RESUMEN
Arteriovenous fistulas for hemodialysis create a leftto-right shunt, resulting in an average 25% increase in cardiac output and subsequent remodeling of cardiac chambers. Some of these patients may develop highoutput heart failure. In this report, we present two cases of heart failure associated with an arteriovenous fistula for hemodialysis, each showing distinct clinical outcomes following either its occlusion or cerclage. Drawing from existing medical literature, we explore potential causes that might account for the divergent clinical courses observed in these cases.
Las fístulas arteriovenosas para hemodiálisis generan un cortocircuito de izquierda a derecha con un incremento promedio en el gasto cardíaco del 25%, asociado a remodelado de las cavidades cardíacas. Un porcentaje de estos pacientes desarrollan insuficiencia cardíaca con alto gasto cardíaco. Presentamos dos casos de insuficiencia cardíaca asociada a fístula arteriovenosa para hemodiálisis, con diferente evolución clínica luego de la oclusión o cerclaje de la misma. Basados en la literatura médica, se discuten las potenciales causas que pudieron justificar las diferencias en la evolución clínica entre ambos casos.
Asunto(s)
Derivación Arteriovenosa Quirúrgica , Insuficiencia Cardíaca , Diálisis Renal , Humanos , Diálisis Renal/efectos adversos , Insuficiencia Cardíaca/etiología , Derivación Arteriovenosa Quirúrgica/efectos adversos , Masculino , Persona de Mediana Edad , Femenino , Anciano , Fallo Renal Crónico/terapia , Fallo Renal Crónico/complicacionesRESUMEN
INTRODUCTION: Kidney transplant continues to be the best treatment option for patients with end-stage chronic renal failure. The shortage of organs and long waiting times mean that many patients arrive at the transplant with a significant level of deterioration. The objective was to analyze the relationship between socioeconomic variables and knowledge about pre-emptive kidney transplant in the pre-transplant consultation. METHODS: Cross-sectional study. A group of patients over 18 years' old who began pre-transplant evaluation was analyzed. Socioeconomic variables were evaluated and a brief survey on nephrological follow-up and information on kidney transplant prior to dialysis (preemptive) was carried out. RESULTS: A total of 164 patients with (mean ± SD) 57 ± 14 years were evaluated. A 56% (n = 92) had a predialysis nephrological follow-up of 33 ± 66 months, with 41% (n = 68) of more than one year. The time on dialysis before the pre-transplant consultation averaged 20 ± 23 months. Seventy-two % (n = 118) did not have information on pre-emptive kidney transplantation. Patients with predialysis nephrological follow-up were more likely to have information about pre-emptive kidney transplantation (OR 2.94; IC 1.30-6.63; p 0.009). DISCUSSION: Referral to the transplant center is postponed by increasing the time on dialysis. Most patients are not aware of pre-emptive kidney transplantation. These findings point out the need to implement policies to improve patient education, access to information, and timely referral to transplant centers.
Introducción: El trasplante renal continúa siendo la mejor opción de tratamiento para los pacientes con insuficiencia renal crónica terminal. La escasez de órganos y los largos tiempos de espera hacen que muchos pacientes lleguen al trasplante con un importante nivel de deterioro. El objetivo es analizar la relación entre variables socioeconómicas y el conocimiento sobre el trasplante renal preemptive en la consulta pretrasplante. Métodos: Estudio de corte transversal. Se analizó un grupo de pacientes mayores de 18 años que inició evaluación pre-trasplante renal en el período comprendido entre agosto 2021 y junio 2023. Se evaluaron variables socioeconómicas y se realizó una breve encuesta sobre seguimiento nefrológico e información sobre trasplante renal previo a diálisis (preemptive). Resultados: Se evaluaron 164 pacientes con (media ± DS) 57 ± 14 años. El 56 % (n = 92) tuvo seguimiento nefrológico prediálisis de 33 ± 66 meses, siendo superior a un año en el 41 % (n = 68). El tiempo en diálisis previo a la consulta pre-trasplante promedió los 20 ± 23 meses. No tenía información sobre trasplante renal previo a la diálisis el 72% (n = 118). Los pacientes con seguimiento nefrológico prediálisis tuvieron más probabilidad de tener información sobre el trasplante renal preemptive (OR 2.94; IC 1.30-6.63; p 0.009) Discusión: La derivación al centro de trasplante se posterga, aumentando el tiempo en diálisis. La mayoría de los pacientes no tienen conocimiento del trasplante renal preemptive. Estos hallazgos señalan la necesidad de implementar políticas de mejora en la educación del paciente, acceso a la información y derivación oportuna a los centros de implante.
Asunto(s)
Fallo Renal Crónico , Trasplante de Riñón , Factores Socioeconómicos , Listas de Espera , Humanos , Trasplante de Riñón/estadística & datos numéricos , Estudios Transversales , Masculino , Femenino , Persona de Mediana Edad , Fallo Renal Crónico/cirugía , Fallo Renal Crónico/terapia , Adulto , Anciano , Diálisis Renal/estadística & datos numéricos , Factores de Tiempo , Conocimientos, Actitudes y Práctica en SaludRESUMEN
Data about the impacts of hemodialysis on antioxidant status and markers of oxidative stress are controversial, probably due to the use of different methodological approaches. The aim of this study was to assess the changes in the oxidative damage markers and antioxidant enzymes, and the serum antioxidant capacity by using in vitro model systems of free radical generation before and after one hemodialysis session. Blood samples were collected from 40 patients with kidney failure before and after hemodialysis. In pre- and post-hemodialysis serum samples, concentrations of biomarkers of oxidative damage and the activities of antioxidant enzymes were measured, as well as the in vitro antioxidant potential. The high concentrations of oxidative stress markers in serum of kidney failure patients were decreased after one hemodialysis session. In pre-hemodialysis, low activities of antioxidant enzymes were observed, including paraoxonase-1, however paraoxonase-1 activity was partially recovered after hemodialysis. Crocin bleaching and radical scavenging assays showed that serum antioxidant potential was decreased after hemodialysis. Although one hemodialysis session increased paraoxonase-1 activity and decreased oxidative stress markers, it caused a decrease in the serum antioxidant potential. Future research is needed to prospect strategies to mitigate the impacts of oxidative stress in the scenario of hemodialysis repetitions.
Asunto(s)
Antioxidantes , Biomarcadores , Estrés Oxidativo , Diálisis Renal , Humanos , Estrés Oxidativo/fisiología , Diálisis Renal/efectos adversos , Biomarcadores/sangre , Masculino , Antioxidantes/metabolismo , Antioxidantes/análisis , Femenino , Persona de Mediana Edad , Arildialquilfosfatasa/sangre , Adulto , Insuficiencia Renal/sangre , Insuficiencia Renal/terapia , Fallo Renal Crónico/terapia , Fallo Renal Crónico/sangre , AncianoRESUMEN
Chronic viral infections caused by the human immunodeficiency virus (HIV), hepatitis C (HCV), and hepatitis B (HBV) are common among patients with end-stage renal disease (ESKD). These infections were once considered contraindications to kidney transplantation due to potential risks associated with long-term immunosuppression. Improved management and antiviral therapies have changed the prognosis and survival of this group of patients, along with an increased experience in transplanting people with these viral infections. We report the first successful kidney transplant in an ESKD patient on hemodialysis with a history of concomitant HIV, HCV and HBV infection in Mexico.
Asunto(s)
Infecciones por VIH , Fallo Renal Crónico , Trasplante de Riñón , Humanos , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Fallo Renal Crónico/cirugía , Fallo Renal Crónico/complicaciones , Masculino , Hepatitis B/complicaciones , Hepatitis C/complicaciones , Hepatitis C/tratamiento farmacológico , México , Persona de Mediana Edad , Adulto , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/tratamiento farmacológico , Resultado del Tratamiento , Diálisis RenalRESUMEN
A global rise in the prevalence of patients with chronic kidney disease (CKD) with end-stage kidney disease (ESKD) has led to a considerable and increasing burden to health systems, patients, and society. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are proven to reduce incidence of cardio-renal outcomes, including onset of ESKD. Recent post hoc analyses of SGLT2 inhibitor trials extrapolate substantial delays in the average time to ESKD over a patient's lifetime. In this article, we explore the possible real-world effects of such a delay by considering the available evidence reporting outcomes following onset of ESKD. From the patient perspective, a delay in reaching ESKD could substantially improve health-related quality of life and result in additional life years without the need for kidney replacement therapies, a target relevant to all CKD subpopulations. Furthermore, should a patient initiate dialysis at an older age as a result of CKD progression, the time spent in receipt of dialysis, and therefore associated healthcare costs, may also be reduced. A delay in progression may also lead to changes in the management of ESKD, such as increased election of conservative care in preference to dialysis, particularly in elderly populations. For younger patients with CKD, those who reach ESKD while employed face considerable work impairment and productivity loss, as may families and care partners of working age. Therefore, a delay to the onset of ESKD will reduce the proportion of their working lives affected by productivity losses or unemployment due to medical reasons. In conclusion, optimised treatment of CKD may lead to a shift in treatment options, but proper and timely implementation is essential for the realisation of improved outcomes.
Asunto(s)
Progresión de la Enfermedad , Fallo Renal Crónico , Calidad de Vida , Humanos , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Diálisis Renal , Insuficiencia Renal Crónica/terapia , Factores de TiempoRESUMEN
INTRODUCTION: In December 2016, an outbreak of sylvatic yellow fever (YF) occurred in the non-endemic areas of the south-eastern region of Brazil. The immune response to the yellow fever vaccine and its safety in individuals with chronic kidney disease (CKD) living in YF-endemic regions are not thoroughly understood. The objective of this study is to assess the incidence of adverse events and the serological response after primary vaccination with the 17DD-YF vaccine in CKD patients undergoing dialysis. METHODS: This was a multicenter, retrospective cohort study involving 223 individuals with CKD who were on dialysis after primary vaccination against YF. Clinical and epidemiologic characteristics were collected and the vaccine adverse event (VAE) were assessed. Around 35 months after vaccination, the serological response was evaluated in 71 (32%) patients using neutralization tests. RESULTS: No serious VAE occurred in any patient. Local reactions were reported in 13 individuals (5.8%), while 6 (2.7%) reported generalized systemic reactions and 205 (91.9%) did not display any VAE. No clinical or epidemiologic characteristic predicted the occurrence of VAE. Adequate serological response was found in 38% of participants and none of the clinical or epidemiological characteristics were associated with immunogenicity. CONCLUSION: The outcomes of our study suggest that the yellow YF vaccine is well-tolerated in CKD patients undergoing dialysis, but it does not induce adequate immune response. Future research should focus on evaluating both cellular and humoral immune responses following administration of various doses of the YF vaccine.
Asunto(s)
Fallo Renal Crónico , Vacuna contra la Fiebre Amarilla , Fiebre Amarilla , Humanos , Vacuna contra la Fiebre Amarilla/efectos adversos , Vacuna contra la Fiebre Amarilla/inmunología , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Fallo Renal Crónico/inmunología , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Fiebre Amarilla/inmunología , Fiebre Amarilla/prevención & control , Fiebre Amarilla/epidemiología , Anciano , Adulto , Inmunogenicidad Vacunal , Diálisis Renal , Adulto Joven , Anciano de 80 o más Años , Brasil/epidemiologíaRESUMEN
BACKGROUND: Brazil has a large public transplant program, but it remains unclear if the kidney waitlist criteria effectively allocate organs. This study aimed to investigate whether gender, ethnicity, clinical characteristics, and Brazilian regions affect the chance of deceased donor kidney transplant (DDKT). METHODS: We conducted a retrospective cohort study using the National Transplant System/Brazil database, which included all patients on the kidney transplant waitlist from January 2012 to December 2022, followed until May 2023. The primary outcome assessed was the chance of DDKT, measured using subdistribution hazard and cause-specific hazard models (subdistribution hazard ratio [sHR]). RESULTS: We analyzed 118 617 waitlisted patients over a 10-year study period. Male patients had an sHR of 1.07 ([95% CI: 1.05-1.10], p < 0.001), indicating a higher chance of DDTK. Patients of mixed race and Yellow/Indigenous ethnicity had lower rates of receiving a transplant compared to Caucasian patients, with sHR of 0.97 (95% CI: 0.95-1) and 0.89 (95% CI: 0.95-1), respectively. Patients from the South region had the highest chance of DDKT, followed by those from the Midwest and Northeast, compared to patients from the Southeast, with sHR of 2.53 (95% CI: 2.47-2.61), 1.21 (95% CI: 1.16-1.27), and 1.10 (95% CI: 1.07-1.13), respectively. The North region had the lowest chance of DDTK, sHR of 0.29 (95% CI: 0.27-0.31). CONCLUSION: We found that women and racial minorities faced disadvantages in kidney transplantation. Additionally, we observed regional disparities, with the North region having the lowest chance of DDKT and longer times on dialysis before being waitlisted. In contrast, patients in the South regions had a chance of DDKT and shorter times on dialysis before being waitlisted. It is urgent to implement approaches to enhance transplant capacity in the North region and address race and gender disparities in transplantation.
Asunto(s)
Disparidades en Atención de Salud , Trasplante de Riñón , Obtención de Tejidos y Órganos , Listas de Espera , Humanos , Masculino , Femenino , Estudios Retrospectivos , Brasil , Persona de Mediana Edad , Obtención de Tejidos y Órganos/estadística & datos numéricos , Adulto , Estudios de Seguimiento , Disparidades en Atención de Salud/estadística & datos numéricos , Pronóstico , Donantes de Tejidos/provisión & distribución , Donantes de Tejidos/estadística & datos numéricos , Fallo Renal Crónico/cirugía , Etnicidad/estadística & datos numéricosRESUMEN
BACKGROUND: Patients with end-stage renal disease undergoing dialysis suffer from muscle cramps, a prevalent and burdensome symptom for which there is a paucity of efficient and safe treatments. AIM: What is the efficacy and safety of pharmacological interventions for the treatment of dialysis-related muscle cramps? DESIGN: A systematic review was conducted in OVID, CINAHL, PubMed, Web of Science, and Central Cochrane databases up to August 25, 2023. DATA SOURCES: Experimental studies reporting on a pharmacological intervention for the treatment of dialysis-related muscle cramps were included. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, and the studies quality was assessed with the RoB2 tool. RESULTS: A total of 4660 studies were retrieved, and 13 articles were included. The studies reported on nine interventions: vitamin C, vitamin E, vitamin K2, vitamin B7, dextrose solutions, gabapentin, sodium chloride, creatine monohydrate, and L-carnitine. The studies testing L-carnitine and creatine monohydrate were the only ones deemed to have a low risk of bias. Side effects were reported in only two trials, consisting primarily of gastrointestinal discomfort and hyperglycemia. Vitamins C and E are the two most studied interventions that showed positive results in reducing the frequency, severity, and duration of dialysis-related muscle cramps. L-carnitine is a promising intervention that warrants further investigation. CONCLUSION: Our review consolidates the existing evidence, elucidating the range of treatments along with their potential benefits and limitations. Future studies should uphold high-quality standards, incorporate patient-reported outcomes, and utilize well-defined, robust samples to improve patient care.
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Fallo Renal Crónico , Calambre Muscular , Diálisis Renal , Humanos , Calambre Muscular/etiología , Calambre Muscular/tratamiento farmacológico , Calambre Muscular/terapia , Diálisis Renal/efectos adversos , Fallo Renal Crónico/terapia , Fallo Renal Crónico/complicacionesRESUMEN
OBJECTIVE: This study aimed to evaluate inflammatory biomarkers in patients undergoing peritoneal dialysis and investigate their association with all-cause mortality or transfer to hemodialysis. METHODS: This prospective cohort study included 43 patients undergoing peritoneal dialysis. Plasma levels of cytokines were measured using flow cytometry and capture enzyme-linked immunosorbent assay. Biomarkers were categorized based on their respective median values. Survival analysis was conducted using the Kaplan-Meier estimator, considering two outcomes: all-cause mortality and transfer to hemodialysis. RESULTS: After adjusting for confounding factors, plasma levels above the median of the levels of CCL2 and plasma, as well as below the median of TNF-α, and the median of dialysate IL-17 levels, were associated with an increased risk of experiencing the specified outcomes after approximately 16 months of follow-up. CONCLUSION: These findings suggest that inflammatory biomarkers may be a valuable tool for predicting all-cause mortality and transfer to hemodialysis in patients undergoing peritoneal dialysis.
Asunto(s)
Biomarcadores , Inflamación , Diálisis Peritoneal , Humanos , Diálisis Peritoneal/mortalidad , Masculino , Femenino , Persona de Mediana Edad , Biomarcadores/sangre , Estudios Prospectivos , Inflamación/sangre , Inflamación/mortalidad , Anciano , Estimación de Kaplan-Meier , Ensayo de Inmunoadsorción Enzimática , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/terapia , Fallo Renal Crónico/sangre , Adulto , Citocinas/sangre , Factor de Necrosis Tumoral alfa/sangre , Factor de Necrosis Tumoral alfa/análisis , Quimiocina CCL2/sangre , Quimiocina CCL2/análisis , Diálisis Renal/mortalidad , Factores de Riesgo , Interleucina-17/sangre , Causas de Muerte , Citometría de FlujoRESUMEN
INTRODUCTION: Patients with end-stage renal disease often face a challenging routine of hemodialysis, dietary restrictions, and multiple medications, which can affect their hemodynamic function. Home-based, safe, and nonpharmacological approaches such as transcranial direct current stimulation (tDCS) should be combined with conventional treatment. OBJECTIVE: To assess the safety and feasibility of tDCS on blood pressure and heart rate in patients with end-stage renal disease undergoing hemodialysis. METHOD: This is a parallel, randomized, sham-controlled trial. Patients undergoing hemodialysis for more than three months were included. The patients received ten non-consecutive 2mA tDCS sessions on the primary motor cortex . Each session lasted 20 minutes. At baseline and after each of the ten sessions, blood pressure and heart rate of the patients were measured hourly for four hours. RESULTS: Thirty patients were randomized to the active or sham group. The mean difference between the groups was calculated as the mean value of the sham group minus the mean value of the active group. Despite there were no statistical changes for all outcomes considering all 10 sessions, we found differences between groups for systolic -10.93 (-29.1;7.2), diastolic -3.63 (-12.4; 5.1), and mean blood pressure -6.0 (-16.3; 4.2) and hear rate 2.26 (-2.5; 7.1). No serious adverse events were found. The active group showed higher blood pressure values at all points, while heart rate was lower in the active group. CONCLUSION: tDCS is safe and feasible for patients with end-stage renal disease undergoing hemodialysis. Future studies should investigate whether tDCS could potentially induce a hypotensive protective effect during hemodialysis.
Asunto(s)
Estudios de Factibilidad , Fallo Renal Crónico , Diálisis Renal , Estimulación Transcraneal de Corriente Directa , Humanos , Diálisis Renal/métodos , Diálisis Renal/efectos adversos , Fallo Renal Crónico/terapia , Masculino , Femenino , Persona de Mediana Edad , Estimulación Transcraneal de Corriente Directa/métodos , Presión Sanguínea , Frecuencia Cardíaca , AncianoRESUMEN
BACKGROUND: Simultaneous liver-kidney transplantation is indicated for patients with concomitant end-stage liver disease and end-stage renal disease. The traditional technique involves separate implantations of the liver and the kidney. In the en bloc approach, the liver is recovered en bloc with the right kidney and the donor renal artery is anastomosed to the donor splenic artery. We aimed to compare the outcomes of the traditional and en bloc techniques for simultaneous liver-kidney transplantation in a single center. METHODS: This single-center retrospective study involved all adult patients who underwent simultaneous liver-kidney transplantation from brain-dead donors from January 2017 to December 2022. RESULTS: A total of 15 patients were included: 10 transplanted with the traditional technique and 5 with the en bloc approach. Patients in the en bloc group presented higher body mass index, shorter kidney cold and total ischemia times, shorter overall surgical time and longer kidney warm ischemia time (29.07 kg/m2vs 23.20 kg/m2 [P = .048]; 560 minutes vs 880 minutes [P = .026]; 615 minutes vs 908 minutes [P = 0.025]; 405 minutes vs 485 minutes [P = .046]; 46 minutes vs 33.5 minutes [P = 0.027], respectively). Ureteroneocystostomy was performed in 2 patients of the en bloc group and ureteroureterostomy in the remaining 3 patients. One patient in the en bloc group presented stenosis of renal artery anastomosis and underwent percutaneous angioplasty. This same patient eventually developed late urinary fistula. In the traditional technique group, there were 2 cases of renal vein thrombosis and 1 of ureteral stenosis. CONCLUSIONS: Compared with the traditional technique, the en bloc approach is feasible and safe, reducing kidney total ischemia time and overall surgical time.
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Trasplante de Riñón , Trasplante de Hígado , Humanos , Trasplante de Riñón/métodos , Trasplante de Hígado/métodos , Estudios Retrospectivos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Resultado del Tratamiento , Fallo Renal Crónico/cirugía , Enfermedad Hepática en Estado Terminal/cirugía , Tempo Operativo , Isquemia Tibia , Arteria Renal/cirugíaRESUMEN
OBJECTIVE: To develop the second evidence-based Brazilian Society of Rheumatology consensus for diagnosis and treatment of lupus nephritis (LN). METHODS: Two methodologists and 20 rheumatologists from Lupus Comittee of Brazilian Society of Rheumatology participate in the development of this guideline. Fourteen PICO questions were defined and a systematic review was performed. Eligible randomized controlled trials were analyzed regarding complete renal remission, partial renal remission, serum creatinine, proteinuria, serum creatinine doubling, progression to end-stage renal disease, renal relapse, and severe adverse events (infections and mortality). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to develop these recommendations. Recommendations required ≥82% of agreement among the voting members and were classified as strongly in favor, weakly in favor, conditional, weakly against or strongly against a particular intervention. Other aspects of LN management (diagnosis, general principles of treatment, treatment of comorbidities and refractory cases) were evaluated through literature review and expert opinion. RESULTS: All SLE patients should undergo creatinine and urinalysis tests to assess renal involvement. Kidney biopsy is considered the gold standard for diagnosing LN but, if it is not available or there is a contraindication to the procedure, therapeutic decisions should be based on clinical and laboratory parameters. Fourteen recommendations were developed. Target Renal response (TRR) was defined as improvement or maintenance of renal function (±10% at baseline of treatment) combined with a decrease in 24-h proteinuria or 24-h UPCR of 25% at 3 months, a decrease of 50% at 6 months, and proteinuria < 0.8 g/24 h at 12 months. Hydroxychloroquine should be prescribed to all SLE patients, except in cases of contraindication. Glucocorticoids should be used at the lowest dose and for the minimal necessary period. In class III or IV (±V), mycophenolate (MMF), cyclophosphamide, MMF plus tacrolimus (TAC), MMF plus belimumab or TAC can be used as induction therapy. For maintenance therapy, MMF or azathioprine (AZA) are the first choice and TAC or cyclosporin or leflunomide can be used in patients who cannot use MMF or AZA. Rituximab can be prescribed in cases of refractory disease. In cases of failure in achieving TRR, it is important to assess adherence, immunosuppressant dosage, adjuvant therapy, comorbidities, and consider biopsy/rebiopsy. CONCLUSION: This consensus provides evidence-based data to guide LN diagnosis and treatment, supporting the development of public and supplementary health policies in Brazil.
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Inmunosupresores , Nefritis Lúpica , Sociedades Médicas , Nefritis Lúpica/diagnóstico , Nefritis Lúpica/tratamiento farmacológico , Humanos , Inmunosupresores/uso terapéutico , Brasil , Creatinina/sangre , Proteinuria/diagnóstico , Proteinuria/etiología , Ácido Micofenólico/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Reumatología/normas , Rituximab/uso terapéutico , Biopsia , Ciclofosfamida/uso terapéutico , Leflunamida/uso terapéutico , Glucocorticoides/uso terapéutico , Hidroxicloroquina/uso terapéutico , Azatioprina/uso terapéutico , Inducción de Remisión , Ciclosporina/uso terapéutico , Medicina Basada en la Evidencia , Consenso , Progresión de la Enfermedad , Fallo Renal Crónico , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Patients with end-stage heart disease who undergo a heart transplant frequently have simultaneous kidney insufficiency, therefore simultaneous heart and kidney transplantation is an option and it is necessary to understand its characteristics and long-term variables. The recipient characteristics and operative and long-term variables were assessed in a meta-analysis. A total of 781 studies were screened, and 33 were thoroughly reviewed. 15 retrospective cohort studies and 376 patients were included. The recipient's mean age was 51.1 years (95% CI 48.52-53.67) and 84% (95% CI 80-87) were male. 71% (95% CI 59-83) of the recipients were dialysis dependent. The most common indication was ischemic cardiomyopathy [47% (95% CI 41-53)] and cardiorenal syndrome [22% (95% CI 9-35)]. Also, 33% (95% CI 20-46) of the patients presented with delayed graft function. During the mean follow-up period of 67.49 months (95% CI 45.64-89.33), simultaneous rejection episodes of both organ allografts were described in 5 cases only. Overall survival was 95% (95% CI 88-100) at 30 days, 81% (95% CI 76-86) at 1 year, 79% (95% CI 71-87) at 3, and 71% (95% CI 59-83) at 5 years. Simultaneous heart and kidney transplantation is an important option for concurrent cardiac and renal dysfunction and has acceptable rejection and survival rates.
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Rechazo de Injerto , Supervivencia de Injerto , Trasplante de Corazón , Trasplante de Riñón , Humanos , Masculino , Persona de Mediana Edad , Femenino , Síndrome Cardiorrenal/cirugía , Funcionamiento Retardado del Injerto , Estudios Retrospectivos , Fallo Renal Crónico/cirugía , Fallo Renal Crónico/complicaciones , Insuficiencia Cardíaca/cirugía , Insuficiencia Cardíaca/mortalidad , Resultado del TratamientoRESUMEN
INTRODUCTION: Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are markers of systemic inflammatory status. The relationship between NLR, PLR, and mortality is controversial among hemodialysis (HD) patients. OBJECTIVE: Evaluate NLR and PLR in the prediction of mortality in chronic HD patients. MATERIALS AND METHODS: We analyzed 130 patients with a follow-up for 66 months. Four groups were established according to NLR-PLR values. Kaplan-Meier curves and Cox proportional hazards analysis were used. RESULTS: NLR-PLR correlated positively with C-reactive protein. Cox regression analysis for overall mortality among the four groups included age (HR 1.027, 95% CI 1.003-1.053) and albumin (HR 0.25, 95% CI 0.073-0.85). For cardiovascular (CV) mortality only pulse pressure differential (PPD) was included (HR 1.033; 95% CI 1.014-1.052). Low NLRs and high PLRs were associated with CV mortality (Log Rank test, p = 0.033). CONCLUSIONS: Low NLRs and high PLRs predict the risk of CV mortality among HD patients.
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Inflamación , Linfocitos , Neutrófilos , Diálisis Renal , Humanos , Diálisis Renal/mortalidad , Masculino , Femenino , México , Persona de Mediana Edad , Inflamación/sangre , Anciano , Plaquetas , Enfermedades Cardiovasculares/mortalidad , Recuento de Plaquetas , Proteína C-Reactiva/metabolismo , Proteína C-Reactiva/análisis , Recuento de Linfocitos , Estudios de Seguimiento , Biomarcadores/sangre , Estudios Retrospectivos , Fallo Renal Crónico/terapia , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/sangreRESUMEN
Heart rate variability (HRV) is a noninvasive approach to studying the autonomic modulation of heart rate in experimental settings, such as active standing sympathetic stimulation. It is known that patients with end-stage renal disease during active standing have few changes in HRV dynamics, which are improved after hemodialysis. However, it is unknown whether the response to active standing is recovered after definitive treatment with kidney transplantation. This work aims to assess the change in HRV dynamics in the supine position and active standing through time and frequency-based metrics, as well as recurrence plot quantitative analysis (RQA). We studied HRV dynamics by obtaining 5-minute electrocardiographic recordings from kidney transplant recipients who underwent an active standing test. The mean duration of heartbeats and their standard deviation diminished in active standing, compared with the supine position. Also, the low-frequency component of HRV and the presence of diagonal and vertical structures in RQA were predominant. A larger estimated glomerular filtration rate was significantly correlated with broader HRV in the supine position and during active standing. The narrower HRV during active standing may indicate a sympathetic response to external stimuli, which is expected in a functional cardiovascular system, and may be influenced by renal function.
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Electrocardiografía , Frecuencia Cardíaca , Fallo Renal Crónico , Trasplante de Riñón , Humanos , Frecuencia Cardíaca/fisiología , Masculino , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/cirugía , Femenino , Persona de Mediana Edad , Adulto , Tasa de Filtración Glomerular , Posición Supina , Recurrencia , Posición de PieRESUMEN
A review from the last seven years (August 2016-July 2023) of questions posted to the International Society for Peritoneal Dialysis (ISPD) website "Questions about PD" by nurses and physicians from around the world revealed that 19 of the questions were associated with optimal approaches for preventing, assessing, and managing issues related to PD catheter non-infectious complications. Our review focused on responses to these questions whereby existing best practice recommendations were considered, if available, relevant literature was cited and differences in international practices discussed. We combined similar questions, revised both the original questions and responses for clarity, as well as updated the references to these questions. PD catheter non-infectious complications can often be prevented or, with early detection, the potential severity of the complication can be minimized. We suggest that the PD nurse is key to educating the patient on PD about PD catheter non-infectious complications, promptly recognize a specific complication and bring that complication to the attention of the Home Dialysis Team. The questions posted to the ISPD website highlight the need for more education and resources for PD nurses worldwide on the important topic of non-infectious complications related to PD catheters, thereby enabling us to prevent such complications as PD catheter malfunction, peri-catheter leakage and infusion or drain pain, as well as recognize and resolve these issues promptly when they do arise, thus allowing patients to extend their time on PD therapy and enhance their quality of life whilst on PD.
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Catéteres de Permanencia , Diálisis Peritoneal , Humanos , Diálisis Peritoneal/efectos adversos , Catéteres de Permanencia/efectos adversos , Fallo Renal Crónico/terapia , Falla de EquipoRESUMEN
BACKGROUND: The Covid-19 pandemic has affected patients with end-stage kidney disease (ESKD). Whether dialysis parameters have a prognostic value in ESKD patients with Covid-19 remains unclear. MATERIALS AND METHODS: We retrospectively evaluated clinical characteristics, blood pressure (BP) and dialysis parameters in ESKD patients undergoing maintenance outpatient hemodialysis, with (Covid-ESKD) and without (No-Covid-ESKD) Covid-19, at four Brazilian hemodialysis facilities. The Covid-ESKD (n = 107; 54% females; 60.8 ± 17.7 years) and No-Covid-ESKD (n = 107; 62% females; 58.4 ± 14.6 years) groups were matched by calendar time. The average BP and dialysis parameters were calculated during the pre-infection, acute infection, and post-infection periods. The main outcomes were Covid-19 hospitalization and all-cause mortality. RESULTS: Covid-ESKD patients had greater intradialytic and postdialysis systolic BP and lower predialysis weight, postdialysis weight, ultrafiltration rate, and interdialytic weight gain during acute-illness compared to 1-week-before-illness, while these changes were not observed in No-Covid-ESKD patients. After 286 days of follow-up (range, 276-591), there were 18 Covid-19-related hospitalizations and 28 deaths among Covid-ESKD patients. Multivariable logistic regression analysis showed that increases in predialysis systolic BP from 1-week-before-illness to acute-illness (OR, 95%CI = 1.06, 1.02-1.10; p = .004) and Covid-19 vaccination (OR, 95%CI = 0.16, 0.04-0.69; p = .014) were associated with hospitalization in Covid-ESKD patients. Multivariable Cox-regression analysis showed that Covid-19-related hospitalization (HR, 95%CI = 5.17, 2.07-12.96; p < .001) and age (HR, 95%CI = 1.05, 1.01-1.08; p = .008) were independent predictors of all-cause mortality in Covid-ESKD patients. CONCLUSION: Acute Covid-19 illness is associated with variations in dialysis parameters of volume status in patients with ESKD. Furthermore, increases in predialysis BP during acute Covid-19 illness are associated with an adverse prognosis in Covid-ESKD patients.
Dialysis parameters were influenced by SARS-CoV-2 infection and may have prognostic value in patients with Covid-19.Increases in blood pressure during acute Covid-19 illness and the lack of vaccination for Covid-19 were predictors of hospitalization for Covid-19.Hospitalization for Covid-19 and age were independent risk factors for all-cause death.
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COVID-19 , Fallo Renal Crónico , Diálisis Renal , SARS-CoV-2 , Humanos , COVID-19/complicaciones , COVID-19/mortalidad , COVID-19/epidemiología , COVID-19/terapia , Femenino , Persona de Mediana Edad , Masculino , Fallo Renal Crónico/terapia , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/epidemiología , Diálisis Renal/estadística & datos numéricos , Estudios Retrospectivos , Pronóstico , Anciano , Brasil/epidemiología , Adulto , Hospitalización/estadística & datos numéricos , Presión SanguíneaRESUMEN
ABSTRACT: Worldwide the assistance on renal replacement therapy (RRT) is carried out mainly by private for-profit services and in a market with increase in mergers and acquisitions. The aim of this study was to conduct an integrative systematic review on privatization and oligopolies in the RRT sector in the context of contemporary capitalism. The inclusion criteria were scientific articles without language restrictions and that addressed the themes of oligopoly or privatization of RRT market. Studies published before 1990 were excluded. The exploratory search for publications was carried out on February 13, 2024 on the Virtual Health Library Regional Portal (VHL). Using the step-by-step of PRISMA flowchart, 34 articles were retrieved, of which 31 addressed the RRT sector in the United States and 26 compared for-profit dialysis units or those belonging to large organizations with non-profit or public ones. The main effects of privatization and oligopolies, evaluated by the studies, were: mortality, hospitalization, use of peritoneal dialysis and registration for kidney transplantation. When considering these outcomes, 19 (73%) articles showed worse results in private units or those belonging to large organizations, six (23%) studies were in favor of privatization or oligopolies and one study was neutral (4%). In summary, most of the articles included in this systematic review showed deleterious effects of oligopolization and privatization of the RRT sector on the patients served. Possible explanations for this result could be the presence of conflicts of interest in the RRT sector and the lack of incentive to implement the chronic kidney disease care line. The predominance of articles from a single nation may suggest that few countries have transparent mechanisms to monitor the quality of care and outcomes of patients on chronic dialysis.