Aldo Peixoto, M.D.
Associate Professor of Medicine
Associate Chief, VACHS Medical Service
Director, Hypertension Clinic - VA Connecticut Healthcare System

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

E-mail: aldo.peixoto@yale.edu

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 references (past 5 years):

•  Santos SFF, Peixoto 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, Peixoto AJ , Santos SFF, Zoccali C. Pre and Post Dialysis Blood Pressures are Imprecise Estimates of Interdialytic Ambulatory Blood Pressure. Clin J Am Soc Nephrol 2006; 1: 389-98.

•  Motiwala S, Brewster UC, Perazella MA, Peixoto AJ . Reliability of a non-invasive device to measure systemic hemodynamics in hemodialysis patients. Blood Press Monit 2006; 11: 33-6.

•  Santos SFF, Peixoto AJ . Hypertension in dialysis. Curr Opin Nephrol Hypertens 2005; 15: 111-8.

•  Xu J, Li G, Wang P, Velasquez H, Yao X, Li Y, Wu Y, Peixoto A , Crowley S, Desir GV. Renalase: a novel, soluble monoamine oxidase that regulates cardiac function and blood pressure. J Clin Invest 2005; 115: 1275-80.

•  Santos SFF and Peixoto AJ . Essential Hypertension. In: Reilly R and Perazella M (Eds.): Nephrology in 30 days. New York : McGraw-Hill, 2005: 330-52.

•  Santos SFF and Peixoto 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, Peixoto AJ , Dorigo D, Patricio P, Santos SFF. Clinical consequences of an individualized dialysate sodium prescription in hemodialysis patients. Kidney Int 2004; 66: 1232-8

•  Ishibe S, Peixoto 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, Peixoto 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, Peixoto AJ . Profile of interdialytic blood pressure in hemodialysis patients. Am J Nephrol 2003, 23: 96-105.

•  Peixoto AJ . Blood pressure control in dialysis patients. In: Bakris G (ed): The Kidney and Hypertension. London : Martin Dunitz, 2003: 213-24

•  Peixoto AJ , White WB. Ambulatory blood pressure monitoring in chronic kidney disease: technical aspects and clinical 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, Lim MA, Parikh CR, Peixoto AJ . Blood pressure effects of warfarin in patients with diabetes and hypertension: submitted.

•  Mallareddy M, Parikh CR, Peixoto AJ . Effect of Angiotensin Converting Enzyme Inhibitors on Arterial Stiffness in Hypertension: Systematic Review and Meta-Analysis. J Clin Hypertens 2006; 8: in press.

•  Krishnan S, Chawla N, Ezekowitz M, Peixoto AJ. Warfarin therapy and systolic hypertension in men with atrial fibrillation. Am J Hypertens 2005; 18: 1592-9.

•  Yarlaggada SG, Hussain A, Bravata DM, Motiwala S, Peixoto AJ . Arterial compliance 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 clinical trial of different dialysis dose in patients with acute kidney injury ( clinicaltrials.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, Peixoto 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.

•  Peixoto AJ . Acute renal failure. Pulmonary Crit Care Update 2006; 20: lesson 11 (online journal of the American College of Chest Physicians accessible @ http://www.chestnet.org/education/online/pccu/vol20/lessons11_12/index.php).

•  Peixoto AJ . Critical issues in Nephrology . Clin Chest Med 2003; 24: 561-81.

The care of patients with advanced kidney disease has also been an important component of my clinical 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 mortality in patients with severe kidney disease (HoSt). In addition, I have been interested in catheter design to improve hemodialysis delivery 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 Peixoto AJ . Renal artery stenosis and cardiovascular risk. Submitted.

•  Fasolo L, Rocha LM, Campbell S, Peixoto AJ . Diagnostic relevance of pyuria in dialysis patients. Kidney Int 2006: in press.

•  Tal MG, Peixoto AJ , Crowley ST, Dembo N, Eliseo 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, Peixoto 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 Peixoto AJ . CKD Series: Cardiovascular risk reduction in patients with chronic kidney disease. Hosp Phys 2003; 39 (6): 29-35, 50.

Although I have published 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 willing to explore the field, especially in the realm of renal disease and hypertension.

Selected references:

•  Peixoto AJ . Birth, death and resurrection of the physical exam: clinical and academic perspectives on bedside diagnosis. Yale J Biol Med 2001; 74: 221-8.

•  Schneiderman H, Peixoto AJ . Bedside Diagnosis. An Annotated Bibliography of Literature on Physical Examination and Interviewing, 3rd ed. Philadelphia : American College of Physicians, 1997.

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