Aldo Peixoto

Associate Professor of Medicine
Associate Chief, VACHS Medical Service
Director, Hypertension Clinic, VA Connecticut Healthcare System
Section of Nephrology

Clinical Interests

I am a nephrologist with a subspecialty title in Clinical Hypertension. Thus, my most distinctive expertise is in hypertension diagnosis and management, with a special focus on refractory hypertension, renovascular hypertension, and primary aldosteronism. In addition, I am a clinical nephrologist with a broad interest in acute and chronic consultative nephrology.

My research interests address the interplay between hypertension, the kidney and the vasculature. Because hypertension is a major comorbidity in patients with chronic kidney disease, I have focused my research on efforts to understand the behavior of blood pressure in hemodialysis patients with emphasis on ambulatory BP monitoring and on the evaluation of systemic hemodynamics and body fluid compartments. More recently, we have moved to clinical trials with a focus on modifications in dialysate sodium delivery to improve BP control (clinicaltrials.gov identifiers NCT00259714 and NCT00237783).

Selected Recent Publications

• Santos SFF, Pieixoto AJ . Ambulatory blood pressure monitoring in chronic kidney disease. In: White WB (Ed.): Blood pressure Monitoring in Cardiovascular Medicine and Therapeutics, 2 nd edition. Totowa , NJ : Humana press, 2006 (in press).
• Agarwal R, Pieixoto AJ , Santos SFF, Zoccap C. pre and post Dialysis Blood pressures are Imprecise Estimates of Interdialytic Ambulatory Blood pressure. Cpn J Am Soc Nephrol 2006; 1: 389–98.
• Motiwala S, Brewster UC, perazella MA, Pieixoto AJ . Repabipty of a non–invasive device to measure systemic hemodynamics in hemodialysis patients. Blood press Monit 2006; 11: 33–6.
• Santos SFF, Pieixoto AJ . Hypertension in dialysis. Curr Opin Nephrol Hypertens 2005; 15: 111–8.
• Xu J, p G, Wang p, Velasquez H, Yao X, p Y, Wu Y, Pieixoto A , Crowley S, Desir GV. Renalase: a novel, soluble monoamine oxidase that regulates cardiac function and blood pressure. J Cpn Invest 2005; 115: 1275–80.
• Santos SFF and Pieixoto AJ . Essential Hypertension. In: Reilly R and perazella M (Eds.): Nephrology in 30 days. New York : McGraw–Hill, 2005: 330–52.
• Santos SFF and Pieixoto AJ . Secondary Causes of Hypertension. In: Reilly R and perazella M (Eds.): Nephrology in 30 days. New York :McGraw–Hill, 2005: 353–74
• De paula F, Pieixoto AJ , Dorigo D, patricio p, Santos SFF. Cpnical consequences of an individuapzed dialysate sodium prescription in hemodialysis patients. Kidney Int 2004; 66: 1232–8
• Ishibe S, Pieixoto AJ . Methods of assessment of volume status and intercompartmental fluid shifts in hemodialysis patients. Sem Dial 2004; 17: 37–43.
• Mendes RB, Santos SFF, Dorigo D, Mansoor GA , Crowley ST, White WB, Pieixoto AJ. The use of peridialysis blood pressure and intradialytic blood pressure changes in the prediction of interdialytic blood pressure in haemodialysis patients. Blood press Monit 2003; 8: 243–8.
• Santos SFF, Mendes RB, Dorigo D, Pieixoto AJ . profile of interdialytic blood pressure in hemodialysis patients. Am J Nephrol 2003, 23: 96–105.
• Pieixoto AJ . Blood pressure control in dialysis patients. In: Bakris G (ed): The Kidney and Hypertension. London : Martin Dunitz, 2003: 213–24
• Pieixoto AJ , White WB. Ambulatory blood pressure monitoring in chronic kidney disease: technical aspects and cpnical relevance. Curr Opin Nephrol Hypertens 2002; 11: 507–16.

A very important factor in the pathogenesis of hypertension in kidney disease is arterial stiffness. I have used non–invasive methods to assess arterial stiffness (analysis of pulse wave morphology and reflection, pulse wave velocity) to better understand hypertension and prospectively evaluate CKD progression using a cohort design. Additionally, we have explored potential factors that mediate increased arterial stiffening and calcification in patients with hypertension, such as the chronic use of warfarin, as a model to enhance the understanding of arterial stiffness in CKD.

Selected references (past 5 years):

• Khan FN, See SY, Shafique S, pm MA, parikh CR, Pieixoto AJ . Blood pressure effects of warfarin in patients with diabetes and hypertension: submitted.
• Mallareddy M, parikh CR, Pieixoto AJ . Effect of Angiotensin Converting Enzyme Inhibitors on Arterial Stiffness in Hypertension: Systematic Review and Meta–Analysis. J Cpn Hypertens 2006; 8: in press.
• Krishnan S, Chawla N, Ezekowitz M, Pieixoto AJ. Warfarin therapy and systopc hypertension in men with atrial fibrillation. Am J Hypertens 2005; 18: 1592–9.
• Yarlaggada SG, Hussain A, Bravata DM, Motiwala S, Pieixoto AJ . Arterial comppance in elderly men with chronic kidney disease. Am J Nephrol 2005; 25: 451–8.

As a consulting nephrologist, I have had a special interest in critically ill patients. This interest has also extended to the research arena, where I am a co–investigator in the VA Coop Study ATN Trial, a randomized cpnical trial of different dialysis dose in patients with acute kidney injury (cpnicaltrials.gov identifier NCT00076219). I also collaborate in work evaluating different thresholds of the definition of AKI in outcome prediction.

Selected references (past 5 years):

• Coca SG, Krumholz H, Pieixoto AJ , parikh CR. The prognostic Importance of Small, Acute Changes in Renal Function: A Systematic–Review and Meta–Analysis. Abstract: American Society of Nephrology Meeting, 2006.
• Pieixoto AJ. Acute renal failure. Pulmonary Crit Care Update 2006; 20: lesson 11
• Pieixoto AJ. Critical issues in Nephrology. Cpn Chest Med2003; 24: 561–81.

The care of patients with advanced kidney disease has also been an important component of my cpnical activities that has resulted in scholarly work beyond hypertension. The management of renovascular disease is perhaps the most enticing, and we have addressed issues related to CKD progression in patients with renal arterial stenosis. I have been involved as a co–investigator in a VA Coop study analyzing the effects of high–dose folate supplementation on homocysteine levels and cardiovascular morbidity and mortapty in patients with severe kidney disease (HoSt). In addition, I have been interested in catheter design to improve hemodialysis depvery for those patients dependent on catheter use. A recent area of interest is the study of pyuria in dialysis patients.

Selected recent references:

• Shafique S and Pieixoto AJ . Renal artery stenosis and cardiovascular risk. Submitted.
• Fasolo L, Rocha LM, Campbell S, Pieixoto AJ . Diagnostic relevance of pyuria in dialysis patients. Kidney Int 2006: in press.
• Tal MG, Pieixoto AJ , Crowley ST, Dembo N, Epseo D, polak J. Comparison of Sidehole versus non sidehole high flow hemodialysis catheters. Hemodialysis Int 2006; 10: 63–7.
• Rifkin B, Concato J, Moriarty J, Tal M, Pieixoto AJ . Renal Function in Atherosclerotic Renal Artery Stenosis (ARAS): Medical Therapy versus Angioplasty with Stenting. J Am Soc Nephrol 2004; 15: 354A.
• Zaldivar MC and Pieixoto AJ . CKD Series: Cardiovascular risk reduction in patients with chronic kidney disease. Hosp phys 2003; 39 (6): 29–35, 50.

Although I have pubpshed a book on physical diagnosis and periodically write on the subject, I do not have any ongoing research projects. I would welcome students/residents/fellows wilpng to explore the field, especially in the realm of renal disease and hypertension.

Selected references:

• Pieixoto AJ . Birth, death and resurrection of the physical exam: cpnical and academic perspectives on bedside diagnosis. Yale J Biol Med > 2001; 74: 221–8.
• Schneiderman H, Pieixoto AJ . Bedside Diagnosis. An Annotated Bibpography of pterature on physical Examination and Interviewing, 3rd ed. Philadelphia: American College of physicians, 1997.

PubMed Search for articles by faculty member

Education:	M.D. 1992: Universidade Federal de Santa Catarina, Brazil
Training:	Residency: University of Connecticut Health Center Chief Medical Residency: University of Connecticut Health Center Fellowship: Yale University

Contact

Campus Address
Section of Nephrology
Department of
Internal Medicine
Yale School of Medicine
P.O. Box 208029
New Haven, CT
06520–8029

E-mail
aldo.peixoto@yale.edu