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BACKGROUND: Point of care ultrasound (PoCUS) is a useful tool for the early diagnosis of thrombosis related to the central venous catheter for dialysis (TR-CVCd). However, the application of PoCUS is still not common as a bedside imaging examination and TR-CVCd remains often underdiagnosed in the routine practice. The aim of this study was to investigate if a compression technique for the diagnosis of TR-CVCd blindly performed by PoCUS experts and medical students is accurate when compared to a Doppler study. METHODS: Two medical students without prior knowledge in PoCUS received a short theoretical-practical training to evaluate TR-CVCd of the internal jugular vein by means of the ultrasound compression technique. After the training phase, patients with central venous catheter for dialysis (CVCd) were evaluated by the students in a private hemodialysis clinic. The results were compared to those obtained on the same population by doctors with solid experience in PoCUS, using both the compression technique and the color Doppler. RESULTS: Eighty-one patients were eligible for the study and the prevalence of TR-CVCd diagnosed by Doppler was 28.4%. The compression technique performed by the students and by experts presented, respectively, a sensitivity of 59.2% (CI 51.6-66.8) vs 100% and a specificity of 89.6% (CI 84.9-94.3) vs 94.8% (CI 91.4-98.2). CONCLUSION: The compression technique in the hands of PoCUS experts demonstrated high accuracy in the diagnosis of TR-CVCd and should represent a standard in the routine examination of dialytic patients. The training of PoCUS inexperienced students for the diagnosis of TR-CVCd is feasible but did not lead to a sufficient level of sensitivity.

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COVID-19 is a viral disease due to the infection of the novel Corona virus SARS-CoV-2, that has rapidly spread in many countries until the World Health Organization declared the pandemic from March 11, 2020. Elderly patients and those affected by hypertension, diabetes mellitus, and chronic pulmonary and cardiovascular conditions are more susceptible to present more severe forms of COVID-19. These conditions are often represented in dialytic renal end-stage patients. Moreover, dialysis patients are more vulnerable to infection due to suppression of the immune system. Growing evidences, although still supported by few publications, are showing the potential utility of ultrasound in patients with COVID-19. In this review, we share our experience in using point-of-care ultrasound, particularly lung ultrasound, to indicate the probability of COVID-19 in patients with end-stage renal disease treated by hemodialysis. We also propose recommendations for the application of lung ultrasound, focused echocardiography and inferior vena cava ultrasound in the management of patients in hemodialysis.

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ABSTRACT Introduction: Vascular access and renal biopsy are common procedures in nephrology. In this study, two artisanal simulators of very low cost and excelent image quality are (prented) presented to guide, by ultrasound, the venous access and renal biopsy. Methods: The simulators are constructed using chicken breast slices, Penrose drain, plastic milk shake straw and pig kidney. Results: Both simulators enable immediate identification of the anatomical structures of interest, vessels and kidney, and enable spatial orientation and hand-eye coordination, essential for the development of the necessary skills to safely carry out invasive procedures. Conclusion: The simulators described, were extremely useful for simulating venous access and renal biopsy guided by ultrasonography, enabling training to reduce the failure rate in punctures and the potential complications associated with the described procedures.

RESUMO Introdução: O acesso vascular e a biópsia renal são procedimentos comuns na prática nefrológica. Neste estudo, são apresentados dois simuladores artesanais de baixo custo e excelente qualidade de imagem para guiar, ultrassonograficamente, o acesso venoso e a biópsia renal. Métodos: Os simuladores são construídos utilizando fatias de peito de frango, dreno de Penrose, canudo plástico milk shake e rim de porco. Resultados: Ambos os simuladores permitem a identificação imediata das estruturas anatômicas de interesse, vasos e rim, e possibilitam a orientação espacial e coordenação olho-mão, essenciais para o desenvolvimento das habilidades necessárias para realizar seguramente procedimentos invasivos. Conclusão: Os simuladores descritos, extremamente úteis para as simulações do acesso venoso e a biópsia renal guiados por ultrassonografia, possibilitam o treinamento objetivando a redução do insucesso das punções e das complicações potenciais associadas aos procedimentos descritos.

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INTRODUCTION: The use of ultrasonography (US) by non-radiologists has increased due to the need of physicians to integrate "new" clinical information into the diagnostic process. A defined and validated ultrasound training program has not been established in Nephrology. This study aimed to present the results of assessment of the development of skills to utilize point-of-care ultrasonography (POCUS) in Nephrology practice. METHODS: Nine residents, four from Nephrology and five from internal medicine program, attended a 16-hour course that covered theoretical and practical aspects of ultrasonography. The course addressed topics related to urinary tract, lung, heart, and blood vessel ultrasonography and use of ultrasound to guide kidney biopsy and central venous catheter insertion. The resident evaluation consisted of cognitive tests (CT) with multiple-choice questions and image association tests, before and after the course, and assessment of skills in generating ultrasound images and performing procedures using the Objective Structured Clinical Examination (OSCE). RESULTS: All residents completed the course. A significant improvement in knowledge was observed by comparing the residents' scores obtained on the CT (p < 0.004) and image association tests (p < 0.02) before and after the course. With the exception of the station regarding the lungs, they demonstrated very good performance on the assessment of the skills using the OSCE exams. CONCLUSION: A 16-hour nephrology POCUS training course that was not limited to topics involving the urinary tract enabled the development of skills to obtain images and perform Nephrology procedures. The program developed can be used as a model for learning POCUS in Nephrology.

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Resumo Introdução: O uso do ultrassonografia (US) por não radiologista tem aumentado e decorre da necessidade de o médico integrar "novas" informações clínicas ao processo diagnóstico. Na Nefrologia, ainda não foi estabelecido um currículo de treinamento em US definido e que tenha sido validado. O objetivo do estudo é apresentar os resultados do desenvolvimento de competências para o uso do ultrassom point-of-care (POCUS) em Nefrologia. Métodos: Nove residentes, quatro de Nefrologia e cinco de clínica médica, frequentaram um curso de ultrassom teórico-prático de 16 horas. Foram abordados temas de ultrassom relacionados ao trato urinário, pulmão, coração, vasos sanguíneos, biópsia renal e inserção de cateter venoso central. A avaliação constou de testes cognitivos (TC) de múltipla escolha e associação de imagens antes e após o curso e de avaliação prática de competências na geração de imagens ultrassonográficas e realização de procedimentos pelo Exame Estruturado de Habilidades Clínicas (OSCE). Resultados: Todos os residentes concluíram o curso. Observou-se melhora significativa dos conhecimentos quando se compararam as notas obtidas pelos residentes antes e após o TC de múltipla escolha (p < 0,004) e de associação de imagens (p < 0,02). A avaliação de competência dos residentes pelo OSCE, com exceção da estação sobre pulmão, foi considerada muito boa. Conclusão: Um curso de POCUS em Nefrologia de apenas 16 horas, não limitado aos temas do trato urinário, possibilita o desenvolvimento de competências na obtenção de imagens e a realização de procedimentos nefrológicos. O currículo desenvolvido pode servir de modelo para o aprendizado do POCUS em Nefrologia.

Abstract Introduction: The use of ultrasonography (US) by non-radiologists has increased due to the need of physicians to integrate "new" clinical information into the diagnostic process. A defined and validated ultrasound training program has not been established in Nephrology. This study aimed to present the results of assessment of the development of skills to utilize point-of-care ultrasonography (POCUS) in Nephrology practice. Methods: Nine residents, four from Nephrology and five from internal medicine program, attended a 16-hour course that covered theoretical and practical aspects of ultrasonography. The course addressed topics related to urinary tract, lung, heart, and blood vessel ultrasonography and use of ultrasound to guide kidney biopsy and central venous catheter insertion. The resident evaluation consisted of cognitive tests (CT) with multiple-choice questions and image association tests, before and after the course, and assessment of skills in generating ultrasound images and performing procedures using the Objective Structured Clinical Examination (OSCE). Results: All residents completed the course. A significant improvement in knowledge was observed by comparing the residents' scores obtained on the CT (p < 0.004) and image association tests (p < 0.02) before and after the course. With the exception of the station regarding the lungs, they demonstrated very good performance on the assessment of the skills using the OSCE exams. Conclusion: A 16-hour nephrology POCUS training course that was not limited to topics involving the urinary tract enabled the development of skills to obtain images and perform Nephrology procedures. The program developed can be used as a model for learning POCUS in Nephrology.

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Objetivo: determinar a taxa de sobrevida e causas de mortalidade em pacientes submetidos à hemodiálise no centro Pró-Renal de Barbacena no período de janeiro de 1999 a julho de 2004. Métodos: trata-se de um estudo de série de casos constituído por 160 pacientes sob tratamento hemodialítico. A análise dos dados obtidos foi realizada no software EPinfo versão 6.04 e SPSS versão 11.5. Foram construídas as distribuições de frequência das variáveis calculando-se médias e desvios-padrão. As curvas de sobrevida foram elaboradas para as variáveis: Kt/V; produto CaxP, hemoglobina, idade, sexo, albumina e PTH. As variações das taxas de sobrevidas foram representadas nas curvas de Kaplan Meyer. A significância estatística adotada nas curvas foi de 5% e as diferenças padronizadas pelo teste log-rank. Resultados: a taxa de sobrevida global foi de 86,2 e 60% em um e cinco anos, respectivamente. As principais causas de óbito foram: doenças cardiovasculares 45,7%; infecções 23,9%; e neoplasias 13%. Valores de Kt/V superiores a 1,2; PTH compreendido entre 300 e 600 ng/dL; albumina sérica acima de 3,5 g%, hemoglobina acima de 10 g/dL e CaxP inferior a 50 estão diretamente relacionados com melhores taxas de sobrevida.Conclusões: as variáveis Kt/V, albumina sérica, hemoglobina, CaxP e PTH estão associadas à sobrevida e são fatores preditivos de risco de mortalidade para pacientes submetidos à hemodiálise. A adequada análise dessas variáveis é fundamental para a melhora daresposta clínica desses pacientes, possibilitando, assim, melhores prognósticos.

Objective: To determine the survival rate and causes of mortality at hemodialisys patients in Pró-Renal Center in Barbacena between january/1999 and july/2004. Method: A series of case study, with 160 patients on treatment of chronic dialysis. The data were analyzed by the software Epinfo vers.6,04 and SPSS vers.11,5. The survival curves were built with the variables: Kt/V, product CaxP, hemoglobin, age, sex, albumin and PTH. The survival rates were represented on the Kaplan Meyer curves. The statistically significant one was 5% and the differences performed with the use of log-rank test. Results: The whole survival rate was 86,2% and 60% in 1 and 5 years, respectively. The major causes of death were cardiovascular diseases 45,7%, infections 23,9% and malignancy 13%. The values of Kt/V up to 1,2; PTH between 300 and 600 ng/dL; serum albumin up to 3,5 g%; hemoglobin up to 10 g/dl and CaxP less than 50 mg/dlwere directly related with a better survival rate. Conclusion: The variables Kt/V, serum albumin, hemoglobin, CaxP, and PTH are associated with survival and they are predictive factors of a mortality risk for hemodialisys patients. The analysis of these variables is indispensable for an adequate intervention, that could result in the improvement of these patients? prognostics.

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