Kotanko, P., Larkin, J. W., Pecoits-Filho, R. 2026: 8968608251412935

  Abstract

  Background and objectivesIron plays a critical role beyond erythropoiesis, yet the prognostic significance of iron deficiency (ID) independent of anemia remains poorly defined in the peritoneal dialysis (PD) population. This study aimed to evaluate the association between iron status, specifically transferrin saturation (TSAT), and mortality in PD patients, independent of hemoglobin levels.Design, setting, participants, and measurementsWe conducted a retrospective cohort study of 11,013 adults who initiated PD at a large US dialysis network between December 2004 and January 2011. Patients had at least 180 days on PD and baseline data on TSAT, ferritin, hemoglobin, albumin, and white blood cell count. The primary outcome was all-cause mortality. Broadly adjusted associations between iron parameters and mortality were assessed using Cox proportional hazards models and restricted cubic splines, with adjustments for demographic, clinical, treatment-related, and laboratory variables including hemoglobin and ESA use.ResultsIron deficiency, defined as TSAT ≤20%, was present in 10% of patients at PD initiation. The cohort was 54% male and 70% Caucasian, with a mean age of 55 years; 39% had diabetes. While 91% received erythropoiesis-stimulating agents, only 34% received IV iron. After comprehensive adjustment, TSAT ≤20% remained independently associated with increased mortality (adjusted HR: 1.26; 95% CI: 1.12-1.42). Spline analyses showed a sharp rise in mortality risk at TSAT levels below 25%. Ferritin was inconsistently associated with mortality risk. During follow-up, 2704 deaths occurred (24.6% of the cohort) over a median 440-day follow-up.ConclusionsIron deficiency is common in incident PD patients and is associated with increased mortality risk, independent of anemia. These findings challenge current anemia-centric treatment paradigms and suggest that iron status, particularly TSAT, should be routinely assessed in PD patients regardless of hemoglobin levels. A prospective, randomized trial is warranted to evaluate whether proactive iron management improves outcomes in this population.

  View details for DOI 10.1177/08968608251412935

  View details for PubMedID 41558040

• International variations in chronic kidney disease patients' pain experience and its management. Clinical kidney journal Raina, R., Nair, N., Kumar, R., Doshi, K., Alencar-de Pinho, N., Tu, C., Bieber, B., Liabeuf, S., Combe, C., Reichel, H., Argyropoulos, C., Guedes, M., Pecoits-Filho, R. 2026; 19 (1): sfaf346

  Abstract

  Background: Chronic pain significantly impacts health-related quality of life (HRQOL) in patients with non-dialysis chronic kidney disease (ND-CKD), yet the management of pain in this population is challenging. We hypothesized that analgesic prescription practices vary internationally, influencing the pain experience and HRQOL of patients with stage 3-5 ND-CKD.Methods: This descriptive, observational, multinational cohort study utilized data from the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps), enrolling adult patients from nephrology practices in Brazil, France and the USA between 2013 and 2020. Analgesic prescriptions within 6months before HRQOL assessment were categorized as non-steroidal anti-inflammatory drugs (NSAIDs), opioids or other analgesics. HRQOL was measured using the Kidney Disease Quality of Life Short Form, assessing multiple subdomains.Results: Among 3945 patients, analgesics were most frequently prescribed in the USA across all CKD stages, with opioids prescribed nearly twice as often compared with Brazil and France. NSAIDs are frequently prescribed in Brazil, including in advanced CKD stages, contrasting sharply with practices in France and the USA. Higher reported pain intensity consistently correlated with poorer outcomes across all HRQOL subdomains.Conclusions: This study identifies considerable international variability in pain reporting and analgesic prescription patterns in patients with stage 3-5 ND-CKD. Randomized controlled trials evaluating the efficacy and safety of analgesics are warranted to improve key patient-reported outcomes such as pain in patients with ND-CKD.

  View details for DOI 10.1093/ckj/sfaf346

  View details for PubMedID 41498063

• Systematic Review of the Effects of Iron on Cardiovascular, Kidney, and Safety Outcomes in Patients With CKD KIDNEY INTERNATIONAL REPORTS Chan, B., Varghese, A., V. Badve, S., Pecoits-Filho, R., Guedes, M., Arnott, C., Kozor, R., O'Lone, E., Jun, M., Kotwal, S., Block, G. A., Chertow, G. M., Solomon, S. D., Vaduganathan, M., Perkovic, V., Neuen, B. L. 2025; 10 (4): 1037-1049

  View details for DOI 10.1016/j.ekir.2025.01.029

  View details for Web of Science ID 001468597200001

• Systematic Review of the Effects of Iron on Cardiovascular, Kidney, and Safety Outcomes in Patients With CKD. Kidney international reports Chan, B., Varghese, A., Badve, S. V., Pecoits-Filho, R., Guedes, M., Arnott, C., Kozor, R., O'Lone, E., Jun, M., Kotwal, S., Block, G. A., Chertow, G. M., Solomon, S. D., Vaduganathan, M., Perkovic, V., Neuen, B. L. 2025; 10 (4): 1037-1049

  Abstract

  Heart failure and chronic kidney disease (CKD) are closely associated, and iron deficiency is highly prevalent in both conditions. However, major cardiovascular and nephrology guidelines offer contrasting recommendations for iron use. We evaluated the effects of iron versus usual care or placebo on the clinical outcomes in patients with CKD.We conducted a systematic review and meta-analysis of randomized trials on i.v. or oral iron in patients with CKD (PROSPERO CRD42023453468). We searched Medline, Embase, and the Cochrane Register from database inception until February 1, 2024 to identify eligible trials. We determined the overall results and stratified them by dialysis- and nondialysis-requiring CKD using random effects models, with certainty of evidence assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. The primary composite endpoint was hospitalization for heart failure or cardiovascular death.We identified 45 trials that met the inclusion criteria. Compared with usual care or placebo, iron reduced the risk of the primary composite endpoint (1659 events; risk ratio [RR]: 0.84, 95% confidence interval [CI]: 0.75-0.94; moderate certainty), an effect consistent across dialysis and nondialysis requiring CKD (P-heterogeneity = 0.70). The effect on the primary endpoint appeared driven by both components of hospitalization for heart failure (RR: 0.77; 95% CI: 0.61-0.96; moderate certainty) and cardiovascular death (RR: 0.81; 95% CI: 0.65-1.02; low certainty). The incidence of serious adverse events was lower for iron compared with usual care or placebo (RR: 0.90, 95% CI: 0.82-0.98; moderate certainty; P-heterogeneity = 0.09).Iron therapy may reduce the risk of heart failure and cardiovascular death in patients with CKD. Randomized trials evaluating the effects of iron on clinical outcomes are needed, especially in nondialysis patients with CKD with or without anemia.

  View details for DOI 10.1016/j.ekir.2025.01.029

  View details for PubMedID 40303218

  View details for PubMedCentralID PMC12034885